Physical Therapy II – 9/23/05
High freq (>10,000 c/sec): US, Diathermy
Low Freq (<1000 c/sec)
Interferential (IF)
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Med freq (1000-10,000 cycles/sec)

Application:
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Quadrapolar: 4 pads (IF application)
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Bipolar: 2 pads (premode application)
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Beat Freq: 1 current at 4000, other at 4150
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150 beat freq
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(acute = 80-150Hz (encephalon release), chronic= 3-5Hz (endorphin release), edema= 1-15 Hz; sub-acute = 1-150 Hz
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Other options:
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Russian stim = 2500 Hz
 Nerve Block = 4000 Hz
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Vector: freq all over pad placement area
 Sweep: range of Hz so pt won’t accommodate
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Premod: pulse freq in the machine so mimic the beat freq w/ bipolar placement
Settings for Chattanooga:
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Channel select (1, 2, both = default)
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Amplitude modulation: 40%= default, 100%, static
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Beat freq: 1-10 (chonic); 80-150 (acute); 1-150 (sub-acute); variable – change parameters; fixed option – freq doesn’t change
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PreMod: (bipolar): continuous (default), 5/5 (edema)
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Beat freq (same choices as on IF above)
How to set up pads:

X pattern for C/S and L/S (focal spot as close to injury as can)
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Nerve Block/Trigger Pt technique:
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Sciatic pain: down leg w/ middle 2 pads overlapped
 Lumbar & Sciatica: 2 crossing L/S at disc level, 2 at begin/end of sciatic pain
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Tennis Elbow: biceps and cross elbow
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Carpal tunnel: forearm and palm of hand
Why to use PT
1.
Control pain
2.
…
3.
Babysit the patient
Piezoelectric & electropiezo (electricity
Types of PT
Wavelength Prob Uses
Low Volt Long, slow, continuous
(good ion
Burn pt easily
(arch from pad to skin)
Ionic exchange
(+ pole drives ions into tissue

exchange across membranes)
Iodine: frozen shoulder,
Zinc oxide: deep tendon healing
(avulsion - +35 yo male weight lifter)
Copper: bad fungal infections
(P.71)
Lidocaine: spasms (depend on state scope of practice)
High Volt
Microcurrent
Rapid (not good ion movement)
Used for mm spasm, nerve block, pain control
Healing – stim periosteum & bone (stress fractures,
Phonophoresis Vibration to gap molecules
– push lg molecules thru
Ionophoresis Diff is size of molecule you are moving
(small)
Pain Control & Modalities: (Nelson)
Pain= “an unpleasant sensory and emotional experience associated w/ actual or potential tissue damage, or described in terms of such damage”
Constellation of feelings (past/present expectations)
Pfain has a purpose = protection is useful
Acurte: experienced when tissue damage is impending (>6 mos in duration
Chronic: (>6 mos) o Persistent pain
Referred APain
Either acute or chronic o Usually myofascial in nature (diffuse, non-specific = use high volt) o Usually in an area that has little relation to existing pathology

o Kehr’s sign= spleen and L shoulder pain o Usually sympathetic driven o Outlast the causative events because of altered reflex patterns (Lag period
= inform patient will linger even after subluxation corrected) o Development of hypersensitive areas = trigger pts
Radiating Pain
2 types of neurological pain (nerve root, sympathetic)
3 levels of compression o Blood= gradual onset o Bone= immediate onset o Disc= gradual or immediate
1 type of chemical: inflammatory
Sclerotomic Pain
Pain Assessment
VAS
Pain charts
Etc
Tissue Sensitivity
In order greatest to least o Periosteum, Jt caspsule o Subchondral bone, tendons, ligaments o Muscle, cortical bone o Synovium and articular cartilage
Avulsion fracture o Periosteal osteosarcoma
Neural Transmission
Fist order nerusons o 4 types from sensory receoptros to dorsal horn o Large diameter fast/small slow o Blocking w/ modalities:
Second order neurons o Dorsal horn to brain o Nociceptive spec`ific
To pass between neurons you need a neurotransmitter o ACH,..
Pain Management
Stimulate large diameter afferent fibers o Tens, massage, analgesic balms (Cyan pepper poultice on feet- stim sensory nerves to block primary neurons)
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LBP: balm on L2; Cervicalgia: balm on C3
Decrease pain fiber transmission w/ cold or ultrasound (Gap cells to ↓ transmission rate w/ pulse of UA)
Stim sm diameter afferents fibers and descending pain control mechanisms w/ acupressure, deep massage, or tens over acupuncture pts or trigger points

Contrast Therapies:
Interferential Therapy
10/3/05
Iontophoresis:
Positively charged ions are driven into tissues from positive pole (vice versa)
The force that acts to move ions is determined by both the strength of the elec field and
….
The quanitity of ions transferred into the tissue is determined by:
1.
The intensity of the current or curre3nt density at the active electrode.
2.
…..
Continuous direct current must be used for iontophoresis, thus ensuring the unidirectional flow of ions that cannot be accomplished using a bidirectional or alternating current
…..
Once the electrode has been prepared. It then becomes the active electrode, and the lead wire to the generator is attached such that the polarity of the wires is the…….
A 2 nd
electrode, the dispersive electrode, is prepared w/ water, gel or other conductive material as recommended by manufacture
Both electrodes must be securely attached to the skin such that uniform skin contact……
The size and shape of electrodes can cause a variation in current density and affects the size of the area treated
Smaller electrodes have higher current density and should be used to treat a specific lesion
Larger should be used when the target tmt area is not…..
Recommendation for spacing btwn the active and dispersive electrodes vary
They should be separated by at least the diameter of active electrode (one source recommends 18 in apart)
↑ spacing will then ↓ current density in the superficial tissue (minimize the potential for burns
Conditions treated:
Spasm: Ca, Mg
Inflammation: hydrocortisone, salicylate, dexamethosone
Analgesia: Lidocaine, Mg
Edema: Mg, mecholyl, hyaluronidase, salicylate
Ischemia: Mg, mecholyl, iodine
Fungi: Cu
Indications:
Inflam, analgesia, Ca depostis, scar tissue, fungi, open skin lesions (DM), Herpes,
Allergic rhinitis, gout, burns, reflex sympathetic dystrophy, spasm, ischemia, edema, hyperhydrosis
Contraindications:
Skin sensitivity rxn, Sensitivity to asprin (salicylates), Gastritis or active stomach ulcer
(hydrocortisone), Asthma (mecholyl), sensitivity to metals (zinc, Cu, Mg), Sensitivity to seafood (iodine)

When the polarity of the delivery electrodes is the same as that of the ion delivered…..
Delivery of the soln directly to the particular target tissue will probably be most effective w/ a small, localized, superficial target tmt area that is easily accessed
If skin integrity is altered at the…l.
Skin damage can also ↓ electrical impedance and ↑ the risk of discomfort and burns w/
DC
It is recommended that electrodes not be …
Clinically, used in tmt of inflammatory musculoskeletal condition, for analgesic effects, scar modification, would healing and tmt edema, Ca deposits, hydroh….
Higher current density and current amplitudes will ↑ the force and speed of propulsion of ions and ,….
**The max current density should therefore be no more than 0.5 to 1.0 mA/cm sq., with the lower end of the range recommended when the delivery electrode is negatively charged.
10/10/05
Phonophoresis
Tmt: trigger pts (traps), chronic LBP
3:1 ratio of US lotion and Biofreeze (analgesic effect)
Acute vs. Chronic setting
Iontophoresis: elec stim to drive spec ions into tissue
Pain control – anti-inflammatory
Soln is already prepared (4x4 packets): Mg, CuSO4, or Potassium salicylate
(asprin), iodex, Zn oxide o Self-adhesive o DO NOT EXCEED 5 mA (use 3 mA for safety)
2 Electrodes: dispersal pad, soln pad
Instruments used: phoresor, Amerex (also has Galvanic/Low volt with it also – does same as the phoresor)
Combination Therapy:
1.
Ultra sound + E-stim a.
Med freq: 1000-10000 Hz b.
HOLD START button when turn machine on c.
Acute (80-120) & Chronic (3-5) d.
Set up: 1 lead wire w/ 2 electrodes in one channel i.
Dispersal electrode (larger) & US head
1.
AT LEAST 3X SIZE OF THE US HEAD e.
Duration: 10 min f.
US parameter: same for using it by itself (continuous for chronic and 1.5
W/cm
2
) i.
Can use US gel + biofreeze for analgesic effect g.
Pt perception from US only (not dispersive electrode)
2.
US and High Volt a.
Settings for acute and chronic

b.
Consider Polarity (+ for acute and – for chronic) i.
+ goes to US and – goes to dispersal electrode c.
2 electrodes: dispersive electrode (3x size of US head) and lead pad i.
Sponge between dispersive pad and the patient (weight on top)
Thurs assignment: look up cold (low level) laser in textbook!!!
10/14/05
Laser Therapy Definition:

Laser therapy is the application of narrow spectral width light over injuries or lesions to stimulate healing w/in those tissues
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It is a painless, sterile, non-invasive, drug-free tmt which is used to treat a variety of pain syndromes, injuries, wounds, fractures, neurological conditions and pathologies
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Can bre used any time a pt requests or needs a drug-less procedure for the control of pain, when conventioinal therapies…
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Effective ness o Does work, how they work and how best to use them is the question o Today we can safely say that lasers have an important biological effect, and a very positive one at that o Not clear duration of tmt, etc
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Scientific Lit o Encosmpasses some 2500 titles, including congressional reports and abstracts (
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Physiological effects o Biostimulation: improves metabolism, ↑ cell metabolism o Imp….
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Notes were too fast – get off web????
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.
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Therapeutic Laser o Microlight laser is the latest and most advanced of our light sources
 LASER: light amplication by stim…
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10/31/05
MICROCURRENT:
1. Dermatome distal technique:
* Location of probe:
*LE: pt at stomach 40, other along lumbar nerve root (treat for 6 sec)
2. Circling the dragon
* Find lesion area: check ROM, isolate NR
* Place around lesion area and go in clockwise pattern w/ probes (keep then at opp ends the whole time)

circle the lesion site