Ch 8 - Physical Modalities Flashcards
What are examples of physical modalities?
- Thermotherapy (heat and cold modalities)
- Hydrotherapy
- Light therapy (ultraviolet [UV] radiation, laser)
- Electrotherapy
- Manual therapy (traction, therapeutic massage, manipulation, mobilization)
- Pressure
- Acupuncture
What is an outcome of thermotherapy?
Combined use of heat and stretching has been shown to significantly increase tendon extensibility
What are contraindications of heat therapy?
Ischemia Bleeding disorders Impaired sensation Inability to communicate Malignancy Acute trauma or inflam Scar tissue Edema Atrophic skin Poor thermal regulation
What does heat do to scar tissue?
Inadequate vascular supply can lead to ischemic necrosis
What is conduction?
Transfer of heat between two bodies at different temperatures through direct contact
What is convection?
Transfer of heat occurs by fluid circulation (typically liquid or gas) over the surface of a body
What is conversion?
Heat transfer occurs through conversion of electromagnetic radiation (nonthermal energy) into heat energy
What is Superficial heat?
Radiant heat (infrared lamps)
Where is US absorption greatest?
Absorption (heating) is greatest at the bone–muscle soft-tissue interface
What are indications of US?
- Bursitis
- Tendinitis (calcific tendinitis)
- MSK pain
- Degenerative arthritis and contracture
- Small joints used underwater but only if water is degassed
- Subacute trauma
What are contraindications of US?
- General heat CI
- Near brain, cervical ganglia, spine, laminectomy sites
- Near the heart, reproductive organs
- Near pacemakers
- Near tumors
- Gravid or menstruating uterus
- At infection sites
- On contact lenses, eyes
- Skeletal immaturity
- TKA or TKA prostheses with methyl methacrylate or high density polyethylene
- Arthroplasties
What is the frequency of US for treatment?
0.8 to 1.1 MHz
What is the frequency of US for treatment of tendinits/bursitis?
1.2 to 1.8 W/cm2 (0.5 to 2.0 W/cm2 range)
What is the duration of US treatment?
5 to 10 minutes per site
What is Phonophoresis?
US to drive medications through the skin by increasing cell permeability
What is Shortwave diathermy?
Produces deep heating through the conversion of radio wave electromagnetic energy to thermal energy
What is MC frequency of Shortwave diathermy?
27.12 MHz
What does Shortwave diathermy provide?
Heat over a larger area as well as deep heat to 4 to 5 cm depth
When is the Inductive coil method indicated?
When heat to more superficial muscles or joints with minimal total superficial tissue is desired
What are indications for Shortwave diathermy?
- Muscle spasms (especially low back)
- Myalgia
- Refractory pelvic inflammatory disease
- Chronic prostatitis
How does cold decrease spasticity?
– Dec muscle spindle activity—dec firing rates of Ia and II afferent fibers
– Dec Golgi tendon organ activity—dec firing rates of Ib afferent fibers
What is cold evaporation used for?
Spray-and-stretch techniques to treat myofascial and musculoskeletal pain
What are effects of UV radiation on wounds?
Increased vascularization of wound margin
What are indications of UV radiation treatment?
Psoriasis treatment—utilizes Goeckerman’s technique, where a coal–tar ointment is applied to the skin prior to UV treatment
What are precautions of UV radiation treatment?
Scars
Atrophic skin
What are the doses of UV radiation treatment?
Minimal exposure time required to cause erythema on the volar surface of the forearm—measured in minimal erythema dosage (MED)
What % of TENS unit pain control is from placebo effect?
30-35%
What is the proposed mech of pain control with TENS unit?
Gate control theory
What is the most effective type of TENS?
High-frequency, low-intensity stimulation
What are clinical uses of NMES?
Strengthens muscles and maintains muscle mass after immobilization
What are benefits of NMES?
Inc muscle mass, stroke volume (SV), and cardiac output (CO), as well as reduce venous pooling
What is iontophoresis?
Transdermal delivery system in which a substance bearing a charge is propelled through the skin by a low electrical current
What are reflexive effects of massage?
- Reflex vasodilation with improvement in circulation
* Dec in pain by means of the gate control or release of endogenous opiates
What are mechanical effects of massage?
Assist in venous blood return from the periphery to the central nervous system
What is effleurage?
Gliding, rhythmic strokes of the hand over the skin in a distal to proximal direction
What is Pétrissage?
“Kneading” technique in which the muscle tissue is “pinched” with the fingers and lifted from its underlying origin
What is Tapotement?
Percussion
What is Friction massage?
Prevents adhesions in acute muscle injuries and breaks adhesions in subacute and chronic injuries
What is Soft-tissue mobilization?
Forceful massage of the fascia-muscle system
What is Myofascial release?
Prolonged light pressure is applied in specific directions of the fascia system to stretch focal areas of muscle or fascial tightness
What is Acupressure?
Finger pressure is applied over trigger points or acupuncture points to decrease pain
What is Thrust?
Impulse, high velocity, low amplitude, final activating force is from the operator
What is Articulation?
Low velocity, high amplitude
What is Muscle energy?
(direct isometric type): Patient contraction is the final activating force.
What is Direct myofascial release?
Tissue is held in a loaded, stretched position until muscle is released
What is Vertebral joint distraction?
Elongation of the cervical spine of 2 to 20 mm; can be achieved with 25 pounds or more of tractive force
What are contraindications of cervical spine traction?
- Cervical ligamentous instability
- Infectious process of the spine
- Cervical spinal stenosis with significant cord compromise
- Atlantoaxial subluxation with spinal cord compromise
- Vertebrobasilar insufficiency
What amount of traction is needed for the cervical spine?
> 25 lbs
What amount of traction is needed for the lumbar spine?
> 50 lbs
