Chapter 12 - Therapeutic Modalities Flashcards
What are the five ways energy can be transferred?
- Radiation
- Conduction
- Convection
- Conversion
- Evaporation
Give a brief summary of radiation.
uses infrared waves without any physical contact (ex. short wave diathermy)
Give a brief summary of conduction.
direct, between two objects using physical contact (ex. ice packs, hot pads)
Give a brief summary of convection.
more rapid than conduction, uses water or air across the body to make temperature variations (ex. whirlpool)
Give a brief summary of conversion.
changing of energy from one from to another (ex. ultrasound)
Give a brief summary of evaporation.
liquid changes to gas state (sweat evaporating on a hot day)
What are the three factors that affect energy transfer?
reflection, refraction, absorption
What is the law related to the inverse relationship between the energy reflected/refracted/absorbed by the superficial tissues vs. the energy transmitted to the underlying tissues
law of Grotthus-Draper
Which law is related to the need for perpendicular application of ultrasound?
Cosine law
Which law is related to the distance between the skin and the energy source?
inverse square law
What type of electromagnetic energy does cryotherapy use?
classified as infrared radiation
T/F: Adipose tissue is a conductor so heat/cold transfer happens more quickly.
False, it is an insulator so it’s slower (resists heat transfer)
What are the main indications for cold therapy?
pain, heat/inflammation, swelling
How does cryotherapy improve an injury?
vasoconstriction and decreased tissue metabolism reduces secondary hypoxia at an injury site. Also reduces pain and inflammation
What is the usual temperature of cryotherapy?
1-10deg C
T/F: Maximal decreases in localized blood flow can occure with cold applications between 12.83deg C and 15deg C.
True
What is the rewarming time for an injured area after 20-30 min of ice?
90 min
What is the use of cold therapy before movement called?
cryokinetics
T/F: For cryokinetics, the pain level must be 1-3 on the 10-point pain scale.
False, must be pain free
T/F: If the athlete is able to participate in the activity, the cryokinetic cycle ends with exercise. If not, it ends in cold.
True
What is the disadvantage of using ice bags as a cold application?
Ice machine can be expensive
What are the stages of sensations in cryotherapy?
CBAN - cold, burning, aching, numbness/analgesia
What adverse reactions can happing with ice bags?
wheal or blister formations in people sensitive to cold
What is the disadvantage of using reusable cold packs?
Can cause frostbite because stored at subzero temperatures (needs wet towel or cloth)
What do Cold and Compression Therapy Units (CCT) attempt to achieve?
decrease blood flow, assist venous return, decrease edema, increase effective depth of cold penetration.
What are the contraindications to using a CCT?
compartment syndrome, fracture, peripheral vascular disease, or impaired circulation.
T/F: A person can complete ROM exercises while wearing a CCT during inflation to enhance blood flow.
False, can be done during the deflation period
What are the disadvantages of instant cold packs?
short duration of cold, expensive for single-use, potential of package tearing and leaking (can chemically burn skin)
Areas where ice massage is most benficial?
small areas
- muscle belly
- tendon
- bursa
- trigger point
T/F: Ice massage is particulary useful for small areas with acute injury.
False, reactive hyperemia is not desired for acute injury.
What are the main physiological effects of ice massage?
cooling of skin and reactive hyperemia (increased blood flow) following treatment
What is a common application of ice massage?
before ROM exercises and deep friction massage for chronic tendinitis or muscle strains.
T/F: Ice immersion is used for acute injuries in the inflammatory phase?
True, helps to reduce edema if above heart or compression wrapped
What are the temperatures of bucket and whirlpool immersion.
Bucket = 4-10 deg C
Whirlpool = 10-15.6 deg C
What is an added effect of whirlpool immersion?
hydromassaging
T/F: Ultrasound, phonophoresis, and diathermy are considered penetrating thermotherapy.
True
What tissue temperature must be achieved for therapeutic effects
40-45 deg C
Where in the tissues is the greated degree of elevated temperature?
skin and subcutaneous tissue within 0.5 cm of skin surface.
T/F: Total body immersion in a whirlpool should take place for at least 30 min to penetrate the deeper body tissues.
False, longer than 30 min can cause dehydration, dizziness, and high body core temperature
The pseudomonas aeruginosa bacteria in whirlpools can lead to what?
folliculitis
What is the maximum water temperature of a large (4-16 person) whirlpool?
38.9 deg C
Which disinfectants can be applied to open wounds before whirlpool use?
povidone, povidone-iodine, sodium hypochlorite
Which method of energy tranfer do heat packs use?
Conduction
What is the most effective way to warm up the musculoskeletal tissue?
exercise (biking, elliptical)
What temperature are hot packs stored at?
70-75 deg C
What are hot packs filled with?
hydrophilic silicate
What is the ratio of paraffin and mineral oil?
6:1 or 7:1
What is the purpose of adding the mineral oil to a paraffin bath?
lowers the melting temperature
What are the two contraindications for using the dip and reimmersed method in a paraffin bath?
edema or patient can’t maintain position for 10-20min
What are the general contraindications for paraffin bath use?
- decreased sensation
- open wounds
- thin scars
- skin rashes
- peripheral vascular disease
Which method of energy transfer does fluidotherapy use?
Convection
What is in a fluidotherapy chmaber?
Heated air and Cellex particles
T/F: Fluidotherapy is more effective than whirlpools and paraffin baths at increasing body temperature?
True
What is mandatory before starting a fluidotherapy test?
skin sensory heat discrimination test of patient
Which tranfer of energy does ultrasound use and what is the effect called?
conversion, reverse pizoelectric effect
What are the thermal effects of ultrasound?
increased: collagen tissue extensibility, blood flow, sensory and motor neuron velocity, enzymatic activity.
Decreased: muscle spasm, joint stiffness, inflammation, pain
What are the non-thermal effects of ultrasound?
increase skin permeability -> decreases inflmmatory response, reduces pain, facilitates soft tissue healing.
T/F: Only pulsed ultrasound reduces nerve conduction velocity.
False, pulsed and continuous.
What does ERA stand for in ultrasound?
Effective radiating area
How deep does 3 MHz ultrasound heat?
2-3 cm
How deep does 1 MHz ultrasound heat?
3-5 cm
What is the total area covered in 5 min with ultrasound?
2-3 x the size of the transducer head
T/F: When using ultrasound in water, the intensity is increased by 0.5 W/cm^2 to compensate for air and minerals in the water.
True
T/F: Using an ultrasound under water creates more heat tranfer to the body than a gel bladder.
Flase, opposite
What is phonophoresis used for?
enhance the percutaneous absorption of anti-inflmmatory drugs and local analgesiscs through the skin
Is continuous or pulsed ultrasound used for Phonophoresis?
Continuous for better tissue permeability
What are the usual parameters for phonophoresis?
1.0-1.5 W/cm^2 for 5-15 min
T/F: The more soft-tissue in an area, the higher the ultrasound intensity (W/cm^2)
True
T/F: Diathermy uses heat to stimulate the motor and sensory nerves.
False, heats with no ion movement so no nerves stimulated.
Which law is applied to the principle that the greater the resistance, the more heat is developed?
Joule’s Law
Is continuous short wave diathermy used in acute, subacute, or chronic injuries?
Chronic
What is the power output of CSWD?
80-120 Watts
What is the goal temperature / physiologically effective range of CSWD?
37.5-44.0 deg C
What is the range the pulse frequency can be in PSWD?
1-700 pps
What power output is used for PSWD?
less than 30 W for non-thermal
greater than 30 W for thermal
up to 120 W
T/F: The indications and contraindications are the same for CSWD and PSWD.
True
What are the four basic currents in electrical stimulation?
DC, AC, monophasic, biphasic
What are the five modes of TENS?
conventional
acupuncture
brief-intense
burst
modulation
T/F: A shord pulse duration in TENS, leads to rapid analgesia.
True
T/F: Galvanic Stimulation is the common name for using DC.
True
What is a disadvantage of Iontophoresis?
electrolysis of NaCl in the body. Potential of burns with small electrodes
What is the benefit of low-level Laser?
increase mast cell release, promote interleukin-6, decrease dermal necrosis, increase collagen formation, degranulation and myofibroblast conversion, promote wound contraction and tensile strength during remodeling
What are the five basic strokes of massage?
- effleurage
- pétrissage
- tapotement
- vibration
- friction
What are the main benefits of massage?
increase circulation, cell metabolism, venous and lymphatic flow to remove edema, stretch superficial scar tissue, alleiviate soft-tissue adhesions, decrease neuromuscular excitability
Which is the most effective massage technique to break up muscle adhesions?
Cross-friction
T/F: Sustained traction is more effective than intermittant traction for lumbar disc issues?
True
What is the recommended force for sustained cervical traction?
10-30lbs
T/F: There are numerous studies showing that sustained traction is better than intermittant traction as a therapeudic modality.
False, no studies on traction at all
