Modalities

Question 0

How does cold effect tissue?

Answer 0

Decreases metabolic rate and therefore need for oxygen. Beneficial bc with acute tissue damage, blood supply and oxygen delivery are impaired, leading to hypoxia and further damage.

Question 1

Cold packs affect temperature up to what depth?

Answer 1

4cm, with temps being effected by adipose tissue, tx time, and types of cold (ice massage is quicker at about 18 min at peak while cold packs are about 30 min)

Question 2

Discuss cryotherapy and MHP effect on neural excitability.

Answer 2

Cold dec ncv, heat increases. Cold inhibits muscle spindle activation during muscle stretch and may be useful when stretching a spading muscle. Heat increases spindle activity and may make stretching a SPASMING muscle a little more difficult. Heat is shown to dec muscle guarding at rest. Both may work via Melzack and Wall’s pain gating mechanism.

Question 3

Describe the effect of ice on local blood flow.

Answer 3

Ice causes sympathetic responses and vasoconstriction. If temperature drops below 15*C, vasodilation occurs due to muscle paralysis.

Question 4

What is the ideal tissue temp with cryotherapy?

Answer 4

15-25C.

Question 5

What depth does MHP reach?

Answer 5

1-2 cm

Question 6

Describe heats effect on blood flow.

Answer 6

Increases vasodilation and delivery of oxygen and nutrients.

Question 7

When should you use heat?

Answer 7

Before stretching a nonspasming muscle or capsule.

To dec pain

After exercise to aid in the delivery of blood during immediate period of recovery from activity.

Question 8

Are heat wraps effective?

Answer 8

Research (Nadler) shows a significant dec in pain, especially with the use of thermacare products.

Question 9

Describe the effect pulse rate, in regards to electrotherapy, has on pain.

Answer 9

1-4: beta endorphins released, longest carryover
15-100: serotonin, long carryover
40-150: enkephalins, short

Question 10

How do phase duration and amplitude effect tissue?

Answer 10

Phase duration contributes to comfort and nerve activation. Shorter durations (50-100 microseconds) effect sensory nerves, longer (200-300) stimulate motor nerves.

Slower frequencies cause a twitch, faster frequencies are tetanic

Greater amplitude goes deeper and causes AP in motor nerves

Question 11

Describe rise time and fall time for estim

Answer 11

Rise is how long it takes from 0 to peak, fall is the opposite. The longer it is, the more comfortable it is

Question 12

Differentiate High volt galvanic current and DC.

Answer 12

HV- excites peripheral nerves, useless for denervated tissue, can’t be used in ionto, can be adjusted to target various tissue

DC- used to excite denervated tissue, creates a thermal and chemical reaction under electrodes, used for ionto, can’t discriminate between tissue

Question 13

What is the relationship between electrode instance and depth?

Answer 13

Current travels path if least resistance, so spreading electrodes out will cause the current to penetrate deeper

Question 14

Discuss Pflüger’s law.

Answer 14

Healthy muscle contacts with less current if stimulated by cathode (neg side) compared to anode. When stimulating tissue with DC (not HV),the cathode should be the active current

Question 15

Describe the use of NMES in strengthening muscle.

Answer 15

Research suggests NMES combined with exercise accelerates gains in muscle strength and activation of the quad post TKA. (10 10 sec quad contractions via Stevens).

Question 16

Outline parameters to inc muscle strength with estim.

Answer 16

Pulse duration 300-300 msec, pulse rate 35-80 hz, intensity: motor contraction, on/off ratio 1:5, 10-20 reps, 3-5x/wk, 3 weeks. Can be used for subluxed shoulders. Shown to improve strength and function post ACL reconstruction, regardless of presence of knee ext lag

Question 17

What is the efficacy of TENS in low back pain?

Answer 17

TENS does not appear to be more effective than exercise alone for chronic low back pain, but may have a placebo effect it may be good at easing muscle guarding in acute low back pain

Question 18

Describe effect if biofeedback in quad function

Answer 18

More effective than estim in promoting recovery of peak torque, equal to estim in recovery of active extension

Question 19

List some commonly used ionic solutions and their indications.

Answer 19

Acetic acid- calcium deposits, neg
Dexamethasone- inflammation, neg
Lidocaine- anesthetic, pos

Question 20

What are the limits with direct current?

Answer 20

Must be less than 1mA/cm2

Question 21

What are the polar effects of anodes and cathodes?

Answer 21

Anodes are positive and hyperpolarize nerves, repel bases, stops hemorrhage, calms, reduces pain

Cathodes: depolarize nerves, attracts bases, more skin damage, increases bleeding, stimulates, reduces chronic pain

Question 22

Where should ionto electrodes be placed?

Answer 22

Active should be placed over treatment tissue, dispersive should be 18in apart usually

Question 23

How does US work?

Answer 23

A quartz or synthetic crystal has a current passed through it and deforms, causing a pulse through tissue (piezoelectric effect)

Question 24

What is the effective radiating area of the transducer ?

Answer 24

About the size of the sound head. Tx area usually should only be 2-3 times the size of the ERA

Question 25

What are the thermal and non thermal ranges of US?

Answer 25

0.1 to 0.3 W/cm2 is non thermal, while anything above is thermal

Question 26

What are the effects of US?

Answer 26

Thermal: preferentially heats collagen tissue, increases elasticity, blood flow, pain threshold. Decreases muscle spasms, pain, joint stiffness

Nonthermal- increases cell membrane and vascular permeability, inc blood flow, stimulates collagen synthesis and phagocytosis, promotes tissue regeneration, breaks down scar tissue, can kill bacteria

Question 27

How deep does US effect tissue?

Answer 27

1 MHz: 2-5cm

3 Mhz: 1-2 cm

Question 28

Describe US use and metal.

Answer 28

May be used over metal but not over plastic implants or joint cement, so usually better to avoid over joint replacements

Question 29

Does US work?

Answer 29

Insufficient evidence at this time for active US. May have a placebo effect