Modalities

Question 1

Describe how TENS helps to block pain and affects guarded muscles?

Answer 1

Gate Control Theory

non noxious stimulus “noise”
goes up spinal cord to brain, blocks pain signals like a soccer goalie

gives an opportunity for muscles that are guarding to relax as well

usually pre-mod setting to provide current variability and prevent desensitization/ “getting used to it”

Question 2

TENS Parameters for:

sensory-level pain relief

waveform 
pulse frequency
pulse duration
amplitude description
treatment duration

Answer 2

mono/biphasic alternating PC

high frequency, low duration
30-150 Hz, higher
50-100 microseconds duration, lower

comfort sensory amplitude

duration varies

Question 3

TENS Parameters for:

motor level/ acupuncture-like pain relief after stim

waveform 
pulse frequency
pulse duration
amplitude description
treatment duration

Answer 3

biphasic PC

low freq 2-4 Hz, high duration 100-300 microseconds

muscle response amplitude

20-45 minutes

Question 4

TENS Parameters for:

noxious level, longer lasting pain relief

waveform 
pulse frequency
pulse duration
amplitude description
treatment duration

Answer 4

DC, mono/biphasic PC

high or low pulse frequency

long pulse duration, 250-1000 microseconds

highest tolerated amplitude

30-60 second treatment duration

Question 5

Interfering biphasic currents at different frequencies that create a dissonance frequency when crossed together, resulting in broader, deeper coverage

Answer 5

IFC

Question 6

NMES preferentially hits which muscle fiber type?

Answer 6

Type 2

which is why you’ll want a treatment with more rest breaks, bc these types of fibers have very high fatigability

Question 7

when NMES is used during functgional activity:

Answer 7

FES

Question 8

NMES is used for?
waveform?
pulse hz?
pulse duration?
amplitude?
tx duration?

Answer 8

muscle strength/re-education

mono/biphasic PC OR medium frequency burst AC (Russian)

30-85 pulse hz

200-700 microseconds

muscular contraction amplitude

1:3-5 duty cycle

Question 9

another name for Russian Stim?

Answer 9

frequency burst AC

Question 10

monophasic pulsed current with double peaked pulses is aka

parameters

Answer 10

Hi-Volt PC

used for wound healing, 4-100 microseconds for 60 min at a comfy amplitude

Question 11

Hi-Volt polarity for inflammation?

Answer 11

positive

Question 12

Hi-Volt polarity for granulation, infection?

Answer 12

negative

Question 13

Iontophoresis:

dexamethasone is used for? polarity?

Answer 13

anti inflammatory

-

Question 14

Iontophoresis:

lidocaine is used for? polarity?

Answer 14

pain/inflammation

+

Question 15

Iontophoresis:

acetic acid vinegar is used for? polarity?

Answer 15

calcific tendonitis

-

Question 16

Iontophoresis:

iodine is used for? polarity?

Answer 16

adhesive capsulitis

-

Question 17

Iontophoresis:

salicylates is used for? polarity?

Answer 17

muscular pain (-)

Question 18

describe therapeutic ultrasound:

Answer 18

really fast mechanical sound waves that cause vibration; travels well through liquids/gel (coupling medium); our soft tissue also acts like a liquid

piezoelectric crystal vibrates creating electric current, high frequency goes from crystal to tissue

Question 19

ideal beam non-uniformity ratio for therapeutic ultrasound? what is BNR?

Answer 19

1:1

peak intensity vs average intensity

6:1 is the FDA limitation of too high of a peak,

Question 20

attenuation

Answer 20

decrease in sound energy due to absorption, reflection or refraction

Question 21

why use ultrasound?

Answer 21

to increase temperature and blood flow

• scar tissue
• subacute inflammation
• facilitate healing through blood flow and microstreaming

temperature increase due to friction between molecules = local blood flow increase

microstreaming: pushing air bubbles through cell walls, cell wall permeability diffusion changes = increase in metabolism and healing that occurs at a cellular level

Question 22

contraindication for ultrasound in kids?

Answer 22

don’t ultrasound over growth plates! it can cause them to seal over early