Therapeutic Modalities

Question 1

What is therapeutic modalities

Answer 1

The administration of thermal, mechanical, electromagnetic, light and other energies for therapeutic purposes.

Question 2

What phases are the remodeling phases broken into?

Answer 2

Phase 3: consolidation phase from day 21 to 60
Phase 4: organizational phase starting on day 62

Question 3

What modalities are used in acute inflammatory phase

Answer 3

RICE –> rest, ice, compression and elevation.

Question 4

what is the purpose of physiotherapy treatment in phase 1?

Answer 4

To move into next healing stage and to decrease pain and swelling.

Question 5

What causes pain in phase 1

Answer 5

Swelling –> increased pressure + healing cascade —> irritates nerves.

Question 6

Why is there such a risk of re-injury during phase 2?

Answer 6

Less pain but new collagen cant withstand same stress as normal tissue.
Feel better –> return activities –> experience a set back

Question 7

what is the focus of physiotherapy in phase 2?

Answer 7

Regain ROM, joint + scar mobilization + exercises. Promotes re-alignment of collagen fibers.

Question 8

what is the main focus in phases 3 and 4

Answer 8

Increasing cellular organization of collagen fibers + strength between bonds.

Question 9

what is the focus of physiotherapy in phase 3 and 4

Answer 9

Regain full range of motion and improving strength. Eccentric exercises and increasing resistive loads.

Question 10

What is the pain gate theory?

Answer 10

The gate is a mechanism where pain signals can be let through or restricted from spinal cord to brain.
Gate open: pain signals pass through and sent to brain for it to be perceived.
Gate closed: signal is restricted and pain is not perceived.

Question 11

What happens when some experiences a non-painful (non-noxious) stimulus

Answer 11

Activates closed gate control mechanism and reduces pain.

Question 12

What is a E-Stim (TENS and NMES)

Answer 12

Electrotherapy that targets nerves via mild electrical current.
TENS: pain relief
NMES: treat muscular weakenss

Question 13

What else can an E-STIM be used for? (3)

Answer 13

Edema reduction (lymphatic drainage), medication delivery, diagnostic testing (neurotransmitter abnormalities)

Question 14

What is frequency in regards to E-STIM

Answer 14

Number of electrical pulses (Hz) per second.
Pulses/sec

Question 15

What is amplitude

Answer 15

Intensity mA –> dial based on P response.

Question 16

What should the ratio of on/off time be for E-Stim treatment

Answer 16

Off time should be three times on time.

Question 17

What is ramp

Answer 17

Gradual increase in amplitude over time –> P comfort
Zero to peak.

Question 18

How does a NMES work to help muscle weakness?

Answer 18

Application of an electrical current over a motor point to elicit a muscle contraction. Selective contraction of muscle groups. less strong than voluntary contraction.

Question 19

Which muscle fibers are recruitment in NMES system.

Answer 19

Recruitment of type II muscle fibers first but mostly affects type I fibers.

Question 20

T/F the recruitment of muscle fibers in voluntary contraction is the opposite as E-STIM

Answer 20

True- voluntary is stronger than E-STIM.

Question 21

What is the goal of NMES

Answer 21

Tetanic contractions of selected muscle groups without pain.

Question 22

How does a TENS function

Answer 22

Large nerve fibers have lower threshold for stimulation and faster conduction velocity than small fibers that conduct pain messages. By Stimulating the A-Beta fibers TENS blocks smaller fiber activity and thus pain

Question 23

How does the TENS block the smaller fiber activity

Answer 23

Hyperstimulation of nociception.

Question 24

T/F for chronic pain the pulse duration is lower than acute pain while the frequency is higher?

Answer 24

False- For chronic pain the pulse duration will be higher than the setting for acute and the Frequency will be lower compared to acute.

Question 25

T/F you want to see active muscle contraction for chronic pain.

Answer 25

True- for acute it should be a comfortable tingling sensation.

Question 26

What is extracorporeal shockwave therapy (ESWT)

Answer 26

Focused, acoustic waves. Releases energy at cellular level.

Question 27

T/F ESWT will get hot.

Answer 27

False

Question 28

What do the proteins that are released by the ESWT do?

Answer 28

Reducing inflammation, short-term analgesia, increase neovascularizaiton, increase osteoblast activity, realigns fibers: more parallel healing.

Question 29

What are some indications for ESWT use?

Answer 29

Osteoarthritis, tendon/ligamentous injuries, non-union or delayed healing fracture.

Question 30

How does Therapeutic ultrasound work

Answer 30

Energy in the sound beam. Absorption + scatter when encountering tissue. Mechanical energy converted to heat.

Question 31

T/F You are at risk for burning the patient with EWST modality

Answer 31

True- need to move the head around constantly.

Question 32

What are the indications/actions of therapeutic ultrasound

Answer 32

Breaks down scar tissue (external and internal), increases the elasticity of the muscle, aids healing, increases circulation, reduces pain and spasm.

Question 33

How does treatment time correlated to sound head diameter

Answer 33

Since tissue temperature must be maintained at 104-112F for at least 5 min. Tx time is usually 5 minutes for every sound head diameter you are treating.

Question 34

What are the different frequencies of ultrasound.?

Answer 34

1MHz: longer wavelength penetrates 2-5 cm; requires higher intensities
3.3MHz: shorter wavelength penetrates 0.5-2.0cm; requires lower intensities.

Question 35

T/F you can use therapeutic ultrasound on neoplasia.

Answer 35

False- at risk of promoting healing and growth.

Question 36

What is PEMF

Answer 36

Pulsed electromagnetic field therapy.

Question 37

What does PEMF do

Answer 37

Use of electrical currents to improve healing. Loop is delivery system for inducing electrical current flow in conductor (tissue)

Question 38

T/F PEMF leads to NO production

Answer 38

True- causes increase in calcium and CaMbinding to create short burs of nitric oxide production.

Question 39

What does Nitric oxide stimulation do? (7)

Answer 39

1) Vasodilation, 2) osteoblast proliferation, 3) immune response, 4) down regulates Cox-2, 5) cellular proliferation, 6) chondrocyte proliferation, 7) reduces the inflammatory process- Cytokines.

Question 40

What are the indications for PEMF

Answer 40

Wound healing, pain management, inflammation, post surgical healing, OA

Question 41

How often should you do PEMF?

Answer 41

Acute- every 2 hours
Chronic- 2-3x weekly.