Ultrasound, Diathermy, Cold Laser

Question 1

What are the indications of ultrasound?

Answer 1

increase extensibility of collagen fibers of tendons and joint capsules
increase blood flow
increase cell metabolism
increased collagen synthesis
decreased joint stiffness
decreased muscle spasm
enhanced tendon, ligament, and muscle healing

Question 2

What are the contraindications of ultrasound?

Answer 2

malignancy
hemorrhage
ischemia
thrombus
infection
gonads
eye
pelvic, abdominal, and lumbar areas of pregnant women
spinal cord after laminectomy
plastic and cemented implants (metal is ok)
near or over electronic implants
unknown etiology

Question 3

What are the precautions of ultrasound?

Answer 3

bony prominences (avoid, use indirect technique, smaller sound head)
epiphyseal plate (may alter bone growth)

Question 4

What happens when the tissue temperature is increased 1 degree Celsius when using ultrasound?

Answer 4

it is associated with an increase in metabolic activity

Question 5

What happens when there is a 2-3 degree celsius increase in temperature while using ultrasound?

Answer 5

it reduces muscle spasm, increases blood flow and reduction of chronic inflammation

Question 6

What happens when there is a tissue temperature increase of 4 degrees celsius while using ultrasound?

Answer 6

alters viscoelastic properties of collagen

Question 7

Does pulsed or continuous US produce heat?

Answer 7

pulsed US does not produce heat, but continuous US does produce heat

Question 8

Acute treatments for US are done at what duty cycle?

Answer 8

done at 50% duty cycle (no heat)

Question 9

Chronic treatments of US are performed at what duty cycle?

Answer 9

performed at 100% duty cycle (heating)

Question 10

1 MHz provides what type of penetration?

Answer 10

provides deep penetration, at 4-5cm

Question 11

3 MHz (or 3.3MHz) is at what kind of penetration?

Answer 11

the most superficial, only going up to 2.5cm

Question 12

Underwater US is preformed the same as what?

Answer 12

same as direct ultrasound (pulsed or continuous)

Question 13

What are the indications of US and E-stim combo?

Answer 13

interferential (premod) for pain relief in combination with the mechanical (pulsed US) and/or thermal effects (continuous US) of ultrasound

Question 14

What are the clinical rationale of US or E-stim combo therapy?

Answer 14

chronic tendonopathies such as lateral epicondylitis and achilles tendonosis are painful with ischemic and fibrotic changes of the tendon. Applying thermotherapy with US in combination with premod helps decrease pain and increase circulation

Question 15

During US and E-Stim combo therapy what do you need to make sure to do with the channel?

Answer 15

be sure the lead is plugged into channel 2 and an electrode is connected to the black connector (black plug). the red connector is “dead.”

Question 16

During direct pulsed ultrasound, what is the treatment area, clinical goal, intensity, frequency, duty cycle, and time?

Answer 16

treatment area: 2-3x size of ERA, move in slow circles
clinical goal: increase healing
intensity: 0.5-2.5 w/cm2
frequency: 1 MHz (deep) or 3.3 MHz (superficial)
duty cycle: 50% NO HEAT
time: 5-10 minutes

Question 17

During Continuous US, what is the treatment area, clinical goal, intensity, frequency, duty cycle, and time?

Answer 17

treatment area: 2-3x size of ERA, move in slow circles
clinical goal: decrease chronic pain, or muscle spasm
intensity: 0.5-2.5 w/cm2
frequency: 1 MHz (deep), 3.3 MHz (superficial)
duty cycle: 100% HEAT
time: 5-10 minutes

Question 18

During underwater US, what is the treatment area, clinical goal, intensity, frequency, duty cycle, and time?

Answer 18

treatment area: when the dead won’t contact the skin flat
clinical goal: increase healing, decrease pain
intensity: 0.5-2.5 w/cm2
frequency: 1 MHz (deep), 3.3 MHz (superficial)
50%-100% HEAT OR NO HEAT
time: 5-10 minutes

Question 19

During combo of US and premod interferential, what is the treatment area, clinical goal, intensity, frequency, duty cycle, and time?

Answer 19

treatment time: 2-3x size of ERA, move in slow circles
clinical goal: chronic tendinosis, trigger points, acute or chronic pain
intensity: 0.5-2.5 w/cm2 premod, patient comfort
frequency: US- 1 or 3 MHZ; premod- 1-15Hz or 60-150 Hz
duty cycle: 50%-100% HEAT OR NO HEAT
time: 5-10 minutes

Question 20

What are the contraindications of Cold Laser?

Answer 20

cancer
pregnancy- over the abdomen and pelvic area
avoid direct exposure to eyes
over areas of active hemorrhage
over the thyroid gland
directly over open wounds
unless covered with a clear protective barrier
epileptic patients

Question 21

What are the precautions of Cold Laser?

Answer 21

infections, testicles, sympathetic ganglia, vagus nerve, cardiac region in those with a heart disease, open growth plates, bruises, photosensitive

Question 22

Which classes of cold laser do not require eye protection?

Answer 22

Class II (

Question 23

Which classes of laser do require eye protection?

Answer 23

Class IIIb (5-500 mW)- can cause eye damage
Class IV (>500 mW)- hazardous to eyes and skin

Question 24

During cold laser with a pulse frequency of 1-5000Hz, what is the clinical goal, intensity, and time?

Answer 24

clinical goal: stimulate healing

intensity: low
time: 2-10 minutes

Question 25

During cold laser pulse frequency 1000 Hz, what is the clinical goal, intensity and time?

Answer 25

clinical goal: inhibit swelling
Intensity: high
time: 1-3 minutes

Question 26

During cold laser pulse frequency 1000-3000 Hz, what is the clinical goal, intensity, time?

Answer 26

clinical goal: acute pain

intensity: high
time: 3-5 minutes

Question 27

During cold laser pulsed frequency, what is the clinical goal, intensity, time?

Answer 27

clinical goal: chronic pain

intensity: high
time: 5-10 minutes

Question 28

If you have a pain level of 1-3, what frequency should cold laser be at?

Answer 28

1000 Hz

Question 29

If you have pain 4-6, what cold laser frequency should you use?

Answer 29

1000-3000 Hz

Question 30

If you have a pain level of 7-10, what frequency of cold laser should you use?

Answer 30

3000 Hz