Injury Treatment

Ms. Bowman

Injury Treatment• 2 areas

o Therapeutic Modalitieso Therapeutic Exercise

Therapeutic Modalities

• Non-exercise treatment optionso Include the use of:

• Heat• Cold• Electrotherapy• Massage• Traction• Ultrasound• Compression

• Vocabularyo Indications-reasons/injuries where it is appropriate to use the modalityo Contraindications-reasons/injuries where it is inappropriate to use the

modality

Thermal Modalities• Transfer energy to or from the tissues; exchange

of energy based on a temperature gradient• Energy transferred through

o Conduction-between two objects that are touchingo Convection-movement of a medium (water, air)o Radiation-transfer without the use of a mediumo Conversion-energy changed to another form o Evaporation-liquid to gas state

Thermal Modalities• Cryotherapy-application of cold modalities

o Effects:• Vasoconstriction• Decreased rate of cell metabolism• Decreased production of cell waste• Reduction of inflammation• Decreased nerve conduction• Decreased pain• Decreased muscle spam• Decreased muscular force production

Thermal Modalitieso Indications:

• Acute injury or inflammation• Acute or chronic pain• Small, superficial, first-degree

burns• Postsurgical pain and edema• Use in conjunction with

rehabilitation exercises• Acute or chronic muscle spasms• neuralgia

o Contraindications:• Cardiac or respiratory

involvement• Uncovered open wounds• Circulatory insufficiency• Cold allergy/cold-induced

urticaria• Anesthetic skin• Advanced diabetes• Peripheral vascular disease• Raynaud’s phenomenon• Lupus

• Cryotherapy• Types:

o Ice bago Ice cupo Cold whirlpoolo Ice immersion

Thermal Modalities• Thermotherapy- application of superficial or deep

heating agentso Effects-

• Vasodilation• Increased rate of cell metabolism• Increased delivery of leukocytes• Increased capillary permeability• Increased venous and lymphatic drainage• Edema formation• Removal of metabolic wastes• Increased elasticity of collagen-rich tissues• Analgesia and sedation of nerves• Decreased muscle tone• Decreased muscle spasm• Decreased pain• Increased nerve conduction and velocity

Thermal Modalities• Indications:

o Subacute or chronic inflammatory conditions

o Reduction of subacute or chronic pain

o Subacute or chronic muscle spasm

o Decreased range of motiono Hematoma resolutiono Reduction of joint contractures

• Contraindications:o Acute injurieso Impaired circulationo Advanced arthritis (vigorous

heating)o Poor thermal regulationo Anesthetic areaso Neoplasmso thrombophlebitis

• Thermotherapyo Types:

• Superficial o Heat packo Warm whirlpoolo Warm immersiono Infrared lampso Paraffin baths

• Deep Heato Microwave diathermyo Shortwave diathermyo ultrasound

Deep Heating Agents• Therapeutic Ultrasound-deep-penetrating

modality capable of producing changes in tissue through both thermal and nonthermal mechanismso Uses acoustical energy

• Effectso Deep-heatingo Increase rate of tissue repairo Wound healingo Increased blood flowo Increased tissue extensibilityo Breakdown calcium depositso Reduction of paino Reduction of muscle spasmo Deliver medications

Deep Heating Agents• Ultrasound

o Continuous Output• Used for heating tissues

o Pulsed Output• Nonthermal effects

o The closer the duty cycle is to 100% the more thermal effects there are. The lower the duty cycle, the less thermal effects

Deep Heating Agents• Thermal Effects

o Increased sensory nerve conduction velocity

o Increased motor nerve conduction velocity

o Increased extensibility of collagen-rich structures

o Increased collagen depositiono Increased blood flowo Reduction of muscle spasmo Increased macrophage

activityo Enhanced adhesion of

leukocytes to damaged endothelial cells

• Nonthermal Effectso Increased cell membrane

permeabilityo Altered rates of diffusion across the

cell membraneo Increased vascular permeabilityo Secretion of cytokineso Increased blood flowo Increased fibroblastic activityo Stimulation of phagocytosiso Production of healthy granulation

tissueo Synthesis of proteino Synthesis of collageno Reduction of edemao Diffusion of ionso Tissue regenerationo Formation of stronger, more

deformable connective tissue

Deep Heating Agents• Contraindications

o Acute conditions (continuous) o Ischemic areaso Areas of impaired circulation/artery

diseaseo Over areas of deep vein thrombosiso Anesthetic areaso Over cancerous tumorso Over sites of active infection of sepsiso Over spinal cord or large nerve plexus

(high doses)o Exposed metal that penetrates skino Areas around eyes, heart, skull, or

genitalso Over the thorax (pacemaker)o Pregnancy when over pelvic or lumbar

areaso Over fracture site before healing is

completeo Stress fracture sites or sites of

osteoporosis o Over the pelvic of lumbar area in

menstruating patients

• Indicationso Joint contractureso Muscle spasmso Neuromao Scar tissueo Sympathetic nervous system

disorderso Trigger areaso Wartso Spasticityo Postacute reduction of myositis

ossificanso Acute inflammatory conditions

(pulsed)o Chronic inflammatory

conditions (pulsed or continuous)

Deep Heating AgentsTemperature Increases and Their Desired Effect

Classification of Ultrasound

Temperature Increase

Used for Thermal Effects

Mild 1ºC Mild inflammation, accelerating metabolic rate

Moderate 2°-3°C Decreasing muscle spasm, decreasing pain, increasing blood flow, reducing chronic inflammation

Vigorous 3°-4°C Tissue elongation, scar tissue reduction, inhibition of sympathetic activity

Deep Heating AgentsRate of Ultrasound Heating (temperature increase per minute)

Intensity Tissue Depth 1MHz 3MHz

0.5 0.04°C 0.3°C

1.0 0.2°C 0.6°C

1.5 0.3°C 0.9°C

2.0 0.4°C 1.4°C

Deep Heating Agents• Shortwave diathermy-uses high frequency

electromagnetic energy to produce deep heat within the tissueo Effects similar to thermal and nonthermal ultrasound

Deep Heating Agents• Effects

o Thermal-• Increased microvascular perfusion• Activation of fibroblast growth factors• Increased macrophage activity

o Nonthermal-• Heating of large area of tissue

o Heat retained 3 times longer than ultrasound

Deep Heating Agents• Contraindications

o Ischemiao Hemorrhageo Acute inflammation (thermal)o Metal within the output fieldo Pacemakero Presence of moistureo Moist dressing, adhesive tape,

skin creamso Skull (extreme caution)o Contact lenses must be

removed before application over head

o Pregnancy (over pelvis, abdomen, or lumbar)

o Menstruating females (over pelvis, abdomen, or lumbar)

o Unfused epiphyseal plates

• Indicationso Acute trauma (nonthermal)o Acute inflammation

(nonthermal)o Edema reduction

(nonthermal)o Subacute inflammationo Pain syndromeso Muscle spasmso Chronic inflammationo Increase blood flowo Stretching collagen-rich

tissues

Deep Heating AgentsPrecautions Against Metal Within the Field of Shortwave

Diathermy

In the Environment Near or On the Patient In the Patient

BedsTreatment tablesChairsWheelchairsMetal stoolsCPM UnitsSplintsBracesMedical instrumentsElectrical modalities

JewelryBody piercingsEarringsWatchesMetal in pockets (keys, etc.)Belt bucklesZippersMetal underwire brasHearing aids

Orthodontic bracesDental fillingsImplanted fixation devicesExternal fixation devicesMetal heart valvesArtificial jointsMetal IUDsBody piercingsCardiac pacemakersImplanted bone growth generatorsPhrenic pacers

Electrical Stimulation• Electrical stimulation-modality that utilizes

electrical currents• Electricity-force created by an imbalance in the

number of electrons at two points (poles)o Electrons flow in an attempt to equalize difference in charges—this

creates an electrical current• Negative pole-area of high electron concentration• Positive pole-area of low electron concentration

o Closed circuit-formed when a complete path is formed between the 2 poles

o Electrical Currents• Direct Current-uninterrupted, one directional flow of electrons; square

wave• Alternating Current-direction of flow changes from positive to

negative in a cyclical manner; no true positive or negative poles; electrons go back and forth between electrodes

• Pulsed Current-one direction of flow that is interrupted by periods of no current flow

Electrical Stimulation• Vocabulary

o Electrode leads-wires that conduct the current to and from the generator, electrodes, and patient

o Electrodes-introduce the current into the body; point where the electrode contacts the skin is where the electrons are converted into ions• When placed closer together, current flows superficially• When places farther apart, the deeper the current flows

Stimulation Levels

Subsensory

Between the point at which the output rises from zero to the point where the patient first receives an electrical sensation

Sensory Stimulation of only sensory nerves

Motor Stimulation that produces a visible muscle contraction

Noxious Stimulation of pain fibers

Electrical Stimulation• Contraindications

o Cardiac disabilityo Pacemakerso Pregnancy (over abdomen, pelvis,

and lumbar regions)o Menstruation (over abdomen,

pelvis, and lumbar regions)o Cancerous lesionso Sites of infectiono Exposed metal implantso Areas of nerve sensitivity

• Carotid sinus• Esophagus• Larynx• Pharynx• Around or on eyes• Upper thorax• Temporal region

o Severe obesityo Epilepsyo Electronic monitoring equipement

• Indicationso Controlling acute and chronic

paino Reducing edemao Reducing muscle spasmo Reducing joint contractureso Inhibiting muscle spasmso Minimizing disuse atrophyo Facilitation tissue healingo Facilitating muscle

reeducationo Facilitating fracture healing o Strengthening muscle

Electrical Stimulation• Types

o High-Voltage Pulsed Stimulationo Transcutaneous Electrical Nerve Stimulation (TENS)o Interferential Stimulationo Neuromuscular Electrical Stimulationo Iontoporesiso Microcurrent Electrical Stimulation

Mechanical and Light Modalities