Name ______
Sports Medicine II—Injury Treatment Guided Notes Page | 3
Injury Treatment
· Therapeutic Modalities
o include the use of heat, cold, electrotherapy, mechanical, light treatments
o Indication-
o Contraindication-
Thermal Modalities· transfer energy ______the tissues
· exchange energy based on a ______
· energy transferred through the following ways
o conduction-
example:
o convection-
example:
o radiation-
example:
o conversion-
example:
o evaporation-
example:
Cryotherapy / Thermotherapy
· application of ______modalities
· effects:
/ · application of superficial or deep ______agents
· effects:
Cryotherapy / Thermotherapy
· Types:
· Indications:
o Acute injury or inflammation
o Acute or chronic pain
o Small, superficial, first-degree burns
o Postsurgical pain and edema
o Use in conjunction with rehabilitation exercises
o Acute or chronic muscle spasms
o neuralgia
· Contraindications:
o Cardiac or respiratory involvement
o Uncovered open wounds
o Circulatory insufficiency
o Cold allergy/cold-induced urticaria
o Anesthetic skin
o Advanced diabetes
o Peripheral vascular disease
o Raynaud’s phenomenon
o Lupus / · Effects Continued
o
· Types:
o superficial:
o deep heat:
• Indications:
o Subacute or chronic inflammatory conditions
o Reduction of subacute or chronic pain
o Subacute or chronic muscle spasm
o Decreased range of motion
o Hematoma resolution
o Reduction of joint contractures
• Contraindications:
o Acute injuries
o Impaired circulation
o Advanced arthritis (vigorous heating)
o Poor thermal regulation
o Anesthetic areas
o Neoplasms
o thrombophlebitis
Thermotherapy Continued
Deep Heating Agents
• Therapeutic Ultrasound-______modality capable of producing changes in tissue through both thermal and nonthermal mechanisms
o Uses ______
• Effects
o Deep-heating
o Increase rate of tissue repair
o Wound healing
o Increased blood flow
o Increased tissue extensibility
o Breakdown calcium deposits
o Reduction of pain
o Reduction of muscle spasm
o Deliver medications
o ______
• Used for heating tissues
o ______
• 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
• Nonthermal Effects
o Increased cell membrane permeability
o Altered rates of diffusion across the cell membrane
o Increased vascular permeability
o Secretion of cytokines
o Increased blood flow
o Increased fibroblastic activity
o Stimulation of phagocytosis
o Production of healthy granulation tissue
o Synthesis of protein
o Synthesis of collagen
o Reduction of edema
o Diffusion of ions
o Tissue regeneration
o Formation of stronger, more deformable connective tissue / • Thermal Effects
o Increased sensory nerve conduction velocity
o Increased motor nerve conduction velocity
o Increased extensibility of collagen-rich structures
o Increased collagen deposition
o Increased blood flow
o Reduction of muscle spasm
o Increased macrophage activity
o Enhanced adhesion of leukocytes to damaged endothelial cells
• Indications
o Joint contractures
o Muscle spasms
o Neuroma
o Scar tissue
o Sympathetic nervous system disorders
o Trigger areas
o Warts
o Spasticity
o Postacute reduction of myositis ossificans
o Acute inflammatory conditions (pulsed)
o Chronic inflammatory conditions (pulsed or continuous) / • Contraindications
o Acute conditions (continuous)
o Ischemic areas
o Areas of impaired circulation/artery disease
o Over areas of deep vein thrombosis
o Anesthetic areas
o Over cancerous tumors
o Over sites of active infection of sepsis
o Over spinal cord or large nerve plexus (high doses)
o Exposed metal that penetrates skin
o Areas around eyes, heart, skull, or genitals
o Over the thorax (pacemaker)
o Pregnancy when over pelvic or lumbar areas
o Over fracture site before healing is complete
o Stress fracture sites or sites of osteoporosis
o Over the pelvic of lumbar area in menstruating patients
Temperature 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
Rate 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
Thermotherapy Continued
Deep Heating Agents
• Shortwave diathermy-uses ______to produce deep heat within the tissue
o Effects similar to thermal and nonthermal ultrasound
• Effects
o Thermal-
• Increased microvascular perfusion
• Activation of fibroblast growth factors
• Increased macrophage activity
o Nonthermal-
• Heating of large area of tissue
• Heat retained 3 times longer than ultrasound
• Indications
o Acute trauma (nonthermal)
o Acute inflammation (nonthermal)
o Edema reduction (nonthermal)
o Subacute inflammation
o Pain syndromes
o Muscle spasms
o Chronic inflammation
o Increase blood flow
o Stretching collagen-rich tissues / • Contraindications
o Ischemia
o Hemorrhage
o Acute inflammation (thermal)
o Metal within the output field
o Pacemaker
o Presence of moisture
o Moist dressing, adhesive tape, skin creams
o 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
Precautions Against Metal Within the Field of Shortwave Diathermy
In the Environment / Near or On the Patient / In the Patient
Beds
Treatment tables
Chairs
Wheelchairs
Metal stools
CPM Units
Splints
Braces
Medical instruments
Electrical modalities / Jewelry
Body piercings
Earrings
Watches
Metal in pockets (keys, etc.)
Belt buckles
Zippers
Metal underwire bras
Hearing aids / Orthodontic braces
Dental fillings
Implanted fixation devices
External fixation devices
Metal heart valves
Artificial joints
Metal IUDs
Body piercings
Cardiac pacemakers
Implanted bone growth generators
Phrenic pacers
Electrical Stimulation
· modality that utilizes ______
· electricity- force created by an imbalance in the number of ______at two poles
o Electrons flow in an attempt to equalize difference in charges—this creates an electrical current
o Negative pole-area of high electron concentration
o Positive pole-area of low electron concentration
o Closed circuit-formed when a complete path is formed between the 2 poles
· Electrical Currents
o Direct Current-______flow of electrons; square wave
o Alternating Current-direction of flow ______; no true positive or negative poles; electrons go back and forth between electrodes
o Pulsed Current-one direction of flow that is interrupted by ______
o Vocabulary
§ Electrode leads-______that conduct the current to and from the generator, electrodes, and patient
§ Electrodes-______that introduce the current into the body; point where the electrode contacts the skin is where the electrons are converted into ions
· When placed ______together, current flows ______
· When places ______apart, the ______the current flows
Stimulation Levels
Between the point at which the output rises from zero to the point where the patient first receives an electrical sensation
Stimulation of only sensory nerves
Stimulation that produces a visible muscle contraction
Stimulation of pain fibers
• Indications
o Controlling acute and chronic pain
o Reducing edema
o Reducing muscle spasm
o Reducing joint contractures
o Inhibiting muscle spasms
o Minimizing disuse atrophy
o Facilitation tissue healing
o Facilitating muscle reeducation
o Facilitating fracture healing
o Strengthening muscle / • Contraindications
o Cardiac disability
o Pacemakers
o Pregnancy (over abdomen, pelvis, and lumbar regions)
o Menstruation (over abdomen, pelvis, and lumbar regions)
o Exposed metal implants
o Areas of nerve sensitivity
• Carotid sinus
• Esophagus
• Larynx
• Pharynx
• Around or on eyes
• Upper thorax
• Temporal region
o Severe obesity
o Epilepsy
o Electronic monitoring equipment Cancerous lesions
o Sites of infection