50 Facts about Therapeutic Modalities

1. Machines or procedures that help in nurchuring physical therapy and exercise are known as therapeutic modalities.

2. Certain modalities can make injury worse or cause other problems if they are not used properly or if they are used on people with certain medical conditions.

3. It is important to have a physical therapist fully assess before applying any modalities.

4. Deep heat causes a temperature rise from the conversion of energy into heat as it penetrates the tissues of body where the energy is applied.

5. Energy sources include (1) high-frequency currents (shortwave diathermy), (2) electromagnetic radiation (microwaves), and (3) ultrasound (high-frequency sound).

6. Shortwave diatheramy is the therapeutic application of high radio frequency electrical currents.

7. The radio frequency of electromagnetic field usually is at a frequency 27.12 MHz (= 11.06 m). Hyperemia, sedation, and analgesia are the basic physiologic effects.

8. The reduction in muscle spasm due to muscle relaxation is a result of increased basic supply to the treated area.

9. A transverse technique is applied to treat a larger anatomic area with the prim concentration at the midpoint between electrodes.

10. Microwave diathermy, a form of electromagnetic radiation, is another deep heat mode that selectively heats tissues with high water concentration.

11. Hyperemia, sedation, and analgesia are the physiologic effects, similar to the results shortwave diathermy.

12. Secondary local vascular dilatation results in increased local metabolism.

13. Ultrasound is a deep heating modality that uses high-frequency acoustic vibration above t human audible spectrum, defined as frequencies >17,000 Hz.

14. Therapeutic ultrasound is in the frequency range of 0.8-1.0 MHz.

15. Ultrasound energy is generated by the piezoelectric effect; electrical energy is applied to crystal, causing it to vibrate at high frequency and to produce ultrasound.

16. Ultrasound is delivered by continuous or pulsed wave (the goal is to produce non-them; effects such as streaming and cavitation) and provides a high heating intensity.

17. Conductive heating is defined as heat transfer from one point to another without noticeabli movement in the conducting medium. Typically, direct contact takes place between the head source and the target tissues.

18. Superficial heat is usually conductive heat, e.g. hot water baths, hot packs, electric heating pads, warm compresses.

19. Convective heating is produced by movement of the transferring heating medium, usually either air or fluid.

20. Methods for providing convective superficial heat include fluid therapy, whirlpool, moist air baths, and hot air baths.

21. The conversion form of heating involves heat transfer by conversion of energy from one energy form, (e,g, light, sound) to another heat.

22. Superficial heat is produced by heat lamps or radiant light bakers, where heat is transferred when the conveying medium (light energy) is converted to heat energy at the skin surface.

23. Several factors determine the extent of the physiologic response to heat, including the following:

1. Level of tissue temperature (usually 40-45° C).

2. Duration of the tissue temperature increase.

3. Rate of increase in tissues temperature.

4. Size of the area being treated.

24. Cryotherapy has the primary effect of cooling tissue.

25. Transcutaneous Electrical Nerve Stimulation (TENS) currently is one of the most commonly used forms of electro analgesia.

26. Hundreds of clinical reports exist concerning the use of TENS for various types of conditions such as Low Back Pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, bladder incontinence, neurogenic pain, visceral pain, and post-surgical pain.

27. A TENS unit consists of one or more electric signal generators, a battery, and a set of electrodes. The units are small and programmable, and the generators can deliver trains of stimuli with variable current strengths, pulse rates, and pulse widths. The preferred waveform is biphasic, to avoid the electrolytic and iontophoretic effects of a unidirectional current.

28. Some physical therapists may use a machine that gives off a laser beam at varying frequencies an wavelengths.

29. Depending on the settings and the amount of time the laser is applied to repair injured tissues.

30. It can help to increase healing and decrease pain following*muscle spasms, saprains, strains, tendinitis fracture, osteoarthritis, carpal tunnel syndrome, wounds, and many other injuries.

31. EMS or “muscle stimulation” is used to stimulate your muscles and cause a muscular contraction. This machine can make your muscles contract without voluntarily trying to contract them.

32. Physical therapists often use EMS plus strengthening exercises, to help you strengthen your muscles after an injury. EMS is not very helpful in building strength on it own.

33. EMS may also be used to re-train muscles how to work after having a nerve or brain injury.

34. Diagnosis and treatment of painful muscle syndromes can be a difficult and frustrating task for any clinician. Typically, the mainstay of therapy for such conditions is therapeutic exercise, analgesics, and the tincture of time.

35. Recent reports have stared that purported effectiveness of using a biologic neuromuscular blocking agent, botulinum toxin, in the treatment of painful conditions associated with skeletal muscle.

36. While poorly understood and at times controversial, use of botulinum toxin in treatment of conditions associated with involuntary muscle contraction, such as focal dystonia and spasticity, is supported by prospective, randomized clinical research; however, the volume of comparable studies in pain syndromes has begun to surface only recently.

37. Epidural steroid injections (ESIs) are integral part of non-surgical management of radicular pain from lumber spine disorders.

38. Radicular pain is described as a sharp, lencinating, and radiating pain, often shooting from the low back down into the lower extremity in a radicular distribution.

39. Radicular pain is the result of a nerve root lesion or inflammation.

40. ESIs have been recommended to deliver steroids in a more localized fashion to the area of affected nerve roots, thereby decreasing the systemic effect of the administered steroid.

41. Studies have indicated that ESIs are most effective in the presence of acute nerve root inflammation.

42. Clinical manifestations of nerve root inflammation include some or all of the following; radicular pain, dermatomal hypesthesia, weakness of muscle groups innervated by the involved nerve roots, diminished deep tendon reflexes, and positive straight leg-raising tests.

43. The first epidural injection using the caudal approach was performed in 1901 when cocaine was injected to treat lumbago and sciatica [presumably pain referred from lumber nerve roots].

44. Reports of the epidurals from the 1920s-1940s involved using high volumes of normal saline and local anesthetics. Injection of corticosteroids into the epidural space for the management of lumber radicular pains was first recorded in 1952.

45. Use of cortisone injections in the treatments of muscle and joint inflammatory reactions is becoming increasingly popular.

46. First popularized by Janet Travell, MD, muscle injections are a remarkably effective adjunct to pharmacologic and physical therapies and are safe and easy to perform. Joint injections, while technically more difficult to perform, also can be of great benefit in the patient’s recovery.

47. Inflammation is one of the body’s first reactions to injury.

48. Release of damaged cells and tissue debris occurs upon injury. These expelled particles act as antigens to stimulate a nonspecific immune response and to cause proliferation of leukocytes.

49. Increase of local blood flow develops to transport the polymorph nuclear leukocytes, macrophages, and plasma proteins to the injured area.

50. A redistribution of arteriolar flow produces stasis and hypoxia at the injury site. The resultant infiltration of tissues by the leukocytes, plasma proteins, and fluid causes the characteristic red swollen painful inflammation.