Enter Title

Thermotherapy

100

ONE REASON WHY WE USE SUPERFICIAL HEAT?

• Heat superficial joints with relatively little soft tissue such as the hand, fingers, patella tendon, etc.

• Decrease pain

• Promote hyperemia to muscles

• Promote relaxation

• Increase flexibility of superficial tissues before stretching or exercise

200

HOW MANY LAYERS ARE NEEDED FOR A CERVICAL HEAT PACK? 

4-5

300

HOW MANY LAYERS ARE NEEDED FOR A LUMBAR HEAT PACK?

7-8

400

HOW MANY LAYERS ARE NEEDED FOR A THORACIC HEAT PACK?

5-6

500

ONE CONTRAINDICATION OR PRECUATION FOR THERMOTHERAPY MODALIITES?

• Peripheral vascular disease 

• Decreased or absent sensation 

• Patient who is unable to give feedback (i.e. child, cognitive impairment, etc.) 

• Malignancies (i.e. areas of known cancer) 

• Over pregnant uterus

• Extreme obesity 

• Bleeding disorders, e.g., hemophilia 

• Over acute inflammation 

• Over areas of active infection

• Over metal (staples, etc.)

CRYOTHERAPY

100

ONE REASON WHY WE USE CRYOTHERAPY?

• Cold is typically the thermal agent of choice in the management of acute injuries

• vasoconstriction reduces bleeding in the area  

• It decreases metabolic rate

• It decreases pain

• It may decrease acute spasm

200

NAME ONE TYPE OF CRYOTHERAPY?

COLD PACK

ICE MASSAGE

300

WHAT TEMPERATURE DO WE KEEP THE COLD PACKS AT?

Packs maintained typically 0-32°F  

400

HOW MANY TOWEL LAYERS ARE NEEDED FOR COLD PACKS? 

1

500

ONE CONTRAINDICATION OR PRECUATION FOR CRYOTHERAPY MODALIITES?

• Ask the patient if they have ever had any unusual response to cold such as a rash or severe pain.

• Cold Hypersensitivity Responses

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  • Cold urticaria - secondary to release of histamine from mast cell degranulation resulting in edema of dermis and subcutaneous tissues

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    • Smooth, slightly elevated patches, red or pale

• Vasospastic disorders

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  • Raynaud’s disease - a vasoconstriction of the distal extremities, upon exposure to cold. Most prevalent in the hand.

  • Livedo reticularis - cyanotic mottling of the skin in a typical fishnet pattern

• Acrocyanosis - characterized by a persistent diffuse cyanosis of fingers, hands, toes, and feet.

• Nerve repairs

• Complex Regional Pain Syndrome (CRPS) 

• Decreased sensation 

• Peripheral vascular disease 

• Hypertension (systemic application of cold may increase BP) 

• Risk of peripheral nerve injury (e.g., peroneal, median) with prolonged exposure and/or compression

Electrical Agents

100

ONE REASON WHY WE USE ELECTRICAL AGENTS?

• Pain relief:

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  • Gate control theory

  • Endogenous opiate release (endorphins, dynorphins, enkephalins) 

  • Counter-irritant (counter-sensation) theory 

  • Placebo 

  • Reduction of muscle spasm

• Muscle re-education 

• Muscle strengthening 

• Reduce edema

• Reduce muscle guarding

200

WHAT DOES TENS STAND FOR?

Transcutaneous Electrical Nerve Stimulation

300

WHAT DOES NMES STAND FOR?

NEUROMUSCULAR ELECTICAL STIMULATION

400

WHAT IS OUR CLINIC PRESET FOR THE TENS FREQUENCY?

Clinic pre-set:  200 µsec, 120 pps, Continuous

500

ONE CONTRAINDICATION OR PRECUATION FOR ELETRICAL MODALIITES?

• High intensity about the heart 

• Over the carotid sinus 

• In areas of neoplasm or infection may irritate the tissue 

• In individuals who cannot give clear feedback 

• About the trunk of pregnant women 

• In areas of thrombophlebitis (may have DVT’s)

• Patients with pacemakers or other implanted electrodes as it may interfere with their signal 

• Over areas of excess adipose tissue (may not get to muscle and/or levels of stimulation needed may cause ANS response)

• In close proximity to diathermy as they may interfere with each other 

• Caution must be used when treatment is applied in patients with decreased sensation 

• Where active motion is contraindicated (tendon repair, fracture) 

• Seizure disorders (transcerebral) 

• Over open wounds (unless treating the wound)