TREATMENTS AND MODALITIES
TREATMENTS AND MODALITIES
Cryotherapy: Cryotherapy is the application of cold in order to gain a therapeutic effect. The desired effect is a decrease in local circulation, cellular metabolism, and tissue temperature which helps to decrease swelling. It is used in the acute stages of the healing process immediately following injury. A secondary effect of cold application is analgesia which results in a decrease in pain sensations.
RICE (Rest, Ice, Compression, Elevation) is most often used method for inflammation control. These four steps serve to protect the body part from further injury and keep post-injury swelling decreased. RICE should be used in the first 24-48 hours after injury.
ICE BAG: Ice bags should only contain enough ice to cover the injured part with one or two layers of ice. All the air should be squeezed out of the bag so that the ice can “lay flat” over the area. The ice bag can then be “wrapped on” with an ace wrap or suran wrap in order to provide compression as well as cold. Ice bags for acute injuries should be left on for 20 minutes. Treatment protocols will vary depending on the extent of injury. Most often RICE treatments call for ice bags to be 20 min on and 40 min off, repeated as much as possible for the 24-48 hours after injury.
Indications: first aid, decrease inflammatory response, decrease pain
Contraindications: cold hypersensitivity, Raynaud ’s phenomenon, cardiac disorders, impaired circulation
Precautions: cold directly over a superficial nerve, wound healing, impaired sensation, don’t leave on too long
Some people are very sensitive to cold. Cold is most effective if applied intermittently. Ice bags should not be left on longer than 30 minutes. Most studies indicate no advantage to icing longer than 30 minutes. After 30 minutes, the body has adapted to the cold and circulation begins to return to normal even if the cold is still applied. Therefore it is better to allow the body to re-warm (with compression applied), so that subsequent cold applications will reduce local circulation again when applied later.
CRYOCUFF: Used for acute injuries when inflammation control is desired. The cryocuff gives compression, some degree of immobilization, does not leak (student-athlete can use in class or anywhere), and a knee cryocuff can be worn all the time inside an immobilizer.
Application:
-add water and ice to appropriate line in cooler
-shake cooler briefly to chill the water
-apply cuff and secure velcro straps
-connect the cooler tube to the cuff
-open top valve on cooler and raise cooler as high as possible
-allow cuff to fill completely (cuff should be firm to the touch)
-unclip tube form cuff
-30 minute treatment time
WHIRLPOOL:
Indications: Sub-acute or chronic inflammatory conditions.
Contraindications: Acute injuries because of the gravity-dependent position of the limb, skin conditions (open wounds, infections)
Precautions:
- whirlpool must be connected to a ground fault interrupter
- do not turn the motor on or off while in water
- keep student-athlete in view during entire treatment
- do not run the whirlpool when it is empty
1. Cold whirlpool - used whenever cryotherapy is desired for a large body area or an irregular area that is difficult to ice. The additional massaging action is helpful for reducing swelling in sub-acute conditions.
Normal cold sensations will be: 1-3 minutes intense cold, 3-7 minutes aching pain and burning feeling, 7+ minutes numbness.
2. Warm whirlpool - used whenever thermotherapy is desired. Helpful when used before therapeutic massage, and helps to increase ROM of affected joint.
Temperatures:
Cold 55(-65( F, Warm 100(-104( F, Hot 104(-110(
ICE CUP:
Application:
The ice cup is "massaged" over the affected body part for the desired treatment time (15 min). Treatment is usually followed by some form of stretching (cryostretch) or rehabilitation (cryokinetics).
CRYOSTRETCH: Used for reducing the pain muscle spasm cycle and for increasing ROM in a strained muscle or tendon.
- Active cyrostretch (student-athlete stretches on own)
a.) Apply ice directly to the skin over the painful area while stretching the body part for 15 min.
b.) Stretch hold 30 seconds.
c.) Relax for 10 seconds.
d.) Repeat above until at least 5 stretches are completed.
Keep all stretching within comfort. Once you reach you maximum pain-free stretch, hold motionless in position for 30 seconds. Do not bounce.
- Assisted cryostretch: The steps (a-d above) are the same, except that a partner will be passively stretching the student-athlete.
Communication is the key to assisted cryostretch. It is critical to keep talking with the student-athlete to be certain the stretching is comfortable, but not painful.
CRYOKINETICS (cryo = cold and kinetics = therapeutic exercise)
Indications: Used in treatment/rehabilitation to exercise and re-educate the injured body part.
Contraindications: Normal cold contraindications. Student-athlete should never perform any exercises which increase pain.
Application:
-15 minutes - cryotherapy treatment (i.e., ice bag, ice cup, cold whirlpool)
-exercise 3-5 min. or until student-athlete begins to feel discomfort. When the student-athlete feels any pain in the affected part, exercise level should decrease to pain-free level for the duration of the 3-5 minute period. If no activity can be performed pain free, the student-athlete may stretch or simply bear weight.
Normally cryokinetic sessions in the early stages of rehab should end on a cold application to prevent any swelling and to help reduce any inflammation caused from exercising the body part. In later stages, end on the exercise period.
Movement Pattern Progressions
The student-athlete must move from basic movement to advanced patterns in a systematic fashion. Begin with the most basic pattern and increase the difficulty by varying the movement pattern and the speed of movement. Advanced movement patterns should mimic sport specific patterns as much as possible. At no time should the student-athlete complain of pain or limp through any of the movements.
Movement Pattern Speed of Movement
non-weight bearing walking
partial weight bearing jogging
standing, weight shifting 1/2 speed
walking forward 3/4 speed
walking backward sprinting
figure eight's
side stepping
carioca's (crossover step)
zig zag
pivoting
skipping
hopping
360's
HOT HYDROCOLLATOR PACK
Moist Hot Packs are filled with a silicone gel that holds heat efficiently. These are stored in water heated to approximately 160 degrees F.
Indications: Subacute or chronic injuries to increase local blood flow, reduce pain and spasm, help improve ROM. (Use of a hydrocollator pack immediately before ultrasound may improve the effectiveness of the ultrasound in heating deep tissues).
Contraindications: Acute injury or inflammation, impaired circulation or sensation, infection, sensitivity to heat.
Application: Remove the hot pack from the water with tongs. Place in the hot pack cover. Place layers of towels on the site to be heated and place the hot pack cover over the towels. Treatment time is 15-20 minutes.
The student-athlete should not lie on top of the hot pack since body weight may accelerate the rate of heat transfer and cause burns. The hot pack should feel warm and not HOT.
ELECTRICAL MUSCLE STIM, ULTRASOUND, COMBO
Indications:
muscle spasm
scar tissue
neuroma
trigger areas
warts
spasticity
post acute reduction of myositis ossificans
chronic inflammatory conditions
Contraindications:
acute conditions
ischemic areas
eyes, heart, skull, genitals
pregnancy
cancer
spinal cord or large nerve plexus
anesthetic areas
over fracture/stress fx site before healing is complete
active infection
areas of impaired circulation
Therapeutic ultrasound is produced by electrical energy flowing through a piezoelectric crystal, housed in a transducer head, to be converted into mechanical energy. Crystals produce positive and negative electrical charges when they contract or expand. It is through the piezoelectric effect (vibrations of the crystal) that ultrasound waves are produced.
TECHNIQUES OF APPLICATION
-use small, circular pattern to cover area being treated
-use coupling agent on the skin (ultrasound lotion or gel)
-always keep the sound head in contact with the skin at all times
-if the surface is irregular and/or the patient cannot tolerate the pressure of the sound head, then submerge the body part in water and hold the sound head 1" away from the body part and increase US intensity.
TREATMENT TIME: 5-10 minutes depending on size of body part.
Electrical Muscle Stimulation
Types: premod, interferential, biphasic, russian
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