Introduction - SportsEngine



Introduction

Treatment Goals

• P! control

o Acute – localized, protective, 2o injury

o Chronic – >6mo p injury…central sensit.

o Referred – MUST assess well to use mods.

o Gating – epicritic ( gate ( proto. inhib.

o Endorphin release 2o EStim, stress, Ex.

• Edema control

o Vasocontrxn, ( vasc. perm., compress.

• Tissue healing

o Ca2+ channels ( activity ( ( rxn rate

o Stages

▪ Inflam – 6d, 4 “-ors”, vasodilation

▪ Prolif – 20d, fibroblasts & revascularization

▪ Matur – p9d, collagen organized, scar strength

• Muscle contraction

o nn. stimulation, ( strength, mm. tone

• Alter tissue extensibility

• Enhance drug delivery

o Iontophoresis, phonophoresis

Compression

Effects

• ( fluid in limb

o Venous, lymph., keep in vessels, “milk” back to (

o Use elevation as adjunct

• Control tissue size/shape

• ( temp 2o insulation

Indications

• Edema control

o Venous insuff. (ulcers), lymphedema, trauma

• DVT prevention

o Intermittent/sequential pump OR stockings

• Residual limb shaping for prosthetic fit

• ( excess scarring

o Collagenase stimulation & local hypoxia

o Silicone, stocking/sleeve/glove/vest/mask

Contraindications & Precautions

• Local malignancy OR infection

• aa. insuf., blocked vessels., CHF

• Fragile skin

• For compression pumps ALSO…

o Acute trauma/Fx, ( sensory, HTN, CVA

Adverse Effects

• Numbing, fluid overload, distal edema

Procedures

• Pumps – max P < dBP (2-3hr/1-2x/2-7d)

• Wraps – distal to proximal…no open areas

• Garments – (low) DVT, scar, vv insuf., lymphed., resid limb (high)

Traction

Effects

• Jt. Distraction – 50%BW for L/S…7%BW for C/S

• ( disc protrusion (NOT ant., large, calcify, low force)

• Stretch soft tiss – mod load, long time

• Relax mm. – esp. paraspin.

• Jt. Mobilization – high soft tiss., low/intermit. Capsule

• Immobilization – short term…low load, long time

Indications

• Disc bulge, nn. root impinge

• Paraspinal spasm

• Jt. Hypomobility (generalized)

• Subacute Jt. inflam. – intermittent to ( P! & edema

Contraindications & Precautions

• Fx, instability, s/p surgery, sequestrated disc

• fat > bone > metal

• Conduction – heat from warm ( cold 2o dir. Contact

o Rate depends on SA, conduct., temp dif, thickness

• Convection – conduction but w/ circulating medium

o Hydrotherapy, fluidotherapy

• Conversion – non-thermal energy ( heat

o Ultrasound, diathermy

• Radiation – heat transfer w/o medium or contact

o Infrared

o Rate depends on intens., source size, distance, angle

• Evaporation – fluid vaporized by heat absorption

o Sweat, spray & stretch

Effects of heating (irreversible damage >45oC)

• Vasodilation

o ( O2, nutrients, waste removal, edema, inflame.

o Smooth mm relax, (SNS activity

• Neuromuscular

o ( spasm, strength for 30min

o (nn cond., P! threshold, strength from 30min-2hr

• Metabolic

o ( rate of healing, O2 input, inflammation

• Connective Tissue

o ( extensibility (plasticity from 40-44oC)

Indications

• Increase ROM…decrease stiffness

• Decrease P! (gate & ( ischemia)

• Decrease mm spasm

• Increase healing rate

• For skin, scars, superficial mm & jt

Contraindications & Precautions

• Acute injury/inflammation

• ( circulation or ( insufficiency

• Hemorrhage, thrombosis

• ( sensory or mentation

• Local CA, pregnancy, metal, topical agents

• For whirlpool

o Maceration, bleed, infection, skin graft

• For full body immersion

o ( instab., infection, epilepsy, respir.prob., MS

Adverse Effects

• Burn (temp, duration, sensitivity)

• Faintin

• Bleeds

• For whirlpool

o (edema

• For full body immersion

o Drowning, burns, fainting, infection, (edema

Thermotherapy Types

• Hot pack – inspect skin…6-8 layers

• Paraffin – dip wrap, dip immerse, pain…~20min

• Fluidotherapy – corn blower…~20min +/- manual Tx

• Hydrotherapy – whirlpool or full body immersion

Infrared Therapy

Background Information

• Radiation lamp w/ 3 (’s (A, B, C)

• Temperature – power, (, distance, angle, skin color

Contraindications & Precautions

• See superficial heating modalities

LASER Therapy

Laser Background

• Monochromatic – single wavelength

• Coherent – all have same path

• Directional – doesn’t spread out

NONlaser Background (LED or SLD)

• Wider beam, larger area

• Multi-frequency, less energy, more superficial

• Lower cost

General Information

• Absorption – density, color, (, f, angle, power

o Shallow & wounds – 3-4mm, visible red

o Deep – 30-40mm, infrared

• High energy ( great effective depth

Effects

• ( ATP prod., tissue repair

• Immune stimulation

• P! control (serotonin & endorphins)

• Vasodilation (N2O)

Indications

• Carpal tunnel, tendonitis (4-8J/cm2 ( 3/5 contrxn

NMES programs

• Strengthening & Endurance

o 60% MVIC…comfort f…10:50…15reps

o (3+/5…35pps…4:12…30-60’ on time

• Facilitation / Re-education – bombard CNS w/ info

o (3+/5…35pps…trigger or 4:12…10-30’/2-3x/day

o (3+/5…35pps…trigger or comfy…10-30’/1-2x/day

• ROM / Contracture management

o 3+/5…35pps…4:12 or ( spas…60-90 / 200 reps

• Spasticity management

o Recip Inhib – ( 3+/5…35pps…4:12…good 20-30’

o Rens Inhib – 3+/5…35pps…4:12…good 20-30’

• Edema management – mm pump (can do bucket Tx)

o 1-3/5…35pps w/ 4:12 or 1-2pps w/ cont…frequent

• Shoulder subluxation – p CVA

o 12-20pps…4:12…30’x3 ( 6-8hrs/day

o 20(12pps…4:12(24:2…6-8hrs/day

Electroanalgesia

• Acute – gating (2mo)

o For P!

▪ 1-5pps…250-300(sec…motor…45-60min

o For spasm

▪ 35pps…>100(sec…motor…cycled…30-60min

• Noxious for chronic (>6mo) / phantom P!

o 1-5pps…500(sec…noxious…8-12pts 15-30sec

Iontophoresis

• Screen for allergies & EStim contraindications

• Effectiveness

o # ions transferred

▪ Current density, duration, intensity, [ions], skin resistance

o Depth of penetration – 3-20mm

o Don’t want ions to become inactive

o Don’t want ions picked up by capillaries

• Main ions used

o Dexamethasone (+ or –)…anti-inflammatory

o Lidocaine (+)…analgesia

• Current considerations

o Density greater w/ smaller electrodes

o Caustic reaction at cathode (–)

o (65mAmin dose for efficacy

o Adjust current SLOWLY!!!

Wound Healing (50-60% ( closure rate)

• For DM or SCI Pts

• ( O2, fibroblasts

• Current of Injury

• Low intensity DC or high voltage

o DC…100(sec… ................
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