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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