Chapter 15: Therapeutic Modalities

Question 1

What are the 4 forms of thermal energy transmission?

Answer 1

Conduction: heating through direct contact, hydroc/paraffin/ice pack/cold pack
Convection: heating indirectly through a medium, hot/cold whirlpools
Radiation: transfer of heat through space from one object to another, shortwave diathermy
Conversion: heating through other forms of energy, balms/shortwave diathermy

Question 2

What are some of the physiological effects of thermotherapy?

Answer 2

Increase extensibility of collagen fibers, decreasing joint pain, reduce pain/inflammatio/edema, relieve mm spasm, increase blood flow

Question 3

What is ischemia?

Answer 3

Lack of blood flow to a body part

Question 4

What is the temperature of the paraffin bath? Hydrocullator? Warm whirl pool?

Answer 4

126-130, 160-170, <104

Question 5

What are the physiological effects of cryotherapy?

Answer 5

Vasoconstriction of the arterioles and venules, numbness, collagen stiffness

Question 6

What is the hunting response?

Answer 6

It causes a slight temperature increase during cooling (vasodilation if 20-30 minutes of cold)

Question 7

What is Raynaud’s phenomenon?

Answer 7

A condition that causes vasospasm of digital arteries lasting minutes to hours and could lead to tissue death. SYS: skin blanching, cyanosis, skin pallor then red, numbness, tingling, burning

Question 8

What is the spray & stretch technique?

Answer 8

Using vapocoolant spray to for treating trigger points & myofascial pain. Stretch the muscle with the trigger point, hold 12cm away, spray the length of the muscle, firmly stretch to tolerance & keep spraying. After the first spray session, warm with a hot pack or vigorous massage.

Question 9

What are the main uses of vapocoolant spray?

Answer 9

Reduce muscle guarding & increase ROM

Question 10

What is cryokinetics? How many minutes of ice/exercise? Should passive exercises me performed?

Answer 10

12-20 minutes of icing, exercise 3-5, ice 3-5, etc…Only active exercises

Question 11

What is the temperature of the cold tub?

Answer 11

50-60 degrees

Question 12

What are the precautions of cryotherapy?

Answer 12

Intensity of the activity should be limited by the nature of the healing process and perceptions of pain.

Question 13

What is Ohm’s Law?

Answer 13

Ohm: resistance of passing an electrical current along a conductor.

V=IR

voltage across a resistor is proportional to the current. OR the current through a conductor between two points is directly proportional to the potential difference across the two points.

Question 14

What is a direct current?

Answer 14

AKA a monophasic or galvanic current. Flows in one direction from the positive pole to the negative pole

Question 15

What is an alternating current?

Answer 15

AKA biphasic…the direction of the current flow reverses once during each cycle…pain & mm contraction. Continuos and bidirectional flow of charged particles – no net charge.

Question 16

What is a pulsatile wave?

Answer 16

AKA Russian…3 or more pulses grouped together, interrupted for short periods then repeat

Question 17

What is the beta-endorphin model of pain control? How does noxious pain control work?

Answer 17

E-stim stimulates sensory nerves to release encephalin from local sites throughout the CNS and the release of B endorphins from the pituitary gland into the cerebrospinal fluid. Pain modulation when applying a current close to the painful site. Point stimulator set as high as tolerable with maximum pulse duration.

Question 18

What are 4 things electrical muscle contraction can be used for?

Answer 18

Muscle pumping contractions, muscle strengthening, muscle reeducation, & retardation of atrophy

Question 19

What is iontophoresis? Dexamethasone? Lidocaine?

Answer 19

Ionto uses electrical current to drive ions into the skin. Dex: antiinflam…Lid: local anesthetic

Question 20

What are the physiological effects of ultrasound?

Answer 20

Stimulates the repair of soft tissue and relieves pain. It is a deep heating modality

Question 21

What is attenuation?

Answer 21

A decrease in intensity as sound enters deeper tissues

Question 22

What is the piezoelectric effect?

Answer 22

Electrical current produced by applying pressure to certain synthetic crystals (quartz)…causes expansion and contraction of the crystals which produces oscillation voltage at the frequency.

Question 23

What is the effective radiating area?

Answer 23

The portion of the surface of the ultrasound transducer that produces the sound wave (energy)

Question 24

What is cavitation?

Answer 24

A nonthermal effect, formation of gas-filled bubbles that expand & compress due to ultrasonically induced pressure changes in tissue fluids. Increases blood flow in area around the bubbles

Question 25

What is Beam Nonuniformity Ratio?

Answer 25

The amount of variability in intensity of the ultrasound beam, lower BNR= more uniform, optimal uniformity of 1:1

Question 26

What is micro-streaming?

Answer 26

Nonthermal effect…unidirectional movement of fluids along cell membrane boundaries from the mechanical pressure wave in ultrasonic field. Can alter cell membrane structure and function

Question 27

What is underwater ultrasound & how far from the body part should the transducer be?

Answer 27

Suggested for irregular body parts…transducer should be 1 inch from the body part.

Question 28

What is phonophoresis?

Answer 28

A method of transporting molecules through the skin with US. Hydrocortisone and anesthetic into tissues ,…helpful for trigger points, tendinitis, bursitis

Question 29

What does LASER stand for?

Answer 29

Light Amplification by Stimulated Emission of Radiation

Question 30

What are some of the physiological effects of laser therapy?

Answer 30

Helium neon (red,2-5mm direct, 10-15mm indirect) or gallium arsenide lasers (invisible, 1-2cm direct, 5cm indirect)… acceleration of collagen synthesis, decrease microorganisms, increase vascularization, reduce pain and inflam, trigger points

Question 31

What is the main therapeutic effect of diathermy?

Answer 31

Temperature increases in deeper tissues, high water content tissues absorb the heat, absorbed by fat

Question 32

What are the main precautions when using diathermy?

Answer 32

Difficult to treat localized body parts, dosage is subjective, towels between applicator and skin, not to be used with metal objects, avoid when hemorrhaging/pregnant/open wounds/contacts, cables and coils can’t touch each other, deep ache may be present

Question 33

What are the 5 types of traction?

Answer 33

Manual-change force, direction, duration and position Mechanical- lumbar/cervical, harness on table Positional- for comfort or tx goal, ex: laying on back with legs and hips flexed Wall-mounted- cervical, plates, sand bags or water bags for weight Inverted- lengthens the spine, gravity pulls trunk weight down

Question 34

What are some physiological effects of traction?

Answer 34

Separate vertebral bodies and stretch ligaments and joints, relieve pressure and pain, stretch muscles, increase and change joint proprioception

Question 35

What are some different forms of compression?

Answer 35

Intermittent, continuous, with cold/ice

Question 36

What are the general treatment parameters when using intermittent compression?

Answer 36

30-50mmHg for upper, 30-60mmHg for lower, thirty minutes reduces edema

Question 37

What are the 5 types of massage?

Answer 37

Effleurage-stroking light and deep, either sedation or encourages venous and lymphatic drainage Pettrissage- loose and heavy kneading, pick up muscles and rolling in opposite direction, loosens adhesions, squeezes congestive materials into general circulation Friction- used where tissue is thin, scars/adhesions/muscle spasms/fascia, stretches underlying tissues develop friction in the area and increase circulation around the joint Tapotement- percussion, hacking, pinching, stimulation to nerves Vibration- quivering or trembling effect, relax and soothe

Question 38

What are some physiological effects of massage?

Answer 38

Increase circulation, increase metabolism to muscles and aid in removing metabolites (lactic acid) helps overcome venostasis and edema, helps with normal venous blood return to the heart

Question 39

Understand the basics of ice massage, ice immersion, and ice packs

Answer 39

massage: used of the belly of the muscle, tendon, bursae ,or myofasical trigger points. small body area. 10 minutes, comfort must be taken into consideration immersion: circumferential cooling is desired. 15 minutes. overcoolig can cause frostbite. allergies? packs: two types - gel and liquid bag within crystals. should use a towel to prevent reaction with skin.

Question 40

What is fluidotherapy?

Answer 40

therapeutic environment with dry heat and forced convection through a suspended airstream. effective in decreasing pain, increasing joint ROM, decreasing muscle guarding, and decreasing swelling. 15-20 minutes

Question 41

Understand basics of moist heat and WWP

Answer 41

moist heat: general relaxation. heat for 20-30 minutes. use towels. doesn't heat deeper muscles, no lying on packs. WWP: massage and water immersion, provides conduction and convention, more body underwater the cooler it should be. should no exceed 20 minutes.

Question 42

What are the 4 types of sensory receptors?

Answer 42

mechanoreceptors: mechanical stress or strain chemoreceptors: chemical stimuli nociceptors: damage or threat of damage to body tissues proprioceptors: sense of position thermoreceptors, osmoreceptors, magnetoreceptors, electroreceptors, photoreceptors

Question 43

What are excitable tissues?

Answer 43

tissue that can undergo rapid change in their membrane potential which is important to transport electrical signals.

Question 44

Difference between cutaneous, deep somatic, visceral, and psychogenic pain

Answer 44

cutaneous: pain caused by the body surface deep somatic: caused by the activation of pain receptors in musculoskeletal tissues visceral: pain we feel when our internal organs are damaged or injured and is by far the most common form of pain psychogenic: pain fro the brain

Question 45

When in the healing process should contrast be used?

Answer 45

works well on chronic pain and stiffness. contrast is best utilized a few days after the initial injury. go back a forth, but ALWAYS end with COLD

Question 46

What are some precautions in using thermotherapy?

Answer 46

pregnancy (avoid abdomen and low back), poo circulation, edema, cardiac insufficiency, areas with metal, open wound, areas where topical counterirritants have recently been applied

Question 47

What is the difference between shortwave and microwave diathermy?

Answer 47

micro has higher frequency and shorter wavelength than shortwave. it generates a strong electrical field and relatively little magnetic field. penetration of shortwave is deeper, but micro has an easier application. micro treats 1 aspect of body while shortwave treats 2. both are used for thermal physiological effects

Question 48

What are the amplitude, peak-to-peak amplitude, phase duration, and pulse duration?

Answer 48

amplitude: measure of its change over a single period peak-to-peak amplitude: difference between the maximum positive and maximum negative amplitudes phase duration: same as pulse duration pulse duration: the time from the beginning of the first phase to the end of the last phase of one pulse, the width of the pulse

Question 49

What is frequency?

Answer 49

The number of waves or pulses per second ... usually measured in Hz.

Question 50

What is impedance?

Answer 50

opposition to the current flow, tissue that resist flow, adipose, bone, tendons, and fascia.

Question 51

What is duty cycle?

Answer 51

Ratio of on time to total cycle time. the higher the duty cycle the more fatiguing the treatment.

Question 52

What is current measured in? resistance? voltage?

Answer 52

current: measured in amperes resistance: measured in ohms voltage: measured in volts

Question 53

What is an asymmetrical current?

Answer 53

changes in amplitude over time. ramp up or ramp down.

Question 54

What are the first order neurons? What are second order? what are third order?

Answer 54

first: they are located in the dorsal root ganglia or the sensory ganglia or cranial nerves. they conduct impulses from cutaneous receptors and proprioreceptors to the brain and spinal cord second: conducts the impulse from the brainstem-spinal cord to the thalamus third: conducts nerve impulses from the thalamus to the primary somatosensory area

Question 55

What are the various neurotrasmitters?

Answer 55

serotonin: active in descending pathways norepinephrine: inhibits pain transmission between first and second order neurons substance P: active in small-diameter primary afferent neurons enkephalins: found in descending patyways B-endorphin: found in the CNS