Physical Modalities in Sports Medicine

nt,’R30-69′); return false; }” xpath=”/CT{06b9ee1beed59419fa2bedb37ace85f4ef50397bb3c2ea48f132154d6696ac7a2f84c1baffad7dc7157c0b06ebf6e33a}/ID(R30-69)” title=”30″ onmouseover=”window.status=this.title; return true;” onmouseout=”window.status=”; return true;”>30).




    General Indications



    • Pain


    • Muscle spasm


    • Contracture


    • Tension myalgia


    • Hematoma resolution


    • Bursitis


    • Tenosynovitis


    • Fibromyalgia


    • Superficial thrombophlebitis


    • Acceleration of metabolic process


    General Contraindications and Precautions



    • Acute inflammation, trauma, or hemorrhage


    • Bleeding dyscrasia


    • Ischemia


    • Insensitivity


    • Atrophic skin


    • Scar tissue


    • Inability to communicate


    • Poor thermal regulation (systemic applications)


    • <DIV span classtion:The process of heat energy transfer between a solid object and a moving gas or liquid.


  • Conversion: The process of energy transfer that involves converting one form of energy to a different form. Use of high-frequency sound waves or electromagnetic (EM) waves to heat tissue will be discussed.


  • Heating modalities are divided into superficial and deep.


  • PHYSIOLOGY OF SUPERFICIAL HEAT



    • Predominant mode of heating is conduction; however, some superficial applications use convection or conversion.


    • Superficial heat effects include vasodilatation, pain relief, reduction of muscle tone and spasticity, increased cellular metabolic activity, decreased joint stiffness, increased soft tissue extensibility, and promotion of hyperemia. Elevation of tissue temperature does not generally exceed 40°C and is usually short lived.


    • Causes superficial vasodilatation preferentially.


    • May be associated with consensual vasodilatation of areas distant to the area being heated; for example, the contralateral limb.


    • Changes of 13-15°C in the finger joint may change joint viscosity by about 20% (93).


    • There is moderate evidence that heat wrap therapy provides short-term pain reduction and disability in patients with acute and subacute low back pain. There is further pain reduction and functional improvement with the addition of exercise (<A onclick="if (window.scroll_to_id) { scroll_to_id(eveslowly decreasing 1/r relationship.
    • Safety: These agents produce erythema (known as erythema ab igne and erythema calor).


  • Chronic use may produce a permanent brownish discoloration.


  • Hydrotherapy



    • Heat tran”P”>Contracture


    • Tension myalgia


    • Hematoma resolution


    • Bursitis


    • Tenosynovitis


    • Fibromyalgia


    • Superficial thrombophlebitis


    • Acceleration of metabolic process


    General Contraindications and Precautions



    • Acute inflammation, trauma, or hemorrhage


    • Bleeding dyscrasia


    • Ischemia


    • Insensitivity


    • Atrophic skin


    • Scar tissue


    • Inability to communicate


    • Poor thermal regulation (systemic applications)


    • Malignancy


    • Edema


    Application Methods


    Hot Packs (Hydrocollator)



    • Transfer of heat energy by conduction


    • Application: Silicate gel in a canvas cover


    • When not in use, these packs are kept in thermostatically controlled water baths at 70-80°C.



    • Used in terry cloth insulating covers or used with towels placed between the pack and the patient for periods of 20-30 minutes.


    • Advantages: Low cost, easy use, long life, and patient acceptance


    • Disadvantages: Difficult to apply to curved surfaces


    • Safety: One should never lie on top on the pack, as it is more likely to cause burns. Towels should be applied between the skin and hydrocollator pack.


    Heat Lamps



    • Heat primarily by the conversion of radiant energy to heat, i.e., the direct application of photons to living tissue leading to heat production.


    • Application: Simple to use but require some attention to avoid injuries or burns.


    • In practice, therapeutic temperatures are usually obtained when the heat sources are about 50 cm from the skin.


    • The intensity of heating of point heat sources, such as incandescent bulbs, drops off in accordance with the inverse squared (1/r2) law; the heating effectiveness of linear sources, such as some quartz lamps, may follow a more nsuming.


    Contrast Baths


    Application



    • Contrast baths consist of two baths: a warm bath at 38-44°C and a cool reservoir at about 10-18°C.


    • Treatment begins by soaking the involved limb in the warm reservoir for about 10 minutes and then progressing to about four cycles of 1- to 4-minute cold and 4- to 6-minute warm soaks (92).


    Advantages/Disadvantages



    • Most commonly used to produce reflex hyperemia and desensitization in patients with complex regional pain syndrome.


    • Athletes may find the cold baths uncomfortable.


    • May increase superficial blood flow and skin temperature; however, no effect on functional outcome (17).


    Spa Therapy (Balneotherapy)



    • Little research has addressed these issues for athletes.


    • In addition, a comparison of the effects of spa therapy, underwater traction, and water jets on low-back pain found no specific benefits attributable to balneotherapy (58).


    Fluidotherapy


    Application



    Contrast Baths



    Advantages/Disadvantages



    • Most commonly used to produce reflex hyperemia and desensitization in patients with complex regional pain syndrome.


    • Athletes may find the cold baths uncomfortable.


    • May increase superficial blood flow and skin temperature; however, no effect on functional outcome (17).


    Spa Therapy (Balneotherapy)



    • Little research has addressed these issues for athletes.


    • In addition, a comparison of the effects of spa therapy, underwater traction, and water jets on low-back pain found no specific benefits attributable to balneotherapy (58).


    Fluidotherapy


    Application



    • Heats by convection: Fine particles fluidized by turbulent, high-velocity hot air, frequently used in hand therapy.


    • Despite widespread use, benefits of this high temperature remain poorly established (3,<A onclick="if (window.scroll_to_id) { scroll_to_id(event,'R16-69'); return false; }" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title=25 class=LK href="#R16-69" name=to-R16-69 xpath="/CT{06b9ee1beed59419fa2bedb3ing heating agent can elevate intramuscular temperatures by about 3.5-4.0°C (25).


    • Penetration is not uniform and depends markedly on tissue properties: Ultrasound beam will selectively heat tissue with high water content.


    • The ability of ultrasound to heat tissue by the conversion of sound energy into heat is its best-understood capability.


    • Nonthermal processes such as cavitation, shock waves, streaming, and mechanical deformation have been identified.


    • Cavitation occurs when small gaseous bubbles are formed in the presence of a high-intensity ultrasound beam and either oscillate stably or grow rapidly in size and collapse (28).


    • No irreversible harmful effects of cavitation have been demonstrated in animal tissue (Treatment: Dipping, immersion, occasionally brushed onto the area of treatment.



    • Safety: Burns are the main safety concern with paraffin treatment.


    • Visual inspection is important: Paraffin bath should have a thin film of white paraffin on its surface or an edging around the reservoir.



    DIATHERMY (DEEP HEATING)



    • The following differences set diathermy apart from superficial heating:



      • Produces higher temperatures


      • Heats tissue faster and heat dissipates more slowly


      • Predominantly uses sound waves or EM energy


    Deep Heating Modalities


    Ultrasound



    • Ultrasound is defined as sound waves at a frequency above the threshold of human hearing (frequencies higher than 20 kHz).


    Heats by Conversion



    • Ultrasound uses sound waves to heat tissues. A wide range of frequencies are potentially useful, but in the United States, most machines operate between 0.8 and 1 MHz.


    • Uses piezoelectric transducers to convert electrical energy into sound.


    Physiology





    • Low-intensity pulse ultrasound eam will selectively heat tissue with high water content.


    • The ability of ultrasound to heat tissue by the conversion of sound energy into heat is its best-understood capability.


    • Nonthermal processes such as cavitation, shock waves, streaming, and mechanical deformation have been identified.


    • Cavitation occurs when small gaseous bubbles are formed in the presence of a high-intensity ultrasound beam and either oscillate stably or grow rapidly in size and collapse (28).


    • No irreversible harmful effects of cavitation have been demonstrated in animal tissue (31).


    • Streaming is described as movements in water-rich tissues and standing waves. Streaming may damage tissue or possibly speed healing.


    • Typical intensity for application is 0.8-1.5 W/cm2.


    • Low-intensity ultrasound (15-400 mW/cm2) may also stimulate cell proliferation, protein synthesis, and cytokine production. Although these findings are limited to the laboratory, they furnish some support for the clinical interest in low-intensity ultrasound in wound healing.


    Premium Wordpress Themes by UFO Themes