Physical Therapy

THERMOTHERAPY (HEAT THERAPY)

Heat is used to reduce inflammation in subacute and chronic injuries. In the subacute and chronic stages of injury, ischemia and irritation occur from certain chemical mediators. Heat promotes drainage of these chemicals into the venous and lymphatic vessels through vasodilation. It also encourages tissue healing by increasing local circulation, which increases ROM of joints. Before heat can be beneficial, however, the active acute process of inflammation must be over.

Indications	Contraindication
Subacute or chronic inflammatory conditions	Acute injuries
Subacute or chronic muscle spasm	Impaired circulation
Decreased ROM	Poor thermal regulation
Hematoma resolution	Areas with decreased sensation
Reduction of joint contractures	Neoplasms

THERAPEUTIC SUPERFICIAL HEAT

Superficial heating modalities must be able to increase the skin temperature to between 104 and 113 degrees. Transfer of heat to underlying structures is limited to less than 2 cm and occurs by conduction. Indicated in subacute and chronic stages of injury. Avoid heat during an active inflammatory cycle. This will increase the rate of cellular metabolism and accelerate the amount of hypoxic injury. Superficial heat modalities include heat packs, paraffin baths, warm whirlpool.

Whirlpool

Mechanical agitation, which relaxes and massages muscles. Kinetic whirlpool combines whirlpool with ROM exercises. Can be used with ulcers that do not involve bone; Abx may be added to the water. Indications include chronic posttraumatic conditions, nerve injuries, painful stumps, decubitus ulcers, postsurgical rehabilitation, arthritis.

Contrast Baths

Although contrast baths involve both hot and cold, the effects are that of a heat modality. Effectiveness is due to reflex hyperemia (hunting effect or response). Particularly good for stimulating circulation, reducing muscle fatigue, edema, and is useful in treating RSD.

Technique

Fill two baths, one with hot water and one with cold water (ice water).

Feet are placed alternately in each for about 1 minute.

Always start and end with cold.

Paraffin wax

Dip foot 6 to 10 times for several seconds and then wrap in plastic and a towel and let sit for 20 to 30 minutes. Good for sprains, strains, and arthritic conditions.

DEEP HEAT

Indications	Contraindications
Chronic posttraumatic conditions	Metal implants
Nerve injuries	Pacemakers
Painful stumps
Decubitus ulcers
Postsurgical rehab
Arthritis

Ultrasound

Therapeutic ultrasound is a deep heating modality that uses a mechanical vibration in the form of sound waves to heat local tissues. There are other benefits to ultrasound besides deep heating, including breaking up adhesions and scars, increased tissue relaxation, and increased local blood flow.

Ultrasound machines have an option of continuous or pulsed sound waves. Continuous US produces both thermal and mechanical effects, while pulsed US produces only mechanical effects. Pulsed US is used in situations such
as a fresh injury with acute inflammation where a heating effect is not desirable.

Ultrasound machines work by a process called the piezoelectric effect. When you apply an electric field to certain crystals, they begin to vibrate, generating ultrasonic sound waves.

Ultrasound does not propagate through air; so a coupling medium is required. The coupling medium must have a low attenuation coefficient, meaning it does not absorb sound, such as US gel or water.

Indications	Contraindications
Edema	Areas with embolism
Pain	Anesthetized skin
Adhesions/scar tissue	Epiphyseal areas in children
	Bony prominences
	Vascular disease (DVT, atherosclerosis, hemorrages)
	Acute infection
	Around metal implants, malignancies
	Patients with pacemakers