Therapeutic Modalities

Preface vi
User’s Guide viii
Reviewers xii
Forward xiii
PART I: IN PERSPECTIVE
1 THERAPEUTIC MODALITIES: WHA T THEY
ARE AND WHY THEY ARE USED 2
Defining and Classifying Therapeutic Modalities 3
Maximizing the Effectiveness of Therapeutic
Modalities 4
Selecting a Therapeutic Modality 5
Rehabilitation and Therapeutic Modalities 5
A Systems Approach to Rehabilitation 7
The Psychology of Rehabilitation 16
Preparation for Using Therapeutic Modalities 16
2 EVIDENCE-BASED PRACTICE 20
Evidence-Based Medicine 21
Patient-Centered Care 36
Clinical Decision Making 36
3 GENERAL APPLICATION
PROCEDURES 44
Application Approaches 45
The Five-Step Application Procedure 46
4 INJURY RECORD KEEPING 50
Record Keeping 51
The Purpose of Keeping Records 51
Using Records and Forms 52
Record Use and Abuse 56
Review Questions 58
PART II: ORTHOPEDIC INJURY,
IMMEDIATE CARE, AND HEALING
5 TISSUE RESPONSE TO INJURY:
INFLAMMATION, SWELLING, AND
EDEMA 62
An Acute Orthopedic Injury Model 69
Secondary Injury 71
Swelling: Hemorrhaging and Edema 72
6 IMMEDIATE CARE OF ACUTE
ORTHOPEDIC INJURIES 78
RICES: The Prescription for Immediate Care 79
The Theoretical Basis for RICES 81
The Physics and Physiology of Cryotherapy 86
Cryotherapy Application Principles 91
Compression Application Principles 99
Contraindications and Precautions to RICES 100
Electrical Stimulation During Immediate Care 101
Application of RICES 102
The Use of Crutches 104
Medicated Ice for Abrasions 106
7 THE HEALING PROCESS 112
The Repair of Injured Tissue 113
The Phases of Repair 113
Healing Modifiers 117
Review Questions 121
PART III: PAIN AND ORTHOPEDIC
INJURIES
8 UNDERSTANDING PAIN AND ITS
RELA TIONSHIP TO INJURY 124
What Is Pain? 125
Pain Basics: The Language of Pain 126
Theories About Pain 134
Drugs, Endogenous Chemicals, and Pain
Relief 137
Pain Perception 138
Postgate Pain Theories 140
More Language of Pain: T ypes/Classification 142
Pain Management 144
9 RELIEVING ORTHOPEDIC INJURY
PAIN 150
The Philosophy and Principles of Pain Relief 151
CONTENTSThe Placebo Effect and Pain Relief 154
Use a Variety of Techniques 155
Tools for Relieving Pain 155
Monitoring and Assessing Pain Relief During
Rehabilitation 159
Review Questions 165
PART IV: THERAPEUTIC HEAT AND
COLD
10 PRINCIPLES OF HEAT FOR
THERMOTHERAPY 168
Defining Thermotherapy 169
Transferring Heat to and From the Body 169
The Therapeutic Use of Heat 172
Radiation and Electromagnetic Waves 173
Thermal Effects of Electromagnetic Waves 176
Applying Radiation 176
Acoustic Waves 178
1 1 SUPERFICIAL THERMOTHERAPY
APPLICATION 180
Superficial Thermotherapy 181
Whirlpool Application 182
Hot Pack Application 185
Paraffin Bath Application 189
Do Not Apply Infrared Lamps 191
Other Superficial Heating Devices 191
12 CRYOTHERAPY BEYOND IMMEDIATE
CARE 196
Cryotherapy: Not Just Immediate Care 197
The Physiological Effects of Cold Application 199
Cold-Induced Vasodilation: Facts and Fallacies 201
Heat vs Cold: When and Why 210
Cryotherapeutic Techniques for Transition and
Subacute Care 211
Recovery Cryotherapy 213
Comparing Heat and Cold for Rehabilitation 214
13 CRYOTHERAPY APPLICATION FOR
POSTIMMEDIATE CARE 220
Transition and Subacute Care Cryotherapy
Techniques 221
Application of Cryokinetics for Joint Sprains 223
Application of Cryostretch for Muscle Injuries 229
Application of Combined Cryostretch and
Application of Connective Tissue Stretch 231
Application of Lymphedema Pumps 233
14 THERAPEUTIC ULTRASOUND 236
Introducing Therapeutic Ultrasound 237
Clinical Therapeutic Ultrasound 238
Components of an Ultrasound Device 238
The Physics of Ultrasound 239
Treatment Parameters 245
Application Techniques 249
Recording Treatment Dosages 252
Thermal Effects 253
Nonthermal Effects 253
Evidence for Therapeutic Ultrasound 254
Cases Where Ultrasound and Joint Mobilizations Were
Used to Restore Full ROM in Severe Injuries 258
Phonophoresis 261
Using Ultrasound and Other Modalities
Collectively 262
Treatment Precautions and Concerns 263
Long Duration Ultrasound 264
The Future of Ultrasound Therapy 266
Challenges to the Efficacy of Therapeutic
Ultrasound 267
Application of Therapeutic Ultrasound 268
15 DIATHERMY 275
Introducing Diathermy 276
T ypes of Diathermy 276
Continuous and Pulsed Shortwave Diathermy 279
Physiological Effects of Diathermy 281
Optimal Tissue Temperatures 282
Treatment Time 282
Clinical Applications of Shortwave Diathermy 283
Diathermy Treatment Contraindications and
Precautions 287
Evidence for Diathermy 288
Advantages of PSWD Over Ultrasound 289
Application of Diathermy 290
Review Questions 294
PART V: ELECTROTHERAPY
16 PRINCIPLES OF ELECTRICITY FOR
ELECTROTHERAPY 300
A Common Language 301
The Basics of Electricity 301
Electrical Equipment 304Output Current Characteristics 308
Tissue Responses to Electrical Stimulation 312
Therapeutic Uses of Electrical Stimulation 318
17 APPLICATION PROCEDURES:
ELECTROTHERAPY 322
Electrotherapy Applications: An Overview 323
Transcutaneous Electrical Nerve Stimulation for Pain
Relief 325
Application of Transcutaneous Electrical Nerve
Stimulation 326
Interferential Current Therapy for Pain Relief 329
Application of Interferential Current Therapy 332
Neuromuscular Electrical Stimulation 335
Application of Neuromuscular Electrical
Stimulation 337
Patterned Electrical Nerve Stimulation 340
Application of Patterned Electrical Nerve
Stimulation 342
Iontophoresis for Transdermal Drug Delivery 344
Benefits of Iontophoresis 344
An Iontophoresis Lab to Produce Numbness 347
Application of Iontophoresis for Transcutaneous
Drug Delivery 348
High-Volt Pulsed Current Stimulation for Wound
Healing 350
Application of High-Volt Pulsed Current
Stimulation 353
Microcurrent Electrical Nerve Stimulation 355
Review Questions 361
PART VI: MANUAL MODALITIES
18 THERAPEUTIC MASSAGE 364
Massage as a Therapeutic Modality 365
Massage Therapy: What Is It? 365
Facts and Misconceptions About Massage 366
Indications and Contraindications 367
Therapeutic Massage vs a Rubdown 368
Common Massage Strokes Used in Basic (Swedish)
Massage 368
Myofascial Release 371
Sports Massage 374
Massage Lubricants 374
Application of Therapeutic Massage 375
19 SPINAL TRACTION 380
Cervical Pain and Lumbar Pain 381
Traction as a Therapeutic Modality 382
The Physiological Effects of Traction 382
Guidelines Prior to Applying Traction 383
Indications for Traction 383
Contraindications for Traction 383
Commonly Used Traction Devices 384
Cervical Traction 384
Lumbar Traction 385
Treatment Parameters 389
Application of Spinal Traction 391
20 POSITIONAL RELEASE THERAPY 396
Introducing Positional Release Therapy 397
Defining Tender Points and Trigger Points 398
Tissue Assessment and Documentation 399
Strain Counterstrain vs Positional Release Therapy 401
Speicher and Draper’s Top 10 Positional Release
Therapy Techniques 404
Summary 410
Application of Positional Release Therapy 410
Review Questions 414
PART VII: OTHER MODALITIES
21 PHOTOBIOMODULATION (LIGHT AND
LASER) THERAPY 418
Photobiomodulation 419
The Nature of Light 419
Photobiomodulation Treatment Parameters 421
Photobiomodulation Therapy 423
Effects of Photobiomodulation 426
Application of Photobiomodulation 429
22 NITROGEN VAPOR
CRYOTHERAPY 433
Review of Cryotherapy’s Physiological
Effects 434
What Is Nitrogen Vapor Cryotherapy? 434
Introduction to Whole- and Partial-Body
Cryotherapy 434
Local Liquid Nitrogen Vapor Cryotherapy 437
Evidence for Whole-Body , Partial-Body , and Local
Cryotherapy 440
Three Cases Where the Partial-Body Cryotherapy Has
Been Beneficial 440
Application of Whole- and Partial-Body
Cryotherapy 441
Application of Local Nitrogen Vapor 23 PULSED ELECTROMAGNETIC FIELD
THERAPY 445
Introduction to Pulse Electromagnetic Field
Therapy 446
Physiological Effects of PEMF 446
Evidence for PEMF Therapy 447
Indications for PEMF 448
Contraindications 448
Precautions 448
Application of PEMF 449
Five Cases of Patients That Used PEMF
Therapy 451
Application of the PEMF 452
Conclusion 453
Review Questions 456
PART VIII: PUTTING IT ALL
TOGETHER
24 DIFFERENTIAL APPLICATION OF
THERAPEUTIC MODALITIES 460
Differential Application of Modalities 461
Limiting Factors to Therapeutic Modality Use 466
25 CASE STUDIES USING THERAPEUTIC
MODALITIES 471
Clinical Case Studies 472
Possible Treatment Regimens 474
Review Questions 478
Appendix A: Answers to Review Questions 479
Glossary 481
Index 503