Therapeutic interventions

• NBS helps you pass your National Board Exams and re-emphasize your understanding of key subject areas
• Physiotherapy induces a physiological response, returning the body to a more normal state of health
• Contraindications for all modalities include hemorrhage, infection with suppuration, and malignancy (except TENS)

Contraindications For All Heating

• Diabetes Mellitus: No local heat!
• Encapsulated swellings are a contraindications for all heating
• Active TB is a contraindications for all heating
• Decreased thermal sensations are a contraindications for all heating
• Edema is contraindications for all heating
• Abdomen or low back during pregnancy are contraindications for all heating
• Acute conditions are contraindications for all heating

Contraindications For All Electrical

• Brain
• Eyes
• Heart
• Carotid Sinuses
• Pacemaker
• Anesthesia (Except HV)
• Pregnancy-low back (Except TENS)
• Open Wounds

Approach For Modalities

• Action Results Indications
• Contraindications
• Penetration (predicts target tissues)
• Dosage / Application / Treatment
• Types
• Wave length and frequency
• Special information

Frequency Picture

Hz, cps, pps

• Ultra Low: less than one, cellular healing
• Low muscles: 1-150, interferential contraction
• Medium Depth: 1,000 - 10,000
• High Chronic: 1 Million Hertz, heating

More About Frequencies

• EMS is low frequency
• Interferential If is 4,000
• HV Low Frequency
• Resistive shortwave is 2,000

Types of Ultrasound

• MENS (Microamps) is an ultra low type of stimulation

Current

• AC, or Biphasic has no polarity
• DC, or Monophasic has polarity

Wave Types

• Symmetrical Sine wave is the best contractor, with no charge left in patient
• Asymmetrical Faradic wave form is sporadic and uneven
• Pulsatile wave forms are Two Sine Waves
• Galvanic wave forms are Make & Break
• High Volt wave forms are Twin Pulsed Peak

Electrical Treatments

Electrothermal: Heat micro-vibration, electrically leads to heat (Joule's Law) Electrochemical: (Ionto & opioids) Iontophoresis is DC current; Opioid freq. 1-10 (endorphins), 70-120 (enkephalins) Electrophysical: (Kinetic) ions push other molecules around shifting Na+/K+ pump resulting in contraction

Treatment Principles

• Increased frequency creates deeper penetration
• Medium frequency decreased skin impedance, best is to use a bigger electrode and increased voltage

Treatment Procedures

• For Pad placement, use motor point, or muscle belly to isolate the muscle, 1 pad
• Either side of the muscle belly, if the muscle is especially weak, use 2 pads
• Pad rule is 1 mA per square inch of pad size, for example with a 3" square pad you would use 9 mA
• Monopolar pad types are for large area or trigger / acupuncture point, dispersal (aka indifferent) = large pad (ground), active pad or pads = small
• Bipolar pad types are for small muscle group, dispersal & active pads are the equal size
• Quadripolar, Crisscross pattern

mA Problem

• If the dispersal pad is too small or active sites are too large, too many mA will result in a Tingle OOPS!
• All EMS have the following diagram, diagram name, and duty cycle options

All EMS Chart

All EMS have the Following Options:

• For the Use of Pain, the diagram is continuous and has N/A duty cycle
• For the Use of Exercise / Rehab, the diagram is a pulse and has 1:3 duty cycle
• For the Use of Fatigue/Spasm, the diagram is pulsed/tetanizing and has 1:1 duty cycle
• Contract agonist, then antagonist = Reciprocating and has N/A as the duty cycle
• Avoids accommodation uses a Modulation diagram and has N/A as a duty cycle
• Packages of stimulation uses a Burst/TENS diagram and has N/A as the duty cycle
• Low Frequency (1-150) PPS Options:
• Pain = 1-20 endorphin, 70-150 enkephalin
• Edema = 3-5
• Exercise = 15-25
• Fatigue ≈ 50
• Increased mA (amps) will increase muscle contraction Electro-induction refers to when charges line up and electrical lines of force are in action, one object produces electromagnetic property in another and Coulomb is measured in charge
• Amp Ampere is the current electricity that flows, which also refers to how the number of electrons flow
• EMF(electromagnetic force) is measured in VOLTS (force behind the electrons) , the difference in force between two objects (whether connected or not)
• Waveform is pulse width interpulse widtli frequency
• Transformer increases or decreases volts
• Capacitance (OHM) is stored up energy
• Resistance is the property of substance to oppose current
• Measured in OHMS, has decreased resistance and increased conduction with shorter path lower temp., increased diameter
• Greater charge increases EMF
• Greater distance decreases EMF
• Impedance slows it down (dampens) via oily skin

Testing

• Strength duration curve (SD curve)
• Chronaxie is the time necessary for contraction when the rheobase is doubled
• Rheobase (threshold) is the minimum volts necessary to excite a nerve
• Reaction of Degeneration (R.D. factor)
• Innervated muscle responds different than denervated muscle
• Galvanic & Faradic current are compared to determine extent of damage & prognosis
• EMG (Electromyography) is used to test muscle best
• NCV (Nerve Conduction Velocity) is used to test nerve best

Laws Of Modalities

• Arndt - Schultz Principle indicates energy of modality must be absorbed by body to stimulate physiological response
• Law of Grotthus-Draper indicates that there is an inverse relationship between penetration and absorption of energy, US

Temperature

• Cool to Cold temperatures results in pumping reactions
• In the Hunting-Lewis Reaction one will experience Cold, Burn, Ache, and then Numbness
• Pumping reaction creates Vasoconstriction, Anesthesia, Vasoconstriction

Treatment Temperatures

• Cold is 55-65 degrees
• Cool is 65-80 degrees
• Tepid is 80-92 degrees
• Neutral Is 92-96 degrees
• Warm is 96-99 degrees
• Hot 99-104 degrees
• Very Hot is 105-115 degrees

Types of Heat Transmission

• Convection: transmission of heat in gases and liquids by circulation of heat particles (Baths (hot & cold), IR) heat liquid → patient
• Radiation: transmission of heat without the intervening medium getting warm (Lamps; MWD, IR, UV ) does not heat air
• Conversion: the conversion of electrical energy into heat or mechanical energy (Ultrasound) changes energy, reverse piezoelectric
• Conduction: the transfer of heat through a substance, often heating up a solid (Ice, hydrocollator, paraffin, IR) heat solid patient does not move

Comparison of Cold and Heat Effects

Heat

• Vasodilation, Increased blood flow (↓B/P) Increased edema, Increased Metabolism, Decreased viscosity Increased ability to stretch, Decreased stiffness, Decreased, Sedate, Decreased muscle spasm Torticollis, tender points (FM) Increased or decreased strength, And Decreased endurance

Cold

• vasoconstriction, Decreased blood flow (↑B/P), Decreased edema, Decreased Metabolism, Increased viscosity Decreased ability to stretch, Decreased, Pain Decreased increased, numb (anesthesia), Increased Decrease skilled motor tasks, Decreased endurance

Cryotherapy

• Action effects are hypothermal and local primary which effect vascular, neuro, increase pain tolerance
• Secondary effects increase viscosity of the blood, decrease cell, metabolism, joint stiffness
• Indications of its use are headaches (migraine), urticaria (red wheals), spasticity (trigger point) MFS, sprain / strain
• Angiomas, warts & herpes
• Contraindications of its use are elderly & infants, hypersensitive to cold, vascular diseases (Raynaud's), high blood pressure Chilblains & frostbite, tension headaches and Spasm, FM Cryotherapy has superficial penetration, dosage is every 20 minutes, each two waking hours

Cryotherapy Types

• Ice packs (moist towel layer increases ice permeability), 20, conduct
• Blue ice (dry towel layer, reusable), 20, conduct
• Vapocoolant spray fluori-methane / ethyl chloride, 5
• 18-24", angle spray, spray one direction, nozzle adjusts
• Ice massage (direct ice has deepest effect, must move), 0-20, conduct
• Ice immersion, Convect, 0-20
• Cryokinetics (ice first, activity second), 0-20, conduct
• Ice massage and passive range of motion, 0-20

Contrast Bath

• With cryotherapy, Hunting-Lewis (pumping) is vasoconstriction & vasodilation and takes under 20min

Infrared Action

• It is thermal and results in vasodilation, perspire, decreased B/P
• It increases blood and lymph flow, decreases spasm and increases phagocytosis
• Erythema is redness or mottled skin and Erythema Ab igne is mottled skin in area habitually exposed or one prolonged exposure
• Musculoskeletal uses are for synovitis, tenosynovitis, sprains, strains, bursitis, arthritis, torticollis
• Catarrhal for bronchitis, sinusitis, laryngitis, coryza
• Infectious for furuncles, burns, ulcer
• Other folliculitis, conjunctivitis, neuritis, Bell's Palsy, Raynaud's
• For general uses it reduces redness of skin, improves skin and muscle time elasticity, it stimulates metabolism and increases red blood cell production

Infrared Contraindications

• To heat in pregnant people or ones with diabetes mellitus or thermal sensitivity
• To heat active TB, for encapsulated swelling, over metal and for fair skin patients with contacts and a fever
• To heat patients with an active skin rash or with a recent scar

Short Wave versus Long Wave Infrared

Short Wave Lamps

• uses distance from 14 18 inches
• includes the types of Luminous, Wire bound around porcelain and Sunlight Heliotherapy
• has a penetration of 10 mm
• intensity of 150-1500 Watts
• uses a wavelength of 7,200 15,000 nm (2,000-4,000)
• has a high frequency, and will take between 10-30 minutes

Long Wave Baths

• uses direct contact with towel - layers
• types are Hydrocollator, heating pad, hot water bottle, baths, fluidotherapy
• has a penetration of 1-3 mm
• has varies intensity
• uses a wavelength of 15,000-150,000 nm (7,000-9,000)
• has a high frequency, and will take between 10-30 minutes

Hydrocollator

• Actions of Hydrocollator are that it uses moist heat to decrease blood viscosity at six towel layers
• The superficial penetration degree lasts for Approximately 20-30 minutes and ranges at 150-170 degrees F.
• Made of canvas, filled with silica gel
• Indications include tension headaches and as a prepare to adjustments, as well as for fibromyalgia and spasm

Hydrocollator Contraindications

• One should avoid use of Hydrocollator for patients with active conditions or recent scars with fair skin
• Myofascial syndrome (MFS), trigger points (TrP) and decrease circulation are also a contraindication

Contrast Bath Types

• Action is Thermal and Results in Vasoconstriction / Vasodilation, using a pumping action
• Application for patients with acute injuries is that it must use caution as it has little to no benefit

Contrast Bath Procedures

1. Hot bath 10 minutes (98 104 degrees F)
2. Cold bath - minute (080-65 degrees F)
3. Hot bath 4 minutes
4. Cold bath takes minute

Continue this cycle for 20-30 minutes, and end with effect you recommend or patient desires

• Subacute connective tissue injuries, bruises, early PVD's, Raynaud's, Buerger's, DM.

Contrast Bath Contraindications

• Contraindications are Anesthesia, advanced arterial compromise and late PVD's(Peripheral Vascular Disease) The temperature of Hydrocollator ranges between 150-170degrees Temperature for Paraffin ranges between 125-130 degrees
• Fluidotherapy has temperatures from 115-120 degrees
• The temperature of a Sitz Bath is normally 105-115 degrees
• A Whirlpool normally is 100-105 degrees
• The temperature of a Contrast bath normally ranges at 98-104degree

Whirlpool Bath Type

• Relaxes, vasodilates, debridement burns & abrasions A Hubbard Tank requires a stainless steel

General Temperature Rules

• Hubbard tank temperatures can range around 100-105 degrees, can vary by patient
• the duration can take from 20-30 minutes (approximately for 2 times a day)
• Used for people with burns but Contraindications in an Increases B/P, or vascular compromised patients

Sitz Bath Type

• Has a Temperature of 105 to 115 degrees F for 2-10 minutes indications
• indications for use on Hemorrhoids, cystitis or dysmenorrhea, to people with coccydynia and prostatitis, and post-partum and Urinary retention

Paraffin Bath

• 125 to 130 degrees F
• 20 minutes for the treatment time
• Apply treat times (usually 7 to 10) and wrap 20 minutes with active exercise, Ratio of 7:1; Paraffin: mineral oil

Perafin Bath Contraindications

• This is contraindicated for acute arthritis and vascular compromise Dry Whirlpool - dry heat - is use a solid cellulose suspended in concealed air chamber with wind Fluidotherapy is a Micro-massage therapy to stimulate thermals
• Results are Relaxation, vasodilator, sedation at a temperature of 115- 120 degrees over a course of 15-20 minutes
• Can treat Chronic arthritis, amputee, strains, for increasing ROM and RSDS, and dystonia as well has open wounds

Laser

• Uses Photobiomodulation with intracellular stimulation of mitochondrial activity
• Has results that indicate photobiostimulation, helping with wound heel and photobioinhibition, which helps with pain management
• Used for decrease swelling from sprains and/or contusions
• Indications include Open lesions, decubitus ulcers, DM ulcers or lacerations, burns, and acute & chronic pain, but can also treat bursitis & tendinitis

Laser Treatment

• Decreases ROM, or for Tic Douloureux irritation or to treat fibromyalgia
• Tattoos, open growth plates, over the eyes, pregnant uterus, photosensitivity

Laser Contraindications

• Infections, dry skin, bruising, malignancies, pace maker, thyroid are all contraindications
• Wave length is (absorbs test into body and does not go to skin surface) at 630-1200 nm Superficial but causes a waterfall effect

Laser Usage

• Doctor uses optic fiber with a probe tip placed directly (or a few millimeters away)

Laser Definition

• LASER = light amplification by stimulated emission of radiation,
• And it is a photo-physiological effect, and it is protein coagulation and is irreversible
• It's also used for neuropathy, failed back surgery, spinal stenosis, plantar fasciitis, and carpal tunnel(still controversial)

Ultraviolet Action

• It is thermal, photochemical, germicidal and antifungal
• Results in vasodilation (with bacteriocidal, phototaxis) erythema

UV Effects

• Releases Histamine (erythema ab igne), increases vitamin D synthesis which increases in calcium
• It also generally improves or increases skin and muscle tone elasticity and function

UV Indications

• Fungal, herpes, zoster (vesicles), burn, carcinomas, rickets and decubitus ulcers

UV Contraindications

• Never treat Vascular disease, suppurative lesions, hemorrhage, tetracycline or SLE

UV Treatment

• 30-36 inches from Lamp uncover holes after at least three months of use, the UV light rays strength will begin to diminish
• Increase duration to a max of three minutes if the lamp if close for 18, if not after 30inches after about 12 month begin diminishing power
• One might use hot quartz-mercury-helium gases, a Kromayer and cold quartz to treat cervicitis depending on each device's specifications

Diathermy

• Diathermy treatments on individuals must be 4 feet from hearing aids, bridge work, etc

Short Wave Diathermy (SWD)

_SWD (outside - in) GENERAL

• For Deep muscle, thoracic cavity, bronchitis, joints, PID, prostatitis Amenorrhea, otitis media

Microwave Diathermy MWD (inside - out) LOCAL

• Diathermy for Deep muscle, joints, PID, prostatitis, otitis externa, best for hip conditions

Diathermy Contraindications

• Do not use Diathermy on Pregnant women, or patients with casts, or metal implants, pacemakers or contacts

Actions and Purposes for Diathermy

• SWD = induction (eddy currents) with Diathermy for outside patients
• MWD Diathermy best heats after use of towel, the heat that will affect skin, and open epiphysis

Ultrasound Diathermy

• Indications include joint and musculoskeletal inflammation and herpes zoster(root)
• Thermal ( hyperemia, increased alkalosis and leukocytosis glands will increase)
• Over spinal cord, fractures and acute infections menstruating uterus and laminctomy and the vascular disease with decreased sensation

All About Ultrasound

• Action or affects are Thermal, mechanical, chemical, physiological or neural
• Always necessary and always use a circular motion
• Couplings should consider the surface or uneven surface of the skin that is being treated
• Remember the bucket best or use the bladder because they will always get over the bony area

Low Power Electrostim (Low Volt)

• Indicated for the polar effects of iontophoresis in connective tissue "itis", disease, or injuries Contraindications:
• Sensory impairment, recent scar tissue, open wound, pregnancy (LBP), pacemaker For electrochemical and electrokinetic uses Anode is (+) and repels positive ions, cathode is (-) and repels negative ions Also electrodiagnosis and denervated muscle

Soluble and Insoluble Ions for Electrostim

Positive Pole Repels Metals

• Magnesium edema, IVD, DJD, arthritis, neuritis, PNE
• Calcium adhesions, capsulitis
• Copper fungus
• Zinc ulcers, gyn., derm
• Histamine PVD, spasm
• Hyaluronidase post-trauma swelling
• Potassium strains
• Xylocaine painful ROM

Negative Pole Repels Non-metals

• Salicylate pain, inflammation, arthritis
• Iodine scars, adhesions
• Chloride adhesions & scars
• Acetate calcium deposits, bursitis
• Niacin PVD, arthritis
• PABA Scleroderma
• Novocaine/alcohol strains
• Hesperidin ecchymosis

High Volt

• Use direct current or DC with twin pulse M stimulation
• Effects: Electrochemical (opiate,
• Always indicated to reduce edema or Spasms , atrophy
• Never treat pacemaker or during pregnancy

High Volt Modes Continuous Reciprocal Surge on /off

Sinusoidal Faradic Action

• Muscle contraction, stretches, hyperemia, decongests with lymphatic fluid
• Contraindicated wht muscle cant contract SINUSOIDAL to treat UMN Faradic to treat

1. Muscle tense
2. Nerve
3. Weakness
4. Reaction for degenerations

TENS Milliamperage Effects and Contraindications Effects

• Pain vs propioception Melzack, walls controls pain, contraction
• Biphasic ( AC / DC
• Contraindicated hemorrhage or pregnancy

Micro current MENS for primary treatments on healing as it reverses the flow, stimulates protien and DNA With no contraction Low

Interference Current Types Vectoring = in motor Scan = to increase muscles Electrokinetic. analgesic and decrease edema

• Two sine waves of medium frequency creates endogenous polyphasic beat wave

Myofascial types Definition from neurological disturbance Always Restore circulation is essential

Biofeedback and body info

Gait Analysis terms stance as a position to be understood 6 long lateral and 2 fingers down

Friction of powder Is good for adhesions Kinetic types are good for all cases Is good for venous flow and edema

All Traction Reduce pressure on the nerves, fatiguing all muscles and spasms with increase of fluids

Traction Types Minimum to max And continuous to days or weeks

Plyometric Types Jump for 20 times and speed increase Ball works excellent

Exercise Rules Unloaded to loading and full arc The more load the more oxygen loss

General rules Use balance to make the core more efficient Breathing is also top for rehab exercises And posture can also bring joints and muscles work

Thoracic and low back exercises There's always the bird test to do The low back position increases a certain degree.

Lower Back pain

WEAKER abds are caused during hyer

WEAKER psas causes hip flexions NOTE: you want to always to flex the hip to to fix it. Good flex and ex actions And it's always an internal Good action for cat cow also internal with the exercise The body chain should flex over it Hams or Quads for tightness issues

Elbow and hand

Lase with teres minor or subscap

Lower extremity joint problems

Knee terrible triad MML ACL UCL ACL to blood Joint joint Joint locks in traction MCMURRYS is reduction

Calf Pain can be both vein and muscle that must not occur

Foot Arch joints and flat feet are arch problems.

Neck Condition scm or over joint is the problem with forward leanings. Also use the joint of the deepness back. These include SCM with masseters with trap with diaphragm with subscapulars.

Test Questions

• If patients take certain medications, these will always be problematic with muscle issues.
• So, determine that the weakness of the area and choose to use to test to get.
• Look to strengthen and help your muscles to be helped to work.

This lesson explores scenarios for therapeutic interventions. It covers when local heat is contraindicated, suitable modalities for chronic conditions, percentage values to consider, and suggestions for patients with specific conditions. Additionally, it identifies when a Sitz bath is appropriate.