Therapeutic Modalities Lecture Notes PDF

Therapeutic Modalities Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Therapeutic or physical modalities are agents used to create a therapeutic response in tissues. Modalities can serve as an integral part of a comprehensive treatment plan for any musculoskeletal (MSK) disorder. • pain relief or m...

Therapeutic Modalities Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Therapeutic or physical modalities are agents used to create a therapeutic response in tissues. Modalities can serve as an integral part of a comprehensive treatment plan for any musculoskeletal (MSK) disorder. • pain relief or modulation • reduce inflammation • tissue healing • scar tissue remodeling Goals • skin condition treatment • increase ROM • enhance muscle activation • preservation of strength after injury or surgery • reduction or elimination of oedema MODALITY PRESCRIPTION Patient’s identifying factors (e.g., name, date of birth), diagnosis, Relevant past medical history (PMH) and associated precautions, Specific modality, location, intensity, duration, and frequency of use. These components of therapeutic modalities should be included when prescribed as part of a comprehensive therapeutic prescription. Thermotherapy A common question that will be posed to a clinician treating MSK pain will be whether to use ice or heat at the site of pain. A general rule to apply is that any acute injury (24–72 hours) would benefit from cold applications to decrease inflammation, and pain; while heat would be beneficial to promote extensibility of tissues and to treat chronic pain after the inflammation and pain associated with the initial injury has resolved . This clinical rule is based on expert opinion and the knowledge of the inflammatory cascade that results from tissue injury. Cryotherapy • Are superficial in nature and usually transfer thermal energy via the principle of conduction. • The most common types of cold modalities include • cold packs, ice massage, • cold water immersion, • cryotherapy compression units, • and whirlpool baths. Relative contraindications or precautions for cryotherapy include impaired sensation, Raynaud’s disease and other cryopathies, arterial insufficiency, cognitive or communication deficits, and cold hypersensitivity Monitoring the skin closely with application of cryotherapy is a must, especially in patients who may suffer from sensory deficits. • Heat can be classified by depth of penetration and by form of heat transfer. • Superficial heating modalities include hot packs, heating pads, paraffin baths, fluid therapy, whirlpool baths, and radiant heat. • Deep heating modalities include ultrasound, short wave, and microwave diathermy. • Mechanisms of heat transfer include conduction, convection, radiation, evaporation, and conversion . Caution should be advised when using heat modalities on those with vascular insufficiency or decreased sensation. General precaution for heat therapy must be taken in pregnant, pediatric, and geriatric populations. Also, precaution must be taken when using heat in proximity to metal implants or open wounds. General contraindications for heat therapy include ischemia of the extremity, bleeding disorders, impaired sensation, malignancy, dementia, poor thermal regulation, and acute inflammation Manual therapy • The most simplistic definition of manual therapy is the use of hands to apply a force with a therapeutic intent. • The common uses of manual therapy are to treat a variety of musculoskeletal conditions. • The therapeutic force may be applied using various techniques including manipulations, massage, and traction. • Historically, the origins of manual therapy can be traced back to parallel developments in many different civilizations during ancient times. • The Old Testament was the first to describe it as “the laying of hands” to heal. • Hippocrates (BC 460–385), the father of modern medicine, was the first to describe the use of prone traction to treat scoliosis • Manual therapy expanded and became a cornerstone in the treatment of musculoskeletal disorders through the centuries. Three Paradigms for Manual Therapy Therapeutic Effects • Physiological: A positive placebo response can be produced. • Biomechanical and Physical: Manual therapy facilitates tissue repair and modelling. • Psychological: Manual therapy can reduce pain which improves an individual's psychological state. Cyriax • Approach: a system of examination and intervention that aims to address nonsurgical, soft tissue lesions through the concept of Selective Tissue Tension (STT) testing and differential diagnosis. Frameworks Lewit Manual Therapy • Approach: dysfunctions are viewed as part of a chain of interrelated pathologies. Kaltenborn-Evjenth Manual Therapy • Approach: the concept uses translatory (linear) joint play movements in association with the treatment plane in both assessment and treatment. Maitland Manual Therapy • Approach: Priorities "clinical evidence rather than a given diagnosis Frameworks Mechanical Diagnosis and Therapy (McKenzie Method) • Approach: Use of repeated or sustained movements to decrease and abolish symptoms and return to function. Mulligan Manual Therapy • System of Prescription: Mulligan’s therapy is based on active patient movements combined with passive correction of the joint position held by a physiotherapist. Manual Therapy Application Framework Speed Location within range of motion (ROM) Force direction anatomical and/or biomechanical Relative movement (anatomical or positional) Subject position (both limb and gross)