Modalities Exam 2 Notes PDF

Ultrasound What is Ultrasound? - Deep Tissue hearing modality o Able to pass through skin and subcutaneous fat layer - Muscles, tendons, ligaments, join capsules, scar tissue - Non-thermal mechanism- depends on setting/goal of treatment Terminology - Transducer: sound head...

Ultrasound What is Ultrasound? - Deep Tissue hearing modality o Able to pass through skin and subcutaneous fat layer - Muscles, tendons, ligaments, join capsules, scar tissue - Non-thermal mechanism- depends on setting/goal of treatment Terminology - Transducer: sound head - Intensity: power (watts) per unit area = w/cm^2 o Strength of sound waves at a given location within the tissue being treated - Frequency: cycles of compressions per second o 1mHz § More deep tissue o 3mHz § Superficial tissue Transducer - Converts energy into sound waves o Electrical outputà mechanical vibrationsà sound wavesà absorbed into tissue - Different sizes o Based on the size of the treatment area Ultrasound Production - Produced by alternating current that flows through a piezoelectric crystal located in the transducer - Piezoelectric crystal o Crystal changes shape rapidly o Vibrations that produce sound waves Effective Radiating Area - Effective Radiating Area: Area of the transducer from which ultrasound energy radiates o Mainly in the middle - General Rule = treatment area 2x size of the sound head Terminology - Spatial Peak Intensity: Peak intensity of the ultrasound beam - Spatial Average Intensity: average intensity of the ultrasound beam over the ERA o Entire width of the ERA - Beam Nonuniformity Ratio (BNR) = SPI:SPA o The lower the BNR, the more uniform the intensity of the sound wave o Low BNR minimizes risk of “hot spot” Conducting Mediums - Air is poor conductor - What are some good conductors? o Ultrasound gel o Diclofenac  o Water based products Parameter Vocabulary - Duty cycle: pulsed non-thermal effects - Duty Cycle: continuous thermal effects - Frequency o 3mHz = Ultrasound is absorbed more rapidly o 1mHz = Ultrasound is absorbed at a slower rate Thermal US: Physiological Effects - Increased blood flow - Reduction of muscle spasm - Increase extensibility - Increased sensory and motor nerve conduction Thermal Effects: Injury Response - Blood flow o Increase blood flow o Vasodilation may last up 45 minutes after treatment - Tissue Healing o Increase tissue strength o Increase collagen synthesis o Increase fibroblastic activity - Increase tissue elasticity - Increase pain threshold Tissue Temperature Rise - 1*C o Mild heating o Increases metabolic activity - 2-3 *C o Moderate heating o Reduces muscle spasm o Increases blood flow o Reduces chronic inflammation - 4*C o Vigorous heating o Alters elastic properties of collagen - What to consider when calculating parameters? o Frequency o Duration o Intensity TTR Formula 0.2 x ()mHz x ()w/cm^2 = x Time = TTR/x Non-Thermal Ultrasound - Pulsed Ultrasound o Not a lot of evidence  - Effects tissue gealing with cellular activity o Pressure by sound waves increase movement in cell activity o Decrease capillary leakage Contraindications - Acute conditions - Eyes, heart, skull, genitals - Over cancerous tumors - Over spinal cord - Over fracture sites - Active infection - Impaired circulation - Plastic implants - Pelvic/lumbar areas in menstruating females - Pregnancy over pelvic/lumbar areas Ultrasound Applications: Phonophoresis - Using Ultrasound to aid in delivery of medication to local tissues - Medications typically used o Anti-inflammatory o Diclofenac - Advantages of phonophoresis - Skin is a factor o What factors § Tattoos § Wound/cuts § Dryness Adverse Effects of Ultrasound - Minimal if used correctly - Burns due to high frequency application - Cross-contamination o Clean heads after use Manual Therapy What is a Massage? - Manipulation of the body’s tissue - Massage and myofascial release, deep and soft tissue - What does it do o Promotes local and systemic relaxation o Breaks down adhesions o Improves lymphatic and venous return Indications for Massage - Increase venous return - Reduction of edema - Muscle spasm - Stimulates blood flow  - Increase ROM Contraindications - Fracture sites - Skin conditions - Opens wounds - Varicose veins - Cellulitis - Abscess or infections - Phlebitis or thrombophlebitis - 24 hrs after scuba diving Mechanical Effects - Movement o Venous and lymphatic flow o Intestinal contents o Hematoma o Decrease inflammation for acute injuries - Mobilization o Muscle fibers o Tendons o Skin and subcutaneous tissue o Scar tissue o Adhesions o Stretches connective tissue Physiological Effects - Increase skin and muscle blood flow - Increase flow of nutrients and removal of wastes - Stimulation of healing process - Increase relaxation through release of specific hormones - Decrease stress hormones Neurologic Effects - Decrease pain - Decrease muscle spasm or tension to the area Psychological Effects - Increase relaxation - Decrease anxiety - Releases endorphins in the brain to help patient relax and calm down Mediums Used - Mediums are used when performing any soft tissue - Why o Helps to not apply too much pressure and with friction - Types o Massage lotion, cocoa butter, deep-prep - What to check for o Allergies or redness Patient Positioning - Dependent on what? o What area is being treated o What is comfortable for you and the patient Professionalism - Ethical o Personal appearance o Personal hygiene o Avoid inappropriate touching o Avoid unnecessary exposure - Care o Wash hands before and after o Jewelry o Nails Methods of Manual Therapy Techniques - Deep Tissue Massage o Individual deep muscle fibers o Release adhesions o Increase blood flow - Lymphatic Massage o Lymphatic system o Remove edema, waste and toxins from body - Myofascial Release o Breaks adhesions and other restrictions in the body’s fascia - Instrumented Assisted o Use of a tool - Active Release Technique o Deep tissue and myofascial release Effleurage - Stroking of the skin distal to proximal - Performed by using your hands - Effect o Deep o Superficial - Indications o Muscle strains o Improve circulation - Techniques o Strokes directed towards the heart o Utilize thumbs o Point of contact Petrissage - Lifting, kneading, rolling - What does it target?  o More specific areas in a muscle - Frees adhesions by stretching and separating muscle fiber, fascia and scar tissue - Indications o Late stages of healing o Chronic injuries o Multiple muscles at a time o Superficial muscles - Technique o Often used following effleurage or heat application o Using one or two hands grip and lift the underlying muscle and move tissue back and forth Friction - What does friction massage do? o Increases extensibility to the area - Two types o Circular friction o Transverse friction - Can be painful - Why do we use friction? o Extensibility - Follow treatment with stretching or roll out - Indications o Musculotendinous adhesions o Scar tissue o Trigger point o Chronic tendinopathy - Technique o Muscle in relaxed position o Use thumbs to pin the tissue o Light to more firm pressure Neuromuscular - Utilized for the relief of a trigger point - Compression o 30-90 seconds o Not suitable for acute injuries § Active assistance Myofascial Release - Combination of effleurage, petrissage and friction strokes with simultaneous stretching of the muscles and fascia - What does it do? o Lengthen muscle and increase blood flow o Can calm patient down before going to the more aggressive - Indications o Chronic soft tissue malalignment  o Chronic pack pain, shoulder pain, scar tissue and adhesions - Techniques o J-stroke § One hand moving skin to place adhesions on stretch § 2 fingers of other hand stroking in opposite direction of the force forming a “j” o Skin Rolling ‘ § Similar to petrissage except it specifically addresses the fascia instead of the underlying muscle § Roll skin between finger Instrument Assisted Soft Tissue Massage (IASTM) - Used to treat myofascial dysfunctions - Encourages realignment and myofascial restrictions that cause improper tensile forces on musculotendinous attachments - Reduces stress on clinicians hand while increasing the effectiveness of the treatment IASTM - Instruments made of stainless steel with beveled edges and contours - Able to manipulate the skin, fascia, muscles and tendons by various strokes - Edges ad contours of tools help conform to different anatomical locations - Evolved from Chinese method call Gua Sha IASTM: How Does it Work? - Controlled microtrauma o Causes stimulation of local inflammatory response o Initiates healing activities that aid in remodeling o Breaking down adhesions to allow full functional restoration o Treatment time = 5-10 minutes or until petechiae occurs § Petechiae = red splotches on skin Cupping - Manual therapy that uses cups to create a vacuum to the patients skin - Blood is drawn to the surface of the skin to pull toxins from the body Cupping: How Does it Work? - Aids in promoting blood flow - Increase blood circulation to the muscles and tissues - Supplies oxygen to the cells - Aids in realignment (knots) - Release and drain excess fluids and toxins Types of Cups - Glass - Rubber - Silicone - Plastic Cupping: How Does it Work? - Treat affected area  - Cup size and number depends on area - 1.5-2 full pumps - Leave cups on for 10 minutes - Gliding technique Color of Cups Meaning - White o Blood deficiency - Pink o Normal healthy blood circulation - Dark pink o Moderate stagnation - Dark purple o Severe stagnation o Blockage to an area o Tells that it helped and improved blood flow to the area and broke up the adhesions - Pink with purple dots o Congestion and toxins in the area What to Expect for Both IASTM/Cupping - Discomfort during and after - Advise patient redness/marks could last days-weeks - Tender to the touch - Inflammation - Educate patient prior Electrical Stimulation Principles IFC/Premod What is Electrical Current? - Flow of electrons - In order to have current o Source of electrons (voltage) o Material that allows passage of electrons or a conductor o Driving force of electrons (voltage) - Electrons possess a positive and negative charge Vocabulary - Ampere (A) = what current is measured in - Coulomb (C) = What electrical charge is measured in o 1 A = the delivery of 1 C of electrical charge per second - Voltage (V) = how much electrical force is being used - Ohm = what resistance is measured in Alternating Current (AC) - Direction of low changes from positive to negative - Possesses no true positive or negative pole - Basic pattern is sine wave - What can it do?  o Pain stimulation o This can help make the stimulation more comfortable Parameter Vocab - Baseline (horizontal axis) represent time - Phase Duration = time required for each phase to complete its shape - Pulse Duration = the distance the pulse covers on the baseline from beginning of phase to the final phase - Interphase = time between phases of a pulse Time Parameters - Rise time = time it takes current to increase from 0 to its peak - Decay Time = time it takes current to decrease from its peak to zero - On/Off Time = time during which current is on vs off - Duty Cycle = on time vs total time of treatment What does IFC/Premod Do? - Electrical stimulation for pain control decreases an individuals perception of pain - Can you use in conjunction with other modalities to be more effective? o Yes Pain Control: Gate Control Theory - High pulse frequency o Frequency 50-180 pulses per second - Short Pulse Duration o 75-150 microseconds - Intensity o Adjusted to tolerance § Strong but comfortable o Avoid muscle contraction - Sensory Level o Targets A-beta nerves - Acute Pain o Blocks pai receptors which limits pain - Treatment time = 20-30 minutes Pain Control: Endogenous Opiate Theory - Low pulse frequency o Frequency 0-10 pulses - Long phase duration o 300-400 microseconds - Intensity o Adjusted to tolerance o Strong, but comfortable muscle contractions - Motor level o Targets motor nerves - Chronic pain o Releases enkephalin and endorphins to produce opiate effect on pain transmission Tissues - Excitable vs Non-excitable o Excitable § Nerves § Muscle fibers § Directly influenced o Non-excitable § Bone § Cartilage § Tendons § Adipose tissue § Ligaments - Stimulation is more effective on excitable tissue than non-excitable Electrode Leads - Connect the electrodes to the generator - A minimum of 2 lead is required to complete an electrical path - FDA requires that electrode lead wires have a jack that prevents unintended contact between patient and electrical power source Electrodes - Introduce the current to the body from the stimulator via the electrode leads - Types o Carbon o Adhesive - Medium o Reduces resistance o Provides a more even distribution Skin Electrode Resistance - Moisten electrodes with water or conductive gel - Remove dirt, oil or flaky skin with alcohol - Remove excess hair Electrode Size - Current density = voltage per unit area - Smaller electrodes have higher current density - Larger electrodes produce stronger, more comfortable contractions - What does electrode size usually depend on? o Area that is being treated Electrode Placement - Proximity of electrodes influence the tissues that are stimulated, the depth of the stimulation and the number of parallel circuits - The closer together the electrodes the shallower the depth - The farther apart the electrodes the deep the depth Electrode Placement: IFC - Quadripolar technique o Use of sets of electrodes both on its own channel  o The current from each channel intersects one another, intensifying and localizing the treatment effects Electrode Placement: Premod - Bipolar technique o AC o Both electrodes located in target treatment area o Equal amount of stimulation occurs under each electrode o If one electrode is placed over stimulation point and the other isn’t the treatment will be weighted over the stimulation point What is IFC? - Uses 2 alternating currents on 2 sperate channels o Ch. 1/2 o Ch. ¾ - Both channels produce sine waves o One channel = constant high frequency o One channel = variable frequency - The currents meet in the body to produce an interference wave with a frequency of 1-299Hz IFC: Constructive Interference - Equal wavelength and phases - Phases cross the baseline at the same point - Amplitude of the combines wave is equal to the sum of its two parts IFC: Destructive Interference - The phases aren’t in sync - The positive peak of the first waveform occurs at the same point on the horizontal baselines as the negative peak of the second wave - Wave intensity is zero - Example o Cant feel it at all o Can feel it on one side but not the other What is Premod? - Bipolar current - Waveform produced by one channel that has the same form as an interferential wave Premod Pad Placement - Place pads at the insertion and origin - Dependent on what you want to target, size of the individual, what pain theory you want to use Contraindications for Electrical Stimulation - Malignancy - Where the electrodes are could affect reflex centers - Over pacemakers - Pregnancy - DVT - Over reproductive organs - Localized infections