Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Physical Medicine and Rehabilitation 14 Physical Agent Modalities 1 PPT-Powerpoint Presentations and lecture notes
Physical Agent Modalities
Definition
n Modalities are physical agents that are used to produce
therapeutic responses in tissue.
- Cold
- Heat
- Sound
- Electromagnetic waves
- Electric currents
- Water
n Adjunctive treatments rather than primary cure.
Cold ( Cryotherapy )
Physiological Effects
n Hemodynamic
? Immediate cutaneous vasoconstriction
? Delayed reactive vasodilatation
? Decreased acute inflammation
n Neuromuscular
? Slowing of conduction velocity
? Increased maximal isometric strength
? Decreased muscle fatigue
? Temporarily reduced spasticity
Physiological Effects
n Joint and connective tissue
? Increased joint stiffness
? Decreased tendon extendibility
? Decreased col agenase activity
n Miscellaneous (acute conditions)
? Decreased pain
? General relaxation
General uses of cryotherapy
n Acute musculoskeletal conditions (sprains, strains, tendinitis,
tenosynovitis, bursitis, capsulitis, etc)
n Myofascial pain
n Fol owing certain orthopedic surgeries
n Component of spasticity management
n Emergency treatment of minor burns
General precautions for use of cold
n Cold intolerance
n Cryotherapy induced neurapraxia/ axonotmesis
n Arterial insufficiency
n Impaired sensation
n Cognitive or communication deficits that preclude
reporting of pain.
n Cryopathies
n Cryoglobulinemia
n Paroxysmal cold hemoglobinuria
n Cold hypersensitivity
n Raynaud's disease/ phenmenon
Cryotherapy agents
1. Cold packs
- Hydrocol ator packs: Cooled in freezer to -12? C
and applied over a moist towel.
- Ice packs: Easily used at home and best applied
with elastic bandage or tape.
n
Duration 20 to 30 min.
n
skin is cooled immediately,
n
sc tissue within mins &
n
muscle at depth of 2 cm cooled by 5? C after 20 min.
Cryotherapy agents
2. Ice massage
n
The direct application of ice to skin using gentle
stroking motions
n
Combines therapeutic effects of cooling with
mechanical effects of massage
n
Water is frozen in a paper cup, with ice being exposed
by tearing the top rim of paper off as the ice melts.
n
Used for localized symptoms and applied for 5 to 10
min per site.
Cryotherapy agents
3. Cryotherapy compression units
n Cuff or boot through which cold water is circulated
and can be pneumatically compressed statically or
serially
n distal to proximal pumping action.
n Combine beneficial effects of cryotherapy with
advantages of pneumatic compression.
n Used primarily after acute musculoskeletal injury with
soft tissue swelling, and after some surgical
procedures.
n Typical temperatures of 7.2? C and pressures up to
60 mm Hg are used.
Cryotherapy agents
4. Cold water immersion
n
Best suited for circumferential cooling of the limbs,
localised burns
n
5 - 13? C.
n
Often uncomfortable and poorly tolerated
HEAT
Physiological effects
Hemodynamic
- Increased blood flow
- Increased edema
- Increased bleeding
- Increased acute inflammation
- Decreased chronic inflammation
Neuromuscular
- Increased nerve conduction velocity
Physiological effects
Joint &connective tissue
- Increased tendon extensibility
- Increased col agenase activity
- Decreased joint stiffness
Miscel aneous (chronic conditions)
- Decreased pain
- General relaxation
General uses of heat
1. Musculoskeletal conditions (tendinitis, tenosynovitis,
bursitis, capsulitis, etc)
2. Pain (neck, low back, myofascial, neuromas,
postherpetic neuralgia, etc)
3. Arthritis
4. Contracture
5. Muscle relaxation
6. Chronic inflammation
General precautions for use of heat
n Acute trauma, inflammation
n Impaired circulation
n Bleeding diatheses
n Edema
n Large scars
n Impaired sensation
n Malignancy
n Cognitive or communication deficit that preclude reporting of
pain.
Classification of various types of
heating
SUPERFICIAL HEAT
1. Hot packs and heating pads (conduction)
2. Paraffin wax baths (conduction)
3. Fluidotherapy (convection)
4. Whirlpool bath (convection)
5. Radiant heat (radiation)
DEEP HEAT
6. Ultrasound (conversion)
7. Shortwave diathermy (conversion)
8. Microwave diathermy (conversion)
Superficial heat
n
Superficial heating agents achieve their maximum tissue
temperature in skin and subcutaneous fat.
n
Deeper tissue heating is limited by vasodilatation and insulating
fat.
n
Used in OA, RA, neck pain, LBP, muscle pain syndromes, and
variety of musculoskeletal conditions.
Superficial heat
1. Hot packs
n Commercial y available hot packs (Hydrocol ator packs) contain
silicon dioxide encased in canvas pack.
n They are immersed in tanks at 74.5 C and applied over several
layers of insulating towels.
n Total treatment time is usual y 30 min.
n In addition to general heat precautions, patient should not lie on
the packs.
n They are among the more common causes of burn in physical
modalities
Superficial heat
2. Heating pads
n Two types :
1) electric heating pads (control heat output by regulating current
flow)
2) circulating fluid pads (control heat output thermostatical y)
n Peak temperature of nearly 52? C achieved with electric heating pad
set on lowest setting.
n In case of electric heating pads, potential of electric shock with moist
toweling.
n Patient should not lie on heating pad, as it can lead to burns (Of
particular concern in slender or cachectic patients)
Superficial heat
3. Paraffin wax bath
n
Paraffin wax: Mineral - 6:1 or 7:1.
n
52.2? C to 54.4? C
n
Methods of application are:
1) Dipping: 7 to 12 dips fol owed by wrapping in plastic and
towels or insulated mitts,
2) Immersion: Several dips to form a thin glove of paraffin
fol owed by immersion for 30 min. Produces greatest quantity and
duration of temperature increase.
3) Brushing: brushing on several coats of paraffin, fol owed by
covering with towels.
- More cumbersome.
- Improves treatment compliance in children.
- Useful for areas difficult to immerse.
n
Open wounds and infected areas should be avoided.
Superficial heat
4. Radiant heat
n
Luminous infrared heat lamps emit radiation in the near ?infrared
spectrum (wavelength 770 to 1500 nm) and non-luminous infrared
lamps emit radiation in the far infrared spectrum (wavelength 1500 to
12500 nm)
n
Infrared radiation produces heating by inducing molecular vibration.
n
Preferable in patients who cannot tolerate the weight of hot packs.
n
Caveats for radiant heat use: General heat precautions, light sensitivity,
skin drying and dermal photoaging.
Deep Heat (Diathermy)
n Deep heat or diathermy, unlike superficial heat, affects the target
tissues like muscle, tendon, ligament, bone without significant
heating of skin and subcutaneous tissue.
n Therapeutic target temperature ranges from 40? C to 45? C.
Deep Heat
1. Ultraound
n >20,000 Hz.
n Reverse piezoelectric effect.
n Most commonly clinically used frequencies are in
the range of 0.8 to 1.1 MHz, although up to 3.0 MHz
are used.
n Ultrasonic energy is absorbed by the tissues ( esp. at
interface) and is ultimately converted into heat via
molecular vibrations, a phenomenon of conversion.
Deep Heat
n A coupling agent is used to prevent reflection of
greater fraction of acoustic
n Commonly used are: Degassed water, mineral oils,
encased silicon gel commercially available coupling
gels .
n Temperatures of upto 46 C are achieved in deep
tissues.
n Duration is generally 5 to 10 min per site
n Ideal for very deep heating e.g hip joint, in such cases
superior to shortwave and microwave diathermy.
Deep Heat
Precautions for Ultrasound
1. General heat precautions
2. Near brain, eye, reproductive organs
3. Gravid or menstruating uterus
4. Near pacemaker near spine, laminectomy sites
5. Malignancy
6. Skeletal immaturity
7. Arthroplasties
8. Methyle methacrylate or high density polyethylene
Other Modalities
2. Phonophoresis
n
Standard ultrasonic coupling gel is mixed with various
chemical substances to produce phonophoresis
coupling agent.
n
Local analgesic gels, corticosteroids
n
Anti-inflammatory effects of ultrasonic and
corticosteroids act synergistically.
Deep Heat
3. Shortwave diathermy
n
Oscillation of high frequency electrical and magnetic
fields produces movement of ions, rotation of polar
molecules and distortion of non-polar molecules,
resulting in heat generation.
n
Most commonly used frequency is 27.12 MHz &
treatment time is 20-30 min
n
Heating produced depends on type of shortwave unit,
and on the water content and electrical properties of
tissues.
Deep Heat
n Precautions:
- General heat precautions
- Metal (jewelry, IUD's, surgical implants, deep brain stimulator
and pacemaker which is absolute contraindication).
- Contact lenses (Potential for focal heating).
- Gravid or menstruating uterus
- Skeletal immaturity
Hydrotherapy
n
External application of hot or cold water, in any form, for treatment
of disease.
n
Arthritis and variety of musculoskeletal conditions, and in
cleansing and debridement of burns and other dermal injuries.
Whirlpool baths and Hubbard tanks
n
Typical y used for treatment of a limb or localized lesion.
Hydrotherapy
3. Contrast baths
n
Consists of alternating immersion of the distal limbs
in hot (42 - 45 C) ,then cold (8.5 ? 12.5 C) water.
n
30 min treatment session are typical, beginning with
10 min immersion in hot, followed by alternating
immersions of 1 min cold and 4 min hot, ending
with cold immersion.
n
Especially suited for rheumatological disease,
neuropathic pain, other chronic pain syndromes like
complex regional pain syndrome.
Other Modalities
Interferential current therapy (IFT)
n
Periodic interference of two AC signals of slightly
different frequency, results in a new wave with cyclic
modulation of amplitude, due to cyclic constructive and
destructive interferencere.
n
IFT machines typically uses medium frequency
currents of 4000 ? 5000 Hz.
n
Most machines use 2,4 or 6 applicators, which can be
arranged in same plane (planar) as in lumbar area or in
different planes (coplanar) as in the shoulder.
n
Useful in variety of musculoskeletal conditions,
neurological conditions and management of urinary
incontinence.
Other Modalities
n
Precautions :
- near implanted stimulators (pacemakers,
intrathecal pumps, spinal cord stimulators)
- near sympathetic ganglia or carotid sinus
- near open incision or abrasions
- near gravid uterus
- in the presence of venous thrombosis
- near SWD.
Factors to consider in
Modality Selection
1.
Target tissue
2.
Depth of heating/cooling/therapeutic response desired
3.
Intensity of heating or cooling desired
4.
Body habitus ( i.e amount of subcutaneous adipose)
5.
Co-morbid conditions ( e.g. malignancy, vascular disease,
neuropathy ,etc)
6.
Associated pt. specific features ( e.g. metal implants,
pacemaker, cold al ergy etc)
7.
Age (e.g. Open epiphysis)
8.
Sex (e.g. pregnant female)
Thank you
This post was last modified on 08 April 2022