Modalities test 1

• electromagnetic
• acoustic
• thermal
• mechanical

inverse or reciprocal

• directly proportional
• higher frequency=higher energy

• (infrared)
• Red
• Orange
• Yellow
• Green
• Blue
• Violet
• (ultraviolet)

• Electrical stimulating currents
• commercial radio and TV
• shortwave diathermy
• microwave diathermy
• Infrared
• visible light
• ultraviolet
• ionizing radiation

shortwave diathermy

longer wavelength=greater penetration

no changes or reactions can occur in the tissues unless the amount of energy absorbed is sufficient to stimulate the absorbing tissues

if the energy is not absorbed it must be transmitted to the deeper tissues

the smaller the angle between the propagating radiation and the right angle, the less radiation reflected and the greater absoption

the intensity of the radiation striking a surface varies inversely with the square of the distance from the source

• can be shortwave or microwave
• high frequency electromagnetic energy
• used primarily to generate heat in tissue (continuous)
• can also produce non-thermal effects (pulse)

• Light Amplification by Stimulated Emission of Radiation
• produces no thermal effects
• promotes fracture healing
• effective for pain management

• physiologic effects that are chemical in nature
• effects occur entirely in cutaneous layers of skin (very supeficial)
• maximum depth of penetration=1mm

• modulate pain
• produce muscle contraction and relaxation
• facilitate soft-tissue and bone healing
• produce net ion movement

• pressure waves due to mechanical vibrations of particles at cellular level
• Cannot travel through space

• "deep heating" modality
• mechanical vibration
• depth of penetration is much greater than with electromagnetic radiations
• also produce non-thermal effects capable of enhancing healing at the cellular level

• Treats soft-tissue and bone injuries
• Pulsed high-pressure short duration sound waves
• treats: plantar fasciitis, epicondylitis, non-union fractures
• Expensive and is often inaccessible for clinicians

stored by an object and has the potential to be created when that object is stretched, bent or squeezed

Energy of motion

occur from trauma or overuse

• Result of trauma, produce immediate pain and disability
• Ex: fractures, dislocations, subluxations, sprains, strains and contusions

• Often called overuse injuries- result of repetitive loading or incorrect mechanics
• Ex: tendinitis, tenosynovitis, bursitis

Inflammatory or hypoxia resulting from primary injury

• Inflammatory-Response Phase
• Fibroblastic-Repair Phase
• Maturation-Remodeling Phase

• redness
• swelling
• tenderness to touch
• increased temperature
• loss of function

• Sx: swelling, pain, warmth, and creptius
• Injury is walled-off
• Sets stage for fibroblastic-repair phase
• Lasts 2-4 days after initial injury

• Histamine: vasodilation & increased cell permeability
• Leucotaxin: margination (leukocytes line cell wall) and increased cell permeability-> forming exudate
• Necrosin: turns on phagocytes

• initially- vasoconstrict
• then vasodilate

• occurs when acute response does not eliminate injuring agent
• Damage occurs to connective tissue resulting in necrosis and fibrosis --> prolongs healing process
• No specific time frame for transition of acute to chronic inflammation

Proliferative, regenerative activity leading to a period of scar formation (fibroplasia) and repair of injured tissue

• Begins within the first few hours following injury
• Signs of inflammation subside
• Pain with movement that stresses injured area
• May last 4-6 weeks

• occurs at day 6 or 7 of fibroblastic repair phase
• Deposited randomly throughout the scar
• Tensile strength increases proportionally to collagen synthesis
• Mature scar is devoid of physiologic function
• Less tensile strength and not well vascularized

• Realignment of collagen fibers along lines of tensile force
• Ongoing breakdown/synthesis of collagen
• May require several years to complete

Extent of injury, Edema, Hemorrhage, Poor vascular supply, Separation of tissue, Muscle spasm, Atrophy, Corticosteroids, Keloids and hypertrophic scars, Infection, Humidity/climate, Age/health

• Controlling edema
• Modulating pain
• Facilitating healing

• Decreases metabolism to control secondary hypoxic injury
• Analgesia (numb/pain reducer)
• Possibly cause vasoconstriction
• Avoid cold bath and gravity dependent position during initial healing

• Cold
• Electrical stimulating currents (avoid generating muscle contractions- may increase clotting time)

• Low power LASER
• Low intensity ultrasound (non-thermal)

• Intermittent compression
• Incorporate active and passive ROM exercise

• When swelling ceases, can go from cold-> heat
• Intermittent compression
• Electrical stimulating currents
• ROM and strengthening exercises

• Heating modalities are beneficial
• Deep-heating modalities (ultrasound, shortwave and microwave diathermy used to increase circulation to deeper tissues)
• Superficial heating modalities are less effective

Bone and soft tissue will respond to the physical demands placed on them causing them to remodel along lines of tensile force

• Acute
• Chronic
• Persistent
• Referred
• Radiating
• Sclerotomic (pain associated with a segment of bone innervated by a spinal segment that is a deep somatic pain)

Line 10 cm long, put line where pain is

used to establish spatial properties of pain

78 words that describe pain are grouped into 20 sets and divided into 4 categories

64 question, self-report tool used to assess functional impairment associated with pain

Rate pain 1-10

"to control acute pain and protect patient from further injury while encouraging progressive exercise in a supervised environment"

Decline in generator potential and reduction of frequency that occurs with prolonged or repetitive stimulus

nerve fibers transmit impulses from the sensory receptors toward the brain

such as motor neurons transmit impulses from the brain toward the periphery

(primary afferents) transmit impulses from the sensory receptor to the dorsal horn of the spinal cord

• Aα - large diameter afferent
• Aβ - large diameter afferent
• Aδ - small, slower (acute pain)
• C - small, slower (chronic pain)

• carry sensory messages up the spinal cord to the brain
• categorized as wide dynamic rang or nociceptive specific

• Substance P (prostaglandin) leukotrines released following injury
• Sensitizes nociceptors by lowering depolarization threshold
• Referred to as primary hyperalgesia= enhances pain response
• Secondary hyperalgesia occurs as chemicals spread, increasing size of painful area

project to sensory cortex or other centers in CNS

• Gate control theory
• Descending mechanism (central biasing)
• Release of endrogenous opoids (β- endorphin)

• use of non-nociceptive stimulus to inhibit pain
• Information from ascending Aβ afferents blocks transmission of pain messages carried along Aδ and C afferent fibers from entering dorsal horn

• Theorized that pervious experiences, emotions, sensory perception could influence transmission and perception of pain
• Pain reduction pathway involves dorsal lateral projection from cells in PAG

• stimulation of Aδ and C afferents can stimulate release of endogenous opoid
• β-endorphin released into blood from anterior pituitary gland
• Dynorphin released from periaqueductal grey

• Stimulate large-diameter afferent fibers
• Decrease pain fiber transmission velocity
• Stimulate small-diameter afferent fibers and descending pain control mechanisms
• Stimulate release of endogenous opioids through prolonged small diameter fiber stimulation with TENS