Physical agents unit 1

  1. Stage 1 of injury
    • Protection phase
    • 2-4 days post injury
    • Acute/inflammatory phase
    • Physiological effects
    • -Vasoconstriction or vasodilation
    • -hemostasis/clot formation
    • -Cell mediated phagocytosis
  2. Stage ll of injury
    • Repair phase
    • 6 weeks or greater
    • Sub-acute/proliferation phase
    • Physiological effect
    • -Epithelialization
    • -Collagen production
    • -Closure/contraction
    • -Revascularization
  3. Stage ll of injury
    • Late phase
    • Between 6 weeks and 3 months
    • Chronic/maturation phase
    • Physiological effects
    • -Collagen balance -- synthesis/lysis
    • -Collagen remodeling
  4. Physiological responses to cryotherapy
    • Decrease blood flow/tissue metabolism
    • Increase threshold for pain perception
    • Decreased blood flow/increased viscosity
    • Decreased inflammation, pain, local metabolism
    • Decreased intramuscular pressure
  5. Physiological responses to thermotherapy
    • Facilitate tissue healing/relaxation
    • Decrease spasms/pain
    • Increase blood flow/tissue extensibility
    • Increase metabolic rate
    • Decreased viscosity and joint stiffness
    • Decreased nerve conduction velocity
    • Slight increase in muscle performance (short duration) or significant decrease (long duration)
  6. Physiological effects of electrotherapy
    • Strengthening/relaxing mu
    • Decrease pain/edema
    • Neuromuscular reeducation
    • Increase tissue and wound healing
  7. Physiological effects of compression
    • Decrease edema
    • Modeling scar tissue
  8. Physiological effects of traction
    Decrease compression on structures
  9. Effects of massage
    • Modulate pain
    • Edema reduction
    • Stretching and loosening of adhesions
    • Muscle relaxation
    • Sedation
    • Increased venous and lymphatic flow
  10. Effleurage
    • Strokes that glide
    • Spreads lube and introduces touch
    • Begins and ends; transitions
    • For the frail, terminally ill, neonates, and infants
    • Facilitates circulation
    • Reduces lower motor neuron excitability and pain perception
  11. Petrissage
    • Firm pressure that mobilizes
    • Kneading, picking up, wringing, skin rolling
    • Mobilizes skin, subcutaneous, and deep muscle tissue
  12. Tapotement
    • Striking to stimulate
    • Stimulates tissue mechanically or by reflex action
    • Cupping, beating, hacking, pounding
  13. Friction
    • Deep compression of tissue
    • Small, localized, penetrating; performed in a circular or transverse direction
    • Mobilize adhesions or treat chronic inflammation
  14. Vibration
    Shake, tremor
  15. Contraindications to massage
    • Acute inflammation
    • Severe varicose veins
    • Phlebitis
    • Areas of recent surgery
    • Thrombophlebitis
    • Cardiac arrhythmia
    • Malignancy
    • Severe rheumatoid arthritis
    • Hemorrhage in area
    • Edema secondary to kidney disfunction
    • Heart failure
    • Venous insufficiency
    • Hypersensitivity
  16. Massage precautions
    • Endangerment sites
    • Abnormal sensation; increased or decreased
    • Diminished skin, joint integrity
    • Debilitated patient
    • Areas with excessive body hair
  17. Effects of myofascial release techniques
    • Increase blood flow, histamine release and temp
    • Decrease heart rate, RR and BP
    • Increase flexibility, decrease NM excitability, edema reduction, and stretch of muscle and scar tissue
    • Reduce anxiety, depression, and mental stress
    • Activate spinal gait and release of endogenous opiates
  18. Myofasical release
    • Stoking and stretching of tissues
    • -Relax tense tissues
    • -Release adhered tissues
    • -Restore tissue mobility
  19. Stretch-cross hand release
    • Myofascial release
    • Heal of one hand in area of restriction; heal of other hand crossed in front
    • Stretch using slow, deep pressure
    • Reduces superficial and deep adhesions
  20. J-strokes
    • Myofascial release
    • One hand places the adhesions on stretch; other hands 2nd and 3rd fingers stroke in opposite direction forming a J
    • Mobilize scar tissue
  21. Neuromuscular effects of heat therapy
    • Increased nerve conduction velocity in normal nerves
    • Decreased firing rate of alpha motor neurons
    • -Relaxation of muscle spasm and contraction
    • Increased pain threshold
    • -via spinal gating mechanism
    • -Sedation of sensory nerve endings with mild heat
    • Decreased muscle strength in first 30 min post application
    • -Increase in strength 2 hours post treatment
  22. Conduction
    • atoms/molecules passed from one object to another
    • Heat transfer from a warmer to a cooler object
  23. Convection
    • Bulk movement of liquid/gas molecules that transfers heat
    • Heat transfer by movement of air or fluid from a warmer area to a cooler area
  24. Radiation
    Heat from a warmer to a cooler object by transmission of electromagnetic energy without heating of an intervening medium
  25. Thermotherapy contraindications and precautions
    • Lack of thermal sensation
    • Vascular insufficiency/disease
    • Areas of recent/potential hemmorage
    • Areas of malignancy
    • Areas of acute inflammation or infection
    • Recently applied liniments or heat rubs
    • Unreliable situations (eg language barriers)
  26. Hydrotherapy effects
    • Decreased weight-bearing
    • Resistance for strengthening
    • Increased venous circulation
    • Increased cardiac volume
    • Increased cardiac output
    • Decreased heart rate and blood pressure response to exercise
    • Decreased vital capacity
    • Increased work of breathing
    • Decreased likelihood of exercise-induced asthma
    • Relaxing or invigorating depending on temp and activity
  27. Aquatic pool therapy precautions and contraindications
    • Aspiration risk
    • Tracheotomy/catheters
    • Cardiovascular problems
    • Uncontrolled seizures
    • Tetraplegia or high paraplegia
    • Respiratory compromise
    • Fever
    • Fear of water
    • Fear of losing balance
    • Neurological impairments
    • Severe kidney disease during immersion
    • Menstruation without internal protection
  28. Indications for whirlpool treatments
    • Decubitus ulcers
    • Open burns and wounds
    • Post-hip fractures
    • Post surgical conditions of hip
    • Subacute and chronic musculoskeletal conditions of neck, shoulders, and back
    • Rheumatoid arthritis
  29. Pulsed Lavage with Suction (PLWS)
    • Non-immersion wound hydrotherapy or pulsed lavage with concurrent suction
    • Wound irrigation
    • Delivers low-pressure saline irrigation to a wound while concurrently suctioning wound debris and water
    • Promotes epithelialization and promotes tissue profusion
    • Decreases risk of cross contamination
  30. Contraindications to hydrotherapy used for heating
    • acute inflammation
    • active bleeding
    • malignancy
    • Peripheral vascular disease
    • Sensory loss
    • Decreased mentation
    • Thrombophlebitis
    • Pregnancy
    • Multiple sclerosis
  31. Contraindications for cold hydrotherapy
    • Open wounds
    • Cold urticaria
    • Cardiac dysfunction
    • Regenerating peripheral nerves
  32. Contraindications to hydrotherapy administered via immersion
    • Bowel incontinence
    • Bleeding wounds
    • Seizure disorders
    • Fear of water
    • Very young and very old
  33. Indications for cold therapy
    • Acute muscle trauma
    • -RICE
    • -Over casts and bandages
    • Pain and muscle spasm
    • Myofascial pain syndrome
    • Spasticity
    • Special considerations
    • -Multiple sclerosis
    • -Facilitation of function in flaccid muscles
  34. Contraindications for cryotherapy
    • Cold urticaria
    • -develop wheels
    • Cryoglobulinemia
    • -abnormal blood proteins that form a gel at low temp
    • Raynaud's phenomenon
    • -blood vessels in fingers and toes go into spasm
    • Paroxysmal cold hemoglobinuria
    • -destruction of red blood cells by autoantibodies
    • Compromised circulation
    • Areas of nerve degeneration
    • Areas of regenerating peripheral nerves
    • Areas of peripheral vascular disease
  35. Precautions for cryotherapy
    • Hypertension
    • Cold hypersensitivity
    • Impaired circulation
    • Thermoregulatory disorders
    • Over superficial nerves
    • Open wounds
    • Impaired sensation
    • Poor cognition
    • In the very young or very old
  36. Ice massage experience
    • 4 steps
    • Cold
    • Burning
    • Aching
    • Numb
  37. Pain mechanisms
    Pain receptors that are activated by intense thermal, mechanical or chemical stimuli called nociceptors

    • Substance P
    • -Chemical mediator released by nociceptors
    • -May help w/ transmission of pain signals by sensitizing nociceptors
  38. Mechanoreceptors
    • Pressure (movement in hair follicles, light, deep, or touch)
    • Base of hair follicles or skin
  39. Nociceptors
    • Pain (distension)
    • Wall of gastrointestinal tract, pharynx, skin
  40. Proprioceptors
    • Tension (distension, length changes, tension changes)
    • Skeletal muscles, between muscles and tendons
  41. Thermoreception
    • Temp change (cold, heat)
    • Skin, skin and capsules in joints and ligaments
  42. C-fibers (group lV afferents)
    • Unmyelinated
    • Mechanical trauma, noxious heat, irritant chemical agents
    • Dull, throbbing, aching, burning, tingling, or tapping
    • Sensations have slow onset and can cover a diffuse area
  43. A-delta fibers (group lll afferents)
    • Finely myelinated
    • High intensity mechanical stimulation, also heat and cold
    • Sharp, stabbing, pricking
    • Sensation has a quick onset and usually localized to a specific area
  44. A-beta fibers
    • Heavily myelinated
    • Proprioception, touch, pressure
    • Prolonged pain or abnormal pain transmission
  45. Interneurons
    • Synapse with afferent nerve fibers in spinal cord and integrate the signals, determining how much pain is actually felt
    • Nociceptive signals carried by C-fibers and A-delta fibers synapse with the spinothalamic tract that sends the signal to the brain
  46. Gate Control Theory
    • Impulses ascending on A-Beta's stimulate the substantial gelationosa as they enter the dorsal horn
    • Inhibits synaptic transmission in the A-delta and C fibers afferent pathways
    • Pain message isn't transmitted
  47. Descending pain control mechanism
    • Central control can affect dorsal horn gating process
    • Impulses from the thalamus and brain stem are carried into dorsal horn
    • These close the gait and block transmission of the pain message
  48. Stage l treatment
    • protection
    • PRICE
    • submaximal isometrics
    • Gentle PROM and AAROM with grade I/II mobilizations
  49. Stage ll treatment
    • Begin to move out of acute phase modalities
    • Heating agents may be of benefit
    • Move from sub maximal isometrics to AAROM, AROM as tolerated
  50. Stage lll treatment
    • Usage of heating modalities
    • AROM with progressive isotonic strengthening, moving towards functional rehabilitation
    • Goal specific training
    • Pain control is important as stages progress
  51. Peripheral nociceptive
    • Source of pain lies within injured musculoskeletal tissue
    • Nociceptors in the tissue stimulated by noxious chemical, mechanical or thermal stimuli
    • A delta and C fibers transmit stimulation
    • Sharp and well localized
    • Associated with acute inflammation and tissue damage; expected to subside as tissue heals
  52. Peripheral neurogenic
    • Injury or dysfunction in peripheral nervous system
    • Abnormal Impuse Generator Sites (AIGS)
    • Injured neural tissue-radicular pain, associated with spinal dysfunction and peripheral nerve entrapment
    • Localized to the nerve root or peripheral nerve sensory distribution
    • Sharp and shooting pain
  53. Central pain
    • Lesion or dysfunction within the CNS
    • Abnormal sensitivity or discharge from the CNS
    • Inconsistent symptoms; little or no correlation between stimulus and response
    • Allodynia and hyperalgesia may occur
    • -Pain provoked by a mechanical stimulus that does not typically cause pain
    • -Heightened response to a painful stimulus
  54. Pain related to sympathetic nervous system
    • Intense burning
    • Out of proportion to expectations following injury
    • Vasomotor instability
  55. Affective pain
    • Related to neurons or pathways concerned with affect or emotion
    • Limbic system most likely to be involvedĀ 
    • Pain behaviors displayed are related to toleranceĀ 
    • -Tolerance is related to fatigue, lack of control, stress and anxiety
    • Modalities unlikely to help
  56. Cognitive Behavioral Therapy
    • Psychological intervention focused on changing thought patterns and behaviors
    • Can help change how the brain interprets pain, giving patients more control
    • Three techniques
    • -Pacing
    • -Attention diversion - focusing on the positive
    • -Goal setting
  57. Beam-non-uniformity ratio
    • Ratio between the spatial peak intensity and its spatial average
    • Smaller ratio's correspond to a more uniform beam
    • Generally ratio's that are 6:1 or lower are acceptable
  58. Thermal effects of ultrasound
    • Micro streaming, cavitation
    • Increased extensibility of connective tissue
    • Alter scar formation
    • Decreased joint pain
    • Increased blood flow
    • Increase, decrease or don't change NCV (based on parameters)
  59. Post trauma effects of ultrasound
    • Possibly increased peripheral nerve healing
    • Increased tendon/ligament healing
    • Increased bone healing after fracture or fusion
  60. Non-thermal effects of ultrasound
    • Increase in intracellular calcium levels
    • Increased cell membrane permeability
    • Increased mast cell degranulation and release of histamine which is especially important in the acute phase
    • Increase macrophage responsiveness
    • Increased rate of protein synthesis by fibroblasts and tendon cells
    • Increased nitric oxide synthesis in endothelial cells, resulting in increased blood flow
  61. Ultrasound indications
    • As a deep-heating modality
    • -Joint contracture and scar tissue
    • -Pain and muscle spasm
    • -Subacute or chronic soft tissue inflammation
    • To facilitate healing
  62. Ultrasound contraindications
    • In the region of a pacemaker
    • During pregnancy; over pelvic, abdominal or lumbar regions
    • Eyes and testes
    • In a region of active bleeding or infection
    • In a region of a tumor/malignancy
    • In the region of a DVT or thrombophelitis
    • Over the heart, stellate, or cervical ganglia
    • Over the epiphyseal plates of growing bones
  63. Clinical applications of thermal or "hot" lasers
    • Increase temperature
    • Dehydration of tissue
    • Coagulation of protein
    • Thermolysis
    • Evaporation
  64. Clinical application of low power or "cold" lasers
    • Photobiostimulation
    • Anti-inflammatory applications
    • Wound healing - combine with debridement
  65. Indications for laser therapy
    • wound healing
    • bone regeneration and fracture healing
    • herpes simplex wounds
    • epicondylitis
    • tendinopathies
    • carpal tunnel syndrome
    • arthritis
  66. Contraindications and precautions for laser therapy
    • Class l, ll, llla pose no to minimal danger
    • Class lllb can cause injury with direct viewing (LLLT)
    • Class lV pose eye, skin, and fire hazards
    • Epilepsy, fever, malignancy, decreased sensation, and infection not recommended
    • Gonads
    • Epiphyseal plates of children
    • Sympathetic ganglia
    • Vagus nerve
    • Mediastinum
    • Pregnancy
  67. Diathermy capacitive method
    Uses an applicator system that requires making the patients tissues part of the dielectric capacitor
  68. Diathermy inductive method
    • Uses an inductive applicator to produce oscillating magnetic fields inducing "eddy" or currents in tissues
    • Tow types of coil applicators - Drums or sleeves
  69. Thermal effects of diathermy
    • increased metabolism
    • increased perspiration
    • vasodilation
    • increased oxygen uptake and accelerated healing
    • increased extensibility of connective tissue
    • muscle relaxation
    • decreased muscle stiffness
  70. Non-thermal effects of diathermy
    • restore cellular membrane potential and balance of ions
    • increased fibroblasts and chondrocytes
    • increased white blood cells and histiocytes in a wound
    • absorption of hematoma
    • reduction of inflammation
    • reduction in edema in rats
    • accelerated collagen proliferation and remodeling in rats
    • accelerated regeneration of peripheral nerves in rats
    • stimulation of osteogenesis in dogs
  71. Pulsed Electromagnetic Fields (PEMF)
    • Type of diathermy
    • Deliver very low intensity electromagnetic waves that do not heat tissues
  72. Microwave diathermy (MWD)
    • Use magnetron device similar to those used in microwave ovens
    • Applicator positioned perpendicular to skin's surface
    • Less penetration depth than SWD
    • Uncommon is USA
  73. Physiological effects of diathermy
    • Combo of prolonged low load stretch + heat shown to effectively increase tissue flexibility
    • Initial decrease in strength, followed by an increase
    • Promotes soft tissue and bone healing
Card Set
Physical agents unit 1
Physical agents unit 1