Kin 188 Therapeutic Modalities And Rehabilitation


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Kin 188 Therapeutic Modalities And Rehabilitation

  1. 1. KIN 188 – Prevention and Care of Athletic Injuries Therapeutic Modalities and Rehabilitation
  2. 2. Therapeutic Modalities <ul><li>Modality applications based upon injury site, type of injury and severity of injury as well as on MD prescription (often implied) </li></ul><ul><li>Used to create optimal environment for tissue healing by limiting inflammatory response and breaking pain/spasm cycle – focus on cryotherapy/thermotherapy </li></ul><ul><li>Indications </li></ul><ul><ul><li>Condition that may benefit from the use of particular modality </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Condition may be adversely affected by use of particular modality </li></ul></ul>
  3. 3. Transfer of Energy <ul><li>Radiation </li></ul><ul><ul><li>Transfer of energy without direct contact – diathermy, heat lamps </li></ul></ul><ul><li>Conduction </li></ul><ul><ul><li>Direct transfer from objects of different temperatures in contact with one another – ice bags, heat packs </li></ul></ul><ul><li>Convection </li></ul><ul><ul><li>Occurs when medium (air/water) passes over skin surface creating temperature change (affected by rate of movement of medium) – whirlpools (cold/warm, fans) </li></ul></ul><ul><li>Conversion </li></ul><ul><ul><li>Changes another energy form into heat – in ultrasound, mechanical energy converted to heat in tissues </li></ul></ul><ul><li>Evaporation </li></ul><ul><ul><li>Heat lost as liquid spread over skin surface (liquid becomes gas) – vapocoolant sprays, sweating </li></ul></ul>
  4. 4. Cryotherapy Principles <ul><li>Typically used in acute situations to limit inflammatory response and decrease cell metabolism </li></ul><ul><li>Pain reduced by decreasing nerve conduction velocity and decreasing muscle spindle activity which decreases muscle spasm and breaks pain/spasm cycle </li></ul><ul><li>Most treatments last ~15-20 minutes </li></ul>
  5. 5. Cryotherapy Principles <ul><li>Indications </li></ul><ul><ul><li>Acute/chronic pain </li></ul></ul><ul><ul><li>Acute inflammation </li></ul></ul><ul><ul><li>Muscle spasm </li></ul></ul><ul><ul><li>Post-operative pain and swelling </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Cold allergy/sensitivity </li></ul></ul><ul><ul><li>Impaired circulation </li></ul></ul><ul><ul><li>Impaired sensation </li></ul></ul><ul><ul><li>Hypertension (severe) </li></ul></ul><ul><ul><li>Open wound considerations </li></ul></ul><ul><ul><li>Cardiac or respiratory disorders (body part specific applications) </li></ul></ul>
  6. 6. Cryotherapy Principles <ul><li>RICE (R) protocol for acute injury </li></ul><ul><li>R – rest </li></ul><ul><li>I – ice </li></ul><ul><li>C – compression </li></ul><ul><li>E – elevation </li></ul><ul><li>(R) – referral, if necessary </li></ul>
  7. 7. Cryotherapy Applications <ul><li>Ice massage </li></ul><ul><ul><li>Ice frozen in cup and massaged onto small area of skin </li></ul></ul><ul><ul><li>Most common application to muscle injuries, spasms </li></ul></ul><ul><ul><li>Fast treatment time (often <5 minutes) </li></ul></ul><ul><li>Ice packs/bags </li></ul><ul><ul><li>Easily combined with elevation and compression </li></ul></ul><ul><ul><li>Mold well to body contours </li></ul></ul><ul><li>Ice immersion/cold whirlpool </li></ul><ul><ul><li>“ Slush bucket” vs. whirlpool – temps kept between 50-60 ˚F – use of toe caps </li></ul></ul><ul><ul><li>Care regarding gravity dependent position for acute injuries – add compression </li></ul></ul>
  8. 8. Cryotherapy Applications <ul><li>Commercial gel/chemical packs </li></ul><ul><ul><li>Gel packs kept in freezer, chemical packs “activated” by squeezing </li></ul></ul><ul><ul><li>Must be careful about leaks and potential for frostbite </li></ul></ul><ul><li>Intermittent compression units </li></ul><ul><ul><li>Boot/sleeve with cold water circulated through it to minimize swelling, typically also elevate affected area </li></ul></ul><ul><li>Vapo-coolant sprays </li></ul><ul><ul><li>Flourimethane is most common, spray and stretch application for spasms/trigger points </li></ul></ul>
  9. 9. Thermotherapy Principles <ul><li>Typically used after inflammatory process has subsided to increase blood flow and promote healing </li></ul><ul><ul><li>If used on acute injury, will worsen swelling </li></ul></ul><ul><ul><li>Vasodilation response brings oxygen and nutrients and rids waste products and debris </li></ul></ul><ul><li>Increases extensibility of connective tissue – pre-stretching/rehab applications </li></ul><ul><li>Most treatments last ~15-20 minutes </li></ul>
  10. 10. Thermotherapy Principles <ul><li>Indications </li></ul><ul><ul><li>Subacute or chronic inflammation </li></ul></ul><ul><ul><li>Muscle spasm </li></ul></ul><ul><ul><li>Decreased ROM </li></ul></ul><ul><ul><li>Joint contracture </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Acute inflammation </li></ul></ul><ul><ul><li>Impaired circulation </li></ul></ul><ul><ul><li>Impaired sensation </li></ul></ul><ul><ul><li>Impaired thermal regulation </li></ul></ul><ul><ul><li>Malignancy </li></ul></ul><ul><ul><li>Open wound considerations </li></ul></ul>
  11. 11. Thermotherapy Applications <ul><li>Warm whirlpool </li></ul><ul><ul><li>Must use GFCI for safety, use of “jets” adds massage effect </li></ul></ul><ul><ul><li>Temps kept between 102-110 ˚F, care with full body immersion </li></ul></ul><ul><li>Moist heat pack </li></ul><ul><ul><li>Hydrocollator (silicate/sand filled) packs kept at 158-170 ˚F </li></ul></ul><ul><ul><li>Wrapped in covers/toweling and applied to body </li></ul></ul><ul><ul><li>Effects are superficial </li></ul></ul><ul><li>Paraffin bath </li></ul><ul><ul><li>Best for providing heat to contoured areas (hands, feet) </li></ul></ul><ul><ul><li>Wax and oil heated to liquid state (118-126 ˚F) </li></ul></ul><ul><ul><li>Immersion method vs. wrap/pack/glove method </li></ul></ul>
  12. 12. Rehabilitation <ul><li>When developing a therapeutic exercise program, often helpful to follow sequential steps in program design </li></ul><ul><li>Patient assessment </li></ul><ul><ul><li>ROM, muscle strength, neurological integrity, joint stability, level of functional activities </li></ul></ul><ul><li>Interpretation of assessment </li></ul><ul><ul><li>Allows for identification of primary and secondary structural and functional deficits </li></ul></ul><ul><li>Establishment of goals </li></ul><ul><ul><li>Short-term and long-term goals for return to functional activities </li></ul></ul><ul><li>Develop and supervise plan </li></ul><ul><ul><li>Establishment of techniques and applications to address each deficit and meet established goals </li></ul></ul><ul><li>Reassess progress </li></ul><ul><ul><li>Goals and/or treatment applications may change based upon progress or the lack thereof </li></ul></ul>
  13. 13. Phases of Rehabilitation <ul><li>Significant variability in language and terminology amongst different references </li></ul><ul><li>Each phase has specific therapeutic objectives and criteria for progression to next phase </li></ul><ul><ul><li>Often overlap between phases </li></ul></ul><ul><ul><li>For all phases, techniques and applications should be as functional as they can be given the circumstances </li></ul></ul>
  14. 14. Phases of Rehabilitation <ul><li>Phase I – Immobilization Phase </li></ul><ul><ul><li>Characterized by desire to limit inflammatory response and minimize effects of immobilization </li></ul></ul><ul><li>Phase II – Introduction of Vigorous Therapeutic Exercise </li></ul><ul><ul><li>ROM, strength/power/endurance, proprioception </li></ul></ul><ul><li>Phase III – Return to Functional Activities </li></ul><ul><ul><li>Sport-specific activities followed by return to play </li></ul></ul><ul><li>Phase IV – Maintenance </li></ul><ul><ul><li>Continued efforts to maintain physiological response to rehab efforts to minimize risk of re-injury </li></ul></ul>