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Kin 188  Therapeutic Modalities And Rehabilitation

Kin 188 Therapeutic Modalities And Rehabilitation






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    Kin 188  Therapeutic Modalities And Rehabilitation Kin 188 Therapeutic Modalities And Rehabilitation Presentation Transcript

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