This document discusses various electrophysiological agents that can be used in sports rehabilitation including cryotherapy, superficial cold modalities, superficial heat modalities, ultrasound, TENS, interferential stimulation, and laser therapy. Cryotherapy can reduce pain and swelling from acute injuries by reducing metabolic rate and inducing vasoconstriction. Superficial cold modalities like ice packs, ice water immersion, and ice massage are indicated for muscle spasm, acute injuries, and inflammation. Superficial heat increases blood flow and can be used to warm up muscles before activity or provide pain relief. Ultrasound and laser therapy can provide thermal and non-thermal effects for pain relief but evidence for their use is limited. TENS and interferential stimulation

1. ELECTROPHYSIOLOGICAL AGENTS IN
SPORTS REHABILITATION
- AKHILA.NATESAN

2. CRYOTHERAPY
 Application of ice immediately following acute injury
will –
a. Reduce sharp pain directly ( Aδ conduction block
by hypothermia) & indirectly ( reduced activation
of type C fibres due to decreased rate of
production of chemical irritants.)
b. Reduce cell death caused by primary injury,
secondary hypoxia & post traumatic enzyme
activity by reducing the local metabolic rate.
c. Decrease swelling/ bleeding by causing local
vasoconstriction.

3. INDICATIONS –
a. Muscle spasm.
b. Trigger point pain.
c. Acute swelling/ edema.
d. Inflammation.
e. Heat illness.
f. Contusion.( eg. Cork thigh)
g. Acute injuries.
CONTRAINDICATION –
a. Cold hypersensitivity.
b. Raynauds disease.
c. Circulatory insufficiency.
DANGER –
Ice burn.
SUPERFICIAL COLD
MODALITIES
1. Reusable cold packs
(≤ 15⁰) (20-30 min)
1. Endothermal cold packs.
(20⁰)(15-20 min)
2. Crushed ice bags. (0⁰)
(5-15 min)
3. Vapulocoolant spray.
(varies)
4. Ice water immersion (0⁰)
(5-10min)
5. Ice massage (0⁰)(5-10
min)
6. Refrigerant inflatable
bladders(10-25⁰)

4. SUPERFICIAL HEAT
 It increases local blood supply & metabolic activity.
 Can be used as a warm up prior to physical activity, as
rise in temperature induces muscle relaxation & thereby
increases its efficiency.
 Provides pain relief.
 INDICATIONS –
a. Muscle spasm.
b. Chronic pain & swelling.
CONTAINDICATION –
a. Circulatory problems.
b. Heat injury.
c. Hyper oe hypo sensitivity to heat.

5.  DANGER –
a. Increased bleeding and swelling ( if used in first
48 hrs after acute injury).
b. Burns.
CONTRAST BATH –
 The alternating heat and cold creates a
mechanical force to reduce swelling.
 End with cold bath to encourage vasoconstriction.
SUPERFICIAL HEAT MODALITIES
a. Heat packs (149⁰) (5 min)
b. Fluidotherapy (35⁰ – 45⁰) (10 – 30 min).
c. Hydrotherapy ( 35- 45) (10- 20 min).
d. Radiant heat. ( upto 10 min).

6. ULTRASOUND
 THERMAL EFFECTS –
a. Increased cellular metabolism.
b. Increased extensibility of connective tissue.
c. Decreases pain.
NON THERMAL EFFECTS –
a. Micro massage.
b. Increases cell permeability.
INDICATIONS –
 Evidences supporting ultrasound treatment on overuse
soft tissue injuries (tendinopathies), shoulder pain, low
back pain, patellofemoral pain are little, poorly
designed and reported. Therefore it is difficult to make
conclusions regarding their efficacy .

7.  The clinical effect of phonophoresis in combination with
a analgesic or anti inflammatory is unknown.
 LIPUS ( Low intensity pulsed ultrasound )
1. ( < 0.1 W/cm2)
2. Used to treat acute and non united fractures.
3. Stationary treatment head over the fracture site for 20 min
everyday.
4. Low intensity therefore no risk of tissue damage.
5. Significant reduction in healing time, therefore time to
return to sports has been reported in case reports.

8. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
 Two types used;
• conventional TENS(high frequency low intensity) – fast pain
relief , short lasting.
• Accupuncture TENS(low frequency high intensity) – latent
pain relief, long lasting.
o INDICATIONS –
a. Acute pain & chronic pain.
b. Muscle spasm
c. Muscle re education – accupuncture tens.
d. Trigger points.
CONTRAINDICATIONS –
a. Carotid sinus.
b. Pacemaker.

9. INTERFERENTIAL STIMULATION
 Pain relief hrough amechanism similar to TENS.
 Decreases edema & swelling through muscle contraction
& vasodilatation ( 90-100Hz).
 Muscle stimulation.
 Increases cellular activity.
INDICATIONS –
 Deep pain ( knee, shoulder etc.)
 Swelling/ edema.
 Muscle spasm.
CONTRAINDICATIONS –
 Carotid sinus.
 Pacemaker.
 Deep vein thrombosis.
 Arteria disease.

10. LASER.
 Galium Arsenide( GaAs)- 904nm, Helium Neon
(HeNe) – 632.8nm are the two commonly used
lasers.
 Decreases muscle spam.
 Promotes healing.
INDICATIONS –
 Subacute tendinopathy.
DANGER –
 Retinal damage with prolonged exposure.

11. REFERENCES
 Clinical Sports medicine; Third edition.Peter
brukner & Karim Khan.
 Electrotherapy explained;Fourth edition. Val
Robertson, Alex Ward et al.
 Clayton’s electrotherapy;Ninth edition. Forster &
Palastanga.

12. THANK YOU