THERAPEUTIC_EFFECTS_OF_LOCAL_TISSUE_HEALING

1. THERAPEUTIC EFFECTS OF LOCAL
TISSUE HEATING
 Encouragement of healing
 Control of infection
 Relief of pain
 Reduction of muscle spasm
 Sedative effects
 Increase of range of joint motion
 Prophylaxis of pressure sores
 Oedema of the extremities
 Skin diseases
by SYED MASOOD

2.  Encouragement of healing:
 Factors like-Increased metabolic activity
-Increased Cell activity
-Increased blood flow
All lead to encouragement of healing.
 Application of heat to inflammatory injuries is
beneficial due to small rise in temperature which
increases phagocytosis and help in tissue
healing.
 All form of therapeutic heating are applied to
wide range of chronic and post traumatic
conditions including arthroses, soft tissue lesions
and post surgical healing.

3. Control of infection:
Dry surface heating, may have a particular
role in the control of surfaces infections,
such as chronic paronychia, a fungal
infection, or other infections.

4. Relief of pain:

5. Reduction of muscle spasm:
Heating the secondary afferent muscle
spindle nerve endings and golgi tendon
organs causes inhibitory effect on motor
neuron to diminish muscle excitation.
Pain and muscle spasm are interdependent, a
reduction in one will cause a reduction in the
other.
• Prophylaxis of pressure sores:
Heat applied to areas of skin produces
greater blood flow in the skin and reduces the
risk of skin breakdown.

6. Sedative effect:
During and after heat treatments patients
have been found to sleep more readily. Thus
if pain decreases, sleep occurs.
Warmth also provides comfort and relaxation.
• Oedema of the extremities:
Vessel dilatation allows increase rate of fluid
exchange and thus increased reabsorption of
exudates. Example: Heat has been
recommended for the treatment of chronic
oedema of hand and foot.

7. Skin diseases:
Fungal infections which are difficult to control
and thrive in moist conditions, are treated
with heat therapy. Example: Paroychia,
Psoriasis.

8. THERAPEUTIC EFFECTS OF COLD
THERAPY
 Acute inflammation
 Pain control
 Oedema
 Recent injury
 Cutaneous heat burns
 Soft tissue injury
 Increased extent of injury
 Muscle Spasm
 Spasticity
 Multiple sclerosis
 Prior to amputations of limb

9. Acute inflammation:
Decreased temperature – decreased
metabolism - decrease stress on the
inflamed tissue so that they can with stand
stress and recover early.
With cold therapy there is decreased
redness, oedema, and local area
temperature. And more over decreased
pain.
Treatment time is 15 minutes or less is
given.

10.  Pain control:
 Indirect effects of cold therapy-
 Decrease metabolism
 Decrease oedema
 Decrease irritants
 Direct effects of cold therapy-
 Conduction of neurons and receptors decreases
i.e. nerve conduction decreases.
 Stimulation of large diameter fibers which inhibit
nociceptive fibers.
 Release of encephalin and endorphin which inhibit
substance P.
All the above effects help reduction of pain.

11. Oedema:
Vasoconstriction occurs due to cold therapy,
and than there is decreased blood flow,
decreased inflammatory mediators like
histamine.
All this decreases swelling and reduces oedema.
• Recent injury:
Cold makes blood more viscid and also
increases vasoconstriction. This diminishes the
blood flow and protect excessive blood flow in
recent injuries.

12.  Cutaneous heat burns:
 If immediately treatment for burn is required, than
cool that area. Thus cold therapy, decreases the
temperature which limits tissue damage.
• Soft tissue injury:
 In acute phase of inflammation, if cooling is done, it
–decreases rate of chemical reactions
-decrease irritants
-decrease swellings
-Thus decreases pain and oedema.

13.  Increased extent of injury:
 Local oedema after several hours lead to
secondary cell damage and further cell necrosis.
Therefore in the initial two hours of injury, cooling is
necessary.
• Muscle spasm:
 Muscle spasm is a protective mechanism, but in
later stages of spasm causes ischemia which leads
to increased pain.
Thus with ice , there is reflex vasodilatation which
decreases pain in pain gate mechanism and by this
spasm pain cycle breaks. Further ROM increases.

14. Spasticity:
By cooling – Thermoreceptors stimulate, thus
increased stimulation of CNS.
- This leads to contraction of
muscles and delay of motor nerve impulse.
- Thus decreased spasticity.
After 30 minutes of icing, 1 hour muscle
relaxation occurs.

15. Multiple sclerosis:
Muscle gets paralysed when there is hardening
of tissues in brain and spinal cord.
Multiple sclerosis symptoms aggravate in hot
climate or during excessive activity.
Therefore general cooling helps in decreasing
the symptoms.
• Prior to amputation of limb:
Cold therapy helps to reduce limb metabolism.

16. Medical conditions like:
-Abnormal skin growth
-Benign nerve growth
-Pinched nerve
-Cervical cancer
-Prostate cancer
-Retinoblastoma i.e. childhood cancer of retina.
In all these cases doctors freeze the nerve ,or
skin growth to deadens the irritated nerve.
This is done by inserting a probe into tissues
or by applying freezing agent to skin.

18. Electrical currents are of three different types:
Low frequency currents (Stimulator,TENS,etc)
Medium frequency currents (IFT, etc)
High frequency currents (SWD, MWD,
Ultrasound, etc)

19. Therapeutic effects of Low frequency currents:
 Facilitation of Muscle contraction
 Re-education of Muscle Action
 Training a new Muscle Action
 Neuropraxia of motor nerve
 Strengthening weak muscles
 Prevention and loosening of adhesions
 Improve venous and lymphatic drainage
 Spasticity reduction
 Pain relief
 Increase local circulation
 Facilitation of tissue healing
 Deformity correction

20. Facilitation of muscle contraction:
Due to pain or injury, there is inhibition of
Voluntary Muscle contraction.
Low frequency currents initiate and facilitate
Voluntary Muscle contraction.
• Re-education of Muscle Action:
Inability to contract a muscle voluntary i.e. a
result of prolonged disuse of muscle.
Low frequency current is applied to produce
contraction of muscle, which help to restore
the sense of movement.

21.  Training a new muscle action:
 After Tendon transplantation or other reconstruction
operation, muscle perform different action from that of
the previous action.
 Low frequency current stimulate Muscle so that new
action is performed and patient attempts to assist new
action with Voluntary contraction.
• Neuropraxia of motor nerve:
 Muscle is unable to contract when the nerve supplying
that muscle is having an lesion.
 In this case impulses from brain are unable to pass
the site of lesion.
Than voluntary power is reduced or lost of that muscle.
 Low frequency currents is applied below the site of
lesion, impulses pass through the muscles causing
them to contract.

22.  Strengthening weak muscles:
 Low frequency currents increases strength of muscle
by converting type 2 fibers into type 1 fibers.
• Prevention and Loosening of adhesions:
 When there is effusion in the tissues, adhesions are
liable to form.
But these adhesions can be prevented, by keeping the
structures moving with respect to each other.
 In adhesion cases, inadequate active exercise is not
possible due to pain. Therefore low frequency currents
is applied.
 Low frequency currents stretch and loosen the
adhesions and help muscle to contract.

23.  Improve venous and lymphatic drainage:
 Current stimulate muscle so that there is alternate
contraction and relaxation of muscles and alternate
joint movements of veins and lymphatic.
This increases venous and lymphatic return.
• Spasticity reduction:
 Electrical stimulation reduces spasticity and regain
voluntary control.
 In spastic patients, stimulation both above and below
the threshold level for 30 minutes per day to spastic
muscle.
This causes reduction in spasticity and improve
voluntary control.

24. Pain relief:
With help of pain gate mechanism, pain is
reduced.
• Increase of local circulation:
Low frequency currents reduces sympathetic
tone, which result in vasodilatation.
Due to vasodilatation, there is increase in local
circulation.
• Facilitation of tissue healing:
Due to low frequency currents, changes occur
in local circulation leading to increased cell
activity.

25. Deformity correction:
Deformity in joints are due to tight muscles. It
can be corrected by using low frequency
currents combined with stretching.

26. Therapeutic effects of Medium frequency
currents:
Pain relief
Oedema relief
Reduce spasm

27. Pain relief:
Due to local pumping effect, there is increased
local circulation.
Therefore blood vessels help to remove
chemical from the area which stimulate
nociceptors.
Short duration pulses stimulate large diameter
nerve fibers. These fibers effect on PG in
posterior horns.
Thus inhibit transmission of small diameter
nociceptive traffic.

28. Oedema relief:
Rhythmic pumping action, produced by muscle
contraction has it’s effects on ANS and thus on
diameter of blood vessels.
This increases circulation and removal of
chronic oedematous fluid. Thus decreases
oedema.
• Reduce spasm:
Healing of tissues induces muscular relaxation,
which result in decrease of muscle spasm and
increase muscle efficiency.

29. THERAPEUTIC EFFECTS OF HIGH
FREQUENCY CURRENTS:
Effects on inflammatory and healing of tissues
Effects in bacterial infection
Relief of pain
Effects on muscle tissue
Control of oedema
Dermal ulcers
Bone fractures
Scar tissue mobilization and increase joint ROM

30.  Effects on inflammation and healing of tissue:
 Due to high frequency currents, there is dilatation of
arterioles and capillaries.
This result in increase in blood flow to that area.
Therefore increased supply of oxygen and nutrient
material.
Thus result in bringing more antibodies and WBC.
 Dilatation of capillaries, increases exudation of fluid
into the tissues.
This is followed by increased absorption which
results in assisting removal of waste products and
thus decreases inflammation.

31. Effects in bacterial infection:
High frequency currents result in vasodilatation.
Thus increases flow of blood This leads to
increase in concentration of WBC and
antibodies.
Thus body’s own defense mechanism activate
and bacterial infection treated.
• Effects on muscle tissues:
Healing of tissues induces muscular relaxation,
which result in relief of muscle spasm and
increases efficiency of muscle action.

32. Relief of pain:
In high frequency currents, pain is relieved
indirectly i.e. in case of inflammation, when
inflammation is reduced, pain is reduced.
But strong heating in this cases cause increase
in pain ,especially in acute inflammation.
Because tension in the tissues may occur due
to increase exudation of fluid.

33. Control of oedema :
Recovery of soft tissue injury reduces pain
and help in removal of chronic
oedematous fluid.
There by breaking of adhesions formed
b/w adjacent layers.
• Bone fractures:
Therapeutic ultrasound is helpful in
fracture healing.
Low dose ultrasound reduce the fracture
healing time.

34. Dermal ulcers:
High frequency currents accelerate
neutrophils , lymhocytes and
macrophages for migration. Thus helps in
killing the invading organism and clear the
area of the wound.
High frequency currents also helps in
proliferation of fibroblasts and then
macrophages.
This increases cell membrane permeability
to calcium ions and helps in enhancement
of wound.

35. Scar tissue mobilization and increase joint
ROM:
Increasing the temp. of soft tissue results
in increasing its extensibility.
When combined with stretching, result in
altered visco-elasticity of collagen.
Thus helps in increase joint ROM and
muscle to regain its normal length.