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Modalities
 
Therapeutic Ultrasound
Mobility can be affected by many factors. Our body responds to the forces that are placed upon it. Most tissues require movement to maintain their structural integrity and health.
 
Ultrasound is one of the most widely used modalities in sports medicine. It has been used for therapeutic purposes as a valuable tool in the rehabilitation of many different injuries primarily for the purpose of stimulating the repair of soft-tissue injuries for relief of pain. Although warm whirlpools and hot packs may be used to relieve pain, these methods cannot penetrate the skin. Ultrasound is classified as a “deep heating modality” and can reach muscles that traditional hot packs and whirlpools cannot. The clinical effects of using ultrasound to heat tissues are similar to other forms of heat that may be applied, including
  1. Decrease in joint stiffness
  2. Reduction of muscle spasm
  3. Modulation of pain
  4. Increased blood flow
  5. Mild inflammatory response that may help in the resolution of chronic inflammation
 
 
 
Using ultrasound in combination with other modalities:
  • Ultrasound is frequently used with hot packs, cold packs, and electrical stimulating currents
Ultrasound & hot packs:
  • Heat is effective in reducing muscle spasm and muscle guarding and is useful in pain reduction
Ultrasound & cold packs:
  • When treating acute injuries, the combination of cold to reduce swelling and ultrasound that promote soft-tissue healing, may be the treatment of choice.
 
 
Electrical Stimulation
 
Therapists use electrical stimulation for the following reasons:
  1. To create muscle contraction through nerve or muscle stimulations
  2. To stimulate sensory nerves to help in treating pain
  3. To create an electrical field in biologic tissues to stimulate or alter the healing process
  4. To create an electrical field on the skin surface to drive ions beneficial to the healing process into or through the skin
Therapeutic gains of electrically induced muscle contraction
  1. Muscle reeducation
  2. Muscle pump contractions
  3. Muscle strengthening
  4. Increasing range of motion
 
Muscle Reeducation
Muscular inhibition after surgery or injury is the primary indication for muscle reeducation. The addition of electrical stimulation of the motor nerve helps restore a more normal balance to the system. A muscle contraction usually can be forced by electrically stimulating the muscle. The patient feels the muscle contract, sees the muscle contract, and can attempt to duplicate this muscular response. The object here is to reestablish control and not to create a strengthening contraction.
 
Muscle Pump Contractions
Electrical stimulation of muscle contractions in the affected extremity can help in reestablishing the proper circulatory pattern while keeping the injured part protected.
 
Muscle Strengthening
Muscle strengthening from electrical muscle stimulation has been used with some good results in patients with weakness or denervation of a muscle group.
 
Gate Control Theory
Electrically stimulating the large sensory fibers when there is pain in a certain area will force the central nervous system to make the brain’s recognition area aware of the electrical stimuli. As long as the stimuli are applied, the perception of pain is diminished.
 
It is certain that a diminution or elimination of pain perception is caused by applying an electrical current to areas close to the site of pain or to acupuncture or trigger points, both local and distant to the pain area.
 
Opiate Pain Control Theory
The point electrode is applied to the chosen site, and the intensity is increased until it is perceived by the patient. The probe is then moved around the area, and the patient is asked to report relative changes in perception of intensity. When a location of maximum-intensity perception is found, the current intensity is increased to maximum tolerable levels.
 
Promotion of Fracture Healing
Fracture healing may be accelerated by passing a direct current through the fracture site.
 
Russian Currents
According to strength-duration curve data, to obtain the same stimulation effect as the duration of the stimulus decreases, the intensity must be increased. To make this intensity of current tolerable, it is generated in 50-burst-per-second envelopes with an interburst interval of 10msec. This slightly reduces the total current but allows enough of a peak current intensity to stimulate muscle very well.
 
Interferential Currents
Nikolova has used IFC for a variety of clinical problems and found them effective in dealing with pain problems (eg., joint sprains with swelling, restricted mobility and pain, neuritis retarded callus formation following fractures, pseudarthrosis).
 
Cryotherapy
 
 
 
Cryotherapyis the use of cold in the treatment of acute trauma and subacute injury and for the decrease of discomfort after reconditioning and rehabilitation.
 
Cold has been demonstrated to be more effective when applied along with compression than using ice alone for reducing metabolism in injured tissue. It is also used immediately after injury to decrease pain and promote local vasoconstriction, thus controlling hemorrhage and edema. Cold is also used in the acute phase of inflammatory conditions such as bursitis, tendinitis, in which heat may cause additional pain and swelling.
Cryotherapy Treatment Techniques
Tools of cryotherapy include ice packs, cold whirlpool, ice whirlpool, ice massage, commercial chemical cold spray, and contrast baths.
Cryo-cuff
The Cryo-cuff device that uses both cold and compression simultaneously. The Cryo-Cuff is used both acutely following injury and postsurgically. It is made of a nylon sleeve that connects via a tube to a 1-gallon cooler/jug. Cold water flows into the sleeve from the cooler. As the cooler is raised, the pressure in the cuff is increased.
 
Physiologic Effects of Tissue Heating
 
Local superficial heating (infrared heat) is recommended in subacute conditions for reducing pain and inflammation through analgesic effects. Heat dilates blood vessels, causing the patent capillaries to open up and increase circulation. Heat is applied in musculoskeletal and neuromuscular disorders, such as sprains, strains, articular (joint-related) problems, and muscle spasms, which all describe various types of muscle pain.
Inflammatory Response Phase
Once a tissue is injured, the process of healing begins immediately. The destruction of tissue produces direct injury to the cells of the various soft tissues. Cellular injury is characterized symptomatically by redness, swelling, tenderness, and increased temperature.
 
Cellular Response
Vascular Reaction
The vascular reaction involves vascular spasm, formation of a platelet plug, blood coagulation, and growth of fibrous tissue. The initial effusion of blood and plasma lasts for 24 to 36 hours.
 
Chemical Mediators
The amount of swelling that occurs is directly related to the extent of vessel damage.
 
Function of Platelets
Plugs obstruct local lymphatic fluid drainage and thus localize the injury response.
 
Clot Formation
Clot formation begins around 12 hours following injury and is completed by 48 hours. The initial inflammatory response lasts for approximately 2 to 4 days following initial injury.
 
Chronic inflammation
Chronic inflammation occurs when the acute inflammatory response does not eliminate the injuring agent and fails to restore tissue to its normal physiologic state. There is no specific time frame in which the classification of acute is changed to chronic inflammation.
 
Fibroblastic-Repair Phase
During fibroblastic phase of healing, proliferative and regenerative activity leading to scar formation and repair of the injured tissue follows the vascular and exudative phenomena of inflammation. The period of scar formation referred to as fibroplasia begins within the first few hours following injury and may last for as long as 4-6 weeks. The patient may still indicate some tenderness to touch and will usually complain of pain when particular movements stress the injured structure. As scar formation progresses, complaints of tenderness or pain gradually disappear. During this stage, the wound is now capable of healing aerobically. Along with increased oxygen delivery comes an increase in blood flow that delivers nutrients essential for tissue regeneration in the area. This normal sequence of events in the repair phase leads to the formation of minimal scar tissue. Occasionally, a persistent inflammatory response and continued release of inflammatory products can promote extended fibroplasia and excessive fibrogenesis that can lead to irreversible tissue damage.
 
Maturation-Remodeling Phase
The tissue gradually assumes normal appearance and function, although a scar is rarely as strong as the normal injured tissue. Usually by the end of approx 3 weeks, a firm, strong, contracted, nonvascular scar exists. The maturation phase of healing may require several years to be totally complete.
 
Factors that Impede Healing
Extent of injury
The extent of the inflammatory response is determined by the extent of the tissue injury. Microtears of soft tissue involve only minor damage and most often are associated with overuse. Macrotears involve significantly greater destruction of soft tissue and result in clinical symptoms of functional alterations.
 
Edema
The increased pressure caused by swelling retards the healing process, causes separation of tissues, inhibits neuromuscular control, and impedes nutrition in the injured part.
 
Hemorrhage
Bleeding produces the same negative effects on healing as does the accumulation of edema, and its presence produces additional tissue damage and thus exacerbation of the injury.
 
Poor Vascular Supply
Injuries to tissues with a poor vascular supply heal poorly and slowly.
 
Separation of tissue
A wound that has jagged separated edges must heal by second intention with granulation tissue filling that defect and excessive scarring.
 
Muscle spasm
Muscle spasm causes traction on the torn tissue, separates the two ends, and prevents approximation.
 
Atrophy
Wasting away of muscle tissue begins immediately with injury. Strengthening and early mobilization of the injured structure retards atrophy.
 
Corticosteroids
Steroid use is debatable in the later stages of healing and with chronic inflammation.
 
Infection
Presence of bacteria in the wound can delay healing and may cause excessive granulation tissue and large deformed scars.
 
Humidity, Climate, and Oxygen Tension
Health, Age, and Nutrition-The elastic qualities of the skin decrease with aging. Degenerative diseases such as diabetes and arteriosclerosis also become a concern of the older patient and may affect wound healing.
 
 
 
 
Contact us For a free consultation if you are interested in learning more and having a specific customized stretching program made for you.
 
     
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