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Physiotherapy final

A short survey on Physiotherapy for Orthopaedicians

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Physiotherapy final

  1. 1. PHYSIOTHERAPYPHYSIOTHERAPY JAYANT SHARMAJAYANT SHARMA M.S.,D.N.B.,M.N.A.M.S.M.S.,D.N.B.,M.N.A.M.S. CONSULTANTCONSULTANT ORTHOPAEDICS & SPORTS MEDICINEORTHOPAEDICS & SPORTS MEDICINE visit at: www.drjayantsharma.com
  2. 2. OVERVIEWOVERVIEW  DEFINITIONDEFINITION  REHABILITATIONREHABILITATION  EXERCISES-TYPES, USESEXERCISES-TYPES, USES  MANUAL THERAPYMANUAL THERAPY  THERMAL MODALITIESTHERMAL MODALITIES  ELECTRIC MODALITIESELECTRIC MODALITIES
  3. 3. REHABILITATIONREHABILITATION  THE WHOLE PROCESS OFTHE WHOLE PROCESS OF RESTORING A DISABLED PERSON TORESTORING A DISABLED PERSON TO A CONDITION IN WHICH HE OR SHEA CONDITION IN WHICH HE OR SHE IS ABLE TO RESUME NORMAL LIFE.IS ABLE TO RESUME NORMAL LIFE.
  4. 4. Rehab is usually divided intoRehab is usually divided into Several PhasesSeveral Phases •Phase one—ImmobilizationPhase one—Immobilization •Phase two-Early motionPhase two-Early motion •Phase three-StrengtheningPhase three-Strengthening •Phase four-Functional activityPhase four-Functional activity •Phase five-Return to full activityPhase five-Return to full activity The Phases of RehabilitationThe Phases of Rehabilitation
  5. 5. PHYSIOTHERAPYPHYSIOTHERAPY  THE BRANCH WHICH DEALS WITHTHE BRANCH WHICH DEALS WITH PHYSICAL METHODS OF TREATMENTPHYSICAL METHODS OF TREATMENT EMPLOYED AS A MEANS FOREMPLOYED AS A MEANS FOR ENCOURAGING RECOVERY OF JOINTENCOURAGING RECOVERY OF JOINT MOVEMENTS AND MUSCLE POWERMOVEMENTS AND MUSCLE POWER..  AimsAims  promote activitypromote activity  correct insufficiencycorrect insufficiency  encourage the patient to use hisencourage the patient to use his abilityability
  6. 6. TYPES OFTYPES OF PHYSIOTHERAPYPHYSIOTHERAPY  PASSIVEPASSIVE- DIRECTED TOWARDS- DIRECTED TOWARDS ALLEVIATION OF SYMPTOMS BYALLEVIATION OF SYMPTOMS BY USING HEAT, COLD, COUNTERUSING HEAT, COLD, COUNTER IRRITATION, MASSAGE,ANDIRRITATION, MASSAGE,AND MANIPULATION.MANIPULATION.  ACTIVEACTIVE--RESTORATION OFRESTORATION OF FUNCTION BY EXERCISES.FUNCTION BY EXERCISES.
  7. 7. PASSIVE MOVEMENTSPASSIVE MOVEMENTS  These movements are produced by anThese movements are produced by an external force during muscular inactivity.external force during muscular inactivity. Manual Mobilization TechniquesManual Mobilization Techniques ClassificationClassification Controlled sustained stretching -Passive stretches to increase ROM. -Stretching adhesions. -Lengthen muscles due to inhibition of tendon protective reflex. Controlled stretching is useful to: -overcome spasticity -overcome resistance of shortened ligaments Manipulation of joints by by Physiotherapist Surgeon Mobilization of joints Small repetitive movements performed accurately in the range & direction of movements
  8. 8. PASSIVE MOVEMENTSPASSIVE MOVEMENTS  A lengthening reaction of a tight orA lengthening reaction of a tight or shortened muscle is obtained byshortened muscle is obtained by strong contraction of antagonist.strong contraction of antagonist.  To restore Range of movement in stiffTo restore Range of movement in stiff joints.joints.  Used to maintain extensibility.Used to maintain extensibility.  Results from application of externalResults from application of external force, when the muscle is not able toforce, when the muscle is not able to contract.contract.
  9. 9. Active MovementsActive Movements  Achieved by muscular contraction inAchieved by muscular contraction in response to a demand, presented in aresponse to a demand, presented in a manner suitable to the patient’s abilitymanner suitable to the patient’s ability to respond.to respond.
  10. 10. ACTIVE MOVEMENTSACTIVE MOVEMENTS VOLUNTARY Free exercises Working muscles are subjected to only the forces of gravity. Performed by patient’sPerformed by patient’s own muscular effortown muscular effort Assisted exercises When the muscle strength or coordination is inadequate ,external force is applied to compensate for the deficiency. Assisted Resisted Muscles may be strong to work Against resistance in part. This type ensure that external forces are adapted in every part of range of muscles. The forces of resistance offered to the action of working muscles are artificially & systematically increased to develop power and endurance. RESISTED
  11. 11. RelaxationRelaxation --  This type of exercise is used inThis type of exercise is used in conjunction with other methods whichconjunction with other methods which induce relaxation to reduce a state ofinduce relaxation to reduce a state of wasteful tension in muscles, whichwasteful tension in muscles, which limits the range of joint movement.limits the range of joint movement.
  12. 12. Orthopaedic AppliancesOrthopaedic Appliances Wrist cricumductor Wall bars Shoulder abduction ladder Shoulder pulley set Wrist gripper Dumbell Skates roller
  13. 13. Orthopaedic AppliancesOrthopaedic Appliances Quadriceps board Hip circumductor Heel exerciser Ankle exerciser Parallel walking bar Training stairs
  14. 14. Isotonic ExerciseIsotonic Exercise  In isotonic exercise, a body part is moved andIn isotonic exercise, a body part is moved and the muscle shortens or lengthens.the muscle shortens or lengthens.  Although sit-ups, push-ups and pull-ups areAlthough sit-ups, push-ups and pull-ups are isotonic, lifting free weights, like dumbbells andisotonic, lifting free weights, like dumbbells and barbells, is considered the classic form ofbarbells, is considered the classic form of isotonic exercise.isotonic exercise.
  15. 15. Isotonic ResistanceIsotonic Resistance
  16. 16. Lifting an object off a desk is an example of isotonic contractions. A near isotonic contraction is known as Auxotonic contraction. • ConcentricConcentric—the “up”—the “up” contraction when acontraction when a muscle shortens.muscle shortens. • EccentricEccentric-the “down”-the “down” contraction when acontraction when a muscle lengthens.muscle lengthens. Forms of Resistance Exercise-Forms of Resistance Exercise- IsotonicIsotonic
  17. 17. EccentricEccentric There are two main features to note regarding Eccentric contractions: As the load on the muscle increases, it finally reaches a point where the external force on the muscle is greater than the force that the muscle can generate. Thus even though the muscle may be fully activated, it is forced to lengthen due to the high external load. This suggests that skeletal muscles are very resistant to lengthening, thereby allowing very high levels of tension to develop as can occur in isometric exercise
  18. 18. OPEN CHAIN ANDOPEN CHAIN AND CLOSE CHAINCLOSE CHAIN EXERCISESEXERCISES  OPEN–OPEN– WHEN LIMB IS NOT FIXED,WHEN LIMB IS NOT FIXED, ALLOWED TO MOVE FREEALLOWED TO MOVE FREE  CLOSEDCLOSED– WHEN THE LIMB IS– WHEN THE LIMB IS FIXED TO MAINTAIN CONTACTFIXED TO MAINTAIN CONTACT WITH GROUND REACTIVEWITH GROUND REACTIVE FORCES.FORCES.
  19. 19.  Closed Chain  Means whether the hand or foot stays in contactMeans whether the hand or foot stays in contact with either a stable surface or a piece of equipmentwith either a stable surface or a piece of equipment that moves in a predetermined way.that moves in a predetermined way.  transmit less force to the joint (although they tootransmit less force to the joint (although they too can be stressful) and often are more functionalcan be stressful) and often are more functional movementmovement  when you perform closed chain exercises, youwhen you perform closed chain exercises, you often strengthen several muscle groups.often strengthen several muscle groups.
  20. 20.  AnAn Open chain activity is one in which theactivity is one in which the extremity can move in any direction.extremity can move in any direction.  Because it is not attached at the end.Because it is not attached at the end.  For example, if you raise one of your feet offFor example, if you raise one of your feet off the ground, you can move that leg in anythe ground, you can move that leg in any direction or sequence of movements.direction or sequence of movements.
  21. 21. Because of the increased stress on joints, keep open chain activities to a minimum. Open chain exercises do a good job of targeting one set of muscles for strengthening, but they increase the forces transmitted to the involved joint If you opt for an open chain activity, keep the resistance lower
  22. 22. Contractions developed while the joints remainContractions developed while the joints remain stationary.stationary. •““The irresistible force meets the immoveableThe irresistible force meets the immoveable object.”object.” •Generally considered the most intense type ofGenerally considered the most intense type of muscle contraction.muscle contraction. Forms of Resistance Exercise-Isometric
  23. 23. ISOMETRICSISOMETRICS  MUSCLE CONTRACTS INDIVIDUAL OF JOINTMUSCLE CONTRACTS INDIVIDUAL OF JOINT ON WHICH MUSCLE ACTS.ON WHICH MUSCLE ACTS.  FIRST FORM OF STRENGTHENING EXERCISEFIRST FORM OF STRENGTHENING EXERCISE  USED DURING PAINUSED DURING PAIN  PREVENT ATROPHYPREVENT ATROPHY  LESSEN SWELLINGLESSEN SWELLING  HELD FOR 5 SECS WITH REST OF 10 SECS.*HELD FOR 5 SECS WITH REST OF 10 SECS.* 10 REPETITIONS.10 REPETITIONS.  DONE AT DIFFERENT ANGLESDONE AT DIFFERENT ANGLES
  24. 24. Isometric ExerciseIsometric Exercise In this type of strength-training exercise, your muscles contract but your joints don't move and muscle fibers maintain a constant length. The exercises are typically performed against an immovable surface for example, pressing your palm against a wall.
  25. 25. Isometric training is effective for developing total strength of a particular muscle or group of muscles. It's often used for rehabilitation because the exact area of muscle weakness can be isolated and strengthening exercises can be administered at the proper joint angle. This kind of training can provide a relatively quick and convenient method for overloading and strengthening muscles without any special equipment and with less chance of injury.
  26. 26. • Generated by the hydraulic style of weightGenerated by the hydraulic style of weight machines, or by Isokinetic dynamometers.machines, or by Isokinetic dynamometers. • Resistance is created by restricting the velocity atResistance is created by restricting the velocity at which a joint can rotate through a Range ofwhich a joint can rotate through a Range of Motion.Motion. • The subject pushes as hard as s/he can, but theThe subject pushes as hard as s/he can, but the machine only allows the exercising body part tomachine only allows the exercising body part to move as fast as the machine is set to go.move as fast as the machine is set to go. Forms of Resistance Exercise-Forms of Resistance Exercise- IsokineticIsokinetic
  27. 27. Isokinetic DynamometerIsokinetic Dynamometer
  28. 28. Manual MedicineManual Medicine  Manual therapy refers to specific skillsManual therapy refers to specific skills by the therapist in muscle, joint andby the therapist in muscle, joint and somatic dysfunctionsomatic dysfunction  As with any discipline, some therapistsAs with any discipline, some therapists have exceptional skills in this areahave exceptional skills in this area  Manual therapy is best utilized as anManual therapy is best utilized as an integrated part of a comprehensiveintegrated part of a comprehensive treatment programmestreatment programmes
  29. 29. Manipulation AndManipulation And MobilisationMobilisation  MOBILISATIONMOBILISATION Low amplitude andLow amplitude and pressure movement.pressure movement.  MANIPULATIONMANIPULATION Larger amplitude andLarger amplitude and more forceful movement.more forceful movement.
  30. 30. ManipulationManipulation  Thrusting techniquesThrusting techniques: Application of a: Application of a high-velocity, low-amplitude thrust to ahigh-velocity, low-amplitude thrust to a jointjoint  Forces the joint beyond the physiologicForces the joint beyond the physiologic range of movement to the anatomicalrange of movement to the anatomical limits of motionlimits of motion  Contraindications:Contraindications: Osteoporosis, AcuteOsteoporosis, Acute inflammation, Infection, Tumor,inflammation, Infection, Tumor, Structural instability, VertebrobasilarStructural instability, Vertebrobasilar insufficiencyinsufficiency
  31. 31. Massage(Manipulation)Massage(Manipulation)  It is defined as the scientific manipulation of the soft tissueIt is defined as the scientific manipulation of the soft tissue which is performed by using the palmar aspect of the hand.which is performed by using the palmar aspect of the hand. It aims to increase the blood circulation and relief from pain.It aims to increase the blood circulation and relief from pain. Therapeutic effectsTherapeutic effects  Increase fluid exchange in tissue without changing volumeIncrease fluid exchange in tissue without changing volume of fluid pressureof fluid pressure  Reduced swellingReduced swelling  Decreases toxinsDecreases toxins  Increased flexibilityIncreased flexibility  Remodeling of connective tissueRemodeling of connective tissue  Decrease spasm in musclesDecrease spasm in muscles
  32. 32. MassageMassage  Reflex EffectsReflex Effects – Stimulation of peripheral receptors in theStimulation of peripheral receptors in the skin produce centrally mediatedskin produce centrally mediated sensations of pleasure and peripherallysensations of pleasure and peripherally cause muscle relaxationcause muscle relaxation  Mechanical EffectsMechanical Effects – Consists of measures to assist return flowConsists of measures to assist return flow circulation of blood and lymph andcirculation of blood and lymph and measures that produce intramuscularmeasures that produce intramuscular motion to stretch adhesions and mobilizemotion to stretch adhesions and mobilize fluid accumulationfluid accumulation
  33. 33. ClassificationClassification  Stroking manipulationStroking manipulation  Pressure manipulationPressure manipulation  Percussion manipulationPercussion manipulation  Shaking manipulation(Hacking)Shaking manipulation(Hacking)
  34. 34. Other StretchingOther Stretching TechniquesTechniques  Progressive stretch mobilizationProgressive stretch mobilization  Sustained progressive stretchSustained progressive stretch  Spray and stretchSpray and stretch  Muscle energyMuscle energy  Strain-CounterstrainStrain-Counterstrain  RolfingRolfing
  35. 35. Myofascial Release &Myofascial Release & StretchingStretching  Myofascial releaseMyofascial release involves activeinvolves active or voluntary muscle contractionor voluntary muscle contraction along with passive massagealong with passive massage  requires feedback from therequires feedback from the patient's body to determine thepatient's body to determine the direction, force and duration of thedirection, force and duration of the stretch.stretch.  to facilitate maximum relaxation ofto facilitate maximum relaxation of the tight or restricted tissuesthe tight or restricted tissues
  36. 36. MobilizationMobilization  Mobilization iMobilization includes those manualncludes those manual procedures which attempt to increaseprocedures which attempt to increase Joint range of motionJoint range of motion beyond thebeyond the resistance barrier which limits passiveresistance barrier which limits passive range of motion or exerciserange of motion or exercise  May involve either an accessory glideMay involve either an accessory glide of the joint or a physiologic movementof the joint or a physiologic movement of the jointof the joint
  37. 37. MobilizationMobilization  Rhythmic repetitionsRhythmic repetitions with minimalwith minimal force may provide pain reliefforce may provide pain relief  Differs from manipulation orDiffers from manipulation or adjustment by the absence of aadjustment by the absence of a forceful thrust or jerking movementforceful thrust or jerking movement  Maitland's grades of mobilizationMaitland's grades of mobilization:: Grade I - Grade IVGrade I - Grade IV
  38. 38. Gate-Control Theory –Gate-Control Theory – Ronald Melzack (1960s)Ronald Melzack (1960s)  Described physiological mechanismDescribed physiological mechanism by which psychological factors canby which psychological factors can affect the experience of pain.affect the experience of pain.  Neural gate can open and closeNeural gate can open and close thereby modulating pain.thereby modulating pain.  Gate is located in the spinal cord.Gate is located in the spinal cord.
  39. 39. TRANSMISIONTRANSMISION
  40. 40. Gate Control Hypothesis: Wall & Melzack 1965 Hypothesized interneurons activated by A-beta fibers act as a gate, controlling primarily the transmission of pain stimuli conveyed by C fibers to higher centers. i.e. rubbing the skin near the site of injury to feel better. i.e. Transcutaneous electrical nerve stimulation (TENS). i.e. dorsal column stim. i.e. Acupuncture
  41. 41. GATE THEOGATE THEO
  42. 42. Voltage Gated ChannelsVoltage Gated Channels
  43. 43. Three Factors InvolvedThree Factors Involved in Opening and Closingin Opening and Closing the Gatethe Gate  The amount of activity in the painThe amount of activity in the pain fibers.fibers.  The amount of activity in otherThe amount of activity in other peripheral fibersperipheral fibers  Messages that descend from theMessages that descend from the brain.brain.
  44. 44. Gate-Control TheoryGate-Control Theory Brain Spinal Cord Gating Mechanism Transmission Cells From pain fibers From other Peripheral fibers To brain Brain Spinal Cord Gating Mechanism Transmission Cells From pain fibers From other Peripheral fibers To brain Gate is open Gate is closed
  45. 45. Conditions that Open theConditions that Open the GateGate  Physical conditionsPhysical conditions – Extent of injuryExtent of injury – Inappropriate activity levelInappropriate activity level  Emotional conditionsEmotional conditions – Anxiety or worryAnxiety or worry – TensionTension – DepressionDepression  Mental ConditionsMental Conditions – Focusing on painFocusing on pain – BoredomBoredom
  46. 46. Conditions That CloseConditions That Close the Gatethe Gate  Physical conditionsPhysical conditions – MedicationsMedications – Counter stimulation (e.g., heat, message)Counter stimulation (e.g., heat, message)  Emotional conditionsEmotional conditions – Positive emotionsPositive emotions – Relaxation, RestRelaxation, Rest  Mental conditionsMental conditions – Intense concentration or distractionIntense concentration or distraction – Involvement and interest in life activitiesInvolvement and interest in life activities
  47. 47. Thermal TherapiesThermal Therapies  A number of thermal modalities thatA number of thermal modalities that produce pain relief directly and indirectlyproduce pain relief directly and indirectly  These include:These include: – VariousVarious Cold applicationsCold applications – HeatHeat in the forms ofin the forms of – Radiant heat,Radiant heat, – Ultrasound,Ultrasound, – Shortwave diathermy,Shortwave diathermy, – Microwave and LaserMicrowave and Laser
  48. 48. HEATHEAT --  Heat is transferred either byHeat is transferred either by conduction,convection & Radiation.conduction,convection & Radiation.  e.ge.g.. InfraredInfrared  MicrowaveMicrowave  Heating leads toHeating leads to -- – -- Increase in metabolic activityIncrease in metabolic activity – -- Decrease in viscosityDecrease in viscosity – -- Collagen tissue extensibility is increasedCollagen tissue extensibility is increased – -- Nerve StimulationsNerve Stimulations – -- Blood vessels - ErythemaBlood vessels - Erythema ((vasodilatation - due to release of substancevasodilatation - due to release of substance 'H' Bradykinin)'H' Bradykinin)
  49. 49. Therapuetic Effest ofTherapuetic Effest of HeatHeat  Encourage HealingEncourage Healing -- – by increasing metabolic rate cell activity.by increasing metabolic rate cell activity. – decreased viscosity.decreased viscosity.  Control of InfectionControl of Infection -- – dry heat like I.R. is used in skin & surfacedry heat like I.R. is used in skin & surface infection.infection.  Relief of PainRelief of Pain -- – Heating is most effective non analgesic method.Heating is most effective non analgesic method.  -It relieves pain by opening the "pain gait-It relieves pain by opening the "pain gait cycle".cycle".  Increase in level of Endorphins.Increase in level of Endorphins.
  50. 50.  Reduction of Muscle spasmReduction of Muscle spasm –– – by inhibiting the lower motor Neuron pool, thusby inhibiting the lower motor Neuron pool, thus there is no excitation & relief from musclethere is no excitation & relief from muscle spasm.spasm.  Sedative EffectSedative Effect -- – Psychosomatic role of EndorphinsPsychosomatic role of Endorphins  Increase in joint ROMIncrease in joint ROM –– – Collagen extensibility analgesic effect increaseCollagen extensibility analgesic effect increase viscosityviscosity
  51. 51.  Prophylaxis of Pressure soreProphylaxis of Pressure sore -- – Decrease blood flow reduce risk of skinDecrease blood flow reduce risk of skin ulcer.ulcer.  Oedema reductionOedema reduction -- – In Reflex sympathetic osteodystrophy,In Reflex sympathetic osteodystrophy, post traumatic oedema, as heat causespost traumatic oedema, as heat causes vasodilatation and increase rate of fluidvasodilatation and increase rate of fluid exchange.exchange.  Excess of HeatExcess of Heat –– – -increases pain-increases pain
  52. 52. Physiological ReactionsPhysiological Reactions to Heatto Heat  The major factors determining theThe major factors determining the number and intensity of thenumber and intensity of the physiological reactions to heat are:physiological reactions to heat are: – Level of tissue temperature: therapeuticLevel of tissue temperature: therapeutic range is narrow: 43range is narrow: 43oo C [109.4C [109.4oo F] to 45F] to 45oo CC [113[113oo F]F] – Duration of tissue temperature elevationDuration of tissue temperature elevation [5 to 30 minutes][5 to 30 minutes] – Rate of temperature rise in tissuesRate of temperature rise in tissues – Size of the area treatedSize of the area treated
  53. 53. Heat IndicationsHeat Indications  PainPain  Muscle spasmMuscle spasm  Decreases joint stiffness andDecreases joint stiffness and contracturescontractures  Myofascial pain and FibromyalgiaMyofascial pain and Fibromyalgia  Hematoma resolutionHematoma resolution  Bursitis and tenosynovitisBursitis and tenosynovitis  Superficial thrombophlebitisSuperficial thrombophlebitis
  54. 54. HeatHeat Contraindications/PrecautionContraindications/Precaution  Acute inflammation, abscess, trauma,Acute inflammation, abscess, trauma, edema or hemorrhageedema or hemorrhage  Bleeding disordersBleeding disorders  InsensitivityInsensitivity  Inability to communicate or respondInability to communicate or respond  Poor thermal regulationPoor thermal regulation  Areas of malignancyAreas of malignancy  Ischemia (Inadequate blood supply)Ischemia (Inadequate blood supply)  Atrophic skin & Scar tissueAtrophic skin & Scar tissue
  55. 55. Conduction – Hot PacksConduction – Hot Packs  Hot (hydrocollator) packsHot (hydrocollator) packs – Clinically useful temperature for 30Clinically useful temperature for 30 minutesminutes – AdvantagesAdvantages include low cost,include low cost, minimal maintenance, long life,minimal maintenance, long life, patient acceptance, and ease ofpatient acceptance, and ease of useuse – Alternatives include electric heatingAlternatives include electric heating pads, gel pads, hot water bottles,pads, gel pads, hot water bottles, and circulating water heating padsand circulating water heating pads – Exposure time: 20 minutesExposure time: 20 minutes
  56. 56. CONDUCTION HEATINGCONDUCTION HEATING  (A)Wax Bath(A)Wax Bath  -- Paraffin wax melts at 54 deg.C. pointParaffin wax melts at 54 deg.C. point can be lowered by adding liquid paraffin,can be lowered by adding liquid paraffin, mineral oils in a ratio of 1:7.mineral oils in a ratio of 1:7.  -- Wax-baths have temp. betweenWax-baths have temp. between 42 - 52 deg.C.42 - 52 deg.C.  -- Wax is in molten state in boxes.Wax is in molten state in boxes.  -- Temperature maintained by thermostat.Temperature maintained by thermostat.
  57. 57. Method of applicationMethod of application  (a)(a) DIP & WrapDIP & Wrap.. – Part is immersed for a second in wax, withPart is immersed for a second in wax, with drawn & allowed to cool, then reinserted 2-3 sec.drawn & allowed to cool, then reinserted 2-3 sec. – Repeat 6-12 times.Repeat 6-12 times. – produce a coating of wax.produce a coating of wax. – Limit the rate of heat loss by wrapping in towel.Limit the rate of heat loss by wrapping in towel. – Terminate after 15 mins. by which time the waxTerminate after 15 mins. by which time the wax is solid.is solid.
  58. 58.  (b)Dip & Leave in(b)Dip & Leave in – for achieving higherfor achieving higher temp. for 15-20 mins,temp. for 15-20 mins, – use paint brush anduse paint brush and apply wax.apply wax. – 1st layer acts as1st layer acts as insulation,insulation, – in between 2nd layer &in between 2nd layer & 1st there is air trapped,1st there is air trapped, adding to insulatingadding to insulating effect.effect.
  59. 59.  EffectsEffects ContraindicationContraindication AnalgesicAnalgesic Open woundsOpen wounds VasodilationVasodilation DermatitisDermatitis Decrease muscle spasmDecrease muscle spasm Defective ThermalDefective Thermal sensation.sensation. Soft and pliable-skin /Soft and pliable-skin / scarscar
  60. 60. Convection – HeatConvection – Heat LampsLamps  Heat LampsHeat Lamps – InexpensiveInexpensive – VersatileVersatile – An easy way to warmAn easy way to warm superficial tissuessuperficial tissues – 250-watt bulb, 40 to 50250-watt bulb, 40 to 50 cm from the patientcm from the patient
  61. 61. ConvectionConvection HydroTherapyHydroTherapy – Whirlpool baths & Hubbard tanksWhirlpool baths & Hubbard tanks – Pumps agitate water and provide convectivePumps agitate water and provide convective heating, massage, and gentle debridementheating, massage, and gentle debridement – Temps: 33Temps: 33oo C to 36C to 36oo C are considered neutralC are considered neutral – Hubbard tank temps limited to 39Hubbard tank temps limited to 39oo CC – Single extremity treatments can be moreSingle extremity treatments can be more rigorous and in a healthy individualrigorous and in a healthy individual temperatures from 43temperatures from 43oo C to 46C to 46oo C are possibleC are possible
  62. 62. HydroTherapyHydroTherapy  Buoyancy allows aerobic exercise, rangeBuoyancy allows aerobic exercise, range of motion and weight bearing that wouldof motion and weight bearing that would not be possible out of waternot be possible out of water  Water can be soothing and relaxing andWater can be soothing and relaxing and particularly helpful to an anxious andparticularly helpful to an anxious and fearful patientfearful patient  Short-term individual treatment shouldShort-term individual treatment should be followed by group classes andbe followed by group classes and thereafter should be carried outthereafter should be carried out independentlyindependently
  63. 63. HydroTherapyHydroTherapy  Therapy in warm water isTherapy in warm water is beneficial for diagnoses suchbeneficial for diagnoses such as:as: – FibromyalgiaFibromyalgia – Myofascial Pain SyndromeMyofascial Pain Syndrome – Rheumatoid ArthritisRheumatoid Arthritis  Therapy in cool water isTherapy in cool water is recommended for heatrecommended for heat sensitive disorders such assensitive disorders such as multiple sclerosismultiple sclerosis
  64. 64. Convection – ContrastConvection – Contrast BathsBaths  Alternating immersion in hot and coldAlternating immersion in hot and cold water to produce a vascular exercisewater to produce a vascular exercise through active vasodilatation andthrough active vasodilatation and vasoconstriction of the blood vesselsvasoconstriction of the blood vessels  Hot/cold ratios are used depending onHot/cold ratios are used depending on patient tolerance; typically ratio is 4:1patient tolerance; typically ratio is 4:1  Thought to be effective due to reflexThought to be effective due to reflex hyperemia produced by the alternatinghyperemia produced by the alternating exposure to heat (43exposure to heat (43oo C) and cold (16C) and cold (16oo C)C)
  65. 65. CONTRAST BATHCONTRAST BATH  -- Both heat & cold appear useful inBoth heat & cold appear useful in relieving pain & spasm.relieving pain & spasm.  -- Spasticity reduced by cooling.Spasticity reduced by cooling.  -- Recent trauma benefits of coolingRecent trauma benefits of cooling later same injury benefits by heat.later same injury benefits by heat.  -- Joint stiffness is reduced by heat.Joint stiffness is reduced by heat.  -- Oedema is reduced by ice.Oedema is reduced by ice.
  66. 66. Deep Heat ModalitiesDeep Heat Modalities  UltrasoundUltrasound  Short wave DiathermyShort wave Diathermy  MicrowaveMicrowave  Laser (non-surgical)Laser (non-surgical)
  67. 67. UltrasoundUltrasound (MICROMASSAGE)(MICROMASSAGE)  Arbitrarily defined as sound at frequencies aboveArbitrarily defined as sound at frequencies above the limits of human hearing (i.e., more thanthe limits of human hearing (i.e., more than 20,000 Hz)20,000 Hz)  Ultrasound machines use ceramic and quartzUltrasound machines use ceramic and quartz piezoelectric crystals to produce ultrasonicpiezoelectric crystals to produce ultrasonic energyenergy  Intensities of 0.5-2.0 Watts/cmIntensities of 0.5-2.0 Watts/cm22 are usedare used  Frequencies of 1 MHz (deep) or 3 MHzFrequencies of 1 MHz (deep) or 3 MHz (superficial)(superficial)
  68. 68.  TheThe Pizoelectric crystalsPizoelectric crystals change the shape &change the shape & frequency & so drive metal plate to & fro atfrequency & so drive metal plate to & fro at same high frequency, producing a train ofsame high frequency, producing a train of compression waves in the medium of contact.compression waves in the medium of contact.  -- 60-80% Ultrasound energy is lost60-80% Ultrasound energy is lost from beam.from beam.  -- Less the protein content of tissue,Less the protein content of tissue, less is the absorption of UltraSound.less is the absorption of UltraSound. Principle --
  69. 69. MODEMODE  CONTINUOUSCONTINUOUS--  USED FOR MUSCULOSKELETALUSED FOR MUSCULOSKELETAL DISORDERS.DISORDERS.  MUSCLE SPASM, JOINT STIFNESS,MUSCLE SPASM, JOINT STIFNESS, PAINPAIN  PULSEDPULSED  FOR SOFT TISSUE INJURIES.FOR SOFT TISSUE INJURIES.
  70. 70. Pulsed  It uses a generator to turn UltrasoundIt uses a generator to turn Ultrasound in short burstsin short bursts  this reduces the time,& intensitythis reduces the time,& intensity  hence the amount of energy availablehence the amount of energy available in each pulse is high for mechanicalin each pulse is high for mechanical than thermal effect.than thermal effect.
  71. 71. PRINCIPLES OFPRINCIPLES OF APPLICATIONAPPLICATION  WATER BATH APPLICATIONWATER BATH APPLICATION ----WHEN PARTS ARE IRREGULAR,WHEN PARTS ARE IRREGULAR, IMMERSIBLE IN BATHIMMERSIBLE IN BATH..
  72. 72. PRINCIPLES OFPRINCIPLES OF APPLICATIONAPPLICATION  DIRECT CONTACTDIRECT CONTACT APPLICATIONAPPLICATION--  USING K-Y JELLY, CREAMSUSING K-Y JELLY, CREAMS  HELPS IN HIGH TRANSMISSIVITY OFHELPS IN HIGH TRANSMISSIVITY OF ULTRASOUND.ULTRASOUND.  THIXOTROPIC SUBSTANCES- WHICHTHIXOTROPIC SUBSTANCES- WHICH BECOME FLUID ON VIBRATIONBECOME FLUID ON VIBRATION
  73. 73. A)A) Thermal effectsThermal effects ––  HyperthermiaHyperthermia –– – Decreases painDecreases pain – Increases extensibility of tissues.Increases extensibility of tissues. – Increases healing.Increases healing. – Increases Scar stretchingIncreases Scar stretching EffectsEffects
  74. 74.  ((B) Non ThermalB) Non Thermal --  a)a) CavitationCavitation :-:- formation of tiny gasformation of tiny gas bubbles in tissuebubbles in tissue Stable Transient or CollapseStable Transient or Collapse for streamingfor streaming damaging.damaging. Use pulse to reduce cavitationsUse pulse to reduce cavitations .. – b)b) Acoustic StreamingAcoustic Streaming :-:- Steady circulatory flow due to radiationSteady circulatory flow due to radiation torque.torque.
  75. 75. Effects on RepairEffects on Repair  (A)(A)AcuteAcute - Decrease Ca++ diffusion- Decrease Ca++ diffusion increasing production & release ofincreasing production & release of wound healing factor.wound healing factor.  (B)(B)ProliferativeProliferative - Promote Collagen- Promote Collagen Synthesis of greater Tensile strength.Synthesis of greater Tensile strength.  (C)(C)RemodellingRemodelling - Improves- Improves extensibility of mature collagen.extensibility of mature collagen.
  76. 76. THERAPUETIC EFFECTS OFTHERAPUETIC EFFECTS OF ULTRASOUNDULTRASOUND  ACUTE AND SUBACUTE TRAUMATIC CONDITION  CHRONIC ARTHRITIS  SCAR- EXTENSIBLITY INCREASED  PAIN RELIEF- IN HERPES ZOSTER  HEALING OF VARICOSE ULCERS  IDENTIFY STRESS FRACTURE – BY PAIN INCREASE ON APPLICATION .
  77. 77. UltrasoundUltrasound  Precautions and contraindicationsPrecautions and contraindications includeinclude:: – fluid-filled cavitiesfluid-filled cavities – joint replacements containingjoint replacements containing cement/plasticscement/plastics – open epiphyseal platesopen epiphyseal plates – CancerCancer – the eyes, brain & testicles should be avoidedthe eyes, brain & testicles should be avoided – should not be used over a pregnant uterusshould not be used over a pregnant uterus  Pain is used as an endpoint to avoidPain is used as an endpoint to avoid tissue destructiontissue destruction
  78. 78. IontophoresisIontophoresis ((PHONOPHORESISPHONOPHORESIS ))  A process in which a continuous directA process in which a continuous direct current is used to drive electricallycurrent is used to drive electrically charged molecules or atoms (ions) intocharged molecules or atoms (ions) into the tissuesthe tissues  Iontophoresis delivers high concentratesIontophoresis delivers high concentrates of polar substances, or medicinalof polar substances, or medicinal agents, into the skin, but to questionableagents, into the skin, but to questionable depthsdepths  The amount of medicine transferredThe amount of medicine transferred through the skin is directly related to thethrough the skin is directly related to the duration of treatment, current density,duration of treatment, current density, and concentration of the ions in theand concentration of the ions in the
  79. 79. IontophoresisIontophoresis  IndicationsIndications ::  musculoskeletal inflammatorymusculoskeletal inflammatory conditions, such as bursitis, andconditions, such as bursitis, and pain reliefpain relief  Common medicationsCommon medications includeinclude dexamethasone, lidocaine anddexamethasone, lidocaine and hydrocortisonehydrocortisone  ContraindicationsContraindications ::  impaired skin sensation,impaired skin sensation,  broken skin or bruises, and metalbroken skin or bruises, and metal in or near the treatment areain or near the treatment area
  80. 80. Short Wave DiathermyShort Wave Diathermy  Radio waves are used toRadio waves are used to heat superficial tissue byheat superficial tissue by conversion with inductionconversion with induction coil applicators orcoil applicators or condenser padscondenser pads  Most commonly usedMost commonly used frequency: 27.12 MHzfrequency: 27.12 MHz  Treatment time: 20-30Treatment time: 20-30 minutesminutes
  81. 81. Electromagnetic Fields -Electromagnetic Fields - ConvectionConvection S.W.D.S.W.D.  The most efficient conversionThe most efficient conversion of electric energy to heat due toof electric energy to heat due to to & fro motions of ion, thusto & fro motions of ion, thus producing high frequencyproducing high frequency convection.convection.  -Heat is produced by dipole-Heat is produced by dipole rotation of polar moleculesrotation of polar molecules back & forth.back & forth.  -There is conversion by-There is conversion by molecular distortion due tomolecular distortion due to electron clouding.electron clouding.
  82. 82. Physiological EffectPhysiological Effect – The therapeutic effects of continuousThe therapeutic effects of continuous SWD given at an intensity that causeSWD given at an intensity that cause Heating.Heating. – -- Increase temp. of both skin & muscles &Increase temp. of both skin & muscles & intra-articular by (3-6.6 deg.C)intra-articular by (3-6.6 deg.C) – (1 deg. Less for Intra articular)(1 deg. Less for Intra articular)
  83. 83. PatternPattern  --Inductive-Inductive- – Cable or coil, wrapped round the partCable or coil, wrapped round the part into flat spiral.into flat spiral.  --CapitativeCapitative –– – Metal plates positioned byMetal plates positioned by supporting arms.supporting arms. – (A) Electrodes placed 2-4 cms skin -(A) Electrodes placed 2-4 cms skin - Electrode distance.Electrode distance. – (B) Electrodes placed parallel to the(B) Electrodes placed parallel to the skin surface.skin surface. – (C) Electrodes placed size should be(C) Electrodes placed size should be enough the achieve uniform electroenough the achieve uniform electro field.field.
  84. 84. DANGERS inDANGERS in :-:-  Burns.Burns.  Cardiac pacemakers.Cardiac pacemakers.  Synthetic materials.Synthetic materials.  Obesity.Obesity.  Eye.Eye.  Pregnancy.Pregnancy.  Implanted slowImplanted slow release Hormonerelease Hormone capsules.capsules.  CONTRAINDICATI0CONTRAINDICATI0 -NS-NS  Implants.Implants.  ExplantsExplants  UncooperativeUncooperative ptspts  IschemiaIschemia  TBTB  TumorsTumors  PyrexiaPyrexia
  85. 85. Pulsed ShortwavePulsed Shortwave -27-12 MHz frequency use for-27-12 MHz frequency use for – -tissue Trauma.-tissue Trauma. – -Accidents-Accidents – -Post op periods-Post op periods – -Traumatic Synovitis-Traumatic Synovitis – -Haematomas-Haematomas  Effects:-Effects:- – -Accelerates tissue healing.-Accelerates tissue healing. – -Accelerates nerve regeneration.-Accelerates nerve regeneration.
  86. 86.  ApplicationApplication :-:- – -Drum type electrodes - Place closed to skin or as-Drum type electrodes - Place closed to skin or as – -Conventional S.W.-Conventional S.W.  DoseDose:-:- – Different pulse width, & repetitions are prescribed.Different pulse width, & repetitions are prescribed. – Wilson -Wilson - 1hr/day-- 600 pulse/s. --38 w.1hr/day-- 600 pulse/s. --38 w. – Pasila -Pasila - 20 mins.—600 pul/s --3820 mins.—600 pul/s --38 w.w.  ContraindicationsContraindications ----Rarely anyRarely any complication so safe except in -complication so safe except in - Pacemakers / TBPacemakers / TB
  87. 87. MICROWAVEMICROWAVE DIATHERMYDIATHERMY Frequency -2450 MHzFrequency -2450 MHz 915915 Wavelength -12.245 cms.Wavelength -12.245 cms. 32.7932.79  High frequency oscillating currentsHigh frequency oscillating currents  produced by Magnetronsproduced by Magnetrons  which produce radio frequencies, which arewhich produce radio frequencies, which are radiated via antennae or a transistor.radiated via antennae or a transistor.  this is fed through a emitter thus a microwave isthis is fed through a emitter thus a microwave is produced.produced.
  88. 88.  These waves are absorbed in tissues toThese waves are absorbed in tissues to provoke ionic movements leading toprovoke ionic movements leading to heating.heating.  The heating is proportional to absorbedThe heating is proportional to absorbed amount.amount.  Heating greater at surface than in withinHeating greater at surface than in within – so use contact emittersso use contact emitters  1/2 value depth of penetration - 3 cms.1/2 value depth of penetration - 3 cms.  Most radiation lost through the skin.Most radiation lost through the skin.
  89. 89. MicrowaveMicrowave  Precaution over bonyPrecaution over bony prominences due toprominences due to reflection of the wave at thereflection of the wave at the bone interface maybone interface may produce increased heatproduce increased heat absorption in the tissuesabsorption in the tissues superficial to the bone.superficial to the bone.
  90. 90. Laser TherapyLaser Therapy  Light amplificationLight amplification by the stimulatedby the stimulated emission ofemission of Radiation.Radiation. WVLWVL RadiatioRadiatio nn Ruby 694 Red light Helium 632 Red light Galliu m 810 IR Arsenic 850 IR Co2 10,000 IR
  91. 91. Effects -Effects -  -- DecreaseDecrease membranemembrane permeability of cellpermeability of cell  -- DecreaseDecrease macrophagic activitymacrophagic activity  -- DecreaseDecrease Fibroblast proliferationFibroblast proliferation  -- Decrease collagenDecrease collagen synthesissynthesis
  92. 92. USESUSES  -- Soft tissue injuries - TearSoft tissue injuries - Tear  HaematomaHaematoma  Post Traumatic joint disorderPost Traumatic joint disorder  RARA  OAOA  Tennis ElbowTennis Elbow  Post Herpetic NeuralgiaPost Herpetic Neuralgia  TendinitisTendinitis
  93. 93. POSSIBLE DANGERSPOSSIBLE DANGERS  BURNSBURNS  TISSUE DESTRUCTIONTISSUE DESTRUCTION  CAVITATIONCAVITATION  BLOOD CELL STASISBLOOD CELL STASIS  MORE LIKELY IF DONE OVER BONYMORE LIKELY IF DONE OVER BONY PROMINENCE.PROMINENCE.
  94. 94. CONTRAINDICATIONSCONTRAINDICATIONS  RAPIDLY DIVIDING TISSUES--RAPIDLY DIVIDING TISSUES-- a)NEOPLASTIC b)PREGNANCYa)NEOPLASTIC b)PREGNANCY c) EPIPHYSEAL PLATESc) EPIPHYSEAL PLATES -SPREAD OF INFECTION-SPREAD OF INFECTION -VASCULAR PROBLEM-VASCULAR PROBLEM -RADIOTHERAPY-RADIOTHERAPY -SPINA BIFIDA,-SPINA BIFIDA, -CERVICAL GANGLIA-CERVICAL GANGLIA -FLUID FILLED EYE-FLUID FILLED EYE -IMPLANTS-IMPLANTS -VENOUS THROMBOSIS AND VARICOSITIES.-VENOUS THROMBOSIS AND VARICOSITIES.
  95. 95. Superficial Cold -Superficial Cold - CryotherapyCryotherapy  Reduces blood flowReduces blood flow  Decreases metabolic activityDecreases metabolic activity  Lessens muscle tone and spasmLessens muscle tone and spasm  Decreases swellingDecreases swelling  Inhibits spasticity and clonusInhibits spasticity and clonus  Increases gastrointestinal motilityIncreases gastrointestinal motility  Slows nerve conductionSlows nerve conduction  Produces analgesiaProduces analgesia
  96. 96. CryoCryo
  97. 97.  A -A - Immediate perception of cold & painImmediate perception of cold & pain .. – Levis's Hunting LawLevis's Hunting Law - There is initial- There is initial vasoconstrictionvasoconstriction lasting forlasting for 15 mins15 mins followedfollowed byby vasodilatationvasodilatation ofof 15 mins15 mins again to beagain to be followed by vasoconstriction. This is calledfollowed by vasoconstriction. This is called Hunting ReactionHunting Reaction .. – This is to prevent ischemic effect ofThis is to prevent ischemic effect of prolonged cold.prolonged cold.
  98. 98. Constriction recurs due to washingConstriction recurs due to washing away of the metabolitesaway of the metabolites The cause ofThe cause of vasodilatationvasodilatation is stillis still not elucidated,not elucidated, –(a) May be due to substance 'H'(a) May be due to substance 'H' (Levers 1936).(Levers 1936). –(b) Muscle activity reduces due to(b) Muscle activity reduces due to fall of temperature & smoothfall of temperature & smooth muscles flattenmuscles flatten..
  99. 99.  Lowering matabolic rateLowering matabolic rate –– –Vant 'Hoff’s LawVant 'Hoff’s Law .. -- reduced O2 uptake.reduced O2 uptake. -- reduced production ofreduced production of metabolities.metabolities. -- Slowing healing.Slowing healing.  Subsequent reduced flow in musclesSubsequent reduced flow in muscles  Decreased nerve conduction &Decreased nerve conduction & decrease in paindecrease in pain..
  100. 100. THERAPUETICTHERAPUETIC EFFECTSEFFECTS (A)(A) Recent injuriesRecent injuries - PRICE- PRICE Initially for 2 hrs, as this reduces Metabolic rate &Initially for 2 hrs, as this reduces Metabolic rate & secondary cell necrosis & release of lysins. Thussecondary cell necrosis & release of lysins. Thus decreasesdecreases local oedema. (Mclean 1989).local oedema. (Mclean 1989). – -This should not be given beyond 25 mins. to 30-This should not be given beyond 25 mins. to 30 mins. or else leads to nerve damage.mins. or else leads to nerve damage. – -Should not be given beyond 48 hrs as the healing-Should not be given beyond 48 hrs as the healing response is delayed as neo-epithehalization isresponse is delayed as neo-epithehalization is delayed.delayed.
  101. 101.  (B)(B)Alleviate pain.Alleviate pain.  (C)(C)Reduces muscle spasm.Reduces muscle spasm.  (D)Facilitate muscle contraction & may(D)Facilitate muscle contraction & may affect strength.affect strength.  (E)(E)Reduce chronic inflammation & jointReduce chronic inflammation & joint effusion.effusion.
  102. 102. Methods of Applying IceMethods of Applying Ice --  ((A)A) Local immersionLocal immersion – Temperature around 16-18 deg.C. for 15-20Temperature around 16-18 deg.C. for 15-20 mins.mins. – Water from Tap + Flaked Ice.Water from Tap + Flaked Ice.  (B)(B) Evaporating SpraysEvaporating Sprays -- – -- Fluroisomethane -Fluroisomethane - – Nozzle 45 cm from skinNozzle 45 cm from skin – 5 sec application.5 sec application.
  103. 103. Cold PacksCold Packs – IceIce -- Terry Towels held inTerry Towels held in plastic sheet.plastic sheet. apply some oil onapply some oil on skin to reduce run off of waterskin to reduce run off of water from skin (Icefrom skin (Ice burns).burns). – Ice TowelsIce Towels - Replaced every- Replaced every 2-3 mins for total 20 mins.2-3 mins for total 20 mins. For muscle & allowsFor muscle & allows movement & exercises to bemovement & exercises to be performed with cold.performed with cold. – Ice massageIce massage – Ice cubesIce cubes in paper or clothin paper or cloth forfor  Pain reliefPain relief  Neuro facilitation.Neuro facilitation.
  104. 104. Contraindications of IceContraindications of Ice --  Cold SensitivityCold Sensitivity  CryoglobinemiaCryoglobinemia  Cold urticariaCold urticaria  Cardiac diseaseCardiac disease  Arterial B.P. if High -Arterial B.P. if High -  DVTDVT  Emotion & Psychology.Emotion & Psychology.
  105. 105. Cold IndicationsCold Indications  Musculoskeletal traumaMusculoskeletal trauma  Edema/hemorrhage control &Edema/hemorrhage control & analgesiaanalgesia  PainPain  Muscle spasmMuscle spasm  SpasticitySpasticity  Adjunct in muscle re-educationAdjunct in muscle re-education  Reduction in metabolic activityReduction in metabolic activity
  106. 106. Cold Contraindications &Cold Contraindications & PrecautionsPrecautions  IschemiaIschemia  ColdCold intolerance/hypersensitivityintolerance/hypersensitivity  Raynaud'sRaynaud's  Severe cold pressorSevere cold pressor responsesresponses  Cold allergyCold allergy  InsensitivityInsensitivity
  107. 107. ElectrotherapyElectrotherapy  Transcutaneous electrical stimulation andTranscutaneous electrical stimulation and Interferential therapyInterferential therapy  are the two most common forms used forare the two most common forms used for pain modulationpain modulation  By varying parameters such as frequency,By varying parameters such as frequency, waveform, pulse duration, electrodewaveform, pulse duration, electrode configuration, and duration of stimulus, aconfiguration, and duration of stimulus, a range of therapeutic effects is possiblerange of therapeutic effects is possible  Both types of electrotherapy are thought toBoth types of electrotherapy are thought to have similar actions through segmentalhave similar actions through segmental inhibition or activation of descending pain-inhibition or activation of descending pain- inhibitory systemsinhibitory systems
  108. 108. ElectrotherapyElectrotherapy  ContraindicationsContraindications includeinclude  pacemakers,pacemakers,  myocardial disease,myocardial disease,  superficial metal implants andsuperficial metal implants and  over pharyngeal or laryngeal musclesover pharyngeal or laryngeal muscles
  109. 109. Electrical StimulationElectrical Stimulation IndicationsIndications – Pain ModulationPain Modulation: TENS, Interferential, H-: TENS, Interferential, H- wavewave – Muscle SpasmMuscle Spasm: Produces muscle fatigue: Produces muscle fatigue & relaxation& relaxation – SpasticitySpasticity: Fatigue of the agonist,: Fatigue of the agonist, reciprocal inhibitionreciprocal inhibition – Impaired Range of MotionImpaired Range of Motion: Used for: Used for mechanical stretchingmechanical stretching – Disuse Atrophy & StrengtheningDisuse Atrophy & Strengthening: Does: Does not strengthen normal muscles morenot strengthen normal muscles more rapidly than traditional approachesrapidly than traditional approaches
  110. 110. Electrical StimulationElectrical Stimulation Indications (contd:)Indications (contd:) – Wound healing & Edema ReductionWound healing & Edema Reduction For immobilized and injured muscles,For immobilized and injured muscles, electrical stimulation maintains isometricelectrical stimulation maintains isometric strengthstrength and when there is splinting and pain, itand when there is splinting and pain, it may supplement volitional movementsmay supplement volitional movements and speed of recoveryand speed of recovery
  111. 111. T.E.N.S.
  112. 112. Transcutaneous ElectricalTranscutaneous Electrical Nerve Stimulation (TENS)Nerve Stimulation (TENS)  produces analgesia in a wide range ofproduces analgesia in a wide range of medical conditionsmedical conditions  TENS units are non-invasive, easy toTENS units are non-invasive, easy to use, safe and inexpensiveuse, safe and inexpensive  TENS units are small simple devicesTENS units are small simple devices consisting of a power sourceconsisting of a power source (rechargeable battery), one or more(rechargeable battery), one or more signal generators and a set ofsignal generators and a set of electrodeselectrodes
  113. 113. Transcutaneous ElectricalTranscutaneous Electrical Nerve Stimulation (TENS)Nerve Stimulation (TENS)  High frequency (or conventional)High frequency (or conventional) TENSTENS typically results in immediatetypically results in immediate pain relief that lasts while the stimuluspain relief that lasts while the stimulus is on, but usually abates when theis on, but usually abates when the stimulation stopsstimulation stops  In acupuncture-like (or low frequency)In acupuncture-like (or low frequency) the high stimulus intensity is painfulthe high stimulus intensity is painful and many patients cannot tolerate itand many patients cannot tolerate it but the benefit is longer lasting painbut the benefit is longer lasting pain reliefrelief
  114. 114. Interferential TherapyInterferential Therapy  It is based on theIt is based on the principle that theprinciple that the interference betweeninterference between two medium frequencytwo medium frequency currents produces a lowcurrents produces a low frequency current thatfrequency current that will be induced in thewill be induced in the deep tissuesdeep tissues
  115. 115. INTERFERENTIAL Allows effective stimulation of deep tissues TENS is predominantly a cutaneous or superficial stimulus Interferential treatments are usually provided directly by a physical therapist Treatment involve the use of two pairs of electrodes and most units allow variation in waveform, frequency and amplitude or intensity Used in a self-administered setting Electrode placement and stimulation parameter remain more art than science
  116. 116. H-Wave TherapyH-Wave Therapy  A powered muscle stimulator that atA powered muscle stimulator that at low frequency produces comfortable,low frequency produces comfortable, rhythmic, non-fatiguing musclerhythmic, non-fatiguing muscle contractions that increase local bloodcontractions that increase local blood flow and lymphatic drainageflow and lymphatic drainage  At high frequency, H-Wave therapy isAt high frequency, H-Wave therapy is purported to break the pain cyclepurported to break the pain cycle similar to conventional TENSsimilar to conventional TENS
  117. 117. SCENAR THERAPYSCENAR THERAPY This treatment method uses the SCENAR (Self Controlled Energo-NeuroThis treatment method uses the SCENAR (Self Controlled Energo-Neuro Adaptive Regulator) deviceAdaptive Regulator) device SCENAR helps the body heal itself through locating problem areas andSCENAR helps the body heal itself through locating problem areas and subsequently re-activating the body’s self-regulatory mechanism whichsubsequently re-activating the body’s self-regulatory mechanism which was destroyed by an accident or diseasewas destroyed by an accident or disease Advantages of SCENAR therapy:Advantages of SCENAR therapy:  One of the best electrotherapy tools availableOne of the best electrotherapy tools available  No negative side effectsNo negative side effects  Very few contraindicationsVery few contraindications  Totally safeTotally safe  No medications requiredNo medications required  Re-actives the body’s self-regulatory mechanismRe-actives the body’s self-regulatory mechanism  Effects felt after just a few sessionsEffects felt after just a few sessions
  118. 118. Functional ElectricalFunctional Electrical StimulationStimulation (FES):(FES):NeuromuscularNeuromuscular electrical stimulation (NMESelectrical stimulation (NMES – The first commercially available FESThe first commercially available FES device treated foot drop bydevice treated foot drop by stimulating the peroneal nervestimulating the peroneal nerve during gaitduring gait – Involve the use of NeuroprosthesesInvolve the use of Neuroprostheses – In the upper motor neuron spinalIn the upper motor neuron spinal cord injured patient,cord injured patient, – May increase strength,May increase strength, – Normalize blood pressure,Normalize blood pressure, – Allow for limited ambulation andAllow for limited ambulation and lead to a sense of well-beinglead to a sense of well-being – Also used for shoulder subluxationAlso used for shoulder subluxation and dorsiflexionand dorsiflexion – Assist in gait training.Assist in gait training.

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