PT 714 physical agents

packs
cups
towels
compression

spacticity
edema
inflame
pain

inflame stage
edema control
MS
cryokinetics and stretch
vasoconstrict
decrease enzyme degrade
decrease spasticity
increase pain threshold

no more than 45 min
no longer than 20 min, at least 1 hour apart

1. Cold hypersensitivity
2. Cold intolerance
3. Cryobulinemia
4. Paroxysmal cold hemoglobinuria
5. Raynaud’s disease/phenomenon
6. Over regenerating peripheral nerves
7. Over area with circulatory compromise/peripheral vascular disease

1. Over superificials main branch of nerve
2. Over open wound
3. Hypertension
4. Poor sensation/mentation
5. Very young/old patients

• Hot packs
• Paraffin
• Fluidotherapy
• Infrared lamps

joint stiffness
Pain

• Vasodilation
• Increased nerve conduction and velocity
• Increase pain threshold
• Increase muscle strength (during first 30 min)
• Increase metabolic rate
• Increased collagen extensibility
• Pain control
• Increased ROM and decreased joint stiffness
• Accelerate healing

1. Hemorrhage
2. Thrombophlebitis
3. Impaired sensation
4. Impaired mentation
5. Malignant tumor
6. IR irradiation of eyes

1. Acute injury/inflammation
2. Pregnancy
3. Impaired circulation
4. Poor thermal regulation
5. Edema
6. Cardiac insufficiency
7. Metal in area
8. Over open wound
9. Topical counterirritants recently applied
10. Demyelinated nerves

pain
muscle spasm

• Increased metabolic rate
• Decrease pain
• Reduced muscle spasm
• Altered nerve conduction velocity
• Increase circulation
• Increase extensibility
(Deeper reach)

100%
1-2cm or <5cm
3MHz or 1MHz
0.5W/cm or 1.5-2W/cm

• Ulcers
• Surgical skin incisions
• Bone fractures
• Carpal Tunnel Syndrome

1. Malignant tumor
2. Pregnancy
3. CNS tissue
4. Joint cement
5. Plastic components
6. Pacemaker
7. Thrombophlebitis
8. Eyes
9. Reproductive organs

1. Acute inflammation
2. Epiphyseal plates
3. Fracture
4. Breast implants

• Increase intracellular calcium
• Increase skin and cell membrane permeability
• Increases mast cell degeneration and their release of histamine
• Promotes macrophage responsiveness
• Increase rate of protein synthesis by fibroblasts
• Increases NO synthesis
• Stimulate prosteoglycan synthesis

20%
1-2cm or <5cm
3MHz or 1MHz
0.5-1W/cm

topica drug preparation

• US enhances delivery
• Increases permeability of skin

20%
0.5-0.75W/cm
5-10min.

1. Malignant tumor
2. Pregnancy
3. CNS tissue
4. Joint cement
5. Plastic components
6. Pacemaker
7. Thrombophlebitis
8. Eyes
9. Reproductive organs

1. Acute inflammation
2. Epiphyseal plates
3. Fracture
4. Breast implants

• Soft tissue and bone healing
• Arthritis
• Pain
• Inflammation
• Ulcers
• Lymphedema
• Neurological conditions

Nonthermal
• Alter cell membrane function, permeability
• Promotes binding of chemicals to cell membrane
• Promotes ATP production
• Vasodilation
Thermal
• Same as heat

• UV
• Short wave diathermy: deep tissue
• Microwave diathermy: deep tissue
• LED: wider delivery, superficial
• SLD: high intensity, wider area than laser, moderate depth
• Laser: deepest penetration

1. Direct irradiation of eyes
2. Malignancy
3. 4-6 months after radiotherapy
4. Hemorrhaging regions
5. thyroid/ other endocrine glands

1. Low back/abdomen during pregnancy
2. Epiphyseal plates
3. Impaired sensation
4. Impaired mentation
5. Photophobia/abnormally high sensitivity to light
6. Pretreatment with one or more photosensitizers

• Disc bulge or herniation
• Nerve root impingement
• Joint hypomobility
• Subacute joint inflammation
• Paraspinal muscle spasm

• Separate joint surfaces and stretch soft tissues
• Reduction of disc protrusion
• Muscle relaxation
• Joint mobilization

Acute: 1-20kg
Static
5-10min.

Joint distraction: 50% body weight, 15/15, 20-30min

Decrease muscle spasm: 25% body weight, 5/5, 20-30min

Disc prob./stretch soft tissue: 25% body weight, 60/20, 20-30min.

1. Where motion is contraindicated
2. Acute injury/inflammation
3. Joint hypermobility/instability
4. Peripheralization of symptoms with traction
5. Uncontrolled hypertension

1. Structural diseases affecting spine
2. Pressure of belts may be hazardous, pregnancy, hernia
3. Displaced anular fragment
4. Medial disc protrusion
5. Severe pain resolves with traction
6. Claustrophobia/psychological aversion to traction
7. Inability to tolerate prone/supine position
8. Disorientation

• Edema
• Venous insufficiency
• Lymphedema
• Prevent DVT
• Venous stasis ulcers
• Scar modification

• Improves venous and lymphatic circulation
• Limits shape/size of tissue
• Increases tissue temp.

tighter proximal

1. Heart failure/pulmonary edema
2. Recent/acute DVT, thrombophlebitis, pulmonary embolism
3. Obstructed lymphatic/venous return
4. Severe peripheral arterial disease/ulcers resulting from arterial insufficiency

1. Impaired sensation/mentation
2. Uncontrolled hypertension
3. Cancer
4. Stroke/significant cerebrovascular insufficiency
5. Superficial peripheral nerves

• Pain control
• Tissue healing
• Joint stiffness

• Vasodilation
• Increase nerve conduction
• Increase pain threshold
• Alteration of muscle strength
• Accelerated enzyme activity
• Increase soft tissue extensibility

• Inductive coil (shortwave & electromagnetic): deep & superficial
• Capactivie plate (shortwave & electric) superficial
• Magnetron (microwave 2450MHz & electro magnetic) small areas

1. Metal implants
2. Malignancy
3. Eyes
4. Testes
5. Growing

1. Implanted/transcutaneous neural stimulators (cardiac pacemakers)
2. Pregnancy

1. Near electronic/magnetic equipment
2. Obesity
3. Copper-bearing intrauterine contraceptive

• Infection
• Pain
• edema

• Modify ion binding and cellular function
• Increase microvascular perfusion
• Growth factor activation
• Accelerate cell growth

Pulsed shortwave (inductive coil drum 27.12MHz) electromagnetic, deep & superficial

1. Deep tissues, internal organs
2. Substitute for conventional therapy for edema
3. Pacemakers, electronic devices, metal implants

1. Pregnancy
2. Skeletal immunity

• Erthema
• MED (minimal erythema dosage)
• Psoriasis, skin disorders
• Wound healing (UVC)

• UVC: germicidal

UVA: longer wavelength
UVC: shorter wavelength

1. Irradiation of the eyes
2. Skin cancer
3. Pulmonary tuberculosis
4. Cardiac, kidney, or liver disease
5. Systematic lupus erythrematosus
6. fever

7. Photosensitivity medications and dietary supplements
8. Photosensitivity
9. Recent x-ray therapy
10. No dose should be repeated until the first dose had disappeared

• Strengthening
• Cleansing effects; remove debris, dissolve surfactants/antimicrobials
• Decreased WB
• Pain control
• Edema control

• Effects on bone density loss
• Less fat loss
• Increase venous circulation
• Increase cardiac volume
• Increase cardiac output
• Decreased heart rate, systolic blood pressure, VO2
• Decreased vital capacity
• Increased work of breathing
• Decreased exercise-induced asthma
• Diuresis
• Increase sodium/potassium excretion
• Decrease pain

Cold: 0-26 C
Tepid: 26-33C
Neutral Warmth: 33-35.5C
Mild warmth: 35.5-37C
Hot:37-40C
Vey hot: 40-43C

Local
1. Maceration around wound
2. Bleeding
Full Body
1. Cardiac instability
2. Infectious conditions
3. Bowel incontinence
4. Severe epilepsy
5. Suicidal pts
Negative Pressure
1. Necrotic tissue
2. Untreated osteomyelitis
3. Malignancy
4. Untreated malnutrition
5. Exposed arteries, veins, nerves, organs
6. Nonenteric/unexplored fistula

Local
1. Impaired thermal sensation
2. Infection in area
3. Confusion/impaired cognition
4. Recent skin grafts
Full Body-hot
1. Pregnancy
2. Multiple sclerosis
3. Poor thermal regulation
Full Body
1. Confusion/disorientation
2. Alcohol ingestion
3. Limited strength, endurance, balance, ROM
4. Medications
5. Urinary incontinence
6. Fear of water
7. Respiratory problems
Negative Pressure
1. Anticoagulant therapy
2. Difficult hemostasis
3. Confusion/disorientation

acute inflame

med exercise
acute inflame

open wounds
pts with circulatory problems
sensory disorders
decreased tone

increase mobility in burns pts

control pain

increase extensibility

NMES(innervated)

EMS(dennervated use DC-at least 10sec.)

russian

biphasic

35-80 pps

150-200ms (small)

200-350 ms (large)

Overload Principle- at least 50% max. contraction

over motor point

35-80 pps

150-200ms (small)

200-350 ms (large)

Overload Principle- at least 50% max. contraction

time mod AC

50 pps

100-150pps;10 sec. on/ 50 sec. off/ 10 min

short duration PC

50 pps

100-150pps;10 sec. on/ 50 sec. off/ 10 min

25-50 pps

150-200ms(small) 200-350ms (large)

35-50 pps

150-200ms(small) 200-350ms (large)

conventional (high rate)

low rate (accupucnture like)

burst

interferential (AC)

premod

100-150pps

50-80ms (depolarize only A-beta)

Gating at spinal cord

2-10 pps

200-300ms (depolarize motor nerves and A-beta)

endorphin release

10 bursts

100-300 ms

endorphin release

2 currents at different freq

Reduce pain and swelling, increase ROM

HVPC (negative polarity)

HVPC (positive polarity)

inflame phase

monophasic

60-125pps

40-100 ms

proliferative phase

60-125pps

40-100 ms

HVPC (negative polarity)

Biphasic

edema associated with inflame

100-120 pps

40-100 ms

Produce comfortable tingling

edema associated with lack of motion

35-50 pps

150-350 ms

Produce visible contraction