Chapter 2: Using Therapeutic Modalities to Affect the Healing Process

OBJECTIVES

Following completion of this chapter, the student will be able to:

• Define inflammation and its associated signs and symptoms.

• Clarify how therapeutic modalities should be used in rehabilitation of various conditions.

• Compare the physiological events associated with the different phases of the healing process.

• Formulate a plan for how specific modalities can be used effectively during each phase of healing and provide a rationale for their use.

• Identify those factors that can interfere with the healing process.

HOW SHOULD THE CLINICIAN USE THERAPEUTIC MODALITIES IN REHABILITATION?

Therapeutic modalities, when used appropriately, can be extremely useful tools in the rehabilitation of the injured patient.^1,2 Like any other tool, their effectiveness is limited by the knowledge, skill, and experience of the clinician using them. For the competent clinician, decisions regarding how and when a modality may best be incorporated should be based on a combination of theoretical knowledge and practical experience. As a clinician, you should not use therapeutic modalities at random, nor should you base their use on what has always been done before. Instead, you must always give consideration to what should work best in a specific injury situation.

There are many different approaches and ideas regarding the use of modalities in injury rehabilitation. Therefore, no “cookbook” exists for modality use. In a given clinical situation, you as a clinician should make your own decision about which modality will be most effective.

In any program of rehabilitation, modalities should be used primarily as adjuncts to therapeutic exercise and certainly not at the exclusion of therapeutic exercises. Rehabilitation protocols and progressions must be based primarily on the physiological responses of the tissues to injury and on an understanding of how various tissues heal (Figure 2–1).³ Thus, the clinician must understand the healing process to be effective in incorporating therapeutic modalities into the rehabilitative process.

In the physically active population, injuries most often involve the musculoskeletal system and in fewer instances the nervous system.^4,5 Some health care professionals have debated whether the terms acute and chronic are appropriate in defining injury.⁶ At some point all injuries can be considered acute; in other words, there is always some beginning point for every injury. At what point does an acute injury become a chronic injury? Generally injuries occur either from trauma or from overuse. Acute injuries are caused by trauma; chronic injuries can result from overuse as occurs with the repetitive dynamics of running, throwing, or jumping.^7,8 Thus, the terms traumatic and overuse injuries are more appropriate.

Primary injuries are almost always described ...