Chapter 15: Using Therapeutic Modalities

William E. Prentice

OBJECTIVES

When you finish this chapter you should be able to

• Recognize the legal ramifications of treating a patient with therapeutic modalities.

• Explain how therapeutic modalities are classified according to the type of energy they produce.

• Describe the theoretical uses of the various types of modalities.

• Correctly demonstrate a variety of thermotherapy and cryotherapy techniques.

• Discuss the physiological basis and therapeutic uses of electrical stimulating currents.

• Examine the use of ultrasound in an athletic training setting.

• Describe how massage, traction, and intermittent compression can be used as therapeutic agents.

KEY TERMS

• ischemia

• conduction

• convection

• radiation

• conversion

• hunting response

• hydrocollator

• spray and stretch

• contrast bath

• whole-body cryotherapy (WBC)

• cryokinetics

• amperes

• ohms

• voltage

• watts

• frequency

• tetany

• iontophoresis

• interferential current

• microcurrent electrical nerve stimulation (MENS)

• Hivamat

• transcranial stimulation

• pulsed shortwave diathermy (PSWD)

• low-level laser therapy (LLLT)

• light emitting diode (LED)

• ultrasound

• attenuation

• piezoelectric effect

• effective radiating area

• beam nonuniformity ratio (BNR)

• coupling medium

• extracorporeal shock wave therapy (ESWT)

• traction

• intermittent compression

• massage

• effleurage

• petrissage

• friction

• tapotement

• cupping

• vibration

• acupressure

• dry needling

INTRODUCTION

Most athletic trainers routinely incorporate the use of therapeutic modalities into their rehabilitation programs.⁷⁶ The athletic trainer can choose from a variety of therapeutic modalities. How the athletic trainer chooses to use a therapeutic modality is an individual decision. The choice must be based on a combination of theoretical scientific knowledge, practical experience, and information found in the literature that provides sound research-based evidence that must be used to guide the clinician in their clinical decision making. When used appropriately, therapeutic modalities can potentially be an effective adjunct to various techniques of therapeutic exercise. This chapter is an introduction to the therapeutic modalities that an athletic trainer may use: thermotherapy, cryotherapy, electrical stimulating currents, shortwave diathermy, light therapy (low-level laser and LED), ultrasound, phonophoresis, traction, intermittent compression, and massage.

LEGAL CONCERNS

Specific laws governing the use of therapeutic modalities vary considerably from state to state. The athletic trainer must follow laws that specifically dictate how athletic trainers can use certain therapeutic modalities. An athletic trainer who uses any type of therapeutic modality must have a thorough understanding of the functions and the indications or contraindications for its use.⁷⁷

The athletic trainer should avoid using a shotgun approach when deciding to incorporate therapeutic modalities into a treatment program. Selection of the appropriate modality should be based on an accurate clinical diagnosis of the injury and a decision about which modality can most effectively reach the desired target tissue to achieve specific results. The manufacturers of therapeutic modality equipment often provide recommended protocols for using their equipment in treating specific problems. ...