Physical therapists, athletic trainers, occupational therapists,
physical therapy assistants, occupational therapy assistants, physical
therapy aides, and chiropractors use a wide variety of therapeutic
techniques in the treatment and rehabilitation of their patients. A thorough
treatment regimen oft en involves the use of therapeutic modalities. At one
time or another, virtually all clinicians make use of some type of modality.
This may involve a relatively simple technique such as using an ice pack for
an acute injury or more complex techniques such as the stimulation of nerve
and muscle tissue by electrical currents. There is no question that
therapeutic modalities are useful tools in injury rehabilitation. When used
appropriately, these modalities can greatly enhance the patient's chances
for complete recovery. Unfortunately, the clinicians' rationale for using a
particular modality is too oft en based on habit rather than on logic or
analysis of effectiveness. For the clinician, it is essential to possess
knowledge regarding the scientific basis and the physiologic effects of the
various modalities on a specific injury. When this theoretical basis is
applied to practical experience, it has the potential to become an extremely
effective clinical method.
It must be emphasized
that the use of therapeutic modalities in any treatment program is an
inexact science. If you were to ask 10 different clinicians what combination
of modalities and therapeutic exercise they use in a given treatment
program, you would likely get 10 different responses. There is no way to
"cookbook" a treatment plan that involves the use of modalities. Thus, what
this book will attempt to do is to present the basis for use of each
different type of modality and allow the clinician to make his or her own
decision as to which will be most effective in a given situation. Some
recommended protocols developed through the experiences of the contributing
authors will be presented.
The following are a
number of reasons why this text should be adopted for use.
Comprehensive Coverage of Therapeutic Modalities Used in a Clinical
The purpose of this text is to provide a theoretically based but practically
oriented guide to the use of therapeutic modalities for the practicing
clinician and their students. It is intended for use in courses where
various clinically oriented techniques and methods are presented.
The chapters in this text are divided into six parts. Each
chapter discusses (1) the physiologic basis for use, (2) clinical
applications, (3) specific techniques of application through the use of
related laboratory activities, and (4) relevant individual case studies for
each therapeutic modality.
of Therapeutic Modalities begins with a chapter that discusses the
scientific basis for using therapeutic modalities and classifies the
modalities according to the type of energy each uses. Guidelines for
selecting the most appropriate modalities for use in different phases of the
healing process are presented. A chapter that deals specifically with the
role of therapeutic modalities in wound healing is followed by a discussion
of pain in terms of the neurophysiologic mechanisms of pain and the role of
therapeutic modalities in pain management.
II—Electrical Energy Modalities includes detailed discussions of the
principles of electricity, and electrical stimulating currents,
iontophoresis, and biofeedback. A chapter that deals with the principles of
electrophysiologic evaluation and testing is included. Although this is not
a therapeutic modality per se, electrophysiologic testing is commonly taught
in classes that cover electrical modalities and thus the decision was made
to include this topic in this text.
Energy Modalities discusses those modalities that produce a change in tissue
temperatures through conduction, including thermotherapy and cryotherapy.
Part IV—Sound Energy Modalities discusses those
modalities that utilize acoustic energy to produce a therapeutic effect.
These include therapeutic ultrasound and a lesser known modality,
extracorporal shockwave therapy.
Energy Modalities includes chapters on both the diathermies and low-level
Part VI—Mechanical Energy
Modalities includes chapters on traction, intermittent compression, and
Based on Scientific Theory
This text discuses various concepts, principles, and theories that are
supported by scientific research, factual evidence, and previous experience
of the authors in dealing with various conditions. The material presented in
this text has been carefully researched by the contributing authors to
provide up-to-date information on the theoretical basis for employing a
particular modality in a specific injury situation. Additionally, the
manuscript for this text has been carefully reviewed by educators,
researchers, and practicing clinicians who are considered experts in their
field to ensure that the material reflects factual and current concepts for
Timely and Practical
Certainly, therapeutic modalities used in a clinical setting are important
tools for the clinician. This text provides a comprehensive resource that
should be used in student instruction on the theoretical basis and practical
application of the various modalities. It should serve as a needed guide for
the student who is interested in knowing not only how to use a modality but
also why that particular modality is most effective in a given situation.
The authors who have contributed to this text have a
great deal of clinical experience. Each of these individuals has also at one
time or another been involved with the formal academic preparation of the
student clinician. Thus, this text has been directed at the student who will
be asked to apply the theoretical basis of modality use to the clinical
Several other texts are available that
discuss the use of selected physical modalities in various patient
populations. This is the most comprehensive text on therapeutic modalities
available in any specific discipline.
The aids this text uses to facilitate its use by students and instructors
Objectives These goals are listed
at the beginning of each chapter to introduce students to the points that
will be emphasized.
Figures and Tables
Essential points on each chapter are illustrated with clear visual
Summary Each chapter has a
summary that outlines the major points covered.
Clinical Decision-Making Exercises The scenarios help the clinician
develop decision-making abilities about how a specific modality may best be
Review Questions Designed
to help the student review the material presented in each chapter by
answering a series of thought-provoking questions.
Self-Test Questions A set of true/false and multiple choice questions
is provided to help the student prepare for a written examination and to
assess student comprehension.
Glossary of Key
Terms A glossary of terms is available for quick reference.
References A list of up-to-date references is
provided at the end of each chapter for the student who wishes to read
further on the subject being discussed.
Studies A series of clinically based case studies are presented to
enhance student understanding of how these modalities may be applied to a
Lab Activities Lab
activities are included to guide the student through the setup and
application of the various modalities.
A chart of trigger points and a list of units of measure are provided.
How to Use the Laboratory Activities
There are a wide variety of laboratory activities found throughout this
Theory, biophysical principles, and range
of potential clinical medicine applications for the various physical agent
modalities will be found in this text. The activities are intended to
provide the student or interested reader with a systematic and sequential
method of completing a therapeutic modality application. The initial
performance of a therapeutic procedure should proceed in a logical stepwise
fashion. They are structured to allow both the instructor or supervisor and
the student the ability to assess competency in a partial or complete
fashion culminating in the independent ability to safely and effectively
provide a therapeutic modality treatment.
therapeutic modality application has a separate sequential checklist.
Similarities will be noted in certain aspects of treatment application and
completion. Space is provided for up to three separate
instructors/supervisors to "sign off" (initial and date) the successful
completion and demonstration of each element of the complete application. A
Master Competency Check List is provided to document the successful
completion of the individual therapeutic modality checklist and when the
student is deemed competent to independently provide that treatment. This
system documents the acquisition of skills necessary for effective physical
agent modality application and ensures accountability by the student and
instructor/supervisor to patients and other concerned parties.
Competency in the skillful application of therapeutic
modalities is gained through diligent and frequent practice. Use of these
activities in the manner described will guide the user in productive
practice and successful acquisition of essential skills. Students are
encouraged to practice each of the procedures on themselves first, thereby
gaining an appreciation of the sensations associated with that particular
modality. Further practice with a variety of lab partners will result in the
development of the desired competence and confidence with any manufacturer's