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Chapter 18. Adjunctive Interventions

The physical therapist has a number of adjunctive interventions at his or her disposal, the use of which is determined by the goals of the intervention (Tables 18–1 and 18–2). Three categories of adjunctive interventions are recognized:

  • Physical agents
  • Electrotherapeutic modalities
  • Mechanical modalities

Table 18–1. Indications and Contraindications for the Use of Therapeutic Modalities
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Table 18–1. Indications and Contraindications for the Use of Therapeutic Modalities

THERAPEUTIC MODALITY

PHYSIOLOGIC RESPONSES (INDICATIONS FOR USE)

CONTRAINDICATIONS AND PRECAUTIONS

Electrical stimulating currents—high voltage

Pain modulation

Muscle reeducation

Muscle pumping contractions

Retard atrophy

Muscle strengthening

Increase range of motion

Fracture healing

Acute injury

Pacemakers

Thrombophlebitis

Superficial skin lesions

Electrical stimulating currents—low voltage

Wound healing

Fracture healing

Iontophoresis

Malignancy

Skin hypersensitivities

Allergies to certain drugs

Electrical stimulating currents—interferential

Pain modulation

Muscle reeducation

Muscle pumping contractions

Fracture healing

Increase range of motion

Same as high-voltage

Electrical stimulating currents—Russian

Muscle strengthening

Pacemakers

Electrical stimulating currents—MENS

Fracture healing

Wound healing

Malignancy

Infections

Shortwave diathermy and microwave diathermy

Increase deep circulation

Increase metabolic activity

Reduce muscle guarding/spasm

Reduce inflammation

Facilitate wound healing

Analgesia

Increase tissue temperatures over a large area

Metal implants

Pacemakers

Malignancy

Wet dressings

Anesthetized areas

Pregnancy

Acute injury and inflammation

Eyes

Areas of reduce blood flow

Anesthetized areas

Cryotherapy-cold packs, ice massage

Acute injury

Vasoconstriction-decreased blood flow

Analgesia

Reduce inflammation

Reduce muscle guarding/spasm

Allergy to cold

Circulatory impairments

Wound healing

Hypertension

Thermotherapy-hot whirlpool, paraffin, hydrocollator, infrared lamps

Vasodilation-increased blood flow

Analgesia

Reduce muscle guarding/spasm

Reduce inflammation

Increase metabolic activity

Facilitate tissue healing

Acute and postacute trauma

Poor circulation

Circulatory impairments

Malignancy

Low-power laser

Pain modulation (trigger points)

Facilitate wound healing

Pregnancy

Eyes

Ultraviolet

Acne

Aseptic wounds

Folliculitis

Pityriasis rosea

Tinea

Septic wounds

Sinusitis

Increase calcium metabolism

Psoriasis

Eczema

Herpes

Diabetes

Pellagra

Lupus erythematosus

Hyperthyroidism

Renal and hepatic insufficiency

Generalized dermatitis

Advanced atherosclerosis

Ultrasound

Increase connective tissue extensibility

Deep heat

Increased circulation

Treatment of most soft tissue injuries

Reduce inflammation

Reduce muscle spasm

Infection

Acute and postacute injury

Epiphyseal areas

Pregnancy

Thrombophlebitis

Impaired sensation

Eyes

Intermittent compression

Decrease acute bleeding

Decrease edema

Circulatory impairment

Reproduced, with permission, from Prentice WE: Using therapeutic modalities in rehabilitation. In: Prentice WE, Voight ML, eds. Techniques in Musculoskeletal Rehabilitation. New York, NY: McGraw-Hill. 2001:289-303.

Table 18–2. Clinical Decision Making on the Use of Various Therapeutic Modalities during the Various Stages of Healing
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Table 18–2. Clinical Decision Making on the Use of Various Therapeutic Modalities during the Various Stages of Healing

PHASE

APPROXIMATE TIME FRAME

CLINICAL PICTURE

POSSIBLE MODALITIES USED

RATIONALE FOR USE

Initial acute

Injury—day 3

Swelling, pain to touch, pain on motion

CRYO

ESC

IC

LPL

Rest

↓ Swelling, ↓ pain

↓ Pain

↓ Swellings

↓ Pain

Inflammatory response

Days 1-6

Swelling subsides, warm to touch, discoloration, pain to touch, pain on motion

CRYO

ESC

IC

LPL

Range of motion

↓ Swelling, ↓ pain

↓ Pain

↓ Swelling

...

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