August 27, 2019

Modalities: (are all types of hot and cold packs, US, laser, and electrical stimulation)

Hot Pack
  • Hot packs are often used to help relax a muscle that is in spasm and help decrease pain felt in an area. Commonly used for more subacute or chronic injuries and conditions, hot packs (and heat modalities in general) increase blood flow to help encourage tissue healing. Using heat can help a muscle relax and increase comfort when experiencing discomfort.  Moist heat is most beneficial.

Cold Pack
  • Cold packs are often used to decrease inflammation and swelling in an area. They can be used throughout the length of an injury, but are very effective during acute injury or reinjury. Some of the science behind using cold packs or cold modalities in general is to slow down the activity of nerves, so your brain does  not process the pain signals as quickly, thus reducing your pain. Cold packs are a great way to decrease pain and reduce swelling after injury.

  • Another type of heating modality, paraffin is a type of wax that is normally used for hand injuries that involves dipping your hand into the wax repeatedly to insulate the heat generated by the paraffin. Paraffin is set to the temperature of ~126°F, which might sound high, but there is a reason for it! Paraffin has a lower specific heat than water does, which means it stores less energy than water, and a lower thermal conductivity.  This means paraffin does not transfer heat as well as water does. This is not a very common form of treatment and won’t be found in every clinic, but if you had a hand injury, this may be something for you to look into!

  • Ultrasound is a type of heating modality that can be used to get to deeper tissue than a hotpack can reach. Ultrasound utilizes vibrating soundwaves that are produced by a crystal in the “head” of the applicator.  These soundwaves are absorbed by the targeted tissues producing a heating effect. Ultrasound is customizable based on what your target tissue is, the size of target tissue, and where it’s located. Your clinician can then choose the size of the treatment head, the frequency,  and the intensity to target your injured tissue.

  • Laser therapy is a unique modality utilized in the physical therapy setting, involving a “low level laser” that penetrates deep into tissues to help reduce inflammation and swelling, as well as promote tissue healing. Laser therapy can be a useful alternative to ultrasound therapy, as they are both “penetrating” modalities that are used to get to deep tissues. The main difference between laser therapy and ultrasound therapy is that laser therapy has a photochemical effect, and ultrasound has a thermal effect. Laser doesn’t produce direct heat. You can compare the photochemical effect that laser has on cells to photosynthesis in plants!

Electrical Stimulation:
TENS (transcutaneous electrical neural stimulation)
  • TENS can be used to help reduce pain levels by sending sensations through the stimulation pads that compete with pain sensations. TENS has 2 separate channels that can be used alone or together to create a “tingling” sensation felt under and around the stimulation pads attached to each channel. TENS does not have to be placed over the painful area in order to be effective! The TENS pads can be placed within adjacent areas if there is something that prevents the pads from going over the painful area, such as an open wound or surface metal.
NMES or “Russian Stimulation”
  • NMES stands for neuromuscular electrical stimulation, which utilizes an electrical current to help create a muscle contraction. NMES is utilized when there is muscle weakness, perhaps after surgery or serious injury. Common situations for NMES use are an ACL repair or knee replacement, in which 2 pads from the NMES machine are placed over the muscle and the intensity of the current is turned up until there is a muscle contraction that is sustained for a set period of time.
Interferential Current (IFC)
  • Interferential current utilizes two crossing channels of electrical stimulation that “interfere” with each other over a desired treatment site.  This set-up allows for less pain and stimulation at the surface of the skin and more in a deeper target area. This type of stimulation is often used to draw blood flow to an area or temporarily reduce the pain there. 

Massage Devices:
“The Stick” Roller
  • A flexible stick with ceramic or plastic beads.  This device allows you roll over the skin and massage the muscles beneath without creating too much friction.  Some areas are easy to perform self treatment, but others you will need assistance.

Foam Roller
  • These come in different diameters but most commonly about 6 inches wide.  The lengths vary from about 12-36 inches, and the densities vary from soft to firm.  This can be utilized by your therapist to assist in massage, or can be used by placing a body part on the roller and moving back and forth to massage the treatment area.  

Percussion Therapy Devices (Hypervolt / Theragun)
  • The hypervolt and theragun are types of massage guns that utilizes “percussion therapy” or a fast pulsation that helps relieve muscle stiffness and soreness, often resulting in decreased pain and increased range of motion. They can also help facilitate the healing process of an injury by improving circulation, can help with warmup prior to a workout and recovery after a workout or training session. The hypervolt comes with various attachments and 3 different speeds that can target different areas in different ways.

Hypervolt Vyper
  • Made by the same company that makes the Hypervolt theragun, this is a vibrating foam roller that utilizes the same percussion therapy as the theragun to help relieve stiffness and soreness in muscles. Foam rollers in general work by overloading the muscle with a pressure signal which in turn helps the muscle relax. Adding the vibration facilitates further relaxation and comfort.
  • Graston is a form of Instrument assisted soft tissue mobilization that involves the use of a metal tool to help accelerate tissue remodeling through light strokes on the skin. There are a variety of different shapes of tools to help target specific areas on the body for various soft tissues. They all have the same goal of facilitating a faster recovery and to decrease pain levels! 

  • Traction involves a light “pulling” on either the cervical spine or lumbar spine to create space for a variety of different injuries. Traction can be done either manually or mechanically. Mechanical traction can be modulated for more or less pull, as well as can be used for longer times than a therapist could be able to provide manually. Traction can be used for radiculopathy, hypomobility, stenosis, and more!

Types of Taping:
Athletic Taping
  • Often found in sports settings, athletic taping involves the use of a stiff tape over a joint that has sustained an injury to increase stability of that area. The area of injury is placed into a stable, safe position and then wrapped in a way that provides additional stability. Common areas that can utilize athletic tape are the ankle and wrist usually following a sprain or strain type of injury. Both athletic trainers and physical therapists can apply athletic tape effectively after taking specific taping education classes!

Leukotape or McConnell Taping 
  • Leukotape is a form of very stiff and high tensile strength tape that can be used for a variety of reasons, such as; a muscular or joint injury, relieving pressure and providing stability. Popularized for patellar (knee cap) taping to improve the alignment of how the patella tracks, this strong tape has multiple uses and can often last for multiple days.

  • Another type of taping Kinesiotape, or “K-tape”, offers a person stability while maintaining the ability to move and fire muscles. Sometimes used following manual therapy performed by a physical therapist, K-tape can help extend the benefits of the manual therapy by helping to facilitate proper positioning without restricting movement. K-tape is malleable and can be used over any joint surface, ranging from the back, to a wrist, or even to a shoulder. If you think kinesiotape will benefit you in your recovery, ask your therapist if they offer this type of taping treatment!

Products That Can Be Purchased for Home Use:
  • TENS units
  • Hypervolt 
  • Hot Packs or Cold Packs
  • Paraffin
  • Kinesiotape
  • “The Stick” Massager
  • Foam Roller or Vibrating Roller
  • Home Traction Units
  • Graston Instruments or similar tools like Hawkgrips

All of the items listed above can be purchased through specific websites. Before purchasing an item, check with your physical therapist to make sure that it will benefit you in your recovery rather than harm you, as well as making sure you understand how to use the items safely!

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