In the name of God

Physical Modalities in Obesity

G. Reza Raissi MD

T. Ahadi MD

A. Prof.

Physical Medicine & Rehabilitation

1

• Modalities are physical agents that are utilized to produce a therapeutic response in tissue

• Heat • Cold• Water• Electricity• Electromagnetic waves

2

• Massage

• Laser

• Biofeedback

• Magnethotherapy

• Transcranial Magnetic stimulation

• Assistive device

• Exercise

3

Alternative and Complementary

• Acupuncture

• Chiropractic

• Herbal medicine

• Homeopathy• Naturopathy

Modalities are extensively used in obesity and condition related to It

4

• Heat• Superficial

• Hot pack (HP)

• Infra red (IR)

• Electrical pad

• Hydrotherapy

• Deep (Diathermies)• Short wave

• Micro wave

• Ultrasound (U/S)

Conductive Heating Agents• Hot packs

• Placement considerations

• Advantages and disadvantages

Radiating Heating Agents

• Infrared Heat Lamps• Very superficial

• 1-10 mm DOP

• Two types• Luminous

• Non-luminous

• Setup• Inverse Square Law

• Cosine Law

Ultrasound

The therapeutic effects of U/S

• THERMAL & NON-THERMAL

• selectively raise the temperature of particular tissues)40-45°C(

• More heated tissues are periosteum, superficial cortical bone, collagenous tissues (ligament, tendon & fascia) & fibrotic muscle

What is Phonophoresis?• Phonophoresis is the therapeutic application of ultrasound

with a topical drug in order to facilitate transdermal drug delivery.

• An ultrasound machine uses sound waves to travel through the skin and into the body.

• A gel is used to help sound waves enter the body and create the effect of deep heat in your muscles and joints.

• Medicine, most commonly a corticosteroid, is added to the ultrasound gel.

• The sound waves from the ultrasound machine push the medicine deep into the body.

(Cameron, 1999; Cameron & Monroe, 1992)

Phonophoresis

• Ultrasound with drugs, used to increase absorption and penetration of drugs up to 5 or 6 cms

• Anti-inflammatory’s• Cortisol• Dexamethasone• Salicylates

• Analgesics• Lidocaine

Electrotherapy

• Decrease pain

• Increase blood flow

• Increase Range of Motion

• Increase muscle strength

• Muscle re-education

• Facilitate absorption of medicines

Electrotherapy• TENS (Transcutaneous

Electrical Nerve Stimulation)

• High-Voltage pulsed stimulation

• Neuromuscular Electrical Stimulation

• Interferential stimulation

• Low-Intensity Stimulation

• Galvanic Stimulation• Russian current• Faradic current• Iontophoresis

Radiofrequency

• Generate electrical energy that heats the dermis

14

Repetitive TranscranialMagnetic Stimulation

• left dorsolateral prefrontal cortex have a non-substance-specific inhibitory effect on craving

15

Transcutaneous Electrical Stimulation of Acupoints

• 30 min per session, two sessions per week for 12 weeks using two surface electrodes, one to the Zusanli (ST36) and the other to Sanyinjiao (SP6) acupoint.

• Effective in reducing percentage body fat and waist circumference

16

Transcranial Direct Current Stimulation

• Transcranial Direct Current Stimulation: A Novel Approach to Control Hyperphagia...Boggio et al. J Child Neurol.2009; 24: 642-643

17

• Low-level, dual-beam laser energy with massage appears to be safe and more efficacious than massage alone for reducing subcutaneous fat in the thighs of normal women

Lach E. Reduction of subcutaneous fat and improvement in cellulite appearance by dual-wavelength, low-level laser energy combined with vacuum and massage. J Cosmet Laser Ther. 2008 Dec;10(4):

19

21

MassageMassage

• Many Massage Techniques• Hoffa Massage• Acupressure/Shiatsu• Connective Tissue• Myofascial Release• Rolfing

• Many Massage Techniques• Hoffa Massage• Acupressure/Shiatsu• Connective Tissue• Myofascial Release• Rolfing

22

Massage Massage

• Massage Has Effects On:• Circulation And

Lymphatic Flow• Nervous System• Muscles• Myofascia

• Massage Has Effects On:• Circulation And

Lymphatic Flow• Nervous System• Muscles• Myofascia

• Skin• Scar Tissue• Psychological

Responses• Relaxation• Pain

• Skin• Scar Tissue• Psychological

Responses• Relaxation• Pain

Vibration

• Low-intensity vibration prevents fat formation 2007

•  May 31, 2009.  pg. 143• Diet, no exercise• same diet intervention, with a conventional fitness

regime• diet intervention plus supervised vibration plate • no intervention

23

• diet only group lost about 6% of their initial body weight

• diet plus conventional fitness lost about 7%• vibration group lost 11%• Fjeldstad C, Whole-body vibration augments resistance training effects

on body composition in postmenopausal women. 2009 May 20;63(1):79-83

24

Heat

• Superficial• Local

• Belt

• Hydrotherapy, Sauna

• Deep Heat• SWD

• Ultrasound

• ES• Massage

25

Cellulite (gynoid lipodystrophy

• Skin dimpling and other changes in skin topography and often a padded or ‘‘orange peel’’appearance

• Iontophoresis, thermotherapy, pressotherapy, (pneumatic lymphatic drainage), Ultrasound, lymphatic drainage massage, radiofrequency, infrared light, and mechanical tissue manipulation, contact cooling, laser diodes, and tissue massage

26

• Effects of cellulite treatment with RF, IR light, mechanical massage and suction treating one buttock with the contralateral as a control. J Cosmet Laser Ther. 2008 Dec;10(4):193-201

27

Conclusion

• Shortness of breath

• muscle weakness

• joint pain

• skin breakdown

• urinary stress incontinence

• difficulty with basic mobility • changing position• walking climbing stairs,using transportation, and

managing personal hygiene

28

• obesity is not a cosmetic disorder but a medical disorder

29