Physical Therapy Modalities for the Office

Jeff G. Konin, PhD, PT, ATC, FACSM, FNATA

Professor & Chair

Physical Therapy Department

University of Rhode island

Rehabilitation Interventions

• Manual Therapy

– Massage

– PNF

– Mobilization/manipulation

• Mechanical Therapy

– Physical Agents

• US, E-Stim, iontophoresis

• Thermo/Cryo Therapy

• LASER, Diathermy, Traction

• Dry Needle

Our Best Modality

Goals Of Rehabilitation

Restore Pre-Injury Function

– Range of motion

– Strength

– Pain/Sensory

– Inflammation

– Proprioception

– Gait

– Posture & Mechanics

Range of Motion

Restoration of functional ROM

Prevent primary & secondary arthrofibrosis

and adhesive capsulitis

Early patient education, offset low pain

thresholds

Manual & mechanical methods

Safe advancement teaching AROM, AAROM,

PROM, RROM

May also decrease accessory motion (instabilities)

Effects of Immobilization

Muscle atrophy

Muscle & ligament adaptive shortening

Bone demineralization

General deconditioning

Decreased proprioception

Compensatory considerations

Thrombus/embolism risk

All lead to adverse outcomes

Range of Motion

Home

Education

Measurement Language?

Strength

Required to regain function

Objectively measure over time

Educate on progression – avoidance

Establish criteria for return to activity

Strength

Pain/Sensory Pain inhibition can

hinder outcomes

Pain modulation methods are very helpful (Modalities, manual therapies)

Sensory integration (scar management, cutaneous nerves, etc….)

Pain/Sensory

Pain/spasm

cycle reduction

is critical

Ice vs Heat?

Thermo/Cryo Therapy

Cryotherapy

- PAIN RELIEF!!!!!!!!!!!!!!!!!!!!!

- Reduces acute pain during inflammatory phase, assists with pain-reduced

exercise

- Combined with compression and elevation can reduce swelling

- 20-30 minute application every 2 hours

- Pain relief due to decreased NCV

Thermotherapy

- Increase skin temperature, but not deep tissue or joints

- Primary benefits include pain reduction and relief of muscle spasm

- Also increase circulation, metabolic activity, inflammation, and tissue elasticity

-Decreases viscosity of fluids (bursa)

- Heat sensation carried by small diameter fibers (A-delta, C), thus analgesia

does not occur via gating mechanism

- 20-40 minute Rx may elicit beta-endorphin response supporting Level III

model

Methods of Application

Electrical Stimulation

Indicated for pain, muscle atrophy, swelling, etc…

Can be performed with supervision or provided with home unit

E-stim

Ultrasound

Adjunct

with

questions

Dry Needling

Inflammation

HINDERS FUNCTION!

• Limits joint range of motion

• Facilitates neuromuscular inhibition

Inflammation

Rehab can help

reduce swelling

Neuromuscular Inhibition

• Pre-synaptic modulation of quadriceps

arthrogenic muscle inhibition. Palmieri et al, Knee Surg Sports Traumatol Arthrosc. 2005

Jul;13(5):370-6

• Arthrogenic muscle response induced by an experimental knee joint effusion is mediated by pre- and post-synaptic spinal

mechanisms. Palmieri RM et al, J Electromyogr Kinesiol. 2004 Dec;14(6):631-40.

• Arthrogenic muscle inhibition is not present in the limb contralateral to a

simulated knee joint effusion. Palmieri RM et

al, Am J Phys Med Rehabil. 2003 Dec;82(12):910-6.

Proprioception

• Diminished following injury

• Ligament sprains and surgical

interventions can lead to joint

interference

Proprioception

BOSU Disclaimer

The BOSU® Balance Trainer is designed to perform a wide variety of

exercises with either the dome side up or black platform side up, “BOth

sides up.” However, standing on the platform side of the BOSU®

Balance Trainer is not recommended, as this information is also

stamped on the bottom of the unit. Standing on the dome side offers a

balance challenge with the least amount of risk or injury.

A woman who broke her hip and wrist while

working with a personal trainer at Planet Fitness

has settled her lawsuit for $750,000. CT Law

Tribune, March 2015

Gait & Weight Bearing

What is 25% weight bearing?

Posture & Mechanics

Summary

• Keep it simple

• Educate first, then implement

• Don’t assume anything basic is known

• Use educational materials & resources

• Early intervention yields best outcomes

• Refer to Rehab – do you really have time

in the office for modalities?????