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Basic Massage Techniques

•Effleurage - includes superficial and deep stroking of the skin

•Petrissage - lifting, kneading, rolling of the skin, subcutaneous tissue, muscle

•Tapotement - series of brisk and gentle tapping or blows administered with relaxed hands in rapid alternating movements

•Vibration - fine, tremulous movement with hands or fingers firmly against body part

•Friction - deep pressure movements; Skin and superficial tissues are moved over the underlying structures

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Cryocompression - Game Ready

Blood Flow Restriction (BFR) Training

Sequential Compression Pumps

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•Static traction - amount of force applied is same throughout treatment session

•Intermittent traction - traction force alternates between 2 set points every few seconds throughout treatment session; force is held for a number of seconds and then decreases for a specified rest period

•Motorized mechanical traction units - Capable of static or intermittent traction to lumbar or cervical spine

•Over-the-door cervical traction devices

•Home traction devices

Self-Traction

•Form of traction using gravity and weight of patient’s body or force exerted by patient to produce distraction upon spine

•Can be used for lumbar spine, but not the cervical spine

Positional Traction

•Prolonged placement of patient in a position to place tension on one side of lumbar spine only

•Low-load force to one side

Inversion traction

•Patient positioned in a head-down position

•Utilizes gravity and body weight to apply traction force

Manual Traction

•Classified as manual therapy

•Application of force by a clinician in direction of distracting the joints

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Surface EMG
Muscle Facilitation
- Signal Gain, higher gain is needed for EMG signal production

Muscle Inhibition
- Signal Loss, lower gain is needed for EMG signal production

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Monopolar - wounds, tissue healing, iontophoresis
Bipolar - muscle stimulation, management of pain and spasms
Quadripolar - Estim to large areas, interferential current and TENS

Waveforms
- Direct current (DC)
- Alternating current (AC)
- Pulsed current (PC)

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Photobiomodulation - direct contact, away from the skin, or HILT devices
- LEDs
- SLDs
- Laser Diodes

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Inductive Coil - used for short wave diathermy
Capacitive Plates - used for short wave diathermy
Magnetron (condenser) - used for microwave diathermy

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Therapeutic - thermal vs nonthermal
Diagnostic
Phonophoresis

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Moist Hot Packs (aka Hydrocollator Packs)
Paraffin Bath
Warm/Hot Whirlpool
Fluidotherapy
Infrared Lamps
Contrast bath

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Ice Packs
Commercial Cold Packs
Ice Massage
Ice Bath
Cold Whirlpool
Vapocoolant Sprays
Cold/Compression Units

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Mechanical therapy

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thermal or non-thermal therapy

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Neuromuscular facilitation

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heat therapy

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cold therapy

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•Increase coordination

•Decrease pain

•Decrease neuromuscular excitability

•Stimulation circulation

•Facilitate healing

•Restore joint mobility

•Remove lactic acid

•Alleviate muscle cramps

•Increase blood flow

•Increase venous return

•Retard muscle atrophy

•Increase ROM

•Edema

•Myofascial trigger points

•Stretching scar tissue

•Adhesions

•Muscle spasm

•Myositis

•Bursitis

•Fibrositis

•Tendinitis

•Revascularization

•Raynaud’s disease

•Intermittent claudication

•Dysmenorrhea

•Headaches

•Migraines

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•Arteriosclerosis

•Thrombosis

•Embolism

•Severe varicose veins

•Acute phlebitis

•Cellulitis

•Synovitis

•Abscesses

•Skin infections

•Cancers

•Acute inflammatory conditions

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N/A

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•Lymphedema

•Traumatic edema

•Chronic edema

•Venous stasis ulcers

•Wound healing following surgery

•Prevention of Deep Vein Thrombosis (DVT)

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•Compartment syndromes

•Peripheral vascular disease

•Presence of (DVT) or thrombophlebitis

•Local superficial infection

•Congestive heart failure (CHF)

•Acute pulmonary edema

•Displaced fractures

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•Impaired sensation or mentation

•Uncontrolled hypertension

•Cancer

•Superficial peripheral nerves

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•Spinal disc bulge or herniation

•Spinal nerve root impingement

•Joint hypomobility

•Subacute joint inflammation

•Muscle spasm

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•Osteoporosis

•Fractures

•Where motion is contraindicated

•Acute injury or inflammation

•Joint hypermobility or instability

•Peripheralization of symptoms with traction

•Uncontrolled hypertension

•Pregnancy

•Positive vertebral artery test (for cervical traction)

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•Structural diseases or conditions affecting spine

•Tumor

•Infection

•Rheumatoid Arthritis

•Prolonged systemic steroid use

•Pressure of traction harness may be hazardous

•Hiatal hernia

•Vascular compromise

•Displaced annular fragment

•Traction no longer appropriate when annular fragment loses connection with body of the disc

•Medial disc protrusion

•When severe pain resolves fully with traction

•Could mean that traction has increased compression on nerve root leading to complete nerve block

•Claustrophobia or other psychological aversion to traction

•Manual or positional traction may be better

•Inability to tolerate prone or supine position

•Cervical traction may be applied in sitting

•Disorientation

•May become entangled in belts/harness

•Recommended that only manual traction techniques be used if patient disoriented

•Temporomandibular joint problems

•Precaution when performing cervical traction;  recommend halter which applies force at occiput and avoids pressure on mandible

•Dentures

•Keep dentures in place during cervical traction to maintain alignment of TMJ

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•Muscle reeducation

•Regaining neuromuscular control

•Increasing isometric and isotonic strength of a muscle

•Relaxation of muscle spasm

•Decreasing muscle guarding

•Pain reduction

•Psychological relaxation

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•Any musculoskeletal condition that a muscular contraction might exacerbate

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•Related to potential responses when a patient performs strengthening and/or cardiovascular exercises when trying to use EMG for muscle facilitation such as:

• Dyspnea, fatigue, angina, other cardiac-related symptoms

• Delayed onset muscle soreness with excessive exercise

•Skin reactions to the use of adhesive electrodes

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•Acute, post-acute, chronic pain

•Stimulation of denervated muscle

•Retarding muscle atrophy

•Muscle strengthening

•Muscle reeducation

•Stimulation of venous and lymphatic circulation

•Management of edema

•Muscle spasms

•Muscle guarding

•Wound, fracture, tendon, ligament healing

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•Pacemaker, implanted cardiac defibrillator

•Infection

•Malignancy

•Pregnancy

•Over areas of known thrombosis or thrombophlebitis

•Musculoskeletal problems where muscle contraction would exacerbate the condition

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•Impaired sensation or mentation

•Cardiac disease

•Areas of skin irritation or open wounds

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•Facilitation of wound healing

•Pain reduction

•Increasing the tensile strength of a scar

•Decreasing scar tissue

•Decreasing inflammation

•Bone healing and fracture consolidation

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•Directly over the eyes

•Malignancy

•Low back or abdomen during pregnancy

•Within 4-6 months of radiation therapy

•Over hemorrhaging areas

•Over the thyroid glands

•Epiphyseal plates in children

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•Impaired sensation or mentation - patient may not be able to report any discomfort during treatment

•Light sensitivity - includes those with abnormally high sensitivity to light and individuals who are taking medication that may make them sensitive to light (photosensitizing medication); usually applies more to the use of UV light; stop use of light if adverse effects occur

•Tattoos - the ink used for the tattoo could potentially overheat; need to avoid treating over areas with tattoos

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•Post acute musculoskeletal injuries

•Muscle guarding

•Joint contractures

•Myofascial trigger points

•Pain management

•Soft tissue healing

•Nerve healing

•Bone healing

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•Acute traumatic musculoskeletal injuries

•Areas with ischemia

•Fluid-filled areas or organs

•Joint effusion

•Synovitis

•Eyes

•Contact lenses

•Moist wound dressings

•Malignancies

•Infection

•Testes

•Pregnancy

•Epiphyseal plates in adolescents

•Cardiac pacemakers & other implanted electronic medical devices

•Intrauterine devices

•Watches or jewelry

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•Areas with acute inflammation

•Metal implants

•Areas of reduced sensitivity to temperature or pain

•Pelvic area during menstruation

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·Acute and post-acute conditions (nonthermal US)

·Soft tissue healing and repair

·Scar tissue

·Joint contracture

·Chronic inflammation

·Increase extensibility of collagen

·Reduction of muscle spasm

·Pain modulation

·Increase blood flow

·Soft tissue repair

·Increase in protein synthesis

·Tissue regeneration

·Bone healing

·Inflammation associated with Myositis Ossificans

·Plantar warts

·Myofascial trigger points

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·Thermal US for acute and post-acute conditions

·Areas of decreased temperature sensation

·Areas of decreased circulation

·Thrombophlebitis

·Eyes

·Reproductive Organs

·Pelvis immediately following menses

·Pregnancy

·Pacemaker or implanted cardiac rhythm device

·Malignancy

·Epiphyseal areas in young children

·Total Joint Replacements

·Infection

·Central Nervous System tissue

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Fracture

·high-intensity ultrasound may cause pain and impair healing

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•Subacute and chronic inflammatory conditions

•Subacute or chronic pain

•Decreased ROM

•Facilitate healing

•Muscle guarding

•Muscle spasm

•Myofascial trigger points

•Subacute muscle strain

•Subacute ligament sprain

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•Acute musculoskeletal conditions

•Areas of impaired circulation

•Peripheral vascular disease

•Skin anesthesia

•Open wounds or skin conditions

•Malignant tumor

•Infrared irradiation of the eyes

•Impaired mentation

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•Pregnancy

•Cardiac insufficiency

•Poor thermal regulation

•Patients who are very young or very old

•Edema

•Metal in the area

•Demyelinated nerves

•Over areas where counterirritants have been applied

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•Over a superficial nerve

•Hypertension

•Impaired cognition

•Patients who are very young or very old

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•Raynaud’s disease or phenomenon

•Over an area with circulatory compromise

•Peripheral vascular disease

•Hypersensitivity to cold

•Skin anesthesia

•Open wounds or skin infections

•Infection

•Cold intolerance

•Cryoglobulinemia

•Paroxysmal cold hemoglobinuria

•Over a regenerating peripheral nerve

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•Acute pain

•Chronic pain

•Acute swelling

•Myofascial trigger points

•Muscle guarding

•Muscle spasm

•Acute muscle strain

•Acute ligament sprain

•Acute contusion

•Bursitis

•Tenosynovitis

•Tendinitis

•Delayed onset muscle soreness

•Reducing temperature