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Pain

Edema

Spasticity

Facilitate Movement

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Decreased local temperature

Decreased metabolism

Vasoconstriction of superficial arterioles and capillaries (at first)

Decreased superficial blood flow (at first)

Decreased nerve conduction velocity

Decreased delivery of leukocytes and phagocytes

Decreased lymphatic and venous drainage

Decreased muscle excitability

Decreased muscle spindle depolarization

Decreased formation and accumulation of edema

Extreme anesthetic effects

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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

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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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Over a superficial nerve

Hypertension

Impaired cognition

Patients who are very young or very old

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Ice Packs:

filled with crushed or cubed ice

can be applied directly to the skin or with a barrier (towel or pillow case; dry or damp)

duration of treatment generally 10-20 minutes

Commercial Cold Packs:

usually filled with a gel material

applied using a barrier between the pack and the patient (towel or pillow case; dry or damp)

dry towel insulates better; warm/damp towel feels better initially and is a better conductor

towel/pillow case also keeps cold pack clean

duration of treatment generally 10-20 minutes

cold pack quicker to apply than ice pack

Ice Massage:

water frozen in paper or Styrofoam cups

applied directly to the skin

duration of treatment 5-10 minutes

numbness/analgesia is the goal of treatment

can be used prior to stretching/ROM activities and for pain management

Cold/Compression Units:

simultaneous use of cold with compression; cold water is circulated from a reservoir

temperature and pressure may be adjustable for the compression sleeve

will discuss further with compression section of course

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pain

increase ROM

accelerate healing

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Increased local temperature superficially

Increased local metabolism

Vasodilation of arterioles and capillaries

Increased blood flow to part heated

Increased leukocytes and phagocytosis

Increased capillary permeability

Increased lymphatic and venous drainage

Increased metabolic wastes

Increased axon reflex activity

Increased elasticity of muscles, ligaments, and capsule fibers

Analgesia

Increased formation of edema

Decreased muscle tone

Decreased muscle spasm

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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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Types: Superficial: Transfer of heat energy limited to tissue depths of 2 cm or less

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Types: Superficial: Transfer of heat energy limited to tissue depths of 2 cm or less

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Moist Hot Packs or Hydrocollator Packs (Terry hot pack cover):

Silicate gel pack heated in water; water temperature 160-170 deg F

Hot pack is wrapped in dry toweling with 6-8 layers of towels between pack and patient

Terry hot pack covers may be used (1 layer equals approx 2-3 towels)

More layers of toweling needed if body part lies on top of heat pack; weight compresses the towels and decreases insulation to the body

Duration of treatment is generally 15 to 20 minutes; recheck patient after 5 minutes of treatment

Paraffin Bath:

Paraffin wax melted and kept in warmer at 126-134 deg F

Paraffin has a low thermal conductivity and low specific heat; safe to apply to the skin at this temperature

Hand is washed before immersion in the wax

Dip hand into wax and remove; once initial wax layer has hardened, repeat dipping and buildup 6 layers of wax

Cover with plastic wrap and towel to hold in the heat

Duration of treatment is generally 15 to 20 minutes

Remove and discard wax when treatment is completed

Fluidotherapy: Constrast Bath:

Dry heating modality that transfers heat via convection; suspended media (ground-up corn cob) circulated by warm air

Has ability to simultaneously provide heat, massage, desensitization

Patient able to exercise part being treated during fluidotherapy

Temperature range varies by body part and patient tolerance (generally100-118 deg F)

Duration 15-20 minutes

Constrast Bath:

Two basins filled with water

one basin with cool or cold water to 50-64 deg F

one basin with warm or hot water to 100-111 deg F

Immerse extremity in water and alternate between warm/cold basins

3-10 minutes in the warm water followed by 1-3 minutes of cool water

repeat cycle 5-6 times; total duration of treatment 25-30 minutes

used to promote superficial circulation, desensitization, decrease pain, improve flexibility while avoiding increase in edema

Some have used contrast baths for edema management based upon rationale of alternating vasodilation/vasoconstriction; no research available to support efficacy of this effect

Cycle:

5 min = warm

1 min = cold

5 min= warm

1 min = cold

5 min = warm

1 min= cold

5 min= warm

1 min = cold

5 min = warm

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Use of electricity to treat disease and dysfunction includes electricity used for:

Muscle contractions for strengthening, improving endurance, improving motor control

Pain management

Edema management

Spasticity management

Tissue healing

Enhancement of transdermal drug delivery

Providing electromyographic feedback

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EMS--- electrical muscle stimulation; application of electricity directly to a muscle to elicit a contraction; used to elicit a contraction in denervated muscle

NMES--- neuromuscular electrical stimulation; stimulation of motor nerves to elicit a muscle contraction; used to elicit a contraction in innervated muscle

FES--- functional electrical stimulation; use of electrical stimulation to activate muscles to perform functional activities; such as use of electrical stimulation to activate ankle dorsiflexion during swing phase of gait cycle

TENS--- transcutaneous electrical nerve stimulation; synonymous with use of electrical stimulation for pain management

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Direct Current (DC):

Also called galvanic current

Continuous unidirectional flow of charged particles

One electrode is always the anode (positive polarity), one electrode is always the cathode (negative polarity) during the stimulation period

An accumulation of charge can occur under the electrodes leading to a chemical effect on the tissues

Used often to deliver medication through skin (iontophoresis) and to stimulate denervated muscle

DC can be perceived as being uncomfortable

Alternating Current (AC):

Continuous sinusoidal, bidirectional flow of

charged particles

One electrode is anode and other is a cathode, however the electrodes continuously changing polarity with each cycle

Can be used for pain management and to elicit muscle contractions

Pulsed Current (PC):

Interrupted flow of charged particles;

current flows in series of pulses

Monophasic---unidirectional like DC

Biphasic--- bidirectional (biphasic) like AC; examples include most TENS units and some NMES units; most commonly used waveform in electrotherapy

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Parameters: Amplitude = Voltage = Current Intensity 

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Parameters: Amplitude = Voltage = Current Intensity 

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Frequency:

Number of cycles per sec (for AC) or

pulses per sec (for Pulsed Current)

Measured in hertz (Hz)

Amplitude (intensity):

Magnitude of the current flow or voltage

Current intensity can be measured in:

Amperes (Amps) or mA or μA

Volts (V) or mV or μV

Labeled as intensity on electrotherapy devices

3 clinical levels of stimulation commonly used with electrical stimulation:

Sensory--- tingling, prickling, or pins and needles

Motor--- muscle contraction

Noxious--- strong, uncomfortable; sharp or burning pain sensation; strong muscle contraction

On and Off times:

On Time (Hold Time)--- number of

seconds the current is on

Off Time (Relax Time)--- number of seconds the current is off

Frequently expressed as a ratio such as:

• 1:1, 10 sec on & 10 sec off

• 1:3, 10 sec on & 30 sec off

1:5, 10 sec on & 50 sec off

Ramp-up and Ramp-Down:

Ramp-up Time--- number of

seconds for current amplitude to reach maximum amount

Ramp-down Time--- number of seconds for current amplitude to return to zero from maximum amount

Gradual increase and decrease in amplitude helps to minimize discomfort when electrical stimulation comes on and goes off

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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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Purpose: Deep heating: Tissue depth of penetration up to approximately 5 cm 

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Purpose: Deep heating: Tissue depth of penetration up to approximately 5 cm 

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Treatment of small areas

Thermal:

Improvement of ROM

Reduction of Pain

NonThermal:

Acceleration of tissue healing

transdermal delivery of medication

bone healing

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Increased circulation

Acceleration of metabolic rate

Decreased pain

Decreased muscle spasm

Increased soft tissue extensibility

Altered nerve conduction velocity; increased in normal nerves

Heats tissues with high absorption coefficients; tissues with higher collagen content;

Lower absorption in tissues with high water content

US well suited for heating tendons, ligaments, joint capsules,

fascia without overheating overlying fat

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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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ROM:

Duty Cycle: 100%

Frequency: 1 or 3 MHz depending on depth of tissue

Intensity: 0.5 to 1.0 W/cm2 if using 3 MHz; 1.5 to 2.0 W/cm2 if using 1 MHz

Duration: 5 to 10 Minutes per area that is 2x the ERA

Pain Control:

Duty Cycle: 100%

Frequency: 1 or 3 MHz depending on tissue depth

Intensity: > 0.5 W/cm2

Duration: 5 to 10 minutes per area that is 2x the ERA

Tissue healing:

Duty Cycle: 20%

Frequency: 1 or 3 MHz depending upon tissue depth

Intensity: 0.5 W/cm2 to 1.0 W/cm2

Duration: 5 to 10 minutes per area that is 2x the ERA

Phonophoresis:

Duty Cycle: 20%

Frequency: 3 MHz (to focus ultrasound energy at the skin level)

Intensity: 0.5 W/cm2 to 1.0 W/cm2

Duration: 5 to 10 minutes per area that is 2x the ERA

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To treat hyperhydrosis

To treat musculoskeletal conditions

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Calcific tendonitis

myositis ossificans

local anesthesia

inflammatory conditions

relief of Joint and Muscle pain

To reduce swelling and edema

skin conditions

Adhesive capsulitis (frozen shoulder)

bursitis

tendosynovitis

tension headache

inhibition of spasticity

Reduce calcification in the body

To manage scar tissue

to relieve local edema

Pilocarpine iontophoresis is also used to stimulate sweat secretion, as part of cystic fibrosis diagnosis.

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open wounds, burns, skin grafting, or scar

cardiac pacemakers

allergy to medication

loss of sensation

greasy or dirty skin

sole of foot (hard for the ions to pass inside)

epilepsy, seizures

heart disease

metal implant

pregnancy

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don’t use two chemicals under the same electrode,even if they are from the same polarity.

don’t administer ions with opposite polarities during the same treatment session

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the skin should be abrasion/cut free and the area carefully washed (soap and water is fine)

dry electrodes are inappropriate and should not be used.

if pre-gelled electrodes are being used, ensure that a good even contact is achieved.

adequate fixation of the electrode and pad to the skin needs to be carefully maintained

uneven current distribution can easily lead to skin burns or irritation.

explain to the patient what is expected and ensure that they know to report immediately if any untoward or painful sensation are felt.

turn the current up slowly to the required amount.

at the end of the treatment time, ensure that the current is turned down slowly

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https://mobilephysiotherapyclinic.net/iontophorosis/#google_vignette

https://www.physio-pedia.com/Iontophoresis

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~the term iontophoresis is simply defined as ion transfer(ionto=ion),(phoresis=transfer)

~introduction of ions into the body using direct electrical current.

~it is a specialized technique of electrical stimulation that uses electrical polarity of continuous direct current to ionize medicines placed beneath surface electrodes and transfers them into the body through the skin.

Basic principle of Iontophorosis :-
Current required:-
~in order to 'drive' the ions into the tissues ,a direct (galvanic) current needs to be employed.
~a monophasic pulsed application can also be used.
~constant current is preferable to constant voltage thus,the magnitude of the applied current will not exceed the preset level in terms of skin resistance.
Ionic Polarity:- Low -level Amplitude:- Electrode size:-
~the negative electrode should be made larger than the positive electrode(usually twice).
~enlarging the negative electrode size lowers the current density on the negative pad,leading to reduction of irritation.
Ionic penetration:-
~penetration does not exceed 1mm.
~subsequent deeper absorption through the capillary circulation.
~the bulk of deposited ion at the active electrode are stored,to be depleted by the sweep of circulating blood.
Acid/alkaline reaction:-
~will get ACID accumulation under the POSITIVE (anode)electrode (weak HCL).
~this is because negatively charged chloride ions (CL- from NACL)is attracted towards the anode.
~this is considered sclerotic,which tends to harden tissues,serving as an analgesic agent due to local release of oxygen.

* Hyperemia:-
~both the positive and negative electrodes produce hyperemia and heat due to the resulting vasodilatation.
~the cathodal hyperemia is generally more pronounced and takes more time to disappear than that of the anode.
~generally,hyperemia under both electrodes,does not last than more hour.
Disscoation:-
~chemical burns
~heat burns
~sensitivities and allergic reactions to ions.
Chemical burns:- Heat burns:- Allergic reactions to ions:-

Calcific tendonitis

myositis ossificans

local anesthesia

inflammatory conditions

relief of Joint and Muscle pain

To reduce swelling and edema

skin conditions

adhesive capsulitis (Frozen shoulder)

bursitis

tendosynovitis

tension headache

inhibition of spasticity

Reduce calcification in the body

To manage scar tissue

to relieve local edema

Pilocarpine iontophoresis is also used to stimulate sweat secretion, as part of cystic fibrosis diagnosis.

~don't use two chemicals under the same electrode,even if they are from the same polarity.
~don't administer ions with opposite polarities during the same treatment session.
Current Density:-
~the current density measured in mA/cm2.
~if the current density reaches too high a level,tissue damage,especially skin burn,may ensue.
~it is suggested that a maximum safe current density of,
~o.5 mA/cm2 is applicable at the negative(cathode) and
~1.0 mA/cm2 at the positive(anodal)electrode.
Current Intensity:-
~calculated as:-
~maximum current(mA)=maximum safe current density(mA/cm2) X electrode area(cm2)
~recommended current intensity is 3 to 5 mA.
Treatment time:-
~treatment time:-ranges between 10-20 min.
~patient should be comfortable with no reported or visible signs of pain or burning.
~check skin every 3-5 minutes for signs of skin irritation.
Formula for iontophorosis:-
Electrodes:-
~Traditional electrodes
~Commercial electrodes
Traditional electrodes:- Commercial electrodes:-
~sold with most iontophoresis systems.
~electrodes have a small chamber covered by a semipermeable membrane into which ionized solution may be injected.
~the electrodes self adheres to the skin.
Electrode preparation:-
~attach self-adhering active electrode to skin.
~ inject ionized solution into the chamber.
~attach self-adhering inactive to the skin and attach lead wires from the generator.
Application:-
~the skin should be abrasion/cut free and
~the area carefully washed (soap and water is fine)

~dry electrodes are inappropriate and should not be used.
~if pregelled electrodes are being used,ensure that a good even contact is achieved.

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Iontophorosis : Indication, Contraindication, Precaution - Mobile Physio.

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the term iontophorosis is simply defined as ion transfer(ionto=ion),(phoresis=transfer), ions into the body using electrical current.

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Biostimulation/tissue regeneration

reduction of inflammation

analgesia

enhanced immune function/antimicrobial

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Dermal wounds (open wounds, chronic ulcers, pressure sores)

Arthritic conditions (Rheumatoid arthritis, osteoarthritis)

Acupuncture and (myofascial) trigger points

Soft-tissue injuries (muscle tears, bruising, hematoma)

Tendinopathies

Pain relief of various etiologies:

Neck / Low Back pain

Arthrogenic pain

Neuropathic and neurogenic pain, including herpes/postherpetic pain

Temporomandibular disorders

Carpal tunnel syndrome

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eyes

over the low back, abdomen or pelvic region during pregnancy or menstruation

regions of known or suspected malignancy

actively bleeding tissue or persons with untreated haemorrhagic disorders

regions with recently radiated tissues (for 6 months following irradiation)

tissues infected with tuberculosis or other forms of virulent bacteria

persons with impaired cognition or communication

regions with active deep vein thrombosis or thrombophlebitis

persons with photosensitivity disorders (xeroderma pigmentosum) or systemic lupus erythematosus

reproductive organs (testes)

over areas of decreased sensation

over the thyroid gland

over the heart or vagus nerve of cardiac patients

persons with infections who have a compromised immune function

persons with epilepsy

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Over infected tissue (e.g. infected open wound)

Over the sympathetic ganglia, vagus nerves and cardiac region in patients with heart disease

Over photosensitive areas

Patient with epilepsy

Areas of altered skin sensation

Areas with Tattoos

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Has instructions for application

https://www.enraf-nonius.com/index.php/enraf-academy/laser-therapy

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Enraf-Nonius, products for physiotherapy and rehabilitation, partner for life

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instrument-based learning process that is based on “operant conditioning” techniques

improve the ability to modify involuntary processes consciously

refine a movement sequence or activation pattern to assist patients to achieve a goal

gets to know his own body signs and that he can control them consciously in the first place using biofeedback equipment, afterwards even without

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Direct Feedback: measured variable, as in the case of heart rate or heart rate variability, where a numerical value is displayed on a wearable device, such as a watch.

Transformed Feedback: measured variable, where the measurements are used to control an adaptive auditory signal, visual display or tactile feedback method. [4]

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Constipation

Fecal incontinence

Urinary incontinence

Chronic pain - includes chronic low back pain, chronic pelvic pain, and other pain syndromes

Chronic insomnia

Migraine headaches

Chronic fatigue

Fibromyalgia

Epilepsy

Motion sickness

Depression

Anxiety

Raynaud phenomenon

CVA

CVS/Fibromyalgia

Chronic pain

Neck pain

Post-traumatic stress syndrome

Hypertension

Headache – migraine – tension headache

Balance disorders

Attention Deficit Hyperactivity Disorder

Epilepsy

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Electromyography (EMG) - measures muscle tension

Thermal biofeedback - measures skin temperature

Neurofeedback/ electroencephalography (EEG) - measures brain wave activity

Electrodermography (EDG) - measures skin electrical activity

Heat Flux - measures the rate at which heat is being dissipated from the body

Pneumography - measures abdominal/chest movement when breathing

Capnometry - measures end-tidal carbon dioxide

Hemoencephalography - measures the differences in the colour of light reflected back through the scalp based on the relative amount of oxygenated and unoxygenated blood in the brain

Photoplethysmography (PPG) - measures peripheral blood flow, heart rate, and heart rate variability