• Ice packs filled with crushed or cubed ice (10-20 mins)

• Commercial cold packs (10-20 mins)

• Ice massage (5-10 mins)

• Cold/Compression Units

Indications: Acute & chronic pain, acute swelling, myofascial trigger points, muscle guarding, muscle spasms, acute muscle strain, acute ligament sprain, acute contusion, bursitis, tenosynovitis, tendinitis, delayed onset muscle soreness, reducing temperature

Contraindications: Raynaud's disease or phenomenon, over an area with circulatory compromise, peripheral vascular disease, hypersensitivity to cold, skin anesthesia, open wound or skin infections, infection, cold intolerance, cryoglobulinemia, paroxysmal cold hemoglobinuria, over a regenerating peripheral nerve

Precautions: Over a superficial nerve, hypertension, impaired cognition, patients who are very young or very old.

References

Curtis, D. (2023). Biophysical agents [PowerPoint slides]. Unpublished class presentation.

• Moist Hot Packs (hydrocollator packs) (15-20 mins checking every 5)

• Paraffin Bath (15-20 mins)

• Fluidotherapy (15-20 mins)

• Contrast Bath (3-10 mins warm followed by 1-3 mins cool for 5-6 rounds)

Indications: 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

Contraindications: Acute musculoskeletal conditions, areas of impaired circulation, peripheral vascular disease, skin anesthesia, open wounds or skin conditions, malignant tumors, infrared irradiation of the eyes, impaired mentation

Precautions: Pregnancy, cardiac insufficiency, poor thermoregulation, patients who are very young and very old, edema, metal in the area, demyelinated nerves, over areas where counterirritants have been applied

References

Curtis, D. (2023). Biophysical agents [PowerPoint slides]. Unpublished class presentation.

• Applied using transducer and coupling agent gel.

• Duty cycle can be adjusted to produce desired array of thermal and nonthermal affects

• Consistently move transducer to reduce risk of hot spots

• Frequency impacts depth of tissue healing

Indications

Acute and post-acute conditions, soft tissue healing and repair, scar tissue, joint contracture, chronic inflammation, increase extensibility of collagen, reduction of muscle spasms, pain modulation, increase blood flow, bone healing, inflammation from Myositis Ossificans, plantar warts, myofascial trigger points.

Contraindications

Thermal ultrasound for acute and post-acute conditions, areas with decreased temperature sensation and 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 tissue.

Precautions

Fracture

References

Curtis, D. (2023). Biophysical agents [PowerPoint slides]. Unpublished class presentation.

• A transdermal drug delivery system where an electric current is used to promote localized, superficial of a medication

• high current, long administration, and electrode placement can cause skin damage, burns, itching, and discomfort.

Indications

Localized delivery of local anesthetics, antiperspirants, anti-inflammatory agents into subcutaneous tissues or joint spaces, and antimigraine agents.

Contraindications

Hypersensitivity to the delivered drug, cardia arrhythmias ro hypercoagulability, pacemakers, pregnancy.

Precautions

Avoid wires, staples, orthopedic implants, skin lesions, and areas with impaired sensation.

Reference

Sheikh, N. K., & Dua, A. (2021). Iontophoresis Analgesic Medications. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553090/

• A non-invasive light source treatment

Indications

Osteoarthritis of hip, knee, ankle, rheumatoid arthritis, shoulder impingement, hip or shoulder bursitis, low back disc degeneration, disc herniation, sciatica, neuropathic pain, tendonitis, tennis elbow, plantar fasciitis, lymphedema.

Contraindications

Anywhere around the eyes, pregnancy, individuals with epilepsy, known site of cancer.

Precautions

Avoid eye exposure.

References

Bahire, E. (2017). Low Level Laser Therapy. Physiopedia. https://www.physio-pedia.com/Low_Level_Laser_Therapy

• EMS - electrical muscle stimulation

• NMES - neuromuscular electrical stimulation

• FES - functional electrical stimulation

• TENS - transcutaneous electrical nerve stimulation

Indications

Acute, post-acute, and chronic pain, stimulation of denervated muscle, slowing muscle atrophy, muscle strengthening and reeducation, stimulation of venous and lymphatic circulation, management of edema, muscle spasms, muscle guarding, wound, fracture, tendon, ligament healing.

Contraindications

Pacemaker, implanted cardiac defibrillator, infection, malignancy, pregnancy, over areas of known thrombosis or thrombophlebitis, musculoskeletal problems where muscle contraction would worsen symptoms.

Precautions

Impaired sensation or mentation, cardiac disease, areas of skin irritation or open wounds

References

Curtis, D. (2023). Biophysical agents [PowerPoint slides]. Unpublished class presentation.

• A technique used to increase external feedback for neuromuscular clients.

• Two main categories - biomechanical, physiological

Indications

Constipation, fecal & urinary incontinence, chronic pain (low back, pelvic, and others), chronic insomnia, migraines, chronic fatigue, epilepsy, fibromyalgia, motion sickness, depression, anxiety, raynaud phenomenon.

Contraindications

N/A, relies on active participants.

Precautions

As sole treatment modality for severe hypertension, clients with acute psychiatric conditions.

References

Malik, K., & Dua, A. (2021). Biofeedback. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553075/

• Mechanical devices that apply force

• mechanical traction

• vasopneumatic devices

• continuous passive-motion machines

Indications

disc herniation, nerve impingement, muscle spasms, postural issues, plantar fasciitis, lymphoedema, burns, fractures, systematic diseases.

Contraindications

Spine malignancy, osteoporosis, osteomyelitis, fracture, insability (such as down syndrome, ehlers-danlos, subluxation, uncontrolled hypertension, Marfan syndrom, Rheumatoid arthritis) sensitivity to pain, bleeding disorders, open wounds, acute inflammation, severe organ conditions.

Precautions

hypersensitivity to touch, superficial pressure, and or pain.

References

Chen, P. (2016). Therapeutic Modalities – PM&R KnowledgeNow. Aapmr.org. https://now.aapmr.org/therapeutic-modalities/