Sports Medicine: Just the Facts

Section 5

PRINCIPLES OF REHABILITATION

68 PHYSICAL MODALITIES IN

SPORTS MEDICINE

Alan P Alfano, MD

INTRODUCTION

• The physical modalities use physical forces to speed
  healing and return an athlete to as full a level of func-
  tion as possible.


• These agents should not be used in isolation: they are
  more effective when used as a part of a comprehensive
  treatment approach including medical and/or surgical
  intervention as well as exercise and education.

THERAPEUTIC HEAT

• Energy transfer by physical modalities typically
  occurs by one of three processes: conduction, convec-
  tion, orconversion.


• Conduction:Heat energy is transferred by contact
  from the object of highest energy to the object of
  lowest energy.


• Convection: The process of heat energy transfer
  between a solid object and a moving gas or liquid.


• Conversion: The process of energy transfer that
  involves converting one form of energy to a different
  form. Use of high frequency sound waves or electro-
  magnetic waves to heat tissue will be discussed.


• Heating modalities are divided into superficialand deep.

PHYSIOLOGY OFSUPERFICIALHEAT

• Predominant mode of heating is conduction; however,
  some superficial applications utilize convection or
  conversion.
  
  
  • Superficial heat effects include vasodilitation, pain
    relief, reduction of muscle tone and spasiticity,
    increase cellular metabolic activity, decrease joint
    stiffness, increase soft tissue extensibility, promote
    hyperemia. Elevation of tissue temperature does not
    generally exceed 40ºC and is usually short lived.
  
  
  • Causes superficial vasodilitation preferentially.
  
  
  • May be associated with consensual vasodilitation of
    areas distant to the area being heated. For example,
    the contralateral limb.
    •Changes of 13 to 15°C in the finger joint may change
    joint viscosity by about 20% (Wright, 1961).
  
  
  
  

GENERAL INDICATIONS

•Pain

• Muscle spasm


• Contracture
  •Tension myalgia


• Hematoma resolution


• Bursitis
  •Tenosynoitis


• Fibromylagia


• Superficial thrombophlebitis


• Acceleration of metabolic process

GENERAL CONTRAINDICATIONS

AND PRECAUTIONS

• Acute inflammation, trauma, or hemorrhage


• Bleeding dyscrasia


• Ischemia


• Insensitivity


• Atrophic skin


• Scar tissue


• Inability to communicate

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