Sports Medicine: Just the Facts

CHAPTER 68 • PHYSICAL MODALITIES IN SPORTS MEDICINE 407

SPA THERAPY (BALNEOTHERAPY)

• Little research has addressed these issues for athletes.


• In addition, a comparison of the effects of spa therapy,
  underwater traction, and water jets on low-back pain
  found no specific benefits attributable to balneother-
  apy (Konrad et al, 1992).

FLUIDOTHERAPY

APPLICATION

• Heats by convection:Fine particles fluidized by tur-
  bulent, high-velocity hot air, frequently used in hand
  therapy.


• Despite wide-spread use, benefits of this high-temper-
  ature, remain poorly established (Alcorn et al, 1984;
  Borrell et al, 1980).


• May be used for analgesia or desensitization.

PARAFFIN BATHS

APPLICATION

• Heats primarily by conduction:Liquid mixture of
  paraffin wax and mineral oil.


• Helpful in the treatment of scars and hand contrac-
  tures. Temperatures (52 to 54°C) are higher than those
  of hydrotherapy (<40 to 45°C) but are well tolerated
  due to the low heat capacity of the paraffin-mineral oil
  mixture and a lack of convection.


• Treatment:Dipping, immersion, occasionally brushed
  onto the area of treatment


• Safety:Burns are the main safety concern with paraf-
  fin treatment.


• Visual inspection is important:Paraffin bath should
  have a thin film of white paraffin on its surface or an
  edging around the reservoir.

DIATHERMY (DEEP HEATING)

• The following differences set diathermy apart form
  superficial heating:
  a. Produces higher temperatures
  b.Heats tissue faster and heat dissipates more slowly
  c. Predominantly utilizes sound waves or electromag-
  netic energy

DEEP HEATING MODALITIES

ULTRASOUND

• Ultrasoundis defined as sound waves at a frequency
  above the threshold of human hearing (frequencies
  higher than 20 kHz).

HEATS BYCONVERSION

•Ultrasound uses sound waves to heat tissues. A wide

range of frequencies are potentially useful, but in the

United States most machines operate between 0.8 and

1 MHz.

• Use piezoelectric transducers to convert electrical
  energy into sound.

PHYSIOLOGY

• The most vigorous and deeply penetrating heating
  agent can elevate intramuscular temperatures of by
  about 3.5 to 4.0°C (Draper et al, 1998).


• Penetration, is not uniform and depends markedly on
  tissue properties: Ultrasound beam will selectively
  heat tissue with high water content.


• The ability of ultrasound to heat tissue by the conver-
  sion of sound energy into heat is its best-understood
  capability.


• Nonthermal processes such as cavitation, shock
  waves, streaming, and mechanical deformationhave
  been identified.
  •Cavitation occurs when small gaseous bubbles are
  formed in the presence of a high-intensity ultrasound
  beam and either oscillate stably or grow rapidly in
  size and collapse (Flint and Suslick, 1991).
  •No irreversible harmful effects of cavitation have been
  demonstrated in animal tissue (Frizzell and Dunn,
  1990).


• Streaming is described as movements in water-rich
  tissues and standing waves. Streaming may damage
  tissue or possibly speed healing.
  •Typical intensity for application is 0.8–1.5 W/cm^2
  •Low-intensity ultrasound (15 to 400 mW/cm^2 ) may
  also stimulate cell proliferation, protein synthesis, and
  cytokine production. Although these findings are lim-
  ited to the laboratory, they furnish some support for
  the clinical interest in low-intensity ultrasound in
  wound healing.

ULTRASOUNDINDICATIONS

•Tendonitis and bursitis

• Muscle pain and overuse


• Contractures


• Inflammation and trauma


• Scars and keloids


• The evidence is mixed. In most cases, ultrasound
  comparisons have been done against placebo con-
  trols, therefore the relative effectiveness of this agent
  over that of other conventional approaches is
  unknown.


• Fractures:Low-intensity ultrasound (e.g., 30 mW/cm^2 )
  accelerates bone healing and is approved by the Food
  and Drug Administration (FDA) for the treatment of
  some fractures (Hadjiargyrou et al, 1998).