Study therapeutic modalities for your Athletic Training certification exam. This guide covers ultrasound, electrical stimulation, cryotherapy, thermotherapy, and hydrotherapy applications.
Q: Healing Phases
Answer: InflammationProliferation (fibroplastic)Remodeling (maturation)
Q: Inflammation Phases
Answer: During inflammation, the injury is contained and stabilized and debris is removed.
Q: proliferation Phases
Answer: During proliferation, fibroblasts, myofibroblasts, and collagen peak to begin granulation tissue formation and angiogenesis.
Q: remodeling Phases
Answer: During remodeling, wound contraction is well under way, and Type III collagen is converted to Type I collagen to stabilize and restore the injury site.
Q: acute care
Answer: Treatment of an acute injury during the first 4 days after the injury.
Q: acute injury
Answer: An injury of sudden onset, caused by highintensity, short-duration forces; examples are sprains, strains, and contusions.
Q: A-delta fiber
Answer: A peripheral nerve that carries sensations, including nociceptive stimuli that result in acute pain; larger and faster-acting than C fibers.
Q: A fiber
Answer: The largest 1-22 um in diameter nerve fiber; conducts action potentials the most rapidly 5-120 m/sec. Some A fibers are sensory; others have a motor function.
Q: agility
Answer: A combination of speed of movement and coordination; developed as skill patterns are performed quickly, usually with sport-specific team drills.
Q: best practice (standard of care, standard therapy)
Answer: Treating a specific patient’s specific condition in the way that will lead to resolution of the condition in the most complete and expedient manner possible; treatment that experts agree is appropriate, accepted, widely used, and reproducible.
Q: biofeedback
Answer: A process of measuring a biological mechanism using an objective means and then telling the patient his scores. The feedback helps the patient progress more quickly.
Q: biphasic
Answer: A pulse with two phases; current flows in both directions.
Q: bipolar technique
Answer: The application of electrodes of equal size, resulting in essentially equal current density under them; both electrodes are, therefore, active.
Q: brief-intense TENS Also known as noxious TENS.
Answer: A modality used to treat chronic pain before rehabilitation by stimulating C fibers; beat frequency varies between low and high and changes periodically; intensity higher than sensory mode TENS . The patient reports a burning, needling sensation and twitch and tetanic muscle contractions.
Q: burst
Answer: A finite series of pulses or a finite interval of AC at a specific frequency flowing for a limited time period, followed by no current flow e.g., turning a pulse train or AC on and off.
Q: chronic injury
Answer: 1 An injury caused by low-intensity, long-duration forces, in tendinitis or bursitis. 2 A recurring acute injury, such as a chronic sprained ankle.
Q: continuous ultrasound
Answer: An ultrasound mode in which the sound intensity remains constant throughout the treatment and the ultrasound energy is being produced 100% of the time.
Q: contraindications
Answer: Situations in which a specific modality should not be used—that is, situations in which it may do more harm than good.
Q: contrast bath therapy
Answer: The alternating immersion of an injured body part in hot and cold water baths.
Q: coulomb
Answer: The basic unit of charge, produced by 6.28 x 1018 displaced electrons 6280 quadrillion.
Q: coupling medium
Answer: In ultrasound, a substance that facilitates the transmission of ultrasound energy by decreasing impedance at the air-skin interface.
Q: coupling medium
Answer: In electrotherapy, a substance that facilitates the transmission of electrical current from the electrodes to the skin; also called couplant.
Q: cryokinetics
Answer: Alternating cold application and active graded exercise for rehabilitating acute joint sprains.
Q: cryostretch
Answer: Alternating cold application, passive stretch, and resistive muscle contraction for rehabilitating acute muscle strains.
Q: cryotherapy
Answer: The therapeutic use of cold; the application of a device or substance with a temperature less than body temperature, thus causing heat to pass from the body to the cryotherapy device.
Q: daily adjustable progressive resistive exercise (DAPRE) technique
Answer: An aggressive, four-set system of isotonic weight lifting that takes advantage of the fact that strength can be redeveloped more quickly than it was developed initially. Patients perform maximal repetitions during their third and fourth sets, and the number of repetitions performed is used as a basis for adjusting the resistance during the fourth set and on the next day, respectively.
Q: deep thermotherapy
Answer: The application of modalities that cause a tissue temperature rise TTR in deeper tissues.
Q: diathermy
Answer: The therapeutic use of high-frequency electromagnetic waves to heat deep tissues.
Q: duty cycle
Answer: The percentage of time that ultrasound is being generated pulse duration over one pulse period.
Q: Radiation
Answer: Radiation is the transfer of energy in the form of infrared waves radiant energy without physical contact. All matter radiates energy in the form of heat. Usually, body heat is warmer than the environment, and radiant heat energy is dissipated through the air to surrounding solid, cooler objects.
Q: Conduction
Answer: Conduction is the direct transfer of energy between two objects in physical contact with each other. A difference in temperature is necessary to initiate the movement of kinetic energy from one molecule to another, and the energy moves from an area of high temperature to an area of lower temperature.
Q: Convection
Answer: Convection, a more rapid process than conduction, occurs when a medium such as air or water moves across the body, creating temperature variations.
Q: Conversion
Answer: Conversion involves the changing of another energy form e.g., sound, electricity, or a chemical agent into heat.
Q: Reflection
Answer: The energy wave may be partially or fully reflected by the tissue layer.
Q: Refraction
Answer: The energy wave is bent as it strikes an interface between two different tissue layer densities.
Q: Absorption
Answer: Energy can be absorbed by one layer reducing the energy available to deeper tissues.
Q: Transmission
Answer: Any energy that is not reflected or absorbed by a tissue layer will continue to pass through the medium to the next layer, where it can again be reflected, refracted, absorbed, or transmitted through the tissue.
Q: cosine law
Answer: When energy is applied to a body part, the maximal effect occurs when energy rays strike the body at a right angle 90°. As the angle deviates from 90°, some of the energy is reflected away from the targeted site, thereby reducing the level of absorption.
Q: Cold application
Answer: Cold application causes vasoconstriction and decreased vascular permeability, which can lead to decreased cell metabolism, inflammation, circulation, pain perception, muscle spasm, muscle force production, and increased tissue stiffness.
Q: What is the intent of cold application?
Answer: The intent of cold application immediately following injury is to reduce the area of secondary injury, thus limiting the total amount of damaged tissue that needs repair. Depth of cold penetration can reach 4 to 5 cm and is dependent on the duration of treatment, the depth, and type of tissue. The longer the treatment, the greater the depth of cooling, and the greater the decrease in temperature.
Q: Ice application time
Answer: Cryotherapy is usually applied for 20 to 30 minutes several times a day for maximum cooling of both superficial and deep tissues. Ice application is continued during the first 24 to 72 hours after injury or until acute bleeding and capillary leakage have stopped, whichever is longer.
Q: cryokinetics
Answer: Cryokinetics alternates several bouts of cold using ice massage, ice packs, ice immersion, or iced towels with active exercise. The injured body part is numbed by applying cold for 10 to 20 minutes, and the individual is instructed to perform various progressive exercises.
Q: Controlled Compression Therapy Units -CCT
Answer: CCT units use static, external compression and cold application to decrease blood flow to an extremity and to assist venous return, to decrease edema, and to increase the effective depth of cold penetration.In doing so, both pain and recovery time is decreased.
Q: Ice Immersion
Answer: Bucket immersion Temperature – 40° to 50°F.Whirlpool temperature – 50° to 60°F.Treatment time- 10 to 15 minutes.
Q: Thermotherapy
Answer: Heat application. Thermotherapy, typically is used during the second phase of rehabilitation to increase blood flow and to promote healing in the injured area. When applied at the appropriate time, however, heat can increase circulation and cellular metabolism; produce an analgesic, or sedative, effect; and assist in the resolution of pain and muscle-guarding spasms.
Q: hyperemia
Answer: An increase in the quantity of blood flow to a body part.
Q: Contrast Baths
Answer: A contrast bath alternates between cold and hot tubs or whirlpools. This elicits a local vasoconstriction-vasodilation fluctuation to reduce edema and restore ROM in subacute or chronic injuries.
Q: Cold whirlpools
Answer: 55°F-65°F for 5-15 minutes
Q: Hot whirlpools
Answer: 98°F-110°F for 20-30 minutes
Q: Paraffin Baths
Answer: Paraffin bath are used to treat subacute or chronic rheumatoid arthritis associated with joint stiffness and decreased ROM as well as other common chronic injuries and diseases, such as systemic sclerosis. The temperature of the paraffin bath is between 113° to 129°F Treatment time is between 15 to 20 minutes.
Q: 1-MHz ultrasound
Answer: The more commonly used 1-MHz ultrasound heats tissue from 3 to 5 cm deep,
Q: 3-MHz ultrasound
Answer: 3-MHz ultrasound heats tissue is usually transmitted from 2 to 3 cm deep.
Q: ultrasound Intensity
Answer: Therapeutic intensities are expressed in Watts per square centimeter W/cm2 and range from 0.25 to 2.0 W/cm2. The greater the intensity, the greater the resulting temperature elevation. Thermal temperature can increase 7° to 8°F up to 2.5 cm deep in the muscle after the application of ultrasound at 1.5 W/cm2 for 10 minutes.
Q: Clinical Uses of Ultrasound
Answer: Ultrasound is used to manage several soft-tissue conditions, such as tendinitis, bursitis, and muscle spasm; to reabsorb calcium deposits in soft tissue; and to reduce joint contractures, pain, and scar tissue. Wound healing is enhanced with low-intensity, pulsed ultrasound.
Q: Clinical Uses of Ultrasound Continued
Answer: It is recommended that ultrasound treatment should begin 2 weeks after an injury, during the proliferative phase of healing. Tissue healing is thought to occur predominantly through nonthermal effects.
Q: Clinical Uses of Ultrasound Continued
Answer: An intensity of 0.5 to 1.0 W/cm2 pulsed at 20% is recommended for superficial wounds. For skin lesions and ulcers, a frequency of 3 MHz or higher is recommended.
Q: Cavitation
Answer: Gas bubble formation because of nonthermal effects of ultrasound.
Q: Phonophoresis
Answer: Phonophoresis is a technique in which the mechanical effects of ultrasound are used to enhance percutaneous absorption of anti-inflammatory drugs e.g., cortisol, dexamethasone, and salicylates and local analgesics e.g., lidocaine through the skin to the underlying tissues.
Q: Phonophoresis Parameters
Answer: Continuous ultrasound is used, because tissue permeability is increased by the thermal effects and, therefore, the medication is more easily absorbed. Treatment occurs at a lower intensity i.e., 1.0 to 1.5 W/cm2 for 5 to 15 minutes.
Q: what is Continuous Shortwave Diathermy used for?
Answer: CSWD is used to increase the extensibility of deep collagen tissue, to decrease joint stiffness, to relieve deep pain and muscle spasm, to increase blood flow, to assist in the resolution of inflammation, and to facilitate the healing of soft-tissue injuries in the postacute stage.
Q: What is Electrical therapy used for?
Answer: The various forms of electrotherapy are used to decrease pain; increase blood flow, ROM, and muscle strength; reeducate muscle; facilitate the absorption of anti-inflammatory, analgesic, or anesthetic drugs to the injured area; and promote wound healing.
Q: Duty Cycle
Answer: Duty cycle refers to the ratio of the amount of time that current is flowing i.e., on time to the amount of time it is not flowing i.e., off time.
Q: Transcutaneous Electrical Nerve Stimulation TENS
Answer: It is thought that TENS works to override the body’s internal signals of pain gate theory of pain or to stimulate the release of endorphins, a strong, opiatelike substance produced by the body.
Q: Neuromuscular electrical stimulation NMES
Answer: NMES units are designed to elicit a muscle contraction of moderately high intensity with relatively little patient discomfort, and they typically involve biphasic currents with a duty cycle.
Q: High-voltage electrical stimulation
Answer: High-voltage electrical stimulation uses an output of 100 to 500 V to reduce edema, pain, and muscle spasm during the acute phase. It also is used to exercise muscle and delay atrophy, maintain muscle size and strength during periods of immobilization, reeducate muscles, and increase blood flow to tissues
Q: Russian Current
Answer: Russian electrical stimulation is designed to produce an isometric contraction and is useful in muscle reeducation.
Q: Iontophoresis
Answer: It is used as a local anesthetic to treat inflammatory conditions, such as arthritis, myositis ossificans, plantar fasciitis; myofascial pain syndrome; and skin conditions by reducing edema.
Q: Massage
Answer: Massage involves the manipulation of soft tissues to increase cutaneous circulation, cell metabolism, and venous and lymphatic flow to assist in the removal of edema; to stretch superficial scar tissue; to alleviate soft-tissue adhesions; and to decrease neuromuscular excitability
Q: What are the five basic Massage strokes?
Answer: 1. Effleurage -stroking2. Petrissage -kneading3. Tapotement -percussion4. Vibration5. Friction
Q: Effleurage – stroking
Answer: Effleurage is a superficial, longitudinal stroke to relax the patient. When applied toward the heart, it reduces swelling and aids in venous return. It is the most commonly used stroke, and it begins and ends each massage.
Q: Petrissage – kneading
Answer: Petrissage consists of pressing and rolling the muscles under the fingers and hands. This “milking” action over deep tissues and muscle increases venous and lymphatic return and removes metabolic waste products from the injured area.
Q: Tapotement
Answer: Tapotement uses sharp, alternating, brisk hand movements, such as hacking, slapping, beating, cupping, and clapping, to increase blood flow and stimulate peripheral nerve endings.
Q: Vibration
Answer: Vibration consists of finite, gentle, and rhythmic movement of the fingers to vibrate the underlying tissues. It is used for relaxation or stimulation.
Q: Friction
Answer: Friction is the deepest form of massage and consists of deep, circular motions performed by the thumb, knuckles, or ends of the fingers at right angles to the involved tissue. These deep circular movements can loosen adherent fibrous tissue scars, aid in the absorption of an edema, and reduce localized muscular spasm.
Q: Continuous Passive Motion CPM
Answer: Continuous passive motion is a modality that applies an external force to move the joint through a preset arc of motion. It primarily is used postsurgically at the knee, after knee manipulation, or after stable fixation of intra-articular and extra-articular fractures of most joints, such as the hand, wrist, hip, shoulder, elbow, and ankle.
Q: Aspirin
Answer: Aspirin is the most commonly used drug to relieve pain and inflammation. A normal dosage is 325 to 650 mg every 4 hours.
Q: Acetaminophen (e.g., Tylenol
Answer: Acetaminophen e.g., Tylenol is an analgesic and an antipyretic, but it does not have any appreciable anti-inflammatory or anticlotting effects. Unlike aspirin, acetaminophen is not associated with gastrointestinal irritation; however, high doses can be toxic to the liver and even may be fatal.
Q: nonsteroidal anti-inflammatory drugs -NSAIDs
Answer: NSAIDs commonly are used to dilate blood vessels and to inhibit the production of prostaglandins. Examples of NSAIDs include ibuprofen e.g., Advil, Nuprin, Motrin, and Rufen, naproxen sodium e.g., Aleve, indomethacin e.g., Indocin, and piroxicam e.g., Feldene. Ibuprofen and the other NSAIDs are administered primarily for pain relief and anti-inflammatory effects;