Physical Agents

Modicication of inflammation and the healing process

Addist furing inflammory phase; Assist during proliferative phase; Assist during the maturation phase

Modifying pain transmission/perception

Affect transmission at the spinal cord level; Change nerve conduction rate; Alter release of neurotransmitters signaling pain

Mechanical Agents

Apply mechanical forces to increase/decrease pressure on the body or its parts; What they do: Alter fluid flow by controlling motion; Examples: Traction (mechanical traction), Compression (elastic bandages, compression pumps), Water (whirlpool), Sound (non-thermal US)

Muscle Tone Abnormalities in Pain Relief

CNS damge causes increased (spastic/rigid) or decreased (flacid) muscle tone; Pain from injury to other tissues - Increased tone occurs around injury to splint and prevent further damage; prolonged "splinting" may slow healing; - Decreased tone occurs secondary to pain and can limit functional activities

Pain relief - Alteration of collagen extensibility

Collagen is the main support system for: skin, tendons, bones & connective tissue; If not used for long periods of time (immobilized, limited ROM, etc) collegenous tissue and its supported structures can become shortened; Increasing the temperature of collagenous tissues prior to completing therapeutic or functional activities ---> Increased ROM

Pain Relief - Length of Use

Continued as long as pain persists but should be stopped when pain subsides

Thermal Agents

Cool or heat tissue, either superficial or deep; What they can do: Change the circulatory rate and chemical reaction of teh tissues following injury; Examples: Deep (Diathermy, Themal US), Superficial heat (hot pack, paraffin, fluids therapy), Cooling (cold pack, ice massage)

Assit during the maturation phase

Helping to balance collagen synthesis and lysis; Improving alignment of the newly laid collagen network

Assist during proliferative phase

Increasing circulation; Increasing enzyme activity rate; Promoting collagen deposition

Effects that may result from the use of madalities

Modification of inflammation and the healing process; Pain relief

Solving the underlying problem causing the pain

Modify tissue inflammation; Alter collagen extensibility; Modify muscle tone

Physical Agents can control pain by

Modifying pain transmission/perception; Solving the underlying problem causing the pain

Modification of muscle tone during Pain Relief

Muscle tone abnormalities; Directly atler muscle tone by altering nerve conduction/sensitivity or altering the biomechanical properties of a muscle; Indirectly alter muscle by reducing pain or addressing teh underlying problem

General Precautions/Contraindications to using Physical Agents

Pregnancy - We don't know all the effects so we take the "better safe than sorry approach"; Malignancy - Will circulation to the area be altered causing the cancerous tissues to spread or grow faster?; Pacemaker - This is usually and ABSOLUTE contraindication. The energy produced by the modality could alter the preset rhythm of the pacemaker and render it ineffective in regulating the heart beat; Impaired Sensation - There is always the possibility the patient could get burned/frostbite from not being able to tell you the temperature is too extreme; Impaired Mentation - Do they understand what you are doing? Can they tell you if the problem is better or not?

Assist during inflammatory phase

Reducing circulation; Controlling motion; Reducing pain; Reducing enzyme activity rate

Physical Agents

The APTA's position on use of physical agents: "Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/madalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy

Three categories of Physical Agents

Thermal agents, Mechanical agents, Electromatgnetic agents

Electomagnetic Agents

Utilize electormagnetic energy to tissue healing; What they do: Alter cellular functional (membrane permeability and transport); Examples: Electromagnetic fields (ultraviolet), Electic currents (TENS, estim)