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96 terms

PTA 130- Physical Agents

STUDY
PLAY
Physical agents
Energy and materials applied to patients
Types of physical agents
Thermal
Diathermy
Ultrasound
cryotherapy
Mechanical
Water
Traction
massage
Electromagnetic
UV
Laser
TENS
Pulsed shortwave diathermy
Electrical Stimulation
General contraindications
Pregnancy
Malignancy
Pacemaker or implanted device
Impaired sensation
Impaired mentation
Effects of physical agents
Inflammation and healing
Pain reduction
Collagen extensibility
Muscle tone
Modalities as adjunct to therapy
Based on the physiological response of tissues
Understand the responses to injury
Understand how tissues heal

Rehabilitative process
Decisions
Available options
Which modality will be most effective
The healing process
Inflammatory response phase
Proliferation(Fibroblastic) repair phase
Maturation remodeling phase
Inflammatory stage
1-6 days
Immediate vasoconstriction
Vasodilation
Clot formation
Phagocytes
Vasoconstriction
rapid constriction of the blood vessels to decrease blood flow to the area
Inflammation
redness Rubor
swelling Tubor
tenderness Dolor
increased temperature Calor
Angiogenesis
Neovascularization
Development of new blood vessels
Healing cannot occur without angiogenesis
Factors that impede healing
Local factors:
Type, size and location of injury
Circulation
Degree of injury
Tissue integrity
Age
Nutrition
Disease/co-morbidity
Infection
Vascular supply
External forces*** physical agents
Healing of musculoskeletal tissue
Type and extent of the injury
Regenerative capacity of the tissue
Vascular supply of the injured site
Extent of damage to the extracellular framework
Cartilage
Limited ability to heal
Lacks lymphatics, blood vessels and nerves

Injuries combined with injury to subchondral bone
Stem cells used
Tendons and ligaments
Repair potential for tendon is controversial
Differences
Stress is needed to increase the strength
Skeletal muscle
Skeletal muscle cells cannot proliferate
Stem (reserve or satellite cells) can proliferate and differentiate to form new skeletal muscle ???
Bone
Able to heal itself with like tissue
Bone can heal by two means: primary or secondary healing
Pain
Unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Nociceptor
A receptor neuron that is preferentially sensitive to a noxious stimulus (causing damage to normal tissues) or a stimulus that would become noxious if prolonged. (Book 2, Chapter 1)
Acute pain
This type of pain has a sudden onset, relatively short duration, mild to severe intensity, with a steady decrease in intensity over several days or weeks. Usually associated with a specific condition, injury or tissue damage caused by disease. (e.g. toothache, needle sticks, burns, childbirth, sprained ankle)
Referred pain
pain that is felt at a place in the body different from the injured or diseased part where the pain would be expected
Trigger points
Small, tense, hypersensitive areas of tenderness that RADIATE pain to specific area when compressed
Afferent fiber
a neuron that carries sensory information to the central nervous system
Mechanisms of pain receptions and transmission
-Specificity and pattern theories
-Pain receptors
-Perioheral nerve pathways
-Central nerve pathways
-Sympathetic nervous system influences
Thermoreceptor
a sensory receptor that responds to heat and cold
A-delta fibers
fast
myelinated peripheral nerve fibers
send sharp
localized
distinct sensations
C fibers
Nerves that transmit
-dull
-poorly localized pain
-nerve fibers that carry messages for dull
-aching
-slow
-Burning
Proliferation
3-20 days
Angiogenesis
Fibrosis
Period of scar formation
*Wound is covered and begins to regain some of initial strength
*During the proliferation phase, an injured area has the greatest amount of collagen, yet tensile strength is low.
Maturation
9+ days
Damaged tissue returning to original cell type
Remodeling replaces temporary cells
Collagen realigns
Cells return to normal function
What tissues are affected by infared modalities?
Superficial
ex. epithelial
Acoustic spectrum
Ultrasound
Wavelength
the distance (measured in the direction of propagation) between two points in the same phase in consecutive cycles of a wave
Frequency
the number of complete wavelengths that pass a point in a given time
Fibrosis
Proliferation of fibrous connective tissue; scar formation
Injury management using modalities
Inflammation stage:
RICE
Second 2 stages:
Various modalities
Chronic injury
Persists
Can have acute symptoms on top of chronic symptoms
Modalities for inflammatory stage
...
Modalities for proliferation
...
Modalities for Maturation
...
Gate control theory
-Nociceptors send afferent signals to spinal cord at C6
-Signal passes through spinal cord to thalamus and to cerebral cortex
-Cerebral cortex sends efferent signals back to the spinal cord
-Meanwhile, beta fibers are stimulated by touch, ice, etc.
-Beta fibers move up afferent pathway to spinal cord where they interfere with efferent signals from the cerebral cortex.
Endorphins and enkephalins theory
Endorphin and enkephalin are the body's natural painkillers.
When a person is injured, pain impulses travel up the spinal cord to the brain.
The brain then releases endorphins and enkephalins along descending nerve fiber from the brain.
Enkephalins block pain signals in the spinal cord (bind to receptor of nociceptor and change signal).
Thermal physical agent
Transfer energy to a patient to produce an increase/decrease in tissue temperature
Types:
Deep heating agents- Ultrasound and diathermy
Superficial heating agents- Hot pack
Cooling agents- Cold pack
Mechanical Physical agents
Agents that apply force to increase or decrease pressure on the body.
Types:
Traction- Mechanical traction
Compression- elastic bandage/stockings
Water- Whirlpool
Sound- Ultrasound
Electromagnetic Physical agents
Apply energy in the form of electromagnetic radiation or an electrical current.
Types:
Electromagnetic fields- Ultraviolet and laser
Electric currents- TENS
ICF model
International classification of functioning and disability.
Considers the body, the whole person, and the person in society.
Physical Agents
Energy and materials applied to patients to assist in rehabilitation.
Usually used with other interventions and not as the sole intervention.
Effects of physical agents
The application of physical agents primarily results in modification of tissue inflammation and healing, relief of pain, alteration of collagen extensibility, or modification of muscle tone.
Physical Agents for promoting tissue healing:
Initial injury
Prevent further injury/bleeding- Static compression, cryotherapy
Clean open wound- hydrotherapy

Contraindications:
Exercise
Motor-level ES
Thermotherapy
PA for Prevent/decrease joint stiffness
Thermotherapy
Motor ES
Whirlpool
Fluidotherapy
PA for chronic pain
Thermotherapy
ES
Laser
PA for increased circulation
Thermotherapy
ES
compression
Hyprotherapy
PA for progression to proliferation stage
Pulsed ultrasound
ES
PSWD
PA for regaining/maintaining strength
Motor ES
Water exercise
PA for regaining/maintaining flexibility
Thermotherapy
PA to control scar tissue formation
Brief ice massage
Compression
Pathological or physical result of an injury
INFLAMMATION PHASE
Vasoconstriction
Vasodilation
Clot formation
Phagocytosis
PROLIFERATION PHASE
Epithelialization
Fibroplasia/collagen production
Wound contracture
Neovascularization
MATURATION PHASE
Collagen synthesis
Collagen realigns
Healed injury
Edema
Swelling caused by fluid accumulation outside the vessels.
Muscle hematomas
Can cause pain, limit motion, and increase scar tissue formation.
During the proliferation phase of healing
...
Informed consent
Intro- Name, qualifications
Inform patient of the activities of the day
Precaution
Think through every part of modality to ensure safety.
Effects of physical agents
Inflammation
Pain reduction
Collagen extensibility
Muscle tone
Angiogenesis
Development of new blood vessels
Veovascularization
Healing cannot occur without angiogenesis
Local factors that effect healing
Type, size, and location of injury
Infection
Vascular supply
External forces
Systemic factors that effect healing
Age
Nutritional status
Concurrent disease
Anemia
Hypovolemia
Drugs and other Tx
Pain
Unpleasant sensory or emotional experience associated with actual or potential tissue damage.
Nociceptors
Respond to noxious stimuli
Chronic pain
Continues beyond the normal time of tissue healing
Persistent
Acute pain
Biologically meaningful
Pathologically
Levels of experiencing pain
Tissue damage
Pain sensation
Thoughts
Emotions
Suffering
Pain behaviors
Thermoreceptors
Sensory receptors which respond to heat or cold.
Pain in cutaneous
Well localized
Sharp, pricking, tingling
A delta fibers
Musculoskeletal pain
Dull, heavy, aching, and harder to localized
Transmission of pain
Nociceptor
Peripheral nerve
Spinal cord
Thamalus
Cerebral cortex
Pain assessment tools
Visual analog
Pain chart/picture
McGill pain questionnaire
Activity profile
Numeric pain scale
McGill pain drawing
...
Ransford pain assessment
...
Numeric pain scale
Most common acute pain profile used in sports medicine clinics.
Patient is asked to rate pain on a scale from 1 to 10 with 10 representing the worst pain they have experienced or could imagine.
Question asked before and after treatment.
Visual analog
10cm line drawn
No pain on left and worst pain on right
Patient asked to mark where their pain is on the line
PT measures where the mark is
# of cm is pain level
Pain management
Pharmacology
Analgesics
NSAIDS: aspirin, ibuprofen, naproxen sodium
-Non-steroidal antiinflammatory drugs
Acetaminophen
Opiods
Antidepressants
Local injection
Borg numeric pain scale
Provides instructions
Provides a list of numbers and associated levels of pain
Asks patients to rate pain now, best day in 30 days, and worst day in 30 days.
Radiation
energy that is radiated or transmitted in the form of rays or waves or particles
radiant energy
energy that is transmitted in the form of (electromagnetic) radiation
-Travels through space in a straight line
-Several modalities fall under radiant
-Depth of effectiveness based on wavelength
Infared
invisible short frequencies of light before red in the visible spectrum
Acoustic spectrum
Ultrasound
Radiation by be:
Reflected
Refracted
absorbed
Transmitted
Infared modalities
Grouped together by wavelength
Penetrating heat that falls within the specific wavelength
What tissues are effected by infared modalities
Superficial
ex. epithelial
Fibroplasia
Period of scar formation
Fibroblasts
Growth
RICE
rest, ice, compression, and elevation
Acute injury
sudden onset due to a specific trauma, such as twisting the ankle
Physical agents used to modify healing process:
Cryotherapy
Thermotherapy
Ultrasound
Electromagnetic radiation
Light
Electric currents
Compression
T Cells
T cells in spinal cord receive excitatory input from nociceptors and inhibitory input from sensory nerves and descending fibers from the brain, determining whether or not a person will feel pain.
Evaluating a patient's pain
Consider:
Patient's source
Intensity
Duration
How it affects a person's function, activity, and participation.
Pain scale uses
Visual analog and numeric best for a quick estimate
Semantic differential for more detailed description
NSAIDS
nonsteroidal anti-inflammatory drugs
Lower doses necessary to reduce pain than to reduce inflammation
Gastrointestinal irritation and bleeding are main long term complications