Modalities mythbusters review
- 1. Modalities Mythbusters Review Casey Christy, MA, ATC, CSCS
- 2. Myth: All inflammation is bad. Without inflammation, there would be no healing. Minimizing the signs and symptoms of inflammation, however, is beneficial. Knight, Draper, Therapeutic Modalities: The Art and Science, pg 39
- 3. Myth: Increasing ultrasound intensity increases the depth of penetration. The ultrasound frequency determines the depth of penetration. 1 MHz penetrates up to 5cm (2in) deep into the tissues; 3MHz approximately 1-3 cm (1in). Intensity affects the heating rate, not penetration depth. Starkey, Therapeutic Modalities, 4th edition, pg 193
- 4. Myth: Ice removes swelling. Cold is effective in preventing or limiting swelling development, but is of little or no value in removing swelling once it occurs. Once swelling occurs, it can only be removed by removing the free proteins in the tissue spaces (remember it is these proteins that attract water into the tissues). Knight, Draper, Therapeutic Modalities: The Art and Science, pg 72
- 5. Myth: Pulsed Ultrasound Does Not Cause Thermal Effects Although a non-thermal treatment can be accomplished via a pulsed setting, thermal effects truly depend on the intensity, treatment duration and the size of the treatment area. For example, assuming identical treatment times and treatment areas, a 50% pulsed treatment at 1.0 w/cm2 will impart the same energy as a continuous treatment set at 0.5 w/cm2 . Knight, Draper, Therapeutic Modalities: The Art and Science, pg 263
- 6. Myth: Icing an acute injury causes the blood to clot, stopping the bleeding. Clotting occurs within the first few minutes after injury to seal the vessel walls and stop the bleeding, often before ice is even applied. Knight, Draper, Therapeutic Modalities: The Art and Science, pgs 57-58
- 7. Myth: Never apply an ice bag directly to the skin. Under normal conditions (short-term application, ie:10-20 minutes, and no contraindications), there is little chance of causing frostbite when using an ice bag prepared from an ice machine and applying it directly to the skin, because the ice is melting. Note that longer application times, or using an instant ice pack or ice from a home freezer can lead to frostbite and tissue damage. Knight, Draper, Therapeutic Modalities: The Art and Science, pg 70
- 8. Myth: Cold therapy should only be used for the first 48-72 hours after injury. For many injuries, cryotherapy continues beyond immediate care. Cold application is effective in facilitating exercise during rehabilitation (cryokinetics) and controlling pain. Knight, Draper, Therapeutic Modalities: The Art and Science, pgs 216, 233
- 9. Myth: Ice from a home freezer is the same as from an ice machine. Cold gel packs, reusable cold packs and ice packs used from a refrigerator or freezer can damage the skin. Ice from a freezer and gel packs are well below freezing (1°F to -5°F) which can cause frostbite. Ice machines store ice just below freezing at about 30°F. Knight, Draper, Therapeutic Modalities: The Art and Science, pg 69
- 10. Myth: The most beneficial effect of ice application is to remove swelling. The main reasons to use ice are for pain control, preventing secondary cell injury, cryokinetics (early return to movement) and swelling prevention/curbing. Knight, Draper, Therapeutic Modalities: The Art and Science, pgs 58, 59, 241
- 11. Myth: Moist heat produces deep heat. Moist heat packs are limited to depths of 1-2 cm. Moderate to intense exercise can increase intramuscular temperatures 5 cm deep approximately 4°F (2.2°C). Although active exercise does not always result in vigorous muscle heating, moderate heating occurs over a larger cross-sectional area and deeper into the muscle than other forms of heat. Starkey, Therapeutic Modalities, 4th edition, pgs 126, 129-131
- 12. Myth: You can use electrical stimulation to build washboard abs. Although some advertisements claim otherwise, you cannot tone your abs in this way. Electrical stimulation cannot cause as strong of a contraction as a voluntary muscle contraction can. Even if it did, the intensity would need to be so high that it would be unbearable. Knight, Draper, Therapeutic Modalities: The Art and Science, pg 166
- 13. Key Points: Ice Ice helps prevent swelling but is not effective in removing it. The main reason to use ice is to reduce cellular metabolism and minimize secondary cellular injury.
- 14. Key Points: Ice Other reasons to use ice are to reduce pain and to apply cryokinetics. Home freezer ice and instant ice packs are colder than ice from an ice machine, and carry a higher risk of frostbite.
- 15. Key Points: Ice Precautions Stick with 20 minute ice bag application times for most injuries unless you are treating an area with superficial nerves or significant adipose. Reduce the treatment time and minimize (or don’t use) compression around superficial nerves; increase the treatment time slightly when treating areas with significant adipose.
- 16. Key Points: Ice Precautions Areas such as the lateral hip, lateral knee and medial elbow are susceptible to nerve compression injury. Use shorter treatment times and light compression with these areas. Watch for neurological signs/sx.
- 17. Key Points: Ice Precautions Keep rewarming times at least twice as long as cooling times; preferably allowing 2 hours in-between applications. Ice from a freezer and gel packs, or using an ice bag too long can cause frostbite.
- 18. Key Points: Heat Ultrasound penetrates deeper than a moist heat pack. Muscle contraction produces deeper heat than a moist heat pack. Heat provided by diathermy lasts longer than ultrasound.
- 19. Key Points: Ultrasound Ultrasound penetrates 1-2 inches depending upon the frequency used. Ultrasound should never be used over epiphyseal areas in young children, or over the spine in any patient.
- 20. Key Points: Ultrasound Thermal and non-thermal ultrasound can be administered depending upon the selected duty cycle. Ultrasound provides a 3-minute stretching window. Stretch immediately afterwards to take advantage of increased tissue elasticity.
- 21. Key Points: Hunting Response The hunting response is a flawed theory, has been identified only in selected areas of the body (ie: fingers, nose) and is most often associated with exposure to extreme environments.
- 22. Key Points: Hunting Response While there may be some vasodilation after a period of vasoconstriction, this effect only lessens the initial vasoconstriction. There is still a net vasoconstriction when compared to the pre-treatment vessel diameter when applying cold therapy.
- 23. Key Points: Compression Intermittent compression spreads the edema out over a larger area (usually proximally), allowing more lymphatic ducts to absorb the solid matter in the edema.
- 24. Key Points: Compression Voluntary muscular contractions encourage venous and lymphatic return by squeezing the vessels.
- 25. Key Points: Compression Electrical stimulation can be used to cause muscle contractions, however, the rate of flow is less than that which occurs during voluntary contractions.
- 26. Key Points: Modality Use Fancy modalities are not required to be a successful athletic trainer The ability to apply various therapeutic modalities may differ depending on state practice acts.
- 27. References: Covington, D. and Bassett, F. When Cryotherapy Injures: The Danger of Peripheral Nerve Damage, The Physician and Sports Medicine, Vol 21, No. 3, March 1993 Draper, et al. Rate of Temperature Decay in Human Muscle Following 3 MHz Ultrasound: The Stretching Window Revealed. Journal of Athletic Training, Vol 30, Number 4, December 1995 Knight, Draper, Therapeutic Modalities: The Art and Science Prentice, Therapeutic Modalities for Sports Medicine and Athletic Training, 3th ed Starkey, Therapeutic Modalities, 4th edition