Physical agent
Qu Yun
MD.

Physical agent modalities are defined by Cameron (2003) as various forms and means of applying of energy and materials to patients.
Modalities
Heat
Cold
Water
Sound
Electricity
Electromagnetic
Waves
Infrared light
Visible light
Ultraviolet light
Shortwave
Microwaves
Pressure

Physical agents include heat, cold, water, pressure, sound, electromagnetic radiation, and electrical currents. 
Elements of a Prescription for Heat and Cold

In U.S.
physical agent modalities
health care practitioners. 

However
not exist commonly standard
Intervention Strategies
Superficial Thermal Agents (hot packs, paraffin, fluidotherapy)
Deep Thermal Agents (Ultrasound, Phonophoresis)
Cryotherapy (cold pack, ice massage, contrasting baths)
Electrotherapy
    a.  Understanding the basis for Electrotherapy
    b.  Transcutaneous Electrical Nerve Stimulation
    c.  Neural Muscular Electrical Stimulation
 Iontophoresis

 

Cryotherapy, also known as cold therapy, is a technique to reduce pain and swelling after injury or surgery by the use of ice or cold temperature.
Effect
Generally, heat quiets and soothes the body, slowing down the activity of internal organs. Cold, in contrast, stimulates and increasing internal activity.
Heat Effects
relief from pain.
getting rid of stress
reducing anxiety.
affects the skin and muscles
 calms the lungs, heart, stomach, and endocrine system by stimulating nerve reflexes on the spinal cord.
Heat types
Hot pack/heating pads
Paraffin baths
Fluidotherapy
Whirlpool
Radiant heat
Shortwave diathermy
Microwave
Classification of Various Types of Heating
Classification of Heat
Modility selection factors. (P49  table  22 2)

Mechanisms of  heat transfer
Look at page 49

Heat Effects
See page 50 (table 22 4)
Hemodynamic
Neuromuscular
Joint and connective tissue
Miscellaneous
General uses of heat in physical medicine(Table 22 5)
General precautions for the use of  heat (Table 22 6)
Superficial heat
Hot packs
74.5℃
Time :30 min
Heating pads
Type:   Electric heating or  circulating fluid heating pads
nearly 52℃
Radiant heat
Infrared radiaton
floidotherapy
Solid gas systerm
46.1℃ to 48.9℃
Paraffin baths
Paraffin wax ︰mineral oil = 6︰1 or 7︰1
52.2℃ to 54.4℃

Deep heat
Ultrasound
Shortwave diathermy
Microwave diathermy
Cryotherapy Types
Cold packs
Ice massage
Cold water immersion
Cryotherapy compression units
Vapocoolant spray
Whiripool baths

Cryotherapy Effects
See page 57
Hemodynamic
Neuromuscular
Joint and connective tissue
Miscellaneous
Hydrotherapy
Is defined as the external application of hot or cold water,in any form,for the treatment of disease.

Main form:whirlpool baths,the Hubbard tank,the shower cart,and contrast baths.

Use:a variety of Musculoskeletal conditions, burns and other dermal injuries.
Contrast baths
Hot (42 45℃)
Cold(8.5 12.5℃) 

Effect: the cyclic vasoconstriction and vasodilatation

Be beneficial in the treatment of rheumatological disease,neuropathic pain,or other chronic pain syndromes such as reflex sympathetic dystrophy.
Risks, Cautions, and Contraindications
Persons with impaired temperature sensation.
Avoid cold application if you are diagnosed with Raynaud's disease.
Hot immersion baths and long, hot saunas are not recommended for those with diabetes or multiple sclerosis.
Women who are pregnant or anyone with abnormally high or low blood pressure.
Elderly people and young children may be exhausted by too much heat and should avoid long full body hot treatments such as baths.
………
Electrotherapy
Electrotherapy involves all those methods of treatment of disorders and injuries in which electricity is used directly.

An important effect of electric current is its subliminal stimulation of sensitive nerve fibers, which blocks pain impulses. Diversion of the pain waves produces a detonicizing and analgesic effect.
Main groups
Contents
Low frequency therapy
Galvanization
Galvanization is a treatment using constant, direct current that continues in the same direction and at the same strength.

Effect
raises the threshold of the nerve fibers that are sensitive to pain
Stop pain
The deep reaching effects influence:
the subcutaneous tissues,
tendons lying near the body surface,
ligaments, muscles,
periosteum
FORMS OF APPLICATION
effect of the current
Local
systemic.
The Period
 last between 5 and 30 minutes
 daily for sports injuries.

The intensity
progressively increased at the beginning
gradually decreased toward the end.
Galvanic currents are used for:
Degenerative
inflammatory disorders,
peripheral circulatory problems,
particularly for postoperative
post traumatic states
athletic injuries and damage.
sprains,
contusions,
dislocations,
hematomas.
Stimulus and Impulse Currents
Faraday and exponential impulse currents are among the low frequency currents; also included are diadynamic and ultrastimulus currents (Trabert).

Faraday Currents
"Faradization" is the administering of a therapeutic induced, uninterrupted current and electric shock.
contraction in the  muscle

Three factors are primarily responsible for the electrical sensitivity of a nerve or muscle:
1. The intensity of the current
2. The direction of the current
3. The duration of the current

Transcutaneous Electrical Nerve Stimulation (TENS)
frequency
0 to 200 Hz
The instruments can use two types of currents:
1. Continuous rectangular impulses
2. Burst impulses

Three forms of stimulation:
1. Conventional TENS (high frequency stimulation): the sphere of activity moves    in frequency of 10 to 100 Hz. 2. AP low frequency stimulation (acupuncture like stimulation): the area of frequency selection lies between 0.4 and 4 Hz 3. Cyclic stimulation (modeled stimulation): to prevent muscle fatigue, the frequency commonly used in modeled stimulation is 30 Hz.
TENS

The duration of the stimulation
 1 to 2 seconds
 the range of impulse
150 to 250 ms per second.
The stimulation and interruption times
 2 to 8 and 2 to 24 seconds
The interruption time
 as the stimulation time.

Diadynamic Currents
also named Bernard currents
50 to 100 Hz.
There are six different types of currents.
Selection of Electrodes
sedative and analgesic effect:

The size of the electrodes is dependent on the area through which the current flows
Selection of Current Quality
The current quality is selected according to the indications.

Differences in their biologic and therapeutic effects.
Selection of Current Type
"FIXED DIAPHASE" (DF).
(Fig. P68).
"FIXED MONOPHASE" (MF).
"SHORT PERIODS" (CP).
"LONG PERIODS" (LP).
P68

Diadynamic currents
Intensity of the Current
the quality of the current
the intensity of the current.
individualized dosage

Length of Application
limited to a few minutes
generally not exceed 12 minutes.
Number of Sessions
two to three sessions
between treatments should not exceed 48 hours.

Trabert's Stimulus Current
This current involves a stepped series of impulses with a frequency of 140 Hz, with an impulse length of 2 ms and an interruption of 5 ms.  
MIDDLE FREQUENCY THERAPY
Middle frequency therapy painless application. muscle relaxing effect deeper bodily tissues effect Contraindications and indications are the same as for low frequency currents.  
HIGH FREQUENCY THERAPY
deep heat analgesic effect. aids circulation and metabolism relaxation of the muscular system.  
HIGH FREQUENCY THERAPY
Treatment FIELDS.
Only the surface tissue layers
The dosage levels should be heeded:
ULTRASONIC THERAPY
Ultrasonic therapy is included in the high frequency range of electrotherapy, although electrical energy is used indirectly.
rapid alleviation of pain
acute or chronic athletic injuries.
MAGNETIC FIELD THERAPY
The effectiveness on the biologic system has long been known. The treatment of various neurologic, vascular, orthopedic, traumatic, and sports medicine cases.
SUMMARY
The specific use of electrotherapy for sports injuries is determined by the type and location of the changed tissue.
Treatment of superficial and deep levels of tissue, partly down to the bone tissue, is made possible through various instruments.
SUMMARY
Electric methods to treat disorders and injuries.
Three group of technique:
Low frequency: 0 1 kHz
Middle freq:      1 300 kHz
High freq:         >300 kHz
SUMMARY
Electrotherapy effects
Release of pain (raise the threshold of nerve fibers.)
Increase circulation of soft tissues
Treatment of skin disorder
Influence the subcutaneous tissues (tendons, ligaments, muscles, nerves)

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