Modalities

Modalities

Heat therapy (Thermotherapy)

Types of thermotherapy:

• Hot packs: Moist heat applied with Hydrocollator packs wrapped in towels
• Paraffin wax baths: Commonly used for distal extremities (e.g., hands, feet)
• Fluidotherapy: Dry heat through suspended cellulose particles
• Shortwave diathermy: Deep heating through electromagnetic energy

Clinical indications:

• Muscle spasm and guarding
• Joint stiffness and decreased ROM
• Chronic musculoskeletal pain
• Increased blood flow for tissue healing

Application parameters:

• Hot packs: 15–20 minutes, use 6–8 towel layers to avoid burns
• Paraffin: 10–15 minutes using the dip-wrap method (5–10 dips)
• Diathermy: Typically 20 minutes for deep heating effects

Contraindications:

• Acute inflammation or bleeding
• Impaired sensation or mentation
• Malignancy in treatment area
• Deep vein thrombosis (DVT)
• Open wounds or infections

Cold therapy (cryotherapy)

Types of cryotherapy:

• Ice massage: Applied directly on a localized area, fastest tissue cooling 5-8 minutes
• Ice packs: Applied with a barrier for 10–15 minutes
• Cold immersion baths: Typically 50–60°F (10–15°C), 10–15 minutes
• Vapocoolant sprays: Used for muscle spasm, applied with 2–4 sweeps

Clinical indications:

• Acute musculoskeletal injuries
• Edema control
• Spasticity management
• Localized pain relief

Contraindications:

• Cold hypersensitivity or intolerance
• Raynaud’s disease
• Open or infected wounds
• Peripheral vascular disease (PVD)

Therapeutic ultrasound (US)

Clinical indications:

• Chronic tendinopathies
• Ligament sprains and muscle strains
• Joint contractures
• Scar tissue management

Application parameters:

• Frequency:
  • 1 MHz: For deep tissue (up to 5 cm)
  • 3 MHz: For superficial tissue (1–2 cm)
• Duty cycle:
  • 100% (Continuous): Thermal effects
  • 20–50% (Pulsed): Non-thermal, acute phase
• Intensity:
  • 0.5–1.0 W/cm²: Superficial
  • 1.0–2.0 W/cm²: Deep tissues
• Duration:
  • 5–10 minutes per treatment area

Contraindications:

• Over malignant areas, reproductive organs
• Over pacemakers, eyes, or carotid sinus
• During pregnancy (lumbar/abdominal regions)
• Over bony prominence, growth plates, and acute bony fracture.

Electrical stimulation (E-stim)

Types and indications:

• TENS (transcutaneous electrical nerve stimulation): Pain modulation via gate control theory (high rate), Endogenous opioid theory (EOT) low rate.
• NMES (neuromuscular electrical stimulation): Muscle re-education, strengthening using biphasic wave form creating a zero net charges to reduce skin irritation.
• **IFC (interferential current):**Uses an interference between two medium frequency (KHz) currents produces a low frequency (beat) current that will be induced in the deep tissues. Effects are similar to TENS
• HVPC (high-voltage pulsed current): Wound healing, with positive polarity, edema control with negative polarity.
• DC (direct current): Iontophoresis for transfer of Ions in solution edema control with negative polarity, and pain control positive polarity. Treatment is dosed in Milliamperes/min (mA/min)

Parameters:

• TENS: 50–150 Hz, 50–80 µs, continuous mode (Gate theory)
• TENS: 1-4 Hz, 150–220 µs, low pulse mode (Endogenous opioid theory)
• IFC: 2 high frequency channels, 3000, and 3500 (Khz) creating an interference wave of 1-299 hz in deeper tissues.
• NMES: 35–50 Hz, 200–400 µs, 1:5 duty cycle
• HVPC: 100–150 V, 50–100 Hz

Contraindications:

• Cardiac pacemakers or defibrillators
• Unstable arrhythmias
• Thrombophlebitis or DVT
• Pregnancy (abdomen/lumbar)

Traction

Clinical indications:

• Herniated discs
• Nerve root impingement
• Hypomobility or facet joint dysfunction

Parameters:

• Static/intermittent:

  • Static best for disc and nerve root impingement
  • Intermittent best for hypomobility

• Cervical traction:

  • Initial force: 10–15 lbs
  • Maximum: 30 lbs
  • Angle: 15–20° flexion for upper cervical spine using over the door TMJ halter seated
  • Angle: 25–35° flexion for lower cervical spine using and occipital halter in supine
  • Duration: 10-15 minutes

• Lumbar traction:

  • Initial force: 25% of body weight
  • Maximum: 50% of body weight
  • Supine position best for upper lumbar segments and hypomobility
  • Prone position best for lower lumbar and disc herniation
  • Duration: 15-20 minutes

Contraindications:

• Acute cervical or lumbar injuries
• Spinal infections or malignancy
• Hypermobility or instability
• Severe osteoporosis