Therapeutic Modalities For Sports Medicine and Athletic Training William

CA p p e n d i x Answers to Self-Quizzes CHAPTER 1 6. A CHAPTER 4 6. D 7. B 7. B 1. F 8. D 1. F 8. C 2. T 9. C 2. T 9. B 3. T 10. A 3. T 10. A 4. B 4. C 5. D 6. D 5. A 11. D 7. C 12. D CHAPTER 2 8. A CHAPTER 5 13. A 9. D 14. D 1. T 10. A 1. F 15. B 2. F 2. T 16. B 3. T 6. A 3. T 17. C 4. B 7. D 4. T 18. A 5. C 8. C 5. F 19. D 9. D 6. T 20. D CHAPTER 3 10. C 7. B 8. C 1. T 9. A 2. F 10. B 3. T 4. B 5. D A-6

CHAPTER 6 6. D APPENDIX C Answers to Self-Quizzes A-7 7. C 1. F 8. A CHAPTER 10 2. F 9. D 3. T 10. C 1. T 6. A 4. B 2. T 7. D 5. A 6. A 3. F 8. A 7. C 4. C 9. D CHAPTER 7 8. B 5. B 10. B 9. C 1. F 10. D CHAPTER 11 6. D 2. T 7. A 3. F 6. C 1. T 8. C 4. D 7. A 2. T 9. D 5. B 8. D 3. F 10. A 9. C 4. B CHAPTER 8 10. B 5. B 1. T 6. C CHAPTER 12 6. C 2. F 7. A 7. A 3. F 8. D 1. T 8. C 4. B 9. B 2. T 9. D 5. A 10. B 3. F 10. B 4. B CHAPTER 9 5. D 1. T CHAPTER 13 6. D 2. F 7. A 3. T 1. T 8. C 4. C 2. F 9. A 5. B 3. T 10. C 4. B 5. D



Glossary A air space plate A capacitor type electrode in which the plates are separated from the skin by the space in a glass absolute refractory period Brief time period (.5 µsec) case; used with shortwave diathermy. after membrane depolarization during which the alkaline reaction The accumulation of positive ions membrane is incapable of depolarizing again. under the negative electrode, which produces sodium absorption Energy that stimulates a particular tissue to hydroxide. perform its normal function. all-or-none response The depolarization of nerve accommodation Adaptation by the sensory receptors to or muscle membrane is the same once a depolarizing various stimuli over an extended period of time. intensity threshold is reached; further increases in acidic reaction The accumulation of negative ions under intensity do not increase the response. Stimuli at the positive pole, which produces hydrochloric acid. intensities less than threshold do not create a depolarizing acoustic impedance Determines the amount of effect. ultrasound energy reflected at tissue interfaces. alternating current Current that periodically changes its acoustic microstreaming The unidirectional polarity or direction of flow. movement of fluids along the boundaries of cell ampere Unit of measure that indicates the rate at which membranes, resulting from the mechanical pressure electrical current is flowing. wave in an ultrasonic field. amplifier A device using electrical components to acoustic spectrum The range of frequencies and increase electrical power. wavelengths of sound waves. amplitude Describes the magnitude of the vibration in a ACTH Adrenocorticotropic hormone. This hormone wave. It is the maximum distance from equilibrium that stimulates the release of glucocorticoids (cortisol) from any particle reaches. It is also referred to as the intensity the adrenal glands. of current flow as indicated by the height of the waveform action potential A recorded change in electrical potential from baseline. between the inside and outside of a nerve cell, resulting in analgesia Loss of sensibility to pain. muscular contraction. anesthesia Loss of sensation. active electrode Electrode at which greatest current annulus fibrosus The interlacing cross-fibers of density occurs or the electrode that is used to drive ions fibroelastic tissue that are attached to adjacent vertebral into the tissues. bodies that contain the nucleus pulposus. acupressure The technique of using finger pressure over anode Positively charged electrode in a direct current acupuncture points to decrease pain. system. acute Pain of sudden onset often associated with physical anoxia Reduction of oxygen in body tissues below trauma. physiologic levels. acute injury An injury in which active inflammation is applicator The electrode used to transfer energy in present that includes the classic symptoms of tenderness, microwave diathermy. swelling, redness, and warmth. Arndt-Schultz principle No reactions or changes can afferent Conduction of a nerve impulse toward an occur in the body if the amount of energy absorbed is not organ. sufficient to stimulate the absorbing tissues. G-1

G-2 Glossary cavitation The formation of gas-filled bubbles that expand and compress because of ultrasonically induced attenuation A decrease in energy intensity while the pressure changes in tissue fluids. ultrasound wave is transmitted through various tissues central biasing A theory of pain modulation where caused by scattering and dispersion. higher centers, such as the cerebral cortex, influence average current The amount of current flowing per unit the perception of and response to pain. Also the use of of time. hyperstimulation—analgesia to bias the central nervous avulsion fracture A fracture in which a small piece of system against transmitting painful stimuli to the bone is torn away by an attached tendon or ligament. sensory recognition area. This occurs through hormonal influences created by brain stem stimulation. B chronaxie The duration of time necessary to cause observable tissue excitation, given a current intensity of bacteriostatic A chemical environment in which two times rheobasic current. bacteria is destroyed. chronic injury An injury in which the normal cellular bandwidth A specific frequency range in which the response in the inflammatory process is altered, replacing amplifier will pick up signals produced by electrical leukocytes with macrophages and plasma cells. activity in the muscle. chronic pain Pain lasting more than 6 months. beam nonuniformity ratio (BNR) Indicates the amount circuit The path of current from a generating source of variability of intensity within the ultrasound beam and through the various components back to the generating is determined by the miximal point intensity of transducer source. to the average intensity across the transducer surface. coherence Property of identical phase and time beat Distinct wave pattern created by combining two relationship. All photons of laser light are the same distinct circuit electrical waves that blend into a gradual wavelength. rising and falling wave. collimate To make parallel. b-endorphin A neurohormone derived from collimated beam A focused, less divergent beam of proopiomelanocortin (POMC). It is similar in structure ultrasound energy produced by a large diameter and properties to morphine. transducer. Bindegewebsmassage Reflex zone massage; uses a common mode rejection ratio (CMRR) The ability of pulling stroke across connective tissue to effect change. the differential amplifier to eliminate the common noise bioelectromagnetics The study of biologic tissues’ between the active electrodes. electrical and magnetic properties. compressions Regions of high molecular density biofeedback Information provided from some measuring (i.e., a great amount of ultrasound energy) within the instrument about a specific biologic function. longitudinal wave. biphasic current Another name for alternating current, conductance The ease with which a current flows along in which the direction of current flow reverses direction. a conducting medium. bipolar arrangement Two active recording electrodes conduction Heat loss or gain through direct contact. placed in close proximity to one another. conductors Materials that permit the free movement of bursts A combined set of three or more pulses; also electrons. referred to as packets or envelopes. congestion Presence of an abnormal amount of blood in the vessels resulting from an increase in blood flow or C obstructed venous return. consensual heat vasodilation Vasodilation and cable electrodes An inductance type electrode in which increased blood flow will spread to remote areas, causing the electrodes are coiled around a body part, creating an increased metabolism in the unheated area. electromagnetic field. constructive interference The combined amplitude of capacitor electrodes Air space plates or pad electrodes two distinct circuits increases the amplitude. that create a stronger electrical field than a magnetic continuous wave An uninterrupted beam of laser light, field. as opposed to pulsed. cathode Negatively charged electrode in a direct current system.

continuous wave ultrasound The sound intensity Glossary G-3 remains constant throughout the treatment, and the ultrasound energy is being produced 100% of the time. direct current Galvanic current that always flows in contrast bath Hot (106°F) and cold (50°F) treatments the same direction and may flow in either a positive or a in a combined sequence to stimulate superficial capillary negative direction. vasodilation or vasoconstriction. direct effect The tissue response that occurs from convection Heat loss or gain through the movement of energy absorption. water molecules across the skin. disk herniation The protrusion of the nucleus pulposus conversion Changing from one energy form into through a defect in the annulus fibrosus. another. disk material Cartilaginous material from vertebral body cosine law Optimal radiation occurs when the source of surfaces, disk nucleus, or annulus fibrosus. radiation is at right angles to the center of the area being disk nucleus The protein polysaccharide gel that is radiated. contained between the cartilaginous end plates of the coulomb Indicates the number of electrons flowing in a vertebrae and the annulus fibrosus. current. disk protrusion The abnormal projection of the disk coupling medium A substance used to decrease the nucleus through some or all of the annular rings. acoustic impedance at the air-skin interface and thus divergence The bending of light rays away from each facilitate the passage of ultrasound energy. other; the spreading of light. cryokinetics The use of cold and exercise in the DNA Deoxyribonucleic acid—the substance found in the treatment of pathology or disease. chromosomes of the cell nucleus that carries the genetic cryotherapy The use of cold in the treatment of code of the cell. pathology or diseases. drum electrodes Induction electrodes that produce current The flow of electrons. a strong magnetic field. Primarily used with pulsed current density Amount of current flow per cubic area. shortwave diathermy. current of injury A bioelectric current produced by any duration Sometimes referred to as pulse width. Indicates type of cellular trauma that plays a key role in stimulating the length of time the current is flowing. healing. duty cycle The percentage of time that ultrasound is being generated (pulse duration) over one pulse period, D which is also referred to as the mark: space ratio. dynorphin An endogenous opioid derived from the decay time The time required for a waveform to go from prohormone prodynorphin. peak amplitude to 0 V. denervated muscle Muscle that has lost its peripheral E nerve supply. depolarization Process or act of neutralizing the cell eddy currents Small circular electrical fields induced membrane’s resting potential. when a magnetic field is created that result in destructive interference Combined amplitude of two intramolecular oscillation (vibration) of tissue contents, distinct circuits decreases the amplitude. causing heat generation. diathermy The application of high-frequency electrical edema Excessive fluid in cells. energy that is used to generate heat in body tissue as a effective radiating area The total area of the surface of result of the tissue to the passage of energy. It may also be the transducer that actually produces the sound wave. used to produce nonthermal effects. efferent Conduction of a nerve impulse away from an differential amplifier Monitors the two separate signals organ. from the active electrodes and amplifies the difference, effleurage To stroke; any stroke that glides over the skin thus eliminating extraneous noise. without attempting to move the deep muscle masses. diode laser A solid-state/semiconductor used as a lasing The hand is molded to the part, stroking with more or medium. less constant pressure, usually upward. Any degree dipoles Molecules whose ends carry opposite charges. of pressure may be applied, varying from the lightest possible touch to very deep pressure. electrets Insulators carrying a permanent charge similar to a permanent magnet.

G-4 Glossary fibrils Connective tissue fibers supporting the lymphatic capillaries. electrical current The net movement of electrons along fibroplasia The period of scar formation that occurs a conducting medium. during the fibroblastic repair phase. electrical field The lines of force exerted on charged fibrosis The formation of fibrous tissue in the injury ions in the tissues by the electrodes that cause charged repair process. particles to move from one pole to the other. filter Changes pulsating DC current to smooth DC. electrical impedance The opposition to electron flow in filters Devices that help to reduce external noise that a conducting material. essentially makes the amplifier more sensitive to some electrical potential The difference between charged incoming frequencies and less sensitive to others. particles at a higher and lower potential. fluidotherapy A modality of dry heat using a finely divided electrolytes Solutions in which ionic movement occurs. solid suspended in a stream with the properties of liquid. electromagnetic spectrum The range of frequencies fluorescence The capacity of certain substances to radiate and wavelengths associated with radiant energy. when illuminated by a source of a given wavelength; a light electromyographic biofeedback A therapeutic of a different wavelength (color) than that of the irradiating procedure that uses electronic or electromechanical source when illuminated by a given wavelength. instruments to accurately measure, process, and feed back focusing Narrowing attention to the appropriate stimuli reinforcing information via auditory or visual signals. in the environment. electron Fundamental particle of matter possessing a free nerve endings Receptors that are sensitive to negative electrical charge and very small mass. extreme mechanical, chemical, or thermal energy. electrophoresis The movement of ions in solution. frequency The number of cycles or pulses per second. electropiezo activity Changing electric surface charges frequency window selectivity Cellular responses may of a structure forces the structure to change shape. be triggered by a certain electrical frequency range. endogenous opioids Opiate-like neuroactive peptide friction massage A technique that affects fibrositic substances made by the body. adhesions in tendon, muscle, or ligament. It is performed endorphins Endogenous opioids whose actions have by small circular movements that penetrate into the analgesic properties (i.e., b-endorphin). depth of a muscle, not by moving the finger on the skin, endothelial cell Cells that line the cavities of vessels. but by moving the tissues under the skin. endothelial-derived relaxing factor Relaxes smooth functional electrical stimulation Utilizes multiple muscle and stimulates blood flow rates in veins. channel electrical stimulators to recruit muscles in a enkephalinergic interneurons Neurons with short programmed sequence that produces a functional axons that release enkephalin. They are widespread in the movement pattern. central nervous system and are found in the substantia gelatinosa, nucleus raphe magnus, and periaqueductual G grey matter. erythema A redness of the skin caused by capillary gap junctions Specialized junction areas connecting cells dilation. of like structure that contain channels for ionic, electrical, excited state State of an atom that occurs when outside and small molecule signaling that passes messages from energy causes the atom to contain more energy than cell to cell. normal. glutamate enkephalin Neurotransmitter proteins that block the passage of noxious stimuli from first order to F second order afferents. They inhibit the release of substance P and are produced by enkephalinergic neurons. facet joints Articular joints of the spine. ground A wire that makes an electrical connection with faradic current An asymmetric biphasic waveform the earth. seldom used on modern electrical generators. ground-fault interrupters (GFI) A safety device that Federal Communications Commission (FCC) Federal automatically shuts off current flow and reduces the agency charged with assigning frequencies for all radio chances of electrical shock. transmitters, including diathermies. ground state The normal, unexcited state of an atom. fiber optic A solid glass or plastic tube that conducts light along its length.

H Glossary G-5 heterodyne Cyclic rising and falling wave form of integration A signal processing technique that measures interferential current. the area under the curve for a specified period of time, high-voltage current Current in which the waveform thus forming the basis for quantification of electrical has an amplitude of greater than 150 V with a relatively activity. short pulse duration. intensity A measure of the rate at which energy is being hot spots Areas at tissue interfaces that may become delivered per unit area. overheated. intermolecular oscillation (vibration) Movement Hubbard tank An immersion tank for the whole body, it between molecules that produces friction and thus heat. may have vertical depth for walking or supine treatment. interneurons Neurons contained entirely in the central hunting response A reflex vasodilation that occurs nervous system. They have no projections outside the in response to cold approximately 15 minutes into the spinal cord. Their function is to serve as relay stations treatment. This has been demonstrated to be only an within the central nervous system. increase in temperature and not necessarily a change in interpulse interval The interruptions between individual blood flow. pulses or groups of pulses. hybrid currents Currents that have waveforms intrapulse interval The period of time between individual containing parameters that are not classically alternating pulses. or direct. inverse square law The intensity of radiation striking a hydrocollator A synthetic hot (170°F) or cold (0°F) gel particular surface varies inversely with the square of the used as an adjunctive modality to stimulate a rise or fall distance from the radiating source. in tissue temperature. ion A positively or negatively charged particle. hydrotherapy Cryotherapy and thermotherapy ion transfer A technique of transporting chemicals across techniques that use water as the medium for heat a membrane using an electrical current as a driving force. transfer. ionization A process by which soluble compounds, such hyperemia Presence of an increased amount of blood in as acids, alkaloids, or salts, dissociate or dissolve into ions part of the body. that are suspended in some type of solution. hyperplasia An increase in the size of a tissue; in the iontophoresis Uses continuous direct current to drive skin, an increased thickness of the epidermis. ions into the tissues. I J impedance The resistance of the tissue to the passage of joint capsule Ligamentous structure that surrounds and electrical current. encapsulates a joint. indication The reason to prescribe a remedy or joint swelling Accumulation of blood and joint fluid procedure. within the joint capsule. indifferent or dispersive electrode Large electrode used to spread out electrical charge and decrease current K density at that electrode site. indirect effect A decreased response that occurs in Kehr’s sign Referred pain pattern involving pain in the deeper tissues. left jaw, shoulder, and arm. induction electrodes Cable or drum electrodes that keratin The fibrous protein that forms the chemical basis create a stronger magnetic field than electrical field. of the epidermis. inflammation A redness of the skin caused by capillary keratinocytes A cell that produces keratin. dilations. infrared The portion of the electromagnetic spectrum L associated with thermal changes located adjacent to the red portion of the visible light spectrum. laser A device that concentrates high energies into a insulators Materials that resist current flow. narrow beam of coherent, monochromatic light (Light Amplification by the Stimulated Emission of Radiation).

G-6 Glossary minimal erythemal dose The amount of time of exposure to UVR necessary to cause a faint erythema Law of Grotthus-Draper Energy not absorbed by the 24 hours after exposure. tissues must be transmitted. modulation Refers to any alteration in the magnitude or leukocytes A white blood cell that is the primary effector any variation in the duration of an electrical current. cell against infection and tissue damage that functions to monochromaticity When a light source produces a clean up damaged cells. single color or wavelength. ligament deformation Lengthening distortion of monophasic current Another name for direct current, ligament caused by traction loading. in which the direction of current flow remains the same. longitudinal wave The primary waveform in which mottling A reddening of the skin in a blotchy pattern. ultrasound energy travels in soft tissue, with the molecular muscle guarding A protective response in muscle that displacement along the direction in which the wave travels. results from pain or fear of movement. low-voltage current Current in which the waveform has myofascial pain A type of referred pain associated with an amplitude of less than 150 V. trigger points. lymph A transparent slightly yellow liquid found in the myofascial release A group of techniques used to relieve lymphatic vessels. soft tissue from the abnormal grip of tight fascia. lymphedema Swelling of subcutaneous tissues as a result of accumulation of excessive lymph fluid. N M nerve root impingement Abnormal encroachment of some body tissue into the space occupied by the nerve macroshock An electrical shock that can be felt and has root. a leakage of electrical current of greater than 1 mA. neuromuscular electrical stimulator (NMES) Also macrotears Significant damage to soft tissues caused called an electrical muscle stimulator (EMS), it is used by acute trauma that results in clinical symptoms and to stimulate muscle directly as would be the case with functional alterations. denervated muscle where peripheral nerves are not magnetic field Field created when current is passed functioning. through a coiled cable that affects surrounding tissues by neurotransmitter Substance that passes information inducing localized eddy currents, within the tissues. between neurons. It is released from one neuron terminal massage The act of rubbing, kneading, or stroking (presynaptic membrane), enters the synaptic cleft, the superficial parts of the body with the hand or with and attaches (binds) to a receptor on the next neuron an instrument for the purpose of modifying nutrition, (postsynaptic membrane). Substance P, enkephalins, restoring power of movement, or breaking up adhesions. serotonin, methionine, acetylcholine, and leucine maximum voluntary isometric contraction Peak torque enkephalin are neurotransmitters. produced by a muscular contraction. nociceptive Pain information or signals of pain stimuli. medical galvanism Creates either an acidic or alkaline noise Extraneous electrical activity that may be produced environment that may be of therapeutic value. by any source other than the contracting muscle. melanin A group of dark brown or black pigments that norepinephrine A neurotransmitter. occur naturally in the eye, skin, hair, and other animal nutrients Essential or nonessential food substance. tissues. meniscoid structures A cartilage tip found on the O synovial fringes of some facet joints. metabolites Waste products of metabolism or ohm A unit of measure that indicates resistance to catabolism. current flow. microcurrent electrical nerve stimulator (MENS) Used Ohm’s law The current in an electrical circuit is directly primarily in tissue healing, the current intensities are too proportional to the voltage and inversely proportional to small to excite peripheral nerves. the resistance. microshock An electrical shock that is imperceptible opiate receptors Neurons that have receptors that bind because of a leakage of current of less than 1 mA. to opiate substances. microtears Minor damage to soft tissue most often associated with overuse.

oscillator Used to produce and output a specific Glossary G-7 waveform, which may be different from that used to power or drive the stimulating unit. resonance is passed through the piezoelectric crystal, output amplifier Used to magnify or increase the the crystal will expand and contract or vibrate at the amplitude of the voltage output of the generator and frequency of the electrical oscillation, thus generating control it at a specific level. ultrasound at a desired frequency. pigmentation Tanning of the skin from sun exposure. P pitting edema A type of swelling that leaves a pitlike depression when the skin is compressed. pad electrodes Capacitor-type electrode used with population inversion A condition where more atoms shortwave diathermy to create an electrical field. exist in a high energy, excited state than those atoms that pain An unpleasant sensory and emotional experience are in a normal ground state; this is required for lasing to associated with actual or potential tissue damage. occur. paraffin bath A combined paraffin and mineral oil power The total amount of ultrasound energy in the immersion technique in which the paraffin substance is beam; is expressed in watts. heated to 126°F for conductive heat gains; commonly proprioceptive nervous system System of nerves that used on the hands and feet for distal temperature gains in provides information on joint movement, pressure, and blood flow and temperature. muscle tension. parallel circuit A circuit in which two or more routes prostaglandins Irritants that are synthesized locally during exist for current to pass between the two terminals. injury in tissue from a fatty acid precursor (arachidonic periaqueductal grey A midbrain structure that plays an acid). They act with bradykinin to amplify pain by important role in descending tracts that inhibit synaptic sensitizing afferent neurons to chemical and mechanical transmission of noxious input in the dorsal horn. simulation. Aspirin is thought to be capable of interrupting periosteum A highly vascularized and innervated the process. Prostaglandins are powerful vasodilators. They membrane lining the surface of bone. induce erythema, increase leakage of plasma from vessels, petrissage Massage technique that is a kneading and attract leukocytes to an injured area. manipulation. Consists of repeatedly grasping and pulse An individual waveform. releasing the tissue with one or both hands or parts pulse charge The total amount of electricity being thereof in a lifting, rolling, or pressing movement. The delivered to the athlete during each pulse. outside characteristic of this movement as contrasted pulse period The combined time of the pulse duration to stroking movements is that the pressure is applied and the interpulse interval. intermittently. pulsed-polyphasic current Current that contains three phagocytic cells A cell that has the ability to destroy and or more grouped phases in a single pulse and that is used ingest cellular debris. in interferential and “Russian” currents. phases That portion of the pulse that rises above or pulsed shortwave diathermy Created by simply below the baseline for some period of time. interrupting the output of continuous shortwave phonophoresis A technique in which ultrasound is used diathermy at consistent intervals; it is used primarily for to drive a topical application of a selected medication into nonthermal effects. the tissues. pulsed ultrasound The intensity is periodically photokeratitis An inflammation of the eyes caused by interrupted with no ultrasound energy being produced exposure to UVR. during the off period. When using pulsed ultrasound, the photon The basic unit of light; a packet or quanta of light average intensity of the output over time is reduced. energy. photosensitization A process in which a person becomes R overly sensitive to UVR. piezoelectric activity Changing electric surface charges radiating pain Pain that moves away from the site of a of a structure forces the structure to change shape. lesion, usually associated with some pressure in the area piezoelectric effect When an alternating electrical of injury. current generated at the same frequency as the crystal radiation The process of emitting energy from some source in the form of waves. A method of heat transfer through which heat can be either gained or lost.

G-8 Glossary S ramping Another name for surging modulation, in which sclerotome A segment of bone innervated by a spinal the current builds gradually to some maximum amplitude. segment. raphe nucleus Part of the brain that is known to inhibit series circuit A circuit in which there is only one path pain impulses being transmitted through the ascending for current to get from one terminal to another. system. sensitization Prolonged depolarization of nociceptive rarefactions Regions of lower molecular density (i.e., a neurons that results in continuous stimulation. Most small amount of ultrasound energy) within a longitudinal sensory receptors are rendered less sensitive after wave. prolonged stimulations. This is not the case with rate of rise How quickly a waveform reaches its nociceptive neurons. maximum amplitude. serotonin A neurotransmitter found in neurons raw A form in which the electrical activity produced by descending in the dorsolateral tract. The dorsolateral muscle contraction may be displayed or recorded before tract is thought to play a significant role in pain control. the signal is processed. Serotonin is found in the vesicles in nerve endings that rectification A signal processing technique that changes bind when released to postsynaptic membranes. Its action the deflection of the waveform from the negative pole is terminated by re-uptake into presynaptic membranes. to the positive pole, essentially creating a pulsed direct It is probably involved in both endogenous pain control current. and opiate analgesia. Increased levels of serotonin in the rectifier Converts AC current to pulsating DC current. central nervous system are generally associated with reference electrode Also referred to as the ground increased analgesia. electrode, it serves as a point of reference to compare the signal gain Determines the signal sensitivity. If a high electrical activity recorded by the active electrodes. gain is chosen, the biofeedback unit will have a high referred pain (referred myofascial pain) When sensitivity for the muscle activity signal. nociceptive impulses reach the dorsal grey matter, smoothing A signal processing technique that eliminates they converge, and their summation can depolarize the high-frequency fluctuations that are produced with a internuncial neurons over several spinal segments, changing electrical signal. causing the individual to feel pain in distal areas specific absorption rate (SAR) Represents the rate of innervated by these segments. energy absorbed per unit area of tissue mass. reflection The bending back of light or sound waves spondylolisthesis Forward displacement of one vertebra from a surface that they strike. over another. refraction The change in direction of a sound wave or spontaneous emission When an atom in a high-energy radiation wave when it passes from one medium or type state emits a photon and drops to a more stable ground of tissue to another. state. regulator Produces a specific controlled voltage output. standing wave As the ultrasound energy is reflected at resistance The opposition to electron flow in a tissue interfaces with different acoustic impedances, the conducting material. intensity of the energy is increased as the reflected energy resting potential The potential difference between the meets new energy being transmitted, forming waves of inside and outside of a membrane. high energy, that can potentially damage surrounding rheobase The intensity of current necessary to cause tissues. observable tissue excitation given a long current stereodynamic interference current Three distinct duration. circuits blending and creating a distinct electrical wave RNA Ribonucleic acid—an acid found in the cell pattern. cytoplasm and nucleolus; it is intimately involved in stimulated emission When a photon interacts with protein synthesis. an atom already in a high-energy state and decay of the Rolfing A system devised to correct inefficient structure atomic system occurs, releasing two photons. by balancing the body within a gravitational field through strain-related potentials Tissue-based electric potentials a technique involving manual soft-tissue manipulation. generated in response to strain of the tissue. Russian current A medium frequency (2000 to 10,000 H2) polyphasic AC wave generaged in 50 burst-per- second envelopes.

strength-duration curve A graphic illustration of the Glossary G-9 relationship between current intensity and current duration in causing depolarization of a nerve or muscle transformer Reduces the amount of voltage from the membrane. power supply. stretching window The time period of vigorous heating transmission The propagation of energy through a when tissues will undergo their greatest extensibility and particular biologic tissue into deeper tissues. elongation. transverse wave Occurring only in bone, the molecules substance P A peptide believed to be the neurotransmitter are displaced perpendicular to the direction in which the of small-diameter primary afferent. It is released from both ultrasound wave is moving. ends of the neuron. trigger point Localized deep tenderness in a palpable substantia gelatinosa (SG) Lamina II of the dorsal firm band of muscle. When stretched, a palpating finger horn of the grey matter. Melzack and Wall proposed can snap the band like a taut string, which produces local that the SG is responsible for closing the gate to painful pain, a local twitch of that portion of the muscle, and a stimuli. jump by the athlete. Sustained pressure on a trigger point summation of contractions Shortening of muscle reproduces the pattern of referred pain for that site. myofilaments caused by increasing the frequency of twitch muscle contraction A single muscle contraction muscle membrane depolarization. caused by one depolarization phenomenon. sun protection factor (SPF) A sunscreen’s effectiveness in absorbing the sunburn-inducing radiation. U synovial fringes Folds of synovial tissue that move in and out of the joint space. ultrasound A portion of the acoustic spectrum located above audible sound. T ultraviolet The portion of the electromagnetic spectrum associated with chemical changes located adjacent to the tapotment A percussion massage; any series of brisk violet portion of the visible light spectrum. blows following each other in a rapid alternating fashion: unilateral foramen opening Enlargement of the foramen hacking, cupping, slapping, beating, tapping, and on one side of a vertebral segment. pinchment. It is used when stimulation is the objective. tetanization When individual muscle-twitch responses V can no longer be distinguished and the responses force maximum shortening of the stimulated muscle fiber. vasconstriction Narrowing of the blood vessels. tetany Muscle condition that is caused by hyperexcitation vasodilation Dilation of the blood vessels. and results in cramps and spasms. vibration A shaking massage technique; a fine tremulous thermal Pertaining to heat. movement made by the hand or fingers placed firmly thermopane An insulating layer of water next to the against a part that will cause the part to vibrate. Often skin. used for a soothing effect; may be stimulating when more thermotherapy The use of heat in the treatment of energy is applied. pathology or disease. viscoelastic properties The property of a material to traction Drawing tension applied to a body segment. show sensitivity to rate of loading. Trager A technique that attempts to establish volt The electromotive force that must be applied to neuromuscular control so that more normal movement produce a movement of electrons. patterns can be routinely performed. voltage The force resulting from an accumulation of transcutaneous electrical nerve stimulator (TENS) A electrons at one point in an electrical circuit, usually transcutaneous electrical stimulator used to stimulate corresponding to a deficit of electrons at another point in peripheral nerves. the circuit. transcutaneous electrical stimulator All therapeutic voltage sensitive permeability The quality of some cell electrical generators regardless of whether they deliver membranes that makes them permeable to different ions AC, DC, or pulsed currents through electrodes attached based on the electric charge of the ions. Nerve and muscle to the skin. cell membranes allow negatively charged ions into the cell while actively transporting some positively charged ions outside the cell membrane.

G-10 Glossary wavelength The distance from one point in a propagating wave to the same point in the next wave. W Wolff’s law Bone remodels itself and provides increased strength along the lines of the mechanical forces placed watt A measure of electrical power. Mathematically, on it. watts = volts ¥ amperes. waveform The shape of an electrical current as displayed on an oscilloscope.

Credits CHAPTER 2 CHAPTER 7 Figure 2–1, From Booher, J. and Thibodeau, G: Athletic Figure 7–1, From Van De Graaff, K: Human anatomy, ed. Injury Assessment, ed. 4, New York: McGraw-Hill Higher 6, Dubuque, IA: McGraw-Hill Higher Education, 2002; Education, 2000; Figures 2–3, 2–5 2–7, From McKinley, Figure 7–5, Courtesy Chattanooga Group; Figure 7–6B, M & O’Loughlin, V: Human Anatomy, ed. 1, New York: Courtesy Tyco Healthcare / Kendall. McGraw-Hill Higher Education, 2006. CHAPTER 8 CHAPTER 3 Table 8–1, From Griffin, J.E.: J. Am. Phys. Ther. Table 3–1, From Previte JJ: Human Physiology, New 46(1):18–26, 1966. Reprinted with permission of the York, McGraw-Hill, 1983; Figures 3–2, 3–3, Used with American Physical Therapy Association; Table 8–2, permission from Melzack, R: Pain measurement and From Ward, A.R.: Electricity fields and waves in therapy, assessment, New York, 1983, Raven Press; Figures 3–5, Maricksville, NSW, Australia, Science Press, 1986; 3–6, From McKinley, M & O’Loughlin, V: Human Anatomy, Table 8–6, From Cameron M, Monroe, L: Relative ed. 1, New York: McGraw-Hill Higher Education, 2006. transmission of ultrasound by media customarily used for phonophoresis, PhysTher 72(2):142-148, CHAPTER 4 1992. Reprinted with permission from the American Physical Therapy Association; Figures 8–2B, 8–3A, B, Figure 4–1, From Bocobo, et al. The effect of ice on intra- 8–21B, Courtesy Chattanooga Group; Figures 8–3C, articular temperature in the knee of a dog; AMJ Phys. 8–19A, 8–21A Courtesy Metron; Figures 8–3D, 8–21C, Rehab, 70:181, 1991; Figure 4–2, Courtesy Cryocup; Courtesy Mettler Electronics Corp.; Figure 8–6, From: Figure 4–4B, Courtesy Duffield Medical; Figure 4–11, Chudliegh, D, Schulthies, SS, Draper, DO, and Myrer, Courtesy Chattanooga Group; Figure 4–23, Courtesy JW: Muscle temperature rise with 1 MHz ultrasound in Parabath; Figure 4–15, Courtesy Thermacare; treatment sizes of 2 and 6 times the effective radiating Figure 4–16, Courtesy of G.E. Millian Inc. Yonkers, NY. area of the transducer. Master’s Thesis, Brigham Young University, July, 1997; Figure 8–12, Courtesy of Castel, CHAPTER 5 JC: Sound Advice, PTI, Inc., 1995. Used by permission.; Figure 8–16B, Courtesy of Cone Instruments; Figure 8–17, Figure 5–26A, Courtesy Chattanooga Group; Figure 5–27, Courtesy of RichMar Medical; Figure 8–16B&C, Courtesy Courtesy Apex Medical Corporation. of Smith & Nephew Inc.; Figure 8–20, From Draper, DO, Schulthies, S, Sorvisto, P, and Hautala A: Temperature CHAPTER 6 changes in deep muscles of humans during ice and ultrasound therapies: an in-vivo study., J Orthop & Sports Figures 6–1B, 6–3B, 6–4, 6–5, Courtesy IOMED; Figure 6–2, Phys Therapy 21:153-157, 199. Courtesy R.A. Fischer Co.; Figure 6–6, Courtesy Travanti Pharma, Inc. C-1

C-2 Therapeutic Modalities Credits CHAPTER 9 CHAPTER 12 Tables 9–1, 9–2, 9–3, Copied with permission from Physio Figure 12–7, Courtesy of Mastercare – The Swedish Technology; Figures 9–2, 9–3B Courtesy Microlight Back Care System; Figures 12–25, 12–31B, Courtesy Corporation of America; Figure 9–3A, Courtesy Laser Chattanooga Group. Therapy. CHAPTER 13 CHAPTER 10 Figure 13–24A, Courtesy Gasteiner-Heilstollen; Figures 10–2A, 10–5, 10–11, Courtesy Mettler Electronics Figure 13–24B, Courtesy Haus der Gesundheit; Corp.; Figures 10–2B, 10–15 Courtesy Scott Medical; Figure 13–28, Courtesy Graston Institute; Figure 13–29, Figures 10–4, 10–10, Modified from Michlovitz, S: Thermal Courtesy Eco-World. agents in rehabilitation, Philadelphia, 1990, FA Davis; Figure 10–14A, Courtesy of International Medical Electronics; Figure 10–14B, Courtesy Physiotechnology, Inc. CHAPTER 11 Figure 11–5, Courtesy Jobst; Figures 11–6, 11–7, 11–8A, Courtesy Chattanooga Group; Figure 11–8B, Courtesy Grimm Scientific; Figure 11–8C, Courtesy BioCompression Systems; Figure 11–8D, Courtesy KCI; Figure 11–10, Courtesy Duffield Medical; Figure 11–12A, Courtesy Aircast; Figure 11–12B, Courtesy GameReady, Inc.; Figure 11–12C, Courtesy VitalWear; Figure 11–12D, Courtesy Bregg.

Index Note: Page numbers followed by f or t indicate figures Anesthesia, 75 or tables, respectively. Annulus fibrosus, 325 Anode, 118 Aα fibers, 41 Anti-inflammatory medication, phonophoretic Abergel, R., 263 Aβ fibers, 41, 44, 45 administration of, 233–234 Absolute refractory period, 125 Arndt-Schultz principle, 8, 267 Absorption, 7, 209t Articular facet joints, spinal traction and, 325 Accommodation, 39, 112 Asymmetrical waveforms, 109, 111f Acidic reaction, 168, 177 Atrophy, 25, 133–134 Acoustic energy, 12–13, 207–210, 208–210f, 214f Attenuation, 209 Acoustic impedances, 209 Average current, 111, 112f Acoustic microstreaming, 220 ACTH (adrenocorticotropic hormone), 47 Back-a-traction, 329f Action potential, 125 Bandwidth, 190 Active electrode, 168, 189 Baths; see Paraffin baths; Whirlpool baths Active release technique (ART), 366, 367f Beam nonuniformity ratio (BNR), 215–216, 216f Activity Pattern Indicators Pain Profile, 35 Beard, Gertrude, 350 Acupressure, 364 Beat modulation, 114 Acupuncture, 364 Beats, 142 Acute injuries, 18, 62 β-endorphin, 41, 43, 46–48, 47f, 137 Acute pain, 34, 43, 52–53 Benson, H. A. E., 234 Aδ fibers, 41, 43, 44, 45, 46 BioCryo, 314 Afferent neurons, 42t Biofeedback, 185–198 Afferent transmission, 40–41, 41f Age, healing and, 25 audio, 194 Airaksinen, O., 307 case studies, 204 Air space plates, 281–282, 281f, 282f clinical applications, 195–197 Alkaline reaction, 168, 177 contraindications, 195t All-or-none response, 127 defined, 186 Alternating current, 107, 107f, 108–109, see also electrodes, 192–194, 193f, 194f electromyographic, 187–191 Biphasic current electromyography and, 185–186 American Massage Therapy Association, 350 equipment, 189f, 192–194, 192f Amperes (A), 105 finger phototransmission, 187 Amplitude, 109, 110–111, 216 indications, 195t Analgesia, 78, 139; see also Pain control information from, 190–191, 191f, 194–195 Analgesic creams, 225, 225f, 355 instruments, 186–187 as measure, 188–189 I-1

measuring electrical activity, 188–189 chronic pain, 53 muscle guarding, relaxation of, 196–197 cold whirlpool, 100–101 muscle reeducation, 195–196 contrast bath, 101 neurologic conditions, 197 diathermy, 300–301 pain reduction, 197 electrical stimulation, 163–165 peripheral skin temperature, 187 hydrocollator warm pack, 100 role of, 186 ice massage, 100 sensitivity settings, 195 intermittent compression, 320–321 skin conductance activity, 187 iontophoresis, 183–184 uses, 185 laser, 275 visual, 194 massage, 377–378 Biologic tissue; see Tissue spinal traction, 347–348 Biphasic current, 107, 107f, 109, 111f; see also ultrasound, 252–253 Alternating current Castel, J., 44, 45 Bipolar arrangement, 189 Cathode, 118 Bladder technique, 226, 226f Cavitation, 220 Blood, conductivity of, 117 Cell membrane Bone depolarization, 125–127, 125f conductivity, 117 resting potential, 124–125, 124f electrical stimulation, 145 Cells laser treatments, 266 frequency window selectivity of, 129 spinal traction, 323 nonexcitatory, 129 ultrasound treatments, 231–232 Center for Devices and Radiological Health, FDA, 268 Wolff’s Law, 28, 323 Cervical traction Bone growth stimulators, 231, 231f manual, 339–341, 340f, 341f, 348 Bork, C., 266 mechanical, 341–342, 341f, 347 Burns C fibers, 41, 43, 44, 45, 46 diathermy, 291–292 Children, ultrasound treatment for, 239 electrical stimulation, 145 Chronaxie, 126 infrared lamps, 86–87 Chronic inflammation, 22, 230, 361 iontophoresis, 177 Chronic injuries, 18 laser treatment, 265, 268 Chronic pain, 34, 40, 43, 53 paraffin baths, 83–84 Circuit, 115; see also Electrical circuits Burst modulation, 114 Circulation cold effects on, 59 Cable electrodes, 284–285, 284f functions, 59 Calcium deposits, 231–232 heat effects on, 58–59, 78 Camphor, 88 massage, 351 Capacitance technique, 280 Climate, and healing process, 25 Capacitor electrodes, 280–281 Clotting process, 21, 21f Capsaicin, 88 Cognitive factors in pain perception, 40 Cartilage Coherence, 257–258 Cold-compression units, 76–77, 77f laser treatment, 266 Cold packs, 68–69, 68f, 236–237 spinal traction, 325 Cold receptors, 60 ultrasound, 231 Cold sprays, 73–75, 74f Case studies Cold whirlpool, 71–73, 71f, 100–101 acute pain, 52–53 Collagen, 22–24 biofeedback, 204 I-2

Collimated beam, 215 ice immersion, 77 Collimation, 257–258 ice massage, 66–68, 66f, 67f, 100 Common mode rejection ratio (CMRR), 190 ice packs, 69–71, 70f Compression; see also Intermittent compression indications, 62–63, 62t inflammatory-response phase, 27 fibroblastic-repair phase, 28 intermittent compression and, 314, 315f first aid management, 25–27 muscle spasm, 60–61 inflammatory-response phase, 27 overview, 11 Compression garment, 309f performance effects, 61–62 Compression pumps, 312–313, 312f physiologic effects, 62–65, 65t Compressions (waves), 207 sensations experienced during, 65 Conductance, 106 techniques, 65–77 Conduction, 57 ultrasound and, 236–237, 237f Conductive thermal energy modalities, 56, 58–62 whirlpool, 71–72, 71f Conductors, 106 Current, 105; see also Electrical currents Congestion, 72 Current density, 119–121, 120f, 121f Connective tissue massage, 361–363, 362f Current intensity, 111 general principles, 362–363 Cycle, of biphasic current, 109 indications and contraindications, 363 Cyriax, James, 360 Connective tissue stretching, 229–230 Cytokines, 21 Consensual heat vasodilation, 78 Constructive interference, 142 Dahners, L., 140 Continuous current, 113–114 Decay time, 112 Continuous wave ultrasound, 218 Delayed union, 145 Contrast baths, 75–76, 75f, 101 Denervated muscle, 127–128 Convection, 57 Depolarization, 125–126, 125f Conversion, 57 Depth of penetration, 12–13 Corticosteroids, 25, 233–234 Cosine law, 8–9, 9f cryotherapy, 66 Coulombs (C), 105 diathermy, 277 Counterirritants, 88–89 laser, 258f, 259 Coupling medium, 223–224, 225f, 234, 235t ultrasound, 214, 214f Cryo-Cuff, 76–77, 77f, 314, 315f Descending pain control theory, 45–46, 46f, 136–137 Cryokinetics, 77 Destructive interference, 142 Cryotherapy, 62–77 Dexamethasone sodium phosphate (Decadron), 234 analgesic effects, 59, 63 Diathermy, 276–293; see also Microwave diathermy; appropriate uses, 57–58 Shortwave diathermy circulation, 59–60 clinical applications, 288–289 cold packs, 68–69, 68f contraindications, 290, 291t cold sprays, 73–75, 74f defined, 7, 276 contraindications, 62t depth of penetration, 277 contrast baths, 75–76, 75f, 101 indications, 289, 291t Cryo-Cuff, 76–77, 77f overview, 9 cryokinetics, 77 physiologic responses, 277–278 defined, 11, 57 precautions, 290–292 depth of penetration, 66 shortwave, 276 first aid management, 25 ultrasound compared to, 290f frostbite, 65 Dicke, Elizabeth, 361 Differential amplifier, 190 I-3

Direct contact (ultrasound), 224–225, 224f of injury, 138 Direct current, 107, 107f, 109, 118f; see also modulation, 113–115, 114f monophasic, 107, 109, 110, 110f, 111f, 113 Monophasic current pulsatile, 107–108, 110f Direct current generators, 112f safety, 146–148 Direct effect, 262 waveforms, 109–114 Disks Electrical energy, 11–12 Electrical field, 279, 281f herniation, 325 Electrical impedance, 106 material, 324 Electrical potentials, 104, 105f nucleus, 325 Electrical shock, 146–147 protrusion, 324 Electrical stimulating currents, 129–148 spinal traction and, 324–325 bone growth stimulation, 145 Divergence, 257, 260 contraindications, 130t Documentation edema control, 133–135 pain assessments, 36 equipment, 129, 130f, 146–148, 238f ultrasound treatments, 227–228 first aid management, 27 Drum electrodes, 283–284, 284f fracture healing, 139–140 Duration, 109, 112, 113, 118 high-volt currents, 129–135 Duty cycle, 123, 218 indications, 130t Dynorphin, 41, 43, 46, 48, 137 interferential, 141–143f, 141–144 intermittent compression and, 314, 314f Eddy currents, 283 iontophoresis, 144–145, 166–178 Edema ligament healing, 140 low-intensity (microcurrent), 138–140 defined, 79, 304 low-volt, 144–145 electrical stimulation, 133–135 maturation-remodeling phase, 28 injury-related, 307–308 medical galvanism, 144 laser treatment, 268 medium-frequency, 140–141, 141f lymphedema, 307–308 muscle contractions, 130–133, 164 negative effects, 308 overview, 12 obstacle to healing, 24 pain control, 135–139, 163 pitting, 307 physiologic responses, 123–129 treatment, 308–309 placebo effect, 145 Effective radiating area (ERA), 212–213, 213t precautions, 145, 146–148 Efferent transmission, 40 premodulated interferential, 144 Effleurage, 351, 353, 356–358, 357f Russian, 140–141, 141f, 165 Einstein, A., 256 tendon healing, 140 Elastic wrap compression, 309 treatment parameters, 117–123 Electrical circuits, 115–117, 115f, 116f ultrasound and, 237–238, 238f Electrical currents; see also Electrical stimulating wound healing, 139 currents Electricity; see Electrical currents alternating, 107, 108–109 Electrodes biologic tissues, 117 air space plates, 281–282, 281f, 282f biphasic, 107, 109,110, 110f, 111f biofeedback, 192–194, 193f, 194f components, 104–107 cable, 284–285, 284f defined, 105 capacitor, 280–281 direct, 107, 109 electrotherapeutic, 107–109 flow, 106–107 I-4

drum, 283–284, 284f biofeedback, 186–187, 189f, 192–194, 192f electrical stimulation, 118–119, 121–123, 121f, diathermy, 278–285, 278f, 279f, 286f, 287f electrical stimulation, 129, 130f, 146–148, 238f 122f iontophoresis, 169f, 170–173, 170f inductor, 282–283 laser, 260 iontophoresis, 171–173, 172f, 173f massage, 354–355, 355f pad, 282, 282f, 283f safety, 146–148, 240, 268–269 shortwave diathermy, 280–284f, 280–285 spinal traction, 333–334, 333f, 337f Electrolytes, 167 ultrasound, 210–213, 210f, 211f, 211t, 227f, Electromagnetic energy, 3–10 effects of, 7 231f, 238f, 240 frequency, 4, 4f Erythema, 67 laws governing, 7–9, 8f Extracellular matrix, 22, 23 modalities, 9–10 Extracorporeal shock wave therapy (ESWT), 13 production of, 6–7 Eye protection, laser treatments and, 268–270 spectrum, 4–5, 5f, 6t wavelength, 4, 4f Facet joints, 325 Electromagnetic energy modalities; see Diathermy; Far field, 215 Laser Fat, conductivity of, 117 Electromyogram, 185 Federal Communications Commission (FCC), 278 Electromyographic biofeedback, 187–192, 188f; see Fibrils, 305 also Biofeedback Fibroblastic-repair phase of injury, 22–23, 23f defined, 185 information from, 190–191, 191f modality use, 27–28 measurement, 188–189 Fibroplasia, 22 motor unit recruitment, 188 Filters, 190 overview, 12 Finger phototransmission, 187 separation and amplification of activity, 510(k) notifications, 269 Fluidotherapy, 84–86, 85f 189–190, 190f Fluori-Methane, 73–75 signal processing, 191 Focusing, 40 Electromyography, biofeedback and, 185–186 Fox, E., 364 Electrons, 105 Fractures Electrophoresis, 167 Electrotherapeutic currents, 107–109; see also electrical stimulation treatments, 139–140 Electrical stimulating currents laser treatments, 266 Elevation, of injured part, 25, 309, 313 stress, 232 Endogenous opiate pain control theory, 46–48, 47f, ultrasound treatments, 231 137–138, 351 Free nerve endings, 38, 39 Endogenous opioids, 42 Frequency, 4f Endorphins, 46 defined, 4, 108 Endothelial cells, 305 electrical stimulation, 117–118 Endothelial-derived relaxing factor, 309 ultrasound, 208–209, 213–215 Energy, 2, 2t Frequency window selectivity, 129 Energy equation, 4 Friction massage, 352, 353, 355, 360–361, 360f, Enkephalin, 41, 42 361f Enkephalin interneurons, 45, 47f Frostbite, 65 Envelopes, 114 Equipment Gain medium, 257 Game Ready System, 314, 315f Gardner, A., 309 I-5

Gate control theory of pain, 45, 45f, 136, 351 Indirect effect, 262–263 Generators, 108–109, 170 Induction technique, 280 Gogia, P., 265 Inductor electrodes, 282–283 Granulation tissue, 22, 23 Infection, 25 Graston Technique, 368–370, 369f Inflammation, 78, 268; see also Chronic inflammation Gridding technique, 260, 260f Inflammatory-response phase of injury, 19–22, 20f Griffin, J. E., 234 Ground, 146 cellular response, 20 Ground-fault interrupter (GFI), 147f chemical mediators, 20–21 Guyton, A., 124 chronic inflammation, 22 laser treatment and, 265 Healing modality use, 27 impeding factors, 24–25, 24t sequence, 21f process of, 19–24 signs and symptoms, 20 ultrasound and, 228 Healing process, 19–24, 19f vascular reaction, 21 fibroblastic-repair phase, 22–23 Infrared lamps, 57, 86–88, 87f inflammatory-response phase, 19–22 Infrared radiation, 5, 56 maturation-remodeling phase, 23–24 Injury; see Sport-related injury Insulators, 106 Heat, defined, 57 Integration, 191 Heat transfer mechanisms, 57, 58t Intensity Hemorrhage, 24 defined, 216 Heterodyne wave behavior, 142–143 electrical stimulation, 118 High voltage, 105 spatial-averaged, 217 Histamine, 20, 228 spatial-averaged temporal peak, 217 Hoffa, Albert, 350, 356 spatial peak, 217 Hoffa massage, 356–360, 357–360f temporal-averaged, 217 temporal peak (pulse-averaged), 217 effleurage, 356–358, 357f ultrasound, 216–217 petrissage, 358, 358f Interburst intervals, 114 routine, 360 Interferential currents, 114, 141–143f, 141–144 tapotement, 358–359, 359f Intermittent compression, 304–316 vibration, 359–360, 360f case studies, 320–321 Hot spots, in ultrasound treatment, 210, 226 cold and, 314, 315f Humidity, and healing process, 25 contraindications, 315–316, 315t Hunting response, 63 electrical stimulation and, 314, 314f Hydrocollator packs equipment, 310f, 311f cold, 68–69, 68f indications, 314–316, 315t warm, 81–83, 81f, 82f, 100 inflation pressures, 310–311 Hydrocortisone, 233–234 injury edema and, 307–309 Hydrotherapy, 58 lymphatic system and, 305–307 Hyperalgesia, 43 on-off sequence, 311 Hyperemia, 78 patient setup and instructions, 313–314 Hypertophic scars, 25 sequential compression pumps, 312–313, 312f sleeves, 313f Ice immersion, 77 techniques, 310–314 Ice massage, 66–68, 66f, 67f, 100 treatment time, 311 Ice packs, 69–71, 70f Immersion technique, 225–226, 226f Indication, 79 I-6

Intermolecular oscillation (vibration), 283 Lamps, infrared, 57 International Association for the Study of Pain, 33 Laser; see also Low-level laser Interneurons, 42 Interphase interval, 110 defined, 256 Interpulse interval, 110 depth of penetration, 258f Inverse square law, 9, 10f development of, 256 Inversion traction, 328–330, 329f, 330f physics of, 257–258, 257f Ionization, 167 types, 258–259 Ions Lateral spinothalamic tract, 44f Law of Grotthus-Draper, 8 defined, 104, 167 LeDuc, S., 166 movement in solution, 167–168 Leukocytes, 20 movement through tissue, 168–169 Leukotrienes, 20–21 Iontophoresis, 144–145, 166–178 Leukotrines, 43 advantages, 166, 167 Lidocaine, 234 burns, 177 Ligament deformation, 323 case studies, 183–184 Ligament healing, 140 clinical applications, 175, 175–176t Ligaments, spinal traction and, 323–324 contraindications, 177t Linens, for massage, 354, 355f current intensity, 170–171, 171f Ling, Peter H., 350 current required, 170 LIS; see Low-intensity stimulator (LIS) defined, 114 Litke, D., 140 duration, 171 Longitudinal wave, 207 electrodes, 171–173, 172f, 173f Low-intensity stimulator (LIS), 108, 138–140 equipment, 169f, 170–173, 170f Low-level laser; see also Laser generators, 170 bone/cartilage healing, 266 indications, 177t case study, 275 ion selection, 173–174, 174t clinical applications, 263–266 mechanisms, 167–169 continuous wave, 261f medication dosage, 171 contraindications, 270t pharmacokinetics, 167 depth of penetration, 259, 262–263 phonophoresis versus, 166–167 dosage, 261–262, 261t precautions, 177–178 edema and inflammation, 268 sensitivity reactions, 178 equipment, 260 Ion transfer, 166 first aid management, 27 gridding, 260, 260f Jobst compression garment, 309f indications, 270t Joint contracture, 133, 229 inflammation, 265 Joint mobilization, 367–368 overview, 9–10 Joints, traction for facet, 325 pain reduction, 266, 267–268 Joint swelling, 304 photochemical effects, 258 precautions, 270 Kahn, J., 174 pulsed, 261f Kana, J., 264 safety, 268–269 Keloids, 25 scanning, 260, 261f Kinetic energy, 13 scar tissue, 265, 268 Kleinkort, I. A., 234 synonyms for, 259 Krause’s end bulbs, 38, 39 I-7

treatment protocols, 266–268, 267t pain reduction, 351 treatment techniques, 259–263 patient preparation, 355–356, 356f treatment times, 262t physiologic effects, 350–352 types, 259, 259f positional release therapy, 365–366, 366f wanding, 260 positioning, clinician’s, 352, 353f wound healing, 263–266, 268 psychological effects, 352 Low voltage, 105 reflexive effects, 351 Low-volt currents, 144–145 Rolfing, 370–371, 370f Lubricant, 355, 355f routine, 360 Lumbar traction skin, effect on, 352 manual, 330–332f, 330–332 strain-counterstrain, 365 mechanical, 332–339, 334–336f, 347–348 techniques, 356–371 positional, 327–328, 327f, 328f Trager technique, 371 Lymph, 304 transverse friction massage, 361, 361f Lymphatic system treatment considerations and guidelines, capillary, 306f massage, 351 352–354, 353f, 354f peripheral structure and function, 306–307 trigger point massage, 364–365 purposes, 305 Mathews, J., 338 structure, 305, 305f Maturation-remodeling phase of injury, 23–24, 23f Lymphedema, 304, 307–308 modality use, 28–29 Maximum voluntary isometric contraction (MVIC), Macroshock, 147 133 Macrotears, 24 Mayayo, E., 266 Macrotraumatic injuries, 18–19 McGill Pain questionnaire (MPQ), 35, 37f Magnetic field, 279, 283f McMaster, W., 64 Maiman, T., 256 Mechanical cervical traction, 341–342, 341f, 347 Manual cervical traction, 339–341, 340f, 341f, 348 Mechanical energy, 13 Manual lumber traction, 330–332, 330–332f modalities, 13 Margination, 20 Mechanical lumbar traction, 332–339, 347–348 Massage, 349–372 Medical galvanism, 114, 144 Medication active release technique, 366, 367f iontophoresis, 171 case study, 377–378 phonophoresis, 232–236 circulatory effects, 351 Medium-frequency current generators, 140–141, connective tissue massage, 361–363, 362f 141f contraindications, 371, 371t Meissner’s corpuscles, 38, 39 defined, 349 Melzack, R., 44, 364 equipment, 354–355, 355f Meniscoid structures, 325 Graston Technique, 368–370 Mennell, James B., 350, 351 hands, clinician’s, 352, 368 MENS; see Microcurrent electrical nerve stimulator history, 349–350 (MENS) Hoffa massage, 356–360, 357–360f Menthol, 88 indications, 371, 371t Merkel’s corpuscles, 38 mechanical effects, 351–352, 351–352 Mester, E., 263–265 metabolic effects, 351 Metabolism, 351 muscular effects, 352 Metabolites, 78 myofascial release, 367–368 Methyl salicylate, 88 I-8

Microcurrent, 108, 138–140 Neuromuscular electrical stimulator (NMES), 108 Microcurrent electrical nerve stimulator (MENS), 108 Neurons, 40–41, 42t Microshock, 147 Neurotransmitters, 41 Microtears, 24 Nikolova, L., 144 Microtraumatic injuries, 19 NMES; see Neuromuscular electrical stimulator Microwave diathermy, 276, 287–288; see also (NMES) Diathermy Nociceptors, 38, 43–44 Miglietta, O., 61 Noise, 189 Modalities; see Therapeutic modalities Nonunion, 145 Modulation, 113 Norepinephrine, 41, 42–43 Monochromaticity, 257–258 Numeric pain scale, 35–36 Monophasic current, 107, 107f, 109, 110, 110f, Nutrients, 78 Nutrition, and healing process, 25 111f; see also Direct current Muscle Ohm, 106 Ohm’s law, 106 conductivity, 117 Overuse injuries, 18 denervated, 127–128 Oxygen tension, 25 innervated, 163 massage, 352 Pacinian corpuscles, 38, 39 spinal traction, 325–326 Packets, 114 Muscle contractions, 127–128, 130–133 Pad electrodes, 282, 282f, 283f Muscle fatigue, 131 Pain, 33–50 Muscle force, 131 Muscle guarding, 196–197 acute, 34, 40, 52–53 Muscle pumping contraction, 132–133 assessment, 34–36, 35f, 36f, 37f Muscle reeducation chronic, 34, 40, 43, 53 biofeedback, 195–197 cognitive influences, 40 electrical stimulation, 131–132, 164 deep somatic, 34 Muscle spasm, 24 defined, 33 cold effects on, 60–61 description of, 38 heat effects on, 60–61, 79 perception of, 33, 38–40 Muscle spindles, 38, 39 persistent, 34 Muscle strengthening, 133, 134 purpose of, 33 Myofascial pain, 63 radiating, 34 Myofascial release, 367–368, 368f referred, 34, 364 Myofascial trigger points, 360f, 363 transmission, 40–44 types, 34 National Certification Examination for Therapeutic Pain charts, 36f Massage and Bodywork, 350 Pain control β-endorphin, 46–48 Near field, 215 biofeedback, 197 Nemec, Ho, 141 descending mechanisms, 45–46, 46f, 136–137 Nerve fibers, 40–41 dynorphin, 46, 48 Nerve responses to electrical currents, 124–127, electrical stimulation, 135–139, 163 endogenous opiate, 46–48, 47f 124–127f gate control theory, 45, 45f, 136 Nerves, spinal traction and, 326 laser, 266, 267–268 Neural transmission, 40–44 massage, 351 Neurologic conditions, biofeedback for treatment I-9 of, 197

mechanisms, 40 Placebo effect, 145, 232 neurophysiological mechanisms, 44–48 Planck’s constant, 4 ultrasound, 232 Plantar warts, 232 Pain management Platelets, 21 goals, 38 Polar Care Cub, 314, 315f guidelines, 48–49 Polarity, 118–123 Pain memory, 40 Paraffin baths, 83–84, 83f chemical effects, 119 Parallel circuit, 115–116, 116f current density, 119–121 Pelvic traction harness, 333, 334f direction of current flow, 119 Pemberton, R., 351 ease of excitation, 119 Penetration electrode placement, 121–123, 121f, 122f absorption versus, 209t on/off time, 123 depth, 12–13, 66, 214, 214f, 258f, 259, 277 Positional release therapy (PRT), 365–366, 366f Percussion; see Tapotement (percussion) Positional traction, 328 Performance, temperature effects on, 61–62 Potential difference, in electricity, 105f Periaqueductal grey (PAG), 46 Potential energy, 13 Peripheral skin temperature, 187 Power, 216 Persistent pain, 34 Precautions; see also Safety Petrissage, 356, 358, 358f diathermy, 290–292 Phagocytic cells, 20 electrical stimulation, 145, 146–148 Phase duration, 110 iontophoresis, 177–178 Phases, of waveforms, 109, 110 laser, 270 Phonophoresis, 166–167, 232–236, 233 ultrasound, 238–240 Photons, 3–4, 257 Premarket Notifications, 269 Physiologic effects Premodulated interferential current, 144 all-or-none, 127 Primary hyperalgesia, 43 cryotherapy, 62–65, 65t Primary injury, 18–19 diathermy, 277–278 Propagation of nerve impulse, 126f direct and indirect effects, 123–124 Proprioceptive nervous system, 324 electrical shock, 147 Proprioceptors, 38–39 electrical stimulation, 123–129 Prostaglandin, 43 excitatory, 123–128 Psychological effects of massage, 352 massage, 350–352 Pulsatile currents, 107–108, 107f, 110–111, 110f mechanical, 351–352 Pulse-averaged intensity, 217 muscles, 127–128 Pulse charge, 111 nerves, 124–127 Pulsed shortwave diathermy, 277–278, 285–286, nonexcitatory, 129 285f nonthermal, 220–221, 220f, 277–278 Pulsed ultrasound, 218 reflexive, 351 Pulse period, 113 thermal, 219–220, 277 Pulses, of waveforms thermotherapy, 65t, 78–79 amplitude, 110–111 ultrasound, 219–221 charge, 112 Piezoelectric crystals, 211 decay time, 112 Piezoelectric effect, 211–212, 212f defined, 109 Pillows, for massage, 354, 356f duration, 113 Pitting edema, 228, 305, 307, 307f frequency, 113 rise time, 112 I-10

Pulse trains, 114 Secondary hyperalgesia, 43 Pulse width, 113 Secondary injury, 19 Sensitivity reactions, 178 Radiating pain, 34 Sensory receptors, 38–39, 39t, 60 Radiation, 57 Sequential compression pumps, 312–313, 312f Series circuit, 115–116, 115f defined, 3 Serotonin, 41 infrared, 5 Shock, electrical, 146–147 ultraviolet, 5 Shortwave diathermy, 278–287; see also Diathermy Ragan, Brian G., 88n Ramping modulation, 114–115 case studies, 300–301 Range of motion, 133, 134 dosage, 279 Raphe nucleus, 46 electrodes, 280–284f, 280–285 Rarefactions, 208 equipment, 278–285, 278f, 279f, 286f Rate of rise, 112 pulsed, 277–278, 285–286, 285f Raw EMG, 191 techniques, 280t Recordkeeping; see Documentation treatment protocols, 289 Rectification, 191 treatment times, 286–287 Reference electrode, 189 ultrasound compared to, 289–290 Referred pain, 34, 364 use of, 276 Reflection, 7 Signal gain, 195 Refraction, 5 Skin Rehabilitation process, 25–29 conductivity, 116–117 Resistance, 106 massage, 352 Resting potential, 124, 124f Skin conductance activity, 187 Rheobase, 126 Smoothing, 191 RICE (rest, ice, compression, elevation), 25 Snyder-Mackler, L., 266 Rochkind, S., 266 Soft-tissue healing, 228–229 Rolf, Ida, 370–371 Soft-tissue mobilization, 367–368 Rolfing, 370–371, 370f Sound energy, 12–13; see also Acoustic energy Ruffini corpuscles, 38 Spatial-averaged intensity, 217 Russell, Gillean, 360 Spatial-averaged temporal peak (SATP) intensity, 217 Russian currents, 140–141, 141f, 165 Spatial peak intensity, 217 Specific absorption rate (SAR), 278–279 Safety; see also Precautions Spectrum, 5 electrical equipment, 146–148 Speed of light, 4 laser equipment, 268–269 Spinal traction, 322–343, 334f ultrasound equipment, 240 articular facet joints, effect on, 325 body position, 334–336 Salicylates, 234 bone, effect on, 323 Saunders, D., 335 case studies, 347–348 Scanning technique, 260, 261f contraindications, 329–330, 342, 342t Scar formation, 22–23 disks, effect on, 324–325, 324f Scar tissue duration, 338 equipment, 333–334, 333f, 337f active release technique, 366 force applied, 336–337 laser, 265, 268 harness, 333–334, 333–335f massage, 352, 360 indications, 342, 342t ultrasound, 229 Schultz, R., 266 I-11 Sclerotome, 34

intermittent, 337–338 Substance P, 41, 43 inversion, 328–330, 329f, 330f Substantia gelatinosa (SG), 42 ligaments, effect on, 323–324 Summation of contractions, 118, 118f lumbar positional, 327–328, 327f, 328f Surging modulation, 114 manual cervical, 339–341, 340f, 341f, 348 Synaptic transmission, 41–43, 43f manual lumbar, 330–332, 330–332f Synovial fringes, 324 mechanical cervical, 341–342, 341f, 347 mechanical lumbar, 332–339, 334–336f, Table, massage, 354 Tapotement (percussion), 356, 358–359, 359f 347–348 Temperature change; see Tissue temperature change mechanical versus manual, 322 Temporal-averaged intensity, 217 muscular system, effect on, 325–326 Temporal peak intensity, 217 nerves, effect on, 326 Tender points, 363, 365 pain, leaning toward/away from, 328, 329f, Tendon healing, 140 TENS; see Transcutaneous electrical nerve stimulator 336, 336f patient setup, 333–334 (TENS) physical effects, 322–326 Tetanization, 118, 118f progressive and regressive, 338, 339f Tetany, 118 spinal movement, 322–323, 323f Therapeutic modalities; see also specific modalities straight leg raise test, 326 sustained, 337–338 fibroblastic-repair phase, 27–28 techniques, 326–342 first aid management, 25–27 unilateral leg pull manual, 332, 332f, 333f inflammatory-response phase, 27 Split table, 330, 330f, 333 maturation-remodeling phase, 28–29 Sport-related injury rehabilitation process, 25–29, 26t cycle of, 18f uses, 17–19 edema from, 307–308 Therapeutic sports massage; see Massage electrical currents of, 138 Therapeutic window, 167 primary, 18–19 ThermaCare wraps, 86, 86f secondary, 19 Thermal energy, 10–11 traumatic versus overuse, 18 modalities, 11 Sports massage; see Massage Thermopane, 72 Spray-and-stretch technique, 74–75, 74f Thermotherapy, 78–88 Standing wave, 210 analgesic effects, 78–79 Stereodynamic interference current, 143 appropriate uses, 57–58 Stillwell, D., 364 circulation, 59–60 Stimulated emission, 257 contraindications, 79t Straight leg raise test, 326 contrast baths, 75–76, 75f, 101 Strain-counterstrain, 365 defined, 11, 57 Strength-duration curves, 126–127, 126f, 127f fibroblastic-repair phase, 27–28 Stress fractures, 232 fluidotherapy, 84–86, 85f Streteching indications, 79, 79t cryotherapy, 74f, 75 inflammatory-response phase, 27 myofascial release, 367–368 infrared lamps, 86–88, 87f ultrasound, 229–230 maturation-remodeling phase, 28 Stretching window, 229–230, 230f muscle spasm, 60–61 Structural integration, 370–371 overview, 11 Substance abuse, pain perception and, 40 paraffin baths, 83–84, 83f I-12

performance effects, 61–62 Ultrasound, 206–241 physiologic effects, 65t, 78–79 amplitude, 216 techniques, 79–88 area treated by, 212–213 ThermaCare wraps, 86, 86f beam, 215–216, 216f ultrasound, 207, 236 bladder technique, 226, 226f, 233 warm packs, 81–83, 81f, 82f, 100 bone healing, 231–232 whirlpool, 80–81, 80f case studies, 252–253 Thoracic traction harness, 334f, 335f chronic inflammation, 230 Tissue clinical applications, 222f, 228–236 connective, 229–230 cold packs and, 236–237, 237f current flow through, 116–117 connective tissue, 229–230 ions’ movement through, 168–169 continuous wave, 218, 218f soft, 228–229 contraindications, 239t ultrasound transmission, 207–210, 208f, 209t, coupling methods, 223–224, 224t depth of penetration, 12–13, 214, 214f 210t, 214f diathermy compared to, 289–290, 290f Tissue separation, 24 direct contact, 224–225, 224f, 233 Tissue temperature change duration, 222–223 electrical stimulation and, 237–238, 238f analgesic effects, 58–59 equipment, 210–213, 210f, 211f, 211t, 227f, circulatory effects, 59–60 231f, 238f, 240 muscular effects, 60–61 exposure techniques, 224–227 performance effects, 61–62 first aid management, 27 physiologic effects of cooling, 62–65 frequency, 213–215 physiologic effects of heating, 78–79 frequency of treatment, 221–222 tissue types, 64f gels, 224–225 Tonic receptors, 39 as heating modality, 207 Total current, 111, 112f heating rate per minute, 223t Traction, 322; see also Spinal traction hot packs and, 236 Traction harness, 333–334, 333–335f immersion technique, 225–226, 226f Trager, Milton, 371 indications, 239t Trager technique, 371 intensity, 216–217 Transcutaneous electrical nerve stimulator (TENS), joint contracture, 229 108, 135–137, 136f, 165 maturation-remodeling phase, 28 Transcutaneous electrical stimulators, 108 overview, 12–13 Transducers, 210–213, 210f, 213f, 226–227 pain reduction, 232 Transmission, 7 phonophoresis, 232–236 Transverse friction massage, 361, 361f physics of, 210–218 Transverse wave, 207 physiologic effects, 219–221 Traumatic injuries, 18 placebo effect, 232 Treatment parameters, 117–123 plantar warts, 232 duration, 118 power, 216 frequency, 117–118 precautions, 238–240 intensity, 118 pulsed, 218, 218f polarity, 118–123 recording treatments, 227–228 Trelles, M., 264–266 safety, 240 Trigger point massage, 364–365 scar tissue, 229 Trigger points, 34, 360f, 363–364 Twin-peak spiked pulse, 112, 112f I-13

soft-tissue healing, 228–229 Walker, J., 266 stress fractures, 232 Wall, P., 44 tissue, transmission of acoustic energy in, Wanding technique, 260 Warm packs, 81–83, 81f, 82f 207–210, 208–210f, 214f Warm receptors, 60 transducers, 210–213, 210f, 213f, 226–227 Warm whirlpool, 80–81, 80f treatment techniques, 221–228 Watt, 106 Ultrasound beam, 215–216 Waveforms, 109–114 Ultraviolet radiation, 5 Ultraviolet therapy, 10 defined, 109 Uncorking effect, 353 pulses versus phases, 109–113 Unilateral foramen opening, 327 shape, 109–110, 109f Unilateral leg pull manual traction, 332, 332f, symmetrical versus asymmetrical, 109, 111f 333f Wavelength, 4, 4f U.S. Food and Drug Administration, 268–269 Whirlpool baths cold, 71–72, 71f, 100–101 Vasoconstriction, 63 contrast baths, 75–76, 75f Vasodilation, 78 maintenance, 73 Velocity, 209 warm, 80–81, 80f Vibration, 360f Wolff’s Law, 28, 323 Vibration (massage), 359–360 Wound healing Viscoelastic properties, 323 electrical stimulation, 139 Visual analogue scales for pain assessment, 35, 35f immunologic responses, 264–265 Vital Wrap System, 314, 315f inflammation, 265 Voltage, 105, 111 laser treatment, 263–266, 268 Voltage sensitive permeability, 124 tensile strength, 264 Volts (V), 105 I-14



Therapeutic Modalities Specifically for Athletic Trainers Stressing the important role therapeutic modalities play in injury rehabilitation, Thera- peutic Modalities for Sports Medicine and Athletic Training continues to be the only comprehensive text written specifically for athletic trainers. With chapters contrib- uted by well-known athletic trainers and educators under the direction of William E. Prentice, the text provides information on the scientific basis and physiologic effects of a wide range of therapeutic modalities, including thermal energy modalities, electrical energy modalities, sound energy modalities, electromagnetic modalities, and mechanical energy modalities. By focusing on clinical applications and spe- cific techniques of application, the text offers students the knowledge they need to greatly enhance their patients’ recovery. Features of the Sixth Edition: Content is fully reorganized to reflect the classification of modalities by the type of energy used to produce a specific therapeutic effect. Chapter 1, The Basic Science of Therapeutic Modalities, is completely revised to increase student understanding of the concepts used throughout the text. Case studies are now integrated into the chapters to facilitate application of key concepts. Treatment Protocol boxes have been added to chapters, detailing how modali- ties are applied and executed.