Modalities
Electrotherapy
TENS (Conventional high-rate/sensory TENS)
Frequency: 100-150 pps. Pulse Duration: 50-80 µs. Amplitude: sensory. Treatment Time: whenever there is pain. Duration of Action: only while on. Typical Conditions: acute injury or repetitive strain. Duration of application: unlimited.
TENS (Low-rate/motor TENS)
Frequency: <10 pps. Pulse Duration: 200-300 µs. Amplitude: small muscle contractions. Treatment Time: maximum 20-30 minutes every 2 hours. Duration of Action: 4-5 hours aftertreatment. Typical Conditions: chronic conditions. Duration of application: 20-30 minutes maximum.
Interferential Current (Acute pain)
Frequency: 100-150 Hz. Time: throughout duration of pain. May be used for 24 hours/day if needed. Modulation: use if available. Amplitude: to produce tingling.
Interferential Current (Chronic pain)
Frequency: 2-10 Hz. Time: 20-30 minutes. Modulation: none. Amplitude: to visible contraction.
Neuromuscular Electrical Stimulation (NMES)
Muscle Strengthening: Pulse Frequency: 35-80 pps. Pulse Duration: 150-200 µs for small muscles, 200-350 µs for large muscles. Amplitude: to >10% or MVIC in injured, >50% MVIC in uninjured. On:Off Time: 6-10 seconds on, 50-120 seconds off, ratio 1:5 initially. Ramp Time: at least 2 seconds. Treatment Time: 10-20 minutes to produce 10-20 repetitions. Times Per Day: Every 2-3 hours when awake.
Muscle Reeducation: Pulse Frequency: 35-50 pps. Pulse Duration: 150-200 µs for small muscles, 200-350 µs for large muscles. Amplitude: sufficient for functional activity. On:Off Time: depends on functional activity. Ramp Time: at least 2 seconds. Treatment Time: depends on functional activity.
Ultrasound
Pain Control
CUS vs. PUS: CUS. Frequency: 1 or 3 MHz. Intensity: 0.5-3.0 W/cm2. Time: 3-10 min.
Tendon Injuries
CUS vs. PUS: CUS or PUS. Frequency: 1 or 3 MHz. Intensity: 0.5-2.5 W/cm2. Time: 3-5 min.
Contraindications
Thermotherapy
Lack of thermal sensation, vascular disease/insufficiency, areas of recent/potential hemorrhage, areas of malignancy, areas of acute inflammation or infection
Cryotherapy
Cold sensitivity (cold uticaria, cryoglobulinemia, Raynaud's phenomenon, paroxysmal cold hemoglobinuria), compromised circulation, over areas of nerve degeneration, over areas of regenerating peripheral nerves, over areas of peripheral vascular disease.
Ultrasound
Cancer/tumor, pregnancy, pacemaker, thrombophlebitis, eyes, reproductive organs, CNS tissue, joint cement/plastic implants, fracture, epiphyseal plates, acute inflammation, breast implants
E-Stim
Pacemaker, pregnancy, over the carotid arteries, over the heart, over or near the phrenic nerve or urinary bladder stimulators, areas of peripheral vascular disease, eyes, areas of active osteomyelitis, areas of malignancy, directly over the spinal cord, active cancer, uncontrolled BP or HR
Diathermy
Pregnancy (patient or therapist), implanted neural or cardiac stimulators, other metal implants, malignancy or cancerous tissue, hemorrhage, acute injury or inflammation, patient with cognitive deficits, loss of sensation or severe circulatory impairments, and fluid filled organs (eyes, testes, ovaries). Precaution: growing epiphyses
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