Medical Machines

January 28, 2009 by Rebecca Deal  
Filed under Massage & Wellness, Physical Therapy

Modern physical therapy often involves the use of modalities. Modalities are anti-inflammatory machines designed to reduce swelling around an injured body part.   During the acute phase of an injury (generally lasts 1-6 days), inflammatory byproducts enter the traumatized area to remove debris and limit bleeding.   The inflammatory phase is characterized by heat, swelling, pain, redness, and loss of function.  The more quickly this phase is resolved, the lower the probability of joint destruction, excessive pain, swelling, weakness, immobilization, and loss of function.  Using anti-inflammatory modalities can accelerate patient progress toward more active participation in rehabilitation and expedite therapy goals for an early return to function.

Electrical Stimulation

Electrical stimulation has a wide variety of clinical applications in physical therapy.  Electrical stimulation is based on the principles of charged particles flowing to reduce inflammation and control pain.  Clinical units generally use two different types of currents to electrically stimulate muscles.  An interferential current is a waveform produced by the interference of two different medium frequency alternating currents from separate channels.  An interferential current is set up with four electrodes in an “X” pattern over a large body part.  A premodulated current uses one channel to deliver a continuous waveform with a medium frequency and a fluctuating current amplitude.  Premodulated electrical stimulation is delivered with two electrodes evenly spaced over a small, inflamed area.  Electrical stimulation treatments are often combined with temperature modalities (hot packs, cold packs) at the end of a physical therapy session for fifteen minutes to control swelling after activity.

Transcutaneous Electrical Neuromuscular Stimulation (TENS) is a popular electrical stimulation modality for controlling pain.  According to the gate control theory of pain, activation of A-beta nerve fibers can inhibit the transmission of the pain signal from the spinal cord to the brain.  Electrical stimulation, when set with appropriate parameters, can selectively activate the A-beta nerve fibers and block the brain from receiving the pain signal from the body.  TENS units deliver a low voltage current and the patient feels a strong, but comfortable tingling sensation.  Patient-friendly TENS units are available for home use at affordable prices.  A physical therapist can give you product recommendations and detailed instructions on how to set the TENS unit for maximum pain relief.  Contact the therapy team at North Tahoe Physical Therapy for pricing and information.

Ultrasound

Ultrasound is a medical machine that uses sound waves to penetrate into tissue for both thermal and non-thermal healing effects.  Ultrasound functions under the principles of piezoelectricity: the ability to change shape in response to an electrical current.  An electrical current is applied to the crystal in the ultrasound “wand” called a transducer.  The piezoelectric crystal responds to the current by expanding and contracting, creating an ultrasound wave.  This wave is able to penetrate through skin using a conducting gel to tissue depths of 1-3mm to bring blood to the injured site and stimulate healing.  Macrophages are cells that work to localize the inflammatory process and recruit repair cells.  The ultrasound machine increases macrophage activity to consolidate inflammation and accelerate the cellular repair response.

Ultrasound treatment can be performed using either a continuous or pulsed setting for duration of eight minutes. Continuous wave ultrasound is used to produce heat and warm the tissues.  Pulsed wave ultrasound recruits macrophages is recommended for anti-inflammatory effects.  During the ultrasound treatment, the patient may feel a minimal sensation from the ultrasound wave.  The patient may perceive warmth from the ultrasound conductive gel.  Ultrasound can be done for a single session or repeated in consecutive treatments to produce the desired anti-inflammatory effects.

Iontophoresis

Iontophoresis is transdermal anti-inflammatory drug delivery using a low voltage direct current to move charged ions across the skin barrier. Ions are transported through skin pores to deliver Dexamethasone (a corticosteroid recommended for the treatment of inflammatory conditions) in the manufacturer recommended 40mA.minutes dosage.  This machine is set up with the medicated, active electrode over the inflamed tissue and a ground electrode at a distant site.  The patient perceives a light tingle under the medicated patch for the duration of the treatment.   Iontophoresis can be done one time, for several sessions consecutively, or in combination with other modalities to produce an overall anti-inflammatory effect.

Modern physical therapy now has several anti-inflammatory modalities from which to choose during the acute phase of healing.  Other medical professionals (MDs, chiropractors, and acupuncturists) may introduce you to similar tools in treatment designed to control inflammation.  Now that you understand the concept of inflammation and how each modality works to reduce swelling and decrease symptoms you can help your medical team make an educated decision about what combination of medical machines will work best for your body under each condition.

Massage and Soreness

October 1, 2008 by Rebecca Deal  
Filed under Massage & Wellness

I just had a massage yesterday, why am I so sore today?

Chances are it was the bodywork you experienced the day before, and it’s perfectly okay. Yes, soreness can be an after-effect of the treatment and it is common to experience it. Soreness or tenderness can result from the pressure used to release the restrictions in your body’s tissue, and also can be a result of under-hydration either before or after the treatment. If the body is not being properly hydrated after the session to flush out the toxins, such as lactic acid, they may be re-deposited into the muscular system causing tenderness. A great approach would to be properly hydrated prior to your treatment by drinking 2-3 glasses in the hours before your appointment. Water is necessary for the liver to filter out the toxins and chemicals from our body, food, and medications.

A professional massage is more than an ordinary back rub. The reason that massage therapy is so effective is that it physically breaks up the restrictions in the muscle tissue causing pain. It is very much like doing a workout. If the muscles are not used to it, they often respond with some soreness. This should only last a day or two, if it does last longer, speak with your therapist about adjusting the treatment. However, just as with exercise, when your body adjusts to having this type of workout your physical response will also be less intense. As a therapist, I want to know how the body is feeling after the soreness does subside.

10 Steps to an Ergonomic Office

Where do you spend the majority of the time during your typical work day? If your answer is sitting in an office chair staring at a computer, it is time to evaluate your work station with regards to your health. Setting up a desk that minimizes prolonged postural stresses can prevent work-related episodes of low back pain. To set up your own ergonomically designed work station, follow these 10 simple steps:

Sitting Posture- When sitting in your chair, it is important to maintain three spinal curves: an inward curve in your low back, an outward curve in the mid-back, and another inward curve in the neck. Shoulder should remain relaxed but kept back in a retracted position. Your head should be kept level with the chin tucked in for the ideal desk posture.

Seat Settings- Adjust your office chair for optimal posture and comfort. For computer work slightly recline the back of the chair. Although some office chairs have lumbar settings, a separate lumbar support pillow is best. A small towel rolled and put in the small of your back works great to maintain the inward lumbar curve. When sitting against the back of the chair, there should be approximately two inches between the edge of the seat and the back of the knees.

Bending in the Chair- To bend over to reach an object out of a low drawer or pick up an object from the floor it is imperative to maintain the inward curve in your low back. Scoot to the edge of the seat and extend one leg out in front of you. Place one hand on the desk surface to assist with balance and bend from the hips. Using your hips as the hinge for this bending motion helps protect the low back.

Turning in the Chair- No Twisting!! When it is necessary to reach into the cabinet behind you or respond to a co-worker in the cubical next to you, it is important to avoid twisting motions that put excessive forces on the spine. Instead, move your body as a single unit in the direction you intend to go with the hips and feet pointed in the same direction.

Foot Rest- Optimal leg position is a 90° angle at the hips and knees. A 90° angle is best obtained using an appropriate height foot rest. Prevent “slouching” by sliding the office chair under the desk as far as possible while making sure to have adequate leg room.

Wrists over Keyboard- Chronic incorrect wrist positioning while typing can lead to the common office injury of carpal tunnel syndrome. To avoid carpal tunnel syndrome, use a wrist rest to position the wrists straight. Keep both of the elbows bent approximately 90° and supported by the desk surface. Adjusting the keyboard to maintain the straightened wrist position can help prevent the excessive wrist extension which leads to carpal tunnel injuries.

Monitor Position- The computer monitor should be angled to be level with the eyes in order to maintain proper head and neck posture. When attempting to type written material, use a document holder to position items at eye level.

Reaching across the Desk- Arrange the work area to eliminate tasks of repetitive reaching. Keep frequently used items close while storing rarely used supplies in a lower drawer. Repetitive lifting can irritate rotator cuff muscles and should be avoided without proper conditioning.

Talking on the Phone- When conducting business on the phone, do not support the receiver between your neck and shoulder. It is best to use a head-set or speaker-phone features to maintain proper neck alignment while talking on the phone for long business conversations.

Take Frequent Rest Breaks for Exercise- To take the strain off your back and prevent fatigue, change positions often. Alternate job tasks that require different postures when possible. The goal for all office workers is to take a break for one minute every hour to stretch and mobilize all the major joints of the body.

So if you’re up for the challenge of setting up your own ergonomically correct work station, print this list out, tape it to the bottom of your monitor and take the time to save your spine from the work-related aches and pains. For additional work station consultation advice or further questions, contact the physical therapy team at North Tahoe Physical Therapy.

-Rebecca L. Deal, MSPT

RICE to Control Swelling

How do I best control swelling after a knee surgery?

Physical therapists often use the acronym RICE to educate patients in the principles of controlling the inflammatory response to injury or surgical trauma:

R: rest- Resting the leg after surgery allows the traumatized tissue structures to relax. Surgical procedures involving a bony repair require eight weeks of non-weight bearing status to allow the bone to heal. After a ligament repair, gentle weight-bearing exercises are allowed under the supervision of a physical therapist. Although an individualized home program is encouraged, excessive exercise is not advised.

I: ice- Cold modalities affect blood vessels through the process of vasoconstriction to decrease joint effusion. Choices include an ice pack, an ice water circulating cooler, or an ice cube massage. An ice bag works best over large, general areas and should be administered 15-20 minutes, 2-3x/day. Ice cooler units circulate cold water for a 15 minute treatment. An ice massage takes only 5-7 minutes and works best over bony prominences.

C: compression- Using an Ace bandage or a surgical sleeve to provide constant pressure around the knee joint prevents inflammatory by-products from collecting in the knee joint or draining into the lower leg during weight-bearing activities. The Ace wrap should be applied from top to bottom encompassing the entire knee joint.

E: elevation- Positioning several pillows under the heel prompts the inflammatory fluid to return to the bloodstream and flush back towards the heart to reenter the circulatory system. The key to elevation is to ensure the leg is above the level of the heart (lay flat on back with leg up). Combining the four RICE principles and resting the leg while compressing the joint with an ice bag in an elevated position for 20 minutes after exercise is the ideal situation to control swelling after a knee surgery.

-Rebecca L. Deal, MSPT

Rotator Cuff Surgery and Repair

July 10, 2008 by Rebecca Deal  
Filed under Physical Therapy

How long does it take a rotator cuff tendon to heal after a surgical repair?

A surgical rotator cuff repair requires a tendon reattachment into a bony anchor in the shoulder. The bone site of tendon reinsertion requires eight weeks to heal. Physical therapy, although specifics depend on the surgeon’s rehab protocol, usually begins three-five days after the surgery and continues for up to twelve weeks in three distinct phases until all prior shoulder function returns.

During phase one, the first eight weeks of physical therapy, while the bone is still healing, rehab is focused on symptom control and the return of symmetrical range of motion (ROM). Educating the patient to ice, encouraging the use of an arm support to rest the irritated tendons, and introducing the Codman pendulum exercises are all common strategies for controlling shoulder symptoms. ROM activities are limited in phase one to passive stretching (the patient must keep the muscles relaxed while the therapist stretches the rotator cuff muscles).

After the surgical repair site has healed and the patient has full ROM, emphasis shifts in phase two to shoulder strengthening. Strength work focuses on both rotator cuff muscles and the interscapular muscles to promote the return of normal shoulder biomechanics. Rotator cuff strengthening begins with isometric contractions and progresses to eventual strengthening with weight or Theraband resistance.

Phase three involves proprioceptive training for the upper extremity to ensure proper reaction time and future injury prevention. During week twelve of physical therapy the patient performs final assessment to determine if they can safely return to all activities of daily living before formal discharge from physical therapy. Once discharged, the patient is encouraged to maintain shoulder flexibility and strength with an independent exercise program.

-Rebecca L. Deal, MSPT

Heat vs Ice for Injuries

When should I use heat or ice for a specific condition?

There are two issue to consider when deciding between heat and cold therapy after an injury. First, consider the timing of the injury. If the injury is in the acute phase (1-2 days) and still showing signs of inflammation, ice is the most beneficial treatment. After swelling has resolved and the injury passes into the sub-acute and chronic phases of healing, switching to heat treatments is advised.

Second, the affected area and placement of the heat/cold modality must be analyzed. Crowded joint spaces, ligaments and tendon attachment sites that are susceptible to swelling and increased joint fluid with conditions like rotator cuff tendinitis or a torn knee meniscus require ice. Cold modalities work to decrease inflammation allowing more joint space and removing the fluid restrictions to range of motion. Muscles respond well to heat. Heat sources to sore muscles act to decrease muscle tension and eliminate muscle spasms.

Sometimes an injury scenario presents itself and the timing and placement issues conflict, leaving you again confuse between ice and heat modalities. What do you do for an acute muscle condition or chronic joint pain? The timing issue takes precedent over the placement so acute muscle pain needs ice, while chronic joint pain requires heat. If it is just too difficult to decide ice versus heat, consider a contrast heat/cold schedule. A contrast schedule alternates between heat and cold modalities in succession to both eliminate inflammation and provide symptom relief.

-Rebecca L. Deal, MSPT at North Tahoe Physical Therapy