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When you see a physical therapist for pain or movement dysfunction, he or she may utilise a variety of strategies to help you move better and feel better. These therapies, known as therapeutic modalities or physical modalities, are utilised to supplement your physical therapy program and assist you in regaining your normal functional mobility.

Physical therapists treat their patients using a range of methods. There are several therapeutic techniques available to help strengthen, relax, and repair muscles. The ones used by your PT may differ based on your unique health issue, demands, and overall rehab objectives.

  • Hot Packs. Heath therapy causes tissues to relax by relaxing tight muscles. This helps to alleviate pain caused by muscle tension or spasms. It also causes vasodilation of the blood vessels, which improves circulation to the affected area. Patients suffering from muscle strains, spasms, or arthritis often benefit from hot pack therapy.
  • Cold Packs and Cryotherapy. Physical therapists utilise cold packs, which are frozen gel materials, to treat regions of pain and inflammation. The cold packs are wrapped in a damp towel and applied directly to the affected area. The freezing effects that are conveyed to the patient's skin, muscle, and tissue have a number of positive consequences. The drop in tissue temperature produces vasoconstriction of the surrounding blood vessels. This reduces inflammation by restricting blood flow by shutting down local blood vessels. Pain and swelling can be controlled and reduced by reducing inflammation.
  • Ultrasound. Ultrasound machines, which employ high or low-frequency sound waves, are a therapeutic method utilised by physical therapists. These sound waves travel through the surrounding tissue and vascular. They permeate the muscles, causing deep tissue/muscle heat. This stimulates tissue relaxation and is hence beneficial in the treatment of muscular stiffness and spasms. The warming action of sound waves causes vascular vasodilation and increased circulation to the region, which aids in healing. In addition, the physical therapist can change the frequency of the machine to employ waves that reduce inflammation. Ultrasound should be utilised with caution.
  • Phonophoresis. Ultrasound and phonophoresis are alike. It entails the use of ultrasound to deliver medicine via your skin and tissues. Your PT will utilise an ultrasound machine and medicated gel to treat your damaged body part during this treatment. During phonophoresis, an anti-inflammatory medication such as dexamethasone is normally employed.
  • TENS. Transcutaneous electrical nerve stimulation is referred to as a TENS unit. It's a little battery-operated equipment that reduces pain through an electrical transmission. The afflicted region is treated using electrodes. An electrical current is supplied via the electrodes after the machine is turned on. The underlying skin and muscle experience a tingling sensation. This signal interferes with the pain signal transmitted from the afflicted area to the nearby nerves. The patient feels less discomfort when this signal is broken.
  • Electrical Stimulation. Electrical stimulation causes a single muscle or a group of muscles to contract using an electrical current. Your physical therapist can engage the proper muscle fibres by inserting electrodes on the skin in various areas. The contraction of the damaged muscle can be improved by using electrical stimulation termed NMES to contract the muscle. Your physical therapist can adjust the current setting to allow for either a strong or moderate muscular contraction. In addition to boosting muscular strength, muscle contractions improve blood flow to the region, which aids in healing.
    Another type of electrical stimulation that your PT could utilise is iontophoresis. Iontophoresis is a procedure in which electricity is used to drive medicine into afflicted muscles, tendons, or ligaments through your skin. Iontophoresis is most commonly used for anti-inflammatory reasons, while it may be used for a variety of conditions.

  • Assistive Devices. To help you move better, your PT may employ a variety of assistive equipment. Various devices may include: Crutches, Standard or wheeled walkers, Wheelchairs, Quad canes, Standard canes, and Lofstrand crutches
  • Light Therapy. Light therapy uses lasers and light emitting diodes to promote healing in wounded tissues. Lasers of a certain wavelength are shined into your wounded tissues, and it is claimed that this light accelerates cellular processes, hence quickening the repair of these injured tissues.
  • Kinesiology Tape. Kinesiology tape, sometimes known as K-Tape, is a newer technique in physical therapy and sports training. To assist reduce pain, increase circulation, or promote muscular function, special fabric tape is put to your body. To assist improve your condition, you can leave the tape on for up to five days. 

A. Details about TENs physiotherapy machine

A TENS machine is a small battery-powered device that is worn on the body. Wires connect the box to adhesive pads that adhere to the skin. Small electrical pulses, similar to electric shocks, are delivered to the body's nerves. Some people with specific forms of pain may benefit from this.

Effectiveness of TENS machines

TENS machine efficacy has been inconclusive so far. To fully understand the role and effect of TENS, further research are required. TENS machines, on the other hand, have proven to be a popular type of pain management for certain people. 

How does a TENS machine work?

There are two ways that TENS machines are supposed to work:

  • The electrical impulses created by the TENS machine interfere with and block pain messages delivered to the brain when used at a high pulse rate of 90-130 Hz. The gate control hypothesis of pain is responsible for this. This suggests that in the brain and spinal cord nerves, there is a gate mechanism (the central nervous system). Pain signals reach the brain when the gate is open, and we experience pain. These pain messages are blocked when the gate is closed, and we do not experience pain. TENS machines are believed to close the gate by stimulating non-pain-carrying nerves. In result, the brain is focused with the messages it gets fast from the TENS machine, rather than the slower (and more unpleasant) pain signals received from elsewhere in the body. 
  • When the machine is set at a low pulse rate (2-5 Hz), it encourages the body to produce endorphins, which are pain-relieving chemicals. These inhibit pain impulses in a similar way to morphine.

How to use a TENS machine?

It's essential to only use a TENS machine if a doctor or other health expert recommends it. They aren't appropriate for every sort of pain or disease. 

TENS machine settings may be changed without needing to see a doctor. A machine is often used for 15-20 minutes every session, many times per day. 

People with musculoskeletal pain, such as long-term (chronic) back pain or knee joint arthritis, are the most prevalent users of TENS machines. They're also commonly used for pain management during the early stages of labour, especially if the mother is at home.  Migraine headaches, menstrual pains, sports injuries, and sometimes (very rarely) non-painful disorders including tiredness, sleeplessness, or dementia.

Instructions for using a TENS machine

Machines come in a variety of shapes and sizes, as well as different brands. Always follow the instructions that came with your machine from the manufacturer.

Some general considerations:

  • TENS machines are meant to be portable, allowing you to walk about as they function. You may put the machine into a pocket or fasten it to your belt.
  • Before applying the electrode pads to the skin, make sure the equipment is turned off.
  • Hold the pads between your fingertips and cautiously turning it on. You may experience a tingling feeling.
  • Ensure that the skin on which the pads are put is clean and dry, with no wounds, grazes, or regions of skin irritation.
  • Position the pads on either side of the pain. On the surface to be applied to the skin, use self-adhesive pads or flexible rubber pads that have been properly covered with conductive gel. The pads should not be placed closer than an inch (2-3 cm) of each other. Your physiotherapist or doctor will instruct you on where to position the pads.
  • If you intend to move around, tape the pads to your skin.
  • Adjust the pulse rate to the desired value (about 100 Hz is about right to start with).
  • Turn on the machine cautiously and gradually increase the power until you experience a tingling feeling. The sensation should be powerful but not uncomfortable. After a few minutes, the sensation will begin to fade gradually. This is referred to as accommodation. When this occurs, turn the machine up slightly and leave it for the rest of the time it is in use. Turning it up too high might induce overstimulation, which can aggravate pain. Muscle contraction should not occur.
  • At the end of the session, turn off the machine and remove the electrodes from it. There is no need to remove the electrode pads from the skin if you wish to use TENS again later. Simply tuck the cables out of the way and go about your life as normal.
  • Make sure the pads or tape don't irritate the skin. If the skin is red, a different type of pad, contact gel, or tape may be required.
  • The machine should be used for at least 45 minutes, but it can be used for up to 12 hours before the electrodes must be cleaned and re-sited.
  • After using the machine for the day, carefully remove the pads from the skin and clean it with regular soap and water. To remove the pads, do not pull directly on the wires. If the pads or tape cause any redness or irritation, use a new region of skin the next time you use the machine.
  • If you use rubber pads, clean the conducting gel off with mild soap and water and thoroughly rinse them. The self-adhesive type of pad should not be washed.

Cautions when using a TENS machine

  • Never use electrode pads on broken or injured skin. 
  • Never use electrode pads on the front or side of the neck, near the eyes, or in the mouth.
  • Do not apply to regions of decreased sensation.
  • Do not use near water, such as in a bath or shower; and 
  • Do not use while driving or using machinery.

Contraindication of TENS machine

 People who have any of the following conditions should not use a TENS machine:

  • When the cause of the discomfort is unknown or undiagnosed.
  • Pregnancy (unless specifically medically advised - or in labour).
  • Pacemakers.
  • Epilepsy, as well as some types of cardiac problems.

B. Details about ultrasonic physiotherapy machine

Ultrasound Therapy is the use of sound waves in physiotherapy to promote physiological healing and pain relief.

Sound energy is mechanical vibration at increasing frequencies. The natural human hearing range is from 16 Hz to around 15-20,000 Hz. Beyond this limit, the mechanical vibration is referred to as ultrasonography. Therapy frequencies are generally between 1.0 and 3.0 MHz.

Use of Ultrasound :

  • Increases healing rates
  • Tissue relaxation
  • Tissue heating
  • Increase local blood flow
  • Scar tissue breakdown.

Effect of Ultrasound on tissue

The effect of ultrasound on local blood flow can be utilised to assist decrease local edoema and chronic inflammation, as well as to facilitate bone fracture repair. Phonophoresis can also be accomplished using ultrasound.

This is a non-invasive method of giving drugs to tissues beneath the skin; ideal for people who are concerned about injections.

During tissue healing, it stimulate the formation of collagen (the major protein in tendons and ligaments).

Indication of Ultrasonic therapy

  • inflammation(Bursitis or tendonitis)
  • chronic pain
  • Muscle Strain and tears
  • Osteoarthritis
  • ligament and tendon injuries
  • non-acute joint swelling and muscle spasm.
  • Tightness or contractures (to improve range of motion)
  • Frozen shoulder
  • Wound healing

Which body Parts use for ultrasound therapy?

  • Muscle pain.
  • Trigger points.
  • Soften the surgical scar.
  • Softening the tendon after tendon transplant.
  • Plantar fascitis.
  • Carpal tunnel syndrome.

What is the condition in which you must avoid Ultrasonic Therapy?

  • Tumor.
  • Pregnancy.
  • Over the metal implants.
  • Knee replacement.
  • Hip replacement.
  • Pacemaker.
  • Eyes.
  • Contraindications of Ultrasound:

    • Directly on open wounds or active infections 
    • Directly on metastatic lesions 
    • On patients with poor sensation 
    • Directly on metal implants 
    • Near a pacemaker or any other device that creates a magnetic field 
    • During pregnancy - except for diagnostic sonography
    •  Furthermore, ultrasonography should not be used on the following areas: The eye The gonads Active epiphysis in children

    Precautions in Ultrasound Treatment

    • Use the lowest intensity that generates a therapeutic response.
    • The applicator's head should move during the treatment 
    • For optimal outcomes, the ultrasonic beam (treatment head) should be perpendicular to the treatment region.
    • For desired therapeutic benefits, all parameters (intensity, duration, and mode) must be carefully examined.

    C. Details about Electrical muscle stimulators

    Electrical Muscle Stimulation, or EMS, can be a beneficial part of your training and rehabilitation.  The treatment is a low-cost, drug-free solution to achieve your goals. 

    What Is Electrical Muscle Stimulation?

    Electrical Muscle Stimulation, or EMS, is a technique that employs electrical impulses to encourage muscles to contract, allowing your muscles to get stronger.

    Electrical impulses might cause your muscles to contract more than they would normally during an exercise. Strength, explosiveness, and fitness performance have all been shown to benefit with EMS therapy. They can also help you recover after an accident or exercise by addressing a variety of medical issues.

    EMS may help with pain relief as well as healing, which is why it's sometimes mistaken with TENS treatment (Transcutaneous Electrical Nerve Stimulation). 

    How Does Electrical Muscle Stimulation Work?

    Electrodes are placed at the site of the injury in order for Electrical Muscular Stimulation to operate. A tingling feeling will develop as the electrical current output is gradually raised. The sensation is increased till it is intense yet not uncomfortable. Because the body adjusts as the current increases, it's important to raise the electrical output every few minutes.

    Depending on the therapy's goal, a typical session lasts 10 to 20 minutes. You may be instructed to contract your muscles throughout the treatment if the goal is to improve muscular strength or function. EMS increases the flow of oxygenated blood to the location, which strengthens muscles, reduces healing time, and relieves pain.

    What Are the Benefits of Electrical Muscle Stimulation?

    EMS is a therapy recommended by doctors as a safe and effective alternative to using medications with negative effects. It has also been shown to benefit athletes in a variety of ways. For healthy persons as well as those who have injuries or medical issues, EMS offers various advantages and applications: 

    EMS has the ability to:

    • Strengthen muscles
    • Reduce muscle soreness
    • Improve muscle performance
    • Increase muscle growth
    • Enhance rehabilitation of muscles
    • Preventing and reversing muscular atrophy.
    • For strained muscles or tendons, increase range of motion.
    • Relax muscles
    • Tone muscles 
    • Improve joint pain and swelling
    • Reduce stress and discomfort
    • Increase local blood circulation

    How Can EMS Help Athletes?

    Athletes can benefit from EMS in a variety of ways. It can help avoid injuries by loosening muscles before workout. EMS is a key component in shortening post-exercise recovery durations. They can also be a good non-drug option for treating sports injuries.

    EMS has been shown to improve strength and jumping ability. EMS increases athletic performance by stimulating and pushing certain muscle fibres to contract. 

    EMS, on the other hand, activates muscle fibres at the motor neuron level by sending pulses through the central nervous system. It is possible to activate up to 100% of the muscle fibres with EMS. Because of muscle memory, the next time the brain sends a signal for that muscle to contract, more muscle fibres will contract.

    EMS has also been demonstrated to increase muscle perfusion in studies. Increased blood flow to muscles can also help you perform better in sports.

    The following are some of the ways that EMS may assist.

    1. Recovery. It has been proved that EMS reduces recovery time, allowing you to workout harder. EMS was proven to be as effective as active recovery and to yield faster recovery periods than passive recovery.
      When you're tired or sore EMS has the benefit of lowering the energy expenditure associated with active recovery.
    2. Sports Injuries. Strains, sprains, fractures, rips, and overuse injuries are all common injuries that can be treated by EMS.