_________: systematic manipulation of the body applied primarily by the use of hands, but also by mechanical modalities such as electrical or battery powered vibrators (ha), rollers, or hydrothermic turbines.
True or False: massage prevents atrophy or remove adipose tissue.
Most famous and enduring contributions to the practice of massage were _____ and ______.
Rohr and Ling (Ling system=swedish massage)
20th century german surgeon _____ _____ wrote the book, Technic der Massage (1890), which is still one of the basic texts on massage. Described the 5 basic strokes.
4 types of strokes or manipulations: list
gliding, percussing, compressing, vibrating
______: strokes that glide
______: knead, lift wring
______: strike, produce stimulus (percussion)
______: compress deeper tissue
______: shake, vibrate
Indications of Massage: 6 things
promote general relaxation
reduce muscle spasms and resultant pain
aide lymphatic return
loosen adherent skin,scars
enables therapist to evaluate soft tissue
Contraindications of Massage: 4 things
skin infections/conditions that spread through blood/lymph
malignant melanoma, cancerous mole/tumor
over area where there is bleeding
some circulatory disorders
______: excess interstitial fluid in the tissues. Manifestation of altered physiological function. Increased capillary pressures, increased capillary permeability, and decreased protein levels.
____-Edema: fluid is mobile; press finger into area for 2-3 sec. Indentation remains after finger is removed. Length of time indentation lasts indicates degree of edema.
_____-Edema: area is firm and discolored. Serum proteins accumulate and coagulate; from infection or trauma. Accumulation of fluid in serous cavities (not usually treated with massage)
______ ______: various modalities which, when applied to the patient, transfer or remove heat from the patient's tissue.
_______ energy emitted throughout the entire range of the electro magnetic spectrum (heat, radio, light, ultraviolet, infrared, x-ray, cosmic rays)
True or False: all forms of radiant energy are self-propagating; the waves are produced by the acceleration of electrically charged molecules that ravel in a vacuum at the speed of light.
True or False: Radiant energy is indirectly proportional to frequency?
False, it is directly proportional. e.g. cosmic rays are more penetrating than infrared radiation.
When electromagnetic energy contacts tissues, the radiation may be: ______, ______, or _______.
reflected, refracted, absorbed
_______-_______ principle: there is an optimal level of intervention that is therapeutically beneficial. No effect occurs in the tissue if the amount of energy absorbed is insufficient to achieve the therapeutic threshold. Damage will occur if the amount of energy is excessive.
Law of _______-_______: if the energy is not absorbed in the tissues, then it is transmitted to deeper layers. The greater amount of energy that is absorbed, the less the amount of energy that is transmitted.
_____ _____: the amount of energy required to raise the temperature of a given weight of material by a given number of degrees.
If the specific heat is high for the physical agent being applied, it should be applied at a (higher or lower) temperature.
Arrange the following in (High Conductivity) or (Low Conductivity): blood, cartillage, ligament, sweat, muscle, fat
High: blood, muscle, sweat
Low: fat, ligament, cartillage
_______: the transfer of heat from a material of higher temperature to a material of lower temperature by direct collision of the molecules.
_______: the transfer of energy by means of current such as liquids or gases.
Conduction (moist packs, cold/ice packs)
Convection (fluidotherapy, whirlpool, blood flow)
________: the transfer of energy by the change or conversion of one form of energy to another form.
________: process by which the energy is propagated from a warmer source to a coooler source without direct contact.
_______: transfer of energy from liquid to vapor.
Conversion (ultrasound, diathermy, metabolism)
Radiation (infrared lamp, sun)
Evaporation (spray and stretch, sweat)
________: application of a cooling agent for the purpose of reducing tissue temperature in order to achieve a therapeutic effect. This is done most commonly by conduction, convection, and evaporation.
The physiological effective cooling range for cryotherapy is ___ to ___ degrees celsius.
10 to 32
_______ ______: the application of a heating agent for the purpose of increasing tissue temperature in order to achieve a therapeutic effect.
Biophysical effects of heating:
(increases or decreases) blood flow.
(increases or decreases) pain threshold.
(increases or decreases) metabolic rate.
(increases or decreases) collagen extensibility.
(increases or decreases) inflammatory response and rate of healing.
increases for all of the above
Biophysiological effects of cooling:
(increases or decreases) blood flow.
(increases or decreases) inflammatory response.
(increases or decreases) nerve conduction (results in pain relief)
(increases or decreases) spacticity by affecting gamma motor neurons and afferent spindle discharge.
(increases or decreases) joint stiffness.
(increases or decreases) metabolic rate.
decreases blood flow
decreases nerve conduction
increases joint stiffness
decreases metabolic rate
Physiological effective heating range: ___ to ___ degrees celsius.
40 to 44 celsius
Depth of penetration
_______: penetrates the skin and subcutaneous tissue within .5 cm of the skin surface (6-8 mins) and muscle up to a depth of one cm (15-30mins).
_______: penetrates skin and deeper tissues up to 3-5 cm below the skin surface, without excessive heating the superficial tissues.
Analgesic effects of Cold:
_____ _____ fibers affected first, then _____ _____ fibers, followed by _______ fibers.
Cooling below __ degrees reduces Ach production.
Cold (increases or decreases) refractory period.
Cold reduces need for pain pills.
small myelinated fibers, large myelinated fibers, unmyelinated fibers.
increases refractory period
______ ______: severe drop in blood flow, a cyclical increase in blood flow is seen. This is thought to be a response to protect the tissue.
Nerve conduction slows ______ to the drop in temperature.
Cold decreases _______ by taking an effect on intrafusal fibers and sensory wrappings of the muscle spindle. It does so by decreasing gamma motor neuron activity first and second by decreasing afferent spindle and GTO activity.
_____ reaction: paitents develops wheals. This is due to mast-cell degranulation resulting in the release of histamines which caused inceased capillary permeability, redness, swelling, and wheal formation.
______ reaction: flushing of the face, sharp drop in BP, and increased heart rate, and syncope (fainting or passing out).
______ ______ ______: condition resulting from exposure to cold in which hemoblobin from lysed RBC's is found in the urine.
Paroxysmal Cold Hemoglobinurias
_________: rare disorder involving an abnormal blood protein that forms a gel when exposed to low temperatures. The gel can lead to ischemia and gangrene and is often associated with multiple myeloma, chronic liver disease etc...
______ _____: present with severe pain, numbness and redness resulting from cold application. Most often found in patients iwth rheumatic diseases or severe trauma to fingers and toes.
______ _____: sudden loss of color in the digits of coooled extremities followed by cyanosis and then redness of the skin, often associated with Thoracic Outlet Syndrome, carpal tunnel, or trauma. Occurs most often with young women.
Precautions for cold therapy: 6 things
over a superficial main branch of a nerve
over an open wound
poor sensation or mentation
very young or old patients
Temperature for Contrast Baths:
warm: ___ to ___ degrees C
cold: ___ to ___ C
Ratio: Warm/cold is __ min/__ min or __ min/__ min with a limit of __x application.
warm: 38 to 44 degrees C
cold: 10 to 18 degrees C
ration: 3 to 1 or 4 to 1
limit: 4x application
_____ _____ dystrophy: multi-systemic progressive condition which is associated with pain, swelling, heat, and disuse of extremity leading to muscle atrophy. When in a chronic stage, contrast baths are not tolerated by pt's.
Reflex sympathetic dystrophy
Application time for Cryo/Cuff:
__ to __ minutes every __ to __ hours
___ to __ degrees F
15 to 20 minutes every 1 to 2 hours
50 to 60 degrees F
Cryotherapy is effective when the underlying cause is an infection, malnutrition, inactivity, or organ failure. True or False.
False: in these situations, edema is addressed by combo of compression, elevation, heat, exercise, and massage
Become semisolid between _-_ degrees, which
is optimal for use.
Apply pack for _-_ minutes reduce/control
pain and swelling. In the case that the pack must travel through several layers
(towels, clothes, braces, etc.) , the time of application should be extended
If ice/cold packs are used to address
spasticity, they should be applied for _ minutes, (checking every 10-15
minutes for contraindications).
_____ ______ _____ – a condition
that affects the muscle fascia and can include a muscle or muscle group.
Myofascial Pain Syndrome (MPS)
Heat is most often used in the _________ or __________ stage.
subacute or chronic
__________ and __________ are good heat insulators.
Cutaneous skin and fat layers
___________, ______________ and _____________ are good conductors of heat.
Local vascular vessels, bone, superficial muscle
Mild heating occurs at ______ degrees Fahrenheit and treats _______ & _________ injuries. Examples of mild heating modalities are _________ & __________.
acute and subacute
heat packs & hydrotherapy
Vigorous heating is used between ______ & _______ degrees Fahrenheit and treats ________ injuries. Examples of vigorous heating are __________, _________ and _________.
paraffin wax, fluidotherapy, infrared
At what temperature does tissue damage occur with superficial heating? Treatment should be kept below this temperature.
113 degrees Fahrenheit
Superficial heat can (increase/decrease) pain, (increase/decrease) muscle spasms, and (increase/decrease) edema.
decrease, decrease, decrease
Superficial heating can also cause
(increase/decrease) metabolic rate
(increase/decrease) mobility of joints
(increase/decrease) extensibility of tissues
List the 7 contraindications of superficial heating.
Paraffin wax baths should be between _____ - ______ degrees Fahrenheit.
The three paraffin wax techniques are:
immersion, dip immersion, dip-wrap
Dosiometry of paraffin:
Duration: ___ minutes
Frequency: ___ for subacute; less frequent for chronic conditions
20 minutes, daily
Fluidotherapy is best used for: (5 things)
rheumatoid arthritis, bursitis, tendonitis, sprains/strains and hematomas
Paraffin wax is most often used on ____ extremities and conditions such as _______ and ________.
distal; osteoarthritis & injured muscles.
Dosiometry of Fluidotherapy:
Intensity: _____-_____ degrees Fahrenheit
Duration: ___ minutes for subacute and ____-____ minutes for chronic
Frequency: ____ for subacute and less frequently for chronic.
Hot packs should be stored in a water cabinet that is kept between _____ and _____ degrees Fahrenheit. They need to be preheated for __ hours and reheated for only ____ minutes when used.
Dosiometry for Hot Packs:
Intensity: depends on patient response
Duration: typically ____-____ minutes
Frequency: usually used ____ or more for subacute.
Commercial covers for hot packs are usually equivalent to ____ to ____ layers of toweling. Add additional towels to have ____ to ____ layers of toweling total between the pack and the patient.
Nonluminous infared lamps produce _______wavelengths and penetrate ___-___ mm; require warm up time.
Luminous lamps produce ____ wavelengths and penetrate up to ____ mm; no warm up time required.
________________: the intensity of radiation from the lamp is greatest when the surface to be treated is at an exact right angle to the line running from the lamp to that surface.
______________: the intensity of radiation varies inversely with the square of the distance away from the source.
Inverse Square Law
Dosiometry of Infared:
Intensity: depends on patient tolerance; distance from the lamp determines the _____ of the heat using the ______ and _______ laws.
Time: ___-___ minutes
Frequency: _____ or ____ daily for subacute; less often for chronic.
cosine & inverse square laws
once or twice
The theory of pain control and modulation states pain is modulated at peripheral, spinal, and cortical levels by endogenous nt's that have the same effects as ______. It was discovered by researchers studying analgesia in _____-_____. Odiopeptins have been found in ____ nerve endings, _____, and raphne nucleus. Odiopeptins indirectly inhibit pain transmission by inhibiting _______ as well as inhibition of inward calcium and potassium flux.
peripheral nerve endings, PAGM
______ analog and ______ scales: allows you to ask paitents to indicate present level of pain on a line or to rate pain numerically on a scale.
_____ pain questionnaire: scale descriptors of sensory, affective, and evaluative aspects of the paitent's pain, and groups words into various categories within aspects including temporal, spatial, pressure and thermal to describe sensory aspects of pain, anxiety, and tension.
Visual analog and numeric scales
McGill pain questionnaire
______: this questionnaire is low back pain disability index. It contains six statements in ten sections. The sections concern impairments like pain, and abilities like personal care, lifting, reading, driving, and recreational section.
______ inorganic signs: indicate psychological components to chronic back pain. It is used to detect malingering in paitents with back pain.
Waddell Inorganic signs
List the important information to include in the thorogh documentation of a patient's:
pain's location, quality, severity, timing, as well as the things that make it better or worse.
______: inhibit pain by blocking the conversion of arachiadonic acid to prostaglandins by cycloxygenase; side effects: gi irritation and bleeding.
_______: used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds and fevers. Its mechanism of action is the inhibition of cycloxygenase. It is highly selective for COX-2.
_______: provide analgesia by mimicking the effects of endorphins by binding to opiod specific receptors in the CNS; may also inhibit the nociceptive pathways.
_______: psychiatric mediaction used to alleviate mood disorders such as major depresion, dysthymia, and anxiety disorders.
_____ _____: block nociceptive transmission when administered spinally and at high doses it can block sensory and adn motor movements.
List the three advantages of the use of physical agents in pain relief:
1. relieve pain directly by moderating release3 of inflammatory mediators, nerve conduction, and endorphin levels.
2. indirectly reduce pain by decreasing sensitivity of muscle spindle system and vascular blood flow.
3. reduce pain by helping resolve underlying cause of painful sensation.