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Heat and Cold Therapy


Heat therapy speeds up nerve impulses, possibly advantageous in conditions where nerve response has become slowed.

It dilates blood vessels, enhancing local blood flow which improves delivery of oxygen and nutrients to tissues, and removes cellular waste from tissues. This helps speed the healing process.

Heat also helps relax muscle tissue--decreasing stiffness and muscle spasms--which allows for greater range of motion. It may be used before stretching, passive range of motion or active exercises to maximize muscle action. It may be used prior to therapy such as myofascial release or joint mobilization, or simultaneously with several other modalities to maximize muscle relaxation. Heat is not used in treating an acute (new) injury.

Cryotherapy (cold) therapy is often one of the first treatments applied to new injuries.

Cold causes blood vessels to constrict (narrow). Vasoconstriction slows blood flow and leakage of fluid from capillaries into the surrounding tissue spaces. This reduces bruising, swelling, inflammation, muscle spasms and acute pain.

In the clinic, cold therapy is often combined with compression therapy to further reduce edema or swelling from fluid buildup in tissue spaces. Patients may also be instructed on the use of cryotherapy or ice massage at home between clinic visits. Cryotherapy also slows nerve impulses, which might help reduce or control overly sensitive or hyperactive nerve disorder activity.



Electrical Stimulation

Electrical stimulation helps reduce pain, inflammation and swelling, and maintains muscle function. Additionally, it helps improve the wound and tissue healing process through increased blood flow which brings nutrients and removes wastes. Electricity also stimulates generation of new cells to repair injured ones.


Small electrodes (like those used on EKG/heart monitors) are applied to the skin in certain patterns. Low voltage current passes from the device to the electrodes and into the tissues at the treatment site. This produces a tingling sensation while stimulating the muscles and nerves in that area. The electrode patterns and electrical properties of the current (waveforms, pulse rates, cycles and duration) can be changed to produced the desired treatment characteristics.


Electrical stimulation therapy can be used for two primary functions in nerve tissue: 


  1.   When nerve tissue is stimulated, it can produce muscle contraction. This effect can be used to strengthen muscle

tissue, or to maintain the strength of muscles to prevent muscle wasting when normal nerve function has been disrupted. Situations in which this disruption occurs include stroke, neurological disease, traumatic injury, or following surgery. Stimulation may also be used to help stop muscle spasm by overly fatiguing the muscle through repetitive contraction. Additionally, induced muscle contraction may help decrease swelling by pumping excess fluid from surrounding tissue spaces back into the vascular system for removal.


  2.   The second use of electrical stimulation is for altering perception of nerve impulses. The tingling sensation

produced by electrical stimulation interferes with the pain signal reaching the brain to be perceived as pain. Depending on the nerves and therapy involved, these pain signals are either blocked outright, or are masked by the tingling sensation.




Ultrasound is usually used for treatment after the acute phase of injury or inflammation process. Ultrasound can be used to treat chronic inflammation, soft tissue injury, nerve root irritation, non-acute bursitis and adhesive capsulitis. Ultrasound may be alternated or combined with other modalities (such as manual mobilization, stretching and therapeutic exercise), in the individualized therapy plan.


The ultrasound device converts electrical current to high frequency sound waves, undetectable by the human ear.

The sound waves penetrate deeply into muscle, nerve, bone and connective tissues. The waves vibrate the cells and cause friction, which creates heat. This occurs much deeper in the tissues (2 inches or more) than heat packs or any other heating modality can reach. The heat causes vasodilation with increased blood flow in the deeper tissues, which results in improved delivery of oxygen and nutrients as well as removal of cell wastes in these tissues. Deep heat also leads to decreased nerve sensitivity and pain by sedating nerve endings. Furthermore, it reduces swelling, inflammation, and muscle spasms as it increases range of motion, muscle relaxation, and tissue healing. Vibration helps to mechanically stretch collagen connective tissue cells to increase flexibility in tendons, ligaments, joint capsules.



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