Ptha 1431 - Physical Agents In Rehabilitation - Cameron Book And Stetz Lecture - Exam 2

Front 1

What is our definition of massage? ***

Back 1

systematic and scientific manipulation of soft tissues of the body for medically therapeutic purposes by means of touching, pressure, friction, and/or kneading

Front 2

What effects does massage have on the nervous system? ***

Back 2

could be stimulated or relaxed, depending on stroke used

faster = more invigorating/stimulating

slower = more relaxing

Front 3

What effects does massage have on the circulatory system? ***

Back 3

circulation does increase, potentially significantly, and could cause adverse effects in some patients

Front 4

What effects does massage have on the lymphatic system? ***

Back 4

the lymphatic system doesn't have its own pump

lymph fluid moves via muscle contraction or when aided by massage
can help reduce edema and assist lymphatic flow

Front 5

Upon what systems can massage have an effect? ***

Back 5

- nervous system
- muscular system (especially fascia)
- circulatory system (potentially significant increase)
- lymphatic system (reduce edema)
- skin (integumentary system)
- potentially some internal organs

Front 6

To where and whom does massage trace its roots? ***

Back 6

- Chinese (3,000 years ago)
- Greeks (specifically Hippocrates )
- Europe - Peter Ling (1834)
- US - Dr. SW Mitchell (1877)

Front 7

Who was Peter Ling? ***

Back 7

father of Swedish massage, and author of “Swedish Manual Therapy” or “Mechano-Therapy”

Front 8

Hippocrates take on massage: ***

Back 8

“The physician must be experienced in many things, but assuredly also in rubbing; for things that have the same name have not always the same effects. For rubbing can bind a joint that is too loose and loosen a joint that is too rigid … Rubbing can bind and loosen; can make flesh and cause parts to waste.”

Front 9

Who brought massage to the US? ***

Back 9

Dr. SW Mitchell

Front 10

What are the five strokes associated with Swedish massage? ***

Back 10

- effleurage
- petrissage
- friction
- tapotement
- vibration

Front 11

What are the characteristics of effleurage? ***

Back 11

- slow, superficial, rhythmic
- use to begin and end massage
- use to distribute lotion
- time to evaluate for spasm, sensitivities

Front 12

What effects does use of effleurage have on the body? ***

Back 12

stimulates blood and lymph circulation

soothes nervous system

Front 13

What are the characteristics of petrissage? ***

Back 13

- deep kneading, pressing, squeezing of tissue
- manipulation of muscle
- pulling, rolling, wringing

Front 14

What effects does use of petrissage have on the body? ***

Back 14

used to assist circulation

decreases muscle spasm

Front 15

What are the characteristics of friction? ***

Back 15

- deep pressure in small areas
- skin moves very little
- work deep areas
- digging in with thumb, knuckle, elbow

Front 16

What effects does use of friction have on the body? ***

Back 16

- decrease adhesions
- break up spasms and nodules
- mobilize tendons

Front 17

What are the characteristics of tapotement? ***

Back 17

- brisk blows
- short and quick
- alternating motions
- hacking, tapping, clapping, cupping, beating

Front 18

What effects does tapotement have on the body? ***

Back 18

- used to reeducate after injury (especially nervous system)
- stimulate muscle memory
- assist bronchial drainage
- conditioning of residual limb (stump)

Front 19

What are the characteristics of vibration? ***

Back 19

- shaking, vibratory, trembling movement

Front 20

What effects does vibration have on the body? ***

Back 20

- used to move congestion within mucous membranes

- assists bronchial drainage

Front 21

What are the conditions for use of a medium during massage? ***

Back 21

- may use a medium, or not
- can use lotion or oil
- should be safe to the body

Front 22

What are some patient needs to consider with respect to massage? ***

Back 22

- patient comfort
- removal of jewelry (patient's AND yours)
- draping consideration
- assessing patient sensitivity to touch (e.g., fibromyalgia)
- emotional response
- tickle (more pressure = less ticklish)

Front 23

How should the massage begin? ***

Back 23

cautiously

with a light touch

assessing patient sensitivity

Front 24

Should the touch be light or deep:
a) at the beginning of massage?
b) at the middle of massage?
c) at the end of massage? ***

Back 24

light at the beginning
deep in the middle
light at the finish

Front 25

When should you use a deeper pressure toward the heart? ***

Back 25

- if the massage is prolonged

- if there are cardiac concerns

Front 26

What effect will a prolonged, vigorous massage likely have? ***

Back 26

fatiguing

Front 27

What are considerations for the therapist administering the massage? ***

Back 27

- clean hands (wash them!)
- short nails
- keep long hair off the patient
- remove your jewelry (even watches)
- use good body mechanics
- protect your finger joints by maintaining a little bend/flexion in fingers

Front 28

What are some indications for massage? ***

Back 28

- sub-acute or chronic pain
- muscle spasm (stuck in contracted position)
- edema
- scar tissue (surface of skin or deeper)

Front 29

How is a retrograde massage performed? ***

Back 29

e.g., when massaging a limb, you start proximally, then move distally a bit at a time (sort of in a looping manner)

you don't want to start at the distal end and try to push all the fluid in the limb from the ankle or wrist right away

Front 30

What are some contraindications for massage? ***

Back 30

- acute inflammation
- thrombus/phlebitis
- active cancer
- tumor
- unstable cardiac condition
- non-union fracture
- skin condition that is contagious or makes the skin fragile
- other contagious disease
- fever

- and use caution with the elderly and very young

Front 31

Why is an unstable cardiac condition a contraindication for administering massage? ***

Back 31

because you're increasing circulation, especially if the massage is prolonged

Front 32

Why is fever a contraindication for massage? ***

Back 32

increasing circulation in this situation is probably not desired

Front 33

What are the physiological effects of massage? ***

Back 33

- increased circulation (possibly significantly)
- relaxation/stretching of tissues
- reduction of edema
- assist lymphatic flow
- affects skin, muscles, fascia, blood, and lymphatic vessels, nerves, and internal organs

Front 34

What is the difference between massage performed by a PT/PTA and massage performed by a massage therapist? ***

Back 34

the PT/PTA is concerned mainly with local massage on a specific area

the massage therapist is more likely to work with the whole body

Front 35

What is a trigger point? ***

(Travell & Simons definition)

Back 35

"a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band"

"the spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena"

Front 36

What is the theoretical source of a myofascial trigger point? ***

Back 36

- a microtrauma from a larger injury creates a local energy crisis
("energy crisis hypothesis")

- a dysfunctional motor endplate/neuromuscular junction
("integrated trigger point hypothesis")

Front 37

What mechanisms can cause or lead to microtrauma? ***

Back 37

- repetitive movement
- high-velocity movement (usually injuries, often sports-related)
- stress positions (postural and skeletal asymmetries)

- overstretching a muscle
- overshortening a muscle
- overloading a muscle

Front 38

What is the sequence of events in creation of a trigger point? ***

(Energy crisis hypothesis)

Back 38

- microtrauma leads to destruction of sarcoplasmic reticulum (SR)
- ionized calcium (Ca++) is released
- the free-floating Ca++ initiates involuntary muscle contraction (likely local at first, but could affect entire muscle)
- this constant state of contraction leads to increased energy demands, but they compress vessels that lead to a reduced energy supply
- result is energy crisis
- lack of ATP decreases reuptake of calcium ions into the sarcoplasmic reticulum, which perpetuates the contraction
- as a result there is a local release of bradykinin and CGRP, which lowers the threshold of nociceptive endings (= pain)

Front 39

What is the sequence of events in the creation of a trigger point? ***

(Integrated trigger point hypothesis)

Back 39

combines the "energy crisis hypothesis" with the following:
- dysfunctional motor endplate
- excessive release of acetylcholine (ACh)
- possibly leakage of Ca++ from SR back to pre-synaptic membrane
- possibly lack of ACh-esterase
- possibly from irritation of motor endplate (MEP)/neuromuscular junction (NMJ)
- leads to continuous local contraction, and perpetuates the MTrP

- increases metabolic demands
- local capillaries vasoconstrict
- oxygenation to area decreases
- area becomes stiff, ischemic
- local energy crisis
- results in trigger point formation

Front 40

Describe the composition of a muscle fiber.

Back 40

Front 41

Trace the pathogenesis of a myofascial trigger point.

Back 41

Front 42

What are the most common clinical symptoms of a trigger point? ***

Back 42

- local pain
- referred pain pattern
- taut band
- tender and painful nodules
- tightness/stiffness
- limited range of motion

Front 43

What are some less-common clinical symptoms of a trigger point? ***

Back 43

- autonomic disturbances (e.g., sweating, palpitations)
- dermatomal hair loss
- sleep disturbances

Front 44

What is the difference between an active and a latent trigger point? ***

Back 44

- active trigger point hurts now

- latent trigger point is currently asymptomatic

Front 45

What are the indicators of an active trigger point? ***

Back 45

- pain without compression
- very tender on palpation
- characteristic referred pain pattern
- impedes muscle flexibility

Front 46

What are the indicators of a latent trigger point? ***

Back 46

- silent, but tender on palpation
- may produce referred pain pattern with ischemic compression
- may exist for years without being reactivated

Front 47

What are two methods of treating trigger points? ***

Back 47

- progressive pressure technique

- friction massage

Front 48

For which type of trigger point is friction massage the better choice? ***

Back 48

friction massage is probably better for a latent trigger point because it is more aggressive; an active trigger point may not be able to tolerate friction massage

Front 49

How is the progressive pressure technique performed on a trigger point? ***

Back 49

- apply steady pressure, moving inward toward the center
- once tissue resistance is felt, stop and wait until resistance dissipates
- should feel a "melting away" sensation
- hold for at least 45 seconds
- repeat several cycles
- when no more resistance is felt, place the muscle in a relaxed position
- patient should breathe deeply and relax
- stretch the muscle

Front 50

How is the friction massage technique performed on a trigger point? ***

Back 50

- identify the trigger point
- use small, friction-like circular motions or cross-friction on the trigger point
- pressure is determined by patient tolerance
- if more than one trigger point is treated, begin distally and move proximally (satellite trigger points)
- patient will report a dulling or numbing effect
- if successful, pain will diminish or subside totally during treatment

Front 51

What is fascia? ***

Back 51

- a tough connective tissue that surrounds and interpenetrates every muscle, tendon, nerve, bone and organ

- is a 3-dimensional, continuous structure throughout the entire body

- denser in some areas than others

Front 52

Every part of the body is connected to _____ ______ ____ of the body by fascia. ***

Back 52

every other part

Front 53

What is the function of fascia? ***

Back 53

- provides shape, stability
- provides support and cohesion to structures, yet allows flexibility
- absorbs and disperses shock
- permits movement between adjacent structures by reducing friction

Front 54

Of what is fascia composed? ***

Back 54

- collagen - protein that provides strength to fascial tissue
- elastin - protein that provides elasticity to fascial tissue where needed
- polysaccharide gel complex ground substance that fills spaces between fibers and provides lubrication

Front 55

Where is fascia located? ***

Back 55

- superficial - directly below dermis
- deep - surrounding and infusing muscle, bone, nerves, blood vessels, and organs
- deepest - dura of brain and spinal cord and craniosacral system

Front 56

What are some causes of myofascial tightness? ***

Back 56

- trauma
- inflammatory process
- habitual poor posture or movements (static or dynamic)

Front 57

What does myofascial tightness lead to? ***

Back 57

- hardening or solidifying of ground substance, or

- development of cross-links

Front 58

Fascia is normally _______,
but once traumatized, it ________, which affects________. ***

Back 58

relaxed and wavy in configuration and moves without restriction

loses pliability and becomes tight and restricted

flexibility and stability

Front 59

Definition of myofascial release treatment approach. ***

Back 59

sustained pressure and stretching techniques used to release tight fascia and other related soft tissue

Front 60

What are two technique categories of myofascial release? ***

Back 60

- soft tissue mobilization (connective tissue massage)

- myofascial release (deep release)

Front 61

Describe soft tissue mobilization/connective tissue mobilization. ***

Back 61

- more aggressive
- breaks of cross links or cross restrictions of collagen in the fascia
- not for acute

Front 62

Describe myofascial release/deep release. ***

Back 62

- more gentle
- affects deeper layers of fascia
- stretches cross links
- changes viscosity of ground substance of fascia (creates heat to change viscosity and allow stretch)

Front 63

Name some strokes/techniques of soft tissue mobilization. ***

Back 63

- J stroke
- vertical stroking
- transverse stroking

- bear claw technique

- scar release
- psoas release

Front 64

How is the J stroke performed? ***

Back 64

- in direction of restriction

- with counterpressure in opposite direction

Front 65

Where does transverse stroking seem to work best? ***

Back 65

at the paraspinals

Front 66

How is the bear claw performed? ***

Back 66

- fingers apart with slight bend at knuckles, drag

- form of slow transverse stroking

Front 67

Where is the bear claw usually used? ***

Back 67

- low back
- gluteals

Front 68

Describe scar release. ***

Back 68

- used for adhesion
- can be done a long while after injury or surgery
- aggressive technique that can be uncomfortable

Front 69

Name some strokes/techniques of deep myofascial release. ***

Back 69

- cross-hands release
- transverse fascial planes release

- arm pull
- leg pull

- occipital release
- cervical release

Front 70

Describe the cross-hands release technique. ***

Back 70

- mild pressure
- pushing crossed hands away from each other
- wait for release

(According to Belinda, you should feel the heat build up, and it should feel as if you're sinking in.)

Front 71

Describe the transverse fascial planes technique. ***

Back 71

- used where there is more fascia (according to Ms. Stetz, seems to correspond with the chakras)
- hands placed over and under the fascial planes to build heat and release tension

Front 72

Describe the arm pull technique. ***

Back 72

- basically, slowly and methodically pulling and rotating arm through 360 degrees

- good for shoulder issues IF they have stability

Front 73

Describe the leg pull technique. ***

Back 73

- basically slowly and methodically pulling and rotating leg/legs through 360 degrees

- good for leg and some lumbar issues IF they have stability

Front 74

Describe the cervical release technique. ***

Back 74

- needs a bit more care exercised

- the higher you lift the head, the lower the stretch goes down the thoracic, and even lumbar spine

- basically, it's manual traction

Front 75

Definition of traction ***

Back 75

force applied to the body to separate joint surfaces and elongate surrounding soft tissue

Front 76

What physical properties affect our application of traction? ***

Back 76

- force -- push or pull (traction is pull)

- friction -- resistive force that arises to oppose motion when two objects slide over one another

Front 77

What is the coefficient of friction? ***

Back 77

a constant which represents the frictional forces between two surfaces

Front 78

What is the coefficient of friction of a body on a plinth? ***

Back 78

0.5

Front 79

What types of traction are used in PT? ***

Back 79

- mechanical
- home units
- manual (not addressed in this class)
- positional (not addressed in this class)

Front 80

What types of mechanical (electrical) traction do we use? ***

Back 80

- lumbar or cervical

- static or intermittent

Front 81

What are some of the effects of traction? ***

Back 81

- joint distraction/mobilization

- muscle relaxation

- soft tissue stretching

Front 82

What are some indications for traction? ***

Back 82

- back or neck pain, with or without radiating symptoms caused by disc bulge or herniation
- disc bulge/herniation
- nerve root impingement
- joint hypomobility
- subacute joint inflammation
- paraspinal muscle spasm

Front 83

How is traction suspected to work for disc bulge/herniation (HNP)? ***

Back 83

- pulling motion produces a suction
- suction decreases intradiscal pressure
- pulls material of HNP back to center of disc

Front 84

What types of disc bulges/herniations (HNP) is traction used for? ***

Back 84

small nuclear protrusions, as it may worsen a larger one

Front 85

How is it decided whether to treat a disc bulge/herniation (HNP) with supine or prone traction? ***

Back 85

- if posterior or post-lateral HNP, treat with prone (anterior pull)

- if anterior HNP, treat with supine (posterior pull)

Front 86

How is it decided whether or not to use the spreader bar for lumbar traction?

Back 86

- if goal is joint distraction, don't use it--you want to concentrate directly in the straight line on the spine

- if soft tissue mobilization is the goal, the spreader bar should give a better effect

- of course, patient tolerance/comfort will also have a say in use of the spreader bar

Front 87

What are some causes of nerve root impingement? ***

Back 87

- disc bulge/herniation (HNP)
- ligament encroachment
- narrowing of the intervertebral foramen (due to arthritis or degeneration)
- osteophyte encroachment (bone spurs)
- spinal nerve root swelling
- spondylolisthesis (a vertebra slides forward)

Front 88

With what type of traction is nerve root impingement usually treated?

What is the exception? ***

Back 88

- usually treat with supine (posterior) pull, unless

- goal is to treat narrowed intervertebral foramen [then prone (anterior)?]

Front 89

What types of joint hypomobility are treated with traction? ***

Back 89

- degenerative joint disease
- a.k.a. osteoarthritis

Front 90

How is osteoarthritis/degenerative joint disease treated with traction? ***

Back 90

usually with a supine (posterior) pull

Front 91

How does traction help treat osteoarthritis/degenerative joint disease? ***

Back 91

- glides and distracts facet joints
- stretches surrounding soft tissue
- lubricates synovial facet joints
- gates pain transmission

Front 92

How is subacute joint inflammation treated with traction? ***

Back 92

usually with a supine (posterior) pull

Front 93

How does traction help treat subacute joint inflammation? ***

Back 93

- reduces pressure on inflamed joint
- gates pain transmission at spinal cord

Front 94

How is paraspinal muscle spasm treated with traction? ***

Back 94

- usually with a supine (posterior) pull

- static or intermittent (per Cameron)

Front 95

How does traction help treat paraspinal muscle spasm? ***

Back 95

- reduces pressure on sensitive vertebral structures
- gates pain transmission
- stretches soft tissue
- breaks pain-spasm-pain cycle

Front 96

What are some contraindications for traction? ***

Back 96

- when motion is contraindicated (unstable fracture, recent spinal surgery, etc.)
- acute injury or inflammation
- joint hypermobility/instability
- increased symptoms (esp. when it pushes sx toward the periphery and farther from the spine)
- uncontrolled hypertension

Front 97

What are some precautions for traction? ***

Back 97

- diseases of the spine (tumor, infection, osteoporosis, RA, prolonged steroid use)
- when pressure on abdomen is unsafe (pregnancy, hiatal hernia, cardiac/respiratory insufficiency, GERD--esp w/feet elevated)
- claustrophobia/disorientation
- displaced anular fragment
- medial disc protrusion (would likely increase sx--see pg. 295C)
- when severe pain resolves fully with traction
- when pt cannot tolerate recumbent (supine or prone) position
- TMJ (cervical)
- dentures (cervical--leave them in)

Front 98

What are the weight specifications for lumbar traction? ***

Back 98

- 1/4 to 1/2 total body weight (TBW)
- 1/4 TBW for start, minimum necessary to overcome friction and increase length of lumbar spine
- 1/2 TBW needed for joint distraction (facet/apophyseal joints)

- don't start at 1/2 TBW, but try to work up to it
- rule of thumb is to not pass 1/2 TBW

Front 99

What are the timing specifications for lumbar traction? ***

Back 99

- static - for 5-10 minutes (initial/acute)

- intermittent - usually 20 minutes at 1:1 interval, but may progress to 3:1 hold:release cycle

Front 100

What is the angle of pull in prone lumbar traction? ***

Back 100

should be neutral

Front 101

What is the angle of pull in supine lumbar traction? ***

Back 101

- as lumbar-sacral flexion increases, traction pull is more superior

- the higher the legs are raised, the more superior the pull--may even get to some thoracic muscles

Front 102

What types of home traction units are available? ***

Back 102

- Saunders Lumbar and Cervical Hometrac (recumbent position with pneumatic pump)

- Cervical over-the-door traction (head sling and chin strap; face door; start with 8 lbs X 10 minutes)

Front 103

What are the indications and contraindications for cervical traction? ***

Back 103

same as for lumbar traction

Front 104

How much does the head weigh? ***

Back 104

about 12 lbs

(although Michlovicz says 14-16 lbs)

Front 105

How much weight is used for cervical traction? ***

Back 105

- begin with 8 lbs for everyone
- increase as tolerated

- need about 7% of TBW to get joint distraction

Front 106

What are the treatment times for cervical traction? ***

Back 106

- static for 5-10 minutes (initial/acute)

- intermittent for 20 minutes
usually at 1:1, but may progress to 3:1

Front 107

What orientation and angle of pull is used for cervical traction? ***

Back 107

- supine

- angle of pull about 25-30 degrees for soft tissue elongation

Front 108

When did spinal traction gain popularity for treatment of disc protrusions?

Back 108

in the 1950s and 1960s

Front 109

Whose recommendations for traction for treatment of disc protrusions increased its popularity in the 1950s and 1960s?

Back 109

James Cyriax

Front 110

Is there much strong empirical evidence supporting the efficacy of traction?

Back 110

no, but it continues to be used and recommended for patients with symptoms attributable to spinal disorders with reports of good success

Front 111

Effects of spinal traction

Back 111

- distract joint surfaces
- reduce protrusions of nuclear discal material
- stretch soft tissue
- relax muscles
- mobilize joints

Front 112

What is low-force traction?

Back 112

10- 20 lbs applied for long duration (usually hours to a few days)

Front 113

What are the joints of the spine called?

Back 113

facet joints

(also spinal apophyseal or zygapophyseal joints)

Front 114

What is the definition of joint distraction?

Back 114

separation of two articular surfaces perpendicular to the plane of the articulation

Front 115

What effects can joint distraction have on the spine?

Back 115

- reduces compression on joint surfaces
- widens intervertebral foramina, potentially reducing pressure on articular surfaces, intraarticular structures, or the spinal nerve roots

Front 116

Lumbar joints require ______ to achieve joint distraction.

Back 116

more force than cervical joints

Front 117

Which undergoes a greater vertebral separation/distraction under the same amount of force, a healthy spine or a spine with disc degeneration?

Back 117

the healthy spine

the same magnitude of force produces greater vertebral separation in healthy spines than in spines with signs of disc degeneration

Front 118

Proposed mechanisms for disc realignment with lumbar traction include:

Back 118

- clicking back of a disc fragment
- suction pulling displaced parts of a disc back toward center
- tensing of posterior longitudinal ligament at posterior aspect of the disc, thereby pushing any posteriorly displaced material anteriorly toward its original position

Front 119

The relief of back pain and related symptoms that occurs with application of traction is thought to be the result of

Back 119

a reduction in protrusion of nuclear discal material

Front 120

In what instances was traction not reported to improve symptoms of nuclear protrusions?

Back 120

- when the discal herniation was large and filled the spinal canal
- when it is applied to those with calcification of the disc protrusion

Front 121

Are self- or manual traction capable of reducing intradiscal pressure?

Back 121

according to some reports, no

Front 122

What does Cameron state is the minimum traction force (lbs) required to reduce disc protrusions and produce symptom reduction in the lumbar spine?

Back 122

60 lbs

Front 123

Soft tissue stretching, using moderate load and prolonged force spinal traction produces what effects?

Back 123

- increased tendon length and
- increased joint mobility,
and possibly
- spinal joint distraction,
- reduction of disc protrusion,
- increased spinal ROM, and
- decreased pressure on facet joint surfaces, discs, and intervertebral nerve roots

even when complete joint surface separation is not achieved

Front 124

How is spinal traction thought to reduce pain?

Back 124

by
- reducing pressure on pain-sensitive structures, or
- by gating of pain transmission by stimulation of mechanoreceptors

Front 125

Reduction of pain by any means can facilitate:

Back 125

muscle relaxation and a reduction in spasms by interrupting the pain-spasm-pain cycle

Front 126

At what point is application of traction most likely to improve the outcome of a patient with a disc bulge or herniation?

Back 126

when it is applied soon after a discal injury when there is protrusion of soft nuclear discal material

Front 127

What is the primary proposed mechanism of providing symptom relief of a disc bulge or herniation?

Back 127

reduction of the bulge or protrusion, thus reduction of pressure on spinal nerve roots

protrusion is reduced, but it can also reduce the risk of further protrusion

Front 128

What should be done to maintain the effects of spinal traction?

Back 128

patients should be instructed in other techniques for reducing stresses on the spine after treatment with traction to avoid a rapid recurrence of symptoms

Front 129

What patient education techniques can help reduce likelihood of recurrence of disc bulges/herniations after successful traction?

Back 129

- correction of posture/body mechanics
- lumbar stabilization through exercise or corset
- self-traction
- cautious, gradual return to prior activities

Front 130

What patients with hypomobility are better candidates for traction? Why?

Back 130

those with hypomobility throughout the spine

because if the spine is hypomobile in one area, and hypermobile in others, it is likely only the hypermobile section will see increase in mobility (potentially producing joint laxity), and the less mobile segments will see no effect

Front 131

How can one somewhat target specific areas of the spine while administering lumbar traction?

Back 131

positioning the lumbar spine in more flexion localizes the force to the upper lumbar and lower thoracic spine

positioning the lumbar spine in neutral or extension localizes the force to the lower lumbar area

Front 132

How can one somewhat target specific areas of the spine while administering cervical traction?

Back 132

flexed position focuses forces on the lower cervical area

neutral or slightly extended position focuses forces on the upper cervical area

Front 133

What effects can traction have on subacute joint inflammation?

Back 133

- reduce pressure on inflamed joint surfaces

small movements of intermittent traction may:
- control pain by gating at spinal cord
- help maintain normal fluid exchange in joints to relieve edema

Front 134

When should intermittent traction be avoided?

Back 134

immediately after an injury, duing the acute inflammatory phase, when the repetitive motion may cause further injury or amplify the inflammatory response

Front 135

Traction should always be applied with a _____ ______ at first, and the patient should be monitored for ________ _______.

Back 135

low force

adverse responses

Front 136

What indications should the therapist be looking for to indicate that traction may be a problem for the patient?

Back 136

- patient's condition worsens
- symptoms increase in severity
- symptoms peripheralize
- symptoms increase in distribution
- symptoms progress to other domains (e.g., from pain to numbness or weakness)

Front 137

What should the patient be advised to try to avoid doing while on full traction? Why?

Back 137

sneezing or coughing

these activities increase intraabdominal pressure and can thus increase intradiscal pressure

Front 138

What other activities should the patient be advised about prior to traction? Why?

Back 138

- empty bladder before traction

- do not eat a heavy meal before traction

the pelvic belt could cause discomfort on a full bladder or stomach

Front 139

How is traction initiated after injury?

Back 139

- not in acute stage (approximately 72 hours)
- static initially
- progression to intermittent as the area tolerates more motion

Front 140

Why should traction not be applied in areas of joint hypermobility?

Back 140

it may further increase the mobility in the area

Front 141

What may cause joint hypermobility?

Back 141

- recent fracture
- joint dislocation
- surgery
- old injury
- high relaxin levels (pregnancy/lactation)
- poor posture
- congenital ligament laxity
- Down sydrome, Marfan syndrome, RA may produce hypermobility and instability, particularly in C1-C2 articulation

Front 142

Why should cervical traction be avoided in patients with RA, Marfan syndrome, and Down syndrome?

Back 142

because they are susceptible to joint hypermobility and/or instability, especially in the C1-C2 articulations as a result of degeneration of the transverse atlantar ligament

Front 143

Ensure you assess ____ levels of the cervical or lumbar spine (depending on which is being treated), not just the _______ ones before treatment

Back 143

all

symptomatic

Front 144

How should a patient with a Down syndrome, Marfan syndrome, or RA be assessed for C1-C2 instability prior to treatment?

Back 144

via radiographic studies

Front 145

When some segments of the spine are hypomobile and adjacent segments are hypermobile, it is recommended that:

Back 145

the hypomobile segments be treated with manual techniques rather than mechanical traction because manual techniques can mobilize individual spinal segments more specifically

Front 146

Traction should be ________ if it causes peripheralization of symptoms.

Back 146

discontinued or modified immediately

Front 147

Why should traction be discontinued or modified immediately if symptoms peripheralize?

Back 147

because, in general, progression of spinal symptoms from a central area to a more peripheral area indicates worsening nerve function and increasing compression

continuing treatment under these conditions could aggravate the initial injury and prolonged worsening of signs and symptoms

Front 148

How may the treatment be modified if peripheralization occurs?

Back 148

- decrease the load

- change patient position

Front 149

Modified traction may be continued as long as

Back 149

peripheralization of symptoms no longer occurs

(mild aggravation of central symptoms alone in a patient with prior central and peripheral symptoms should not cause discontinuation of treatment)

Front 150

_______ traction should be avoided in patients with uncontrolled hypertension.

Back 150

inversion

Front 151

Clinicians should assess a patient's cardiovascular status before applying ____ traction.

Back 151

cervical

Front 152

In a patient with resting blood pressure over 140/90, check blood pressure and heart rate after application of cervical traction and discontinue if:

Back 152

systolic or diastolic blood pressure increases by more than 10 mm Hg, or

heart rate increases by more than 10 bpm

Front 153

In cases where traction should be applied with caution, first ______, then _______.

Back 153

coordinate with the referring physician

start with a low level of force and progress slowly, monitoring the patient's response to treatment closely at all times

Front 154

How is traction used on patients with structural compromise of the spine (tumor, infection, RA, osteoporosis, prolonged steroid use)?

Back 154

low force traction

manual traction which allows more direct monitoring of patient response, may be better

Front 155

How can compression of femoral arteries in inguinal region be avoided in traction?

Back 155

- ensure the pelvic belt is positioned with its lower edge superior to the femoral triangle, - tighten the belt, and
- keep it in direct contact with skin to prevent slipping during treatment

Front 156

How are displaced anular fragments likely to be affected by traction?

Back 156

traction will likely not improve symptoms in this case

Front 157

How are medial disc protrusions likely to be affected by traction?

Back 157

may aggravate symptoms

Front 158

Why may severe pain that resolves fully with traction be a bad thing?

Back 158

it may indicate the traction has increased compression on a nerve root, causing a complete nerve block

Front 159

What should the clinician do if traction may be causing a nerve block?

Back 159

check indicators of nerve conduction (sensation, reflexes, strength)

if worse--stop traction immediately
if not worse--reduce traction by 50%

Front 160

What may happen if traction is maintained at a level that causes a nerve block?

Back 160

the patient may sustain a severe nerve injury

Front 161

What should be used to apply cervical traction to a patient with TMJ?

Back 161

- occipital halter, vice a halter that applies pressure through occiput and mandible

many clinicians use occipital halters only, to prevent causing or aggravating TMJ

Front 162

How should a patient with dentures be treated for cervical traction?

Back 162

keep dentures in

use occipital halter to protect dentures and TMJ

Front 163

How should traction weight be progressed?

Back 163

start low for the initial treatment

gradually increase, within the recommended range, to the point of maximum benefit

Front 164

What are the advantages of mechanical traction?

Back 164

- force and time well controlled, readily graded, and replicable
- once applied, doesn't require clinician to stay with patient the entire treatment
- control allows static or intermittent application
- home units are inexpensive and convenient

Front 165

What are the disadvantages of mechanical traction?

Back 165

- expensive
- time-consuming to set up
- lack of patient control or participation
- restriction by belts poorly tolerated by some
- mobilizes broad regions of spine, rather than individual segments and thus may induce hypermobility in normal or hypermobile joints

Front 166

Specifics for electrical mechanical traction units

Back 166

- can apply forces up to 150 lbs
- static or intermittent
- lumbar or cervical
- allow fine, accurate control of forces
- allow considerable variation in patient position
- can finely control speed of traction

limitations include cost and size

Front 167

For what are over-the-door units used?

Back 167

- static cervical traction only
- home use

Front 168

What are the advantages of over-the-door cervical traction units?

Back 168

- inexpensive
- easy to set up
- compact

Front 169

Before treating at home, the patient should be educated on:

Back 169

- positioning of the unit and head
- amount of force to use
- duration of treatment

Front 170

How do you determine optimal patient positioning?

Back 170

- comfortable position
- that allows muscle relaxation
- while maximizing separation between involved structures

Front 171

What does flexion or extension of the spine during traction determine?

Back 171

which surfaces are most effectively separated

Front 172

Flexed position (supine) of the spine for lumbar spinal traction results in greater separation of:

Back 172

posterior structures, including the facet joints and intervertebral foramina

Front 173

Neutral or extended position (prone) of the spine for lumbar spinal traction results in greater separation of:

Back 173

anterior structures, including the disc spaces

Front 174

Would you ever use a unilateral traction force?

Back 174

Possibly, if the patient presents with unilateral symptoms you could offset the axis of traction in the direction that most reduces patient's symptoms

symmetrical central force in line with the midsagittal axis is the norm, however

Front 175

Which traction position is more commonly used, supine or prone?

Back 175

supine

Front 176

Clinically, symptoms of discal origin are usually most reduced in the ______ position, where the lumbar spine is in _____ or _____ and the disc space is most separated.

Back 176

prone

neutral, extension

Front 177

Clinically, symptoms caused by facet joint dysfunction are most reduced when the patient is positioned ______ with the hips and lumbar spine _______ and facet joints are most separated.

Back 177

supine

flexed

Front 178

Prone neutral positioning of the lumbar spine localizes the force of the traction to:

Back 178

the lower lumbar segments

Front 179

Supine flexed positioning of the lumbar spine localizes the force of the traction to:

Back 179

upper lumbar and lower thoracic segments

Front 180

If using a split table, ______ traction force is needed.

Back 180

less

since less traction force is lost to friction

Front 181

The nonslip belt surface should be placed:

Back 181

directly in contact with the patient's skin, and not over clothing

Front 182

May the thoracic and pelvic traction belts be applied to the patient while standing?

Back 182

yes

or placed on the table and applied after the patient lies down on them

Front 183

What is the purpose of the thoracic belt?

Back 183

- to stabilize the upper body; and

- to isolate the traction force to appropriate spinal segments

Front 184

How is the thoracic belt positioned on the patient?

Back 184

- lower edge aligns with the superior limit at which the traction force is desired

- upper edge aligns approximately with the xiphoid immediately below the greatest diameter of the thorax

Front 185

How is the pelvic belt positioned on the patient?

Back 185

- superior edge aligned with inferior limit at which traction force is desired

- generally just superior to the iliac crests (or superior to the superior edge of the sacrum if the patient is prone)

Front 186

How is the rope positioned for lumbar traction on a supine patient?

Back 186

- the rope should be positioned posteriorly so that the pull is primarily from the posterior aspect of the pelvis

(all while the patient is supine with a slight flexion in the spine and the pelvic belt placed with the fastening anteriorly to maximize distraction of the posterior spinal structures)

Front 187

How is the rope positioned for lumbar traction on a prone patient?

Back 187

- the rope should be positioned anteriorly so that the pull is primarily from the anterior aspect of the pelvis

(all while the patient is prone, neutral or with a slight extension in the spine and the pelvic belt placed with the fastening posteriorly to maximize distraction of the anterior spinal structures)

Front 188

When should the therapist break the table during intermittent traction?

Back 188

allow the traction to pull for one hold cycle to take up the slack in the belt and rope,

then during the following relaxation of the traction, release the sections of the table slowly

Front 189

When should the therapist break the table during static traction?

Back 189

the sections may be released after the traction force is applied, but the therapist should manually control the rate of separation to prevent sudden motion of the table

Front 190

What is important regarding the lower (moving) section of the split table?

Back 190

it is essential that it actually does move back and forth during the hold and relax cycles rather than remaining stationary at the point of maximal excursion

if it does, it will act as a static surface

Front 191

What should the therapist do at the outset of treatment?

Back 191

assess the patient's initial response to the traction within the first 5 minutes and make any necessary adjustments

Front 192

What should the therapist do at the end of treatment?

Back 192

- lock the split sections
- release the tension on the traction ropes
- allow patient to rest briefly before getting up and recompressing the joints
- then examine the patient

Front 193

Cameron's recommended parameters for initial/acute phase lumbar traction:

Back 193

- 29-44 lbs
- static
- 5-10 minutes

Front 194

Cameron's recommended parameters for lumbar traction for joint distraction:

Back 194

- 50 lbs; 50% of body weight
- 15/15 hold and relax
- 20- 30 minutes

Front 195

Cameron's recommended lumbar traction parameters for decreasing muscle spasm:

Back 195

- 25% of body weight
- 5/5 hold and relax
- 20 to 30 minutes

Front 196

Cameron's recommended lumbar traction parameters for disc problems or stretching soft tissue

Back 196

- 25% of body weight
- 60/20 hold and relax
- 20-30 minutes

Front 197

Why do some authors recommend static stretch only?

Back 197

to avoid a stretch reflex of the muscles

Front 198

With which treatment can higher forces (more pounds) be used: static or intermittent?

Back 198

intermittent

Front 199

When would the therapist choose to use static traction?

Back 199

- if the area being treated is inflamed
- if the patient's symptoms are easily aggravated by motion, or
- if the patient's symptoms are related to a disc protrusion

Front 200

When would the therapist choose to use intermittent traction with long hold times?

Back 200

for treatment of symptoms related to disc protrusion

Front 201

When would the therapist choose to use intermittent traction with shorter hold and relax times?

Back 201

- for symptoms related to joint dysfunctions
- to decrease muscle spasm

Front 202

On what does the ratio and duration of hold and relax times for intermittent traction depend?

Back 202

on the patient's condition and tolerance

Front 203

In general, if intermittent traction is used for treatment of a disc problem, what hold and relax times should be used?

Back 203

- longer, approximately 60 second hold
- shorter, approximately 20 second relax

Front 204

In general, if intermittent traction is used for treatment of a spinal joint problem, what hold and relax times should be used?

Back 204

shorter hold and relax times of approximately 15 seconds each

Front 205

How does symptom severity affect determination of hold and relax times for traction?

Back 205

- when symptoms are severe, long hold and long relax times are recommended to limit the amount of movement

- when symptoms become less severe, relax time can gradually be decreased

- when discomfort has decreased to local ache rather than pain, hold time can also be reduced so that when symptoms are mild the traction produces an oscillatory motion with very short hold and relax times of 3-5 seconds each

Front 206

Upon what does the optimal amount of force for traction depend?

Back 206

- patient's clinical presentation
- goals of treatment
- patient's position during treatment

for all applications, the force should be kept low during initial traction session to:
- reduce the risk of reactive muscle guarding and spasm, and
- to determine if traction is likely to aggravate the patient's symptoms

Front 207

What is the recommended starting weight for all applications of lumbar traction?

Back 207

30-45 lbs

Front 208

What weight should be used in lumbar traction to decrease compression on a nerve root or facet joint?

Back 208

between 50 lbs and 60% of patient's body weight

this is sufficient force to separate the facet joints

Front 209

What weight should be used for lumbar traction when the goal is to decrease muscle spasm, stretch soft tissue, or exert centripetal force on a disc by spinal elongation without joint surface separation?

Back 209

for these, lower forces are effective

approximately 25% of patient's total body weight for the lumbar spine

Front 210

When spinal elongation is the goal, what other modality should be added?

Back 210

a hot pack in conjunction with the traction may result in greater spinal elongation and thus more effective relief of symptoms

Front 211

When should the therapist decrease the force of traction (weight) during the treatment?

Back 211

- if there is any peripheralization of signs or symptoms

- if there is complete relief of severe pain

Front 212

If the patient's symptoms are moderately decreased by lumbar traction, by how much should the therapist increase the force (weight) each session?

Back 212

5-15 lbs each session

until maximal relief of symptoms is achieved

Front 213

Traction force to the lumbar spine should generally not exceed ____% of the patient's body weight.

Back 213

50

Front 214

What should the ratio of the hold and relax forces (weights) generally be?

Back 214

the relax force (weight) should be approximately 50% of the maximum force or less

Front 215

When would the therapist use total release of force during the relax phase?

Back 215

never

not recommended because it could result in rebound aggravation of the patient's symptoms

Front 216

How long should an initial traction session last?

Back 216

- 5 minutes if initial symptoms are severe

- 10 minutes if initial symptoms are moderate

both are to assess patient's response

Front 217

If severe symptoms are significantly relieved by brief low-force traction,, the duration of treatment should:

Back 217

be kept short, otherwise symptom exacerbation after treatment is likely

Front 218

If moderate symptoms are partially relieved after 10 minutes of traction, the duration of treatment should:

Back 218

not be extended

Front 219

If moderate symptoms are unchanged after 10 minutes of traction:

Back 219

- the hold force may be increased slightly, or
- the angle of pull modified, and
- treatment may be continued for a further 10 minutes

Front 220

When is traction treatment longer than 40 minutes beneficial?

Back 220

it is not thought to be beneficial to treat for more than 40 minutes

Front 221

Although there are no published studies evaluating traction treatment frequency, some authors state spinal traction treatment frequency should be ________

Back 221

daily to be effective

Front 222

For seated cervical traction, how would the therapist produce flexion or extension?

Back 222

- if flexion is desired, seat patient facing toward the door/machine
- if extension is desired, seat patient facing away from door/machine

Front 223

For seated cervical traction, how would the therapist focus traction forces on the upper cervical spine?

Back 223

by placing the cervical spine in a neutral or slightly extended position

Front 224

For seated cervical traction, how would the therapist focus traction forces on the lower cervical spine?

Back 224

by placing the cervical spine in a flexed position

Front 225

How is maximum posterior elongation of the cervical spine achieved?

Back 225

when the neck and angle of pull are approximately 25-35 degrees of flexion

Front 226

Why is maximum posterior elongation of the cervical spine desired?

Back 226

to maximize separation of the intervertebral foramina and the disc spaces

Front 227

What should the therapist consider when selecting the most appropriate halter for cervical traction?

Back 227

- adjustability of the halter
- patient position
- status of the TMJs

Front 228

What are the parameters for initial/acute cervical traction?

Back 228

- 7-9 lbs
- static hold
- 5-10 minutes treatment

Front 229

What are the parameters for joint distraction during cervical traction?

Back 229

- 20-29 lbs; 7% of body weight
- 15/15 hold and release
- 20-30 minutes treatment

Front 230

What are the parameters for decreasing muscle spasm during cervical traction?

Back 230

- 11-15 lbs
- 5/5 hold and release
- 20-30 minutes treatment

Front 231

What are the parameters for treating disc problems or stretching soft tissue during cervical traction?

Back 231

- 11-15 lbs
- 60/20 hold and release
- 20-30 minutes treatment

Front 232

For what is intermittent cervical traction especially suited?

Back 232

- reducing pain
- increasing cervical ROM
- helping reduce symptoms of mechanical neck disorders

Front 233

If symptoms are moderately decreased by mechanical cervical traction, traction force can be increased by _____ at each subsequent treatment session until maximum relief is achieved

Back 233

3-5 lbs

Front 234

Traction force to the cervical spine generally should not exceed:

Back 234

30 lbs

Front 235

Name of our mechanical cervical traction

Back 235

Saunders

Front 236

You know that traction is working when the pain

Back 236

regresses and centralizes

Front 237

ICT

Back 237

intermittent cervical traction

Front 238

Trigger point treatment can significantly reduce pain in ___ sessions

Back 238

1-2

if done right!

Front 239

Trigger points remain and perpetuate because:

Back 239

they can't fix themselves because of the local energy crisis
- lack of ATP
- Ca++ can't be reabsorbed

Front 240

Active trigger points refer pain:

Back 240

whether pressure is applied to them or not

Front 241

Latent trigger points refer pain:

Back 241

only when pressure is applied to them

Front 242

Description of diathermy ***

Back 242

therapeutic energy produced by CONVERSION of high-frequency electromagnetic energy to mechanical energy

also radiation

Front 243

How does thermal diathermy produce heat? ***

Back 243

heat is produced by vibration caused by resistance to electromagnetic energy entering tissue

Front 244

In what portion of the electromagnetic spectrum does diathermy operate? ***

Back 244

10 - 100 MHz (book says 1.8 - 30 MHz) - shortwave
300 MHz - 300 GHz - microwave

Front 245

Frequency of shortwave diathermy ***

Back 245

27.12 MHz

Front 246

What is continuous shortwave diathermy? ***

Back 246

- thermal
- deep
- produces heat in tissue
- penetrates up to 5 cm (longer wavelength than microwave, thus penetrates deeper)

Front 247

What is pulsed shortwave diathermy (PSWD)? ***

Back 247

- non-thermal
- does not produce heat in tissue
- vibrates tissues and causes reactions at cellular level
- penetrates up to 5 cm (longer wavelength than microwave, thus penetrates deeper)

Front 248

Frequency of microwave diathermy ***

Back 248

2450 MHz

Front 249

What is continuous microwave diathermy? ***

Back 249

- thermal
- deep
- produces heat in tissue
- penetrates up to 3 cm (shorter wavelength than shortwave, thus doesn't penetrate as deep)

Front 250

What is pulsed microwave diathermy? ***

Back 250

- non-thermal
- does not produce heat in tissue
- vibrates tissues and causes reactions at the cellular level
- penetrates up to 3 cm (shorter wavelength than shortwave, thus doesn't penetrate as deep)

Front 251

Which type(s) of diathermy are still used? ***

Back 251

only shortwave

microwave isn't used anymore

Front 252

Means of administering diathermy (equipment types) ***

Back 252

- capacitive plates

- inductive coil

Front 253

How do capacitive plates work? ***

Back 253

- high-frequency alternating current flows through the patient from one plate to the other

- patient completes circuit

- produces magnetic field perpendicular to the electrical field

- causes oscillation of charged particles, increasing tissue temperature

Front 254

Setup of capacitive field ***

(a.k.a. condenser field)

Back 254

- conducting (metal) electrodes encased in plastic housing

- placed 1-3 inches from patient (per manufacturer's guide)

- may use towel to separate electrodes from patient, especially with thermal (continuous) to absorb perspiration

Front 255

How does inductive coil work? ***

Back 255

patient is placed in the electromagnetic field

Front 256

Setup of induction field ***

(drum or cable/coil)

Back 256

- drum - with air space and single towel (can put drum directly on patient)

- cable/coil - wrap around extremity or place on trunk with towel beneath cables
(cables should not touch each other)

Front 257

Brief description of microwave diathermy ***

Back 257

- magnetron oscillator produces high frequency alternating current in antenna, which then produces electromagnetic energy

- antenna beams electromagnetic energy to patient

- director (antenna and reflector) must be tuned

- director placed about 3 inches from patient with perpendicular beam

- intensity should produce sensation of mild warmth

- penetration depth unknown (Cameron says less than SWD, but it is still considered a deep heat)

Front 258

Which means of administering diathermy penetrates muscle best? Fat and bone? ***

Back 258

Inductive coil - penetrates muscle deepest

Capacitive plates - penetrates fat, then muscle (and bone)

Front 259

Indications for thermal (continuous mode) diathermy ***

Back 259

- pain - subacute, chronic
- decreased circulation
- joint/soft tissue stiffness

Front 260

Indications for pulsed diathermy ***

Back 260

- edema
- acute pain
- wounds (incisions, ulcers)
- nerve injury
- bone injury

Front 261

Contraindications for all types of diathermy ***

Back 261

- metal (needs to be 1-2 m away; not in/on body, no metal furniture, etc.)
- pacemaker, stimulators
- cancer
- pregnancy (patient or therapist)
- eyes
- testes
- growing epiphyseal plate

Front 262

Precautions for all types of diathermy ***

Back 262

- IUD (if copper)
- obesity (may heat fat excessively; esp capacitive plates)
- electronic or magnetic equipment in the vicinity

Front 263

Adverse effects of diathermy ***

Back 263

- controversy around possibility of electromagnetic energy causing cancer or other medical problems

- PT/PTA treating with diathermy are exposed

- some POSSIBLE connection between electromagnetic energy and fetal deformities

Front 264

Treatment time for diathermy (shortwave or microwave) ***

Back 264

- continuous = 20-30 minutes

- pulsed = 30-60 minutes

Front 265

History of diathermy

Back 265

- dates to 1892
- d'Arsonval used 10 kHz RF electromagnetic fields to produce warmth without muscle contractions that occur at lower frequencies

- used in 1930s in US to treat infections
- by 1950s, antibiotics and potential hazards of use put diathermy treatment of infection out of favor

Front 266

Reasons diathermy fell out of favor

Back 266

- advance of antibiotics for infection treatment
- potential hazards to patient and operator
- interference it caused with other equipment
- devices were large, expensive, and cumbersome

Front 267

Reasons for diathermy's comeback

Back 267

- devices are smaller and better shielded
- application of gentle heat in large areas
- promote tissue healing (nonthermal, pulsed)

Front 268

FCC-allotted frequencies for SWD devices

Back 268

- 13.56 MHz (+- 6.78 kHz)
- 27.12 MHz (+- 160 kHz)
- 40.68 MHz (+- 20 kHz)

Front 269

Which frequency is most commonly used for SWD and why?

Back 269

27.12 MHz, because it has the widest bandwidth and is therefore the easiest and least expensive to generate

Front 270

Other names for pulsed shortwave diathermy (PSWD)

Back 270

- pulsed electromagnetic field (PEMF)
- pulsed radiofrequency (PRF)
- pulsed electromagnetic energy (PEME)

Front 271

What ultimately determines whether diathermy heats tissue?

Back 271

amount of energy absorbed by the tissue

Front 272

What factors influence the amount of energy absorbed by tissue in administration of diathermy?

Back 272

- intensity of electromagnetic field

- type of tissue to which the field is applied

Front 273

Why doesn't pulsed diathermy produce heat?

Back 273

heat is allowed to dissipate during the off cycle

Front 274

What factors actually determine if tissue will be heated?

Back 274

- strength of electromagnetic field reaching the tissue
- type of tissue
- tissue perfusion

Front 275

What factors should the clinician use to ascertain an increase in tissue temperature?

Back 275

- report of the patient

- information provided by the manufacturer

Front 276

What are diathermy's advantages over hot packs and ultrasound for providing heat?

Back 276

- it can heat deeper than hot packs

- it can heat larger areas than ultrasound

Front 277

Is diathermy reflected by bones?

Back 277

no

therefore it does not concentrate at the periosteum or pose a risk of periosteal burning, like ultrasound

Front 278

What is the only thing you need to know about microwave diathermy? ***

Back 278

- it is a deep heat, but not as deep as shortwave diathermy

- it isn't used anymore

Front 279

Benefit of SWD for the therapist

Back 279

requires little time for application and does not require the clinician to be in direct contact with the patient throughout the treatment

Front 280

PSWD devices use what type of applicators?

Back 280

- inductive coil applicators

- in drum form or capacitive plates

Front 281

How does SWD with inductive coils work?

Back 281

- alternating current flows through coil
- produces magnetic field perpendicular to coil
- magnetic field induces electric eddy currents in the tissues
- electric currents cause charged particles in tissue to oscillate
- friction of oscillation raises tissue temperature

Front 282

Heating with an inductive coil diathermy applicator is known as:

Back 282

heating by the magnetic field method

because the electric current that generates the heat is induced in the tissues by a magnetic field

Front 283

Amount of heat generated in SWD with inductive coils is influenced by:

Back 283

- strength of the magnetic field
- strength and density of induced electric eddy currents

Front 284

Strength of the magnetic field generated in SWD with inductive coils is determined by:

Back 284

- distance of tissue from the applicator

(decreases in proportion to the square of the distance of the tissue from the applicator according to the inverse square law, but does not vary with tissue type)

Front 285

Strength of electric eddy currents generated in SWD with inductive coils is determined by:

Back 285

- strength of the magnetic field in the area

- the electrical conductivity of the tissue in the area

Front 286

Electrical conductivity of tissue depends primarily on:

Back 286

- tissue type

- frequency of the signal being applied

Front 287

Which types of tissues have high electrical conductivity?

Back 287

- tissues with high water and electrolyte content

- muscle or synovial fluid

Front 288

Which types of tissues have low electrical conductivity?

Back 288

- tissues with low water content

- fat, bone, collagen

Front 289

SWD with inductive coils produces the most heat in tissues that:

Back 289

- have high electrical conductivity

- are closest to the applicator

Front 290

Heating with capacitive plate diathermy applicators is known as:

Back 290

heating by the electric field method

because the electric current that generates the heat is produced directly by an electric field

Front 291

For SWD with capacitive plates, as with inductive coils, amount of heat generated in an area of tissue depends on:

Back 291

- strength and density of the current, with most heating occurring in tissues with the highest conductivity

Front 292

Because current will always take the path of least resistance, when a capacitive plate applicator is used, the current will generally:

Back 292

concentrate in the superficial tissues and not penetrate as effectively to deeper tissues if there are poorly conductive tissues, like fat, superficial to them

Front 293

In contrast to SWD inductive coil applications, capacitive plates generally produce most heat in:

Back 293

skin, and less in deeper tissues

Front 294

In SWD with inductive coils, the coils produce most heat in:

Back 294

deeper structures because the incident magnetic field can achieve greater penetration to induce the electric field and current within the targeted tissue

Front 295

SWD capacitive plates produce more heat in:

Back 295

skin and superficial tissues

Front 296

SWD inductive applicators produce more heat in:

Back 296

deeper structures

Front 297

Physiological effects of increasing tissue temperature:

Back 297

- vasodilation
- increased rate of nerve conduction
- elevation of pain threshold
- alteration of muscle strength
- acceleration of enzymatic activity
- increased soft tissue extensibility

Front 298

Superficial heating agents primarily increase cutaneous circulation, while SWD:

Back 298

significantly increases circulation in muscles

Front 299

How are PSWD psysiological effects thought to be produced?

Back 299

modification of ion binding and cellular function by the incident electromagnetic fields and resulting electric currents

Front 300

For how long is PSWD applied at manufacturer settings to induce physiological effects?

Back 300

approximately 40-45 minutes

Front 301

What effects does 40-45 minutes of PSWD have on tissue?

Back 301

increased local microvascular perfusion in healthy subjects and around diabetic ulcer sites

Front 302

Increased microvascular perfusion, thus increased circulation can also increase:

Back 302

- local tissue oxygenation
- nutrient availability
- phagocytosis

Front 303

What are two nonthermal effects of PSWD?

Back 303

- increased microvascular perfusion

- altered cell membrane function and cellular activity

Front 304

What effect does PSWD have on the cell membrane?

Back 304

affects ion binding to cell membrane, triggering a cascade of biological processes

Front 305

What biological processes is PSWD thought to enhance?

Back 305

- growth factor activation in fibroblasts, chondrocytes and nerve cells
- macrophage activation
- changes in myosin phosphorylation

Front 306

How is PSWD thought to affect the cell cycle?

Back 306

by altering calcium ion binding

Front 307

How is PSWD thought to affect cell growth and division?

Back 307

exposure to electric fields can
- accelerate cell growth and division when it is too slow
- inhibit cell growth and division when it is too fast

Front 308

What are some other potential benefits of PSWD at the cellular level?

Back 308

- stimulation of ATP
- increase in protein synthesis

Front 309

List of PSWD benefits at cellular level:

Back 309

- increased local microvascular perfusion
- increased local circulation
- increased local tissue oxygenation
- increased local nutrient availability
- increased local phagocytosis

- activation of growth factor in fibroblasts, chondrocytes, and nerve cells
- macrophage activation
- changes in myosin phosphorylation
- altered calcium ion binding
- accelerate slow cell growth/division
- slow accelerated cell growth/division
- stimulation of ATP
- stimulation of protein synthesis

Front 310

Benefits of SWD and increased tissue temperature are the same as for other thermal agents:

Back 310

- pain control
- accelerated tissue healing
- decreased joint stiffness
- increased joint ROM if used with stretching

Front 311

Because diathermy can increase heat deep in large structures it is good for

Back 311

- the hip joint

- diffuse areas of the spine

Front 312

Ginsberg used PSWD in the 1930s to

Back 312

fight infection without producing a significant rise in tissue temperature

this was before widespread use of antibiotics, however

Front 313

Nonthermal levels of PSWD are now used clinically to

Back 313

- control pain
- control edema
- promote nerve, wound, and fracture healing

Front 314

Nonthermal PSWD effects on soft tissue healing

Back 314

benefited
- incisional wounds
- pressure ulcers
- burns
- tendon injuries

through
- increased collagen formation
- WBC infiltration
- phagocytosis

- increased circulation and improved tissue oxygenation
- increased fibroblast and chondrocyte proliferation

Front 315

PSWD should not be used as a substitute for conventional therapy for:

Back 315

edema and pain

it is intended to be an adjunctive modality to compression, immobilization and medications

Front 316

Nonthermal PSWD may POSSIBLY be used to treat soft tissue adjacent to most metal implants, however, what precautions must be taken?

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if the metal forms closed loops, such as wires for rods or fixating plates in surgical fracture repair, heating may occur because current can flow in the wire loops

Front 317

Because the therapist is at increased risk of exposure, what precautions should be taken?

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- stay 1-2m away from continuous diathermy

- stay 30 to 50 cm away from PSWD

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At this time there are no recommendations against using nonthermal PSWD in areas of

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malignancy

Front 319

What tissue is at the greatest risk of burning during diathermy?

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fat tissue, especially if capacitive plate applicators are used

Front 320

Why should the patient's skin be kept dry with a towel during diathermy?

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because water is preferentially heated by all forms of diathermy, wrap the patient's skin with a towel to prevent scalding from hot perspiration

Front 321

Diathermy can be a good choice when direct contact with the patient is not possible or desirable, such as:

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- if infection control is an issue

- through a cast

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If thermal-level diathermy is used, it is recommended that clothing:

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should be removed from the area so towels can be applied to absorb local sweating

Front 323

What is the gauge of heating used in clinical practice?

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the patient's reported sensation, because calculations of energy delivery and temperature increases are not reliable because there are too many variables (amount of reflection; electrical properties of tissue; tissue size and composition; type, size, geometry and orientation of applicator, etc.)

Front 324

Application time for
- thermal diathermy
- PSWD?

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- usually 20 minutes
- 30 to 60 minutes

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Thermal level diathermy is the most effective modality for:

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increasing the temperature of large areas of deep tissue

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PSWD can be used to treat what stages of injury?

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- chronic
- subacute
- acute (and literature and anecdotal reports suggest better results are achieved with acute conditions)

Front 327

Factors for placing inductive applicator with a cable:

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- wrapped around a towel-covered limb
- or coiled into flat spiral over 6-8 layers of towel
- at least 3 cm apart; use rubber or wood spacers

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Factors for placing inductive applicator drum:

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- as close as possible with slight air gap for heat dissipation
- avoid contact if infection
- facing and parallel as possible to tissues
- instruct patient to move as little as possible because strength of field changes by square of distance

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Factors for placing capacitive applicator:

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- equidistant on each side of area to be treated
- 1-3 inches from skin
- equal placement ensures even field distribution (field is most concentrated near the plates

Front 330

When and how do you do a vertebral artery scan?

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before administering cervical traction

extend neck, bend laterally, rotate and look up for 20-30 seconds

check for nystagmus (eye flitting) afterwards, which may indicate a possible occlusion