Therapeutic modalities for musculoskeletal injuries / Craig R. Denegar, Ethan Saliba, Susan Saliba

Therapeutic Modalities for Musculoskeletal Injuries, Second Edition, is an introductory text to the theory and application of therapeutic modalities in the rehabilitation of athletic injuries. Like its predecessor, Therapeutic Modalities for Athletic Injuries, the text provides a clear perspective of the physics and physiological responses to the modalities discussed, and the new edition also prepares readers for the challenges arising in the ever-changing health care system.

Part of Human Kinetics' Athletic Training Education Series, this text has been revised and updated to present current research related to therapeutic modalities. Additional insight from two experts also helps to expand the content of this second edition and encourage more diverse thinking among students. New chapters have been added on the use of therapeutic laser treatment and the basic concepts of evidence-based practice.

Therapeutic Modalities for Musculoskeletal Injuries, Second Edition, goes beyond the how of modality application to ask why and when. Specific treatment for individual problems is not prescribed, but reference is made to specific guidelines, summary papers, and research papers. The text prepares students to search this type of literature and apply the information, so as clinicians they can seek evidence to find the optimal treatment strategy and support the clinical decisions they make.

Human Kinetics' Athletic Training Education Series contains five textbooks, each with its own supporting instructional resources. Featuring the work of respected athletic training authorities, the series was created to parallel and expound on the content areas established by the National Athletic Trainers' Association (NATA) Educational Council. Therapeutic Modalities for Musculoskeletal Injuries, Second Edition, addresses the following NATA content areas: Therapeutic Modalities and Psychosocial Intervention and Referral.

To learn more about the books in this series, visit the Athletic Training Education Series Web site at www.HumanKinetics.com/AthleticTrainingEducationSeries .

Author Notes

Craig R. Denegar, PhD, ATC, PT, is associate professor of orthopedics and rehabilitation and kinesiology at Pennsylvania State University. He has more than 25 years of experience as an athletic trainer and extensive clinical practice experience related to persistent orthopedic pain.

Dr. Denegar is a member of the National Athletic Trainers' Association (NATA) and is the former vice chair for free communications on the NATA Research and Education Foundation Research Committee. He is also a member of the American Physical Therapy Association and the recipient of the William G. Clancey Medal for Distinguished Athletic Training Research in 2003 and of the Distinguished Merit Award from the Pennsylvania Athletic Trainers' Society in 2004.

Currently serving as the senior associate editor of the Journal of Athletic Training (JAT), Dr. Denegar also serves on the editorial boards of JAT, Journal of Strength Training and Conditioning Research, and Journal of Sport Rehabilitation. He received his PhD in education with a specialization in sports medicine and a master's degree in education with a specialization in athletic training from the University of Virginia. He earned a master's degree in physical therapy from the School of Physical Therapy, Slippery Rock, Pennsylvania.

In his spare time, Dr. Denegar enjoys playing soccer, cycling, and studying the history of the American West. He and his wife, Susan, live in State College, Pennsylvania.

Susan Foreman Saliba, PhD, is a senior associate athletic trainer and a clinical instructor at the University of Virginia in Charlottesville, where she has taught therapeutic modalities for over 12 years. A certified athletic trainer and licensed physical therapist, Dr. Saliba also taught therapeutic modalities at James Madison University in Harrisonburg, Virginia. She is chairperson of the National Athletic Trainers' Association Clinical Education Committee and a member of its Education Executive Committee. She earned a master's degree in athletic training and a PhD in sports medicine from the University of Virginia.

Ethan Saliba, PhD, has been teaching therapeutic modalities at the University of Virginia in Charlottesville for over 18 years. He is currently head athletic trainer, overseeing 24 varsity sports. Dr. Saliba is a certified athletic trainer, licensed physical therapist, and sport-certified specialist who has written extensively on various aspects of athletic injuries and rehabilitation. He earned a master's degree and PhD in sports medicine from the University of Virginia.

Introduction to the Athletic Training Education Series	p. ix
Preface	p. xi
Acknowledgments	p. xiii
Credits	p. xv
Chapter 1 The Contemporary Use of Therapeutic Modalities	p. 1
Legal Aspects of Therapeutic Modality Application: Practice Acts and Negligent Treatment	p. 3
The Rehabilitation Plan of Care	p. 6
Learning Aids	p. 11
Chapter 2 Psychological Aspects of Rehabilitation	p. 13
Psychological Response to Injury	p. 15
Maximizing Compliance With a Rehabilitation Plan of Care	p. 17
Barriers to Successful Rehabilitation	p. 20
Clinical Outcomes and Efficacy of Therapeutic Modalities	p. 23
A Word About Placebo	p. 24
Learning Aids	p. 24
Chapter 3 Tissue Injury, Inflammation, and Repair	p. 27
Healing Tissues and Inflammation: An Overview	p. 28
Acute Phase of the Inflammatory Response	p. 29
Repair Phase of the Inflammatory Response	p. 35
Maturation Phase of the Inflammatory Response	p. 35
Chronic Inflammation	p. 36
Swelling	p. 36
Learning Aids	p. 39
Chapter 4 Pain and Pain Relief	p. 43
What Is Pain?	p. 44
Pain and the Physical Exam	p. 45
Pain Assessment	p. 46
Transmission of the Pain Sensation	p. 49
Pain Control Theories	p. 59
Learning Aids	p. 66
Chapter 5 Persistent Pain and Chronic Pain	p. 69
Sources of Persistent Pain	p. 71
Sources of Chronic Pain	p. 79
Learning Aids	p. 80
Chapter 6 Impact of Injury and Pain on Neuromuscular Control	p. 83
Integration of Components of Neuromuscular Control Into a Rehabilitation Plan of Care	p. 84
Why Is Neuromuscular Control Lost?	p. 86
The Role of Therapeutic Modalities in Restoring Neuromuscular Control	p. 90
Learning Aids	p. 91
Chapter 7 Evidence-Based Application of Therapeutic Modalities	p. 93
The Need for Evidence-Based Practice	p. 94
Tools Necessary for Assessing Outcomes	p. 95
Finding and Assessing the Evidence	p. 99
Learning Aids	p. 102
Chapter 8 Cold and Superficial Heat	p. 105
Energy Transfer	p. 106
Cryotherapy and Cryokinetics	p. 108
Superficial Heat	p. 119
Heat and Cold: Contrast Therapy	p. 123
Heat, Cold, and Contrast Therapy: Deciding What to Apply	p. 124
Learning Aids	p. 125
Chapter 9 Principles of Electrotherapy	p. 129
Basics of Electricity	p. 130
Types of Electrical Current: Alternating, Direct, and Pulsatile	p. 132
Parameters of Electrical Stimulation	p. 134
Electrode Considerations	p. 142
Learning Aids	p. 147
Chapter 10 Clinical Uses of Electrical Stimulation	p. 149
Pain Relief: Transcutaneous Electrical Nerve Stimulation	p. 150
Muscle Reeducation: Neuromuscular Electrical Stimulators	p. 162
Iontophoresis and Stimulation of Denervated Muscle: Direct Current Stimulator	p. 166
Wound Healing: Microcurrent Electrical Nerve Stimulator	p. 172
Learning Aids	p. 173
Chapter 11 Ultrasound, Diathermy, and Electromagnetic Fields	p. 177
Application of Acoustic Energy: Ultrasound	p. 178
Efficacy of Ultrasound Therapy for Musculoskeletal Conditions	p. 187
Application of Electromagnetic Energy: Diathermy and Pulsed Electromagnetic Fields	p. 188
Efficacy of Diathermy and PEMF Therapy for Musculoskeletal Conditions	p. 190
Stimulation of Fracture Healing	p. 191
Learning Aids	p. 192
Chapter 12 Low-Level Laser Therapy	p. 197
Electromagnetic Energy	p. 199
Laser Production	p. 200
Properties of Laser Light	p. 202
Laser Classification	p. 203
Laser Parameter Selection	p. 203
Comparing Low-Level Laser Therapy Treatments	p. 206
Biological Effects of Laser	p. 211
Safety Considerations	p. 213
Contraindications and Precautions	p. 213
Learning Aids	p. 214
Chapter 13 Mechanical Energy	p. 217
Manual Therapies	p. 219
Is Manual Therapy Effective?	p. 227
Traction	p. 228
Intermittent Compression	p. 235
Traction and Intermittent Compression: Effective Therapies?	p. 236
Learning Aids	p. 237
Chapter 14 Treatment Plans for Acute Musculoskeletal Injuries	p. 241
Management in the Acute Stage: Rest, Ice, Compression, Elevation	p. 245
Modalities Used in Addition to RICE	p. 246
Repair Phase	p. 247
Maturation	p. 248
Learning Aids	p. 251
Chapter 15 Neuromuscular Control and Biofeedback	p. 253
Volitional Control and Biofeedback	p. 255
Clinical Applications: Restoring Control of Volitional Contraction	p. 257
Clinical Applications: Functional Progression	p. 258
Learning Relaxation	p. 261
Learning Aids	p. 263
Chapter 16 Clinical Management of Persistent Pain	p. 265
Treating Persistent Pain	p. 268
Diagnosis and Plan of Care Problems	p. 270
Treating Chronic Pain	p. 276
Learning Aids	p. 277
Glossary	p. 279
Index	p. 285
About the Authors	p. 295

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