Electrical Stimulation/Neuromuscular Electrical Stimulation (NMES)

Electrical Stimulation is the application of current to elicit a muscle contraction. Contracting the muscle via electrical stimulation helps strengthen the affected muscle and also promotes blood supply to the area which serves to assist in healing. The use of E-Stim in orthopedic and neuromuscular rehabilitation has grown significantly in recent years. . E-Stim is performed by placing electrodes on the skin so the physical therapist can recruit the appropriate muscle fibers for contraction. The physical therapist can change the current settings to allow for a forceful or a gentle muscle contraction, pain relief, swelling control, and strengthening.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is one of the most commonly used forms of electrostimulation for pain relief. TENS is utilized for conditions such as low back pain, myofascial and arthritic pain, neurogenic pain, and postsurgical pain Electrodes are placed around the affected area and an electrical current is sent through the electrodes. A tingling sensation is felt in the underlying skin and muscle. This signal disrupts the pain signal that is being sent from the affected area to the surrounding nerves. By breaking the signal, the patient experiences a decrease in pain.

Ultrasound

Ultrasound is a modality that emits high frequency sound waves that vibrate the tissues deep inside the injured area. This vibration creates heat that draws blood and nutrients to the injured area to assist in the healing process. It is used to treat pathologies related to tendons, muscles, and other joint structures. It effects promote tissue relaxation, increase soft tissue extensibility and range of motion, decrease muscle spasm, inflammation, and pain thus speeding up the healing process.

Phonophoresis

Phonophoresis is a modality where an anti-inflammatory steroid or pain relieving cream is applied to the injured/inflamed tissue and ultrasound is then used to penetrate the medicine into the underlying tissues. The heat created by the ultrasound waves increases the energy of the molecules in the drug; therefore, decreasing inflammation and pain.

Iontophoresis

Iontophoresis is a non-invasive method of delivering anti-inflammatory medications into the skin and to deeper tissues through the use of electrical polarity. It is based on the principal that like charges repel. With a direct current, an electrical charge can be applied to a charged medication of the same polarity and the drug will be ‘pushed’ into and through the skin. The most common medication used in this treatment is the corticosteroid drug, dexamethasone. When properly applied, it is virtually painless and the medication is delivered directly to the treatment site. Because it avoids injection, there is a decreased risk of infection and very minimal potential for skin trauma. This treatment also enables a greater concentration of medication to reach a localized area than oral medications, and reduces the risk of side effects. It is also completed in a short amount of time. Iontophoresis is commonly used to treat soft tissue and other musculoskeletal inflammation including tennis elbow, achilles tendonitis, plantar fasciitis, and TMJ disorders. For optimal results, this modality is used in combination with exercise, activity modification, and manual therapy.

Mechanical Traction

Spinal traction is a treatment technique that uses forces to stretch and mobilize the spine. It alleviates pain in the neck or lower back by stretching tight muscles along the spine and widening the space between each vertebra to relieve pressure and nerve impingement. The separation is only temporary but can last long enough to allow patients to exercise and function without aggravating their symptoms. Application of traction is dependent on the area treated and the amount of force that is needed. It can also be applied continuously or intermittently. Traction is most commonly used in the cervical and lumbar regions, neck and back respectively. Traction is a widely used modality whose ultimate purpose is to reduce pain and increase patient function.

Extremity Whirlpool

Whirlpool is a modality that consists of a warm water bath. This technique is very beneficial and used to increase blood flow, promote muscle relaxation, decrease pain, increase range of motion, promote healing, desensitize nerve endings and assist with wound healing. Whirlpool can also assist with wound cleansing and mechanical debridement.