Use Of Physical Modalities Research Articles

SEVERE POSTURE AND GAIT DISTURBANCE IN LUMBAR SPINAL STENOSIS: A CASE REPORT

One of the causes of low back pain is lumbar spinal stenosis (LSS). LSS is defined as a disorder resulting from degenerative processes leading to narrowing of the spinal canal. The nature of pain in LSS—the neurogenic claudication—was aggravated by upright or extended trunk positions, such as during walking, descending stairs, or simply standing. Patient self-adjustments in response to pain can induce further muscle disturbance and worsen the condition. A 56-year-old male suffering from poor posture with antalgic and Trendelenburg gait. The MRI showed multiple spinal canal stenosis with compression of the L4-S1 nerve roots affected the gait and worsened posture. Physical medicine rehabilitation (PMR) program—including the use of ultrasound diathermy for severe muscle spasm followed by muscle stretching, Transcutaneous Electrical Stimulation (TENS) for pain relief, Neuromuscular Electrical Stimulation (NMES) for muscle strength improvement and several therapeutic exercises—has proven beneficial in reducing patient’s symptoms thus correcting the posture and gait. At this point spinal canal narrowing is not only causing pain with neurological deficit but may lead to posture and gait disturbance that increasing the patient's disability. The use of physical modalities combined with exercise has been shown to benefit patients similarly to surgery but without invasive approach.

Physical modalities for the conservative treatment of wrist and hand's tenosynovitis: A systematic review

The management of wrist and hand's tenosynovitis remains challenging and needs to be individualized. Physical modalities are accepted among conservative treatments, but there is currently no systematic assessment of their role and efficacy. The aim of this review is to analyze the literature including studies dealing with the use of physical modalities in De Quervain disease, Dupuytren disease and trigger finger, in order to obtain indications for everyday clinical practice. A systematic literature search of the following databases was conducted: MEDLINE (through PubMed), Cochrane Library, PEDro and Scopus. All kind of papers, except for case reports and case series, were included, due to the small amount of scientific evidence in literature about this topic. The inclusion criteria were papers regarding the effectiveness of conservative treatment with physical modalities of adult humans affected by De Quervain disease, Dupuytren disease and trigger finger. The review included articles in English language published before 10 May 2020. The exclusion criteria were papers whose topic were surgery or conservative treatment with therapeutic tools different from physical modalities for hand and wrist's tenosynovitis. The literature search identified 2422 papers, but only 15 were included in this review. While 10 of the 15 studies (66.6%) were RCTs, only 2 had a lower risk of bias according to the Cochrane library assessment tool. For the conservative treatment of De Quervain disease 7 papers were found, studying ultrasound therapy, low level laser therapy, phonoporesis, and anodyne therapy, alone or associated. For Dupuytren disease 3 papers were found, studying extracorporeal shock wave therapy (ESWT), temperature controlled high energy adjustable multi-mode emission laser, electron beam therapy and radiofrequency. For trigger finger 5 papers were found, studying ESWT and ultrasound therapy. Laser therapy and therapeutic ultrasound were the most used and effective physical therapies for De Quervain tenosynovitis. ESWT was found the most efficient and safe therapy for Dupuytren disease; radiotherapy, electron beam therapy, targeted radiofrequency and laser therapy could be promising therapeutic options at Dupuytren's onset. ESWT turned out to be the most frequent physical mean used for functional improvement and pain control in trigger finger. However, more high-quality studies are still needed to further define evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.

A comparative study of the therapeutic efficacy of vertical oscillatory pressure and transverse oscillatory pressure in the management of Chronic Low Back Pain

BACKGROUND: The use of physical modalities in treatment of Chronic Low Back Pain (CLBP) is potentially beneficial, but the general evidence still leaves questions about its security application. OBJECTIVE: This study sought to investigate and compare the relative efficacy of Vertical Oscillatory Pressure (VOP) and Transverse Oscillatory Pressure (TOP) in the management chronic low back pain (CLBP) of mechanical origin. METHODS: A two-group, quasi-experimental design was utilized, involving a total of forty-two participants purposively recruited with due consideration of the specific inclusion and exclusion criteria. Five research questions were raised with corresponding hypotheses formulated for them, which were tested at 0.05 level of significance. The participants were randomly assigned to the VOP and TOP groups, and were subsequently managed thrice weekly for a duration of six weeks. The pain intensity rating, straight leg raising, and spinal range of motion were the outcome measures selected, which were assessed before and after treatment. Data were collected, organized, and analyzed using descriptive and T-Student test analytical statistics. RESULTS: The results of the study showed a significant difference in each of the outcome measures for both groups (p<0,05). CONCLUSION: This suggested that both VOP and VOP were relatively effective in managing CLBP.

Phisical modalities on the functional performance in knee osteoarthritis: a sytematic review

Abstract Introduction: Despite recent advances in the treatment of osteoarthritis (OA), few studies have evaluated the longitudinal effect of physical modalities in functional capacity in patients with knee OA. Thereby, since the physical components and pain can affect the functional performance of daily activities, the effect of these treatment’s form is still to be established. Objective: Evaluate the effectiveness of therapeutic ultrasound, electrical stimulation and phototherapy in the functional performance, in patients with knee osteoarthritis. Methods: Articles present in the PubMed, Lilacs, SciELO and PEDro’s databases were evaluated. The used keywords were “pulsed ultrasound therapy”, “ultrasound therapy”, “electric stimulation” and “low level laser therapy” in combination with “knee osteoarthritis”. Were included in this presented review, randomized clinical studies using ultrasound, electrical and laser stimulation in subjects with knee osteoarthritis. To evaluate the methodological quality of the selected studies, was used the PEDro’s scale. The dependent variables of the study were: pain, physical function, joint stiffness, life quality and functional performance. Results: 268 studies were found, of these, 41 studies met eligibility criteria and were classified for analysis in full. The used methodology in the studies varied widely, however, in most cases there was improvement in functional performance of individuals with knee OA, with the use of physical modalities, for the pulsed ultrasound, continuous ultrasound, electrical stimulation and laser resourses. Conclusion: The physical modalities used in the studies demonstrated improvement in functional performance of individuals with knee OA.

The Effects of Extracorporeal Shock Wave Therapy in Patients with Coccydynia: A Randomized Controlled Trial.

Coccydynia is pain in the coccygeal region, and usually treated conservatively. Extracorporeal shock wave therapy (ESWT) was incorporated as non-invasive treatment of many musculoskeletal conditions. However, the effects of ESWT on coccydynia are less discussed. The purpose of this study is to evaluate the effects of ESWT on the outcomes of coccydynia. Patients were allocated to ESWT (n = 20) or physical modality (SIT) group (n = 21) randomly, and received total treatment duration of 4 weeks. The visual analog scale (VAS), Oswestry disability index (ODI), and self-reported satisfaction score were used to assess treatment effects. The VAS and ODI scores were significantly decreased after treatment in both groups, and the decrease in the VAS score was significantly greater in the ESWT group. The mean proportional changes in the ODI scores were greater in the ESWT group than in the SIT group, but the between-group difference was not statistically significant. The patients in the ESWT group had significantly higher subjective satisfaction scores than SIT group. We concluded that ESWT is more effective and satisfactory in reducing discomfort and disability caused by coccydynia than the use of physical modalities. Thus, ESWT is recommended as an alternative treatment option for patients with coccydynia.Trial RegistrationClinicalTrials.gov NCT02313324

Wound Management with Physical Modalities in Sports Medicine

An often overlooked area of beneficial treatment in sports injuries is open wounds. With the increase in the overall prevalence of such infectious disease, methicillin-resistant Staphylococcus aureus (MRSA), as well as indications for improvement and access to treatment options, clinicians should consider the use of physical modalities [1]. Physical modalities are common devices in the sports medicine clinic, and although their uses are more well known in other areas of treatment, there is evidence in using such methods in accelerating wound healing in physical activity related injuries [2,3]. In a review by Foster et al. (1995) it was noted that despite the information on wound healing, superficial, there is little notation in certain parameters, to include frequency [4]. There continues to be an absence of literature on the specific parameters for common wounds in physical activity injury. Therefore it is important that this information be accessible to clinicians and the value of open sourced journals should not be underestimated. The purpose of this brief review is to provide an outline of commonly used modalities in sports medicine clinic as component wound management of physical activity related injuries or others common to the population.

Current Status of the Use of Modalities in Wound Care: Electrical Stimulation and Ultrasound Therapy

Wound healing is a complex pathway that requires cells, an appropriate biochemical environment (i.e., cytokines, chemokines), an extracellular matrix, perfusion, and the application of both macrostrain and microstrain. The process is both biochemically complex and energy dependent. Healing can be assisted in difficult cases through the use of physical modalities. In the current literature, there is much debate over which treatment modality, dosage level, and timing is optimal. The mechanism of action for both electrical stimulation and ultrasound are reviewed along with possible clinical applications for the plastic surgeon.

Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions

To evaluate recent trials and reviews of physical modalities and conservative treatments for selected upper extremity musculoskeletal conditions for evidence supporting their use. Recent evidence suggests that many localized tendinopathies are related more to degenerative than inflammatory processes. With this realization, there is increased emphasis on finding new modalities to treat tendinopathies and other localized musculoskeletal conditions that rely on other than anti-inflammatory mechanisms. Although there is good evidence to support the short-term benefits of corticosteroid injections, convincing evidence in support of other conservative treatments and modalities is generally lacking. Extracorpal shock wave therapy may have significant clinical benefit for calcific tendinitis; however, it requires intravenous sedation in most cases and does not appear to be effective in lateral epicondylitis. The most consistent positive treatment effects for rotator cuff tendinitis were achieved by ultrasound-guided subacromial corticosteroid injection as well as manual therapy in conjunction with therapeutic exercise. Although there is evidence supporting the use of several different physical modalities and conservative treatments for upper extremity musculoskeletal conditions, there is a strong need for larger, higher quality randomized controlled trials. Although most studies are able to demonstrate short-term benefits, there is a lack of high-quality data demonstrating that these conservative treatments have long-term benefits, particularly, with regard to functional outcomes.

Of Rehabilitation Medicine and the Rehabilitation Physician

Rehabilitation Medicine or Physiatry (as is known in North America) is the medical specialty dealing with “restoration of function in people affected by physical disabilities”. The disease categories with which the specialty is mainly concerned are neurological conditions like stroke and brain injury, spinal injury, musculoskeletal disorders and limb amputation. The rehabilitation paradigm differs from the curative one in many ways. It is an individualised, patient-oriented activity focused on disability rather than disease. Rehabilitation moves from impairment towards helping the patient find “ability” in the presence of obvious disability. Specialists practising Rehabilitation Medicine are known as Rehabilitation Physicians or Physiatrists. How does a Rehabilitation Physician go about restoring function? He does it through the prescription of therapeutic exercises, use of physical modalities, teaching of new and/or compensatory skills, proper advice on use of orthotics and assistive devices, and judicious use of medications. To do so effectively, he needs to have good grasp of the underlying disease process and impairments arising, the complex relationship between impairment and disability, and the patient’s desired functioning in society. He is also expected to have sound knowledge of functional anatomy, biomechanics, gait analysis and pain, given that many patients with disabilities will have mobility-related problems and associated pain. Other skills that a Rehabilitation Physician may acquire include nerve blocks and botulinum toxin injection for the treatment of spasticity, interventional procedures for low back pain like facet joint injection, trigger point injection and acupuncture in the management of various musculoskeletal and myofascial pain syndromes, and strong knowledge of rehabilitation pharmacology, especially in the area of neuro-rehabilitation (Interestingly, amongst the handful of Western physicians who are also practising acupuncturists locally, 4 are rehabilitation physicians). The Rehabilitation Physician usually works with an interdisciplinary team of allied health care professionals, including therapists, nurses, psychologists and medical social workers. He must be able to guide the team to set clear, specific and realistic rehabilitation goals for the patient, and to monitor and evaluate the effectiveness of the rehabilitation intervention. In addition to leadership qualities, he also needs to have good communication and motivation skills. In this issue of the Annals, which has been devoted to Rehabilitation Medicine, the focus is on review articles of common conditions treated by the Rehabilitation Physician.1-9 These include traumatic brain injury rehabilitation in paediatric and adult patients, evidence on use of Botulinum toxin in treatment of spasticity, recovery and regeneration treatment after spinal cord injury, new therapies in stroke rehabilitation and myofascial pain. With this issue, it is hoped that the general reader will have a better understanding of the specialty of Rehabilitation Medicine and the role of the Rehabilitation Physician.

Comparison of the therapeutic efficacy of phonophoresis and iontophoresis using dexamethasone sodium phosphate in the management of patients with knee osteoarthritis

Many treatment options, including non-pharmacological and pharmacological measures, have been recommended in the management of osteoarthritis (OA). Among the non-pharmacological approach is physiotherapy, which involves the use of physical modalities like, heat therapy, exercise therapy, electrical stimulation, therapeutic ultrasound, iontophoresis, and phonophoresis. This study was therefore designed to compare the effectiveness of 0.4% Dexamethasone sodium phosphate (DEX-P) phonophoresis (PH) with 0.4% DEX-P iontophoresis (ION) therapy in the management of patients with knee joint OA. Fifty patients (19 males and 31 females) with a mean age of 53.6 +/- 8.9 years were randomly assigned to PH or ION groups with 25 patients in each group. Ultrasound waves of 1 MHz frequency was applied for 5 minutes to the target knee, so also was the direct current for 10 minutes for 10 sessions treatment period. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, 20 meters ambulatory time, and knee range of motion (ROM) were evaluated before and after therapy as the outcome measures. At the end of two weeks, significant improvement in total WOMAC scores was observed in 15 (60%) and 16 (64%) patients in the PH and ION groups respectively, indicating no significant difference in the improvement rate. Twenty (20) metres ambulatory time and knee range of motion also improved significantly in both groups, yet these variables showed no significant difference between the two groups. Both therapeutic modalities were found to be effective and generally well tolerated after 10 treatment sessions. DEX-P phonophoresis was not superior to DEX-P iontophoresis in the treatment of patients with OA of the knee.

A biochemical approach to wound healing through the use of modalities

Wound healing is a complex pathway that is energy dependent. Nonhealing wounds frequently require the use of physical modalities to achieve healing. There is much debate over which treatment modality to use, with varying clinical results in the literature. This review paper describes a common biochemical pathway that helps the clinician understand, at a molecular level, how the transference of energy to a wound can result in positive clinical results. The mechanisms of action for ultraviolet light, electrical stimulation, and ultrasound are reviewed along with a proposed biochemical roadmap. An emphasis on protein biochemistry is supported with an extensive review of the literature.

Noninvasive treatments for headache

Primary headache disorders are often accompanied by neck pain or other symptoms referable to neck muscles. Therefore, physical therapy and other physical treatments are commonly prescribed for headache management. A medical literature review was completed in order to gather information regarding the efficacy of selected physical modalities in the treatment of primary and cervicogenic headache disorders. After analyzing the collected data, expert opinions were developed regarding the utility and efficacy of selected physical modalities in the management of primary and cervicogenic headaches. Based on this review, the following four expert opinions are presented: physical therapy is more effective than massage therapy or acupuncture for the treatment of tension-type headache and appears to be most beneficial for patients with a high frequency of headache attacks. Physical therapy is most effective for the treatment of migraine when combined with other treatments such as thermal biofeedback, relaxation training and exercise. Chiropractic manipulation demonstrated a trend towards benefit in the treatment of tension-type headache, but evidence is weak. Chiropractic manipulation is probably more effective in the treatment of tension-type headache than it is in the treatment of migraine. In general, strong evidence is lacking regarding the efficacy of these treatments in reducing headache frequency, intensity, duration and disability in many commonly encountered clinical situations. Many of the published case series and controlled studies are of low quality. Physical treatments are unlikely to pose a significant risk, with the exception of high velocity chiropractic manipulation of the neck. Consideration must be given to financial costs and lost treatment opportunity by prescribing potentially ineffective treatment. In the absence of clear evidence regarding their role in treatment, physicians and patients are advised to make cautious and individualized judgments about the utility of physical treatments for headache management. In most cases, the use of physical modalities should complement rather than replace better validated forms of therapy. The evidence base to determine the safety and efficacy of physical treatments in the management of headache disorders would be substantially improved by using standard scientific rigor in the development and conduct of future clinical studies.

A survey of primary care physician practice patterns and adherence to acute low back problem guidelines.

This study evaluated physicians' self-reported management of acute low back problems in adults and adherence with published guidelines. Self-administered written survey based on the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) guideline on acute low back problems in adults. A region of northern Illinois with a population around 250 000 and encompassing a medium-sized city. One hundred eighty-two primary care physicians (nonpediatric) with medical staff appointments at area hospitals. Adherence to published recommendations. Eighty-seven surveys were received for a 48% response rate. Overall, survey respondents recognized 5 of 7 red flags representing serious underlying abnormality 50% or less of the time. Forty percent (35/87) of physicians provided patients with written educational material, and only 25%(22/87) indicated they evaluated motor function of the fifth lumbar nerve, the most commonly affected level in intervertebral disk disease disease. About 25% (24/87) reported routine use of plain films; and 16% (14/87), routine use of computed tomography or magnetic resonance imaging. Most oral medication use was consistent with recommendations, but many also used drugs conditionally discouraged by the guideline (muscle relaxants, 91% [79/87]; opioids, 62% [54/87]) or cautioned against (oral steroids, 45% [39/87]; antidepressants, 23% [20/87]; injection therapy, 52% [45/87]). Only 22% (19/87) of respondents used or recommended manipulation. The management of patients with acute low back problems by primary care physicians differs significantly from Agency for Health Care Policy and Research guideline recommendations in several key areas that include awareness of red flags, use of medication, use of radiographic studies, the need for patient education, and the use of physical modalities. Future research should focus on the impact of guideline compliance on patient outcomes and cost-effectiveness. Arch Fam Med. 2000;9:1015-1021

Female Pelvic Floor Functions, Dysfunctions, and Behavioral Approaches to Treatment

This article has reviewed normal pelvic floor function and the type of evaluation and treatment programs that should be offered to the woman who presents with pelvic floor dysfunction. Pelvic floor muscle contraction is an acquired function. It is not innate. Development of pelvic floor muscle strength requires specificity training and dedication to an exercise program. It is imperative that women be educated about the functions and dysfunctions of the pelvic floor complex in order to promote preventive rather than restorative benefits of pelvic floor exercise. Exercise programs should be specific to the type of pelvic floor muscle dysfunction and its causes. Behavioral treatment options focus on traditional physical therapy techniques of education, therapeutic exercise, and the use of physical modalities that aid in the restoration of muscle function. Exercises for the pelvic floor should be part of every woman's fitness regime. Health care providers, health educators, and fitness personnel need to ask women more questions about pelvic floor function, encourage women to exercise these muscles, and to seek medical care for their dysfunctions. Only then will the magnitude and prevalence of pelvic floor muscle dysfunctions receive the attention that they need.

Can the use of physical modalities for pain control be rationalized by the research evidence?

Physical modalities, including cold and heat, are widely used in the conservative management of pain associated with musculoskeletal disorders. This review has critically appraised the literature supporting the use of these modalities in the treatment of musculoskeletal pain. It was concluded that, apart from a few exceptions and in a few types of disorders, existing evidence does not support the use of these modalities in long-term pain control. There was, however, evidence that several modalities, specifically cold and a form of deep heat (shortwave diathermy), do have short-lived analgesic effects and so may contribute to more painfree function in the short term. Further research is clearly warranted to define the short- and long-term therapeutic efficacy of physical modalities in the treatment of musculoskeletal pain to justify their continued use in clinical practice.

Some Guidelines for the Use of Physical Modalities

Some Guidelines for the Use of Physical Modalities

Effective Use of Physical Modalities

Effective Use of Physical Modalities