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Jeremy R. Hawkins and Shawn W. Hawkins

Thermotherapy is commonly used by athletic trainers. Data are lacking as to how athletic trainers treat common injuries with thermotherapy. The purpose of this study was to ascertain how collegiate athletic trainers approach the use of thermotherapy and whether that usage reflects what current knowledge we have of thermotherapy. Survey results indicated respondents took three different approaches to the treatment of three different types of injuries. The majority of their approaches were applied according to current knowledge. Treatment guidelines could be strengthened with additional clinical outcomes data. Certain aspects of the application of the different thermotherapies should be reviewed and use adjusted accordingly.

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Blaine C. Long and J. Ty Hopkins

Context:

It is reported that thermotherapy decreases motoneuron-pool recruitment. Any decrease in recruitment might have a significant impact on an athlete’s ability to return to competition.

Objective:

To determine whether moist heat application influences involuntary motoneuron-pool recruitment or voluntary plantar-flexion peak torque of the soleus muscle immediately or 30 min after application.

Design:

A 3 × 3 crossover design.

Setting:

Biomechanics laboratory.

Participants:

Eighteen healthy subjects with no history of lower extremity surgery or injury 12 months before the study volunteered.

Intervention:

A series of short-duration, high-intensity stimuli was delivered to the tibial nerve to find the Hmax and Mmax measures. Immediately after the Hmax and Mmax measures, subjects were positioned on an isokinetic dynamometer where they performed 5 submaximal warm-up repetitions. Immediately after the warm-up, 5 maximum-intensity peak plantar-flexion torque repetitions were performed. After the dynamometer measures, subjects returned to the table, where a moist heat pack, no heat pack, or a dry nonheated heat pack was applied.

Main Outcome Measures:

Hmax, Mmax, peak plantar-flexion torque, surface temperature (°C), and ambient temperature (°C).

Results:

Moist heat did not influence the H:Mmax ratio or peak plantar-flexion torque. Temperature increased with moist heat pack. Ambient temperature remained constant.

Conclusions:

Moist heat did not influence involuntary motoneuron-pool recruitment or voluntary peak plantar-flexion torque of the soleus muscle immediately or 30 min after application.

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Jennifer Ostrowski, C. Collin Herb, James Scifers, Teraka Gonzalez, Amada Jennings and Danvirg Breton

Thermotherapy has several physiological effects that are beneficial to the healing process, including increased metabolism, 1 increased blood flow, 1 , 2 decreased pain and muscle spasm, 3 – 6 decreased tissue stiffness, and increased collagen extensibility. 4 – 7 It has been recommended that

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David A. Kaiser, Kenneth L. Knight, Jeremy M. Huff, Lisa S. Jutte and Preston Carlson

Objective:

To determine the time needed to heat hot packs to water temperature (73–75 °C) in 4- and 8-pack Hydrocollator® units.

Design and Setting:

A 2 × 2 factorial design, with heating unit (4- or 8-pack) and number of packs added (1 or 3/7) as independent variables. Dependent variables were hot-pack and Hydrocollator-water temperatures.

Measurements:

Temperatures were measured with type T thermocouples interfaced with a 16-channel Isothermex™. Hydrocollator temperatures were measured with 2 thermocouples, and hot-pack temperatures, with 6 thermocouples inserted in 6 cells of a hydrated, 10- by 12-in Hydrocollator pack. Temperature was measured every 30 s for 5 min before and 45 min after pack immersion.

Results:

Packs warmed rapidly from ~18 to 65–68 °C by 10 min and to 72.5–75 °C by 20 min. Heating slowed by ~5% when 7 packs were added to the large unit. Water temperatures decreased ~2 °C (from ~75 °C) after 7 packs were immersed and returned to preimmersion temperatures by 20 min.

Conclusions:

Rewarming is quicker than commonly believed (20–150 min) and might be a function of the number of packs being simultaneously warmed.

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Eric Winters, Steven Doty and Sean Newell

Objective:

To explore changes in bovine Achilles-tendon elasticity relative to 3 thermal conditions.

Design and Setting:

Posttest-only design with assignment by convenience. Manufactured-apparatus-clamped excised tendon, delivered tensile stress, and provided strain measures. Stress was increased at 1-minute intervals. Strain was observed for each level of stress. Before testing, cold-group tendons were submerged in cold water for 20 minutes. Heat-group tendons were tested in the presence of an ultraviolet lamp. A third group of tendons was tested at room temperature.

Subjects:

Frozen bovine Achilles tendons provided by a meat-rendering factory and segmented into 3 longitudinal strips.

Measurements:

Stress and strain were sequentially measured. Elastic region was identified, elastic-region Young's modulus determined, and elastic limit calculated.

Results:

Young's modulus for cold was 0.956 gigapascal (GPa; ± 0.0621); room temperature, 0.753 GPa (± 0.0624); and heat group, 0.487 GPa (± 0.0407). Significant differences were identified between each of the 3 conditions.

Conclusions:

A direct relationship was observed between imposed thermal energy and tendon elasticity. Thermal energy does not affect the elastic limit.

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Alissa C. Rhode, Lauren M. Lavelle and David C. Berry

Clinical Scenario: ReBound is a portable shortwave diathermy unit used to heat tissues using the same principle as induction drum shortwave diathermy. It is unclear if ReBound can vigorously (4°C) heat intramuscular tissue as efficiently as other thermal agents. Clinical Question: In adults (P), is ReBound diathermy (I) compared with other thermal agents (C) effective at increasing intramuscular tissue temperature by 4°C (O)? Summary of Key Findings: (1) Three studies were included for review, all randomized crossover studies. (2) All studies agreed ReBound does not achieve vigorous (4°C) heating effects during a 30-minute treatment to the triceps surae muscle (depth = 1 and 3 cm). (3) Studies agreed that the heat generated by ReBound dissipates slower than (P < .001) or similar to pulsed shortwave diathermy at 3 cm and faster than moist hot packs (P < .001) at 1 cm. (4) One study found that intramuscular tissue temperatures increased more with ReBound (3.69°C [1.50°C]) than moist hot packs (2.82°C [0.90°C]) at superficial depths (1 cm, d = 0.70). (5) Two studies compared ReBound with MegaPulse II pulsed shortwave diathermy at a 3 cm depth. One found that the MegaPulse II increased intramuscular tissue temperature by 4.32°C (1.79°C) compared with the ReBound’s 2.31°C (0.87°C) increase (d = 1.43). The final study reported that the MegaPulse II increased triceps surae muscle temperature by 3.47°C (0.92°C) versus ReBound at 3.08°C (1.19°C) (d = 0.37). (6) The combined results are an increase of 3.81 (1.38°C) for the MegaPulse II and 2.77 (1.12°C) for ReBound (d = 0.83). Clinical Bottom Line: Results strongly indicate that the ReBound should not be used for vigorous (4°C) heating effects in the triceps surae muscle at 1 and 3 cm. Clinicians can use ReBound when traveling or instead of moist hot packs for moderate (2°C–3°C) heating effects at deep and superficial levels (1 and 3 cm) for large treatment areas with subcutaneous fat thickness <15 mm. Strength of Recommendation: Consistent level B findings indicate that ReBound does not achieve vigorous heating effects (4°C).

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Kosuke Fujita, Masatoshi Nakamura, Hiroki Umegaki, Takuya Kobayashi, Satoru Nishishita, Hiroki Tanaka, Satoko Ibuki and Noriaki Ichihashi

Context: A recent review or article reported that thermal agents (TA) or physical activity (PA) can increase range of motion (ROM) and that the combination of TA with stretching is superior to performing stretching only. However, since ROM is affected by the psychological factors, it is questionable whether these studies measured the effect of these interventions on muscle flexibility. By measuring muscle stiffness, the authors attempted to evaluate the effect these interventions on muscle flexibility. Objective: To compare the individual effects of TA and PA on muscle flexibility, as well as their effectiveness when combined with static stretching (SS). Design: Crossover trial. Setting: University research laboratory. Participants: 15 healthy men without a history of orthopedic disease in their lower limbs. Interventions: 15 minutes of 3 different conditions: hot pack as TA, pedaling exercise as PA, and the control group with no TA or PA intervention, followed by 3 min of SS for the hamstrings. Main Outcome Measures: Joint angle and passive torque of the knee during passive elongation were obtained prior to interventions, after 3 kinds of intervention, and after SS. From these data, muscle-tendon-unit (MTU) stiffness of the hamstrings was calculated. Results: Although knee-joint ROM increased with both TA and PA (P < .05), there were no significant differences in MTU stiffness between pre- and postintervention measurements for either of the interventions (TA, P = .477; PA, P = .377; control, P = .388). However, there were similar significant decreases in MTU stiffness between postintervention and post-SS for all conditions (P < .01). Conclusions: TA and PA did not decrease MTU stiffness, and combining these interventions with SS did not provide additional decreases in MTU stiffness compared with performing SS alone.

Open access

Erica S. Albertin, Emilie N. Miley, James May, Russell T. Baker and Don Reordan

Exclusion Criteria Inclusion Criteria • Studies that compared traditional hip therapeutic exercise (including 1 or more of thermotherapy, stretching, modalities, or strengthening) or sham mobilization or a hip mobilization • Limited to publications within the past 10 years (2007–2016) • Limited to the

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Sara J. Golec and Alison R. Valier

, better function, and fewer days missed from work. 9 Further, there is a lack of high quality, consistent evidence regarding the effectiveness of therapeutic ultrasound, electrical stimulation, thermotherapy, therapeutic massage, mechanical traction and EMG biofeedback on outcomes for patients with low

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Jennifer Ostrowski, Angelina Purchio, Maria Beck, JoLynn Leisinger, Mackenzie Tucker and Sarah Hurst

Unlike thermotherapy, the therapeutic range for cooling is unknown; therefore, it is generally assumed that greater localized temperature decreases provide greater therapeutic benefit. 10 – 14 The acronym RICES (rest, ice, compression, elevation, and stabilization) is often suggested as treatment during