Beruflich Dokumente
Kultur Dokumente
CRYOTHERAPY
DEFINITION: The therapeutic use of cold
Ice is inexpensive, readily available to both practitioner and patient and can be used in a
variety of forms.
Has relatively few contraindications, and can be very effective in the treatment of pain,
edema, spasm and inflammation, especially in the first 24 to 48 hrs after an injury.
In many instances in which heat is considered the modality of choice for its "soothing"
qualities, cooling would probably afford longer lasting and more complete results, and
therefore should be considered more often.
CRYOTHERAPY
EFFECTS
Anesthesia
Analgesia
Reduction of edema
Reduced Muscle spasm
Reduced Spasticity
Reduced manual Dexterity
CRYOTHERAPY
INDICATIONS
Acute sprains and strains
Acute inflammatory processes
Acute trauma
Acute and Chronic muscle spasm
Spasticity associated with neurological disorders
CRYOTHERAPY CONTRAINDICATIONS
Caution with geriatrics, infants, and cachexics
Individuals with psychological aversion to cod
Hypersensitive individuals
CRYOTHERAPY APPLICATIONS
Ice packs
Ice massage
Cold compresses
Extremity baths
HOT MOIST HEAT
This is the most commonly used heat modality
Transfers heat to the patient primarily by conduction
Most common cause for malpractice in physiotherapy today is burns, and they are most
frequently caused by hot packs.
The moist packs should be totally submerged in water to a minimum of 30 to 40 minutes
between use to regain their correct temperature (150 -180 degrees F)
Hot moist heat can be used in conjunction with other therapies.
Moist heat vs. dry heat: dry heat causes stiffness.
1
EFFECTS
Increased circulation to the area being treated.
Relaxation
Decreased pain
Decreased muscle spasm
Generalized effect (PR, BP)
INDICATIONS
Non-acute sprains/strains
Sinus conditions
Menstrual cramps
Arthritis, tendinitis, bursitis, capsulitis
Decreasing pain before exercise
CONTRAINDICATIONS
Acute conditions
Patients on anti-coagulants
Psychological hysteria or drug dependent
Dermatological conditions
Diabetic or alcoholic neuropathy
Severe vascular occlusions
Always have patient inform you if hot pack is too hot.
Do not use steam packs over cuts or abrasions
Do not use heat packs in conjunction with skin balm or liniments.
Do not use toweling that is moist from use.
PARAFFIN THERAPY
Paraffin is essentially hot wax that consists of seven parts paraffin and one part mineral oil
Some authorities recommend a 4:1 ratio
Purpose of the mineral oil is to lower the melting temperature of the wax.
Without the mineral oil, the melted wax would be far too hot for therapeutic purposes.
Because the paraffin-oil mixture has a low specific heat, it can be applied directly to the skin
if the circulation to the part is normal.
Before the application, the part to be treated should be cleaned and dried, the thermesthetic
sense should be ascertained to be normal, and all jewelry on the part to be treated should be
removed.
Temperature of the melted wax should be checked with a thermometer, but a finger pretest
by the doctor/therapist will even more assure the apprehensive patient that the mixture is not
too hot.
Paraffin offers the same effects and advantages as any other form of superficial heat that is
transferred by conduction.
2
PARAFFIN THERAPY
CONTRAINDICATIONS
Paraffin should not be used over open wounds, abrasions, acute skin disorders, or where
there is diminished sensation.
METHODS OF PARAFFIN THERAPY APPLICATIONS
When constant heat is required for a long period, two or three hours, the application of the
paraffin boot, properly insulated, gives excellent results either by direct or reflex application.
Dipping method: After washing and drying the extremity, dip the part in and out of the bath
quickly, allow time between dipping for congealing, dip again, and keep repeating until the
thickness of the paraffin is from 1/4 inch to 1/2 inch.
Depending upon the intended duration of the treatment, wrap the part in wax paper and
insulate all around with a towel.
When the treatment is completed, remove the paraffin and discard it
When dipping hands, keep fingers spread apart.
The part treated should now be massaged and passively exercised.
The entire treatment usually takes about 20 to 30 minutes.
Immersion method: For heat treatments of shorter duration, 10 to 30 minutes, use the
immersion method.
Dip the part in and out of the bath quickly so that a thin coating of paraffin congeals on the
skin.
Repeat several times until the glove of paraffin is of sufficient thickness to allow the part to
remain in the bath with comfort.
Keep the part immersed from 20 to 30 minutes.
At the end of the treatment, remove the wax and discard it.
Brush on method: To apply paraffin bath heat treatment to parts of the body which cannot be
immersed in the paraffin bath conveniently, paint the surface rapidly with a soft paint brush.
When first applied, the paraffin will feel very warm, keep brushing until a thick coating
covers the area
Allow it to remain for twenty to thirty minutes.
After removal, discard the wax.
The part treated should be massaged and passively exercised.
THERAPEUTIC ULTRASOUND
THERAPEUTIC ULTRASOUND
Therapeutic ultrasound is that which is used for therapeutic (rather than diagnostic) purposes
and is usually produced at 1 megacycle or 1 million cycles per second
US has replaced diathermy for many types of conditions because it is less time consuming
and penetrates tissues well.
There is less danger of burning
It takes only 8-10 minutes
It is capable of penetrating 5 cm into the tissues.
Continuous US causes a thermal effect. The friction caused by the vibration within the
patient’s tissues will produce heat.
Because US is transmitted by skin and fat, the heat can be directed to the deeper muscle layers
where it is needed.
3
PULSED ULTRASOUND
The energy is on for a short period of time, then off; alternating so that the "on time" or duty
cycle is approximately 5-50% of the total time.
The "off time" allow the tissues to disperse the heat created, thereby minimizing or
eliminating the thermal effect.
PULSED ULTRASOUND
With the 5% duty cycle, there is virtually no heating
With the 50% duty cycle, some heating occurs.
Pulsating US is advantageous when the thermal effect may be detrimental.
BIOLOGICAL EFFECTS
Inflammatory—increase fragility of lysosome membrane nd thus enhances the release of
their contained enzymes which helps to clear the debris and allow next stage to occur.
Proliferative—fibroblast and myofibroblast may have ca++ ions driven to them by US.
Fibroblast are stimulated to produce collagen fibres to from scar and myofibroblast contract
to pull the edges together.
Remodeling--- increase tensile strength of scar by affecting the directions, strength and
elasticity of fibres.
ULTRASOUND EFFECTS
Tissue temperature rise
Decreased nerve conduction velocity
Increased circulation
Increased tendon extensibility
Reduced adhesion formation
Decreased pain
Muscle relaxation
ULTRASOUND INDICATIONS
Neuromuscular, musculoskeletal disorders
Sprains and strains; adhesive capsulitis
Arthritic conditions - acute and chronic
Bursitis, tendinitis, including calcific tendinitis
Neuromas, scars, dupuytrens contracture
Plantar warts
Hematomas
Adhesions
PRECAUTIONS
Over heating of the cutaneous tissues may occur if
the intensity is set too high
Transducer is moved too slowly
Transducer surface is not kept parallel to the skin surface
PRECAUTIONS
Over heating of the periosteum may occur if:
~ The transducer is held too close to the bone
~ The intensity is set too high
~ The transducer is moved too slowly
4
CONTRAINDICATIONS
Epiphysis of growing bones
Over reproductive organs
Over a gravid uterus
Over the heart
Over the eye; over anesthetic areas
Over ischemic areas; directly over the spinal column or brain
Over a fracture (until well healed)
Deep vein thrombosis
Arterial disease, hemophilia, malignancy
TB of the lungs or bone
Over the thoracic region of a patient with a pace maker
APPLICATION OF ULTRASOUND
Apply coupling medium to the part being treated and place the transducer against the
coupling medium. The unit should never be turned on without coupling medium because the
crystal may over heat.
Keep the transducer moving slowly
Turn the intensity up to the desired level
Avoid bony prominences and keep the transducer parallel to the skin as possible
The patient may get a mild sense of warmth. If the patient gets too hot, or uncomfortable, the
wattage should be reduced to a tolerable level
Treat for the desired time
US IMMERSION METHOD
Good for treating hands, wrists, feet and elbows
Place the transducer and the treating part in a container of water
Keep the transducer moving slowly and within 1cm of the part being treated.
Duration: acute 3-4 minutes; chronic 5-10 minutes
SHORT-WAVE DIATHERMY
Uses high frequency currents to heat the body tissues
The heat results from the resistance offered by the tissue to passage of the electric current.
The patient's sensation is an important guide as the regulation of dosage, as it should produce
only a mild comfortable sensation of warmth and not a sensation of heat
It is imperative that the sensory perception of the patient be normal in the use of diathermy.
PRECAUTIONS
Remove metallic pins, buttons, and hair
Metallic objects must not contact the patient, as they will concentrate the heat and could
cause burns.
Pins, keys, jewelry, watches and buckles.
TEN MAJOR EFFECTS
Thermal
Stimulation
Increased Blood flow
Hypotonicity
5
Increase in visceral circulation
Endocrine changes
Oxidation
Phagocytosis
Detoxification
Increase in capillary pressure
DOSAGE LEVEL I
For patients who have no appreciable specific pain or in the treatment of visceral conditions,
gradually increase temperature to where the patient just perceives a comfortable yet distinct
sensation of “velvety" warmth.
Dosage Level II
For patients who have pain, the temperature is increased to a point just below the level of
Dosage I.
The patient should perceive no detectable sensation of warmth
GENERAL RULE
The more acute the condition to be treated, the less temperature elevation and the shorter the
treatment duration.
ELECTRODE POSITIONS
The three common electrode positions are:
Transverse
Longitudinal
CO-planar
GENERAL RULE
The thicker the body part to be treated, the greater should be the electrode -skin distance,
which is provided by air spacing or towels
INDICATIONS
URI
Chronic osteoarthritis
Prostatitis
CONTRAINDICATIONS
Over pregnant uterus
Over wet skin
Patients with pacemaker
Peptic ulcers
Rheumatoid
Malignancy
MICROWAVE DIATHERMY
The configuration of a pattern is determined and controlled by the distance that it is placed
from the patient and the shape of the reflector.
The power output of the microwave unit is adjusted in accordance with the size and shape of
the body part treated.
The smaller heat output of a microwave unit warms tissues in a much more local area.
6
There is little penetration into deeper organs.
Most of the effects of microwave radiation are due to heating of tissues by conversion.
The heat build up occurs mainly because of the resistance offered by tissue constituents to
high frequency current, and a specific temperature distribution results within body tissues.
Contact is not necessary, and smaller confined areas can often be treated more effectively.
The field that can be heated at any one time is relatively small.
Microwave has little, if any effect on deep joints or viscera
TREATMENT DURATION
Treatment duration exceeding 2O minutes is inadvisable
INTERFERENTIAL THERAPY
The name interferential therapy stems from the concept of two currents interfering with
each other
The major problems with the standard low frequency currents lie with the resistance
offered by the skin and the relatively long pulse duration. Normal human skin has a very
high resistance to the passage of a low frequency current.
When the skin resistance is high, a larger potential difference (voltage) has to be applied to
the skin in order to achieve an adequate current flow in the tissues.
The larger the applied voltage, the more likely it is that the stimulus will become
uncomfortable for the patient.
If the skin resistance is lowered, then a smaller applied voltage will be required to produce a
given current flow in the tissues.
Little resistance is offered to a higher frequency alternating current
The net result is that if the applied current has a higher frequency, the skin resistance will be
low, with all the advantages of a more comfortable and efficient stimulation. In addition, the
higher frequencies will mean shorter pulse durations and this will lead to a more
comfortable stimulus
Problems arise, however, that in order to gain the advantages of lowered skin resistance, the
frequency of the current used needs to be approximately 4,000 Hz,
At this medium frequency the current is well outside the usual biological range of between
0.1 and 200 Hz.
If however, two medium frequency sine waves are applied to the skin and tissues in such a
way that there is a difference in frequency between the two currents, then a rather interesting
7
effect occurs,
I.F. currents are produced by the interfering of the two medium frequency, alternating
currents. Two such medium frequency currents, one at 4,000Hz and the other at 4, 100 Hz
When these two currents are superimposed on one another, it can be seen that the effect of
the blending of these two medium frequency sine waves is a variable increase in amplitude
(intensity) of the resultant current.
The intensity of the current rises and falls, this is described as a "beating "of the two
frequencies.
The "beat" frequency is the number of times in each second that the current rises and in
intensity to the maximum and falls away to its minimum value
The beat frequency in Hz is simply the difference in frequency between the two medium
frequency currents. This "beating" is the actual "interferential effect"
The beat frequency relates solely to the number of times per second the intensity increases
and decreases.
The medium frequency (4,000 Hz) is called the carrier frequency
The current flowing in the tissues is approximately 4,000 Hz but its intensity is increasing
and decreasing (beating) within the range of about 0.1 to 200 times per second.
8
If the patient's condition is unchanged after one or two treatments, then the situation needs
re-assessing.
Assuming that the machine is working correctly and is applied properly, then poor results
should indicate possible change in electrode position and/or a change in frequency/intensity.
INDICATIONS
Pain relief both acute and chronic
Reduction of edema
INTERFERENTIAL THERAPY
I.F. can and should be combined with other modalities.
Combining treatments implies giving two different but complimentary treatments at different
times or in some instances at the same time (ice, moist heat)
Spinal Traction Definition
The application of a drawing or pulling force along the long axis of the spine in order to:
Stretch soft tissues
Separate joint surfaces
Separate bony fragments
DISTRACTION
A form of dislocation in which joint surfaces have been separated without rupture of the
binding ligaments and without displacement
INVERSION
Turning upside-down or other reversal of the normal relation of a part
TYPES OF TRACTION
CONTINUOUS TRACTION
This particular form involves lightweight applied for prolonged periods of time.
It is generally accepted that this form is ineffective at producing separation because of the
slight force used.
This type of traction is generally used to align and stabilize adjacent body parts when there
are fractures and/or dislocations.
CONTINUOUS TRACTION
An example of continuous spinal traction is the halo type device used following a fracture of
the cervical spine.
It may also be used after certain surgical procedures such as spinal fusions.
SUSTAINED (STATIC) TRACTION
Sustained traction applies a constant amount of force.
Sustained traction is used from only a few minutes to as long as 30 minutes
The shorter duration seen with static traction is coupled with a greater traction force than that
9
seen with continuous traction.
Static traction is used mostly for WD herniations and may be effectively applied in both the
cervical and lumbar spine
Sustained traction is probably most helpful in the early phases of treatment when there is
significant guarding and muscle spasm present.
As the patient's condition improves, intermittent traction may prove to be more helpful.
Home cervical traction units (over-the-door) devices are examples of sustained traction.
These devices use a traction force that ranges from 5 to 15 pounds
Although the forces probably are not great enough to create any significant separation, many
patients find these devices helpful
INTERMITTENT TRACTION
Utilizes a mechanical traction device that alternately applies traction and allows relaxation
for a time period of several minutes to one-half hour.
This allows intermittent stretch of soft tissues, joint separation and inhibition of the disc,
which can be beneficial for the treatment of soft tissue injuries, joint fixation, nerve root
compression, degenerative disc disease, or an acute or chronic herniated disc.
The application of different traction forces that are alternately applied and released
(hold/rest).
In this form of traction a moderate force is applied for a period of time usually from 30 to 60
seconds.
This is referred to as the “hold time"
The moderate force is then reduced to a lesser traction force that is applied for a shorter
period from 10 to 20 seconds - the “rest period"
The traction device alternates between the two different forces for the treatment duration,
thereby producing not only traction and separation, but also some degree of movement.
It is most often used for joint dysfunction and degenerative disc disease.
It can be used for disc protrusions with longer hold/'rest periods (60 seconds hold 20 seconds
rest).
MANUAL TRACTION
Traction applied manually by the doctor.
The traction forces usually are applied for a few seconds at a time and, typically, in a
rhythmic nature.
Although manual traction may often be beneficial by itself, it is often employed prior to other
mechanical forms of traction in order to assess the patient's tolerance.
Patients who may be intolerant of manual traction probably will not respond well to more
aggressive forms of traction
Manual traction may often provide relief for patients with cervical stiffness, disc problems,
headaches, and other conditions.
The amount of traction applied may vary, depending upon the patient’s condition, the part of
the spine being tractioned, and the strength of the doctor.
10
POSITIONAL TRACTION
Involves placing the patient in a particular position to increase motion in a specific direction
at a specific segment of the spine.
Pillows, blocks, and sandbags may be used to accentuate the position and increase traction.
These techniques are incorporated into many of the procedures used by McKenzie in his
extension protocols for LBP patients.
INTERSEGMENTAL
TRACTION
Involves the application of mechanical rollers that move up and down vertically as they track
longitudinally along the paraspinal structures.
The tension, speed, and amount of travel of the rollers are modified to patient comfort.
As they move, the rollers lift and separate the vertebral units and exert a mild tractioning effect.
This type of "traction" is more appropriately termed a form of Passive mobility rather than
traction.
In addition to the application of the mechanical forces, many of the intersegmental traction
tables simultaneously incorporate the use of vibration and heat with the mobilization.
The primary benefit of intersegmental traction is seen in patients who are stiff, tight, and
generally tense.
11
This is a very gentle form of therapy that affects whole segments of the spine.
In addition to any mild effect that this procedure may have on the movement of the spine, it is
very comfortable and relaxing.
INTERSEGMENTAL TRACTION
Intersegmental traction meets with high patient acceptance; consequently, it is overused in
many practice situations
As with all other forms of therapy, Intersegmental traction should be provided to those
patients who will benefit from the procedure.
INDICATIONS
IVD protrusions
Facet syndrome
Nerve root compression
Spondylolisthesis
Retrolisthesis
Discogenic spondyloarthrosis
Muscular spasm
Anterior or posterior innominate
Sacral inferiority
Early scoliosis
It should be borne in mind, that traction is usually not the only therapy used. As with other
forms of therapy, when it is used the doctor should be alert to changes in the patient's
condition that warrant modification in treatment methods.
It is particularly important to keep in mind the following rule.
- If treatment increases peripheral pain and/or symptoms, it should be discontinued until
both the condition and the therapy have been re-evaluated
PRECAUTIONS
To minimize any potential injury resulting from inappropriate use of traction (e.g.. too much
weight or improper patient position), traction should be initiated gently, with progressively
increasing force and time as the patient condition warrants.
Following the application of traction, a patient should be allowed a short rest period before
resuming activities.
It is not uncommon for patients to feel some pain relief during the application of traction, only
12
to have the relief disappear at tile end of tile treatment session.
It is suggested that the patient should be gradually returned to the upright position to maintain
relief.
CONTRAINDICATIONS
Structural disease secondary to tumor or infection
Vascular compromise, hypertension, atherosclerosis, phlebitis, angina, and a history of stroke
or transient ischemic attack.
Acute sprains, strains, and other musculoskeletal inflammatory processes.
Pregnancy
Instability
Osteoporosis and other bone-weakening conditions
Hiatal hernia
Ankle, knee or hip joint dysfunction
Patients with aortic aneurysms
Patients with active peptic ulcers
Patients who are claustrophobic
CERVICAL TRACTION
Maximum separation of the cervical vertebrae occurs when the cervical spine is flexed to 25 to
30 degrees except for the atlantoocccipital and atlantoaxial joints, which should be tractioned
with a 0 degrees angle of pull.
Research has shown that supine traction is superior to sitting traction.
It is particularly important that patients are able to relax
Consideration must be given to the effect of the traction device on the TMJ
In order to produce a desired effect the traction force must be great enough to effect a
structural change at the spinal segment
Much less force is required for the cervical region
CERVICAL TRACTION
13
PATIENT POSITION
Positioning of the patient has a direct effect on the location of the traction effect:
If the head is allowed to lay on the table with the cervical spine in a neutral or extended
position, the traction will exert its maximal effect on the anterior intervertebral structures such
as the IVD.
When the objective is separation of the interbody joints, the patient should be positioned in
such a neutral or extended position.
If the head is maintained in a flexed, forward- bent position, the traction will exert its maximal
effect on the posterior structures, such as the facet articulations and the WF.
When the objective is separation of the posterior articulations, the patient should be positioned
with the neck in a flexed position.
The greater angle of flexion, the lower in the cervical spine is the area affected by the traction
force.
The position of the head and neck can be adjusted to ensure that separation occurs at the
desired location.
This is most easily accomplished by communicating with the patient during the initial
application.
The best position is the one that localizes the traction force in the area of pain.
CERVICAL TRACTION ANGLE OF PULL
It is suggested that an angle of 0 to 15 degrees be used for the upper cervical spine.
The angle should be increased by 5-degree increments for each progressively lower cervical
segment
Both the angle of pull and the position of the head have a similar effect in changing the
location of the traction forces.
CERVICAL TRACTION DURATION
Traditionally, spinal traction is applied in 20-minute increments
Treatment times may vary depending on the nature of the condition, the type of equipment
used, and the response of the patient.
CERVICAL TRACTION
TREATMENT FREQUENCY
As with other forms of therapy, spinal traction has a specific physiologic effect and should be
used when that effect is desired.
The application of sustained and intermittent traction is usually only warranted for relatively
short periods of time.
Daily treatment is suggested for the first 3 days, followed by three times weekly for 2 to 3
weeks
If traction is to be helpful, some relief should be seen within the first three to five treatments.
Unlike other forms of traction, intersegmental traction may be warranted on a continuing basis
in some patients.
It should not, however, serve as a substitute for stretching and flexibility exercises, nor should
it be used as a standard procedure for all patients seen.
LUMBAR TRACTION
There is a great variation in the methods used to apply traction to the lumbar spine.
14
Traction node (sustained or intermittent) depends on both the disorder being treated and on the
comfort of the patient.
Disc protrusions usually are treated more effectively with sustained traction or with longer
hold-rest periods of intermittent traction (60 seconds hold, 20 seconds rest).
Joint dysfunction and degenerative disc disease usually respond to shorter hold-rest periods of
intermittent traction (30 seconds hold, 10 seconds rest)
LUMBAR TRACTION
PROPER POUNDAGE
Begin with approximately 50 pounds
If the patient improves, continue at the same poundage or increase poundage by 10-pound
increments to a maximum of 125 pounds.
The patient position, whether prone or supine, and the amount of flexion or extension used
depend on the disorder being treated, on the experience of the doctor, on the comfort of the
patient, and on the type of equipment being used.
15
EFFECTS
Contraction of innervated muscle
Pain relief
Edema reduction
16
TENS
TENS should apply to any form of electrical stimulation that is applied via surface
electrodes.
The term has been used for small portable stimulators that can be attached to the belt or
clothing and used for various time periods for the relief of pain.
In general the primary effect of TENS is the relief of pain.
Many health practitioners are finding TENS to be an effective, safe, noninvasive, and
cost effective method of treating acute, chronic and psychogenic pain of innumerable
origins.
TENS INDICATIONS
Chronic pain
Acute pain
Intractable pain (TENS can provide adequate relief of pain secondary to malignancy.
Results are best with trunk and extremity pain and worst with pelvic and perineal pain.
Rehabilitation: The use of TENS for the reduction of pain during rehabilitation can
increase performance and shorten disability.
Care must be taken to not allow the TENS to obliterate pain to the extent that the patient
loses protective cues and overstresses the part being rehabilitated.
TENS CONTRAINDICATIONS
Pacemakers
Carotid nerve stimulation
Laryngeal stimulation
During pregnancy
TENS ELECTRODE PLACEMENT
Electrode placement is one of the most critical factors for the success of TENS
Directly over or around the painful site
Over trigger points
Over acupuncture points
Within a specific dermatome
At the site of the corresponding nerve root
TENS
The most significant complication of TENS is local skin rashes produced by the
conduction gel or tape.
There are no contraindications to 24-hour use of "high TENS". "Low" TENS, however,
should be used only 30-40 minutes at a time, as "Low TENS" causes muscle contraction and
may cause soreness if used for longer periods.
Electrodes should be removed every day or two to clean the skin and inspect the area.
17
EFFECTS
Mechanically assisting the flow of blood and lymph to increase circulation and reduce edema
Maintenance of muscle flexibility and viability
Breaking up scar tissue, adhesions, and fibrosis
Sedation
Stimulation
CONTRAINDICATIONS
Acute circulatory disturbances
Acute inflammation
Malignancy
Edema secondary to heart decompensation, kidney disease, embolus, obstruction of lymph
channels, thrombus
Hyperesthesia of the skin
Communicable disease
SPECIFIC METHODS
Effleurage - stroking motion and begin with light pressure and progress to heavier pressure as
tolerated and terminate with light pressure.
Petrissage - Kneading or rolling motion, strokes are either in a centripetal direction or
transverse to the muscle fibers
Rolfing - is a deep massage that strives to separate the fascia between muscles Friction - is used
to break up superficial and/or deep adhesions of muscle or other soft tissues. No lotion is used
and small circular or linear strokes are used to loosen the tissue beneath the skin.
Transverse friction - is a specific type of friction massage that is used to treat tendinitis or
tenosynovitis. It is performed perpendicular to the tendon sheath, causing the tendon to separate
from the sheath and slide through it more easily.
Tapotement - includes tapping, slapping, cupping motions. It is useful for increasing circulation
to an area and for postural drainage to increase the release of abnormal secretions from the lungs.
18
19
20
21
Frequency (50 to 100 hz ) and duration (0.1 -1 ms)
22
23
24
25
26
27