PHYSICAL THERAPY METHODS AND TECHNIQUES
Rehabilitation, when applied to athletic injuries, means to restore to health. Traditionally this has meant exercising muscles to restore strength, endurance, and normal range of motion. A broader interpretation includes other methods and techniques that facilitate the healing process in your child.
Physical agents such as heat, cold, massage, and electric current can be used in conjunction with exercise programs--and sometimes, medications--to hasten rehabilitation.
The first three can often be used at home under the supervision of a doctor, physical therapist, or trainer. These trained professionals can oversee your child's progress, shifting from one type of exercise to another when advisable. The different methods are explained in greater detail below. Electrical current can only be performed with specialized equipment in a clinical setting, but it is very effective in muscle retraining and restoration of strength.
HEAT When heat is applied to an injury, it dilates (enlarges) small blood vessels in the area, increasing blood flow. The increased blood supply nourishes the tissues and hastens healing. Heat also reduces pain in an injured area and reduces muscle spasm. But heat increases the chance that small capillaries will leak blood and plasma into soft tissues around the injury. While dilation of the blood vessels and increased blood flow are desirable in healing, capillary leakage is undesirable. It leads to greater fluid accumulation and swelling, which retards the healing process. To be beneficial, heat should not be applied until the capillaries have had a chance to seal and stop leaking. This usually requires 24 to 48 hours following your child's injury--if ice, compression, and elevation were used immediately.
Depending on the type of injury, heat can be applied in several ways: hot compresses, hydrocollator packs (see Glossary), heat lamps, heating pads, whirlpool baths or hot tubs, ultrasound, or diathermy (seldom used now--see Glossary).
Your doctor or therapist must prescribe the best program for your child and provide supervision and guidance throughout the child's rehabilitation program. You and your child will need instructions about when to start, how long to apply heat during each treatment, and how long to continue with heat treatments. These factors are determined by many variables, such as type and extent of injury, previous medical history, and healing rate.
COLD (CRYOTHERAPY) During the past several years, cold treatment has been used increasingly in first aid and in rehabilitation of athletic injuries. Localized cold treatments provide these important benefits:
-- Reduction and control of swelling (edema).
-- Facilitation of active or passive joint motion, allowing the child to return to exercising sooner than is possible without cryotherapy. Ice is applied before exercise during the healing phase.
-- Reduction of pain and muscle spasm.
Because ice can be applied prior to exercise, reducing your child's pain and muscle spasm, muscle and joint movements can start sooner without interfering with the healing process. A thin margin of safety regarding when exercise should start and continue makes clinical supervision necessary during rehabilitation.
Ice can be applied as ice packs, ice compresses, or ice massage. Ice massage is particularly helpful for sore muscles or muscles in spasm.
Techniques of ice massage:
-- Fill a large Styrofoam cup with water and freeze.
-- Tear a small amount of foam from the top so ice protrudes.
-- Massage firmly over the injured area in a circle about the size of a softball.
-- Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Gentle massage is useful for treating your child's sore muscles. It consists of gentle or firm stroking of the injured area. Strokes should be directed toward the heart. The appropriate amount of pressure and length of the massage should be determined by the person receiving the massage. Massage that increases pain is too hard. When properly administered, massage can reduce fluid accumulation and swelling around an injury. It will stimulate circulation through the veins and lymphatic vessels. However, overzealous massage can aggravate a child's injury and increase bleeding.