• Water as a medium: 10-20 minutes
• Temperature guidelines: 105-110 degrees
• Sprains, strains, contusions, joint stiffness, arthritis, tenosynovitis

• Used for local heating
• Chronic problems of hands and feet
• Mixture of paraffin and mineral oil
• Temperature 125-130 degrees

• Moist heat pack
• Toweling: 6-8 layers
• Duration: 15-30 minutes daily

• After the acute stress
• After the first 48-72 hrs with no increase in swelling
• Minimal point tenderness 

• Cold and compression
• Acute
• Post-surgical

• 50 degrees or lower
• Limb or body
• Anti-gravity position

Cold Spray

• No deep penetration 
• good before therapy
• Need good ventilation
• Only effects superficial nerve ending NOT swelling

Cold Whirlpool

• Limb 50 to 60 degrees
• 20-30 minutes
• Body 65 to 80 degrees 
• 5-15 minutes
• Considerations: Anti-gravity position&no ice particles

Ice Bag

• 30 minutes every 2 hrs
• Moist towels increase transmission
• Dry towels decrease transmission

Cold Pack

• 8 degrees
• Cold moist towels 
• Plastic bags
• 30 minutes every 2 hrs is ideal

Ice massage

• Relaxed or on a stretch
• Circular pattern 
• 10 minutes
• Larger areas 15-20 minutes
• Numb in 7-10 minutes

heat

• Develop a rationale for each modality 
• Discontinue modality
• When goals are met
• Failure of modality to meet goals
• Poor patient response to care

• Identify the problem
• Establish treatment goals
• Integrate problems and goals 
• Pain management
• Beyond pain management: breaking spasm, increase ROM, retard atrophy

Classifications

• Electromagnetic: electrical stimulation
• Acoustic: ultrasound
• Mechanical: whirlpool

• Widely used in sports related injuries
• Not the single most important factor in the treatment of injuries
• Serve to reduce pain and act with exercise

• No acute swelling
• Full pain free ROM
• Normal strength
• Normal endurance 
• Normal speed
• Normal girth size
• All exercise(s) pain free
• Desire to return (confidence
• Athlete can meet all demands of sport
• Physician clearance (if needed)

• Minimize swelling
• Control pain 
• Restore full ROM
• Restore strength and endurance 
• Regain balance
• Maintain cardiorespiratory endurance
• Incorporate functional progrssions

• Initial injury and assessment 
• ROM
• Strength
• Endurance
• Power
• Speed/Agility
• Restoration or function
• Fully functional/ return to activity
• Maintenance program

• Exercise(s)
• Purpose(s)
• Precaution(s)
• Limitations due to surgery
• Duration
• Intensity
• Progression
• Neuromuscular re-education

Goals

• Rehabilitation should begin as soon as possible
• One day of inactivity=2-3% of strength loss
• Consistency 
• Should be done everyday
• Later can move to 3 times a week
• Measure progress daily/weekly

• Increases tissue temperature
• Increases muscle flexibility
• Gets the body ready for exercise

Program Development

1. Assess needs
2. Develop program
3. Implement program
4. Evaluate program

• establish a goal
• select a program

• rehabilitive
• exercises are usually the same with lower intensity
• Restore function to the greatest possible degree in the shortest period of time

• Attain and maintain
• high intensity
• full ROM
• general

• restore function
• lower intensity
• limited ROM
• specific 

1. First Aid
2. Restoration of ROM, strength, endurance
3. Restoration of function

• hyperextension (being hit on tip of finger)
• often can have an associate fracture

Phalangeal Fracture Etiology

• external force/direct trauma

• external force "jammed finger"

• typically 'punching' force

• caused by force on outstretched hand, compressing scaphoid between radius and second row of carpal bones
• often fails to heal due to poor blood supply

• contusion
• muscle strain
• sprain
• fracture
• dislocation
• neurovascular

• joints: radiocarpal joint, carpal joints, metacarpal joints, phalangeal joints
• nerve distribution: median nerve and ulnar nerve

• contusion
• muscle strain
• sprain
• fracture
• dislocation
• neurovascular
• bursitis

Elbow

• 2 joints: humeral-ulnar and radial-ulnar
• significant or severe injury can result in permanent loss of ROM

• Falling on an outstretched hand, forceful lifting, repeated overhead motions

• Upper rim of the labrum has been torn from front to back

• contusion
• strain
• tendonitis
• sprain
• fracture 
• dislocation
• sublaxation
• neurvascular

• very complicated joint
• great degree of mobility with a greater degree of instability and higher incidence of injury
• ligaments and musculature are at high risk of injury
• 4 joints: sternoclavicular(SC), acromioclaviclur(AC), gelenohumeral(GH), Scapulothoracic

• External: contusion and muscle strains
• Internal: sprains, dislocation, labral injuries, fractures

Hip

• strongest joint
• very deep
• designed for stability: standing 1/3 of body weight, standing one foot 2 times body weight, walking 1-6 times body weight, running 4-5 times body weight

• contusion
• strains
• fractures: rupture of rectus femoris

• Largest bone--femur
• Largest/strongest muscles--control hip & knee
• Rectus femoris, vastuc lateralis, vastus medalis, vastus intermedialis: hamstrings 
• Biceps femoris, semitendinosis, semimembranosis 

• Tibiofemoral: sprains-ACL, PCL, MCL, LCL. unhappy triad- ACL, MCL. Meniscus. Fractures
• Patellofemoral: Bursitis, tendonitis, subluxation, dislocation, osgood schlatters, chondromalacia 

• skeletal-weak
• ligament-moderate
• muscle-strong

Knee

• Two separate joints: tibiofemoral and patellofemoral 

• strains
• achilles tendonitis/rupture
• medial tibial stress syndrome (shin splints)
• neurovascular: compartment syndrome
• fractures

• Between knee and ankle
• Bones: tibia and fibia

Injuries to ankle

• sprains
• strains: peroneal lateral ankle
• fractures: acute and stress

Prevention to injuries in foot/ankle

• flexibility of achilles tendon
• general strength 
• proper footwear
• bracing/taping

Ankle

• Common site of injury
• Ankle sprain #1 injury: laterla ankle- ATF, CF, PTF, ligaments. medial ankle- deltoid ligament. syndesmosis or 'high'- tibiofibular ligament

• Generally high incidence of injuries in collision sports and/or sports with lower body emphasis
• Recognition and management can be difficult

• muscle strains
• sprains-turf toe, mid toe
• contusions-heal, in-step
• fractures- acute, stress, jones fracture
• bursitis-inflammation of the bursa
• fascitis

• open chain- theraband exercises on table
• closed chain-balancing exercises 
• biomechanical factors-orthotics
• gait-stance phase, swing phase