Therapy Modalities: Manual, Physical, and Adjunctive Techniques
This domain tests indications, parameters, contraindications, and safe application of manual therapy, physical agents, and adjunctive tools within scope. Expect questions on ultrasound frequency, cryotherapy timing, and modality contraindications.
Core rules
- Manual therapy includes soft tissue mobilization, stretching, and joint mobilization. It should be applied within pain-free range and followed by active exercise; passive treatment alone rarely changes performance.
- Therapeutic ultrasound: 1 MHz heats deeper tissues, 3 MHz is more superficial. Typical continuous intensities are 0.5–2.0 W/cm²; pulsed modes are used where heating is undesirable. Move the head continuously.
- Cryotherapy reduces acute inflammation and pain; apply for about 15–20 minutes with a barrier. Thermotherapy is for chronic, non-acute conditions and is contraindicated over acute inflammation, tumors, or open growth plates.
- LASER dosage is expressed in J/cm²; TENS and NMES target pain or muscle activation; PEMF is adjunctive. Evidence varies, so use measurable goals.
- Contraindications include pregnancy over the abdomen, malignancy, active infection, thrombosis, and areas of sensory loss.
Worked example
A horse has an acute mid-substance SDFT injury with heat and swelling. Reasoning: do not use continuous ultrasound or heat in the acute phase. Start with cold therapy, controlled rest, and veterinary direction. Later, pulsed ultrasound at low intensity may be considered to support remodeling, but only after acute inflammation resolves and with a re-examination plan.
Traps
Using heat on an acute injury; applying ultrasound over a bony prominence or open growth plate; leaving a cryotherapy boot on too long; and treating modalities as a substitute for loading and exercise.