Ask a Vail Sports Doc: Physical therapy heals large number of injuries |

Ask a Vail Sports Doc: Physical therapy heals large number of injuries

Dr. Rick Cunningham
Ask a Vail Sports Doc
Physical therapists may employ a vairety of therapeutic modalities to treat an injury.
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The Vail Valley is fortunate to have excellent physical therapists. A large number of the injuries that I see in the office can be treated effectively in physical therapy, and your physical therapist may employ a variety of therapeutic modalities to treat your injury.

Types of Therapy:

Cryotherapy or icing is one of the most basic modalities utilized after injury. Cryotherapy decreases pain in the acute setting. Studies have also demonstrated decreased swelling and edema after icing. Cold Water Immersion techniques lead to less delayed onset muscle soreness.

Thermotherapy or heat therapy increases the elasticity of muscle tissue and decreases the viscosity of connective tissue. Thermotherapy also increases blood flow and tissue metabolism.

Heat is typically applied after the acute recovery phase has concluded (during which ice is recommended), not during this phase as it can increase swelling of injured tissues. Combining heat with stretching improves range of motion more than simply doing heat or stretching alone. However, for managing certain conditions such as low back pain, studies have not found any advantage of using heat versus ice.

Ultrasound uses mechanical vibration in the form of an inaudible sound wave. This heats the treated tissue, improving blood flow and stimulating soft tissue repair, increasing joint elasticity and modulating pain.

Ultrasound waves travel deeper into tissues than other heating modalities. Deep ultrasound is commonly used for the management of muscular spasms or strains.

Electrical stimulation has three types of uses: tissue, nerve and muscle contraction. Electrical stimulation is typically delivered through electrodes placed on the skin, but it can also be administered by an implant.

With a Transcutaneous Electrical Nerve Stimulation unit, multiple electrodes are placed on the skin and the current flows between the electrodes with the body serving as a conductor of the electrical current. The theory is that the electrical current inhibits pain by inhibiting these pain receptors or blocking them.

Neuromuscular electrical stimulation is used to activate dormant muscles. Electrodes are placed over the muscle being treated and the current depolarizes the nerve that supplies it, causing the muscle to contract. This is fatiguing to the muscle so cycles of rest between muscle stimulation is recommended. This modality can be useful to help recover muscle function faster after anterior cruciate ligament reconstruction surgery.

Lontophoresis uses electrical current to deliver chemicals to a biologic tissue. For instance, the steroid dexamethasone is commonly used to decrease inflammation of an injured tissue.

Laser therapy is used for pain modulation and wound healing. In this, photons are absorbed by local tissues stimulating protein synthesis and thus wound healing. More studies are needed to determine what conditions benefit from this modality.

Dr. Rick Cunningham is a Knee and Shoulder Sports Medicine Specialist with Vail-Summit Orthopaedics. He is a Physician for the US Ski Team. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit

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