Cheap and cheerful way to treat injuries. Ice is believed to control pain by instigating local anesthesia, decreasing edema, nerve conduction velocities, cellular metabolism and shunting local blood flow. The effect of the cryotherapy depends on the method, the duration, temperature of the ice and the depth of the subcutaneous fat. Types that we use in clinic: cold packs and ice massage.

Transcutaneous electrical nerve stimulation (TENS)

• Intended for temporary pain relief in acute and chronic pain- works through pain gating by stimulating large-diameter fibers (A-beta) that inhibit small-diameter fibers (A-delta and C).
  
  • Low-frequency (<10 Hz), high-intensity TENS induces analgesia by inhibiting pain transmission through the recruitment of descending inhibition mechanisms and is more frequently used for the treatment of chronic pain.
  • High-frequency TENS (80–100 Hz) is more often used for acute pain since it activates the gate control by stimulating A-beta fibers.

Interferential current (IFC) electrical stimulation

• Intended for symptomatic relief of acute, chronic, and post-traumatic or post-surgical pain. Similar to TENS, but stronger and deeper penetrating to the skin. Effects are longer lasting than TENS.

Mechanical vibration at increasing frequencies is known as sound energy. Beyond 20,000 Hz, the mechanical vibration is known as ultrasound. The frequencies used in therapy are typically between 1.0 and 3.0 MHz (1 MHz = 1 million cycles per second)

• Continuous (Thermal): most effective in heating the dense collagenous tissues for muscle relaxation and preparation for remodeling/lengthening.
• Pulsed (Non-thermal): attributed primarily to a combination of stable cavitation and acoustic streaming resulting in the cell membrane becoming ‘excited’, thus increasing the activity levels of the whole cell. The ultrasound energy essentially acts as a trigger for the increased cellular process, but it is the increased cellular activity which is in effect responsible for the therapeutic benefits of the modality. Pulsed ultrasound has been demonstrated to assist in reducing inflammation, promoting proliferation and remodeling in tissues.

• Electrical muscle stimulation (EMS)
  • Intended for strengthening muscles, aiding in muscle hypertrophy, improving muscular endurance, and accelerating muscle recovery. Also like TENS but designed to make the muscles contract strongly.
• Russian stimulation
  • Intended for strengthening muscles, increasing muscle size, improving muscular endurance, and accelerating muscle recovery.
  • Like EMS, but uses high frequency, sinusoidal stimulation waveforms.
• Neuromuscular electrical stimulation (NMES)
  • Intended for relaxing muscle spasms, preventing muscle atrophy, increasing blood circulation, maintaining or increasing range of motion, and especially for re-educating the neuromuscular system.
  • Essentially the same as EMS, but typically focused on therapeutic use (rehab) instead of athletic use (training).
• Functional electrical stimulation (FES)
  • Intended for relaxing muscle spasms, preventing muscle atrophy, increasing blood circulation, maintaining or increasing range of motion, and especially for re-educating the neuromuscular system.
  • Essentially the same as NMES, but especially effective for neurological rehabilitation, as the stimulation is automatically controlled to turn muscle contractions into functional movements.
  • Usually incorporated into an exercise or bracing device to maximize functionality.