Therapies — Description & Application

Description

Coherent light absorbed by cellular chromophores to stimulate mitochondrial activity, reduce inflammatory mediators, and speed soft-tissue repair. Dosing is by joules per point and total joules per area.

Application

1. 1Both the patient and the operator wear the protective eyewear for the device's wavelength — every session, no exceptions.
2. 2Clean the skin; the emitter contacts the skin directly with no gel unless the device requires it.
3. 3Follow the clinic dosing table for the treatment area — points, joules per point, total joules, and time per area.
4. 4Hold each point for the full programmed time, then advance to the next marked point.
5. 5Chart the area, number of points, total joules and time.

Typical settings

• Follow the clinic Laser Therapy Protocols dosing table for each area

Indications

• Acute soft-tissue injury
• Tendinopathy and myofascial trigger points
• Post-surgical healing when ordered

Cautions & contraindications

• Never aim at or near the eyes
• Over malignancy or the thyroid
• Pregnant abdomen
• Photosensitizing medication

Charting

• Area
• Points treated
• Joules and time
• Eyewear used

Description

Pulsed electrical current delivered through surface electrodes to produce a muscle contraction or sensory response, used to reduce muscle spasm, manage pain, and support muscle re-education.

Application

1. 1Confirm the ordered region and check the skin for rashes, breaks, or lotions.
2. 2Place electrodes over or around the target muscle or painful area, following the clinic electrode-placement guide.
3. 3Start the intensity at zero and raise it slowly until the patient feels a strong but comfortable tingle or a visible muscle contraction, whichever the order specifies.
4. 4Set the ordered treatment time — commonly 10–15 minutes.
5. 5Hand the patient the stop control and stay within earshot.
6. 6At the end, reduce intensity to zero before removing pads, wipe the skin, and inspect for irritation.
7. 7Chart the region, minutes, contraction quality or sensory level, and patient response.

Typical settings

• 10–15 minutes typical
• Pulse rate 35–50 Hz for contraction, 80–150 Hz for sensory pain relief
• On/off duty cycle per device protocol

Indications

• Muscle spasm and guarding
• Pain modulation
• Disuse weakness / muscle re-education when ordered

Cautions & contraindications

• Pacemaker or implanted electrical device
• Pregnancy — avoid over abdomen and low back
• Over the eyes, anterior neck, or carotid sinus
• Active malignancy, DVT, or infection in the field
• Broken skin or impaired sensation under the pads

Charting

• Region and pad placement
• Minutes
• Attended vs. unattended
• Patient response

Description

Superficial heat that increases local circulation, relaxes muscle guarding, and improves tissue extensibility before manual therapy or exercise. Effect is limited to about 1–2 cm of depth.

Application

1. 1Confirm the visit order calls for heat — in the acute phase most protocols call for ice, not heat.
2. 2Pull the pack from the hydrocollator and wrap it in a minimum of six layers of towel or a commercial cover.
3. 3Position the patient comfortably, expose the treatment area, and place the pack over the region — never let the patient lie directly on top of it.
4. 4Set the timer for 15–20 minutes and leave the call bell or your position within earshot.
5. 5Check the skin at 5 minutes and again at the end. Mottled red is normal; blistering, white patches, or blotchy welts are not.
6. 6Remove, dry the skin, and note the area treated and the time on the Daily Treatment Note.

Typical settings

• 15–20 minutes
• 6+ layers of insulation
• Pack over the patient, not under

Indications

• Subacute or chronic muscle spasm and stiffness
• Pre-treatment warm-up before manual therapy or therapeutic exercise
• Chronic myofascial pain

Cautions & contraindications

• Acute injury within the first 48–72 hours (use ice unless the provider orders otherwise)
• Acute swelling, bleeding, or open wounds
• Impaired sensation, diabetic neuropathy, or patients who cannot report discomfort
• Over an area receiving radiation therapy, or over malignancy

Charting

• Region treated
• Minutes applied
• Patient response and skin check

Description

Cold application that reduces local blood flow, inflammatory response, swelling, and pain conduction. Standard first-line thermal therapy in the acute phase.

Application

1. 1Place a damp barrier towel between the pack and the skin.
2. 2Apply over the injured region with the patient supported in a comfortable position.
3. 3Time 10–15 minutes — do not exceed 20.
4. 4Expect the cold–burn–ache–numb progression; numbness is the endpoint. Stop early for pain that keeps escalating.
5. 5Inspect skin on removal and chart region, minutes, and response.

Typical settings

• 10–15 minutes
• Barrier towel always
• May repeat every 1–2 hours at home

Indications

• Acute injury, first 48–72 hours
• New flare-up or post-exercise soreness
• Post-injection or post-procedure soreness when ordered

Cautions & contraindications

• Cold intolerance / cold urticaria, Raynaud's phenomenon
• Impaired circulation or sensation over the area
• Do not apply directly over superficial nerves for prolonged periods

Charting

• Region treated
• Minutes applied
• Patient response

Description

A motorized table with rollers that passively mobilizes the spine, gently stretches spinal segments, and promotes relaxation of paraspinal muscles while increasing circulation to the discs and surrounding tissues.

Application

1. 1Confirm the provider has ordered intersegmental traction for this visit.
2. 2Help the patient lie face-up on the roller table and position them so the rollers align with the ordered spinal region.
3. 3Set the timer for the ordered duration — commonly 10–15 minutes.
4. 4Start the rollers at a slow, comfortable speed and ask the patient to report any sharp or radiating pain.
5. 5Place a drape or towel over the patient for comfort and modesty.
6. 6Stay within earshot; check on the patient at least once during the session.
7. 7At the end, stop the table, help the patient sit up slowly, and note the region and time on the Daily Treatment Note.

Typical settings

• 10–15 minutes typical
• Slow roller speed
• Cervical or lumbar region per order

Indications

• Chronic spinal stiffness and muscle guarding
• Disc-related complaints as an adjunct to the care plan
• Pre-adjustment relaxation and tissue warm-up

Cautions & contraindications

• Acute fracture, instability, or recent spinal surgery
• Severe osteoporosis or bone tumor
• Radiating pain or numbness that worsens during traction

Charting

• Spinal region treated
• Duration
• Patient response

Description

Activities that retrain movement, balance, coordination, posture, and proprioception — balance boards, stabilization, and postural retraining — rather than pure strengthening.

Application

1. 1Set up in a safe area with a stable support the patient can grab.
2. 2Guard the patient hands-on throughout balance or unstable-surface work.
3. 3Cue posture and movement quality; quality beats repetitions.
4. 4Chart the activity, what deficit it addresses, and the total one-on-one minutes.

Indications

• Balance or proprioceptive deficit
• Postural dysfunction
• Movement-pattern retraining after injury

Cautions & contraindications

• Fall risk — never leave the patient unguarded
• Vertigo or dizziness

Charting

• Activity performed
• Deficit addressed
• Total minutes

Description

Exercise prescribed to restore strength, endurance, range of motion, and flexibility, progressed in phases across the care plan from gentle range of motion to resisted strengthening.

Application

1. 1Confirm the ordered phase and exercise list for this visit.
2. 2Demonstrate each exercise, then watch the patient perform it and correct form before adding repetitions or resistance.
3. 3Stay one-on-one with the patient for the exercise minutes you will bill.
4. 4Progress only on the provider's order — do not add resistance or new movements on your own.
5. 5Chart the exact exercises, sets, reps, resistance, and total minutes.

Typical settings

• Phase 1: pain-free active range of motion
• Phase 2: isometric and light band work
• Phase 3: progressive resistance and endurance

Indications

• Strength or endurance deficit
• Restricted range of motion
• Deconditioning during recovery

Cautions & contraindications

• Stop for sharp pain, radiating symptoms, dizziness, or shortness of breath
• Do not progress past the ordered phase

Charting

• Specific exercises with sets/reps/resistance
• Body part and goal addressed
• Total one-on-one minutes

Description

Acoustic energy delivered through a coupling medium. Continuous output produces deep heating (up to ~5 cm) for chronic tightness; pulsed output produces non-thermal effects used in subacute tissue healing.

Application

1. 1Expose the region, apply generous gel, and set the ordered frequency, output and time.
2. 2Choose the sound head so the treatment area is no larger than 2–3 times the head size.
3. 3Move the head continuously in slow overlapping circles or strokes — never hold it still.
4. 4Ask about warmth; with continuous output mild warmth is expected, sharp or aching pain is not.
5. 5Treat 5–10 minutes per area, wipe the gel, and chart region, frequency, intensity and minutes.

Typical settings

• 1 MHz for deep tissue, 3 MHz for superficial
• Continuous for thermal, 20–50% pulsed for non-thermal
• 0.5–2.0 W/cm², 5–10 minutes per area

Indications

• Chronic soft-tissue tightness
• Scar and adhesion pliability
• Subacute tendon/ligament healing (pulsed)

Cautions & contraindications

• Over the eyes, testes, or a pregnant abdomen
• Over a pacemaker, implants with cement, or laminectomy site
• Over malignancy, DVT, active infection, or an open growth plate
• Impaired sensation

Charting

• Region
• MHz and W/cm²
• Continuous vs. pulsed
• Minutes (timed code)

Description

Skilled, hands-on passive movement of joints and soft tissues to improve range of motion, reduce pain, and address mechanical dysfunction. Performed by the provider; staff may set up the room and assist with positioning.

Application

1. 1Prepare the treatment room and ensure the table height is appropriate.
2. 2Confirm the ordered region and any precautions from the provider.
3. 3Assist with draping so the target area is accessible while preserving modesty.
4. 4Stay available for requests; do not perform manual therapy unless licensed to do so.
5. 5Chart is usually completed by the provider — staff note that manual therapy was performed per order.

Typical settings

• Duration varies by region and technique
• Provider-directed only

Indications

• Joint hypomobility
• Myofascial restriction
• Pain with movement

Cautions & contraindications

• Acute fracture or instability
• Severe osteoporosis
• Recent surgery or infection in the region

Charting

• Region treated
• Technique if specified
• Provider initials

Description

Dynamic functional activities such as lifting, carrying, pushing, or sport-specific drills used to restore real-world movement capacity. Distinct from therapeutic exercise because it is goal-directed functional training.

Application

1. 1Confirm the ordered activity and goal for the visit.
2. 2Set up any cones, weights, bands, or props needed.
3. 3Demonstrate the movement, then supervise the patient performing it with safe mechanics.
4. 4Stay one-on-one for the minutes you will bill.
5. 5Chart the activity, goal, sets/reps or distance, and total minutes.

Typical settings

• One-on-one direct contact required
• Progress only per provider order

Indications

• Functional movement deficit
• Work or sport-specific retraining
• Activity intolerance

Cautions & contraindications

• Stop for sharp pain, dizziness, or unsafe mechanics
• Do not progress without provider approval

Charting

• Specific activity
• Functional goal addressed
• Sets/reps or distance
• Total minutes

Description

Use of a mild electrical current to drive a topical medication through the skin into underlying tissues. Often used with anti-inflammatory agents for localized soft-tissue conditions.

Application

1. 1Confirm the medication and ordered dose with the provider.
2. 2Clean and dry the skin over the target area.
3. 3Place the medication electrode over the target and the dispersive pad at the recommended distance.
4. 4Set the current low and increase slowly until the patient feels a comfortable tingling.
5. 5Treat for the ordered time, then remove electrodes and wipe the skin.
6. 6Chart medication, site, current, and time.

Typical settings

• Typically 10–20 minutes
• Current and polarity per medication protocol

Indications

• Localized inflammation
• Tendon or bursal irritation
• Post-injection adjunct when ordered

Cautions & contraindications

• Pacemaker or implanted device
• Metal implants near the field
• Pregnancy
• Broken skin or allergy to adhesive

Charting

• Medication and dose
• Site
• Current/polarity and time
• Patient response

Description

Warm paraffin coating used to deliver superficial heat to distal joints, most commonly hands and feet, before exercise or mobilization.

Application

1. 1Check the paraffin temperature and ensure it is within the device's safe range.
2. 2Inspect the skin for open areas, infection, or decreased sensation.
3. 3Dip or paint the hand/foot per device protocol and allow the wax to coat evenly.
4. 4Wrap with a plastic liner and towel for the ordered time.
5. 5Peel the wax off, inspect the skin, and chart region, minutes, and response.

Typical settings

• 10–20 minutes typical
• Temperature checked before each use

Indications

• Chronic hand or foot stiffness
• Pre-exercise warm-up for distal joints

Cautions & contraindications

• Impaired sensation or circulation
• Open wounds or infection
• Diabetic neuropathy

Charting

• Region treated
• Minutes
• Skin check and response

Description

Low-voltage electrical stimulation used primarily for symptomatic pain relief. Often dispensed for home use with patient education, or applied in-office as an adjunct.

Application

1. 1Confirm the ordered placement and parameters.
2. 2Clean and dry the skin; place electrodes around or over the painful area.
3. 3Start at zero intensity and increase until the patient reports a comfortable tingling.
4. 4Set the timer and instruct the patient not to adjust settings without provider approval.
5. 5For home units, document education, pad care, and troubleshooting given.

Typical settings

• In-office: 10–15 minutes typical
• Home: per provider order and device instructions

Indications

• Chronic pain management
• Acute flare-up pain modulation

Cautions & contraindications

• Pacemaker or implanted device
• Pregnancy — avoid over abdomen/low back
• Over eyes, anterior neck, or broken skin

Charting

• Electrode placement
• Settings and time
• Patient education if home unit dispensed

Description

Use of electronic monitoring to give the patient immediate information about muscle activity, often used for pelvic floor retraining, postural muscle education, or relaxation training.

Application

1. 1Set up the device and sensors per manufacturer protocol.
2. 2Position the patient comfortably and explain what the feedback means.
3. 3Coach the patient through the ordered exercise or relaxation task while watching the display.
4. 4Chart the muscle(s), goals, and total one-on-one minutes.

Typical settings

• One-on-one coaching required for billed time
• Sensor placement per protocol

Indications

• Muscle re-education
• Pelvic floor dysfunction when ordered
• Relaxation training

Cautions & contraindications

• Pacemaker or implanted device
• Skin irritation from sensors

Charting

• Muscle or region monitored
• Exercise or task performed
• Total minutes