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Now in its Fourth Edition and 20th year of publication, Therapeutic Modalities has evolved to reflect the current status of health-care principles—specifically, its emphasis on therapeutic modalities as primarily an adjunct to active exercise. Concurrent with these changes are deletions and additions to the devices described. As in the prior editions, the text is organized into five sections.

The first two chapters of Section One describe the body’s response to injury: the injury response and pain—to provide the context of the therapeutic modalities presented in subsequent sections and the basis for the Development and Delivery of Intervention Strategies (Chapter 3) and the Administrative Considerations (Chapter 4) pertinent to the use of these devices. Chapter 3, authored by Sara Brown, has been updated to include sections on the World Health Organization’s International Classification of Functioning, Disability, and Health; developing patient-based clinical questions and outcomes, and searching for and incorporating evidence into patient care.

Section Two consists of two chapters. Chapter 5 addresses the physiological effects of cold and superficial heat. The clinical applications of these techniques are described in Chapter 6. The biophysical effects and clinical application of deep-heating agents—therapeutic ultrasound and shortwave diathermy—are presented in Section Three.

Electrical stimulation is covered in Section Four. The basic principles of electricity and therapeutic electrical currents are presented in Chapter 11, followed by the biophysical effects and the electrical stimulation goals covered in Chapter 12. Chapter 13, Clinical Application of Electrical Agents, describes how to deliver electrical current to the body based on the current’s parameters.

Many mechanical agents are described in individual chapters in Section Five: intermittent compression (14), continuous passive motion (15), cervical and lumbar traction (16), massage (17), electromyographic feedback (18), and laser (19). Several long-standing therapeutic techniques, such as infrared and ultraviolet lamps, have been removed. Several techniques that do not demonstrate physiological or clinical efficacy are still included but with the rationale as to why they may be ineffective treatment devices.

This edition continues to build on its tradition of incorporating current research (evidence) into the discussion and limitations of the devices’ effects. When relevant, chapters include a discussion of the overview of the evidence supporting or refuting a device’s effects. As noted in Chapter 3, reviewing and applying the evidence of therapeutic interventions are less straightforward than diagnostic techniques. My hope is that the information presented here will help students and clinicians in making informed treatment decisions. Likewise, I attempt to instill in the reader the personal responsibility to remain up-to-date in research.

This edition carries over most of the existing features of its predecessor, such as the At a Glance, Treatment Strategies, Practical Evidence, and Clinical Techniques boxes. Examination of Orthopedic and Athletic Injuries have been adapted for use with therapeutic modalities. These helpful bits of evidence have a clinical slant and will, I hope, be easy for students to understand and apply. Schematics of the effect(s) that each type of modality has on physiology and healing response should help remove some of the mystery of how the energy affects healing. New to this edition is a series of Animated Learning Modules, available to students on the text’s DavisPlus Web site (at These Animated Learning Modules work hand-in-glove with the text to provide a strong visual understanding of key concepts in Therapeutic Modalities.

As always, I encourage reader feedback, and I am always willing to respond to questions or help clarify any of this information for instructors or students (but I will not do your homework for you!). Feel free to contact me at

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