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Section Two

Cold therapy application is the intervention of choice. The ideal combination of ice, compression, and elevation to limit post-injury fluid collection is best obtained with ice bags or conventional gel ice packs. The physiological changes reduce the release of inflammatory mediators, decrease prostaglandin synthesis, and decrease capillary permeability.

The clinical symptoms in this case are from a prevention standpoint, because the injury just occurred. The ice application is aimed at limiting swelling accumulation, minimizing pain, limiting muscle spasm, and limiting range of motion loss.

Ice application may be implemented after acute reinjury episodes ("rolling" ankle incident, or exercise or activity in excess), to reduce pain on a "bad" day, to reduce muscle spasm, or to assist in restoration of range of motion. Other thermal agents can include ice immersion, whirlpool (cold-warm temperature), and ice massage. The ice immersion allows range of motion to be performed simultaneously to increase patient's active role in recovery; the whirlpool will allow range-of-motion exercise, and the temperature can be increased as the injury moves into the subacute phase of recovery to enhance metabolism to promote healing. Ice massage works best for small, uneven local regions of injury (such as the lateral ligaments or foot intrinsics) where the trauma primarily occurred. Thermal agents may be an option if acute inflammation has resolved, but low intensity is recommended owing to high ratio of bone to soft tissue in the injured region.

Section Three

Shortwave diathermy induction coil drum is the best option owing to large surface area of involved tissues, marked muscle spasm, and the open wound in the lumbar region. The clinician should be certain that there is no metal within the field of the shortwave diathermy. If the patient has scoliosis with a rod implanted in his spine, for example, the treatment may need application of a sterile dressing to minimize the risk of infection and sterile towels used as a hot pack cover.

During heating, the following physiological responses are stimulated: local cellular metabolism, blood flow, fibroblastic activity, collagen deposition, and new capillary growth.

Heating agents may place the patient at higher risk for infection with contact from nonsterile towels or hot pack covers. Ultrasound can only be applied to a portion of the problem area, due to the wound.

Clinically, treatment is addressing marked muscle spasm, range-of-motion loss, pain, and wound healing.

Section Four

In a clinical setting, the best option for this patient varies tremendously according to the clinician's previous success rate, patient preference, and concurrent treatment approaches implemented. Much success comes from removing the source, the computer workstation ergonomics. Until the workstation is adjusted for proper body mechanics, the problems are unlikely to resolve. Intervention options could include thermal ultrasound, massage, cryostretch (e.g., spray and stretch), and neuromuscular or interferential electrical stimulation. Physiologically, ...

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