Therapeutic Modalities, ed 3.

Therapeutic Modalities, ed 3 Starkey C. Philadelphia, PA 19013, FA Davis Co, 2004, hardcover, 421 pp, illus, ISBN: 0-8036-1140-4, $54.95.

This book is an excellent resource for students or for experienced athletic trainers, physical therapists, or medical personnel who use thermal, electrotherapeutic, mechanical, and light modalities when managing patients or training athletes. The book is split into 5 sections according to topic. The more commonly used modalities are presented as well as those that are less prevalent today, plus alternative modality applications that may become more accepted in the future. The numerous tables and illustrations and appendixes further enhance this friendlier edition.

Case studies and boxes appear throughout the text to demonstrate clinical application. Definitions to bolded terms found at the bottom of pages as well as the quizzes at the end of each section increase the book's appeal to students. In addition, to address the evolution of evidence-based practice, the author includes a subsection, "Controversies in Treatment," as part of the discussion of each modality to provide an overview of research findings.

The first of the 5 sections, chapters 1 through 4, sets a foundation for modality implementation by addressing injury response, pain, treatment planning, and administrative issues. Primary trauma to epithelial, adipose, muscular, nervous, and connective tissues and the injury process are addressed in chapter 1. Chapter 2 explores the pathophysiology and psychological perception of pain, an inherent component of injury. Diagrams are used to help the reader understand the neuroscience and pain modulation theories. The third chapter is an excellent explanation of the decision-making process for the use of modalities. This process is demonstrated by a case study focusing on recognition of the problem, prioritizing, goal setting, treatment planning, and re-evaluation. Modalities are selected using the conceptual model of problem solving to develop goals that depend on tissue pathology, function, an inflammatory state, and contraindications. Chapter 4 concludes the first section by highlighting the administrative issues of safety, reimbursement, facility management, and legal issues.

Section 2, "Therapeutic Cold and Superficial Heating Agents," focuses on the superficial thermal and cooling agents. The physics and biophysical effects of heat and cold are presented and contrasted in the text as well as in easy-to-read tables. Chapter 6 describes the most common clinical applications of superficial heat and cold. The "at a glance" pages give the reader a quick overview of the text for each modality. They include a description of the modality application, primary effects, indications, contraindications, and precautions.

Section 3, "Deep-Heating Agents," covers ultrasound and shortwave diathermy. Ultrasound's acoustical parameters are described in relation to its ability to produce mechanical nonthermal effects in addition to its use as a thermal agent. The clinical techniques of ultrasonic bone growth generators as well as phonophoresis are included in this chapter. The clinical application of 1-MHz and 3-MHz therapeutic ultrasound is covered in the next chapter. Rather than using a cookbook method, the author encourages clinicians to use their own decision-making process to apply modalities appropriately, depending on the tissue depth and type, the injury, and the goal of therapy. Shortwave diathermy is presented similarly in chapter 9, describing induction and capacitive field diathermy as well as continuous and pulsed modes of application. At the end of this chapter, the case study from section 1 is continued, and a new case study is presented that enhances the lesson discussed in chapter 9.

Section 4 "Electrical Stimulation," is divided into 3 chapters: "Principles of Electrical Stimulation," which builds a solid foundation; "Electrical Stimulation Techniques," which discusses the biophysics of electrical stimulation; and "Clinical Application of Electrical Agents," which covers clinical application of various common waveforms to address specific goals. Basic treatment strategies for pain control, neuromuscular stimulation, and edema reduction are described with set-up and application explanations for one or more of these waveforms: high-voltage pulsed stimulation (HVPS), transcutaneous electrical nerve stimulation (TENS), interferential stimulation (IFS), neuromuscular electrical stimulation (NMES), and microcurrent electrical stimulation (MET). Iontophoresis also is included in the clinical applications chapter.

Section 5, "Mechanical and Light Modalities," includes 8 chapters describing agents that rely on mechanical force, light, or chemical effects to alter the injury response process. The biophysical effects of intermittent compression, continuous passive motion, massage, traction, biofeedback, and the light therapies--as well as alternative therapies such as hyperbaric oxygen and magnets--are described. The text is tied together by the continuation of case one through this section, besides additional case exposure. Three new case studies are at the end of section 5.

The consistent format of the book makes it an easy-to-follow reference as well as a suitable textbook for students. The numerous illustrations, figures, boxes, and quick reference pages successfully complement this user-friendly edition.

Rose L Smith, PT, DPT, SCS, ATC 

University of Cincinnati 

Cincinnati, Ohio

Dr Smith is Assistant Professor in the Department of Rehabilitation Sciences, Interim Director of the Health Sciences Program, Adjunct Instructor in the Athletic Training Program, and Novacare Rehabilitation Specialist for the UC Athletic Department.