So, as he said, my name is Julie Kramer, I'm an assistant athletic trainer, physical therapist with the Kansas City Chiefs, and I'm going to be talking about training room modalities. I don't have any disclosures. So they told me I had 15 minutes to talk about modalities, so we're really not going to start talking about anything about theory, because we just don't really have the time to get into that. So we're going to talk more about what our intentions are with modalities and why we're using them, instead of all the science and background behind it in that regard, and then also looking at the modalities we're using across the NFL, and then looking at some of those on-the-go modalities, because we know all of us only have so much time that we have with these athletes and how to make the most of our time while still treating them while they're not with us. So if we look at the truest form of what are therapeutic modalities, again, it's going to be any therapeutic meaning promoting tissue or injury healing, and then modality and application of an agent. So anything you're taking that you are putting an outside source and trying to make something better, feel better, and heal. So why are we using modalities? The big one is to propagate a conducive environment for healing, and what does that mean? Mother nature is undefeated. Everything takes a certain amount of time to heal. You're really not going to be able to change that, but what you can do is put it in the best position to heal on the underside of what that is, so two to four weeks. So put it on the underside of that. You're not going to magically make something heal in two days that takes six weeks to heal, no matter what any company, modality company, tells you it's going to do. So what you can do is try to put it in the best environment that's going to help it to heal as quickly as it can. We want to prep the tissue. So in our room, we use it a lot as a way to get ready for exercise. So what do we need to do to get that tissue ready? And then there's a huge psychosomatic component to it as well, as we were just talking about some of the mental health stuff. This is your time that you get to spend with that athlete. So just putting your hands on them, you doing something to them, that placebo effect, they already think they're feeling better. They already think it's doing something. Then it's also just your time to spend time with them. So they're going to start talking about some of their, what's going on in their life, what's going on in their day. So again, that in and of itself is going to help them feel better. So I'm going to talk a lot about a bunch of different fancy machines and different things that you can do. But at the core of it all, I want everybody to remember that your biggest and best modality is actually exercise. We are a huge exercise-based athletic training room in Kansas City. So we are going to, our kind of rule of thumb is every 20 minutes you spend on the table, you have to give us 40 minutes of exercise. Our guys know this. They know they're going to get something on the table, but they are going to get up and move. If you think about it, if you think about Wolf's Law, everything is, you put, the body is going to respond to the demand that you put on it. If you don't put demand on the body, it's not going to get better. So you have to stress the tissue. No modality is going to stress the tissue, like exercise is going to stress the tissue to help them heal. So our four basic, very broad categories of therapeutic modalities are your thermal, mechanical, electromagnetic, as well as your light energies. Here's a very large list, but by no way an exhaustive list of a bunch of different modalities that are out there. Again, we probably have almost all of them in some form on there. Again, it's not an exhaustive list. It's just something for you guys to look at as a point of reference. So the first is that mechanical. So this is going to be anything where you're doing something to tissue, so your soft tissue, your mobilizations, your instrument-assisted soft tissue. This is where we spend most of our time when it comes to modalities on the table in Kansas City. So our hands, we think, are our biggest tools when it comes to this, so we will spend the most time with this compared to any other machine. Again, don't forget that this is a modality. I think people think when they think modality, it's something electrical or something that you're doing to them, but this stuff is also considered a modality. I know some of your tools can get very expensive. The other difficult part about talking about modalities to this room is there's a very large, vast population, right? We have high school, collegiate. We have people in a PT, AT clinic. You're not getting reimbursed for modalities, so you're going to use modalities that they might at a collegiate or professional level. At the high school level, things are really expensive. So as much as tools can be expensive, you can find really cheap ones as well. So I challenge you to think outside the box with some of that stuff as well. The tool that's down there in the corner on the bottom right, that's actually a leather etching tool. You can buy, I think we get a pack of three for like 5.99, but it works really well around joints to get into those little nooks and crannies. So again, just be creative with what you're doing and you can find a way to get those things done. We do a lot of things through a range of motion. So down in the corner doing things, tissue tension through a range of motion, we're making those athletes move and being more engaged in it. It's not just a lay on the table type situation. We do a lot of trigger point dry needling as well. We found that this is very efficient and effective, so it can be fairly quick and it does have a big result for us. So we do it both by itself where we will piston, so find a spot and piston in that one spot to clear the area as well as adding some e-stim to it as well if it's a bigger, larger area. We do use cups as well. Again, you're going to keep hearing me say the same thing. They're not just going to lay there on the table with cups on. If we have guys that we're using cups on, we're going to move them. So get them up and same thing, tissue tension through range of motion. Get them moving. If they're on the back, do some cat cows, get them doing some rotation stuff, get them up and get them moving because that's really going to be your bread and butter of where they're starting to feel better. You're going to start to see some of these cups are coming out now that are mechanical. They have the LED lights, they vibrate. So again, just another way to add something else to the treatment. So as I said, we don't do a lot of on-the-table type stuff. So what we like to do is put a lot of this stuff on guys to go to meetings. We don't want to waste time for a 20-minute bone stim while they're sitting in the athletic training room. So we'll put that on them while they're going to meetings. We'll get it to them where they can wear it when they're going home. Same thing with, if you guys are familiar with a SamSport, it's a low-level ultrasound machine. You can wear those for up to four hours. So again, not something we're just going to put on a guy and let him sit around. We're going to put that on them while they go to meetings. We're going to put that on them when they go home at the end of the day. Same thing with the bottom right is a CareWear patch, uses LED photomodulation to try and stimulate the mitochondria to get some cellular turnover, something they can wear to go. The Firefly uses NEMS for recovery. So again, just things that we can put on them. So we're constantly treating them, even though they're not with us. Some more on-the-go stuff is your Hyperice Normatec products. These have really worked out really well for us in travel as well. So the guys really like the heat, the vibration, the bottom right picture there does contrast. So things that they can use on the plane to try to help mitigate some of the soreness, stiffness that they get while we're traveling, as well as things that we can use when they're going into meetings. Same thing, something that'll keep them warm, that heat before they have to come and go right into a practice or walk-through. We're also not a STEM athletic training room. We're not going to have anybody on the table where they're just sitting there using eSTEM. So these are all things that we can put on them while they're going into their meetings. Again, it kind of just depends on what you're looking for. Some will have different settings. Some will be more targeted towards recovery. Some will be more targeted towards pain modulation. We will use the BioWeave, which is the blue box up in their upper left corner. We will use that in conjunction with exercise. So somebody has a SCAC sprain, we will put that on to help try and decrease some of that pain to get some more range of motion and be able to get them to do some more things. So again, not trying to just have them sit around, but what can we do it as well as, what can we apply while we're doing exercise? The bottom left is the Ionto patch, which is nice now too, because now that's a to-go throwaway. So we have started using those again. Same thing for guys when they're going into meetings or at the end of the day to be able to deliver some medicine with that eSTEM. You guys have all seen some of the thermal energy compression stuff that's out there. They have advanced in the last couple of years, and now you have some that do contrast as well. So it will go hot, cold. You can make it do all hot. You can make it do all cold. Some of those, again, I know they're getting in the more expensive. Once you start getting into those, there are some high school programs for refurbished stuff, if you guys are looking for some cheaper options as well. But now, like I said, they have moved into that contrast. Looking at some of your compression therapies, there's a couple different companies as far as what you can do for the compression boots. They also do upper extremity. They do hips as well. We've really started using BFR as a compression recovery mode. So that is ischemic post-recovery. So we will put that same thing. We'll put it on guys, potentially, while they're going to meetings. This is one we'll sometimes do in the athletic training room as well. But the guys have seemed to have really good results with that. And guys who like the BFR for exercise really like the BFR as a recovery aspect as well. So now we're going to get into what I call kind of your high-end modalities. Pretty much everything from here on out is going to be almost $10,000 and above. So just to be aware, diathermy, I think, has made a resurgence. When I was in college and going through my modality courses, your big diathermy machine looked like a dinosaur that no athlete would ever want you to use on them. So they've become more streamlined. And then with that coming back out to car therapy is one that has become more recent in the last couple of years as well. It uses diathermy. It uses it on the kilohertz compared to diathermy as a megahertz. So it is a different, a little bit smaller waveform there. But the TACAR is also one that you can use with movement. So you can see the picture up top there. They're using the capacitors while they're going through some range of motion and through some movement. There are some electro pads that you can do where you can put those on them as well while they move through some ranges of motion. The TACAR targets both, it calls capacitive and resistive. So the capacitive is your soft tissue stuff. The resistive is more your bony stuff. So there are two different conducers to try and target different tissue with that. Your TACARs are looking at probably about 20,000 plus, depending on which unit you want to go with. Your diathermies, which typically most of your diathermy units are only diathermy, so not the most cost effective if that's the only thing they can do, but still about 10 grand for a diathermy. Looking at your lasers and shockwaves, again looking at shockwave you have your focused as well as your radial. Your radial is the one on the bottom left that has the piston. And that's the one that's going to, you'll hear it almost sounds like a gun piston repeatedly. And that's the one that's going to cause some trauma to the area and is not the most comfortable when you are applying it. But it's gotten its bread and butter in treating tendinopathies. So your Achilles tendon, your plantar fasciitis, things like that. Your focused is going to penetrate a little bit deeper than your radial and is more comfortable. It is about two to three times more expensive than a radial. Your radial you're looking at 20,000, your focus can get up to 40 and $50,000. So again, not the cheapest machines that you got out there. Lasers really class three, class four is what you're looking at there. And again, they've come down in price, but you can still go from anywhere in a laser from 20 up to $120,000 depending on what you're looking at. The pulse electromagnetic fields or PMF, also the high energy inductive therapy, they're pretty much the same thing just used interchangeably. They've made kind of a surgence in the last couple of years as well. And that's using those magnetic fields to target the energy of the cell. These are a very wide array. Now you can find these, you can buy a mat off of Amazon for a couple hundred dollars and then range up to some of these machines are 20 and $40,000 as well. So a big rampant here of where those kind of fall. When you get into things that are even more expensive, once you get into your cryo chambers, float tanks, hyperbaric chambers, looking at your sauna and steam rooms. Most of our facilities in the NFL do have some sort of sauna or steam room. These are things that our guys, we're not necessarily prescribing for them as part of their rehab program, but things they can use throughout the day. So the hyperbaric chamber is not something that we have for the chiefs because researchers have shown the longer you are in it, the better results that you have. We don't have time with our guys to be using that. So we do have guys that own them in their home because they sleep in them or they use them for a couple hours when they go home. Our guys aren't hanging around the facility for a couple hours to get in a hyperbaric chamber. Our day's pretty condensed. They go from one thing to the next and when they're done, they're out of there. So not something that we have. I'm not saying that there's not other teams within the NFL that have them, but the float tank, again, same thing. We don't have one. There are other NFL teams that have one, but it has been shown to help with some of the sensory deprivation, as well as help with concussive events or in concussion return to play protocols as well. So the biggest thing is really just know your stages of healing when you're picking your modality and then choose to maximize your time. Like I said, we all know we only have so much time with these guys. So what's going to be the biggest bang for your buck as far as treating them? And then always use it in conjunction with exercise. Like I said, just remember as much as every athlete thinks there's some fancy machine that's going to fix them, there's really not. They need to get off the table and move in order to feel better.

training room modalities

exercise

soft tissue mobilization

trigger point dry needling

PEMF