Which of the following is a contraindication for the application of superficial heat?

Acute inflammation (within first 48 hours). Superficial heat is contraindicated during acute inflammation (first 48-72 hours) because it increases blood flow and metabolic rate, which can worsen swelling and inflammation. Cryotherapy (cold) is the appropriate modality during the acute inflammatory phase. Heat is appropriate for chronic conditions, muscle spasm, and joint stiffness.

When performing cervical traction for a patient with cervical disc herniation, the recommended force is:

25-35 lbs (or 10-15% body weight). Cervical traction for disc conditions uses 25-35 lbs or 10-15% of body weight in an intermittent mode. The cervical spine requires much less force than the lumbar spine (which uses 50-65% body weight). The neck is typically positioned in approximately 25 degrees of flexion to maximally open the intervertebral foramina.

In iontophoresis, dexamethasone (a negatively charged medication) would be placed under which electrode?

The negative (cathode) electrode. In iontophoresis, the medication is placed under the electrode with the SAME charge. Since dexamethasone carries a negative charge, it is placed under the negative (cathode) electrode. Like charges repel, so the negative current drives the negatively charged dexamethasone ions away from the electrode and into the tissue.

Shortwave diathermy is ABSOLUTELY contraindicated in patients with:

Metal implants. Shortwave diathermy uses electromagnetic energy, which rapidly heats metal. Any metal in or on the patient (internal fixation hardware, joint replacements, jewelry, piercings) is an absolute contraindication because the metal will heat to dangerous levels, potentially causing tissue burns. This also applies to pacemakers and other electronic implants.

A patient with Raynaud disease would have a contraindication to which modality?

Cryotherapy (ice packs). Raynaud disease causes excessive vasoconstriction in the extremities in response to cold exposure. Cryotherapy (ice, cold packs) would worsen the vasospasm and potentially cause tissue damage. Cold hypersensitivity, Raynaud disease/phenomenon, and cryoglobulinemia are all contraindications to cryotherapy.

5.2 Therapeutic Modalities | NPTE Physical Therapy Exam | Free Exam Prep

Key Takeaways

Cryotherapy (cold): reduces pain, spasm, inflammation, and metabolic rate; applied for 10-20 minutes; contraindicated in Raynaud disease, cold hypersensitivity, and impaired sensation
Thermotherapy (superficial heat): increases blood flow, tissue extensibility, and metabolic rate; applied for 15-20 minutes; contraindicated over malignancy, acute inflammation, and impaired sensation
Ultrasound (thermal): continuous mode at 1-2 W/cm2 increases tissue temperature; used to improve joint extensibility before stretching; contraindicated over growth plates, eyes, reproductive organs, and implants
Diathermy (shortwave): deep heating modality using electromagnetic energy; heats tissues 3-5 cm deep; contraindicated with metal implants
Mechanical traction (cervical): intermittent traction at 25-35 lbs or 10-15% body weight for disc herniation; contraindicated in ligamentous instability, VBI, malignancy, and RA with atlantoaxial instability
Mechanical traction (lumbar): intermittent traction at 50-65% body weight for disc conditions; sustained traction at 25% for muscle spasm
Hydrotherapy: water temperature ranges from cool (79-92F) for exercise to warm (92-98F) for pain/stiffness; hot (98-104F) for chronic conditions; contraindicated with open wounds in whirlpool (cross-contamination risk)
Iontophoresis uses direct current to drive ions of medication through the skin: dexamethasone (negative pole, anti-inflammatory) and lidocaine (positive pole, anesthetic)

Therapeutic Modalities

Physical therapy modalities are used as adjuncts to therapeutic exercise and manual therapy. The NPTE heavily tests the indications, contraindications, parameters, and physiological effects of each modality.

Thermal Agents

Cryotherapy (Cold)

Method	Application Time	Depth of Penetration
Ice pack/cold pack	10-20 minutes	Superficial (1-2 cm)
Ice massage	5-10 minutes (or until numbness)	Superficial
Cold whirlpool	10-20 minutes	Superficial to moderate
Vapocoolant spray	Seconds (spray and stretch)	Skin surface only

Physiological Effects:

Vasoconstriction → decreased blood flow → decreased inflammation and edema
Decreased nerve conduction velocity → pain relief
Decreased muscle spindle firing → reduced spasm
Decreased metabolic rate → reduced secondary injury

Contraindications:

Raynaud disease or phenomenon
Cold hypersensitivity or cold urticaria
Cryoglobulinemia
Impaired sensation (risk of frostbite)
Over open wounds (ice pack only — cold whirlpool may be appropriate)
Peripheral vascular disease (compromised circulation)

Superficial Heat

Method	Application Time	Depth
Hot pack (hydrocollator)	15-20 minutes	1-2 cm (superficial)
Paraffin wax	15-20 minutes (dip-wrap or immersion)	1 cm (superficial); excellent for hands, feet
Fluidotherapy	15-20 minutes	1-2 cm; dry heat
Warm whirlpool	15-20 minutes	Superficial to moderate
Infrared	15-20 minutes	Superficial

Physiological Effects:

Vasodilation → increased blood flow → promotes healing
Increased tissue extensibility → improved stretching effectiveness
Decreased pain via gate control mechanism
Increased metabolic rate → promotes tissue repair
Decreased muscle spasm

Contraindications (ALL heat modalities):

Acute inflammation or trauma (first 48-72 hours)
Over malignancy
Impaired sensation
Impaired circulation (PVD)
Active hemorrhage or bleeding disorders
Over the eyes, reproductive organs, growth plates

Deep Heating Modalities

Therapeutic Ultrasound Parameters Summary

Parameter	Thermal Mode	Non-Thermal Mode
Duty cycle	Continuous (100%)	Pulsed (typically 20%)
Intensity	1.0-2.0 W/cm2	0.5-1.0 W/cm2
Frequency	1 MHz (deep) or 3 MHz (superficial)	1 or 3 MHz
Duration	5-10 minutes per area	5-10 minutes per area
Primary effects	Tissue heating, improved extensibility	Cavitation, acoustic streaming, tissue repair
Best used	Before stretching contractures, chronic conditions	Acute injuries, wound healing, fracture healing

Ultrasound Contraindications:

Over the eyes, heart, brain, reproductive organs
Over growth plates (epiphyseal plates) in children
Over malignancy
Over spinal cord after laminectomy
Over joint cement or plastic components (thermal mode)
Over thrombophlebitis/DVT
Pregnancy (over abdomen/pelvis)

Shortwave Diathermy

Deep heating using electromagnetic energy (shortwave radio frequencies)
Heats tissues to 3-5 cm depth (similar to 1 MHz ultrasound)
Particularly effective for heating large tissue volumes
Absolute contraindication: metal implants (internal or external) — electromagnetic energy heats metal rapidly
Also contraindicated over pacemakers, pregnancy, malignancy, and areas with impaired sensation

Mechanical Modalities

Traction

Type	Cervical	Lumbar
Force	25-35 lbs (or 10-15% body weight)	50-65% of body weight
Disc conditions	Intermittent: 15 sec on, 5 sec off	Intermittent: 15 sec on, 5 sec off
Muscle spasm	Sustained: lower force, longer hold	Sustained: 25% body weight
Position	25 degrees cervical flexion (foraminal opening)	Prone or supine; hook-lying reduces lordosis
Duration	15-20 minutes	15-20 minutes

Traction Contraindications:

Ligamentous instability
Vertebrobasilar insufficiency (VBI) — for cervical
Rheumatoid arthritis with atlantoaxial instability
Malignancy in the spine
Acute disc herniation with progressive neurological deficit
Osteoporosis (severe)
Pregnancy (lumbar)
Untreated hypertension

Iontophoresis

Iontophoresis uses direct current (DC) to drive charged medication ions through the skin:

Medication	Charge/Polarity	Purpose
Dexamethasone	Negative (-)	Anti-inflammatory (tendinopathy, bursitis)
Lidocaine	Positive (+)	Local anesthetic (pain relief)
Acetic acid	Negative (-)	Calcium deposits (calcific tendinitis)
Salicylate	Negative (-)	Anti-inflammatory

Rule: The medication is placed under the electrode with the same charge (like charges repel, driving the ions into the tissue).

NPTE Physical Therapy Exam

1Introduction: NPTE Exam Overview

2Chapter 1: Musculoskeletal System

3Chapter 2: Neuromuscular & Nervous Systems

4Chapter 3: Cardiovascular & Pulmonary Systems

5Chapter 4: Integumentary & Other Body Systems

6Chapter 5: Non-Systems (Equipment, Safety & Professional Practice)