Foreword

Pertain: be appropriate, related, or applicable.

synonyms: concern, related to, be connected with, be relevant to, regard, apply to, be pertinent to, refer to have, affect, involve, touch on

Sustain: strengthen or support physically or mentally

synonyms: comfort, help, assist, encourage, succor, support, give strength to, buoy up, carry, cheer up, hearten

The American Physical Therapy Association defines physical therapists as professional health care providers who …

"… will be responsible for evaluating and managing an individual's movement system across the lifespan to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. The movement system is the core of physical therapist practice, education, and research." (http://www.apta.org/Vision/)

There is little doubt that embedded within this definition is the recognition that physical therapists are outstanding authorities on movement pathology and, as such, are responsible for the implementation of new procedures and technologies, irrespective of the patient population for which each possesses the greatest treatment skills. While the advent and assimilation of novel manual skills and assistive technologies are undeniable, throughout our distinguished history a common thread has weaved its way through our professional fabric: our use of modalities as either primary sources of treatment or as adjuncts to our manual skills and the concurrent discourse with our patients. One might say that modalities pertain to much of what we do … often to relax or excite tissues or structures in preparation for enhanced function. More often than not, such applications bring comfort to our patients and foster compliance with the totality of a therapeutic plan. We could even believe the tools that we call modalities sustain us because so often there is unequivocal evidence of the immediacy to which our patients respond to their physiological impact. Such positive responsiveness infuses confidence in us by our patients and reaffirms that we are on the right path toward improving an existing pathology.

While this perspective appears encouraging and may validate the belief that we are truly helping our patients, we are equally justified in our concern that perhaps we have come to take for granted the myriad of modalities and the conditions that they can positively influence. Without a reference that is continuously updated and to which any clinician can turn with unabated confidence, perhaps we might lose sight of advances in these agents or in our ability to maintain our position as the foremost authorities in their use. Modalities for Therapeutic Interventions, originally called Thermal Agents in Rehabilitation in its first iteration as the very first volume within the Contemporary Perspectives in Rehabilitation (CPR) series exactly 30 years ago, is now experiencing its sixth edition. The fact that this text has truly withstood the test of time is testimony to how well it has evolved and become beloved as the "go to" textbook on modality use in rehabilitation. This edition has been brilliantly conceived by Drs. Bellew, Michlovitz, and Nolan and now—for the first time—is even more vibrant owing to the four-color format and color photos that pervade its content. All chapters have been updated, and the tradition that "binds" all volumes of the CPR series—challenging case histories and clinical decision-making formatting—is pervasive, as is the infusion of Key Points distributed throughout each chapter. These points stand out in blue print as beacons from which students can extract essential information within subject material.

Jim Bellew provides a new and exciting introductory chapter that reminds students and clinicians about the importance and use of modalities. New chapters on ultrasound (Chapter 4, David Lake), mechanical compression (Chapter 8, Robert Marsico), electrical stimulation for pain control (Chapter 11, Richard Liebano), and modalities for improving range of motion (Chapter 12, Andrew Starsky) and new content on laser therapy within the chapter on Therapeutic Modalities for Tissue Healing (Chapter 15, Ed Mahoney) are contributions that contain information not previously addressed in the fifth edition. Throughout the text, attention is directed not only to evidence supporting the circumstances for optimal use of a modality (a concept gathering greater appreciation as we struggle to support additional treatment for our patients) but also—equally as significant and so often overlooked—the identification of situations and circumstances where evidence is lacking.

In a time when modalities might be less appreciated, we must not lose sight of the fact that our treatment approaches have become far more dynamic and interactive. If we choose a perspective that advocates for modality application as a vehicle to foster functionally based activity either in conjunction with its use or as an immediate consequence, we begin to see these steadfast stalwarts as our faithful partners, who have always been there for our use but whose appeal can be viewed in a more contemporary mode. For over 70 years they have been a part of our armamentarium. Indeed, they do pertain to the totality of our treatment, and their very presence has always been there to sustain us.

Our collective hope is that this philosophical bent will be conveyed to the next generation of students and clinicians, who will view this text as the friend it has become to past generations.