Week 3 Summary TI - PDF

3.9 SHOCKWAVE THERAPY Obj What is Extracorporeal Shockwave Therapy (ESWT) 2 types Parameters Application, Precautions, contraindications ESWT is the transcutaneous use of high energy acoustic waves for a biophysical effect. NOT ultrasound. ESWT is cold tech. Much lower freq, and higher intensity Ultr...

3.9 SHOCKWAVE THERAPY Obj What is Extracorporeal Shockwave Therapy (ESWT) 2 types Parameters Application, Precautions, contraindications ESWT is the transcutaneous use of high energy acoustic waves for a biophysical effect. NOT ultrasound. ESWT is cold tech. Much lower freq, and higher intensity Ultrasound energy is lost in the form of heat Shockwaves is cold tech, so penetrates deeper because of no loss of energy Used to breakdown tissue to promote healing and repair. MACRO affect- promotes inflammatory affect in tissue Microjets promote increased permeability in the same tissue 2 types FOCUS, RADIAL Shockwave Parameters High peak amplitudes, Short Ramp Times freq 1-4hz. 1000-4000 shock wave pulses. Measured in joules per area (mJ/mm^2) # of shockwaves/sec This means 4000 to 16000 pulses/sec Therapeutic Effects from ESWT Increased collagen synthesis cellular proliferation and wound healing pain reduction neovascularization decrease in soft tissue calcifications decrease in inflammation indications Found to be MOST USEFUL for chronic musculoskeletal conditions for tissue healing like achille tendinopathis, knee osteoarthritis, chronic plantarfaciitis : Radial vs Focused Focused- inside applicator or wand , focused be lens , deeper tissues. Radial- means of compressed air through a tube, More superficial, for superficial muscle, and myofascial trigger point treatments Contraindications pacemakers prolonged blood clotting children pregnant acute injuries - Inf . occur gold in standard using shockWave therapy is therapeutic munt SAME HELP PT acute . 2 Imax Nadia M4Hz 3.10 Diathermy Diathermy - Definition - Use of electromagnetic waves from radio frequency or microwave frequency ranges of electromagnetic spectrum - Electromagnetic waves are defined as being an electrical field that couples w/ a magnetic field - 7 types of waves ordered by energy - From high to low - Gamma, X-Rays, Ultraviolet radiation, visible light, Infrared radiation, microwaves, radio waves - Delivered in 2 forms - Shortwave Diathermy - Microwave Diathermy Principles of SWD - Continuously delivered through pulses or bursts of energy - Primary benefit is its ability to produce heat - Allows deeper penetration that other heat modalities - As radio or micro waves pass through tissue, energy is gradually converted to heat - Increases tissue temperature - Speed of tissue change depends on parameters of waveform & distance away from target tissue - Intensity, pulsed, continuous - Radio & micro waves frequencies encounter minimal reflection at tissue interface & on bone - Shortwave Diathermy - Capacitive - Use condenser plates to transfer oscillations of electric field b/w plates - Target tissue placed b/w condenser plates, acts as capacitor to store electrical charge - More prone to cause burns in patients if modality is not used properly - Graded response to electrical fields, depends on how much energy is absorbed by treated tissue - Adipose tissue has naturally higher level of resistance to electrical waves - Does not heat tissue as deep as inductive - Inductive - Contain coils that create a magnetic field - Coils confined to flexible cables or within rigid drum - Field projects forward to generate circular electric field within target tissue - More commonly used in clinical settings - Can selectively heat muscles, safer application Physiological Effects - Will not depolarize nerves or muscles - Pulse rate is 36 nanoseconds - Goal is to increase temperature of body tissues - Thermal Effect are dependent - Continues vs. Pulsed - Proximity of emitter - Duration of treatment Indications - Metabolic Reactions - Vascular Effects - Neuromuscular Effects - Connective Tissue Effects - Diathermy has shown to promote soft tissue & bone healing - Studies show benefits in treating peripheral neuropathies, knee OA, chronic pelvic pain, lateral epicondylitis - Other studies show no benefits in subacromial pain, chronic neck pain - Considered to be one of most effective modalities to heat tissue - Best used for heating large joints/muscles - Tissue temperatures should be elevated to 104-113 F Application - Important clinical considerations need to be made before using Precautions & Contraindications can we make an index card for these Take Aways - Diathermy refers to use of electromagnetic waves from radio or micro waves frequency ranges of electromagnetic spectrum - Diathermy is one of the most effective modalities to therapeutically heat tissue - Know the precautions & contraindications of this modality 3.11 Laser Therapy Definiton - An acronym for “light amplification by stimulated emission of radiation” - Use of laser to promote a positive photo-biostimulatory effect in tissue - Laser therapy is variable medicine - Low-Level Laser or Cold Laser - Low intensity non thermal lasers, for healing wounds & painful inflamed neuromuscular conditions Principles - Light produced in stimulated emission is a single wavelength - Absorption will vary, depends on wavelength of the light - Greater the energy, greater energy absorbed - Theorized effect of laser - Energy from amplified light is transferred to cells of soft tissue - Lasers in therapy are classified as 3b lasers - Eye protection is needed from both clinician & patient Physiological Effects - Tissue Repair Quantity of light absorbed is tied to therapeutic effects of laser - Light absorbed by cells can result in alteration, facilitation, or inhibition of cell-mediated chemical reactions - Within cell membranes, photosensitive molecules correspond to specific wavelengths of light - Infrared, stimulates mitochondrial cytochromes - Visible, stimulates myoglobin & hemoglobin - Infrared light found to increase ATP synthesis, promotes cellular repair & reproduction - Also increases production of RNA, which codes for pro-collagen production - Promotes neuron growth in animal studies - Pain & Inflammation - Associated w/ increased levels of endogenous opiates, increased vasodilation - Also decreased inflammatory mediators, decreased depolarization of C fibers, decreased motor & sensory nerve connectivity Indications - Studies on safety & effectiveness of laser therapy - Relative benefits to the use of low-level laser therapy in neck pain, jaw pain, hyper mobility, fibromyalgia, plantar fasciitis - Considered to adjuvant treatment - Does not offer same benefits of more effective interventions, like exercise & chronic spine pain - Found to offer a positive ADD-ON effect - Superior to placebo effects when used in isolation - Not a stand alone treatment in management of pain syndromes, info, or promotion of wound healing - Offers pain management benefits in conditions of pain syndromes at infrared wavelength of intensity - Lower dosages seem to have better outcomes - TMJD: temporal mandibular jxn dysfxn - Most heavily reported use of infrared lower-level laser therapy - Consistent therapeutic benefits in management of pain - Wound Healing - Outcomes varied, mechanisms have not bee verified - Recently shown some positive add ons to traditional care - Seems to help metabolism of human skin cells w/o affecting neural biofilm bacteria or fungi - Therapy should be predicated to an individuals response to specific modality Application - Most laser devices require entering specific dosage - Laser delivering parameters need to be set - Treatment times for musculoskeletal conditions usually last 30-60 sec - Joules per point - Laser wand applicator held over tissue site until energy has been delivered - Joules per centimeters squared - Applicator applied in arcs across area of treatment Precautions & Contraindications Take Aways - Use of laser to promote positive photobiostimulatory effect in tissue is laser therapy - Literature on use of laser therapy is conflicting - more consistent benefits when treating myofascial pain syndromes & promoting wound healing - Know the precautions & contraindications