My thoughts....
--- Scott Epsley <[log in to unmask]> wrote:
> Dear vanessa,
> I haven't read the article, but it's funny you
> should mention this
> because it is something that I have long considered.
> I guess
> you need to look at what you are doing with the US,
> and that is
> breaking down mast cells to create a contolled
> inflammatory
> process (as I'm sure you know).
I have a problem with this statement - who has shown
that ultasound breaks down mast cells and who has
shown that it creates a CONTROLLED inflammatory
process. Literature and lectures from Dr. Tim Watson
of Hertfordshire University have taught me that
ultasound is stimulatory to the main inflammatory
process cells - such as "ultrasound can stimulate
platelets and mast cells to degranulate and
macrophages to release several chemical faactors which
in turn activate local fibroblasts and stimulate the
revascularisation process (Fyfe & Chal, 1982)".
> Then you need to look at how
> tendons heal. Firstly we know that they have a poor
> blood
> supply. Tendons heal via the "common wound
> concept". ie
> proliferation of fibroblasts to creat a scar
> (extrinsic healing). We
> now know that they also heal via "intrinsic
> healing", ie. tenocytes
> can produce collagen. In light of these facts, US
> is good at
> encouraging fibroblastic activity, but the question
> is what does
> it do to new collagen? Does it decrease the cross
> links and thus
> deteriorate its tensile strength? My feeling is
> that this is quite
> possibly the case. My tendon repair post op
> management notes
> state that you shouldn't use US in the first 6 weeks
> as this can
> have a detrimental effect on healing.
Is this protocol that based on common/ previous
practise? "we've always done it like this" - again the
lectures by Tim Watson have the following to say ...
"Ultrasound in the early stage [of inflammation] would
therefore appear to be a pro-inflammatory treatment
which results in the stimulation of the proliferative
repair stage." Inflammation is a very good and
effecient method of repair of many body tissues - it
seems that the use of ultrasound would stimulate the
inflammation process to move quicker through it's many
over-lapping phases - surely a good thing in the
appropriate circumstances. Therefore - why not in
tendon repair?
And having
> said all of this I
> have just found the reference I think you are
> looking for:
> van Strein G. (1990). Postoperative Management of
> Flexor Tendon
> Injuries. In Rehabilitation of the Hand, Hunter,
> Schneider, Mackin,
> Callahan (Eds), Ch, 30, 3rd edit. Mosby Co, StLouis,
> Baltimore
> Philidelphia, Toronto.
> I also know of a study that looked at using US in
> horses for
> tendonitis, and found that it actually made the
> problem worse when
> used daily for ? number of weeks as opposed to
> imtermitent use.
Thoughts .... (but I haven't read the paper)
Overall outcome of problem worse or initial pain and
other symptoms worse? How appropriate was the
dosages? How appropriate was the frequency of
treatment in relationship to dosage? Are horses
comparable to human healing parameters?
> Thus, I would be wary of US in know tendon damage
> and would
> prefer to use digital ischaemic pressure, grI
> frictions and gentle
> stretches.
> Hope this helps,
> Scott Epsley
> Physiotherapist
> Brisbane, QLD. Australia.
> --
>
> On Mon, 8 Nov 1999 19:11:05 fizzy wrote:
> >Hi colleagues,
> >
> >I recently heard there's been some research
> suggesting that ultrasound may be harmful when
> treating tendinitis. I think the general idea was
> that it is not possible to distinguish if tendon
> degeneration/ to what degree degeneration is
> present, and that ultrasound could be harmful if
> degeneration of the tendon is present as opposed to
> inflammation without tendon degeneration. As you can
> tell I haven't read the article and wondered if
> anyone had heard of this and had any references or
> comments on the matter?
> >
> >look forward to hearing your ideas
> >
> >Vanessa MCSP
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