Could not agree more, Wendy
Simon Mesner B.Sc. (HONS) MCSP SRP
> -----Original Message-----
> From: Wendy Johnson [SMTP:[log in to unmask]]
> Sent: 09 November 1999 23:04
> To: [log in to unmask]
> Subject: Re: u.s. & tendinitis
>
> 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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