Dera Wendy,
thanks for your reply. This is a good discussion. Nick, thanks for
your replies also.
What I was suggesting when I asked about US over an apophysis
is that maybe by stimulating early ossification at the apopysis
we might decrease the duration of the disorder. Now I don't
necessarily believe this, but I'm throwing thoughts out there
for people to digest. (Oh, by the way nick my Gray's is right
here beside me, not under my Harry connick jr collection!!).
I agree US is Contra over specialised tissues because we are not
100% sure of it's effects on these tissues. My argument about
the apophysis is that it is not contributing to growth of the
tibia, even though there is a connection to the tibial epiphysis.
If the body makes bone (as nick suggested by the presence of
calcification on x-ray, a finding I too have observed) then this must
be in some way a profitable reaction, or the body wouldn't do it
naturally. As to whether US would even be specific enough to
do thisI have no idea, but I'm trying to expand our thinking.
Maybe nick you have some other suggestions now that I have
further explained myself?
scott.
--
On Sun, 5 Mar 2000 03:47:21 Wendy Johnson wrote:
>I tend to assume that if a growthplate is still in
>situ then it has the potential to be active at that
>time and even if it were fully dormant would
>electrotharpy stimulate it? - whether that stimulation
>would be adverse or not!
>
>In terms of using electrotherapy "as long as the
>growth plate is not in the line of fire" ... as I
>understand things shortwave-type modalities have a
>huge radius of 'fire' - the wavelength is 30 - 3
>metres (Low and Reed, 1990), and although the further
>the part is from the source of radiation the less the
>intensity of radiation there is still the potential of
>irradiating the whole body (!) to a certain extent -
>all be it very small especially if low doses and
>pulsed applications are used.
>
>The other side of the argument is that these
>modalities have been used for many years now and
>hopefully if there were drastic effects they would
>have shown up etc. This said, I personally don't think
>we know enough about risks and future risks. So I
>explain to any children, adolescents or their parents
>that the full story isn't yet clear and that
>electrotherapy to a potentially still growing area/
>person is not a techniques that I am prepared to do.
>All of my patients thus far have been perfectly happy
>with this explanation.
>
>I think we should use our own professional judgement
>until more concrete evidence is there to guide us.
>Listen to the thoughts/ opinions of others but then
>digest them individually ourselves and don't be afraid
>to question those thoughts and come to your own
>rational conclusions and open-ended conclusions.
>
>
>Wendy Johnson
>
>--- Lisa Woolley <[log in to unmask]> wrote:
>> An electrotherapy tutor advised me not to use
>> electrotherapy when the
>> individual growth plate is at it's most active
>> stage, but when is that?
>> Also it is safe to use as long as a growth plate is
>> not in the line of
>> 'fire'.
>>
>> Lisa
>>
>>
>> >From: Wendy Johnson <[log in to unmask]>
>> >Reply-To: [log in to unmask]
>> >To: [log in to unmask]
>> >Subject: Re: Electrotherapy use on Children
>> >Date: Tue, 29 Feb 2000 14:12:33 -0800 (PST)
>> >
>> >I totally agree with the comments from Nick - but
>> at
>> >what age should one start electrotherapy if
>> indicated
>> >... Grays anatomy states the ages at each growth
>> plate
>> >ossifies - e.g. the SIJ may only fully ossify at
>> >25years old! Personally I still go on the safety
>> side,
>> >but without further research I don't suppose we'll
>> >have solid guidelines.
>> >
>> >Wendy Johnson
>> >
>> >--- nick bent <[log in to unmask]> wrote:
>> > > Dear Andy,
>> > >
>> > > I did a bit of a mini-literature search on this
>> > > myself
>> > > recently and there is not much out there. The
>> > > trouble
>> > > is that it would probably be unethical to expose
>> > > kid's
>> > > growth plates to electrotherapy in the long-term
>> and
>> > > then see what happens.
>> > > However,
>> > >
>> > > Witlink et al (1995) exposed developing
>> metatarsal
>> > > rudiments of rats to ultrasound in vitro. After
>> 4
>> > > days
>> > > of pulsed rather than continuous ultrasound,
>> > > longitudinal growth was significantly increased.
>> > >
>> > > Doyle and Smart (1963) demonstrated that
>> repeated
>> > > exposure of the growing epiphysis of the femur
>> of
>> > > rats
>> > > to Shortwave diathermy increased the rate of
>> growth
>> > > compared to the untreated legs.
>> > >
>> > > Doyle and Smart (1963) Stimulation of bone
>> growth
>> > > by
>> > > shortwave diathermy. Journal of Bone and Joint
>> > > Surgery. Vol. 45, No. A1, p15-23.
>> > >
>> > > Witlink et al (1995) Effect of therapeutic
>> > > ultrasound
>> > > on endochondral ossification. Ultrasound Med
>> Biol.
>> > > Vol. 21, No. 1, p121-7.
>> > >
>> > > Personally, I think that the fact that there is
>> some
>> > > evidence to suggest alteration of bony growth
>> with
>> > > electrotherapy, weighed against the possible
>> > > benefits
>> > > of administering such treatments in youngsters
>> who
>> > > should not need to be rushed back to action,
>> means
>> > > that it is sensible to go on the side of safety.
>> > >
>> > >
>> > > Nick
>> > >
>> > >
>> > > --- Andy Thomas <[log in to unmask]> wrote:
>> > > >
>> > > > Is anybody aware of any research articles
>> related
>> > > to
>> > > > the specific use of any
>> > > > electrotherapy modality on Children
>> particularly
>> > > > related to the growth
>> > > > plate.
>> > > >
>> > > > Many Thanks
>> > > >
>> > > >
>> > > > Andy Thomas
>> > > >
>> > > >
>> > > >
>> > >
>>
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