They appear to be non-compatible as ultrasound, using the correct settings
for the type of lesion, is pro-inflammatory and NSAID's are supposedly
anti-inflammatory.  However the mechanism of action of NSAID's is inhibition
of the enzyme cyclo-oxygenase which is involved in the prostagladin
formation cascade.  A major action of prostagladin after trauma is
sensitisation of pain receptors.  So are these drugs truely
anti-inflammatory or more accurately described as painkillers?
Another seemingly non-compatible technique is the use of ultrasound to
administer corticosteroid, iontophoresis.  Here a true anti-flammatory drug
which stabilises the cell membranes of mast cells is used in conjunction
with a pro-inflammatory technique which causes mast cell degranulation.
It seems some people use techniques anecdotally with out thinking about what
effect the intervention is supposed to have.  Another example to indicate
why evidence based practice and clinical reasoning are so important.

Simon Mesner B.Sc. (HONS) MCSP SRP Cert. Sports Physiotherapy 

> -----Original Message-----
> From:	G J Harrison [SMTP:[log in to unmask]]
> Sent:	10 November 1999 15:16
> To:	[log in to unmask]
> Subject:	Re: u.s. & tendinitis
> 
> Hi Colleagues,
> Could anyone explain why patients on NSAIDs come into the departments
> and have ultrasound treatments to boost the inflammatory process to
> promote healing, how are these two treatments compatable? 
> Regards  Gay
> 
>  In message <41182AC96458D211A15D0000F8300FC11BB669@devon_1>, Mclean,
> Chris <[log in to unmask]> writes
> >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 
> >>  
> >> 
> >> __________________________________________________
> >> Do You Yahoo!?
> >> Bid and sell for free at http://auctions.yahoo.com
> 
> -- 
> G J Harrison


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