Physiotherapy

 

General methods of therapy for lameness:

1. Physical Therapy:( Physiotherapy)
   It is restoration of form, function and promotion of tissue healing by assisting normal physiology.

1.	Cold
2.	Heat
3.	Massage
4.	Exercise
5.	Light
6.	Counter-irritation
7.	Electricity
8.	Manipulation
9.	Mechanical devices
10.	Cryotherapy

 

1. Cold: In acute/Hyperacute, noninfectious inflammatory process like in sprain of muscles, tissues, tendons, ligaments, joints and in burns. It will decrease exudates, decrease inflammation and decrease diapedisis. It prevents swelling and edema. Cold with compression bandage will result in reflex vasodialation after vasoconstriction, so applied with rest before 24-48 hours after trauma.

2.    Heat:

1.	Radiant Heat	By IR Light
2.	Conductive Heat	By Hot water bottle,Electrical heating pad, Hot fomentation or poultice
3.	Conversive Heat	Developed in tissues by resistance to high frequency electrical energy(Diathermy) or sound waves(Ultrasound)

 

Heat to be applied after 24-48 hours of trauma, will help in the resorption of swelling caused by blood or serum by vasodialation by heat, by which there will be more flow of oxygen, phagocytes, lymph flow, increased vessel permeability and increased metabolism in local cells resulting in more absorption of toxins.

Disadvantage : In infection , bacteria spreads deeper into tissues.

Superficial heat: By hot water poultices, heating pads, turbulator and U.V light.

Deep Heat: By Diathermy upto 2 inches. In ultra short wave diathermy current oscillates several million cycles per second. The high frequency electrical energy passes from one electrode through the tissues to the other electrode.

 

Ultrasound: Ultra high frequency sound waves produced by conversion of high frequency electrical energy waves to sound waves by crystal head of the instrument.

Massage:

In subacute and chronic swelling, combined wih liniments, lubrication quality of the liniment aids massage. It aids in reducing edematous swelling, pain of an injured tendon or a joint.

Faradic current :

Treatment by strong , intermittent alternating electrical current from secondary winding of an induction coil. It stimulates contraction of muscles, can be varied in intensity and timing. It prevents atrophy and promote joint mobilization. It prevents atrophy and helps disperse inflammatory fluids and haematoma, by increased blood flow, removing accumulated by products from muscle metabolism. Eg: Sprains and strains, injury of muscles, hastens recovery from injury and soreness.

Exercise:

In subacute and acute conditions to remove swelling in puncture wounds of limb, mid line incisions and castration in horses. To rehabilitate and strengthen the limb after tendon or ligament injury.

Swimming is best way to rehabilitate to muscle. Water helps to reduce edema and fibrosis of joint capsule.

• Physiotherapy helps

• To correct deformities,
• Develops the paralyzed muscles,
• Makes joint movement more supply,
• Prevents deforming tendencies.

PRINCIPLES OF TREATMENTS

• The ultimate aim of physiotherapy is the restoration of the fullest functional activity possible. Physical therapy can be achieved by some principles
  • Increase / maintenance of tissue fluid interchange, by stimulating circulation and metabolic interchange locally it is possible
    • To promote healing in cases where it is required.
    • Minimize risk of adhesion by absorption of excess inflammatory exudates.
    • To disperse metabolic waste products / oedema
    • To reduce pain and limiting the toxic effects.
    • To compact the effects of inactivity and there by reduce the risk of tropic change or disuse atrophy.
    • To prepare muscles to work.
    • To maintain unaffected tissue in a healthy functional state.
  • Increased / Maintenance of joint mobility:  
  • Muscle power must be maintained and increased
  • Adequate perspiration – tissue ventilation
    Transmission of heat

• Conduction: Transfer of heat energy from a hot body to cold. Hot Spoon – other end of spoon– hot.
• Convection: heat transference takes place by movement of a mass. Room can be heated with a stove – air in contact with heat warms the room. Liquids and gases are heated.
• Radiation: Heating of body by the radiation Eg: earth is warmed by sun’s radiation.
• Other: Heat energy may convert from some other form of energy. High frequency electrical currents – Diathermy. High frequency mechanical energy – Ultra sound.

CLASSIFICATION

• Physical methods
• Massage
• Exercise etc.,.
• Physical agents

• Conduction–Water-Hydrotherapy: Treatment by using water, either cold or hot.
• Thermo therapy: Treatment by using heat through conduction, convention,radiation and conversive methods.
• Radiation: Infrared therapy, UV therapy
• Conservation: Diathermy: Use of high frequency currents
• UltrasonicTherapy : Use of high frequency currents with oscillations

• Electrotherapy: Treatmentusingelectricalcurrent,Electrical stimulation,electrodiagnosis,faradism,and galvanisation

MASSAGE

• Manipulation of soft tissues with hand and fingers. Massage improves

• Circulation
• Nutrition supply
• Removes waste products
• Reduces edema
• Reduces indurations
• Loosens contracted tendons, ligaments and muscles.

• Indications
• Subacute, Chronic inflammatory conditions can be combined with the use of linaments
• Contradications
• Acute inflammatory conditions
• In danger of hemorrhage
• Presence of foreign bodies under skin
• Existence of new growth.
• Effects
• Stimulation/ Sedation of Sensory nerve endings in skin assists in local and general relaxation.
• Local hyperemic effect  
• Mechanical assistance by alternative pressure and relaxation due to venous and lymphatic return.
• Stretching and softening effect of fibrous tissue due to movement of skin and subcutaneous tissue.
• Lubricants

• These soften the skin during massage. Olive, mustard or coconut oil or fine grounded talcum powder can be used to reduce friction while massaging.

• Methods

• Stroking, kneading or friction.   
  • Slight Friction: It is performed with the tips of the fingers or the flant of the hand in centripetal direction.  
  • Methodical pressure:  this consists of applying firm pressure on to tissues with the pulp of the thumb or with fingers or the heel of the palm or with closed fist so as to act no deep seated structures.
  • Individual Compression of Muscles: A portion of the muscle is seized between the fingers and thumbs and manipulate from its insertion towards its origin compressing and displacing it.  
  • Percussion: Consists of superficial or deep percussion of the tissues by striking the part perpendicularly with the fingers or the closed hand.
•  Techniques
  • Hand massage: The strokes may be linear, circular or direct compression  
  • Friction massage: The stroke is small and is performed by using the tip of one finger reinforced by a second.   
  • Ice massage: local areas can be massaged with a handhold ice cube  
  • Machine massage: Massage machines have a series of fitments and vibrate rather than massage
  • Lineaments and rubs: Preparatory lineaments can be rubbed over  

EXERCISE

• Exercise constitutes active and passive movement of a part or whole of the body so as to strengthen or maintain the muscle and skeletal system.
• Indications

• Joint stiffness
• Poor posture
• Spasticity
• Paralysis
• Orthopedic problems.
• Effects
• Mechanical pumping effect   
• Sensory stimulation   
• Mobility   
• Passive movements stretch and soften the fibrous tissues.
• Restricted movement will build up muscles power.
• Balance and coordination can be improved.
• Cardiovascular and Respiratory capabilities improvement.
• Methods

• Passive exercise: In this method, the affected joint is grasped and its flexion and extension is done 10 – 15 times.  
• Active exercise: This includes walking, grazing and slow running up on a slope.   
• Techniques
  • Walker: The animals have been tied to the revolving arm of the walker.  
  • Use of weight: Place atleast 1.5 to 2.0 kg weight with a piece of gamgee above the fetlock and bandage.  
  • Treadmill: The moving belt of the treadmill ensures that the horse must move using all four limb evenly in order to remain in balance
  • Swimming: An excellent way to rehabilitate and condition the musculature of a horse without concussion to the limbs

HYDROTHERAPY

• Water absorbs more heat per unit of weight than any other substance. The solvent properties of water help checking infection and accelerate wound healing by removing dirt and necrosed tissue. A treatment time of 10-30 min. is sufficient for this effect.
• Buoyancy of water: These can be used to relieve pressure on effected parts.  
• Whirlpool hydrotherapy: It is essentially a water bath in which an extremity or the entire body is submerged in either warm or cold swirling water.
• Irrigation: Irrigating the affected part with a stream of water through a house pipe is a simple and cheap method.  
  Cold water application

• The normal temperature of skin is 68-86⁰ F.
• The temperature of cold water varies from 46.5-59⁰ F.
• The best result are obtained when the water is at a temperature of 50⁰ F.
•  Indications
• Acute congestion,
• Acute inflammation
• Septic lesions with diminished blood supply.
• Effects
• Hypothermia of tissues induces Vasoconstriction and decreases extravasation of blood
• Pain, muscle spasms and tissue metabolism are also reduced.
• Methods of application
• It is generally combined with compression bandage and rest, to limit the swelling.
• It is used during the first 24 – 48 hrs after trauma.
• Each application should last for 10 – 30 minutes with one hour application.
• For deep seated lesions like sprains, water at a lower temperature may be applied.
• Methods
• Cold effect may be produced by
• Ø Blowing air
• Ø Evaporation of volatile liquids
• Ø Applications of ice packs
• Ø By running cold water on the affected part
• Techniques

• Running stream: A pen built in a preferably fast running stream enables a horse to be stored in water for varying time and is labour free.
• Whirlpool tube: The injured leg is palced in to a container. Treat for 20-30 minutes and suitable for knee or hock curbs.
• Wille boots : place the leg in boot ,fill with water and treat for 20-30 minutes.
• Housing : Run cold water over the injured area for 15-20 minutes from a hose tube connected to the cold water tap.
• Cold bandaging: the bandages are designed with materials that when damped and placed in deep freeze, reduce to and remain it 6 ⁰ for 10 minutes.
• Frogen gamgee/ Cotton wool pads : Apply to the injured area over a towel to avoid ice burn.
• Ice massage: Rub ice over the area.
  Hot water application

• Indications
• Substance and chronic inflammations
• Recent inflammation after the acute stage has passéd
• Septic lesions in which the vitality of tissues lowered and they are threatened with deaths.
• Effects
• Analgesia by softening and relaxing the tissues.
• Hyperemia- exudation- interstitial infiltration, leucocytosis- phagocytosis.
• Reabsorbing of exudates.
• Methods
• The temperature gradually rose from 30 – 113⁰ F or even 122⁰ without scalding.

THERMOTHERAPY

• Indications
  • Sub acute and chronic inflammatory conditions
  • Sprains, contusions, sprains and myositis
  • To hasten the suppuration process Ex.: abscess maturation.
• Effects
  • Heat increases the tissue temperature which leads to sedation and analgesia.
  • Heat produce vasodilatation and promote phagocytosis, helps in the healing process.
  • Heat enhances metabolism and lymph flow .
• Adverse effects
  • Increased permeability of blood vessels leading to tissue edema
  • Increased absorption of toxins.
  • Heat should not be applied if infection is present due to spread bacteria and toxic products deep into the tissues
  • Thermo therapy should not be used during the initial 24 to 48 hrs after trauma.
    Conductive heat

• Conductive heat is superficial and does not penetrate beneath the skin so helps in reducing, swelling because of its higher osmotic property. The source of heating includes
• Hot water bottles
• Hot moist pack
• Hot water bath
• Fomentation
• Poultice
• Electrical Heating Pads
• Electrical blankets
• Paraffin Application
• Hot water poultices
• Hot water whirlpool is used for application of moist heat
• Various drugs. Ex: magnesium sulphate
• Commercial hot packs are available in different sizes, shapes and conversions.
• The packs are soaked in water at a temperature of 75⁰ C, heat is retained for 20 to 30 min. Adequate padding with a towel should be provided to prevent burns from hot packs. Exposures to desirable heat for 15 to 20 minutes are sufficient.
• Hot packs are more effective when used in a combination with massage, exercise or electrical stimulation.

Radiant heat

• Infrared therapy
• Ultraviolet therapy

INFRARED THERAPY

• Infrared rays are the radiant energy with wave length of 770 to 1,00,000 mu immediately after the visible light in electro magnetic spectrum.
  Classification

• Long wave infrared

• Emitted by all heated bodies, Low temperature bodies like hot water bottles, electric heating pads ,dull red heaters are good sources
• Wave lengths extend mostly from 1500 to 12,000 mu.
• Do not penetrate to deeper than 2mm
• Strongly absorbed in upper layers of the skin.
• Short wave infrared
  • Emitted by all incandescent bodies such as sun, electric incandescent lamps and specially designed high temperature infra radiators
  • Wave length extends from770 – 1500 to 1800 mu
  • The employment of special red glass filter restricts these sources
  • Penetrate to 5 to 10mm of skin tissues and influence blood vessels, lymph vessels, nerve endings and other subcutaneous structures directly.
  • Source
  • Natural: Sun light is most important natural source of intra red radiation and comprise over 60% in an average sunlight, the rest being UV and visible light.

• Artificial: These are of two types

• Low temperature / Non luminous / IR radiators: A bare wire carbon held in suitable non conducting material is used. It emits red glow and a quantity of red radiation.
•  High temperature/ Luminous / Heat lamps: Incandescent filament radiators are the principal sources of luminous heat radiation consists of tungsten filament enclosed in a glass help mounted at the center of concave reflector in an evacuated or gas filled glass bulb.

• Effects:
• Heating the superficial tissue of the body with infrared radiation exerts local as well as central effects.
• Local effects
• Effect on circulation
• Effect on nerve endings

Effect on circulation

• With in a few minutes of exposure to radiant heating the skin turns red and feels hot.
• This results in erythema in the form of a red spot or a network of red lines.
• It persists depending upon the length of exposure from 10 minutes to 1 hour.
• This excites an inherent tone in the capillaries that causes vasoconstriction and subsequent release of vasodilator substance.
• Upon the absorption of vasodilator substance more capillaries become active and more blood is supplied to the body.

Effect on nerve endings of the skin

• Mild heating results in sedation or relief of pain while strong heat stimulates marked counter irritation.
• General effects: Every local application of heat brings about a certain amount of general heating. The local excess heat is taken up by the blood stream and carried into the general circulation. The temperature control mechanisms of the body will immediately through off the additional heat by mild perspiration. The general recognized effects of mild general body heating are

• Increased heat limitation and professed perspiration.
• Circulation, a rise of the pulse rate
• Lowering of blood pressure
• Increased respiration
• Increased elimination through the kidney.
• Clinical uses

• Sub acute and chronic traumatic and inflammatory conditions in locations accessible to external heating such as contusions and muscle strains, traumatic synovitis and tenosynovitis, sprains, dislocations and fractures.

• Various forms of arthritis and rheumatic conditions,neuralgia
• Acute, sub acute and chronic catarrhal conditions of the mucous membranes/Conjunctivitis coryza, sinusitis
• Circulatory disturbance of the extremities
• Infections of the skin, folliculitis, furunculous and deep abscess in the skin.
• As preliminary heating to other physical measures, like massage, voluntary and passive exercise.

Technique of application

• The patient should be placed in a comfortable and relaxed position
• Direct the radiation from the generator over the part at a distance
• The distance will average from 2 to 3 feet according to the sensitivity of the parts
• Exposure is continued for10 to 15 minutes when the objects is nearly to warm up the parts preliminary to some form
• Treatment for 20 to 30 minutes is sufficient if heat radiation is the source of treatment.

Dangers and Precautions

• Erythemal response consists of individual dark red spots
• Hypersensitivity may produce after the initial erythemal, wheal formation, local edema and eventually blistering.
• Special precautions are imperative in patient whose skin sensation is impaired in those which scars on the skin after burns or other injuries that have destroyed part of the normal skin or its nerve conditions.

ULTRAVIOLET THERAPY

• The range of radiant energy designated as Ultraviolet extends from 390 to 180. Very hot bodies and ionized gases emit Ultra violet rays.
  Classification

• Near Ultraviolet radiation: Which is continuous to the luminous rays and consists of comparatively long range extending downward to 290 mu
• For ultra violet radiation: Consists of comparatively short rays extending from 290 to 180mu wave length.

• Source:
• Natural: The chief natural source of ultra violet radiation is the sun.
• Artificial: Radiation from artificial sources represent only approximations to sun light and no two are alike in respect to the spectral distribution of the energy they emit.
• Electric arcs between electrodes of metals and of carbon

Mercury in quartz

• Mercury Vapor Lamp: Mercury is a liquid metal at a room temperature when vaporized in a quartz container by intense heat emits a spectrum rich in UV light characterized by a series of intense spectral lines or bars.  
• These are classified as
  • Hot Quartz Lamps – High Pressure – 1 to 10 atmosphere.
  • Moderately warm lamps – Medium pressure 0.1 atmosphere
  • Cold Quartz Lamps Low pressure 0.001 atmosphere.
• Fluorescent Sun Lamp : -  The 20w lamps will produce minimal erythemal at a distance of 2 feet in 20 minutes, the bare lamp produce in 7 minutes with a reflection.
• R.S.types sun lamp (Reflector): -These consists of a mercury arc tube enclosed in a special glass bulb .These lamps emit Ultra violet radiation of minimum perceptible erythema in 5 minutes at 24 inches.
  Effects

• Physical properties: UV rays penetrate to a very limited extent through bodies.
• Physiological effects
• Erythemal production: Radiant energy between prevalence of 320 to 240 mu produce erythema of the skin within 2 to 8 hrs. 
• Nerve endings: stimulation produce marked analgesia.
• Blood: Bactericidal effects of blood are increased.
• Pigmentation: Repeated irradiation with erythema
• Metabolic effects
• Activation of Vitamin D
•  Bactericidaleffects: Spectral Band at 265.2 mu produces maximum bactericidal effects.

Technique of UV irradiation

• For general irradiation entire undraped body should be exposed.  
• The genetalia should be covered by a cloth.
• The centre of the part to be exposed to be in direct line of irradiation.
• A timer should be used to measure the time of exposure.

Dosage

• The erythemal response of the individual patient serves as a guide for dosage  
• Distance of the Burner: Distance of 30 inches  
• Duration of Exposure: Local : 3 to 5 minutes, Systemic:15 minutes -5 days usually 20 exposures are required to effects a complete cure.
  Clinical uses

• General tonic effect
• Chronic Ulcers
• Tuberculosis.
• Skin conditions a) Psoriasis b) Acne
• For Diagnosis – In dermatological cases with the aid of woods lamp to detect fungal infection.

Dangerous of UV Irradiation

• Dermatitis due to UV energy
• Local ulceration: impetigo, folliculitis  
• Excessive irradiation - death from general toxemia.
• Exposure for a longer period produces atrophy, wrinkling, and warty skin.

 

DIATHERMY

• The principal physical effect of high frequent current is the heating of the tissue.  
•  High frequency tissue heating is an important heating modality in which tissues get heated without superficial heating.
• A high frequency current is defined as an alternative current consisting of a million or more oscillations per second.
  • Long wave diathermy – Oscillations of a frequency of about million per second and applied through bare metal electrodes placed in direct contact with the skin or mucus membrane.
  • Short wave diathermy - Oscillations from 10 to 100 million per second applied through a spacing of air or rubber.
  • Micro wave diathermy – Oscillations of 3000 millions per second which are used by focusing single beam of electro magnetic emery from some distance to the region to be created.

•  Clinical effects

• Effects on circulation 

• Local Effects: The local application of diathermy results in an active arterial hyperemia – in increased flow of lymph – an increase in the volume of the part thus effected.
• General Effects:  Rapid dilatation of peripheral blood vessels ,an increase in the pulse rate and respiration and perspiration – an increase in the general body metabolism.
• Effects on nervous tissue

• Diathermy exerts a marked sedative effect on the spasms and cramps

Clinical uses

• Deep hyperemia causes: An increased arterial flow with more oxygen and improved nutrition while the greater venous flow carries away larger degree the products of local metabolism.
• It promotes disintegration of inflammatory exudates  
• The pain and spasm relieving effect of diathermy makes its used indicated in irritation of sensory and motor nerves.
• In traumatic and inflammatory conditions of bursas, bones and joints after the acute stage.
• In painful and exuberant callus formation and fibrous ankylosis, joint injuries.
• In post operative adhesions in extremities.
• Spastic conditions of the stomach.
• In the treatment of neuritis and certain conditions of neuralgia or myalgia.
• In the treatment of chronic infections.

Contra Indications

• In acute inflammatory process accompanied by fever and suppuration

• In tendency to hemorrhage recent hemoptysis
• In malignant tumors.

APPLICATION OF DIATHERMY

Methods of applications

• Heating in the electrical field
  • It is the physical characteristic of electrical oscillation of very high frequency that in a capacitor arrangement with conductive tissue placed in between two electrodes.
• Heating in the electro magnetic field
  • A flexible heat insulated cable in the form of the coil or loop is placed in the form of a pancake over part of the body.

•  Microwave heating

• This is eradiated electro magnetic fild the energy is deemed from an antenna and no contact is required for its transmission.  
• Physiological and clinical effects of diathermy are due to raising of the temperature of the parts under influence of the heating currents.
•    

TECHNIQUE OF SHORT WAVE AND MICROWAVE DIATHERMY

Technique of short wave diathermy

•  
  • Condenser pads are held in place by elastic bandaging or perforated rubber band
  • Double Cuffs: Consists of a pair of long or narrow condenser pads that are applied along lymph flow at suitable distance from each other. 
  • Air spaced condenser plates: Consists of circular metal plates or disks covered with insulating material.
  • Inductance Coil: For coil fill heating or inductothermy 2 or 4 thickness of Turkish toweling should be placed between the cable and skin. 
    Technique of microwave diathermy

• The minimum spacing with any director is 1-2 inches. In applying microwave diathermy one should see that the surfaces treated are dry and no toweling should be placed over the skin, equip mental moisture can be wiped off from time to time.
• The director should not be used without their protective coverings.
• The directory should never be placed with an open side against the metal surface of a table.
• Special care is advised in treating the region of the head speciality the eyes.

ELECTRO THERAPY

• Electricity employed for the diagnosis of certain nerves and muscular legions is called as Electro Diagnosis and the treatment of different affections by electricity is called electro therapy.
• Electro Diagnosis Electricity used in this respect reveals information on the degree of contractibility of muscles, the integrity of alterations of motor nerves. To ascertain the degree of contractibility of muscles, the continuous and reduce currents are applied.
  Technique

• Diagnosis of the affections will depend upon
• Whether there is hyper excitability or hypo excitability.
• Whether contractions are produced with both faradic (AC) and Galvanic (DC) currents or by DC or only by AC.
• Whether any difference in the contractions (excitability) is noticed by stimulation with
• Galvanic current after inter change of the electrode.

• Hypo or Hyper excitability:  In hyper excitability contraction is obtained with relatively weak current.
• Response to AC / DC Currents: Either DC or AC currents produce normal contractions. In case of partial degeneration of muscles only galvanic current ( DC) produce  contraction of the muscle whereas with faradic current no contraction will occur. In case of complete degeneration both currents (AC/DC) will not produce contractions.
• Response to inter change of electrodes – On Galvanic stimulation of normal muscle maximum response in flow of current will be seen when the cathode is placed distally (KCC ACC i.e. the cathode closing current is higher than the anode closing current). In case of partically degenerated muscles maximum response will be soon in the flow of the current when the anode is placed distally (ACC KCC). This is called as inversion formula of muscle currents under galvanic currents.

• Continuous currents (DC) Galvanization
• Induced currents (AC) Faradisation
• High frequent currents – Dorsonavalisation
• Electrical sparks and flashes – Fulguration.

•   If muscles respond to faradic current the positive electrode should be at the distal part of each muscle, the negative electrode should be on the course of the nerve at any point of its emergence or where it is superficial 3-4 minutes is the duration of the time. If the muscle do not react of to faradic current then use galvanic current.  

IONOPHOROSIS

• Electricity used to cause penetration of the tissues by medicaments dissolved in water. By the action of current the molecules agent are decomposed to or several as of which some charge positively descend the current and other charge negatively ascend the current.

• Agents
• Sodium chloride, Salicylate of Soda, lodide of potassium, Quinine, Zinc and lithium.

Technique

• The solution must be prepared with distilled water and galvanic current is employed. The electrode positive or negative according to the active ion of the medicament negative or positive covered with a thick layer of cotton wool saturated with solution is placed on the region affected and fixed by an elastic bandage to ensure close contact with the skin. The other electrode is placed at a point so that the current gradually increased to a tolerate degree for 10 – 30 minutes of every alternative day.

• Conditions: Ulcers, Neuralgia, Neuritis, Phlegmatic arthritis.

Fulguration

• Employment of electrical sparks or splashes in the treatment. It is affected by means of high frequency currents brought to an electrode which is placed at a certain distance from the tumor projects on to it a series of long flashes.
•  The hemorrhage is immediately arrested and the surface of the wound becomes blackish gray, then the paid disappears or diminishes a capacious flow of lymph occur and after a few days granulations from followed by cicatrisation on the production of fibrous tissue which encloses the affected part and prevent extension of the disease.
• Conditions: Ulcers, Neuralgia, Neuritis, Phlegmatic arthritis and Gout.

ULTRASONIC THERAPY

• Ultrasound is classified as a heating agent when used therapeutically. Therapeutic heating agents are divided into two categories. Those that heat superficial tissues and those that heat deeper tissues.  
• These agents only elevate skin temperature with little changes in the temperature of the under lying structures.
• Deep heating agents cause temperature elevations in tissues to depths or 3 cm or more, without over heating the superficial tissues. Besides ultrasound, short wave and microwave diathermy are included in this category but of these, ultrasound is by far the most appropriately designed tool.
• Ultrasound is used for diagnosis imaging of internal structures. For tissue destruction surgery for tumor irradiation and lithotripsy, for physical therpy to promote deep tissue healing and restores function in points. The various properties of ultrasounds are listed below.
  Physical properties

• A molecule set in motion will cause its neighbour to move, and in turn its neighbour, until the vibration has propagated throughout the material. Propagation of vibratory motion is the basic element of sound wave production.
• The vibratory frequency of sound wave affects its absorption into body tissue.
• The higher the frequency, the less the sound waves diverge. Sound waves at greater than the audible sound range (20-20000 Hz) appear to spread out in all directions.
• Physical therapy devises products – beam of sound at a frequency of one million cycles per second (1 MHz) that is sufficiently collimated to penetrate to selected target tissues.
• As sound wave frequency increases, its absorption by the tissue increases. As absorption increases there is less sound energy available to propagate further through the tissues.
• Therapeutic frequencies of 1 MHz penetrate as deep as 4 – 6 cm into the tissues. Tissues with a high fluid content, such as blood and muscle, will absorb sound waves better than less hydrated tissues.
• Nerve tissue has a high coefficient of ultrasound absorption. This expands treating possibilities to sounding nerve roots that are associated with peripheral conditions.

THERMAL, CHEMICAL AND THERAPEUTIC EFFECTS

Thermal effects

• The ultrasound wave travels through the medium, mechanical energy is converted to heat.  
• With in the body tissue, wave reflection is greatest at interfaces of bone and soft tissue because of the greatest difference in their acoustical absorption.
•  Blood vessels and membranes in the path of the interacting waves could also suffer thermal damage.  
• Thermal damage can be avoided by using low intensities  
• Absorption of ultrasound takes place on the molecular level and protein molecules are the major absorbers skin and subcutaneous fat do not absorb ultra sound well, so the skin surfaces may remain cool while underlying structures are heated. This unique characteristics among heating modalities makes ultrasound an ideal therapeutic total for sports insures, such injuries usually occur to the nerves, ligaments, tendons, joint capsules and muscles, all tissues with a high protein component and high coefficients of ultrasound absorption.
•  Chemical effects

•  Ultrasound waves are made up of alternating areas of compression and rarefaction increased density and pressure (compression) areas of decreased density and pressure (Rarefaction).
• Rarefaction causes air bubbles in the blood or tissues fluids to expand because of the decrease in pressure. During expansion gas enters the bubble.
• The compression phase for the wave caused the gas to flow out of the bubbles.
• Rarefaction and compression phase forms the gaseous exchange with exerts mechanical stress on the surrounding called cavitations, a nerve that refers so to variety of bubble activities ranging a from stable vibration in response to the regularly repeated pressure change induced by the sound wave, to violent implosion of the bubbles under high ultrasound intensities.

•  Therapeutic effect

• An increase in point range of motion

• stiffness and a decrease in flexibility must be addressed with stretching exercise to region normal point function. Stretching exercises are facilitated by the heating effects of ultrasound.
• Elevating the tissue temperature before passive or active stretching will enhance the effects of the stretch.

•  Decrease in pain and muscle spasm
• It reduce pain following injury or surgery.
• Ultrasound has an effect on nerve fibre conduction
• Ultrasound therapy was used successfully on painful neuromas and post –operative scars.
• It is useful in back pain and herniated intervertebral disc syndrome.
• Calcium deposits: Ultrasound can be used to stimulate the resorption of calcium deposits splints.
• Wound healing
• Wound healing is more rapid.
• Ultrasound promotes the healing of pressure sores increase the rate of protein synthesis by fibroblasts, increased lysosomal permeability.
• It enhances tendon repair.

PHONOPHORESIS

• It is a special use of ultrasound in which the sound waves aid in the transport of medications through tissue membranes. The sound wave drives whole molecule subcutaneously up to a depths of 6 cms.
• The medications used in phononhores is are anti-inflamatory agents and anaesthetics. Hydrocorotisone is the drug used most often in the treatment to tendoints, epicondylitis, burnitis and other myofacial pathologies. For this technique mix the drug in proportions of 5 to 10% into the transmission gel.  
  Continuous versus pulsed wave

•   Use the continuous wave form when heating is desired.   
•   Muscles blood flow provides a cooling mechanism so tissue interfaces are not overheated in such area as long as the sound head is moved steadily.  
• Use pulsed ultrasound then effects other than heat are desired. The non-thermal effects of ultrasounds include acoustic streaming. Which enhances the process of diffusion.  
  Dosages

• To arrive at the appropriate usage, consider power output intensity (Watts), the duration of exposure, and the size of the surface areas over the structures to be treated.   
  Treatment precautions

• Pain by over heating of superficial compact bone.   
• The uterus should not be exposed to therapeutic ultrasound.
• The heart should not be directly sonated.
• Ultrasound should not be used repeatedly over or near growth centers of bone until bone growth is essentially complete.
• Ultrasound should not be used on an injured area immediately after exercise.