|
THERAPEUTIC TREATMENT GUIDELINES
LASER AND LASER TREATMENTS
The word Laser Stands for Light Amplification by Stimulated Emissions of Radiation.
Laser light is produced by exciting atoms in such a manner that they collide with each other. During this collision in the excited state, each atom releases photons; some of these photons lock together and travel in the same direction, wavelength and frequency.
Thus by exciting a specific substance and producing a chain reaction of the atoms, a coherent light is produced; this phenomenon is called Stimulated Emission.
This Light is then Amplified by refocusing it into a tight beam and allowing it to Radiate out.
When a laser beam is applied to living tissue it produces both a thermal, and a photochemical reaction.
The ability to focus the laser beam into a tightly controlled area, and the thermal cell destruction phenomena, are being used successfully in both major surgery, and plastic surgery.
Sophisticated techniques have been developed using high intensity lasers that have a considerable advantage over conventional surgical methods by reducing scarring, and by providing better control over bleeding.
Photochemical reactions follow the application of low energy laser beams, and consist of the reactions that occur when the cells take in the light energy, and incorporate this into their metabolic processes.
The intake of laser light causes the cell mitochondria to produce more energy, thus stimulating cell replacement, it increases ATP production providing more useable energy, and it causes a reduction of nerve cell excitability, providing instant reduction in pain and inflammation levels.
The energy produced by the laser light is measured in Joule, 1-Joule equals the energy produced by a 1000 mw laser in 1 second, or the energy produced by a 10-mw laser in 100 seconds.
Therefore a 4-joule treatment with a 30-mw laser will require 2 minutes and 15 seconds.
It is also important that the laser tip is held stationary on the treatment area; this reduces laser light loss, and maintains penetrating ability.
Treatments
For a worthwhile healing effect of muscle or ligament damage, and depending on the type of injury being treated, it is generally accepted that 2 to 8 Joule of laser energy needs to be absorbed by each 2x2 cm area of tissue at each treatment session.
Therefore the time spent treating each area depends entirely on the output of the laser.
Most injuries will require from 10 to 20 treatments.
It should also be noted that the joule output as described is based on a laser with a continuous beam, not a pulsed beam, as this dramatically reduces the joule output.
Acupuncture
Low output lasers are especially effective for acupuncture treatments, as each treatment spot only requires 0.5 joule of energy absorption.
Safety
Lasers emit powerful light radiation that can damage the eye retina, never stare directly into the laser beam, or allow others to do so.
All persons within the treatment area should wear suitable eye protection.
Allow laser treatment only when the hand piece tip is pressed firmly onto the treatment area.
Remove highly reflective surfaces from the treatment area, such as stainless steel fittings and mirrors. Do not allow anyone, especially children, to play with a laser.
APPLICATION NOTES FOR ULTRASOUND THERAPY
Ultrasonic therapy is the principle of applying waveform energy at frequencies above the normal range of hearing, but lower than radio frequencies.
Ultrasonic therapy uses a frequency of one million cycles per second (1 megacycle).
Normal range of hearing ceases above 20,000 cycles per second.
Ultrasonic energy penetrates body tissues to a depth of 5 cm or more, and affects the tissues in three ways simultaneously, thermally, mechanically, and chemically.
Thermally, the energy is transformed to heat, increasing blood flow and stimulating healing.
Mechanically, it has a stirring action within the tissue, providing a cellular micro massage effect.
Chemically, it increases cellular permeability and the diffusion of ions into and out of the cells.
The blood supply and lymph drainage are improved, more than by the application of heat alone.
In inflamed tissues, acid breakdown products are drained away.
Muscle spasms and pain are relieved in skeletal muscle, ligaments and tendons.
Ultrasonic therapy is normally applied utilising two different types of output; they are continuous wave, and pulsed wave.
The use of continuous ultrasound is generally limited to cases where the major aim is to deliver heat to the muscle tissue, or in large muscle bulk that is capable of absorbing the heat so produced.
Treatment with pulsed ultrasound reduces the heat effect, but enhances the micro-massage effect.
Pulsed ultrasound is best employed when treating small muscle areas, or when ultrasound treatment is undertaken to ligament or tendons, as in most instances this treatment will involve radiating the bone under the ligament or tendons.
When continuous ultrasound is used for this type of treatment it increases the chance of causing periosteum (bone) pain.
Each pulse of ultrasound energy consists of a large number of individual vibrations, which cause specific reactions to occur within the tissue, these reactions remain, until the next pulse arrives.
It is therefore unnecessary to increase power or exposure time, when pulsed beams are used.
Cautions In Ultrasound Therapy
Always use a good coupling agent such as a quality clear ultrasound gel, the addition of any type of liniment to the coupling medium is totally contraindicated.
For two reasons:
The addition of any particles to the coupling agent will reflect some of the energy produced by the ultrasound back into the ultrasound head, increasing the temperature of the face plate, and increasing the chances of damaging the barium titanite crystal.
Liniments are formulated to produce heat on the surface of the skin, and contain ingredients that may cause either kidney or liver damage when the ultrasound energy punches them through the skin and they have to be excreted from the body via the blood stream and the internal organs.
Over-Dosage
Of ultrasound produces a general feeling of fatigue and debility, which may also be accompanied by headaches and nausea.
It is therefore not a good idea to treat your Greyhound with ultrasound therapy in the 24 hours prior to racing.
Selection Of Dosage
It is desirable to always use the smallest effective dosage; the use of a short high dose is not equivalent in effect to a longer period of low dosage.
In general start with a low intensity 0.8 to 1.0 watt per cm for fresh injuries, and in subsequent treatments increase the dosage slowly to a maximum of 1.8 watts per cm.
Deep Seated Injuries
Due to the absorption in the tissues, ultrasound energy decreases with depth, after penetrating a tissue layer of 5 cm the intensity is reduced to half of its original value.
For deep-seated injuries when the power of the output needs to be increased to 2.0 watts per cm it is best to use a pulsed output to reduce the heat in the upper layer of muscle.
Should the head of the ultrasound unit get hot?
Not more than a comfortable body temperature, if the head gets hot there is something wrong with the unit.
Always unplug the ultrasound unit when not in use, or at the very least turn off the power point, it is far to easy for the unit to be turned on accidentally and burn out the face plate.
TENS APPLICATIONS
T.E.N.S this abbreviation stands for Transcutaneous Electrical Nerve Stimulation, the term Transcutaneous simply meaning “through the skin”.
TENS treatment utilises short electrical pulses that are designed to penetrate the skin and travel along the nerve pathways to the brain.
The main function of this is to interfere with the pain impulses that travel along the same pathways, providing pain relief for many chronic problems.
However a considerable body of evidence exists that indicates that the electrical pulses produced by the TENS also stimulate healing in damaged muscle tissue, and in damaged bone surface.
Pain Relief
An analgesic reaction may be achieved by setting the unit switch to NORMAL, the FREQUENCY to 100 and INTENSITY to 5.
Position one ELECTRO PAD on each end of the painful muscle or joint.
Treatment time is 30 minutes or more, and may result in a pain control period of 6 to 36 hours.
Caution, the masking of pain prior to strenuous exercise may result in a more severe injury.
To Accelerate Healing
Place the 4 ELECTRO PADS close around the injury site, with the pads of each pair being placed directly opposite each other. The field of maximum stimulation is central to each pair.
Set unit switch to NORMAL, FREQUENCY to 100 and INTENSITY to 5.
Treat for 10 minutes twice daily for 3 days, and then treat as for severe muscle strain.
Severe Muscle Strain
Place one ELECTRO PAD of a pair at each end of the muscle to be treated, set unit switch to NORMAL, FREQUENCY to 4 and slowly increase INTENSITY until a slight twitching movement is noted in the muscle being treated. Treatment time is 1 minute for the first treatment and 3 minutes for the next two daily treatments.
Thereafter treat as for general muscle strain.
General Muscle Strain
Place one ELECTRO PAD of a pair at each end of the muscle to be treated, set unit switch to BURST, and slowly increase INTENSITY until full but comfortable contractions are achieved.
Treatment time is 1 to 3 minutes twice daily for 3 days.
Treatment should be comfortable for the patient, if any signs of pain or discomfort are noted REDUCE INTENSITY, check setting, and resume treatment at a lower setting.
Electro Pads
It is vital to ensure good electrical contact between the pads and the area being treated. This is best done using a good conductive clear ultrasonic gel.
After each treatment rinse pads in warm water, and allow to dry.
Please Note
There are a large number of different brands and types of TENS treatment units on the market, and the controls may vary to the examples given. However it is essential that the unit design include a burst setting, as this is the only setting suitable for muscle re-education or contracting.
WHY TENS TREATMENT?
The Greyhound is racing over 515 meters and hurts itself, and you treat the injury with an ultrasound or laser until the damage is repaired. Unfortunately at this point in time, the rest of the Greyhound is capable of running over 515 meters, except the muscle you have treated and healed.
The healed muscle does not have the muscle tone to stand up to racing over the same distance, and you have two choices. Either give the Greyhound 2 or 3 runs over a shorter distance until the muscle tone in the healed muscle catches up with the rest of the body, or you follow up the ultrasound or laser treatment with either muscle contractor treatment or TENS treatment and re-tone the muscle.
Failure to do this is the main reason the same muscles keep breaking down run after run.
|
