Week 6 (parts 1 and 2)

Question 1

what is Ultrasound (US)

Answer 1

Not imaging
Mechanical vibration (energy) = sound
Human hearing 16 vibrations per second (Hz) to 15 to 20,000 Hz
Above this is Ultrasound 1-3 million Hz or 1-3 MHz

Question 2

How does Ultrasound work

Answer 2

Sound passes into the tissue and causes molecules to vibrate
Basically increases the activity of the cells – may enhance healing.
Can also heat tissues at high doses.
Contraindications – eg pregnancy, malignancy
Precautions – tissue bleeding, pacemakers
Set up
gel
Dosage

Question 3

What is Ultrasound

Answer 3

Not imaging
Mechanical vibration (energy) = sound
Human hearing 16 vibrations per second (Hz) to 15 to 20,000 Hz
Above this is Ultrasound 1-3 million Hz or 1-3 MHz

Question 4

how do you use Ultrasound

Answer 4

• Need to have gel to allow US to travel from the device into the body
• 3 MHz – superficial (<2cm)
• 1 MHz – deeper (>2cm)

Question 5

what the precautions associated with Ultrasound

Answer 5

• Ensure that the applicator is moved throughout the treatment (speed and direction not an issue)
• If a thermal dose is intended, ensure that any contraindications that apply have been considered
• Caution is advised in the vicinity of a cardiac pacemaker or other implanted electronic device
• Continuous ultrasound is considered unwise over metal implants

Question 6

What is Transcutaneous Electrical Neural Stimulation (TENS)

Answer 6

Electrical stimulation for pain relief
Pain gate (probably too simple a theory) and or opioid system
Placement of pads usually either side of the painful area.

Question 7

What the TENS precautions

Answer 7

Pregnancy (local+general), Malignancy, Specialised Tissues, Active Implants, Tissue Bleeding, Metal Implant, Local Circulatory Insufficiency, Epilepsy, Devitalised Tissues, Active Epiphysis
TESTS:
Thermal skin test, sharp/blunt test

Question 8

TENS - parameters

Answer 8

Intensity/strength
Usually 0-80mA
Usually strong but comfortable
Pulse rate/frequency
2-150 Hz (pulses per second)
Pain gate – 90-130 Hz
Opioid – 2-5 Hz
Duration of each pulse
40-250 millionths of a second
Not thought to be that important

Question 9

what is shockwave therapy

Answer 9

• Bit like thunder after lightening or a sonic boom
• Initially used for breaking up kidney stones
• Potential effects
• Increased blood flow
• Increased cellular activity – trigger stalled repair sequence
• Reduce pain
• Systematic review - Knee OA
• Liao et al 2019
• Beneficial – reduce pain and improve outcome measures
• Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT)
• Low level evidence
• Korakakis et al 2018
• NICE – 2016
• Achilles Tendinopathy – efficacy inconsistent evidence

Question 10

what are the contraindications of shockwave therapy

Answer 10

• Lung Tissue
• Epiphysis
• Haemophiliac or patients on blood thining
• Malignancy
• Infection in local area
• Joint replacements

Question 11

what are the principles of cold therapy

Answer 11

• Cooling – the transfer of heat energy away from the tissues by conduction
• Effects of Cold Therapy
• Reduced blood flow through vasoconstriction
• Reduce pain
• Reduce metabolic rate eg inflammation
• Reduce swelling
• Limiting Tissue damage
• May reduce Delayed Onset Muscle Soreness (DOMS) post exercise

Question 12

what is the evidence for cold therapy

Answer 12

• Review of the evidence cryotherapy post knee replacement
• Conflicting evidence – lack of good studies eg long term outcomes (Thacoor and Sandiford 2019)
• Lack of quality evidence to support use of ice following lateral ankle sprains despite commonly used (Yerhot et al 2015)

Question 13

what are the precautions needed for cold therapy

Answer 13

pregnancy, malignancy, specialised tissues, active implants, tissue bleeding, metal implant, local circulatory insufficiency, epilepsy, devitalised tissues, active epiphysis

Question 14

what are the theoretical effects of heat therapy

Answer 14

Theoretical Effects
Increased blood flow - vasodilation
Reduce pain – not sure how occurs
Increase soft tissue extensibility
Aid healing – not in acute phase <36 hours post injury
Increase ROM
Reduce muscle spasm

Question 15

what the evidence for heat therapy

Answer 15

• Heat and naproxen more effective than naproxen with acute low back pain
• Hot water bottle 20 mins x2/day for 1 week
• Was done in Iran
• Dehgan and Farahbod 2014
• Systematic review treatment of low back pain
• Moderate evidence to for heat therapy
• Chou et al 2016

Question 16

what do you need to consider when using physical agents

Answer 16

clinical reasoning, contraindications, precautions and dosage.