The technology behind electrical stimulation and ultrasound treatments continues to change. Unfortunately, the administration of electrical stimulation and ultrasound treatments hasn’t always kept pace with the changing technology. Physical therapists recently had the opportunity to learn the correct way to complete electrical stimulation and ultrasound treatments at a seminar sponsored by Advantage Medical Rehab Equipment and Supplies.
The one-day seminar provided physical therapists with a comprehensive overview of the history, theories and proper administration of ultrasound and electrical stimulation treatments. Participants learned the correct frequency and time required to correctly achieve a 1 to 4 degree rise in tissue temperature when using an ultrasound. The guidelines for achieving a rise in tissue temperature are outlined below:
Tissue Temperature Rise
(Degrees Centigrade)
1.0 MHz Frequency (1.0 w/cm2)
Time Required
3.0 MHz Frequency (1.0 w/cm2)
Time Required
1
2 minutes 32 seconds
51 seconds
2
5 minutes 4 seconds
1 minute 42 seconds
3
7 minutes 35 seconds
2 minutes 32 seconds
4
10 minutes 6 seconds
3 minutes 22 seconds
Seminar participants also learned proper techniques for completing nerve blocks, pain modulation, muscle re-education, tissue healing, edema management and other electrical simulation and ultrasound treatments. A few simple things physical therapists can do to immediately improve electrical stimulation and ultrasound treatment administration include:
1. Avoid using ultrasound gel warmers. When heated, the viscosity of the ultrasound gel decreases and reduces the efficiency of sound wave transmittal.
2. Take it easy. During an ultrasound treatment, gently glide the ultrasound head on top of the gel along the patient’s body. Do not press so hard on the device that the gel pushes out from the sound head. The added pressure can make the treatment less effective and more painful for the patient.
3. Use quality electrodes. The type of electrodes you use impacts outcomes. Mesh electrodes may cost less but do not conduct electricity as well as carbon based electrodes. To provide patients with the best possible outcomes invest in carbon-based electrodes.
4. Take time to consider the patient before doing a treatment. Take your patient’s age, health and purpose of treatment into consideration. Use this information to determine the right frequency to use for the treatment you’re planning to give.
5. Talk with patients prior to giving a treatment. Help patients understand how the treatment works, how they can expect the treatment to feel and any risks and benefits associated with the procedure.
Plantar fascitis is , a repetitive strain injury of the medial arch and heel, is one of the most common causes of foot pain. It is an inflammation of the dense, fibrous connective tissue structure originating from the medial tuberosity of the calcaneus. It has 3 portions :- medial, lateral and calcaneal and the largest is calcaneal.
The function of the plantar fascia is twofold: statically, it stabilizes the medial longitudinal arch; dynamically, it restores the arch and aids in reconfiguring the foot for efficient toe-off. When this tissue
becomes damaged, pain and/or weakness may develop in the area.
Risk factors
overweight
training errors
lack of stretching before sports
repetitive strain injuries of foot
occupations
foot wear
flat foot deformity
prolonged standing, walking
Biomechanics of the foot and ankle during walking and running
A runner’s gait can be separated into two phases: the stance phase and the swing phase. During the stance phase, the foot contacts and adapts to the ground surface; during the swing phase, the leg accelerates forward and prepares for ground contact. The stance phase consists of the following four sub-phases: initial contact, loading response, midstance, and terminal stance. During initial contact, the heel contacts the ground surface. The loading response occurs immediately after initial contact, ending
when the contralateral foot lifts off of the ground surface. The midstance phase starts when the contralateral foot lifts off of the ground surface; the contralateral leg is now the swing leg. The midstance phase ends as the tension on the gastrocnemius, soleus, and achilles tendon of the stance leg causes the heel to lift off of the ground surface. The terminal stance phase begins when
the heel lifts off of the ground and ends when the swing leg contacts the ground
The subtalar joint consists of the articulation of the undersurface of the talus with the calcaneus.Movement of the subtalar joint is pivotal in transforming the foot from a rigid lever during initial ground contact to a mobile shock absorber during loading response and early midstance, and back into a rigid lever as the foot prepares for toe-off. The two primary movements that occur at the subtalar
joint (STJ) are pronation and supination.
Symptoms
pain occurs when placing foot on the ground at very first in the morning
swelling occurs
limmited range of motion in severe cases
inferior heel pain
Treatment
Literature indicates that plantar fasciitis may be successfully treated using a conservative approach.An understanding of the anatomy and kinematics of the foot and ankle, the static and dynamic function of the
plantar fascia during ambulation, and knowledge of the contributing risk factors associated with plantar fasciitis aid in developing a proper treatment and preventative protocol for this condition.
General principles of treatment
examine lower extremity for possible factors :- pes cavus or pes planus, LLD, fat pad atrophy,signs of arthritis
review questions for possible traning errors or overuse findibgd in runners and atheletes
identify poor shoe wear, hard walking, or running surface,supinator or pronators like wear of running shoes
assessment of tight calfs and hamstring that may contribute to this condition
treatment are more aggressive or more invasive if first phase is unsuccessful
patient education- to ensure patient does exs at home, time table
phase 1
SRICE
electrotherapy- ultrasound, TENS, cold pack, cryo Plantar fascia stretching
1.Cross your affected leg over your other leg.
2.Using the hand on your affected side, take hold of your affected foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia.
3.Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.
4.Hold the stretch for a count of 10. A set is 10 repetitions.
5.Perform at least 3 sets of stretches per day. You cannot perform the stretch too often.
Calf stretch Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind your other leg.Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg. Hold the stretch for 15 to 20 seconds. Repeat 4 times.
Deep friction massage of the plantar fascia- Apply gentle pressure across the entire foot as you smoothly glide down the foot. This will help loosen the tendon and direct tissue towards the heel to either help prevent or heel a bone spur, a condition which often goes hand in hand with plantar fasciitits.
Exercises
Marble lift- Put marbles on the floor next to a cup. Using your toes, try to lift the marbles up from the floor and put them in the cup.Repeat exercise 15 times.
Toe curls on towel- curl up your toes on towel. Try to grab the towel with your toes. Hold for 10 seconds and do 20 reps
Balance exercises on wobble board
ROM exercises for ankle and toes
Shoe wear modifications ( Running shoes )
Flared stable heel to help control heel stability
Firm heel counter to control hindfoot
Soft cushioning of the heel, raising the heel 12-15mm higher than the sole
Well molded achilles pad
Avoid rigid leather dress shoes that increase torque on the achilles tendon
Anti-inflammatories
Oran anti-inflammatories have variable results. Ex : cyclooxygenase
Myofascial techniques have been shown to stimulate fibroblast proliferation, leading to collagen synthesis that may promote healing of plantar fasciitis by replacing degenerative tissue with a
stronger and more functional tissue. There is considerable clinical evidenceto support the effectiveness
of deep tissue procedures in treatment of strain/sprain injuries.
Referrence
Department of Foot and Ankle surgery- Kaiser permanente
Kinesiology of the Musculoskeletal system- Donald A.Neumann
improve rom of joints especially at your pelvic floor
abdomen strengthening and especially pelvic floor to prevent urine leaking
maintaining a good upright posture through your pregnancy
teaching relaxation techniques through your pregnancy
teaching breathing control to assist you during labour
In the UK, you're recommended to attend antenatal classes and breastfeeding workshops (NCCWCH 2008). Traditional teacher-led classes are now making way for classes where mums-to-be and their partners set the agenda. This is because interactive classes help women have a better birth experience and make the early weeks with their babies easier to cope with (NCCWCH 2008).
Below are some good video on antenatal exerices together with some notes on the exercises in pdf format.
This is an assessment form produced by the American Spinal Injury Association. It is intended for use in patients who have suffered a spinal cord injury. It includes motor, sensory and functional assessment
A new study reports that yoga can reduce the stress of cancer diagnosis and treatment experienced by childhood cancer patients and their parents. The findings were published in the September/October 2010 edition of Journal of Pediatric Oncology Nursing, published by the Association of Pediatric Hematology/Oncology Nurses (APHON).
"Parents and adolescents showed a decrease in anxiety and increase in sense of well-being" following yoga sessions conducted for the study, the authors wrote. Megan V. Thygeson, BA, Mary C. Hooke, PhD, RN, CNS, CPON, Jeanine Clapsaddle, MA, LAMFT, CCLS, Angela Robbins, MS, RN, CNP, and Kristin Moquist, MA, RN, CNP, CPON wrote the study, which they conducted at the Children's Hospitals and Clinics of Minnesota.
"Yoga is emerging as an effective complementary therapy in adult oncology," the authors wrote, "promising benefits for decreasing symptom distress including fatigue, insomnia, mood, and stress resulting in improved quality of life." The authors explored a new area, focusing on childhood cancer patients and their families, noting that parents experience stress and anxiety because of the uncertainty of the disease and the suffering of their children.
Children in the study between the ages of 7-12 did not show any change in their anxiety or sense of well-being. However, adolescents between the ages of 13-18 years and the parents of hospitalized patients showed significant improvement.
"Teens reported that that they felt relaxed and calmer, and that it (yoga) was fun," the authors wrote. Parents detailed even greater benefits. Parents found the yoga sessions were relaxing, allowed them to stretch their muscles and strengthen their bodies, and relieved stress. They felt better about themselves, and those who participated in the sessions with their children felt it helped them bond with their children.
Yoga lowers heart rate and blood pressure and improves circulation and oxygenation. It also improves muscle tone, circulation, pulmonary function, coordination and flexibility. "Larger studies are needed to evaluate the influence of yoga on other distressing patient symptoms such as fatigue, sleep disturbance, pain and nauseam" the authors wrote.
Source:
Association of Pediatric Hematology/Oncology Nurses (APHON)
Many of us not really knows much about short wave diathermy. Here's a brief note on it and a video on how to apply shortwave diathermy for patients
Short waved diathermy is the therapeutic elevation of temperature in the tissue by means of an oscillating electric current.
The tissue and body organs are overheated, which increases local metabolism, supports absorption of chronic inflammatory, post-injury and post-operation infiltrates, improves tissue elasticity and has analgetic effects.
Indication: chronic diseases of joints, tissue and sinews, chronic inflammations, both gyneacological and urological, post-operation states, urge incontinence
Contraindication: cardiostimulator, direct application to metal implants, malignant tumors, acute inflammations, bleeding states, tromboflebitis etc. During the menstrual period the procedure cannot be applied to patient´s stomach, as well as to growth zones.
The procedures must always be prescribed by the doctor.
