Laser therapy, ultrasound, shock wave therapy

Ultrasound therapy (UST) is a therapeutic method based on ultrasound. It is indicated for the treatment of various diseases, as well as their prevention, and has become widespread in various medical fields. UST helps reduce the frequency of exacerbations and reduce the time required for the body to recover in the postoperative period or after acute forms of disease.

Ultrasonic waves first became known in 1899, and their practical application occurred a little less than 20 years after their discovery. The result of joint research by a Russian engineer and an inventor from France was the emergence of a source emitting ultrasound. Its functioning was based on the piezoelectric effect. A little later, an apparatus appeared that worked on the basis of magnetostriction. Over time, the device was improved, and its rays became more focused on a specific object. Thanks to this, this device has found application in the industrial sector. In the field of medicine, ultrasonic waves became widespread after 1927.

The use of the ultrasound method in the treatment of various diseases was provoked by the description by scientists in their works of the biological influence of ultrasound on the human body. There is an assumption that Pohlmann was the first to find the use of ultrasound. It was he who was the creator of the vibrator, which studied ultrasonic waves, and used it to treat the following diseases:

• myalgia;
• sciatica;
• neurogia.

Such therapy has shown its effectiveness, which will lead to widespread use of the UST method in many countries by 1945. Only 8 years later this therapeutic technique began to be used in Russia. The first to try it was the scientist V.A. Plotnikov, while treating a patient with Dupuytren’s contracture. Just a couple of years later, this method of treatment was applicable to people suffering from joint, skin and neuralgic pathologies. The first domestically produced ultrasound devices appeared in the early 60s of the last century. Their serial production gave impetus to the spread of ultrasound therapy.

Mechanism of Ultrasound Therapy

Currently, several mechanisms of the influence of ultrasound on the human body are known, which relate to the primary mechanisms of ultrasound.

Among them:

1. Thermal – providing for the transition of ultrasonic waves into heat after they are absorbed by tissues. This leads to an increase in their temperature by about one degree. At this time, the activity of enzymes inside cells and biochemical reactions increase. Heat appears exclusively at the boundaries of tissues that have different densities. Thermal energy is absorbed to a greater extent by organs in which there is a lack of blood flow and saturation with collagen fibers, as well as nerve and bone tissue.
2. Mechanical – which is based on high-frequency vibrations transmitted to tissues. At this moment, a vibration elusive to humans occurs, provoking an acceleration of blood circulation and an increase in cellular metabolism. The vibration effect helps to liquefy the cytoplasmic fluid, accelerate the diffusion of microelements, and also loosen connective tissues. All this increases the metabolic rate. When high-frequency waves are applied, an increase in the degree of permeability of histohematic barriers is observed.
3. Physico-chemical - provoked by mechanical resonance and contributing to an increase in the speed of movement of molecular structures. This type of impact accelerates the breakdown of molecules into ions, resulting in the formation of new electric fields. Lipids are oxidized faster, the functioning of mitochondrial cellular structures is optimized. These and many other processes, activated under physicochemical influence, contribute to the rapid restoration of tissues.

The use of ultrasound therapy is directly related to the effect it has on tissue:

1. The creation and release of thermal energy provokes an improvement in biochemical reactions and diffusion processes, and also stimulates microcirculation and the production of substances that the body needs.
2. Micro-massage, which appears as a result of the action of a mechanical wave, sets in motion the fluid located inside and outside the tissues, increases the metabolic rate and improves the functioning of organs.

Historical information
Ultrasonic waves were discovered in 1899, they were discovered by K. Konig. The Russian engineer K.V. Shilovsky and the French inventor Langevin tried to use ultrasound in practice in 1914-1918. The research of these scientists led to the creation of an ultrasound emitter. It worked on the basis of the piezoelectric effect in accordance with the development of the Curie brothers. After this, a device was made based on magnetostriction. Over time, the rays emanating from the device became more focused on a specific object. This allowed the use of ultrasonic waves in industry and medicine. Ultrasound began to be used in medicine after 1927.

The impetus for the use of ultrasound was the work of scientists on the biological effects of ultrasound on the body. There is an opinion that R. Pohlman was the first to use ultrasound. He created a vibrator that emits ultrasonic waves. Pohlman treated sciatica, neuralgia, and myalgia with ultrasound waves. The results of the treatment were positive. By 1945, UST began to be used in Germany, Western Europe, the USA, and Japan. In our country, the technique began to be used only in 1953. Scientist V.A. Plotnikov first tried to treat Dupuytren's contracture with ultrasound. In 1955, ultrasound waves began to be used in the treatment of neurological, joint pathologies, and skin diseases. Since 1961, domestic ultrasonic devices began to be produced. Their production was mass-produced, which served as an impetus for the development of ultrasound therapy. In 1986, scientists from Belarus (L. I. Bogdanovich, V. S. Ulashchik, A. A. Chirkin) were awarded a prize in the field of science and technology. Ultrasound therapy techniques in physiotherapy are used very widely today to treat various diseases.

Characteristics of ultrasonic waves

For physiotherapeutic procedures, ultrasound waves with a frequency of 800-3000 kHz are used. For surgical manipulations, the oscillation frequency is 20-100 kHz. The dosage of ultrasound exposure on the body depends on the intensity, duration of exposure, as well as the type of generation of ultrasound waves (continuous, pulsed).

Ultrasound wave intensity:

• Low (no more than 0.4 W/cm2)
• Medium (0.5-0.8 W/cm2)
• High (0.9-1 W/cm2)

With continuous exposure to ultrasound, ultrasound waves are directed onto tissue without stopping.
The pulse effect on organs is an intermittent stream of waves lasting 2.4 or 10 ms. The degree of absorption of ultrasonic waves depends on the acoustics and vibration frequency. If the tissues are soft, then absorption will occur at a depth of 4-5 cm at a frequency of 800-900 kHz, at a depth of 1.5-2 cm at a frequency of 3000 kHz. Tissue absorption relative to blood:

• fat – 4 times more effective;
• muscular - 10 times better;
• bone - 75 times more intense.

At the transition site of different types of tissue, the intensity of absorption of ultrasonic waves is much higher.
They are immediately absorbed in the air, so various media are used for ultrasonic physiotherapy. Mechanism of influence of ultrasonic radiation

There are several mechanisms by which ultrasound affects the body. These include: mechanical, thermal, physico-chemical, neuro-reflex. They are the primary mechanisms of ultrasound therapy. The mechanical effect consists of high-frequency vibrations that are transmitted to tissues. In this case, a very small vibration occurs, invisible to humans. Vibration effects lead to increased blood circulation and increased metabolism in cells.

Under the influence of vibration in the cell, the viscosity of the cytoplasmic fluid decreases. The connective tissue in the tissues begins to loosen. The diffusion of microelements in cells is accelerated, and the work of lysosomes is stimulated. Enzymes begin to emerge from the lysosomes, which increase the function of protein compounds. These processes help speed up metabolism. When high-frequency waves are applied, the permeability of histohematological barriers increases. The thermal effect involves the transition of the energy of ultrasound waves after absorption by tissues into heat. The temperature in them increases by 1°C. At the same time, enzymatic activity inside tissues is accelerated, biochemical reactions are stimulated. Heat is generated only at the boundaries of tissues of different densities. Thermal energy is absorbed more by organs with a deficiency of blood flow, saturated with collagen fibers, as well as nervous and bone tissue.

The physico-chemical effect is caused by mechanical resonance. It increases the speed of movement of molecular structures, the process of decomposition of molecules into ions increases, and new electric fields appear. Lipid oxidation accelerates, the functioning of mitochondrial structures of cells improves, physical and chemical processes in the tissues of the body are stimulated. Biologically active substances such as histamine and serotonin are activated. Under the influence of ultrasound waves, breathing and oxidation in organs improves. All these processes accelerate tissue restoration.

The following phases of the body's reaction are distinguished:

Ultrasound waves are a specific irritant when they act on organs and tissues. If the effect of ultrasound is directed on the skin, an inflammatory reaction is formed, skin redness, and metabolism increases. During ultrasound therapy (UT), the number of mast cells increases, the function of cambial (stem) cell structures is stimulated, and the concentration of mucopolysaccharides increases.

During therapy, the function of the glandular apparatus (sebaceous sweat glands) in the skin increases, and the skin's reaction to irritants becomes brighter. The tissues of the nervous system are very sensitive to the effects of ultrasound waves. Ultrasound inhibits the functioning of synaptic cleft receptors, which helps reduce the speed of transmission of nerve impulses. The general condition of patients with disorders of the autonomic nervous system improves. If ultrasound waves act on the glandular areas, this leads to stimulation of hormone synthesis. Immune activity increases.

When affecting the cardiovascular system, ultrasound can increase blood flow, slightly lower blood pressure, and increase heart rate. The rheological properties of blood become better, the function of erythrocytes and leukocytes increases.

Indications for UT use

• ENT diseases (presence of adenoids, tonsillitis, pharyngitis in the recovery stage and other diseases)
• Sjögren's disease
• Therapy of scar changes in the postoperative period
• Eczema, neurodermatitis
• Pathologies of the nervous system
• Diseases of the articular apparatus
• Enuresis
• Osteochondrosis of the lumbar region
• Lumbar radiculopathies, lumbar hernias
• Arthritis, arthrosis (rheumatoid, as well as with joint deformation)
• Trigeminal neuralgia
• Eye pathologies (cataracts, corneal lesions, retinal diseases)
• Scoliosis. Scar contractures
• Scars after burn injury
• Consequences of injuries
• Ulcers due to venous insufficiency
• Fractures of bones (tubular)
• Prostate pathology
• Decreased ovarian function, infertility
• Serous mastitis
• Diseases of the uterus, tubes, ovaries, pelvic adhesions

Restrictions

• Purulent discharge or abscess
• Arrhythmia
• Intoxication
• Thrombophlebitis
• Hypotension
• Jaundice syndrome
• Vein thrombosis
• Hepatic and renal colic
• Hyperthyroidism, thyrotoxicosis
• Asthenia
• Autonomic dysfunction
• Hemophilia
• Diabetes mellitus (late stage)
• Chronic nephritis
• Atherosclerotic vascular lesions
• Tuberculosis of lung tissue
• Severe hypertension
• Malignant tumor process
• Infectious diseases of any etiology
• Gestation period
• Blood clotting disorder
• Facial nerve neuropathy, neuralgia

Technique of procedures

When using ultrasound treatment, the emitter should not be directed at the heart, brain, or bone growth points in children. UT technology and devices When performing ultrasound physiotherapy, it is necessary to eliminate purulent foci of infection. This can be done with the help of medications and disinfectant solutions. Infectious diseases of a viral or bacterial nature should also be treated. The physiotherapy algorithm is as follows. Before starting therapy, the skin at the site of contact with the hardware head of the emitter must be lubricated with a special substance (vaseline, lanolin).

Turn on the device, adjust the intensity of the waves, and set the time. After this, the emitter is placed in the required area on the surface of the skin and begins to move at a speed of 1 cm per second. At the initial stage of treatment, no more than 1-2 fields can be processed in 1 session. After two days of treatment, up to 3-4 fields can be irradiated. The duration of the procedure in the first two days should not exceed 5 minutes. Subsequent sessions last up to 15 minutes. For children, it is recommended that the procedure last no more than 10 minutes.

When treating extremities with ultrasound (feet, hands, joints, forearm, lower leg), the procedure is carried out in water. The patient lowers his arm or leg into the bath, and the emitter is immersed there. The temperature regime for water is 32-36°C. The duration of the physiotherapy procedure is up to 15 minutes. During therapy, it is necessary to ensure the safety of medical personnel. The nurse who holds the emitter in the water should wear a wool mitten and a rubber glove on top. This protects the healthcare worker's hand from exposure to ultrasound. A mitten made of wool has air in its pores, which completely absorbs ultrasonic waves.

use in children

Ultrasound therapy is prescribed to children only from the age of 7. The technique should not be used at an earlier age. Therapy is used for the same indications as for adults.

In adolescent girls, UST is used to treat menstrual irregularities. For younger patients, ultrasound is indicated for adenoiditis and other ENT pathologies. Ultrasound treatment for children is also necessary for enuresis. Ultrasound waves improve the condition of the bladder tissue, which helps to form a normal urination reflex and reduce bladder reactivity.

Conclusion

Ultrasound therapy is a relatively safe treatment method. It is used for various diseases. Hospitals, as well as sanatorium-resort institutions, are allowed to use ultrasound treatment methods. To undergo ultrasound therapy, you must consult a doctor. He will determine the duration of the sessions, the intensity of exposure to ultrasonic waves, and the duration of the course.

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Basic techniques

During the procedure, the emitter should be positioned only perpendicular to the skin to which the ultrasound action is directed. If this condition is violated, the reflection coefficient increases, which leads to a decrease in the penetration coefficient of ultrasound into tissue.

The technique of the procedure is of decisive importance for prescribing UT in each specific case. There are the following methods of exposure to ultrasound:

1. Stable (fixed), which provides for installation of the emitter in accordance with the location of the lesion. He must remain in this position throughout the entire procedure. Today, the stationary technique is not often used due to the high probability of overheating due to the mechanical heterogeneity of tissues and the potential occurrence of so-called “standing” waves. This technique is most popular in dentistry and ophthalmology, as well as in the treatment of ENT pathologies. In general physiotherapy practice, only individual elements of the stationary technique are used.
2. Labile (movable), which is the most commonly used ultrasound therapy technique. Its essence boils down to the fact that the emitter moves along the surface of the human body at a low speed not exceeding 2 cm/sec. Stroking movements of a longitudinal and circular direction are made with barely perceptible pressure. The beginning of the process is preceded by the application of a contact agent to a specific area of ​​the body that will be exposed to ultrasound. The peculiarity of the ultrasonic wave is its rapid attenuation and inability to propagate through the air. This explains the need to use a contact agent. It guarantees contact between the body area and the emitter. It is recommended to use gel-like contact agents of domestic and foreign production. As soon as the contact substance is applied, the emitter head is placed on the surface of the body, and only after that the device is turned on. When moving the emitter, make smooth wave-like movements, avoiding separation from the skin.
3. Underwater (subaquatic), which is prescribed if it is necessary to expose parts of the body to complex configurations and if it is impossible to ensure the required degree of contact of the emitter with the skin. The procedure is carried out in a special bath filled with water, or through a rubber bag that also contains water. One of its sides takes the shape of the area that is subject to ultrasonic influence, and the second comes into contact with the radiation source. Ultrasound therapy under water is carried out using degassed or distilled water, the temperature of which does not exceed 32 degrees. First, the part of the body that is subject to ultrasound exposure is lowered into the bath, and then the emitter is lowered into it. They make slow movements, maintaining a 1-2 cm distance from the surface of the skin, in accordance with the location of the source of pathology.

How does this device work?

The sensor on which the sound crystals are located converts electricity into sound waves of therapeutic ultrasound; We do not perceive these sounds by ear. The portable transducer is able to focus sound energy at the site where musculoskeletal pain is present, providing therapeutic effects and helping tissue heal. Low frequency ultrasonic waves, concentrating in a certain area of ​​the body, provoke vibrations in tissues, create heat, which allows you to get rid of muscle spasms, pain, eliminate joint contractures. A convenient method of ultrasound treatment helps to more quickly cure ailments, improve blood flow to tissues, saturate them with oxygen, it It also allows you to relax tissues and dissolve scars on them in order to increase the level of mobility in the joints.

You can carry out ultrasound treatment yourself. It is well suited for the treatment of various injuries, pain, cramps, fractures, pinched nerves. Important: ultrasound can be used for treatment close to the wound, only on intact tissue.

Indications for ultrasound therapy

The UST method is applicable today in various medical fields in the treatment of a wide range of diseases. Among them are diseases of the cardiovascular system, including angina pectoris, ischemia, and hypertension. It is also indicated for patients with primary muscular atrophy, flaccid paralysis, injuries and diseases of the musculoskeletal system, gastrointestinal tract, cystitis, gynecological inflammation and prostatitis. UST has shown its effectiveness in the fight against vasospasm, pyelonephritis, trophic ulcers and pathologies of the upper respiratory tract.

The method is common in therapy:

• hernias;
• diseases of the spine;
• osteochondrosis;
• myalgia;
• neuritis;
• myositis.

It is also used for pinched nerves and joint inflammation.

Exposure to ultrasound leads to a decrease in the sensitivity of nerve receptors, and also optimizes the functioning of the autonomic nervous system and regulates the speed of transmission of nerve impulses. This was the reason that ultrasound therapy, the indications for which are determined by the doctor, has also shown its effectiveness in neurology, radiculitis, spinal injuries, neuropathy, multiple sclerosis and spinal cord injuries.

The ultrasonic wave treatment method is intensively used in the field of beauty. With its help, figure correction, peeling, hardware massage are carried out and various defects are eliminated:

• wrinkles;
• scarring;
• stretch marks and adhesions;
• hyperpigmentation;
• consequences of atopic dermatitis;
• skin inflammation;
• age-related degenerative skin changes.

Treatment of joints using ultrasound

As you know, the main factors causing joint diseases are all kinds of injuries, fractures, dislocations and sprains. Excessive physical stress on the joint can cause deformation of the articular elements, microcracks in the cartilage and bones. Some concomitant diseases (for example, rheumatoid arthritis, ankylosing spondylitis or gout) can provoke inflammatory processes in the joints. Metabolic disorders have a negative impact on the condition of the cartilage tissue of the joints.

Ultrasound therapy helps to increase blood supply to the joints, normalize metabolic processes, and also prevent further degenerative changes in articular cartilage. Here you can add relief from pain and reduction of inflammation. In many cases, ultrasound therapy helps avoid joint deformation.

This therapy is used both as an independent method and in combination with other procedures. The best effect is achieved by combining ultrasound and drug treatment. This technology makes it possible to combat joint pathologies such as various types of arthritis

(infectious, traumatic, dystrophic, etc.) and
arthrosis
(gonarthrosis, coxarthrosis, etc.). In addition, ultrasound therapy of joints is also used in the treatment of all kinds of injuries and bruises.

Contraindications

Ultrasound therapy, contraindications to which depend on a number of factors, are divided into two categories:

1. Absolute, which include:
   tendency to bleed;
2. benign tumors with a threat of degeneration;
3. feverish states, convulsions and paralysis;
4. pathologies of the circulatory system;
5. infectious diseases in acute stages;
6. malignant formations.
7. Relative, including diseases of systems and organs in the last degree, as well as exacerbations of chronic diseases. This group also includes:
   active stage of tuberculosis;
8. severe endocrine disorders;
9. diabetes;
10. atherosclerosis;
11. hypertension 3-4 degrees;
12. pregnancy.

In the case of relative contraindications, it is recommended to consult a specialist who, based on an assessment of the overall clinical picture, will determine whether the use of UST is possible in each specific case.

Ultrasound for children

Ultrasound therapy, the indications and contraindications for which, especially in the case of treating diseases in children, should be discussed with the attending physician, has its own characteristics when applied to pediatric patients. It is indicated from the first month of life if the child has diseases of the musculoskeletal system. In each individual case, the doctor selects the appropriate time and intensity of exposure, and the ultrasound density should not exceed the following values:

• 0.05 W/cm2 for children under one year of age;
• 0.1 W/cm2 for children one year old.
• 0.6 W/cm2 for children over one year old.

It should be understood that the physiology, tissue structure and functional characteristics of the child’s body have a number of differences and change as the child grows. This must certainly be taken into account when determining a specific therapeutic factor when choosing parameters for the influence of ultrasound, localization and duration of the procedure.

Differences between a child’s body and an adult’s:

• lower thickness of cell layers;
• accelerated formation of reflexes, excitatory processes prevail over inhibitory ones;
• bone density is lower, which causes a higher degree of tissue trauma;
• muscle fibers are thinner, they are freely located; in combination with the large size of the heart, this determines specific features of the physiology of cardiac activity;
• wide ureters and renal pelvises, low glomerular filtration capacity;
• narrow and short nasal passages, poorly developed paranasal sinuses, low degree of airway humidification;
• low bone density and high water content in it.