Shockwave Therapy

Shockwave is an acoustic wave with an extremely high power output, such as those who occur in the atmosphere after a natural explosion manifestation, such as lightning or breaking the sound barrier. The shockwave differs from ultrasound in extremely large amplitude pressure.

The term “shockwave therapy” refers to the mechanical pulses that are spread through the human body in the form of a wave.

Effective and non-invasive method for the treatment of localized pathology of the musculoskeletal system such as: epicondylitis, plantar fasciitis, rotator cuff disorder, trigger point, a number of chronic tendinopathy and many other indications.

Physical therapy ─ SWT application in physical therapy is generally associated with the treatment of chronic disorders of muscles and tendons, cervical pain, back pain and treatment of trigger points. Compared to traditional manual therapy and massage using specific machines, SWT is extremely effective. SWT reduces the number of therapeutic treatments and leads to better results in the long run.

Typical indications are:

• painful shoulder,
• epicondylitis-tennis elbow,
• lower back pain,
• pain in Achilles tendon,
• patellar tendinitis,
• treatment of trigger points-sore points,
• frozen shoulder,
• periartritis humeroscapularis,
• calcar calcanei-plantar fasciitis,
• arthrosis-secondary symptoms,
• achillodynia,
• lateral and ulnar (medial) epicondylitis,
• muscular distension,
• prolonged treatment of distortionof the wrist,
• flank pain,
• hip pain,
• low back pain,
• achillodynia

Laser therapy

The word comes from the abbreviation LASER─ Light Amplification by Stimulated Emission of Radiation. Lasers are divided into four groups, and lasers from the third group (therapeutic lasers) are used in physical therapy, the range of 50-500 mW. The infrared solid-state laser,  that penetrates into the tissue up to 5 centimeters, proved to be the most successful. Therapeutic lasers are harmful to the eyes, so both the patient and the therapist need to wear the protective eyewear.

Application methods:

• the technique by the direct contact is mainly applied to small surface area (so-called dot laser),
• scanning technique-applied while treating larger body surface area

Effect:

Laser stimulates collagen synthesis and in that way promotes healing of wounds, relieves the pain (has analgesic effect), reduces swelling, reduces scar tissue, it has a thermal effect on skin surface and has a beneficial effect on the immune system.

Galvanic Electrotherapy

Galvanization is the application of a constant low-frequency electric current via electrodes for therapeutic purposes.

We distinguish between transverse/transregional galvanization and longitudinal galvanization. In some cases, the electrodes must be shaped in a particular manner due to the specific shape of body part on which we want to apply the current (for example, Bergoni’s semi-mask used during trigeminal nerve treatment). The current that penetrates the skin stimulates sensory nerves endings what patient feels like a light flow, tingling, numbness, but in no case burning or pain.

Effect of Galvanic current:

• on the motor nerves: increases excitability and conductivity of motor nerves and muscles,
• on vasomotor nerves: improves circulation,
• on pain: reduces pain (analgesic effect),
• on the central nervous system: depending on the position of electrodes, it may cause calming effect or excitability

Diadynamic current

Diadynamic current is a low frequency semi-wave or full-wave sinusoidal current, 50-100 Hz frequency.

They are modulated by the frequency and strength, with a combination of two frequencies that alternate rhythmically. Nowadays, mainly four current combinations, i.e. modulations are applied (CP, LP, DF, MF).

Effect:

• reduces pain (analgesic effect),
• improves circulation (dilates blood vessels),
• on striated muscles (muscles influenced by our will)-reduces muscle tension,
• affects the removal of edema and hematoma,
• on smooth muscles (muscles that are not influenced by our will)-reduces stomach, intestines, bladder spasm, etc.,
• setting up the nervous system balance (migraine, peripheral circulatory disorder based on arteriosclerosis, Buerger’s disease, Raynaud’s disease, Sudeck’s dystrophy…)

Interfering current

Interference currents are currents with the deepest effect and they are applied to the different places, depending on the localization and type of pathological process, i.e. complaints. They are result of the two sinusoidal alternating currents overlapping in intensity, phase, and frequency.

The interference happens in the depths of the tissue, so we also call them endogenous currents.

Considering the application technique, interferring current is used in three different ways:

• static or stable interference is commonly applied in a way that four electrodes are placed on the body surface that wants to be treated, so both circuits crisscross in the area of greatest pain;
• mobile or kinetic interference consists of continuous change in places during the treatment, so specific surface is therapeutically treated on all sides; for this purpose we use glove-like electrodes that therapist puts on his hand and makes movements in different directions while at the same time making a particular pressure on the tissue;
• dynamic interference enhances the effect of interfering currents by adjusting and rhythmical change of interference vectors.

Effect: Interfering current is similar to diadynamic current, but there are differences in the way of application and effect localization, i.e. deeper effect along with better sustainability is achieved. They can be applied in a combination with vibrating vacuum massage taking in consideration that, before the application and depending on the indication, the vibration frequencies need to be determined, what will eventually lead to the better effect in the deep tissue.

TENS

Transcutaneous Electrical Nerve Stimulation is one of the most effective methods in the fight against pain that enables the patient to be in control of both acute and chronic pain while reducing the use of analgesics. Using this therapeutic method, the pain is treated by electrical stimulation of sensory nerve endings in the skin. This method uses low-frequency alternating current that blocks the transmission of pain impulses to the CNS. TENS is applied by the means of different electrodes that are placed on the skin above painful points, along muscles and peripheral nerves.

Electric Stimulation Therapy

Electric stimulation therapy is therapy that uses low-frequency currents and electrical impulses of different intensity, shape and duration in order to stimulate muscle contraction that for certain reasons are not able to function in a normal way. Muscle contraction can be stimulated with the use of electrical impulses through the motor point of muscle (the point where the nerve enters the muscle) and motor nerve point (the point where the nerve trunk is closest to the skin).

Sonotherapy

Sonotherapy is the application of acoustic energy for therapeutic purposes thus achieving mechanical and thermal effect. A drug can be delivered in this way as well (sonophoresis). The term ‘sound’, i.e. ‘sound wave’ implies the mechanical flicker of a substance through the solid, liquid and gaseous setting. The ultrasound therapy is most successfully used in the following situations:

• injuries of muscle tendons and ligaments,
• treatment of keloids and scars,
• pain in lumbar and cervical spine are,
• injuries and pain in joints,
• after post-traumatic condition,
• Dupuytren’s contracture,

The frequency of ultrasound intended for therapeutic use varies between 0.75 and 3 MHz. Velocity of ultrasound is not constant and varies depending on the density of the setting it passes through. In liquid composition of the human body that speed amounts to 1500 m/s, in organs it amounts to 1400-1600 m/s and in bones it amounts to more than 4000 m/s. Ultrasound spreads through the tissue in the form of clotting and dilution. It is most absorbed in bone cartilage, tendons and ligaments, and the least in the blood and fatty tissue. With its mechanical influence it leads to clotting and dilution of tissue that is manifested in the form of micro-massage.

Advantages of ultrasound in relation to other types of physical therapy

• penetrates deeper into the tissue and is most absorbed in the ligaments and tendons (structures with a high level of collagen),
• it has analgesic effect (reduces pain),
• enhances the tissue regeneration and reduces muscle spasm,
• causes reabsorption of the swelling and increases local blood flow,
• spurs the healing of inflammation and enhances healing of tendons and muscles after injuries,
• stimulates bone osteogenesis after fracture and is used in very small doses for that purpose

Ultrasonosonophoresis is a procedure of drug delivery into the body by the means of ultrasound. Ultrasound increases the permeability of the skin and spurs the movement of drug particles. The most common types of drugs used for this treatment are anesthetics, steroidal anti-inflammatory drugs and non-steroidal anti-inflammatory drugs.

Ultrasound Therapy

Ultrasound therapy consists of administering ultrasound energy for the purpose of treatment. Ultrasound is inaudible sound whose lowest limit band frequency amounts to 20KHz. Ultrasound devices operate on the principle of producing mechanical oscillations that are transferred to the crystal within the ultrasound sound head. Alternating polarization of crystals leads to its vibration that is transferred into the setting, i.e. tissue.

Methods of application:

• The most commonly applied method is the direct contact method. The ultrasound sound head firmly adheres to the surface that is being treated and in order to achieve that, the use of glycerin oil or contact gel is required. Also, we can use creams and various drugs that are being applied under the ultrasonic probe known as sonophoresis. Sonophoresis provides better drug absorption on the treated area, usually a rheumatoid swollen joint.
• The inverse method (immersion method)-the ultrasound sound head is immersed in the contact medium, usually water. This method treats regions where due to anatomical reason the direct contact is impossible (small joints of hands and feet). The part of body being treated is immersed in water and the ultrasound sound head is held about 2 centimeters above the body part that is being treated.

Effect:

• The mechanical effect-easy surface tissue massage with massage appliances is being performed.
• Biochemical effect causes the conversion of gel state into liquid state and disassembling of large molecular complexes (for example, muscle contractures, myogelosis, etc.).
• Heating/thermal effect-with the mechanical massage of the tissue the energy is being converted into heat/thermal energy, especially at places of reflection (i.e. scattering of the ultrasound) what is the boundary between soft tissues and bones (tendon insertion site, epitenon, menisci) and thus increases the permeability of cell membranes.

Phototherapy

Phototherapy is the application of light energy for the case of treatment and prophylaxis-protection. It is applied from natural sources-from the sun and artificial sources. Air energy, used in light therapy consists of the following groups of air: the visible part that affects retina and causes a feeling of light, and infrared and ultraviolet parts that are invisible.

Light beams have capability of penetrating deep into the body. During this process, the air energy stimulates the tissue and causes a series of complex physical and chemical changes within it. Infrared rays convert into thermal energy within the body, what causes an increase in local and general temperature, a feeling of warmth, expansion of blood vessels- hyperemia. They enhance the function of tissue and improve metabolism.

Ultraviolet rays enhance the metabolism of proteins, carbohydrates and phosphates and, what is really important, calcium. Under the influence of UV radiation the vitamin D is created within the tissue, what enhances the deposition of calcium salts in the bones. Ultraviolet rays act bactericidal. The light has a significant analgesic effect (relieving pain) on our tissue. The impact of air energy on the CNS and the psyche is well known to everyone.-how we feel during sunny days and during the rainy season.

Intense ultraviolet radiations influence the lowering of blood pressure, reduction of the blood sugar, increasing calcium in the blood. The light causes certain changes in the balance of the vegetative nervous system-whose operation is not affected by our will-and plays a great role in regulating functions, toning and nutrition of individual organs and the entire body.

Bioptron Lamp

Bioptron is a medical device for light therapy with a specific optical unit emitting light similar to that part of electromagnetic spectrum that is naturally emitted by sun, but without UV radiation.

Effect:

• improves microcirculation,
• harmonizes the metabolic processes,
• enhances the immune system,
• stimulates regenerative and reparative processes in the body,
• improves wound healing,
• relieves pain.

Infrared Radiation

Infrared rays are part of the electromagnetic spectrum of wavelengths from 770 to 15000 nm. In physical medicine these rays are used for the purpose of surface warming. The sun is a natural source of infrared rays and when it comes to artificial sources that are used in therapy, we usually use SoLux lamps.

Magnetotherapy

Magnetotherapy is therapy that uses low-frequency pulsating electromagnetic fields. The effect of magnetic field is based on cellular basis, i.e. it penetrates into the cell. Magnetotherapy does not specifically affect any particular indication, but enhances the cell function what is actually the cause of any disease. The use of magnetotherapy during a certain time leads to the normalization of electrical potential difference, affects the metabolism and cell’s energy and improves cell oxygen saturation. Magnetotherapy has a remarkable effect on bone healing, it reduces osteoporosis, improves blood supply to the tissue and relieves pain and inflammation.