Joint diseases often occur in those people who have crossed a significant age limit. This is explained by the physiological involutional processes of aging, thinning of cartilage tissue, sclerosis and thickening of the synovial membranes, impaired articular circulation, decreased formation of synovial fluid, and deterioration of general metabolic processes.
Important! Physical inactivity and obesity, due to decreased lymph and blood flow and increased load on joints, aggravate these age-related pathological changes. Due to unphysiological load and excess weight on the joint, the cartilage tissue becomes deformed.
The replacement of cartilage tissue with spines and bone growths occurs in the same way, especially in places of inflammatory processes and injuries. Gradually this leads to irreversible pathological changes in the joints.
The most common age-related joint diseases include arthrosis and arthritis of the hands, hip, ankle and knee joints.
Drug therapy is aimed at reducing the severity of inflammatory processes, improving local blood flow and relieving pain. It should be borne in mind that today no drug can completely reverse the course of the disease or stop it.
To increase the range of motion in the joint and relieve symptoms, symptomatic therapy is used, which is represented by a group of non-steroidal anti-inflammatory drugs that have a lot of limitations and side effects. Most contraindications are for the elderly.
In addition to these medications, chondroprotectors are used, which improve the structure of cartilage and slow down the progression of arthrosis. The course of therapy with chondoprotectors is quite long - from 2 to 6 months.
In case of serious illness, doctors prescribe hormonal therapy, which is also accompanied, sometimes quite serious, by adverse reactions.
Ultrasound treatment is considered a well-tolerated method with the least side effects.
Ultrasound is almost always indicated in the complex treatment of arthritis and arthrosis of the joints. Against the background of well-chosen physical therapy, heat therapy methods, massages and mud baths, ultrasound therapy is used much more often.
For joint diseases, the effects provided by ultrasound are most relevant:
These and other effects are due to the complex biological effects of ultrasonic waves - mechanical, thermal and physico-chemical.
For joint diseases, various methods of ultrasound treatment are used. The action of the waves is directed directly to the affected areas of the joint and paravertebral areas of the spine (for legs at the level of segments T10 - L1, for arms - C5 - T10).
The treatment is performed with slow circular movements of the emitter in the area of the affected joint. The intensity of ultrasonic waves is 0.2-0.4 W/cm2. The technique is labile, continuous mode, contact method. The duration of the daily session is 10-12 minutes. The course of treatment consists of 15 procedures.
During the procedure, the patient lies on his side. The drug “Fastum gel” is applied to the hip joint area. The ultrasound emitter is applied around the hip joint. The intensity of ultrasonic waves is 0.2-0.8 W/cm2. The technique is labile, continuous mode, contact method. Sound zones:
If there are symptoms of bursitis in the trochanteric area, this joint and the femoral neck are treated. The duration of the daily session is 10-15 minutes. The course of therapy is 15 procedures.
New technologies for the treatment of gonarthrosis have been developed, based on local therapy with the drug Arthro-active. This method expands the possibilities of providing effective care to patients with gonarthrosis.
The intensity of the influence of ultrasonic waves in this technique is 0.2 - 0.8 W/cm 2 with a frequency of 880 kHz. The physicochemical characteristics of the drug are preserved.
Indications for the use of this method of treatment are gonarthrosis:
This technique is contraindicated for:
It must be remembered that physiotherapy is only a component of an extensive complex treatment of joint diseases. To achieve good results, the patient must follow the basic rules:
Arthrosis of the knee joints (gonarthrosis) is a degenerative disease of the cartilage of the knee joint with subsequent involvement of bone structures and periarticular tissues in the process.
In terms of incidence, it ranks first among all arthrosis, occurring in 25% of the population after 45 years.
Arthrosis develops in cases where damaging factors prevail over protective mechanisms. There are several main reasons:
The main manifestation of the disease is pain. With the initial manifestations of arthrosis of the knee joints, the pain is of a “starting” nature, i.e. after prolonged immobility (for example, after sleep), the first steps are accompanied by pain in the joint, which quickly passes as you “walk.” This is explained by the accumulation of joint destruction products on the surface of the cartilage. During the first movements, these products are pushed into the joint cavity and the pain goes away.
Arthrosis is a joint disease associated with the destruction (wear and tear) of the cartilage layer (cartilage). What is arthrosis, its symptoms and treatment?
Arthrosis is divided into two subtypes: primary and secondary. Primary appears:
The primary disease appears in people after 40 years of age, most often in the weaker sex, women. Accompanied by high blood pressure, arteriosclerosis, it appears on the hands between the phalanges of the fingers. The main symptom is severe pain in the joint area. weak mobility, crunching.
A secondary disease occurs at any age, as a result of certain diseases, injuries, and affects the joints of the arms, legs, and spine. Bone growth occurs and joint spaces decrease. The main symptom is swelling or swelling, inflammation, pain in the joint during exercise. immobility, if lower limbs, lameness.
When the first signs of cartilage-wearing joint disease appear, you should consult a doctor. What kind of doctor treats arthrosis?
At the initial stage, with arthrosis, nagging, aching pain that disappears after rest, you should contact a rheumatologist, who will prescribe medications in a timely manner. In case of a prolonged illness, when it is already difficult to move, you should contact an orthopedist who will examine the lesion and prescribe treatment and effective remedies for arthrosis. There are cases when surgical intervention is necessary, to make a prosthesis or use synthetic lubricant, then this is a surgeon.
With age, joint diseases quite often occur, which is associated with the natural involutional processes of aging as a result of thinning of cartilage tissue, thickening and sclerosis of synovial membranes, decreased formation of synovial fluid, impaired blood circulation in the joint area, and a decrease in general metabolic processes. Obesity and physical inactivity aggravate these age-related pathological changes, mainly by increasing the load on the joints and reducing blood and lymph flow. Cartilage tissue is deformed from excess weight and non-physiological load on the joint. Cartilaginous tissue is also replaced by bone growths or spines, especially in places of injury and inflammatory processes. This gradually leads to irreversible processes in the joints. The most common age-related joint diseases are arthritis and arthrosis of the hands, knees, ankles and hip joints.
Often, elderly and old people, for no particular reason, experience pain in one or more joints, which periodically increases and then subsides. This can continue for many months and even years. But sooner or later, especially without timely diagnosis and treatment, the pain becomes constant and changes in the joint . which ultimately lead to limitation of his mobility. The pain is accompanied by the appearance of stiffness, limited mobility, crunching and swelling of the tissues around the joint itself. These signs indicate already progressing osteoarthritis.
Ultrasound therapy is widely used in the treatment of musculoskeletal disorders. So, in addition to such a method as physical therapy , ultrasound therapy is also used for arthrosis, which is becoming more and more popular in modern medicine.
Ultrasound therapy is widely used for diseases related to arthrosis . Ultrasound therapy is also important for the treatment of bruises, injuries, as well as exacerbations of the disease osteochondrosis . So, for that. To relieve the symptoms of arthrosis and quickly get rid of the complications of the disease, ultrasound therapy is used in medical practice.
Ultrasound has the ability to have a beneficial complex biological effect on a living organism, namely:
Moreover, ultrasound therapy helps to increase the permeability of cell membranes, has the ability to accelerate the processes of cellular diffusion, and also promotes better penetration of gels, ointments, etc. into the skin. promotes capillary blood circulation and activation of redox processes in the body.
The effectiveness of ultrasound therapy and contraindications
Ultrasound therapy is a fairly effective method. Treatment of arthrosis in modern medicine is possible along with such methods as electrophoresis or physical therapy, massage, etc. Despite this, this type of treatment for arthrosis is applicable only in cases where there is no synovitis . and there is also pain in the area that is affected by arthrosis, as well as if there are proliferative changes in the periarticular tissues. There are also contraindications for ultrasound treatment. Contraindications for such ultrasound treatment of arthrosis are menopause, atherosclerosis, fibroids, mastopathy and other diseases.
Arthrosis is a disease that can lead to disability. In its final stages, the only possible treatment is prosthetics, i.e. complete joint replacement. To prevent this, it is necessary to pay due attention to the problem in the initial stages of development, while there is still cartilage tissue in the joint.
The main method of therapy in the early stages is medication. Daily use of medications (chondroprotectors, analgesics, etc.) increases the risk of side effects. Physiotherapy for arthrosis can enhance the effect of drugs, reduce their dosage and side effects.
It runs courses several times a year. The type of physiotherapy is chosen by the physiotherapist based on the patient’s condition, various indications and contraindications. It also happens that such treatment is absolutely contraindicated.
Physiotherapy – the ability to deliver medicine “exactly to the address”
The following physiotherapeutic methods used in the treatment of arthrosis can be distinguished:
exposure to a magnetic field;
radiation exposure (infrared, ultraviolet, laser radiation).
Let's take a closer look at them.
This therapy method is based on the principle of the movement of charged particles in an electromagnetic field. The ions of the drug substance act as charged particles, and the electric field is created using two electrodes installed in the right places. For example, this could be the area of the knee joint.
A heel spur is a spiky or beak-shaped bony protrusion that grows from the plantar surface of the heel bone, its base merging with the calcaneal tubercle.
If you believe the latest research, heel spurs are detected in the majority of elderly or middle-aged people (about ten percent), and these people do not present absolutely any complaints to doctors. From this we can say that the presence of heel spurs on the legs is not at all a direct disease.
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It may also be the other way around: if the disease is present, all signs of a heel spur may be absent.
There can be many causes of heel spurs; women over forty years of age most often suffer from this disease.
The main symptom of heel spurs is heel pain. This pain may be chronic, sudden, or gradually increasing. The heel is the very first and most important point of support for a person during axial load. And it is more fully understandable that as soon as a person suffering from a heel spur gets to his feet, he immediately begins to experience terrible and unbearable pain. The most appropriate comparisons for the pain experienced are described by patients as “stepping on a nail” or “a needle in the heel.” Over time, while walking, the pain decreases somewhat due to the body’s adaptation, but this does not mean at all that it is time to forget about treatment.
The most excruciating pain when walking occurs with a bilateral process. Very often, such patients move even with the help of crutches or a cane. In this case, when walking, the patient tries to load the edge of the foot in order to avoid annoying pain in the heel as much as possible; for this reason, the legs get tired very quickly. Patients suffering from this disease become very nervous and irritable, and their performance decreases.
Also, the situation is greatly aggravated due to a special mistrust of doctors, who quite often prescribe ineffective and inadequate treatment. When examining the heel, use your finger to find the most painful point; most often it is located in the area of the inner process of the heel tubercle, that is, slightly closer to the inner edge of the heel bone. The final diagnosis is confirmed only after an X-ray examination. Most often, more complex examinations, such as computed tomography or MRI, are never performed for heel spurs.
Treatment of heel spurs can be at home, but only in the initial stages, also surgical or conservative.
Conservative treatment of heel spurs is, first of all, painkillers, physical therapy in various forms, or warm foot baths.
All therapeutic measures carried out by doctors for heel spurs are also supplemented with heel pads, which are made of soft fabric, as well as orthopedic shoes or orthopedic insoles. In some cases, if all of the above measures do not bring the desired result, then in such cases it is necessary to undergo surgery or undergo radiotherapy sessions.
Today, the most effective and most popular method of treating heel spurs is, of course, shock wave therapy (ultrasound treatment).
The result of treatment is the same as with x-ray therapy, but only in this case there are no complications. In very rare cases, most often with a very advanced state of this disease, such treatment options may not help, then they resort to surgery. As a result of the operation, the heel spur is completely destroyed. But if the causes of this disease remain, then this disease will appear again. In addition, bone that was injured during surgery is more susceptible to recurrence of heel spurs.
Every year, treatment of heel spurs using ultrasound is becoming more and more popular. Naturally, this type of treatment requires special equipment. During ultrasound treatment, the most painful areas on the heel are heated, but not more than two degrees; it is this process that regenerates damaged tissue and accelerates metabolic processes. Also, ultrasound has a resolving and antispasmodic effect and improves blood microcirculation.
It is worth considering that ultrasound treatment is allowed only if there are no unfavorable factors.
Due to the presence of the above contraindications, it is necessary to be very prudent and careful in the methods of treating heel spurs, and it is also necessary to regularly monitor the general state of health during the procedures.
The dolphin is considered to be the progenitor of the ultrasound therapy technique. The method itself involves the use of ultrasonic vibrations of a certain frequency range for therapeutic purposes.
In medicine, it is common to use ultrasound in the frequency range 20–3000 kHz:
Wave vibrations caused by ultrasound enhance the adsorption of medications when applied to the skin at the time of the procedure, and also directly affect organs and tissues when the radiation is applied.
The influence of the ultrasound method of therapy (USMT) is multifactorial:
The mechanical aspect of ultrasonic influence can be compared to massage at the micro level, carried out due to environmental fluctuations. The thermal effect is caused by the conversion of motion energy into heat energy. This effect occurs with prolonged constant exposure to high intensity.
The effect of ultrasound at the chemical level is expressed in:
Physical changes are caused by increased ionic decay, changes in the electrical activity of the cell, increased osmosis and diffusion, as well as other physical phenomena occurring in tissues at the atomic-molecular level.
Ultrasound treatment is based on the ability of an ultrasound device to cause high-frequency mechanical vibrations in the environment, which helps to activate the work of the human body at the cellular level.
Ultrasound physiotherapy is successfully used for therapeutic purposes in almost all branches of medical science. UT methods are very often used in inflammatory diseases to administer anti-inflammatory drugs and antibacterial agents. Postoperative scars, burns and joint contractures respond well to treatment. In this case, during the procedure, you can use products with a resolving and reparative effect (Lidase, Karipazim, Ronidase). In case of intense pain, ultrasound in combination with local anesthetics has a quick and noticeable effect.
UZMT is actively used in such areas of medicine as:
Cosmetology uses ultrasound no less actively. And not only for medicinal purposes (treatment of hyperpigmentation, acne, acne), but also for rejuvenation purposes (lifting, peeling) and to get rid of cellulite. The hardware method using ultrasound allows you to destroy the fibrous tissue frame around the cellulite cell. Thanks to increased blood circulation, skin turgor improves and fat deposits in the area treated with ultrasound are reduced.
Focused ultrasound is considered a promising area of ultrasound therapy. This method of using ultrasound makes it possible to locally influence disease-modified structures that are located deep in healthy tissue.
It would be more correct to attribute these phases to changes in the body's response to the effects of ultrasonic waves over time. The influence of ultrasound begins when the device is turned on and disappears within 3 months after the influence ceases.
Conventionally, the whole process is divided into stages:
At the stage of directly receiving the procedure, the human body experiences the effects described above from the procedure. The influence of ultrasound from mechanical to chemical is fully manifested.
In the activation stage:
In the limiting phase, synthesis processes in tissues are enhanced, cellular metabolism is accelerated, due to which the body’s regenerative abilities increase, and spasmodic muscles relax.
In the compensatory stage, cellular respiration increases, cell division accelerates, and the movement of blood and lymph accelerates. For another three months after completion of treatment, all types of metabolic processes are actively occurring in the body.
Ultrasound damages the cell membrane of bacteria and affects nonspecific immunity, activating it.
Ultrasound therapy provides multiple effects even when applied pointwise, due to its ability to stimulate the natural mechanisms of the human body, bringing its internal environment to a physiological norm. USMT stimulates the launch and development of internal reactions:
Almost all major systems of the human body respond to USMT. One of the most sensitive systems to USMT is the nervous system. Ultrasound has a noticeable effect on nerve conduction, has a positive effect on autonomic function, and reduces receptor sensitivity.
When exposed to ultrasound at the site of projection of the endocrine glands, it is possible to achieve the release of free form hormones into the bloodstream in sufficiently large quantities. This will allow you to increase the body’s nonspecific resistance to external unfavorable factors.
Using UST methods, it is possible to achieve a positive response from the myocardium and the vascular system as a whole, expressed in improved blood circulation both in the periphery and in the myocardium itself. You can also expect a slight decrease in blood pressure and an increase in heart rate.
The blood system quickly responds to influence in the ultrasonic range: leukocytes and red blood cells are functionally activated, and the rheological properties of blood (viscosity, fluidity) improve.
A whole range of beneficial effects can be expected from the influence of ultrasonic oscillations in the therapeutic range, such as:
Ultrasound is able to restore the conductivity of nervous tissue, increase the absorption capacity of the skin and improve tissue trophism.
When receiving the procedure, the patient may experience slight swelling, redness and warming of the skin at the site of contact with the sensor. You should not be afraid of this phenomenon - it is a weak and fleeting exudative inflammation, which is caused by increased metabolic processes, an increase in the number of mast cells, and accelerated cell activity.
Ultrasound therapy is a whole group of methods. What they have in common is that the procedure is carried out through a contact medium. This environment is designed to prevent air from entering between the surface being treated and the ultrasonic emitter. Usually it is medical Vaseline or degassed water. In the latter case, the emitter should not touch the affected area - it is kept at a distance of 2 cm from the treated area.
There are methods for carrying out the procedure:
If the procedure is performed by the cavity method, the doctor puts a condom on the emitter. In case of purulent pathologies, it is advisable to clean the surface or cavity affected by pyogenic microflora.
Procedures can be carried out:
The duration and course of treatment is determined by the physiotherapist. Typically, a therapeutic course consists of 6–12 sessions and lasts no more than a quarter of an hour.
The procedure is absolutely painless and comfortable for the patient. The maximum that he can feel upon contact with the sensor is a slight tingling sensation.
If the patient feels discomfort, pain or burning, the procedure should be stopped and be sure to report your feelings to the doctor.
The scope of application of ultrasonic therapy is so vast that it is problematic to provide the entire list of pathologies for which these techniques are effective. The main groups of diseases for which such procedures are most often prescribed are the following:
It is also believed that pre-targeted treatment of the tumor with ultrasound increases the sensitivity of the pathologically altered tissue to radiation therapy.
Despite the undoubted benefits of UST methods, the comfort and non-invasiveness of the procedure, it is not allowed for all patients. Ultrasound is not prescribed if there is :
There are other general contraindications for physiotherapeutic procedures , so treatment using this method should only be carried out as prescribed by a doctor.
Good results are obtained by ultrasonic therapy in combination with thermal procedures, magnetotherapy, and high-frequency therapy methods. In this case, UST is prescribed after these procedures. If ultrasound is prescribed in combination with electrophoresis, then it is better to do it first.
Having the properties of sound and light, ultrasonic waves propagate in tissues predominantly longitudinally in the direction of the ultrasonic beam. A process of alternating compression and “liquefaction” of the substance occurs. This process constitutes one cycle of oscillations, and their number in 1 s is the oscillation frequency in hertz.
In an ultrasonic field, in the direction of traveling waves, zones of compression and “liquefaction” of the substance are on duty, causing variable acoustic pressure, the amplitude of which depends on the intensity of the vibrations. One of the mechanisms of action of ultrasound is connected with this: the transition of solutions and substances through biological membranes.
During the propagation of ultrasound in an inhomogeneous medium, part of the energy is reflected, and the other passes into the next medium. Reflection of ultrasound depends on the magnitude of the acoustic resistance of the media, the angle of incidence and the frequency of wave oscillations.
Provided that the acoustic resistance in the area of influence differs slightly, the reflection of ultrasound on the edge of these media is insignificant. If there is a large difference in acoustic impedance, then the incident wave is completely reflected from the limit of the media. Thus, ultrasound is reflected to the limit of air and biological tissue by 99.7%. This dictates the basic condition of the ultrasound therapy technique - close contact of the applicator with the area of the body that is being affected. For this purpose, so-called contact media (water, petroleum jelly, vegetable oil, glycerin, ointments) are used, which are applied to the affected area. Since the acoustic properties of these media and biological tissues are similar to each other, the impact of ultrasonic waves is insignificant (ranging from 0.1 to 1%).
The reflection of ultrasonic waves also depends on the angle of their incidence on the action area. As the angle of incidence increases, the reflection coefficient increases. The more the angle of incidence deviates from the perpendicular drawn to the surface of the medium, the greater the reflection coefficient. It can become such that the propagation of ultrasound completely stops. That is why the shortest prerequisite
energy transfer to tissues involves applying the emitter to the skin with its entire surface.
Tissues absorb ultrasound unevenly. Weak absorption occurs in subcutaneous fatty tissue, more in muscles, nerves and especially in bones. Tissues that perform the function of support, and tissues that receive and transmit mechanical stress, have higher adipose tissue values than tissues of parenchymal organs. The ultrasound absorption coefficient for bone tissue is 12-15 times higher than for muscle tissue. The depth of penetration of ultrasound into the bone is minimal and is about 0.3 cm. The maximum energy of ultrasound is absorbed on the verge of dividing different tissues: skin - subcutaneous fatty tissue, fascia - muscle, periosteum - bone. In pathological processes of absorption, ultrasound begins to vibrate. If the pathological process is accompanied by tissue swelling, then the absorption coefficient of ultrasonic waves decreases. Infiltration of tissues with cellular elements leads to an increase in the absorption coefficient.
It is believed that under conditions of a whole organism, ultrasound with a frequency of 800-1000 kHz propagates to a depth of 5-6 cm, and with a frequency of 2500-3000 kHz - to 1.5-2 cm. Since the amplitude of ultrasonic vibrations gradually decreases, to assess the depth of their penetration depends on the size of the semi-absorbing layer. It shows at what depth the intensity of vibrations as a result of claying with tissues is halved. The greater the viscosity of the fabric and the higher the vibration frequency, the smaller the size of the clay layer. Yes, at a frequency of 800 kHz, the size of this layer for soft tissues (fat and muscle) is 4.9 cm, and at a frequency of 2400 kHz - 1.5 cm. Taking this into account, a frequency of 880 kHz is used to treat diseases of internal organs, and in In dermatological practice, ultrasound with an oscillation frequency of 2000-3000 kHz is more often used. And the main dosimetric parameters of ultrasonic therapy are power, intensity, mode and severity of action. Power is the amount of energy that is transmitted by the entire surface of the ultrasonic head. In physiotherapy, the concept of “intensity” is more often used. Intensity is the amount of ultrasonic energy that passes through 1 cm2 of emitter area during 1 s. It is presented in watts per 1 cm2 (W/cm2). The division of ultrasound intensity into low (0.05-0.4 W/cm2), medium (0.6-0.8 W/cm2) and high (1.0-1.2 W/cm2) was approved. And generation mode Ultrasound can be constant (continuous ultrasound) and pulsed, when vibrations are applied in separate pulses at intervals (pulsed ultrasound). In this case, the pulse frequency is 50 Hz, trivality is 10.4 and 2 ms, and the duty cycle (the ratio of the duration of the entire period to the duration of the pulse) is respectively 2.5 and 10. In pulse mode, at the same intensity of oscillations for the same period of time energy is emitted on average less than during continuous.
In the mechanism of ultrasound influence on the body, the main ones are mechanical, thermal and physico-chemical factors. The mechanical factor, which is driven by variable acoustic pressure, turns out to be a kind of “micro-massage” at the cellular and subcellular levels. In this case, there is an increase in the permeability of cell membranes, histohematic barriers and increased penetration of speech through the skin; The depolymerizing effect of ultrasound on hyaluronic acid is also important. Activation of electrokinetic (electrocapillary) phenomena occurs, which occur on the verge of media with different acoustic resistance and are of great importance in phonophoresis. Acoustic microcurrents appear in the protoplasm, movement of internal inclusions, changes in their spatial relationship, which causes stimulation of the function of cellular elements and the cell as a whole.
The thermal factor of ultrasound is associated with the absorption of the energy of ultrasonic waves and its conversion into heat. Previously, when high intensities of ultrasound were used, a significant increase in tissue temperature was observed, and therefore this factor was considered the most important in the mechanisms of action of ultrasound. When using low intensities and a labile technique, the effect of a significant increase in tissue temperature is not observed. At present, without denying the importance of the thermal factor, the main value behind it is not determined. A consequence of the thermal effect of ultrasound can be considered a change in diffuse processes, the rate of biochemical reactions, the emergence of temperature gradients, which ultimately manifests itself in the vitality of the sounded tissues.
The physicochemical factor of ultrasound turns out to be a change in biochemical reactions and biophysical processes; in the gene
The physicochemical effect of ultrasound is associated with the spatial rearrangement of intracellular molecular complexes. The activity of a number of enzymes increases, the intensity of tissue redox processes increases, the mitotic activity of cells increases, and biologically active substances are formed in the tissues - heparin, histamine, serotonin, etc.
The mechanism of therapeutic action of ultrasound is diverse. Evon consists of local and general reactions realized through neuroreflex and humoral pathways. These reactions develop in phases and are distinguished by a long-lasting aftereffect.
With the correct dosages, ultrasound has an analgesic, dissolving, anti-inflammatory, antispasmodic, and fibrinolytic effect. Under its influence, regenerative and reparative processes are accelerated, the excitability of the neuromuscular system is increased, the conduction of impulses along the peripheral nerve fiber is enhanced, the transmission of nerve impulses in the sympathetic ganglia is activated, and the trophic function of tissues is improved.
Devices. For ultrasound treatment, the ultrasonic therapeutic portable UTP-1-APA¬RAT is used (Fig. 82); ultrasonic therapeutic hospital UTS-1-APPARAT; devices for dermatological practice UTP-3, UTP-3 M and ultrasonic devices of an improved design with smaller overall dimensions UT-5, UZT-101, etc. Different sets of applicators are added to all devices.
Currently, several types of ultrasound devices are used in physiotherapeutic practice: ultrasound therapeutic stationary (UTS-1, UTS-1M) and portable (UTP-1, UTP-ZM, Uz-t5, UZT-101, UZT-102 , UZT-103, UZT-104, UZT-31, ENT-1A, ENT-2, ENT-3).
Ultrasonic devices of the UZT series have emitters of various shapes and areas (IUT -
ultrasonic therapeutic emitter), used depending on the intended purpose. Of the models in this series, the UZT-101 device is used for the treatment of diseases of internal organs, the musculoskeletal and nervous systems, UZT-102 - for the treatment of dental diseases, UZT-103-FOR the treatment of urological diseases, UZT-104 - for the treatment eye diseases, UZT-31 - in gynecology.
“\Technique and methodology for carrying out procedures. Periodically
Ultrasound power should be monitored using a VPU-3 power meter. The position of the patient during the procedure depends on the disease and the area on which the action is directed.
There are such methods of influence with ultrasound: contact, when the vibrator directly touches the surface, and underwater. Each of them can be carried out using a mobile (labile) or stationary (stable) technique. Since air creates an obstacle to the propagation of sound vibrations, for good penetration during the contact technique, the skin of the entire area of influence is lubricated with glycerin with water, Vaseline or paraffin oil
In the case of using the moving technique, the applicator is used to first perform slow stroking linear movements, and then apply the strokes. The surface of the applicator should fit tightly to the skin.
In the case of using a stationary technique, the applicator is located in one area all the time during the procedure. The severity and intensity of influence should be less than in the case of using the mobile technique. Fixed techniques are rarely used to avoid tissue overheating and pain. •
Using the underwater technique, the appropriate limb and vibrator are dipped into a bath with fresh water heated to +32.„4-36 ° C (such water contains fewer gas bubbles). The vibrator is installed motionless or moved under water along the area of influence at a distance of 1-2 cm from it (Fig. 83).
•^The infusion can be direct or indirect. In the first case, they directly influence the corresponding organs and tissues (muscles, joints, etc.), in the other, they influence the affected organ through the corresponding reflex zones (spinal cord roots and sympathetic ganglia - segmental influence).
To act on individual areas of the body (eye, maxillary sinus, nose, etc.), additional attachments or tubes attached to the vibrator and filled with water are used.
Ultrasound procedures are performed on limited areas of the body, which have an average area of 150-200 cm2. If there is a need to influence a large surface, it is divided into separate fields, influencing 2-3 fields in turn.
The procedures are dosed according to the intensity of ultrasound and their duration. Intensity is measured in watts per 1 cm2 of applicator surface (W/cm2). Weak intensity is usually considered to be 0.2-0.4 W/cm2, medium - 0.6-0.8 W/cm2, strong - 0.9-1.2 W/cm2. The duration of an ultrasound procedure, as a rule, depends on the area of the
la: it is 5-17 spins, but no more than 10-15 spins for all fields. Procedures are prescribed every other day, for a course of 10-15 procedures. With a stable technique, the intensity of ultrasound is reduced to 0.05-0.02 W/cm2, and the duration of the procedure is reduced.
At the end of the procedure, the contact substance is removed from the applicator, wiped dry and secured on the side wall of the device.
To avoid the intense thermal effect of ultrasound, especially when using a stationary technique, ultrasound is sent in separate pulses after certain intervals of time (pulse mode).
The use of ultrasound in combination with certain medicinal substances in the form of an emulsion, which is also a contact medium, has become widespread - ultraphonophoresis. In these methods, instead of petroleum jelly, the contact medium can be appropriate solutions and ointments (hydrocortisone, prednisolone, analgin, bicilin, etc.). The effect of ultrasound is enhanced by the pharmacological influence of the corresponding drug.
Ultraphonophoresis with hydrocortisone is used in patients with a pronounced allergic component.
Depending on the general condition of the body, the intensity and nature of the pathological process, ultrasound is performed daily, less often - every other day. During ultrasound treatment, you should refrain from using x-ray radiotherapy. Ultrasound procedures can be combined with physical therapy, and on free days - with baths.
Considering that the aftereffect of ultrasound procedures is long-lasting, it is not recommended to repeat the course of procedures earlier than after 3-5 minutes. Deforming arthrosis, intervertebral osteochondrosis, radiculitis, glenohumeral periarthritis, ankylosing spondylitis, bursitis, Dupuytren's contracture (initial stage), neuralgia, neuritis, joint injuries, peripheral nerves, scars and adhesions of superficial and deep tissues, peptic ulcer of the stomach and duodenum (except perforating and calcific ulcers), asthmatic bronchitis, neurodermatitis, mastitis, some gynecological and eye diseases.
Contraindication. Malignant tumors, blood disorders, tendency to bleeding, pregnancy, stage III hypertension, severe atherosclerosis, coronary sclerosis, arterial hypotension, diencephalic syndrome, sharp variations of psychoneuroses, diseases of the central nervous
systems, including cerebrovascular accident, syphilis, diabetes mellitus, thrombosis, congestion, in the pelvic veins.
Ultrasound should not be applied to the area of the head, heart, stomach ulcer that is bleeding, pregnant uterus
SPECIAL METHODS OF ULTRASOUND THERAPY Effect on sore joints. The procedure is prescribed for the lower joint and paravertebral areas of the spine. The patient should be in a sitting position (Fig. 84). The oprominyu-vach is moved with stake movements in the area of the joint, calcaneus, plantar surface of the foot, and so on. The technique is labile. The contact medium can be Vaseline oil, analgin or hydrocortisone ointment. Continuous mode. The intensity of ultrasound in the case of action on the shoulder joint is 0.2-0.4 W/cm2, on the elbow joint and hand - 0.2-0.6 W/cm2, on the knee - 0.4-0.6 W/cm2 , on the area of the pelvic bones and hips - 0.4-0.6 W/cm2, - on the spot bones - 0.4-0.6-0.8 W/cm2. The duration of the procedure is 3-5 minutes for each zone, daily or every other day. The course of treatment includes 8-10-15 procedures. Small joints can be affected directly through water (Fig. 85).
Action on the spine (Fig. 86). The patient can sit or lie down. The effect of ultrasound on the paravertebral zones is performed 2-3 cm to the right and left of the spinous processes of the spine. The intensity should be 0.2-0.4 W/cm2, the duration of the procedure is 3-5 minutes per field if the mode is continuous, and 6-8 minutes if the mode is pulsed.
Effect on peptic ulcers of the stomach and duodenum (Fig. 87). Before the procedure, the patient drinks 1 - 2 glasses of liquid (boiled water, tea) to push the gas bubble into the upper parts of the stomach. They act with ultrasound on the epigastric area and paravertebral at the level of Tp-tphp. The patient lies first on his back, then on his stomach. The operating mode for the epigastric area is continuous, paravertebral is pulsed: The contact medium should be Vaseline or Vaseline oil. The intensity is 0.2-0.4 W/cm2. The technique is labile. The duration of the procedure is 3-5 minutes per field, 4-5 procedures are carried out every other day, then daily. The course of treatment consists of 10-12-15 procedures.
Ultraphonophoresis of hydrocortisone for diseases of the genital organs (Fig. 88). The skin of the projection of the internal genital organs is lubricated with hydrocortisone ointment. Sounding is carried out with ring movements of the head of the ultrasonic irradiator at an intensity of 0.6-0.8 W/cm2. The time of procedures gradually increases from 5 to 10 minutes. Segmental (paravertebral) sounding lasts 3-5 minutes at an intensity of 0.2-0.4 W/cm2. There are 15-20 procedures per course of treatment.
Treatment of prostate adenoma (Fig. 89). After emptying the intestines, 2 ml of an oil emulsion containing 0.25 g of a 12.5% solution of oxyprogen is injected into the rectum through a catheter.
sterone capronate. The ultrasound head is placed over the prostate projection. Pulse mode, intensity 0.4 W/cm2, duration 5-8 minutes, daily. There are 8-10 procedures per course.
Treatment of psoriasis. The localization site of psoriatic plaques is lubricated with hydrocortisone and labilely sounded in a continuous mode, intensity 0.6-0.8 W/cm2, duration 6-10 minutes. During this time, 2-3 fields are sounded, located behind the affected area. Then they perform paravertebral sounding of the spinal cord segments corresponding to the lesion: if the psoriatic process is localized on the upper extremities, then they act on the C(-s, on the lower ones - on the C-C Intensity 0.2-0.4 W/cm2, triva¬leaf 3-5 xv per field.Contact center - Vaseline oil (in case of action on segments of the spinal cord).For a course of treatment 10-15 procedures.
In the mechanism of ultrasound on the body, the main significance is mechanical, thermal and physico-chemical factors. The mechanical factor, which is caused by variable acoustic pressure, turns out to be a kind of “massage” at the cellular and subcellular levels. In this case, there is an increase in the permeability of cell membranes, histohematic barriers and increased penetration of speech through the skin; The depolymerizing effect of ultrasound on hyaluronic acid is also important. Activation of electrokinetic (electrocapillary) phenomena occurs, which is observed on the edge of media with different acoustic resistance and is of great importance in phonophoresis. Acoustic microcurrents appear in the protoplasm, movement of internal inclusions, changes in their spatial relationship, which causes stimulation of the function of cellular elements and the cell as a whole.
The thermal factor of ultrasound is associated with the absorption of the energy of ultrasonic waves and its conversion into heat. Previously, when high intensities of ultrasound were used, a significant increase in tissue temperature was observed, and therefore this factor was considered the most important in the mechanisms of action of ultrasound. When using low intensities and a labile technique, the effect of a significant increase in tissue temperature is not observed. At present, without denying the importance of the thermal factor, the main value behind it is not determined. A consequence of the thermal effect of ultrasound can be considered a change in diffusion processes, the rate of biochemical reactions, and the emergence of temperature gradients, which ultimately manifests itself in the vital activity of sonicated tissues.
The physicochemical factor of ultrasound turns out to be a change in biochemical reactions and biophysical processes; in the generation of free radicals, activation of redox processes, formation of biologically active substances, changes in pH, increase in cell colloids. Different aspects of the biological action of ultrasound are interconnected. The influence of ultrasonic vibrations on physicochemical and biophysical processes is closely intertwined with the mechanical and thermal components of its action.