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Therapeutic Ultrasound Benefits Review


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Therapeutic Ultrasound Benefits Review

  1. 1. Therapeutic Ultrasound Benefits Casey Christy, MA, ATC, CSCS
  2. 2. Does US Promote Healing? <ul><li>Although the majority of research has been done with animals, Draper and Knight suggest ultrasound may promote tissue healing. </li></ul><ul><li>Two ways ultrasound accomplishes this is through aiding the inflammatory response and connective tissue healing . </li></ul>
  3. 3. Aiding the Inflammatory Response <ul><li>Remember the body’s inflammatory response is necessary for healing to take place, and ultrasound may help to accelerate some of these processes. </li></ul>
  4. 4. Aiding the Inflammatory Response: <ul><li>Mast cells are a type of “resident cell” in connective tissue that contain a substance called histamine , a primary initiator of the acute inflammatory response. </li></ul><ul><li>Histamine attracts leukocytes (white blood cells), which clean up debris in the injured area. </li></ul>
  5. 5. Aiding the Inflammatory Response: <ul><li>Monocytes (a type of leukocyte) drawn to the area release agents that stimulate fibroblasts and endothelial cells (these form the inner lining of blood vessels) to form collagen-rich, well-vascularized tissue for the development of new connective tissue. </li></ul>
  6. 6. Aiding the Inflammatory Response <ul><li>Ultrasound has been shown to stimulate the release of histamine from mast cells, therefore facilitating inflammation and healing. </li></ul><ul><li>Scientists suggest pulsed ultrasound at 20% duty cycle. </li></ul>
  7. 7. Aiding Connective Tissue Healing <ul><li>Collagen is a protein found in connective tissue and is the primary solid substance in ligaments, tendons and scar tissue. </li></ul><ul><li>Collagen is made by fibroblasts. </li></ul>
  8. 8. Aiding Connective Tissue Healing <ul><li>In several studies ultrasound increased collagen formation, encouraged collagen to lie down in a more parallel orientation, and even helped with injured nerve regeneration. </li></ul><ul><li>Scientists say ultrasound stimulates collagen synthesis and cellular proliferation. </li></ul>
  9. 9. Aiding Connective Tissue Healing <ul><li>Fibroblasts are relatively large, star-shaped cells and produce protein fibers (collagen) in connective tissue. They are the most common resident cells found in connective tissue. </li></ul><ul><li>Fibroblasts play a key role in forming new connective tissue and appear 3-5 days after an injury. </li></ul>
  10. 10. Aiding Connective Tissue Healing <ul><li>Fibroblasts exposed to ultrasound are stimulated to produce more collagen, which strengthens the new connective tissue. </li></ul>
  11. 11. Aiding Connective Tissue Healing <ul><li>Low-dose pulsed US increases glycosaminoglycan and hydroxyproline, two important components of collagen remodeling. </li></ul>
  12. 12. Aiding Connective Tissue Healing <ul><li>Macrophages are another type of resident cell found in connective tissue that function as scavenger cells and remove debris. </li></ul><ul><li>They are the main cell-type present in wounds 4-5 days after injury. Macrophages secrete substances that stimulate fibroblast production. </li></ul>
  13. 13. Aiding Connective Tissue Healing <ul><li>When exposed to ultrasound, macrophages increase fibroblast proliferation. </li></ul><ul><li>Acoustical streaming increases cell membrane permeability. This allows calcium to enter the cell which encourages protein release, which in turn stimulates healing. </li></ul>
  14. 14. Additional Thermal Effects <ul><li>Pain reduction </li></ul><ul><ul><li>Heat production produces gating effect . </li></ul></ul><ul><ul><li>US also increases nerve conduction velocity along normal nerves, acting as a counterirritant. </li></ul></ul>
  15. 15. Additional Thermal Effects <ul><li>Increased extensibility of collagen-rich structures </li></ul><ul><ul><li>Collagen-rich tissues such as tendons, ligaments, joint menisci, superficial bone, large nerve roots, intermuscular fascia and scar tissue are preferentially treated with US. </li></ul></ul><ul><ul><li>Tissues that are largely fluid-filled such as fat are “transparent” to the heating effects. Since muscle is largely fluid filled, it is not well heated (compared to the above-mentioned tissues) via ultrasound, but scar tissue within the muscle belly is. </li></ul></ul>
  16. 16. Additional Thermal Effects <ul><li>Increased blood flow </li></ul><ul><ul><li>This brings oxygen and nutrients to the area </li></ul></ul><ul><li>Reduction of muscle spasm </li></ul>
  17. 17. US Effects Summary <ul><li>US stimulates histamine production which aids the inflammatory and healing process. </li></ul><ul><li>Ultrasound increases fibroblast proliferation and collagen formation. </li></ul><ul><li>The thermal effects of US provides a gate mechanism pain relief, increased blood flow and increased tissue extensibility among other effects. </li></ul>
  18. 18. References <ul><li>Denegar et al. Therapeutic Modalities for Musculoskeletal Injuries. </li></ul><ul><li>Knight and Draper, Therapeutic Modalities; The Art and Science. </li></ul><ul><li>Starkey, Therapeutic Modalities. </li></ul>