Contraindications in Physical Rehabilitation: Doing No Harm
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The Electrophysical Forum aims to provide an interactive platform for questions, comments, discussion and opinion related to the use of Electro Physical modalities in therapy.
It is supported by an Internationally renowned expert panel and a broad sphere of clinicians, researchers, educators and students. Active participation is welcomed. I have a 13 year old male patient who sustained an elbow injury during a rugby match 1 year ago. There was an impact to his elbow whilst it was in full extension, and he was diagnosed with a lateral epicondylar flake avulsion injury.
Subjectively he complains of pain when his arm is in sustained elbow flexion, e. Objectively he has full ROM with pain at end range flexion. He has slightly reduced strength in elbow flexion and extension, with pain on resisted elbow extension.
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The patient has been advised that ultrasound may be an effective treatment for his symptoms, however I am concerned that ultrasound over the growth plate in minors is contraindicated; favouring instead exercise therapy, soft tissue work and mobilisations. Does anyone have any thoughts on this subject, or can anyone recommend any appropriate research articles that may support or refute my hypothesis that ultrasound is an inappropriate treatment for this case study?
Post a reply. Thank you very much colleagues for your input on this topic. It is clearly a debatable subject! I did decided not to use ultrasound in the end, mainly for the reason that I felt other therapies were more appropriate for this chronic pain pattern.
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I agree that it seems unlikely that any harm would come from a superficial therapeutic dose, however I do feel that even if there is a small chance of doing lasting damage , I would rather not use it. The use of ultrasound over growth plates in children and teenagers is something which comes around and around - and has done for years. As you will have seen from previous contributions, US in this kind of circumstance is commonly listed as either a contraindication or a precaution. The evidence is all animal model based fairly predictably - nobody is going to lend us a load of children to do experiments on!!
The evidence of a detrimental effect is not strong - even with high dose US applied with high frequency on very young animals. In therapy, the US energy COULD have a detrimental effect on growth plate activity, and thus the general advice would be not to deliver directly over active growth zones. My general clinical thinking would be:?? Applied at low dose intensity and in a pulsed mode, I can not actually see any evidence for a detrimental effect, and I suspect that the general guidance is over conservative for understandable reasons.
Clearly this does not give you a definitive answer, but without additional evidence, I would have thought that the chance of having a detrimental effect on the underlying growth area is extraordinarily small.
Contraindications in Physical Rehabilitation: Doing No Harm
The question whether US can or cannot be used on epiphyseal plates may go on for quite a while. On the other hand I thought why bother? Wouldn't it be an option to use microcurrent? This technique is known for causing tissue repair and there's no doubt that your patient has a tissue damage. In the case you described I couldn't see any contraindication for microcurrent.
So why not try? Early warnings that US affected growth plates arose from studies that applied US to isolated ex vivo animal bones maintained in culture. Extrapolation to clinical situation is questionable. I agree with views expressed by others that it should be used judiciously over growing bone - i.
Cervical traction helps to relax the muscles, which can significantly relieve pain and stiffness while increasing flexibility. It can alleviate pain from joints, sprains, and spasms. Cervical traction devices work by stretching the spinal vertebrae and muscles to relieve pressure and pain. Force or tension is used to stretch or pull the head away from the neck. Creating space between the vertebrae relieves compression and allows the muscles to relax. This lengthens or stretches the muscles and joints around the neck.
These improvements may lead to improved mobility, range of motion, and alignment.
This will allow you to go about your daily activities with greater ease. A meta-analysis of studies analyzed the effectiveness of cervical traction in relieving neck pain. This report found that the treatment significantly reduced neck pain immediately following treatment.
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Pain scores were also reduced in the follow-up period. More in-depth, high-quality studies are needed to learn more about the long-term effects of this treatment. A study found that mechanical traction was effective in treating people with pinched nerves and neck pain. Mechanical traction was more effective than exercising alone or exercising in addition to using over-door traction. There are several ways to do cervical traction, either with a physical therapist or on your own at home. Your physical therapist can help you to decide upon the best method to suit your needs.
Your physical therapist may recommend that you buy cervical traction equipment to use at home.
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Certain devices may require you to have a prescription. Cervical traction devices are available online and in medical supply stores. Your physical therapist should show you how to use the device properly before you use it on your own. Manual cervical traction is done by a physical therapist. Your physical therapist will make adjustments to your exact positioning in order to get the best results. Mechanical cervical traction is done by a physical therapist. The harness hooks up to a machine or system of weights that apply traction force to pull your head away from your neck and spine.
An over-the-door traction device is for home use. You attach your head and neck to a harness. This can be done while sitting, leaning back, or lying down. The treatment should be totally pain-free. This may even lead to fainting. Stop if you experience any of these side effects, and discuss them with your doctor or physical therapist. You should avoid cervical traction if you have:. Discontinue use if you experience any pain or irritation or if your symptoms get worse. There are several exercises that can be done using cervical traction devices.
Make sure to listen to your body and go to your own edge or threshold in terms of stretching and the duration of your exercises. To use an air neck traction device, place it around your neck and adjust the straps as necessary. Then, pump it up and wear it for about 20—30 minutes. Do this a few times throughout the day.
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You can wear the device while doing activities where you tend to slouch. Your physical therapist can recommend the right amount of weight for you to use. Pull and hold the weight for 10—20 seconds and then slowly release. Continue this for 15—30 minutes at a time.