Tag: Chattanooga

The benefits of high power laser treatment

Posted on | by Matthew Blackwell

Laser therapy devices have been used as an adjunct in physical therapy treatments for decades, providing pain relief for injured muscles and joints.1 However, in the past these devices tended to be relatively low in power, requiring extended periods of use to provide therapeutic effects.

Nowadays, more modern devices are capable of delivering therapeutic light energy much faster, but what exactly are the benefits of high power laser treatment?

What is laser therapy?

Laser therapy, or photobiomodulation, applies light energy to the body with the aim of promoting healing. Laser radiation is absorbed in the cell mitochondria and converted into energy (ATP) by the cell, which helps synthesize protein and stimulate the creation of new cells. This leads to the normalization of the affected region by promoting a reduction in swelling, relieving pain, and accelerating the tissue repair process.2

Low level laser therapy devices have an output measured in mW, meaning the time to deliver therapeutic amounts of light energy can make them inefficient, especially when treating deep-lying injuries or large areas such as quadriceps.

High power laser therapy devices, on the other hand, have multiple Watts of power, greatly reducing the treatment times of even large or deep structures. This makes high power laser treatment an effective and practical physical therapy modality.

What are the benefits of high power laser treatment?

From reducing pain to improving mobility, studies have shown there are many documented benefits of high power laser treatment.

Increased hamstring force

In a study by Verma et al. (2022),3 high power laser therapy was used on two groups of athletes with proximal hamstring tendinopathy. The group receiving high power laser therapy in addition to conventional physiotherapy showed an increase in hamstring force (Isokinetic Peak Torque in Nm) of 13% after treatment, compared to 1.5% in the group that received only conventional physiotherapy.

Better shoulder mobility

Atan et al.’s 2021 study4 Involved using high power laser therapy to treat patients with frozen shoulder. Those in the group that received high power laser and exercise showed 60° better shoulder mobility after treatment compared to 38° in the group that used only exercise.

Less tennis elbow pain

A study by Roberts et al. (2013)5 demonstrated that patients who received eight sessions of high power laser treatment experienced a 93% decrease in tennis elbow pain and a 71% improvement of function in the joint. This was compared to no improvement in pain and worsening function in the placebo control group.

Reduced jaw pain

In Ekici’s 2022 study,6 patients with temporomandibular disorder who were treated with high power laser experienced a 55% decrease in jaw pain, compared to 4% of those treated with a placebo laser.

Less carpal tunnel pain

Ezzati et al. (2020)7 showed that patients treated with high power laser therapy benefitted from 68% less carpal tunnel pain compared to 30% with low level laser therapy when using the same fluence (8J/cm.)

Less knee osteoarthritis pain

The knee osteoarthritis patients in Kim et al.’s 2016 study8 experienced 38% more pain relief and 37% additional functional improvement than those who were only given conventional physical therapy.

Less back pain

Patients with lumbar disc protrusion who took part in Chen et al.’s 2018 study9 had 25% more pain relief when high power laser treatment was added to traction therapy than when they received traction therapy alone.

The benefits of LightForce® high power laser therapy

In the field of high power laser treatment, Chattanooga’s® LightForce® laser therapy devices stand out. These products have been used to deliver an estimated 1.2 million treatments per month in 29 countries around the world, enabling clinicians to provide their patients with the beneficial effects of high power laser therapy.

Chatterjee et al.’s 2019 study10 showed that LightForce laser therapy added to standard of care for neuropathic pain resulted in a 30% greater improvement in pain compared to standard of care with placebo laser in patients with diabetic neuropathy.

The same study also demonstrated a 42% greater improvement in quality of life. Furthermore, no side effects or adverse events were reported during the study period, adding to the evidence that high power laser treatment for musculoskeletal disorders is a safe technique.11

LightForce laser therapy

Customers seeking to offer high power laser therapy can choose from three different LightForce devices, each with their own maximum level of power:

LightForce® FXi Therapy Laser – 15W

Portable but powerful

Although lightweight, with a maximum power of 15W, the FXi still has more than enough energy to enable fast, effective laser treatments. Weighing just 3.2kg and with a rechargeable battery that lasts for up to half a day on a single charge, the FXi is a great choice for physios looking to bring the clinic to the patient.

LightForce FXi

LightForce® XPi Therapy Laser – 25W

The next step in laser therapy

Boasting a maximum power of 25W, the XPi makes treating patients even faster. And with its smart handpiece providing real-time visual and haptic feedback on dosing speed, users can be even more confident in delivering effective high power laser treatment.

LightForce XPi

LightForce® XLi Therapy Laser – 40W

Maximum power, maximum efficiency

For the busiest practices, the LightForce® XLi provides maximum benefit. With an impressive top power of 40W and the XL Treatment Cone included, clinicians greatly reduce the time needed to treat effectively, allowing them to fit more patients into their daily schedule.

LightForce XLi

You can download our infographic on the benefits of high power laser therapy here:

Download PDF

To learn more about LightForce therapy lasers visit lightforce.rehab

As laser light can damage the eye, make sure to wear protective glasses during your treatment and never look into the laser beam.

References

  1. Kitchen, S. S. & Partridge, C. J. (1991). A Review of Low Level Laser Therapy: Part I: Background, Physiological Effects and Hazards. Physiotherapy 77(3): 161-168.
  2. da Silva, J.P., da Silva, M.A., Almeida, A.P., Lombardi Junior, I., Matos, A.P. (2010). Laser therapy in the tissue repair process: a literature review. Photomed Laser Surg. Feb;28(1): 17-21.
  3. Verma, S., Esht, V., Chahal, A., Kapoor, G., Sharma, S., Alghadir, A.H., Khan, M., Kashoo, F.Z., Shaphe, M.A. (2022). Effectiveness of High Power Laser Therapy on Pain and Isokinetic Peak Torque in Athletes with Proximal Hamstring Tendinopathy: A Randomized Trial. Biomed Res Int. May 20;2022:4133883.
  4. Atan, T., Bahar-Ozdemir, Y. (2021). Efficacy of high-intensity laser therapy in patients with adhesive capsulitis: a sham-controlled randomized controlled trial. Lasers Med Sci. Feb;36(1):207-217.
  5. Roberts, D.B., Kruse, R.J., Stoll, S.F. (2013). The effectiveness of therapeutic class IV (10 W) laser treatment for epicondylitis. Lasers Surg Med. Jul;45(5):311-7.
  6. Ekici, Ö., Dündar, Ü., Büyükbosna, M. (2022). Effectiveness of high-intensity laser therapy in patients with myogenic temporomandibular joint disorder: A double-blind, placebo-controlled study. J Stomatol Oral Maxillofac Surg. Jun;123(3):e90-e96.
  7. Ezzati, K., Laakso, E.L., Saberi, A., Yousefzadeh Chabok S., Nasiri, E., Bakhshayesh Eghbali B. (2020). A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med. Dec;56(6):733-740.
  8. Kim, G.J., Choi, J., Lee, S., Jeon, C., Lee, K. (2016). The effects of high intensity laser therapy on pain and function in patients with knee osteoarthritis. J Phys Ther Sci. Nov;28(11):3197-3199.
  9. Chen, L., Liu, D., Zou, L., Huang, J., Chen, J., Zou, Y., Lai, J., Chen, J., Li, H., Liu, G. (2018). Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: A randomized controlled trial. J Back Musculoskelet Rehabil. Feb 6;31(1):191-196.
  10. Chatterjee, P., Srivastava, A.K., Kumar, D.A., Chakrawarty, A., Khan, M.A., Ambashtha, A.K., Kumar, V., De Taboada, L., Dey, A.B. (2019). Effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes: a pilot randomized clinical trial. BMC Geriatr. Aug 12;19(1):218.
  11. Arroyo-Fernández, R., Aceituno-Gómez J, Serrano-Muñoz, D., Avendaño-Coy, J. (2023). High-Intensity Laser Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med. Feb 13;12(4):1479.

The link between COVID-19 and heel pain

Posted on | by Matthew Blackwell

Since the COVID-19 pandemic began in 2020, the number of patients reporting heel pain has risen. The condition is now so common it has come to be known as “pandemic foot”. Is there really a link between COVID-19 and heel pain, and if so, what treatment options are available?

What is plantar fasciitis?

While “pandemic foot” might be a catchy name, the correct medical term is plantar heel pain, or plantar fasciitis. This condition presents as pain felt on the bottom of the foot around the heel and arch. It is an overuse condition often associated with runners, especially those over the age of 40.

Excessive pressure on the foot, along with a tight calf or Achilles tendon, can cause inflammation of the plantar fascia, the thick band of tissue on the bottom of the foot connecting the heel to the toes.

The pain is commonly felt during the first step, as well as during weight-bearing tasks, particularly after periods of rest.1 Patients often report the pain at its worst as they take their first steps of the day after getting out of bed. It typically decreases as the calf and Achilles tendon become looser during activity, only to return the following day after things have tightened up again during the night.

Does COVID-19 cause plantar fasciitis?

There is no current evidence to suggest there is a direct link between COVID-19 and heel pain. Instead, the rise in plantar fasciitis is more likely to be due to the changes in our daily lives the pandemic has brought about.

Gym attendances have declined since the beginning of the pandemic, with outdoor running and walking becoming more popular instead. More running and walking mean more stress on the plantar fascia, which, due to an increase in flexible working, can be exacerbated by more time spent walking around at home in bare feet, slippers, or flip-flops.

Without the additional support that a heeled shoe can provide, like those typically worn in office environments, the foot spends more time in a flat position, which, for extended periods, can put additional strain on the fascia. Add to this stiff muscles and tendons from running, and you have a recipe for plantar fasciitis. This is the indirect link between COVID-19 and heel pain.

How can heel pain be treated?

There are a number of conservative treatment options for plantar fasciitis. They range from relatively simple orthotics to more advanced rehabilitation devices.

Taping for heel pain

Physio tape (also known as kinesiology tape) like Chatt-Tape is elastic adhesive tape that can be applied to parts of the body to aid healing and recuperation of the soft tissue.2

Tape can be applied to the heel, ankle, and underside of the foot to release tension in the plantar fascia as well as stabilize it. A study by Tezel et al. (2020) showed that kinesiology tape provided pain relief and improved quality of life for patients with plantar fasciitis, as well as improved functionality.3

Chatt-Tape plantar fasciitis
Aircast AirHeel and Dorsal Night Splint

Bracing for heel pain

Plantar fasciitis can be relieved by wearing an orthotic during the night to help reduce the tightening of the calf muscles and Achilles tendon.4 One such device is Aircast’s Dorsal Night Splint; this product is worn while the patient sleeps, to maintain the position of the foot at 90°, thereby helping to stretch the calf and Achilles tendon.

Another type of foot orthosis for plantar fasciitis is a pneumatic ankle brace. Also from Aircast, the AirHeel is designed to treat plantar fasciitis, Achilles tendonitis, and heel pain. Using two interconnected aircells located under the foot arch and in the back of the heel, the brace applies pulsating compression with every step to help reduce swelling and discomfort and enhance circulation.

Kavros’s 2005 study showed that patients with higher plantar fasciitis pain experience faster relief with the Airheel than with a shoe insert.5

Shock wave therapy for heel pain

Shock wave therapy is an electronic modality that uses acoustic waves to stimulate the body on a cellular level for healing purposes. Generally divided into focused shock wave (F-SW) and radial pressure wave (RPW) therapy, shock wave therapy has been shown to be a clinically proven treatment option for plantar fasciitis, especially when treatments like taping have not been successful.1

In a 2022 study by Wheeler et al., RPW treatment provided significant improvement of pain and function in patients with chronic plantar fasciopathy.6

Intelect 2 RPW
LightForce laser therapy

High power laser therapy for heel pain

High power laser therapy, like that offered by LightForce, uses the energy of focused light to trigger the body’s natural healing processes, thereby speeding recovery.

Ordahan et al.’s 2018 study demonstrated that high power laser therapy provided improvement of pain and function in patients with plantar fasciitis.7

Combining laser therapy with shock wave therapy has shown to be even more effective.8

To learn more about products for heel pain, visit enovis-medtech.eu

References

  1. Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British journal of sports medicine, 55(19), 1106–1118.
  2. Homayouni, K., et al. (2013). Comparison between kinesio taping and physiotherapy in the treatment of de Quervain’s disease. J. Musculoskelet. Res. 16(4).
  3. Tezel, N., Umay, E., Bulut, M., Cakci, A (2020). Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study. Saudi J Med Med Sci. Sep-Dec;8(3):181-187.
  4. Powell, M., Post, W. R., Keener, J., & Wearden, S. (1998). Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot & ankle international, 19(1), 10–18.
  5. Kavros, S. J. (2005). The efficacy of a pneumatic compression device in the treatment of plantar fasciitis. Journal of applied biomechanics, 21(4), 404–413.
  6. Wheeler, P. C., Dudson, C., & Calver, R. (2022). Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to “minimal-dose” rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons, 28(8), 1356–1365.
  7. Ordahan, B., Karahan, A. Y., & Kaydok, E. (2018). The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers in medical science, 33(6), 1363–1369.
  8. Takla, M. K. N., & Rezk, S. S. R. (2019). Clinical effectiveness of multi-wavelength photobiomodulation therapy as an adjunct to extracorporeal shock wave therapy in the management of plantar fasciitis: a randomized controlled trial. Lasers in medical science, 34(3), 583–593.

How Chattanooga products are supporting neurological rehabilitation

Posted on | by Matthew Blackwell

As a manufacturer of rehabilitation equipment, there are few things we find more rewarding than witnessing the positive difference our products can make to people’s lives. This is why the story of Chattanooga’s latest Center of Excellence is so inspiring.

A Chattanooga Center of Excellence (CoE) is a facility recognized for its contribution to the improvement of patient rehabilitation. Recognition can be earned on the basis of clinical practice, educational initiatives or expertise, or clinical research in the fields of sport rehabilitation and orthopaedics, pain management, neurology, or long-term care. All Chattanooga Centers of Excellence have expertise in one or more Chattanooga physical medicine modalities or technologies.

Our latest CoE is Spain’s DACER clinic. Based in Madrid, DACER is a rehabilitation center specializing in the treatment of adults and children with neurological injuries. Using products supplied by Enovis Spain, it helps its patients to make what many people might consider to be small steps, but which they experience as massive gains.

The DACER team receiving their Chattanooga Center of Excellence Certificate

One such patient is Lucas de Ulucia. In 2019, Lucas’s professional motorcycle racing career was tragically cut short when an accident left him quadriplegic. Though he was informed by doctors at Spain’s leading neurology clinic that progress was unlikely, Lucas refused to accept their prognosis, and instead turned to DACER for help.

Two years later, thanks to intensive daily training supported by DACER’s dedicated team of professionals and Chattanooga rehab products, Lucas has regained a significant amount of mobility and greatly improved his quality of life.

Lucas de Ulucia

No head injury is too severe to despair of, nor too trivial to ignore.

Quote by Hippocrates, seen on the wall of DACER center

Standing quietly in the background of this story is Xavier Cardona, General Manager of Enovis Spain. Xavi’s relationship with DACER goes back more than a decade to when he introduced its clinicians to VitalStim for dysphagia. Since then, the clinic’s portfolio of Chattanooga products and associated expertise has grown to the point that it has achieved the status of Chattanooga Center of Excellence. The center now acts as a key opinion leader in its field, educating physical therapists from around Spain and Latin America, as well as providing a practical training environment for Chattanooga products.

When Xavi visited DACER last month to present them with their certificate, he was met with an award of his own in recognition of the support he has provided them over the years. It’s clear to see the admiration both parties have for one another, as well as the dedication they share for improving the lives of patients through rehabilitation.

And while both awards were gratefully received, it’s safe to say neither are as rewarding for their recipients as the satisfaction of seeing patients like Lucas reclaiming their freedom through movement.

Xavi (right) receiving his award
Learn more

Application guidelines for radial pressure wave therapy

Posted on | by Cliff Eaton

Radial pressure wave (RPW) therapy can be used on a range of anatomical structures, each requiring different application techniques and parameters. These treatments can be combined in a session depending on the pathology and the condition.

Treating trigger points with RPW therapy

RPW therapy can help release trigger points and reduce the associated pain.

Patient position

Place the patient in a relaxed position with the affected muscles slightly stretched. Observe the level of pain experienced and reduce the stretch if necessary.

RPW transmitters

The most commonly used transmitters for trigger point treatment have a diameter of 15 mm or 20 mm, with 20mm myofascial transmitters being the most effective.

Intensity

The application pressure for trigger point treatment varies between 1 and 5 bar, depending on the transmitter size and the patient’s rating of pain intensity, which should not exceed grade 5 to 7 on a Visual Analogue Scale.

Frequency

The therapeutic pulse frequency is 4 to 20 Hz. In general, higher frequencies seem to be more tolerable than low frequencies.

Number of pulses per trigger point

As the objective should be to reduce the patient’s pain by at least half, the number of RPW pulses required depends on the envisaged degree of pain relief. Once the desired pain reduction level has been reached, move on to treat the next trigger point in the same way. Typically the range of shocks will lie between 1,000-2,000.

Number of pulses per session

This depends on the patient’s condition, but the total number of pulses to be applied can reach 6,000 to 10,000 depending on the treatment surface, divided between local treatment and large-area muscle treatment. It is recommended that no more than 6,000 shocks should be applied over a specific point.

Area to be targeted

Treat active trigger points as well as satellite trigger points in the area of referred pain. If trigger points cannot be identified, target painful muscle spots. Bear in mind active myofascial trigger points refer distally and may present as an insertional tendinopathy.

Application technique

Hold the applicator at a right angle to the muscle surface to have the shortest possible distance to the target area. RPW devices with 5 bar of pressure and a good quality 20 mm diameter transmitter have been shown to have a maximal penetration depth of 7.60 mm. Ensure the transmitter stays in close contact with the skin without pressing too hard; firm pressure is only required with inferior handpieces. Treating over bone is not harmful but can cause severe discomfort, so patients should be informed for their consent. Treatment directly over the spine or to the head is contraindicated.

Treating tendons and tendon insertions with RPW therapy

Application techniques

Use small circular movements on the pain points along the tendon both medially and laterally using the stamping technique described below.

Treating muscles with RPW therapy

Two different techniques can be used:

  • Smoothing

To reduce muscle tone, move the applicator slowly along the skin surface in the direction of the muscle fibre, working from distal to proximal, without exerting pressure, but keeping the transmitter touching the skin via the transmission gel.

  • Stamping

Using the same treatment parameters and application direction as for muscle smoothing, apply 30 to 50 radial pressure waves to an identified trigger point or painful area at medium contact pressure before moving the applicator by the width of the transmitter head to the next application site. So named because this technique leaves a ‘stamping pattern’ (temporary redness) due to increased blood flow that quickly resolves.

Number of pulses

500 to 6,000 pulses, depending on pain intensity and the size of the muscles and muscle groups. For example, quadriceps, hamstring, gluteal, and calf muscles require 6,000 pulses using a smoothing technique.

Treating fascia with RPW therapy

The fascial system is one continuous structure that exists from head to toe without interruption. A healthy fascia is elastic and can glide along other fascial structures, but if this gliding quality is restricted, so-called adhesions occur in the system. Because of the interconnection of the fascia, the effects of fascial adhesions can spread through the entire kinetic chain. RPW therapy can help release connective tissue adhesions and constrictions.

In myofascial release, the restricted tissues are manipulated to promote normal sliding and gliding movements of muscles and fascia. RPW fascia transmitters deliver pressure waves tangentially into the tissue instead of vertically to optimize the required movement of the tissue layers. Applications with these transmitters are not carried out at a 90° angle as with other RPW transmitters, but at 45° instead.

Please see the user manual of your RPW device for a full list of clinical indications, contraindications, warnings, and precautions.

Learn more

An introduction to LightForce® Therapy Lasers

Posted on | by Matthew Blackwell

Laser therapy is a clinically proven effective adjacent treatment modality in the physical therapy practice intended for the relief of painful muscles and joints associated with acute and chronic tissue injuries1. It is also indicated for helping relieve pain and stiffness associated with osteoarthritis through its ability to increase localized blood flow.2

Although Low Level Laser Therapy (LLLT) devices have been used in physical therapy treatments for decades3, their relative low power means treatment times are excessive and impractical when treating larger areas and/or deeper tissues.

However, High Power Laser (HPL) therapy devices are capable of delivering sufficient power (at a level of Watts compared to the mW output of LLLT devices) to achieve therapeutic dosage without prolonging the application time. This allows treatment of a wider range of indications including deep and large structures within reasonable times, making HPL both an effective and practical physical therapy modality.

LightForce Deep Tissue Therapy Lasers

In the field of therapeutic laser technology, LiteCure® has long been one of the market’s leading manufacturers, with its LightForce® range of products used to deliver an estimated 1.2 million treatments per month in 29 countries around the world. Founded in 2006, the company has recently been acquired by DJO®, a leading global provider of medical technologies. By adding LiteCure to its portfolio, DJO plans to further increase the global presence of LightForce products and make their therapeutic value available to even more clinicians and patients.

All three devices share a set of core features which work together to provide users with safe, user-friendly, and controllable functionality, so that no matter which model they choose they can be assured of a positive and effective user experience.

LightForce Therapy Lasers – three different devices to meet your needs

Customers looking to introduce high power laser therapy into their practice have three different LightForce devices to choose from, each with its own maximum level of power, ranging from 15W to 40W.

All three devices share a set of core features which work together to provide users with safe, user-friendly, and controllable functionality, so that no matter which model they choose they can be assured of a positive and effective user experience.

LightForce® XLi Therapy Laser – 40W

Increased power, for the busiest practices treating the most challenging cases.

Capable of delivering up to 40W of power, the LightForce® XLi is the most powerful device in the range. Its increased power reduces the time needed to apply a therapeutic dose of light energy, and with real-time dosing feedback and the XL Treatment Cone, deeper structures can be treated faster over larger areas, all of which helps clinicians to increase the efficiency of their practice.

LightForce® XPi Therapy Laser – 25W

As above, but with a maximum of 25W of power.

LightForce® FXi Therapy Laser – 15W

A portable unit for practices treating in multiple locations in or out of the office.

At 3.2 kg, the LightForce® FXi is easy to transport, with a rechargeable battery that lasts for up to half a day on a single charge, making it the ideal choice when you need to bring the treatment to the patient. And despite its more compact size and lighter weight, with up to 15W of power it still has the energy to deliver effective laser treatments in short amounts of time.

LightForce devices benefit from the following features:

Empower IQ

LightForce’s Empower IQ delivery system gives the user real-time feedback on treatment speed to help them treat effectively. Each device’s hand-held laser applicator comes equipped with a sensor that tracks its speed during treatment and feeds back to the user via a colour-coded light. As soon as they begin treating too slowly the light changes from green to red to indicate they need to speed up; go too fast and it will turn yellow to tell them to slow down.

*Not included with LightForce FXi

Built-in protocols

LightForce products feature in-depth protocol settings that detect which head is in use and recommend the appropriate power level. This helps guide the user in matching applicator heads to power output levels, giving them extra confidence during treatments and reducing learning time.

influence® technology

influence® technology helps guide LightForce users in using the appropriate treatment settings for their patients. Simply enter the patient’s parameters based on condition, skin type, body type, and acuity, and the device will select the correct dose to be administered. These settings can then be saved in preparation for future sessions and adjusted as necessary.

Learn more

References

  1. Simunovic Z. (1996). Low level laser therapy with trigger points technique: a clinical study on 243 patients. Journal of clinical laser medicine & surgery, 14(4): 163–167.
  2. Kheshie, A. R., Alayat, M. S., & Ali, M. M. (2014). High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers in medical science, 29(4): 1371–1376.
  3. Kitchen, S. S. & Partridge, C. J. (1991). A Review of Low Level Laser Therapy: Part I: Background, Physiological Effects and Hazards. Physiotherapy 77(3): 161-168.

Treating low back pain with electrotherapy

Posted on | by Matthew Blackwell

Among the many impacts of the coronavirus pandemic, one of the least publicised is that of low back pain. Far more of us are currently working from home, often without the necessary ergonomic support of chairs and desks designed to prevent back problems, and as a result, physiotherapists are seeing a growing number of patients presenting with low back pain.

One way of treating low back pain is with electrotherapy. The practice takes advantage of the high excitability of nerve fibres, stimulating them with electrical pulses to achieve a number of therapeutic effects. As well as pain relief, this includes stimulation to help strengthen muscles, meaning it can be used to address both the symptoms and causes of low back pain.

Treating the SYMPTOMS of low back pain with electrotherapy

Most acute low back pain is a result of injury to the muscles, ligaments, joints, or discs. The body’s reaction to injury is to instigate an inflammatory healing response, which can cause severe pain.

TENS (Transcutaneous Electrical Nerve Stimulation) uses electrical pulses to provide pain relief by blocking pain signals from reaching the brain. High frequency (HF) TENS, or sensory stimulation, uses pulses of 80-100 Hz and works via the gate control mechanism, inhibiting the transmission of pain signals to the brain while producing a pleasant tingling sensation. As a result, HF TENS is effective for providing patients with relief from the symptoms of lumbar pain.1

However, rather than just treat the cause of the pain, it’s important to also address the cause of the injury. Thankfully, electrostimulation also has an answer for this.

Treating the CAUSES of low back pain with electrotherapy

Sitting slumped over a desk while you work puts increased strain on the muscles and ligaments in your back, which can then lead to injury and low back pain. To address the cause of posture-related low back pain, we need to restore balance between the trunk flexors and extensors and strengthen our paraspinal and abdominal muscles to improve spinal stability and help us sit up straight. This is where NMES can help.2,3

NMES (Neuro Muscular Electrical Stimulation) uses electrical pulses to produce muscle contractions, mirroring the impulse sent from the brain. NMES can be used as a standalone treatment, but is most effective when used in combination with voluntary exercise such as proprioceptive or functional rehabilitation.

By safely controlling the contractions, the muscles can be made to exert themselves much more than the patient would be capable of voluntarily, and without placing additional stress on joints. Additionally, NMES can help the patient to recruit the deep lumbar stabilizers.3,4 This allows patients to effectively and safely strengthen their trunk muscles during exercise, thereby helping to address the causes of low back pain.2,3

However, if symptoms remain, functional rehabilitation for low back pain can still be carried out by combining NMES and TENS in a single treatment. One device with this function is Chattanooga’s Intelect Mobile.2

Intelect Mobile 2 – the next generation in electrotherapy

Intelect Mobile 2 is an innovative device designed to provide clinicians with everything they need for effective electrotherapy treatment, and comes in three different configurations, STIM, ULTRASOUND, and COMBO.

All three options include an intuitive touchscreen user interface, a library of suggested protocols, and Bluetooth connectivity for easy software updates. And as the name suggests, the device is truly mobile, enabling it to be easily carried or mounted on a wheeled cart.

Intelect Mobile 2 STIM and COMBO provide 2-channel electrotherapy with over 20 different waveforms, offering therapists multiple treatment options. For instance, when treating a patient with low back pain, Channel 1 can be used to deliver TENS treatment for pain relief, while Channel 2 provides muscle stimulation to support functional rehabilitation exercises. Or therapeutic ultrasound can be used as an adjunct pain-relieving modality.5

Altogether, Intelect Mobile 2 is an excellent option for therapists interested in using electrostimulation for treating not only low back pain, but also a range of other neuromuscular conditions.

Learn More

References

  1. Jauregui JJ, Cherian JJ, Gwam CU, Chughtai M, Mistry JB, Elmallah RK, Harwin SF, Bhave A, Mont MA. A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Surg Technol Int. 2016 Apr;28:296-302.
  2. Durmus D, Akyol Y, Alayli G, Tander B, Zahiroglu Y, Canturk F. Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial. Rheumatol Int. 2009 Jun;29(8):947-54.
  3. Baek SO, Cho HK, Kim SY, Jones R, Cho YW, Ahn SH. Changes in deep lumbar stabilizing muscle thickness by transcutaneous neuromuscular electrical stimulation in patients with low back pain. J Back Musculoskelet Rehabil. 2017;30(1):121-127.
  4. Coghlan S, Crowe L, McCarthypersson U, Minogue C, Caulfield B. Neuromuscular electrical stimulation training results in enhanced activation of spinal stabilizing muscles during spinal loading and improvements in pain ratings. Annu Int Conf IEEE Eng Med Biol Soc. 2011;2011:7622-5.
  5. Goren A, Yildiz N, Topuz O, Findikoglu G, Ardic F. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial. Clin Rehabil. 2010 Jul;24(7):623-31.