Enhancing Treatment.

Ultrasound

Diagnostic ultrasound is often used to aid the accurate management of sporting injuries. Recently, diagnostic ultrasound machines have been added to our practice to enable us to improve your injury management. All our Sports Physicians have undergone intensive training in the use of these machines, for diagnostic purposes, as well as utilising them for guided injections.

We still refer to radiology for imaging when required, but in many cases, the use of ultrasound in the rooms enables us to streamline your care in the early stages, and accurately monitor your progress.

Autologous Blood Injection

Autologous Blood Injection involves taking some blood from a vein in your arm (similar to a blood test) and then injecting it directly into the abnormal part of a tendon, using an ultrasound scanner to ensure accurate placement. Some local anaesthetic is injected around the site prior to the blood being injected.

This procedure is undertaken with the intent of healing the damaged tendon.

In order to maximise the chances of this being successful, it is important that we respect the body’s natural healing times.

Post Injection instructions

1. Pain flare

A small percentage of people do get a flare of their pain immediately following injection that may last up to 72 hours. If this occurs, it will usually respond to panadol or panadeine, but your doctor will have given you a prescription for panadeine forte that you can fill if you require extra analgesia. Icing the area is also usually very helpful. This flare does not happen to everyone.

2. Gait aids

We routinely advise the use of crutches or a walking stick for 10 days after lower limb autologous blood injection and often use braces for the same time in the upper limb.

3. Activity restrictions

You are still able to do all of your normal daily activities, but we do restrict any activity that may put unwanted load on your tendon in the healing phase. We will give you specific instructions for your condition.

4. Increasing activity

You are not to increase your activity level until you have been reviewed by your doctor, which usually occurs 2 weeks after the injection. A general rule is that you should not do anything that would have been painful before the injection until after you have been reviewed.

5. Muscle pain

You may experience some discomfort in the muscles near the site of injection and this is commonly due to spasm of these muscles rather than any issues from the injection into the tendon. You can self manage this with massage.

6. Rehabilitation

The key ingredient to success is your rehabilitation of strength and stability. All things going well, this starts after your 2 week review.

Shock Wave Therapy

This form of treatment was developed from other medical indications (treating kidney stones). It is widely used in Europe and North America for treatment of tendon and other soft tissue conditions. It has been used here in Melbourne for many years by AFL and other elite sporting teams and in other Sports Medicine clinics.

There are numerous published scientific studies, which you are free to examine, the majority of which demonstrate positive outcomes. Most importantly it has been demonstrated as a safe treatment option.

Radial shockwaves are high energy soundwaves transmitted from a probe held against and passing through the skin and spreading outwards into the underlying tissues. This is believed to induce increased blood flow and metabolic activity around the site of pain, accelerating the healing process. It can effectively reduce pain from this area to allow you to continue other rehabilitation exercises.

ABOUT THE TREATMENT:

After a simple examination of the affected area, shockwaves are applied via a handpiece held against the skin. The initial phase of treatment may cause some deep pain however this indicates correct targeting of the problem area. This is usually followed by numbness or heaviness in the area and the latter phase of the treatment feels less painful. The treatment sessions are of about 5 minutes duration during which you may receive up to 3000 pulses. Many patients get pain relief in just 8-10 days after the first treatment. For most conditions you will receive 3 treatments at weekly intervals, although for some conditions you may only require 1-2 treatments or, less commonly, 4 treatments.

AFTER THE TREATMENT:

You may feel some soreness, which may intensify on the night of treatment. Simple analgesia and icing may be required to control this pain. There may also be some minor bruising in the treatment area. You should rest from aggravating activities for 2-3 days after treatment, as your doctor will discuss.

SIDE EFFECTS:

Post-treatment pain: as above.

Local bruising: uncommon and minor.

Tendon rupture has not been reported following radial shockwave therapy, unlike cortisone injection and surgery.

CONTRAINDICATIONS:

Please inform your doctor if you have one of the following conditions, as this form of treatment may not be appropriate for you:

Pregnancy

Bleeding and blood coagulation disorders, or blood-thinning medications.

Skin wound or acute inflammation in treatment area.

Tumour in treatment area.

RESULTS:

Obviously the human body is a complex structure and like many things in medicine we can provide no guarantees of effectiveness of treatment. We can only keep up-to-date with the latest quality scientific research and make this available to you to make your decision. If you have any questions please feel free to discuss these with your doctor.

Low intensity Pulsed Ultrasound (LIPUS)

LIPUS is a form of ultrasound where the sound waves responsible for producing heat energy are removed from the spectrum.

Low-intensity pulsed ultrasound refers to pulsed-wave ultrasound with a spatial-average temporal average intensity equal to or less than 0.1 W/cm2. This compares to the intensity range of 0.5-3 W/cm2 traditionally used in clinical practice.

Research has revealed a beneficial effect of low intensity pulsed ultrasound on injured connective tissues, and on bone in particular. In three well-designed randomized controlled trials, low-intensity pulsed ultrasound therapy was found to reduce healing times in tibal , radial and scaphoid fractures by between 30% and 38%, when compared to placebo treated fractures. After pooling the results of the 158 fractures investigated, a weighted average size was calculated at 6.41 which converts into mean difference in healing time of 64 days between low-intensity pulsed ultrasound treated and placebo treated fractures. This represents a significant reduction in healing time and patient morbidity.

In addition to its beneficial effects on acute fracture repair, low-intensity pulsed ultrasound has also been shown to facilitate healing in fractures displaying delayed-and nonunion. When applied to non-united fractures, it stimulated union in 86% of cases.7 These are fractures that would not have otherwise healed without intervention.

While low-intensity pulsed ultrasound has the potential to be used for the treatment of complete bone fractures, its benefits are thought to extend to other injuries and tissues. Considering stress fractures heal in comparable stages to complete bone fractures and that they consist of small undisplaced fractures similar to those intervened in the randomized controlled trials on fracture repair, the LIPUS is anticipated to have beneficial fractures on stress fractures. The use of low-intensity pulsed ultrasound in the treatment stress fractures has good early research results.

Lipus is less commonly used for ligament injuries, but there is some indication of benefit to date and it maybe useful when recovery within a timeframe is required.

Iontophoresis

Iontophoresis is the introduction of various ions (charged particles) into the skin by the means of electricity. There are reports of electricity being used to administer medication that date back to 1745.

Iontophoresis is a means of drug delivery that ensures high local doses of medication in the treatment area while minimising the exposure of the rest of the body. It is a convenient, safe, non invasive route for delivery of drugs for optimum local effects with minimal side effects and low risk of toxicity.

How does it work?

The iontophoresis machine creates a small electrical current that drives the charged particles of medication from the delivery electrode, which is placed over the area of your pain, to the non active electrode, which is placed over a nearby muscle. Studies have shown that the medication penetrates under the delivery electrode into the structures under the skin.

What can I expect?

Most courses of iontophoresis involve 6 treatments over 2 weeks. This may be varied by your doctor depending on your specific condition.

Does it hurt?

Iontophoresis is not painful. You will feel some tingling or warmth at the treatment site. If you feel any significant discomfort during the procedure, you should notify the doctor immediately.

Does it hurt after treatment?

Occasionally people will get a flare of their pain after administration of corticosteroids (the commonest medication used) by any method. This is not predictable. If it does occur, it does not alter your chances of a good outcome, but it does result in discomfort for up to 48 hours after treatment. Flare responses usually lessen after subsequent treatments.

Do I need to change my usual activity?

Your doctor will discuss any need for activity modification with you prior to commencing iontophoresis. In many cases, you do not need to change anything, but occasionally, some modification is necessary to achieve optimum outcomes.

When will I see a difference?

Iontophoresis does not work straight away. Most people start to see an improvement after 4 treatments, but some may not improve until the whole course is finished. Your outcome is assessed when you see the doctor 2 weeks after the completion of your course.

What if it doesn’t work?

Iontophoresis can be very effective on its own. Occasionally it is only partially effective, but in these cases, repeat courses or other adjunct therapies will often lead to a complete response. If iontophoresis is unsuccessful, your doctor will discuss other treatment options for your condition at your follow up visit.

Iontophoresis is the introduction of various ions (charged particles) into the skin by the means of electricity. There are reports of electricity being used to administer medication that date back to 1745.

Iontophoresis is a means of drug delivery that ensures high local doses of medication in the treatment area while minimising the exposure of the rest of the body. It is a convenient, safe, non invasive route for delivery of drugs for optimum local effects with minimal side effects and low risk of toxicity.

How does it work?

The iontophoresis machine creates a small electrical current that drives the charged particles of medication from the delivery electrode, which is placed over the area of your pain, to the non active electrode, which is placed over a nearby muscle. Studies have shown that the medication penetrates under the delivery electrode into the structures under the skin.

What can I expect?

Most courses of iontophoresis involve 6 treatments over 2 weeks. This may be varied by your doctor depending on your specific condition.

Does it hurt?

Iontophoresis is not painful. You will feel some tingling or warmth at the treatment site. If you feel any significant discomfort during the procedure, you should notify the doctor immediately.

Does it hurt after treatment?

Occasionally people will get a flare of their pain after administration of corticosteroids (the commonest medication used) by any method. This is not predictable. If it does occur, it does not alter your chances of a good outcome, but it does result in discomfort for up to 48 hours after treatment. Flare responses usually lessen after subsequent treatments.

Do I need to change my usual activity?

Your doctor will discuss any need for activity modification with you prior to commencing iontophoresis. In many cases, you do not need to change anything, but occasionally, some modification is necessary to achieve optimum outcomes.

When will I see a difference?

Iontophoresis does not work straight away. Most people start to see an improvement after 4 treatments, but some may not improve until the whole course is finished. Your outcome is assessed when you see the doctor 2 weeks after the completion of your course.

What if it doesn’t work?

Iontophoresis can be very effective on its own. Occasionally it is only partially effective, but in these cases, repeat courses or other adjunct therapies will often lead to a complete response. If iontophoresis is unsuccessful, your doctor will discuss other treatment options for your condition at your follow up visit.