|Harnessing technology in practice can improve treatment outcomes and extend the RMT’s career.
I started using therapeutic ultrasound (TU) initially to promote a thermal response in my patient’s tissue thereby enhancing myofascial work and reducing the physical load on my hands.
Thermal levels of ultrasound produce mechanical as well as tissue heating effects. Due to the selective absorption of ultrasound by non-homogenous complex tissues (typically those high in protein content), ultrasound is the modality of choice for structural heating. Thermal effects of ultrasound are classified as mild (one degree Celsius temperature increase); moderate (two degrees Celsius temperature increase) or vigorous (three to four degrees Celsius temperature increase). They occur at intensities of greater than 1W/cm2 at 1MHz and 0.5W/cm2 at 3 MHz.
Associated physiological changes include:
With Vigorous Heating – Increased extensibility of collagen tissue (fascia, tendons, joint capsules, scar, etc.). This facilitates ease of stretch and increase range of motion (ROM) of contracted collagen structures.
With Moderate Heating – Elevated motor and sensory nerve conduction velocities. This increases overall neurological input to facilitate pain reduction through gating and central biasing mechanisms; altered contractile activity of skeletal muscle and reduced muscle spindle activity. This assists in reducing muscle spasm. Altered a-gamma fibre activity can also lead to spasm reduction through modification of the anterior horn reflex arc; Increased blood flow due to vasodilatation. This facilitates decreased chronic inflammation.
With Mild Heating – Increased rate of chemical reactions due to local temperature rise. This increases metabolic rate thus accelerating tissue healing.
Therapeutic ultrasound also has many non-thermal effects, such as, increased cell membrane and vascular wall permeability, increased capillary density and improved blood flow, increased calcium ion flux and most importantly the increased oscillatory movement of tissues and cells loosens microscopic structures assisting in reduction of adhesions and edema.
As mentioned earlier, my initial use of TU was to heat up fascia thus making it more extensible and thus easier on my hands. I like to call this working smarter – not harder. There are, however, many conditions TU can assist in treating. These include:
- Mature scar tissue – excellent in treating scars that have altered structure and function
- Tendon and ligament insult – very effective in treating Repetitive Strain and IT Band Syndrome
- Calcific deposits – ideal for calcific tendinitis in biceps long head
- Wound healing – very effective in post surgical wound healing
- Bone healing – great for fracture repair
- Muscle spasms – common to low back and neck pain
- Bursitis and tendinitis
- Joint contracture and adhesive capsulitis
- Pain modulation – very effective, however, I prefer laser.
I was introduced to therapeutic laser, or phototherapy, in 1999 – I had a neck injury and received therapeutic low density laser. Initially, I was in more pain from the laser. It was explained to me that this was due to an increase in the inflammatory cascade and improved nerve function. After three treatments, my neck started feeling pain free and more mobile. I have not had problems with my neck since.
Since then I have experimented using different lasers and settled on a unit that can treat three different areas at the same time. This way I can still treat other areas while reducing pain and increasing tissue extensibility in the areas targeted for laser.
Laser therapy works by emitting photons in very specific bands of the electromagnetic spectrum. Photons of near infrared and visible red penetrate the skin and promote an immune response. There is an enhancement and/or increase in macrophage, mast cells, fibroblasts, keratinocytes, serotonin synthesis, endorphin synthesis, nerve cell action potential and a decrease in bradykinins. The result is a reduction of pain, accelerated inflammatory process and wound healing.
I use laser for treating many types of injuries that RMTs encounter, such as the following:
- Cervical spine – Tension or cervicogenic headache, whiplash, facet joint syndrome, cervical radiculopathy, herniated disc, osteoarthritis and reflex sympatheic dystrophy.
- Shoulder and Arm – Deltoid, bicipital and supraspinatus tendinitis, subdeltoid bursitis, impingement and rotator cuff syndrome and adhesive capsulitis.
- Spine and Hip – Thoracic spine – myofascitis, costochondritis, compression fracture and disc herniation;
- Lumbosacral – disc herniation, sciatic neuralgia, lumbar facet syndrome, lumbosacral strain/sprain, sacroiliac joint dysfunction, osteoarthritis, foraminal stenosis.
- Hip – Osteoarthritis, capsulitis and trochanteric bursitis
- Knee – Osteoarthritis, chondromalacia patella, ligamentous injuries, Osgood Schlatter’s Disease and post-operative rehabilitation.
- Ankle and foot – Achilles Tendinitis, ankle sprain, osteoarthritis, bunion, fracture, reflex sympathetic dystrophy, plantar fasciitis.
- Full body – Fibromyalgia.
Accreditation, contraindications and uses
The CMTO classifies both these modalities as being in the public domain and, therefore, they can be used by RMT’s. Courses for these modalities are also listed as Category B CEUs.
It is important that courses instil an understanding of important concepts such as when using these modalities, you can harm your patient if they are used improperly.
There are a few contraindications for these modalities – use of them around pregnant women is prohibited and for ultrasound, use around the eyes and around the cervical-thoracic/thoracic-lumbar and lumbo-sacral junctions is not indicated. When we see pregnant patients in acute pain at the clinic, we are very fortunate to have acupuncture available.
Please understand that these are adjunct therapies to enhance your soft tissue work and help reduce the physical load on your hands. I do not use these modalities as “standalone” therapies. They are great assistants in soft tissue rehabilitation. If you do use them on their own I would recommend you charge less as this is not considered a massage therapy session, and should not be billed as such.
Costs for implementation
Therapeutic ultrasound units commonly begin at $500 and can be as expensive as $3,000. Low intensity lasers can sell for a minimum of $5,000 and as much as $25,000. I believe both are a great investment towards improved treatment outcomes, increased revenue and ultimately, extending your career as an RMT. Many companies have lease-to-own plans, which are easier on the monthly budget.
Richard Gibbon practises in Toronto. He is currently completing his ND and Diploma in Counselling. He teaches courses in cranial-sacral, myofascial release, therapeutic ultrasound and low intensity laser in Toronto.