Transcript Therapeutic techniques

Therapeutic techniques
General principles:
• Aims:
– Reduce pain;
– Regain full use & movement of an injured area;
– Restore or enhance strength.
• Some treatment methods help speed up the healing process.
• In many cases, conventional medicine is insufficient to cure a
lameness / injury.
• Alternatives methods and high-tech therapies can be used.
• Complementary therapies are often used, but will be reviewed in
a later session.
Types of therapies
Physical therapies, e.g.:
– Flexing & extending limbs
(stretches);
– Massage / equine sports
massage therapy;
– Chiropractic;
– Osteopathy;
– Manipulation;
– Controlled exercise / rest;
– Riding / groundwork;
– Foot balancing and / or
corrective shoeing;
– Nutrition;
– Poultices;
– Hot &/ cold therapy.
Veterinary / hi-tech
therapies, e.g.:
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Drugs;
Surgery;
Hydrotherapy;
Magnetic therapy;
Ultrasound;
Laser therapy;
TENS;
Shockwave treatment;
Inferential treatment;
Stem cell therapy.
Areas for consideration:
• Identification of techniques;
• When to use / not to use different techniques /
suitability for different injuries;
• Effects of techniques;
• Effectiveness / success;
• Cost;
• Length of treatment;
• Accessibility / availability;
• Equipment & people required;
• Case studies.
Pain relief
• Example of drug:
• Bute (phenylbutazone) = non-steroidal, antiinflammatory drug.
– acts directly on musculoskeletal tissue
– controls inflammation
– reduces secondary inflammatory damage
– alleviates pain
– helps restore range of motion.
• Can cause side effects, e.g. liver / kidney damage,
etc.
Pain relief
• Example of technological method:
• Transcutaneous Electrical Nerve Stimulation (TENS).
• Also – electrical muscle stimulation (EMS),
electroanalgesia, lasers & ultrasound.
• Injury causes muscle tension & decrease in blood flow.
• This causes the build-up of waste products at the
injury site.
• Pain relief limits the inflammatory response, enabling
quicker healing.
• Stimulate circulation to tissues (for oxygen, nutrients
& removal of waste products).
T.E.N.S
• Used primarily for pain relief
• Used frequently and almost anywhere on
horse
• Used on either side of lesions
• Over nerve roots
• Over peripheral nerve
• At trigger points / acupuncture points
Hot and cold therapy
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Relieving pain
Relieving muscle spasms
Different roles
Cooling for immediate injuries
48 hours later benefits from heat
treatment
• Cold diminishes healing at later stage
• Heat encourages swelling, cold
discourages
Risks Inherent in Cold
Therapy
• Damage to local tissues incl. Burns
• If area has damage to autonomic
nerves, tissue cooling occurs more
rapidly and more deeply
Heat Therapy
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Pain relief
Sedative effect
Encourages healing
Increase in range of motion
Hot packs
Infrared
Hydrotherapy
Hydrotherapy
Magnetic Therapy
• Static
– Boots
– Rugs
• Electromagnetic
Electromagnetic stimulation
• Allegedly improves oxygen supply & increases temperature.
• An electrical current applied across a bone fracture site can
help stimulate bone repair, reduce healing time & improve final
union of the fractured bone.
• A fracture site induces a negative polarity electrical charge, and
is particularly useful where there is non-union of the fracture.
• Direct current – applied via implanted electrodes (invasive).
• Pulsing electromagnetic fields (PEMFs) – a current is passed
through special circular coils that are placed either side of the
bone. The pulse can be varied in size, shape & rate.
• Portable, rechargeable & mains-operated systems are available.
• Biomagnetic, flexible, rubber / plastic pads surrounding a foil
are also used. The foil contains a magnetised iron compound.
Laser
• LASER (Light Amplification by the Stimulated
Emission of Radiation)
• 2 main types: high-energy (hot) & low-energy (cold).
• High-energy – light-beam capable of cutting & burning
tissues.
• Used to treat the base of the wound after surgical
removal of a tumour / tissue mass, but can also be
used to remove them.
Laser
• Low-energy – a more recent innovation. Used mainly
for physiotherapy, cosmetic surgery & acupuncture.
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• Mainly used for treatment of soft tissue injuries
• Re-establish lymph flow
• Enhances circulatory flow
• Pain relief
• Regeneration of nerve
• Little scientific data to substantiate claims of
accelerating healing – not known how it occurs.
Uses of Laser
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Tendon and ligament injuries
Oedema
Pain reduction
Nerve compression or bruising
Open and post surgical wounds
Not for use around the eye nor in
pregnant mares
LLLT
Day 1
Day 15
Day 28
Pharmacology
• The science of drugs – divided into 2 parts:
• Pharmacodynamics – the study of the way in which
the functions of the living body are affected by
drugs.
• Pharmacokinetics – the absorption, metabolism &
excretion of drugs by the body.
• Therapeutics = rational & optimal use of drugs in the
management of disease states or in the manipulation
of physiological functions.
• Drug classification
• Often classified according to:
• The way in which they bring about their effect on the
body, and
• Which body system or infective agent they affect.
Acupuncture / acupressure
• High-tech methods of stimulating the
acupuncture points are:
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heat application;
laser radiation;
electrical stimulation;
injection of drugs / saline to prolong
stimulation of the nerve.
Surgery
• There are many
different forms &
procedures, dependent
on the problem, e.g.
respiratory tract,
gastro-intestinal tract,
urogenital tract,
hernias, castration etc.
• No guarantee of success
– many complications can
arise.
• Need to consider the
cost of surgery
compared to the value
of the animal & extent
of possible recovery &
future use.
The operating theatre
Padded induction / recovery room
Laparascopic surgery
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Laparoscopic surgery is available
for minimally invasive surgery
Used for cryptorchid surgery,
removal of stones in the urinary
bladder, amongst other
problems.
While specific procedures may
require general anesthesia,
other procedures can be
performed with only sedation
and local anesthetic blocks.
Because of the small incisions
that are made with this
technique, many horses are able
to return to athletic usefulness
much faster than if traditional
surgery had been utilised.
Fracture Repair
• Vets are becoming more
knowledgeable in
assessment and repair
of fractures in horses.
• Repair of long bone
fractures in the leg is
facilitated by
anesthetic recovery in a
hydropool, greatly
decreasing the risk of
injury or refracture
during recovery.
Cryosurgery
• Local application of intense cold to destroy tissues.
• Tissue is rapidly frozen to -20C (-4F) or lower, then slowly
thawed, then refrozen (number of cycles depending on type of
tissue / depth of required penetration / overall area).
• Freezing causes the water content of cells to form ice, swelling
the cell, followed by death & rupture of the cell membranes.
• The frozen tissues die & gradually slough off to leave a healthy,
granulating wound.
• Frequently used for removal of skin tumours, e.g. sarcoids, and
also exuberant granulation tissue & cataract extraction.
• Can be used for neurectomy of the lower limb.
• Has proven to decrease the number of treatments per case &
reduces the incidence of recurrence at the original site.
Ultrasound
• Heats deeper / larger / denser musculoskeletal
components.
• Relaxes aching muscles & improves circulation.
• Reduces spasm in muscles & tendons.
• Useful in cases of arthritis or constrictive scar
tissue.
• Used as either a continuous wave or a pulse at regular
intervals.
• Often combined with cold therapy.
• Ideally followed by physical therapy
• Do not use over open / contaminated wounds – can
drive bacteria further into the tissues.
Ultrasound
• When to use
• When not to use
 Soft tissue sport
injuries
 Surgical wounds
 Chronic arthritis
 Circulatory problems
 Scar tissue
X Tumours
X Recent
haemorrhaging
X Pregnant uterus
X Epiphyseal plates
• Electroanalgesia
• Similar to TENS, but uses different frequencies. Low
& high frequencies are available.
• Electrical output is mildly amplified to produce visible
muscle twitches.
• Electrical muscle stimulation
• EMS exercises & strengthens atrophied muscles by
passively producing muscle contractions.
• Can exercise a limb without it having to be weightbearing & without undue stress while healing.
• Improves circulation, therefore enhancing the healing
process.
Shockwave Therapy
• Extracorporeal high-energy shock wave therapy is a non-invasive
and repeatable method of treatment with hardly any side
effects that has been successfully used in the treatment of the
locomotor apparatus of man for many years. Shockwave therapy
is useful for a number of conditions causing lameness in the
horse. These conditions include:
• Suspensory ligament disease
• Bowed tendons
• Ringbone
• Bone spavin
• Bucked shins
• Splints
• Fractured splint bones
• Sore backs
• Navicular syndrome
• Fractures not healing properly
Shock Wave
• During the treatment, a total of approximately 7501500 shock waves are applied.
• The ultrasound localization and/or bio-feedback gridscan technique employed allows the target area to be
precisely scanned step by step and exposed to about
200-300 shock waves at a time.
• Treatment is generally started at a low energy level
allow the horses to get used to the shock waves.
• In the course of the treatment session, the energy
level can be gradually increased.
• The entire therapy takes about 20 minutes and is
repeated two to three times, in an interval of three
to six weeks, according to the diagnosis and the
healing process.
• Slight sedation has proved useful to calm the horse .