HEALING PROTOCOLS - Basic concepts

Ultrasound (US) - Ultrasound therapy consists of continuous or pulsed applications.

High intensity continuous - heats tissue (1-1.5 w/cm²) to initiate tissue repair and in chronic (1-.5 w/cm²) for tendon extensibility, initiates repair and lymph.

Low intensity continuous - (.1 w/cm²) stimulates tissue repair and bone growth.

High intensity pulsed - (1-1.5 w/cm²) stimulates blood flow and initiates healing

Low intensity pulsed - (.5-.1 w/cm²) stimulates tissue repair and bone growth.

 Electrical stimulation (ES) – offers the choice of positive or negative polarity.

1.     Positive is used in the first 6 hours post injury and also in ischemic wounds. This will control bleeding, build tissue, depolarize and sedate.

2.      Negative is then used up to 4 days post injury or in infection, it will hyperpolarize, stimulate repair, soften tissue and enhance blood flow.

3.     Positive alternating with negative is used from 4 days to 3 weeks post injury, positive for tissue repair while negative increases blood flow and nerve growth.

Positive Polarity			Negative Polarity
Hyperpolarize membrane	Membrane effect		Depolarize membrane
Oxidative reaction	Biochemical effects		Reductive reaction
Macrophages migrate	Galvanotaxis		Neutrophils migrate
Fibroblasts migrate			Chondrocytes migrate
Endothelial cells migrate			Epithelial cells migrate
Osteoclasts migrate			Osteoblasts migrate
			Neurites grow faster
Maturation - epithelialization	Phase of Injury		Inflammatory
Remodeling			Early maturation
Ischemia			Infection

Acute vs. Chronic

Acute – use positive polarity, voltage 30-50 volts or (50-70) % of sensory and ultrasound either .5 w/cm² pulsed or .1 w/cm² continuous.

Chronic - negative polarity, voltage 50 - 100 volts or (80-90) % of sensory stimulation: ultrasound either 1 w/cm² or .5 w/cm² can be continuous or pulsed.

 
Ultrasound
The Soundhead – must be kept flat against the skin and constantly moving. Use nice even strokes toward the heart or slow circular motions. You should treat, for an adequate time to achieve the desired result, an area up to 25 cm² and then move to new treatment area of up to 25 cm².  So work small circular or rectangular sections then move on to a new area. 

Pulsed Voltage - The voltage should be set to 80% of sensory level; slowly increase the voltage until they feel it and then reduce the voltage by 20%. For the following the polarity should be kept on negative.

Thermal – US continuous at (1-1.5) watts/cm² raises tissue temperature to 40-45 degrees C in 4 to 10 minutes.

·       Increase range of motion, extensibility of connective tissue and circulation to area

·       Initiate a healing response by targeted thermal to stimulate repair

·       Up-regulate heat shock protein (Hsp70) with salicylic acid as a topical agent to increase the removal of damaged or aged proteins (see Facial)

·       Muscle spasm

Minimal thermal – US pulsed at (.5 – 2) watts/cm², this is a minimal thermal effect with a strong mechanical effect or continuous at (.2-.5) watts/cm²

·       Reduce calcium deposits (1) w/cm² pulsed

·       Arthritis, encapsulitis and fibrositis (.75) watts/cm² pulsed

·       TMJ, bursitis and tendonitis (.25) watts/cm² continuous then pulsed

Non-thermal – US (.1 - .5) watts/cm² pulsed or (.1) watts/cm² continuous for a non-thermal effect that stimulates protein synthesis and tissue regeneration.

·       Reduce scar tissue (.5) watts/cm² continuous then pulsed

·       Tissue regeneration  (.1) watts/cm² continuous

Treatment times using ultrasound

·       4-8 minutes continuous

·       5-15 minutes pulsed