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There Is Evidence to Support the Effectiveness of High-Energy Dose of Therapeutic Ultrasound in the Treatment of Patellar Tendinopathy? Ann Sports Med Res 7(3): 1153

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There Is Evidence to Support the Effectiveness of High-Energy Dose of Therapeutic Ultrasound in the Treatment of Patellar Tendinopathy? Ann Sports Med Res 7(3): 1153 Central Annals of Sports Medicine and Research Letter to the Editor *Corresponding author Stasinopoulos Dimitrios, Department of Physiotherapy, University of West Attica, Athens, Greece, Email: There is Evidence to Support the [email protected] Submitted: 29 June 2020 Accepted: 06 July 2020 Effectiveness of High-Energy Published: 08 July 2020 ISSN: 2379-0571 Copyright Dose of Therapeutic Ultrasound © 2020 Dimitrios S in the Treatment of Patellar OPEN ACCESS Tendinopathy? Stasinopoulos Dimitrios* Department of Physiotherapy, University of West Attica, Greece DEAR EDITOR, 7cm2 Therapeutic Ultrasound (TUS) is a modality that the study was . Technically speaking, ERA is always smaller physiotherapists use daily in their clinical practice [1]. There is (10-20% approximately) that the transducer [8]. On the other strong evidence that TUS has positive effects on tendon healing ERAhand, must many be manufacturers referred in the fail study. to make The the most distinction common between injured [2,3]. This strong evidence is supported by animal studies. areaERA andin PT the is transducerin the inferior [8]. Morepole ofdetails patella about [9]. transducerThe authors and of The effectiveness of TUS is based on its parameters [4]. The parameters of TUS are: frequency, mode, and intensity, duration tendon from the inferior pole of patella to tibial tuberosity. TUS of treatment, movement or not of the soundhead (transducer), the study [6] did not explain why they applied TUS in the whole coupling medium, treatment intervals and effective radiated area [4]. Higher doses of TUS might be necessary in order to produce TUStreatment treatment time depends was 8 minutes upon the in areathe study of the [6], injury however [10]. Typically, this time period of TUS was applied without explanation. The duration of (PT) [5]. the area should be divided into zones that are approximately the significant improvements in patients with patellar tendinopathy same size as the treatment head, and then each zone should be effectiveness of high energy dose of TUS in the management of has as the treatment goal the thermal effects, the rate of muscle Searching databases, only one study was found to assess the patellar tendinopathy (PT) [6]. The results of this study cannot treated for 1 minute [7,8]. Moreover, if the application2 and at variousof TUS intensities and frequencies must be taken into account [7]. They the TUS dosimetric parameters of this research protocol can be temperature increase per minute, per W/cm be discussed because the study is a research protocol. However, report that the energy is 4032J/ per application [6]. They did not discussed since it was applied with sub-optimal parameters. in the article the energy density, the total energy and the dose frequency is 3MHz [7]. The frequency of TUS in the above study mention how they calculated the above energy. They must refer Patellar tendinopathy is a superficial condition and the ideal 2 per treatment [8]. Finally, the application of TUS was carried out (1MHz) was sub-optimal [6]. The mode of continuous ultrasound twice per week for 8 weeks in the above study [6]. They did not with intensity 1.2 W/cm was used in the reported study [6]. The explainThe whyauthor they of choose this letter this frequencydoes not ofintend treatment. to recommend a mode of continuous TUS is not wrong in the chronic condition when the goal is to achieve thermal effects [7,8]. The authors single ‘right’ dose. The use of a fixed ultrasound dose (right or of the study did not refer firstly the effects of continuous TUS, intervention, but that is the nature of reductionist quantitative suffered from chronic or acute PT. The ideal pulse ratio for acute wrong) as a sole intervention would not be a clinically common secondly why this intensity was used and finally if the patients2 [4]. The dose of TUS depends on the severity of the lesion, the There are different diameters of TUS transducers ranging from research. There is not ‘one’ fixed single right dose for all patients. 1PT to is 10cm 1:4 and[4] andthe theintensity ideal transduceris much lower in the than management 1.2 W/cm of PT treatment area relative to the size of the treatment head, etc. is a small transducer – approximately 1cm [4]. The authors of The conclusion of the above study [6] must be read very They only mentioned that the Effective radiation area (ERA) in parameters. the above study [6] did not mention which transducer was used. carefully because TUS was applied probably with sub-optimal Cite this article: Dimitrios S (2020) There is Evidence to Support the Effectiveness of High-Energy Dose of Therapeutic Ultrasound in the Treatment of Patellar Tendinopathy? Ann Sports Med Res 7(3): 1153. Dimitrios S (2020) Central REFERENCES a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). 2008; 47: 467-471. 1. Pope GD, Mockett SP, Wright JP. A survey of electrotherapeutic modalities: ownership and use in the National Health Service in England. Physiotherapy. 1995; 81: 82–91. CE. High-energy dose of therapeutic ultrasound in the treatment of 6. depatellar Jesus JF,tendinopathy: de Albuquerque protocol TAB, ofShimba a randomized LG, Bryk placebo-controlledFF, Cook J, Pinfildi 2. Demir H, Menku P, Kirnap M, Calis M, Ikizceli I. Comparison of the effects clinical trial. BMC Musculoskeletal Disorders. 2019; 20: 624. of laser, ultrasound, and combined laser and ultrasound treatments in experimental tendon healing. Lasers Surg Med. 2004; 35: 84-89. 7. Prentice W. Rehabilitation techniques in sports medicine. Dubuque, IA, USA: WCB/McGraw-Hill; 1999. 3. Ng GY, Ng CO, See EK. Comparison of therapeutic ultrasound and exercises for augmenting tendon healing in rats. Ultrasound Med Biol. 8. Belanger AY. Therapeutic Electrophysical Agents. Evidence Behind 2004; 30: 1539-1543. Practice. Wolters Kluwer, 2015 4. Stasinopoulos D, Cheimonidou AZ, Chatzidamianos T. Are there 9. Cook JL, Purdam CR. Rehabilitation of lower limb tendinopathies. Clin effective ultrasound parameters in the management of lateral elbow Sports Med. 2003; 22: 777-789. tendinopathy? A systematic review of the literature. Int J Phys Med 10. Stasinopoulos D. There is lack of evidence to support the effectiveness Rehabil. 2013; 1: 117. of therapeutic ultrasound in the management of patellar tendinopathy. 5. Warden SJ, Metcalf BR, Kiss ZS, Cook JL, Purdam CR, Bennell KL, et al. Physical Therapy Reviews. 2015; 20: 268-269. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: Cite this article Dimitrios S (2020) There is Evidence to Support the Effectiveness of High-Energy Dose of Therapeutic Ultrasound in the Treatment of Patellar Tendinopathy? Ann Sports Med Res 7(3): 1153. Ann Sports Med Res 7(3): 1153 (2020) 2/2.
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