Transcript Diapositiva 1 - Mazowieckie Centrum Rehabilitacji STOCER

Calcification: formation-resorption cycle
1
Methods
3 patients suffering from calcifying tendonitis of supraspinatus, resting phase, were
treated with Hilterapia®. Treatment lasted 14 days.
Total Tx: 10
Tx/week: 5
Scanning mode: 730 mJ/cm2 x 3 times
Point to point: 490 mJ/cm2 x 4 s (calcification trigger point assessed by
sonography)
Constant shoulder score(*), VAS score and US assessment at:
• T/0
• T/1 after 30 days
• T/2 after 60 days
(*)It is the recommended scoring system of the European Society of Shoulder & Elbow Surgery (SECEC/ESSE)
2
Constant Scale
100
90
80
70
60
50
40
30
20
10
0
Pt 1
Pt 2
Pt 3
T0
T1
T2
3
VAS score (0-20)
20
0
20
18
16
14
12
10
8
6
4
2
0
Pt 1
Pt 2
Pt 3
T0
T1
T2
4
Calcifying tendonitis of supraspinatus
Case 3 : 14,5 mm
T/0
T/1 (30 days later)
5
Calcifying tendonitis of supraspinatus
Case 3 : 14,5 mm
T/0
T/1 (30 days later)
6
Results
These preliminary data indicate that Hilterapia® has got good results on the
resorption of the calcification, on shoulder functionality and decrease/control
of pain
Particularly, HILT is able to induce resorption of calcifying tendonitis of
supraspinatus
Finally, Hilterapia® has to be inserted in a complex rehabilitation program
7
Early treatment and recovery of the injured athlete
(Lubich et al. 1997. Medicina dello Sport. 50; 1: 71-83)
88 athletes (age11-73) with traumatic/overload pathologies* affecting
Ankle and foot
Tendonopathies-Distortions
28
Knee
Tendonopathies-Synovitis
20
Muscles/Tendons
Distraction-Fascitis
11
Shoulder
Impingement syndr.-Tendonopathies
9
Iliopubic region
Adductors pain syndrome
4
Wrist-elbow
Epicondylitis-Styloiditis
9
* the table shows the more common pathologies
8
Treatment protocol and laser settings
ma ...
10 Tx completed in 2 weeks
5 Tx / week
1 Tx / day
Scanning mode: 13.7 – 15.8 W/cm2, 40-60 s
Point to point: 8.7 – 9.5 W/cm2, 7 s
- treatment was performed by the same operator in all sessions
- device emission power was tested periodically
- dose was calibrated according to the skin phototype (race, color, ethnicity) and, in
case, skin pigmentations
9
Evaluation of the results:
- VAS scale
- Functionality through active and passive goniometric evaluation
- Times of recovery
10
Results
ma ...
80
75 %
• EXCELLENT: disappearance
70
of the pain and restoration
60
of the functionality
50
• DISCREET: attenuation of
40
the pain and increase of the
30
functionality
18 %
20
7%
10
• ANY EFFECT: scarce or any
improvement of the
0
Excellent
Good
Poor
symptomatology
Early treatment and recovery of the injured athlete
11
Treatment of rectum-adductors syndrome
(Verardi et al. 2000. Medicina dello Sport. 53; 4: 342350)
31 athletes, age: 15 yrs.÷ 56 yrs.
12
RECTUM-ADDUCTORS SYNDROME
It consists in an insertional tendinopathies of m.m. adductors and/or rectumadductors, eventually associated to an osteoarthopathy of the insertional pubic
zone, with a microtraumatic origin.
Frequent in football, it presents a biomechanical or postural disequilibrium.
13
Treatment protocol and laser settings
ma ...
10 Tx completed in 2 weeks
5 Tx / weeks
1 Tx / day
Scanning mode: 13.7 – 15.8 W/cm2, 90-120 s
Point to point: 8.7 – 9.5 W/cm2, 7 s (after 5th Tx)
Monotherapy
14
Results
ma ...
50
45 %
45
• EXCELLENT: disappearance
42 %
of the pain and restoration of
40
the functionality
35
30
• DISCREET: attenuation of the
25
pain and increase of the
20
13 %
15
10
functionality
5
• ANY EFFECT: scarce or any
0
improvement of the
Excellent
Good
Poor
symptomatology
Treatment of adductors syndrome
15
Treatment of Tendinopathies in Athletes
(Mondardini et al. 1997. Medicina dello Sport.)
79 athletes (age 10-64) with different tendon pathologies
 Insertional tendinopathies
 Tenosynovitis: stenosing, hypertrophic
 Peritendinitis
 Tendinosis
16
Treatment protocol and laser settings
ma ...
10 treatments (Tx) completed in 2 weeks
5 Tx / week
1 Tx per day
Scanning mode: 13.7 – 15.8 W/cm2, 40-90 s
Point to point: 8.7 – 9.5 W/cm2, 7-10 s
- treatment was performed by the same operator in all sessions
- device emission power was tested periodically
- dose was calibrated according to the skin phototype (race, color, ethnicity) and, in
case, skin pigmentations
17
Results
90
•EXCELLENT: disappearance
79.8 %
of the pain and restoration
80
of the functionality
70
60
• DISCREET: attenuation of
50
the pain and increase of the
40
functionality
30
15.1 %
20
5.1 %
10
• ANY EFFECT: scarce or any
improvement of the
0
Excellent
Good
Poor
symptomatology
Athlete tendon pathologies treatment
18
HILT ®: Sport injuries and pain management
ma ...
(Mondardini
P. Atti seminario HILT , Don Gnocchi
foundation, 2002, pp 2—9)
405 patients (age: 37.5 yrs - media.) with pathologies* affecting
287 ACUTE AND SUBACUTE PATHOLOGIES
•Shoulder
•Elbow
•Wrist
•Ankle
•Knee
•Joints
118 DEGENERATIVE PATHOLOGIES
Loin-sacred arthrosis
45
Gonarthrosis
35
Cervico-dorsal arthrosis
32
Algo-dystrophic syndromes 5
Shoulder arthrosis
1
* the table shows the more common pathologies
19
Treatment protocol and laser settings
ma ...
10 Tx completed in 2 weeks
5 Tx / weeks
1 Tx / day
Scanning mode: 13.7 – 15.8 W/cm2, 40-60 s
Point to point: 8.7 – 9.5 W/cm2, 7 s
- treatment was performed by the same operator in all sessions
- device emission power was tested periodically
- dose was calibrated according to the skin phototype (race, color, ethnicity) and, in
case, skin pigmentations
20
Results
ma ...
80
• EXCELLENT: disappearance
72.6 %
70
of the pain and restoration of
60
the functionality
50
• DISCREET: attenuation of the
40
pain and increase of the
30
14.8 %
20
12.6 %
10
functionality
• ANY EFFECT: scarce or any
0
Excellent
Good
87.4%
Poor
improvement of the
symptomatology
Sport traumatology and pain therapy
21
“Complex rehabilitation in “painful shoulder” syndrome from partial tear and
from calcific tendinopathy of the rotator cuff ”.
Saggini R, University G. D’Annunzio – Chieti - 2007.
Purpose: to estimate the persistence of the results obtained with a complex rehabilitative approach
in the treatment of partial lesions and calcific tendinopathy of the cup of the rotator muscles.
Discussion: 40 patients affected by partial lesions and calcific tendinopathy of the cuff rotator
muscles were clinically controlled for 360 days since the first treatment.
Method: The patients were random collected in two groups: the first group was treated with
Hilterapia® and kinesitherapy; the second one was treated with high energy electrohydraulic shock
waves with rapid gradient and kinesitherapy. The clinical evaluation was based on Costant and
Murley protocol; the pain threshold was evaluated by both V.A.S. scale and Fisher algometer;
moreover echography evaluation was performed.
Results: Both groups of patients showed a significant improvement of subjective and objective
conditions related with pain and dysfunctional state of the shoulder.
Conclusion: This study proved that it is possible to codify a routine approach in the therapy of the
cuff incomplete lesions of the rotator muscles by the use of different physical energy, through both
Hilterapia® and high energy electrohydraulic shock waves with rapid gradient.
22
“The carpal tunnel syndrome: treatment with Hilterapia® ”.
Bodini G, Croce - A.M, Specialistic Rehabilitation Hospital Unity – “San Camillo” Care Facility
– Brescia - 2007.
Purpose: to assess the effectiveness of HILT laser treatment for carpal tunnel syndromes.
Discussion: in this study were included 25 subjects affected by mild or medium –level carpal
tunnel syndrome.
Method: The patients underwent HILT laser treatment and were assessed through clinical
(e.g. pain gravity though V.A.S. scale, presence of edema), echographic and EMG tests.
Assessment was performed before and after treatment and 3 months after its end.
Results: Every patient showed an improvement of subjective and objective symptoms, e.g. a
decrease of pain, a decrease of local inflammation.
Conclusion: This study shows that the Hilterapia® is a valid method to treat the carpal
tunnel syndrome, especially in the early stages of pathology.
23
“HILT ® treatment in epicondylitis”
Ganzit G.P., Gurin E., Institute of Sport Medicine, Torino - 2006.
Purpose: to assess the efficacy of Hilterapia® on pain control and functional recovery in patients
affected with epicondylitis
Discussion: The Hilterapia® reduces pain and improves the functional state of the hand in
epicondylitis
Method: 23 patients (mean age 42 years) have been enrolled. They were tennis players and were
affected by epicondylitis, which did not respond to other therapies. The subjects were treated with
Hilterapia® (10 sessions). The pain and functional state were assessed before the treatment, after 5
and 10 sessions by Steinbroker scale, VAS and isometric strength.
Results: pain significantly decreased after 5 sessions and was furtherly reduced after 10 sessions.
Prehension strength strongly increased at the end of the therapy.
Conclusion: The treatment with Nd:YAG laser has positive effects on patients affected by persisting
epicondylitis due to sport practice.
24
“HILT ® treatment in calcific tendinopaty of the shoulder. A controlled
perspective study”.
Melegati G., Galeazzi Institute for Orthopaedics - 2006.
Purpose: to compare the results obtained with different treatments on 3 groups of patients
affected by calcific tendinopaty of the shoulder.
Discussion: A correlation has been shown between the disappearance of calcification and
improvement of the clinical picture. The best performance in the control of pain symptoms in the
post-treatment was obtained with the Hilterapia® .
Method: 20 patients have been divided in 3 groups: the first was treated with shock waves, the
second was treated with kinesitherapy and the third was treated with Nd:YAG laser. Assessment
was made before and after the treatments by the use of the Constant scale, and x-ray 6 months
after the treatment.
Results: In the B group no significant improvement of the clinical picture was observed. In A and
C groups a significant improvement of the clinical picture was obtained. In the C group the best
results in the post-treatment were obtained, expecially in the control of the pain.
Conclusion: both shock waves and Hilterapia® improve the clinical picture in patients affected by
calcific tendinopaty of the shoulder, but Hilterapia® has a greater analgesic effect in comparison
with shock waves
25
The Nd:YAG laser in the treatment of the lateral ligamental lesions of the ankle.
Di Caprio F., Ghermanti R., Grandi G., Buda M., Buda R., Rizzoli Institute for Orthopaedics, Bologna 2006.
Purpose: valuation of the effectiveness of the treatment with Nd:YAG laser in the ligamental lesions
of the ankle.
Discussion: The Nd:YAG laser has analgesic, anti-inflammatory, anti-aedematous effects, which can be
monitored by clinical observation.
Method: 15 athletes with ligamental lesions of the ankle have been enrolled. 10 patients have been
treated with Nd:YAG laser and 5 with CO2 laser. Assessment has been made by scale pain,
tumefaction area and functional state of the joint before the treatment, after 1, 2, 3, 6, 12 weeks and
14 months from the treatment (follow up)
Results: the patients treated with the Nd:YAG laser showed a very fast improvement in the pain
symptoms and functional recovery with resume of the training, decrease of tumefaction area
Conclusion: In sporting traumatology the effects induced by Hilterapia® hasten the recovery time and
this is particularly important in the case of agonists
26
“The Nd:YAG laser in the treatment of the osteocartilagineous lesions of the
knee”.
Buda R., Buda M., Gigolo B., Di Caprio F., Ghermanti R., Zati A., Rizzoli Institute for Orthopaedics,
Bologna - 2006.
Purpose: evaluation of the effect of the treatment with Nd:YAG laser in the osteocartilagineous
lesions of the knee.
Discussion: The Nd:YAG laser induces the growth of jaline cartilage in the lesion foci in a different
extent depending on the age of the patients and the position of the lesions
Method: 7 patients waiting for autologous transplantation of chondrocytes for osteo-chondral
lesions of the femoral condyles have been considered. 5 patients have been treated with Nd:YAG
laser in between the two arthroscopic procedures, while 2 patients have not been treated.
Hystologic and immunohystochemical analyses have been performed on bioptic specimens.
Results: In comparison with control, the laser treatment induced increase of grow factors in
synovial fluids, decrease of inflammation factors and re-growth of jaline cartilage
Conclusion: The Hilterapia® has anti-inflammatory and biostimulating effects, which have been
demonstrated with histological and immunohystochemical tests, and induce the re-growth of
cartilage.
27
“Therapeutic approach with Hilterapia® in the pathology of the shoulder with
tenosynovitis of the omeral biceps”
Saggini R.,Bellomo R.G., Baldassarre V., Medicine and physics of rehabilitation, University of Chieti 2006.
Purpose: evaluation of the effectiveness of Hilterapia® in the treatment of the tenosynovitis of the
omeral biceps
Discussion: it is suggested that the laser treatment can have analgesic effect together with
endorphyne increase, biostimulating effect, anti-inflammatory and anti-edematous effect.
Method: 30 patients were enrolled and divided in 2 groups. The former started the HILT®
treatment immediately after the enrollment, utilizing the latter group as control. At the end of the
treatment for the former group, the latter started the therapy. Assessment was made by VAS,
evaluation of joint mobility and muscle strength, echography. The treatment was made utilizing a
Nd:YAG laser.
Results: Significant reduction or complete disappearance of the pain, reduction or Complete
disappearance of the edema of the tendineous sheath.
Conclusion: Hilterapia® causes the quite complete reversion of the pain symptoms and a
significative decrease in the edema of the tendineous sheath. Therefore it is an effective tool in the
treatment of the with tenosynovitis of the omeral biceps
28
“HILT ® in the treatment of patellar tendinopathy in sportsman”
Buda R, Di Caprio F, Ghermandi R, Buda M., Institutes Rizzoli, Bologna, Poliambulatorio Life, RSM
– 2007
Purpose: to evaluate the effects of lasertherapy HILT for rehabilitation of patellar tendinopathy
Discussion: This study shows that the HILT ® treatment is a valid therapeutic method for patellar
tendinopathy.
Method: 20 patients were divided in two groups: in the former group there was 10 subjects
treated with HILTherapy and in the latter there was 10 subjects treated with a CO2 laser.
Hilterapia® was performed by a pulsed laser Nd:YAG (maxima fluence=1780J, pulse energy<120
sec; spot= 5mm); CO2 laser treatment consisted of 20W for 15 sec.. Patients were evaluated
with clinical and echographic tests before, during and after the treatments.
Results: patients of both groups showed an improvement of clinical and echographic
parameters. Only two patients complained after HILT ® treatment
Conclusion: Patients treated with HILTherapy showed an improvements of clinical parameters
and produced a more quick recovery.
29
“Hilterapia®. An approach in the treatment of lumbosciatalgy” Finocchiaro
S., Poliambulatorio della Misericordia, Pistoia - 2007
Purpose: the aim of this work is to evaluate the efficacy of Hilterapia® in the treatment of
lumbosciatalgy.
Discussion: in this study is demonstrated that Hilterapia® is efficacious not only to decrease
of pain in lumbosciatalgy, but also because biostimulates tissues.
Method: 80 patients affected by lumbosciatalgy were included in this study and were
divided in two group: one of the groups was treated with a protocol HILT ® through a CO2
laser; the other one was treated with both CO2 laser and Nd:YAG laser. The therapeutic cycle
was based on 5 days of treatments for 2 weeks. Follow-up was until 60 days after the end of
therapy. Patients were evaluated through V.A.S. scale.
Results: patients treated with CO2 laser showed a slow and progressive improvement, while
with both laser treatments there was quick improvement.
Conclusion: The Hilterapia® showed an early analgetic improvement, moreover this study
suggest that Hilterapia® induces a biostimulating effect.
30
“Treatment of chronic lumbosciatalgy: back school versus Nd:YAG laser”.
Conte PG, Lelli G, Lopresto A, Mazzaracchio M., Rehabilitation division, SS. Annunziata Hospital,
Taranto – 2007
Purpose: the aim of this study is to compare the efficacy of the treatment with back school versus
the combined treatment back school and laser Nd:YAG.
Discussion: the control group (7 subjects) was treated with back school only; the other group (7
subjects) was treated with back school followed laser Nd:YAG therapy. The latter was more
effective, suggesting that Nd:YAG laser has a positive effect in treating lumbosciatalgy
Method: The back school treatment was based on different physiotherapeutic exercises (e.g.
stretching, Klapp posture…). The Nd:YAG laser was used at different fluences and modality, but
with the same total energy (1500). The evaluations of the results was performed by V.A.S. scale.
Results: Both the groups of patients showed an improvement of the clinical paramenters, but the
subjects treated with both therapies showed a more evident improvement.
Conclusion: even if the number of studied patients is small, this study showed the potentiality of
Hilterapia® in the treatment of chronic lumbosciatalgy.
31
“Comparison between II generation cyclo-oxygenases and HILT in the
treatment of backache”.
Carrara R., Consulting Room Milici, Catania - 2007
Purpose: to evaluate the effects of Hilterapia® in the treatment of human rachis affections
Discussion: The results obtained with Hilterapia® were satisfactory and without collateral effects.
Method: 90 patients were divided in 4 groups; the different treatments were the following: 1)
Hilterapia® (10 sessions); 2) massage therapy (3 sessions/week); 3) cox2 therapy for 3 weeks
(75mg and 90mg); 4) fisiokinesitherapy (20 days). The evaluation was based on clinical parameters
and on the presence/absence of phlogistic processes.
Results: 78% of patients treated with Hilterapia® showed a decease of painful symptomatology,
while only 42% of patients treated with Cox2 therapy showed a clinical improvement. Patients
treated with massage therapy and patients treated with fisiokinesitherapy showed an
improvement in 75% and 62% of cases.
Conclusion: Hilterapia® can be usefully applied for pain treatment in the backache, because it is
able to reach deep tissues with safety and induce a prompt decrease of the symptoms.
32
“Clinical results in treatment of gonarthrosis with Hilterapia®”
Valent A., Cimone Volley, Modena - 2007
Purpose: to evaluate the efficacy of Hilterapia® in the treatment of gonarthrosis.
Discussion: in this study were recruited 15 patients, affected by gonarthrosi; the evaluation of both
functionality and pain were evaluated before and after the treatment with Hilterapia®.
Method: Each patient was treated for 14 days (5 sessions during the first week, 2 sessions during
the second week). HILT therapy was performed by Hiro 3 laser (fluence= 1430-1780 mJ/cm2,
frequency= 20-30Hz; total energy= 3000J). Clinical evaluation was performed by V.A.S. scale,
Womac form. Follow-up was 1 month.
Results: after Hilterapia®, 74% of patients showed an improvement of functionality and 66% of
patients showed a decrease of pain.
Conclusion: these preliminary showed that Hilterapia® can be successfully used in the treatment of
gonarthrosis.
33
SCIENTIFIC REPORT: Hilterapia®
CONTENTS
•HILT – High Intensity Laser Therapy
•Cytoproliferative activity of the HILT
•High Intensity Laser Therapy in arthrosis
•High Intensity Laser Therapy in the treatment
of gonarthrosis
•High Intensity Laser Therapy (HILT)
•HILT vs TENS and NSAIDs
34
ENERGY FOR HEALTH:
Proceeding of the International Meeting on Hilterapia® - Venice 2008
CONTENTS
• Treatment of proprioceptive balance disorders: comparison between
kinesistherapy and Hilterapia®. Bodini G., Croce A.M.
• Treatment of chronic low back pain: back school versus Hilterapia®.
Conte P.G., Santamato A., Fiore P., Lopresto A., Mazzaracchio M.
• Effects of Hilterapia® vs. Viscosupplementation in knee osteoarthritis
patients: a randomized controlled clinical trial.
Viliani T., Ricci E., Mangone G., Graziani C., Pasquetti P.
• Hilterapia® efficiency in handling the post surgical pain after the release
of the carpal tunnel. Gleiser J.
• Muscle lesions in athletes: case comparison between Hilterapia® and
traditional therapy. Valent A.
• Effects of pulsed Nd:YAG laser at molecular and cellular level. A study on
the basis of Hilterapia®. Monici M., Cialdai F., Fusi F., Romano G., Pratesi R.
Abstract
• Hilterapia® and chronic ankle pain syndromes. Saggini R., Bellomo R.G.,
Cancelli F.
• Clinical experience using Hilterapia® in “knee arthrosis”. Sabbahi S.A.
• Comparison of the clinical results of Hilterapia® and eswt in the lateral
epicondylitis. Kang H.J., Her M.S.
35
ENERGY FOR HEALTH:
Proceeding of the International Meeting on Hilterapia® - Athens 2009
CONTENTS
•Relationship between cellular and systemic effects of pulsed
Nd:YAG laser. Cialdai F., Monici M.
•Laser-tissue interaction principles: beam penetration in tissues.
Romano G., Conti A., Fusi F.
•The HILT domain by the pulse intensity fluence (pif) formula.
Fortuna D., Masotti L.
•The challenge of shoulder pain. Vissarakis G., Charamidis N.
•“High intensity laser therapy in knee osteoarthritis: comparison
between two different pulsed-laser treatment protocols”.
Viliani T., Martini C., Mangone G., Pasquetti P
Abstract
•Hilterapia® and lymphoedema. Nicolaou V.
•CliFrozen Shoulder Syndrome weighted comparison from “static &
dynamic” treatment with Nd/YAG 10W pulsed laser. Sicheri M.
36
The material of support for
Hilterapia®
37
TOOL BOX
A complete packet of materials to popularize and
propose to the patients the Hilterapia®
38
DVD
An important and practical tool that it illustrates in the detail the
potentialities of the Hilterapia®.
39
VIDEO MANUAL
A real practical course on the application of the Hilterapia® to the
different patologies. With this tool, the doctor can effectively apply the
Hilterapia®.
40
ON LINE TRAINING
 Hilterapia® Course
 Laser Safety On line Course
41
WEB SITES
www.asalaser.com
www.hilterapia.com
42