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Ultrasound-guided Microtenotomy & IASTM

Discussion in 'Biomechanics, Sports and Foot orthoses' started by BEN-HUR, Mar 30, 2014.

  1. BEN-HUR

    BEN-HUR Well-Known Member

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    Waiting For Healing:

    I think we all would agree with the saying: "prevention is better than cure". Unfortunately most who make Podiatry appointments relating to movement/sport induced pain are the result of an already present injury... usually soft tissue – high percentage of which being muscle & tendon related. Whilst adequate assessment will usually find a causative factor (or combination of factors)... & subsequently lead to a treatment program which will reduce/resolve (individualised) pathological forces (i.e. via orthotic therapy) as well as incorporate an associated exercise/conditioning program to help recondition the area/body (i.e. aiding strength &/or flexibility)... there is always the issue of healing time. Body tissues (i.e. muscle, tendon, bone) will heal in their own time, with the usual phases of bleeding (depending), inflammation, proliferation & remodelling resulting/required – a process which can take up to 6 – 8 weeks, sometimes longer... & the practitioner seems to have little control over reducing the length of healing time at their in-clinic disposal (i.e. apart from inducing increased vascularisation). The patient’s age, health, diet/nutrition/hydration, lifestyle (i.e. sleep patterns) does play a role in recovery but all in all some injuries will last for some time after the initial consultation for treatment – despite the best medical knowledge (we aren’t yet privy to the likes of Star Trek’s Dermal Regenerator – albeit NASA appears to be interested in something similar: BioReplicates).

    One problem resulting from the healing phase (i.e. proliferation & remodelling) is the formation of scar tissue. I see it a lot - scar tissue can be a real problem for athletes (& general public) in that it is weaker, more inflexible (with more adhesions) than the parent tissue, thus can easily be reinjured/re-irritated... weeks, months, even years down the track form the initial injury. Recently I came across an interview in Medscape with Dr Gloria Beim, MD (Team USA Chief Medical Officer for the 2014 Winter Olympics in Sochi, Russia). The part I found of particular interest was on page 5 (Medscape - may need to login) with regard to her views on "new treatment or diagnostic modalities learned" of during her travels. These being:
    1/ instrument-assisted soft tissue mobilization (IASTM) &
    2/ Ultrasound-guided Microtenotomy...

    It appears Dr Beim hasn’t been aware of IASTM for that long. However, from what I can gather it’s been around in the West (USA) to some degree since the ‘70’s (it seems also referred to as the "Graston Technique")... where the use of a smooth firm object (i.e. usually stainless steel) helps maintain massage pressure (i.e. reducing finger/hand fatigue) whilst helping provide feedback pertaining to tissue irregularities (scar tissue/adhesions). It seems the focus is on breaking up scar tissue & adhesions, increasing circulation, improving fibroblast proliferation, promoting normal collagen alignment, subsequently increasing range of motion whilst eliminating compensatory movement patterns.

    Next the interview discusses Ultrasound-guided Microtenotomy...

    I couldn’t find much information on this (Ultrasound-guided Microtenotomy) but it does sound very interesting – clearing away the offending tissue (scarring) at the location with minimal trauma (not even a stitch apparently) to the area, in a short period of time & under local anaesthetic. Main uses are for two conditions very common (& potentially problematic) within the field of Podiatry i.e. Achilles Tendinosis & Plantar Fasciitis.

    Are there any Podiatrists out there using the above techniques or have further opinion on them? Being that U.S Podiatrists are more surgically based, are there any out there performing Ultrasound-guided Microtenotomy... or think it would be something worth looking into? Australian based views would be appreciated as well (for my interest).

    Any other views on helping reduce healing times?

    [Sorry for the loaded post – but been thinking on these issues for a while]
    Last edited by a moderator: Sep 22, 2016

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