Page Ten P H Y S I O T H E R A P Y Marih, 1958. R e p rin t fro m „ U L T R A S C H A L L I N M E D I Z I N U N D G R E N Z G E B I E T E N .” U ltra s o n ic s . V ol. 8.1— M a rc h , 1955. Les U ltra s o n s. W issens>:hftliche V ereinigung f u r U ltra s c h a llfo rs c h u n g e. V. B onn. Successful Application of Ultrasonic Therapy (Die praktische Bewahrung der Ultraschalltherapie) B y Dr med. K. S T U H F L A U T H Ultra s o n ic th e r a p y d e v e lo p e d f r o m a n id e a o f th e p h y s i­c is t P ohlm an in 1939 to u tiliz e m e c h a n ic a l v ib r a tio n s o f h ig h fre q u e n c y fo r th e tr e a tm e n t o f r h e u m a tic d ise ases. A f te r th e w a r a n a p p a r a tu s f o r a p p ly in g th is ty p e o f th e r a p y w as d e v e lo p e d , a n d its u se s p re a d w ith in a few y e a rs fro m G e rm a n y , v ia S w itz e rla n d , I ta ly , F r a n c e a n d S p a in to a lm o s t a ll th e c o u n tr ie s o f th e w o rld . D u r in g th is tim e c o n tr a d ic to r y o p in io n s w e re e x p re ss e d by th e G e rm a n m e d ic a l p u b lic c o n c e rn in g u ltr a s o n ic th e r a p y . A fte r th e first e n th u s ia s m s u b s id e d , a tim e fo llo w e d in w hich th is m e th o d w a s lo o k e d u p o n sc e p tic a lly a n d o f te n e ven m et w ith a n e g a tiv e a tt i tu d e w h ic h in m a n y c ases w as u n ­ fo u n d e d . T h e a p p r a is a l o f u ltr a s o n ic th e r a p y by th e m e d ic a l w o rld fo llo w e d th u s e x a c tly th e sa m e p a tt e r n as th a t o f X -ra y th e r a p y . A f te r X -ra y th e r a p y h a d b e e n e n th u s ia s tic a lly re ce iv e d it w a s a lm o s t d e c la re d ille g a l d u r in g th e 1920’s o n a c c o u n t o f th e d a n g e rs in v o lv e d . A s a re s u lt o f th e n e g a tiv e a tt i tu d e to w a r d s u ltra s o n ic th e r a p y th e G e r m a n H e a lth I n s u r a n c e C o m p a n ie s re fu s e d to r e fu n d p a y m e n ts f o r it. T h is d e c is io n w a s a m e n d e d o n ly in A p r il 1954 w h e n u p o n th e s u g g e s tio n o f P rofessor von B ra u n b e h re n s th e p re v io u s d e c isio n w a s re v e rse d b e c a u s e a n u m b e r o f E u r o p e a n c o u n tr ie s h a d in tro d u c e d u ltr a s o n ic th e r a p y a n d a c k n o w le d g e d it a s a c c e p ta b le fo r I n s u r a n c e C o m p a n ie s . T h e e x a g g e ra te d fe a rs o f th e s o -c a lle d u ltr a s o n i c th e r a p y — w h ic h by th e w a y , u n til to d a y d id n o t c a u s e o n e sin g le d e a t h — w as th e re s u lt o f o b s e rv a tio n s o f u n d e s ira b le effects in a n im a l e x p e rim e n ts , in tr e a tm e n t o f p a tie n ts w ith a n o v e rd o s a g e a n d in c a s e s w h e re su c h tr e a tm e n t w as c o n tr a ­ in d ic a te d . R e s u lts f r o m re s e a rc h w ith u ltr a s o n ic v ib r a tio n s u sin g is o la te d tis s u e s o r liv in g a n im a ls c a n n o t a s su c h b e a p p lie d to t h e h u m a n . T h e y w ill o n ly p r o v i d e a n in te re s tin g in s ig h t in to t h e a c tio n o f th is t h e ra p y . T h e p e d ia tric ia n A d a m fo r i n s ta n c e r e p o r t s 1500 sin g le a p p lic a tio n s o f u ltra s o n ic s in c h ild re n w ith o u t a n y c a s e o f th e b o n e d a m a g e b e in g o b se rv e d e ven th o u g h B u c h ta la , B a rth a n d B tilow c le a rly d e s c rib e b o n e d a m a g e a n d in te rfe re n c e o f g ro w th w h e n tr e a ti n g y o u n g d o g s. I n a ll a n im a ls d o sa g e s w e re u se d w h ic h by f a r s u rp a s s e d th e th e r a p e u tic sa fe m a rg in , a n d w h ic h u s u a lly , w e re a p p lie d w ith th e s ta tio n a r y m e th o d o f a p p lic a tio n . T h e fo llo w in g te s ts sh o w h o w im ­ p o r t a n t it is to c o n s id e r th e ty p e o f a p p lic a tio n fo r a c c u ra te e v a lu a tio n o f th e r e s u lts : M a ib a u e r r e p o rts a p p lic a tio n o f u ltr a s o n ic th e r a p y o n g u in e a -p ig s u sin g th e m a s sa g in g m e th o d w ith d o s a g e s u se d in t r e a tm e n t o f h u m a n b e in g s. I n n o t e ven o n e sin g le case d id he o b se rv e sk in d a m a g e . B a u m a n n a n d P resch u sin g th e sa m e d o s a g e , h o w e v e r, w ith th e s ta tio n a r y m e th o d , o b se rv e d e d e m a , b lis te rs a n d finally e v en tis s u e d e s tr u c tio n . K lin k m iille r o b s e rv e d th e effect o f u ltr a s o n ic th e r a p y o n a leg w h ic h w as s c h e d u le d f o r a m p u ­ ta ti o n . D e fin ite tis s u e d a m a g e w as o n ly fo u n d in th o s e s p o ts w h ic h w e re e x p o se d f o r 2 0 m in u te s to s ta tio n a r y so n ic v ib ra tio n s . T h e e m p iric a lly d e te r m in e d d o sa g e s n o w u s e d a re f a r b e lo w th o s e u s e d fro m 1947 t o 1949. H in tz e lm a n n fo r in s ta n c e lis ts in h is d o s a g e ta b le r a d ia tin g in te n s itie s fro m 0,2 to a m a x im u m o f 3 w a t t- c m 2. A n in c re a s e o f th is d o s a g e f o r th e p u r p o s e o f o b t a in in g a b e tte r th e r a p e u tic a l e ffect o f te n r e s u lts in u n to w a rd -e ffe c ts , s u c h a s p a in s a n d s p a s m . I m e n tio n e d a lre a d y in 1950 t h a t ir r a d ia tio n w ith th e p re v io u s ly u se d h ig h d o sa g e s c a u s e d a n im b a la n c e o f th e a u to n o m ic n e rv o u s sy ste m in v e ry se n sitiv e p e rs o n s a n d t h a t c ir c u la to r y d is tu rb a n c e s su c h a s a n g in a p e c to ris a tta c k s , d izzy sp e lls c a u s e d by d r o p o f b lo o d p r e s s u r e etc., m a y o c c u r. T h e fin d in g s w ere c o n firm e d re p e a te d ly b y P ezold, B unse a n d c o -w o rk e rs , a s w ell a s L e ic h t a n d c o -w o rk e rs . I t is f u r th e r m o r e o f in te r e s t t h a t s u c h s y m p to m s , a s re p o rte d by o t h e r a u th o r s , c a n a ls o b e o b s e rv e d a f te r X -ra y th e ra p y , w h e n la r g e r v e g e ta tiv e n e rv e c o rd s o r g a n g lia a re d ir e c tly ' a ffe c te d by th e r a d ia tin g e n e rg y (A r k u s s y , G iinsel a n d S te fa n o w ). W ith th e low u l tr a s o u n d d o sa g e s n o w used, o n e d o e s n o t h a v e to r e fra in f r o m tr e a tin g o ld e r o r c irc u la to ry -la b ile p e rs o n s w ith u ltr a s o n ic th e ra p y . W e c a n r e p o r t f r o m e x p e rie n c e s g a th e re d a t o u r c lin ic t h a t w ith a m a x im u m r a d ia tio n in te n s ity o f 2 W a t t - c m 2 a n d a n a v e ra g e r a d ia tio n in te n s ity o f 0 ,3 — 0,5 W a t t - c m 2 such s y m p to m s n o lo n g e r o c c u r. A d ir e c t s o n ic tr e a tm e n t h o w e v e r, o f th e p r e c o r d ia l a r e a a n d th e c e rv ic a l g a n g lia s h o u ld b e a v o id e d w h e n t r e a tin g p e r s o n s w ith a h is to r y o f h e a r t disc ea se . I t is im p o r t a n t t o u se th is n e w ly d e v e lo p e d th e ra p y d is c rim in a te ly a n d to a p p ly o n ly in c a s e s w h e re i t is in d i­ c a te d . M a n y e r ro r s h a v e b e e n m a d e in th is r e s p e c t, p a rtly d u e t o e x a g g e ra te d c la im s , p a r tly d u e to u n ju s tifie d c o n ­ c lu s io n s fro m a n im a l e x p e rim e n ta tio n . A n o th e r e r r o r w as m a d e b y th e o re tic a lly c o m p a r in g th is fo rm o f th e r a p y w ith o t h e r m e th o d s o f p h y s ic a l t h e ra p y . A g o o d e x a m p le o f th is is th e q u e s tio n o f so n ic tr e a tm e n t o f t u m o r s . F r o m b io lo g ic a l e x p e rim e n ts w e c a n s ta te , t h a t s im ila r r e s u lts w e re o b ta in e d w ith X -ra y a n d u ltr a s o u n d , w h ile th e e ffe c tiv e n ess d iffe re d g re a tly . A c c o rd in g to i n f o r m a tio n o b ta in e d f r o m W allace, B u sh n e ll a n d N e w ­ c o m er th e effe c tiv e n ess o f u ltr a s o n ic w a v es m a y be r ig h t­ fu lly c o m p a re d w ith t h a t o f e le c tro m a g n e tic o r c o rp u s c u la r io n iz in g ra y s. T h e sa m e d a m a g e c u rv e w as p lo tt e d w ith u ltr a s o n ic a n d X -ra y tr e a tm e n t o f d r o s o p h i la m elan o -( g a s te r. N e w c o m e r a n d W allace o b s e rv e d m u ta t io n p r o ­ c esses w h e n tr e a tin g c o rn , w h ile A sc h e c le a rly d isc o v e re d “ C o lc h ic in e ffe c ts” o n p la n t cells w h e n in th e p ro c e s s o f c ell d iv is io n , a n d W oeber fo u n d w ith th e W a lk e r - C a rc in o m a c ary o rh e x is a n d c aro ly sis w hich d e stro y th e tu m o r tissue. H ow ever, th e fa c t th a t in spite o f a ll th is k n o w ­ ledge tu m o rs h ave never b een tre a te d successfully in h u m a n b e in g s is d u e to th e to o lo w u l tr a s o u n d in te n s itie s u se d w h ic h a ls o m a y le a d t o a n o p p o s ite -e ffe c t. W e f o u n d it to. b e tr u e t h a t to o lo w in te n s itie s — n o t o n ly o f u ltr a s o u n d b u t a ls o o f io n iz in g ra y s — c a n r a t h e r le a d to a n in c re a s e d g ro w th in p a tie n ts w ith tu m o r s in a r e a s w h ic h w e re n o t re a d ily a c c e s sib le to a s o u n d b e a m o f sufficient s tro n g in te n s ity . W e th e r e f o r e su g g e st to re fr a in fro m so u n d tr e a tm e n t o f tu m o rs , since ra p id g ro w th o f m e ta s ta s e s w as o b s e rv e d a f te r s o u n d tr e a tm e n t. U n le s s su c h tr e a tm e n t c o u ld b e c o m b in e d w ith s im u lta n e o u s X -ra y th e ra p y , w h ic h — a c c o rd in g t o te s ts by W oeber— re s u lts in s e n s i­ tiz in g o f th e c ells t o w a r d X -ra y s. U n p e r t u b e d by th e h e a te d d is c u s s io n p r o a n d c o n tr a th e e ffect o f u ltr a s o n ic th e r a p y , w e fin d t h a t m a n y c lin ic s a n d a lm o s t a ll in s titu te s o f p h y s ic a l th e r a p y h a v e in c lu d e d u ltr a s o n ic th e ra p y i n to th e ir a rm a m e n ta r iu m o f m e d ic a l tr e a tm e n t, a s well a s s h o r t w a v e th e ra p y , X -ra y , u ltr a v io le t R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Marth, 1958. P H Y S I O T H E R A P Y Page Eleven light tr e a tm e n ts , e tc . C lin ic a l e x p e rie n c e n o w p e rm its fairly e x a c t in d ic a tio n s o f u ltr a s o n ic th e r a p y fo r su c c essfu l tre a tm e n t o f v a r io u s d ise ases. S ta tis tic a l d a ta w e re c o m ­ oiled d u rin g th e la s t y e a r by th e “ S cien tific A s s o c ia tio n for U ltrasonic R e s e a rc h . ” 285 p r a c titio n e r s a n d s p e c ia lis ts a nd a lso 27 c lin ic s p a r tic ip a te d in th is su rv e y , a n d o f th e 1 2 0 , 0 0 0 in d iv id u a lly tre a te d , c ases a t o ta l o f 103,000 w ere e v alu ate d ( W u lff). T h e fo llo w in g in d ic a tio n s a re lis te d a c c o r d in g t o th e e ffe c tiv e n ess o f u ltr a s o n ic th e r a p y : S ta tistic s o f re c o ve ry o f the gro u p in cluding m ore than 100 cases tre a te d , ( T o ta l n u m b e r o f c ases tr e a te d 103,360) arranged a c cording to tre su lt o b ta in e d in Recovery g ro u p s L u m b a g o M y a lg ia C o n tu s io n s D i s t o r t i o n s I n f l a m m a t o r y s k i n le sio n s S c ia tic a [ P e ria r th ritis H e r p e s z o s t e r T e n o s y n o v i t i s . C h ilb la in s S to m a c h U lc e rs A r t h r i t i s R a y n a u d ’s D is e a s e , E p ic o n d y litis S u d e c k ’s A tr o p h y P lexus N e u ra lg ia B u e rg e r’s D is e a s e A rth ro s is def, B r a c h ia lg ia n o c t , S tu m p N e u ro m a S p o n d y la rth ro s is U lcus c ru ris W a rts P ro s ta titis S c le ro d e rm ia M a rie -S tru m p e ll D ise a se C h o le c y s to p a th y A s th m a I = v ery g o o d success I I = g o o d success. I I I = n o o r ra re ly su ccess. IV = d e te r io r a tio n . r ain indications fo r U ltrasonnic T herapy. A rth ro s is a n d s p o n d y la r th r o s is w ith r h e u m a tic a n d n e u ­ ralgic m a n ife s ta tio n s su c h a s sc ia tic a , lu m b a g o , m u sc u la r rh e u m a tis m , p e r ia r th r i t is h u m e ro s c a p u la ris , p le x u s n e u ­ ra lg ia , m y alg ia e tc ., a re th e m a in in d ic a tio n s f o r u ltra s o n ic th e ra p y . O f 103,000 c ases t r e a te d a n d e v a lu a te d , 5 5 % sh o w ed very g o o d re s u lts a n d 3 8 % g o o d re su lts . T h e p h y sic ia n s re p o rte d th e a p p lic a tio n o f u l tr a s o u n d th e m e th o d o f c h o ic e in th e s e c a s e s. O n th e o t h e r h a n d we find th a t a c u te in fla m m a to ry a r th r i t is a n d a d v a n c e d c ases o f B e c h te re w d ise ase re a c t less f a v o u ra b ly t o u ltr a s o u n d tre a tm e n t. E x c e lle n t r e s u lts a re fo r in s ta n c e re p o rte d by R e ic h e l in tr e a tin g c o n tu s io n s a n d s p ra in s , d is lo c a tio n s etc. (6 0 % v ery g o o d r e s u lts ; 3 0 % g o o d re s u lts ). F re y , o f B e rn , S w itz e rla n d , su c c essfu lly tr e a te d th e Sw iss O ly m p ic te a m d u r in g th e Olympic g a m e s in H e ls in k i w ith u l t r a ­ s o u n d . E d e m a a n d o th e r sw ellin g s r e s u ltin g f r o m s p ra in s a n d f ra c tu re s (Z a u n e r) d is a p p e a r m u c h f a s te r w ith u l tr a ­ sonic tr e a tm e n t. In fla m m a to ry sk in c o n d itio n s , su c h as f u ru n c le s, o r g la n d u la r a b sc esses c a n b e tr e a te d su c c e ss­ fully. T h e re s o r p tio n o f in fla m m a to ry in d u r a tio n s , f o r in s ta n c e a f te r t o o th e x tra c tio n s , is g re a tly a c c e le ra te d . A c c o rd in g to o u r o w n e x p e rie n c e s a n d t o r e p o r ts given by o th e rs , r a d ic u la r u ltr a s o u n d tr e a tm e n t is v ery effective, e sp e cially in c ases o f severe p a in in h e rp e s z o s te r, even w hen o th e r th e r a p e u tic m e th o d s h a v e fa ile d . U l tr a s o u n d I I I I I I IV 74 25 1 _ 72 26 2 -- 62.5 35.5 1 1 58.5 34.5 7 _ 57.5 41 1.5 -- 55.5 42 2.5 .- 41.5 48 10.5 - 39 ' 44 14.5 2.5 36.5 58 5.5 — 34 61 5 — 32.5 44.5 23 — 32.5 56 9.5 2 30.5 31.5 38 — 30 36.5 33.5 — 28.5 53.5 18 — 28 54.5 16.5 1 23.5 36 36 4.5 27 61 1 2 — 2 1 50.5 28.5 — 2 1 53.5 25.5 — 2 0 58.5 21.5 — 18.5 52 18.5 1 18 2 2 60 — 16 53 31 — 14.5 31 54.5 — 14.5 62.5 23 — 13 70.5 16.5 — 11.5 51.5 35 2 h e re m a y b e c o n sid e re d th e m e th o d o f c h o ic e . S im ila r g o o d re s u lts w e re re p o rte d b y c lin ic s a n d p r a c t itio n e r s in c a u s a lg ia s (C hateau), c o c c y g o d y n ia (F orestier), p o s t ­ o p e r a tiv e n e u ritis a n d n e u ra lg ia o f th e j a w (H e rrm a n n ). B eh ren d o f N e w Y o rk e m p h a s iz e s d im in u tio n o f rig o r , sp a sm a n d p a in in h e m ip le g ia , P a r k in s o n ’s dise ase a n d m u ltip le sc le ro s is a fte r r a d ic u la r s o u n d tr e a tm e n t, L ess g o o d r e s u lts in s p ite ,o f in itia lly e n th u s ia s tic r e p o r t s c a n be o b ta in e d in S u d e c k ’s a tr o p h y , u lc u s c ru ris , b ro n c h ia l a s th m a a n d s c le ro d e rm ia . T h e s e g o o d re su lts re p o rte d fro m G e r m a n y , S w itz e rla n d a n d I t a ly a r e now c o n firm e d by la rg e s ts tis tic s o rig in a tin g in U .S .A ., w h e re A id e s a lo n e tr e a te d m o re th a n 170 c ases o f s u b d e lto id b u rs itis a n d B eh r e n d r e p o r te d a t o ta l o f m o re t h a n 10,000 tr e a tm e n ts . M o s t o f th e in d ic a tio n s f o r u ltr a s o n ic th e ra p y m e n tio n e d a b o v e a re a ls o v a lid fo r t h e u s e o f o th e r o r t h o d o x m o d a l­ itie s o f p h y sic a l th e ra p y . M a n y o f th e d ise a s e s q u o te d h a v e a lre a d y p re v io u s ly b e e n su c c essfu lly t r e a te d w ith a n a lg e s ic d o sa g e s o f X -ra y th e r a p y , fo r in s ta n c e a r t h ­ ra lg ia a n d a r th r itis , in fla m m a to ry c o n d itio n s o f th e sk in a n d in fla m m a tio n o f th e ly m p h g la n d s . X -ra y r a d ia ti o n o f th e s y m p a th e tic c h a in a n d o f th e g a n g lia fo r tr e a tm e n t o f a n g io -s p a s tic sy m p to m s h a s b e e n u s e d fo r a lo n g tim e a n d is c o n s id e re d to re p la c e th e d r a s tic s y m p a th e c to m y a c c o r d in g to L e ric h e. T h is in v ite s c o m p a r is o n w ith p a r a - v e r ta b r a l s o u n d tr e a tm e n t w h ic h a c c o rd in g to S tu h lfa u th a n d a s s o c ia te s h a s a lm o s t th e p h a rm a c o lo g ic a l effect o f a m ild n o v o c a in -b lo c k . P a in fu l r h e u m a tic afflictio n s o f th e m u sc le s a n d n e u ­ ra lg ia a r e su c c essfu lly tr e a te d b y p r a c titio n e r s w ith s h o r t w ave th e ra p y . I t is n o w u p to t h e p h y sic ia n t o c h o o s e fro m th e m a n y th e r a p e u tic a l m e th o d s o ffere d , to w h ic h u l t r a ­ s o n ic th e r a p y h a s re c e n tly b e e n a d d e d . H is fin al d e c isio n w ill d e p e n d o n th e p re v a ilin g c irc u m s ta n c e s in e a c h in d i­ v id u a l c ase. C o m p a r a tiv e te s ts w ere m a d e b y D a licho in tr e a tin g jo in t d ise ases. D alicho c o m p a re d u l tr a s o u n d th e ra p y w ith X -ra y th e ra p y , in tr e a tin g a r th r a lg ia . H e fo u n d t h a t th e r e s u lts o b ta in e d w ith u ltr a s o n ic th e r a p y a r e a lm o s t id e n ti­ c a l w ith th o s e o f X -ra y th e ra p y . T h is c o m p a r e s w ith a r e p o r t by W allace a n d a s s o c ia te s o n a n im a l e x p e rim e n t­ a tio n w ith d ro s o p h ila m e la n o g a s te r. O n th e o th e r h a n d th e r e s u lts o b ta in e d a r e m u c h m o r e fa v o u ra b le a s w h e n o n ly th e r m a l th e r a p y w as u se d . W h en t r e a tin g la r g e r j o in t s w h ic h a r e n o t so re a d ily a cc essib le to u ltra s o n ic s re s u lts a r e less fa v o u ra b le . T h e p e rc e n ta g e o f h ip jo in ts tr e a te d su c c essfu lly w ith X -ra y th e r a p y is 73 % c o m p a re d to o n ly 4 4 % w h e n tr e a te d w ith u ltr a s o u n d (P a n n e w itz). O n e a d v a n ta g e o f u ltr a s o n ic th e r a p y o v e r X -ra y th e ra p y is its low c o st w h ic h p e rm its its u s e by a n y p h y sic ia n . I t f u r th e r p e rm its well lo c a liz e d tr e a tm e n t o f s m a lle s t a re a s a n d it is sp e c ia lly re c o m m e n d e d f o r tr e a tm e n t o f th e re a d ily re a c tin g a u to n o m ic n e rv o u s sy ste m (S tu h lfa u th , Z a c h ). T h e a d v a n ta g e o f X -ra y th e r a p y c o n sists in its g re a te r in te n s ity a n d d e g re e o f p e n e tr a tio n . T h e c h o ic e b e tw ee n th e s e tw o th e r a p e u tic m o d a litie s th e r e f o r e d e p e n d s o n w h e th e r su p e rfic ia l o r d e e p e r lo c a te d a re a s o f th e b o d y o r d e e p -s e a te d c e n tre s , j o i n t s o r in fla m m a to ry fo c i a re t o b e tr e a te d . The a ctio n o f U ltrasound. T h e a c tio n o f u ltr a s o u n d is n o t y e t fu lly u n d e r s to o d , w h ic h a ls o h o ld s tr u e f o r m a n y o t h e r m o d a litie s o f p h y s ic a l th e r a p y . I t is s till u n d e r d is c u s s io n w h e th e r o r n o t th e p r im a r y e ffect o f u ltr a s o u n d is m e re ly a th e r m a l o n e , a n d t o w h ic h e x te n t o t h e r m e c h a n ic a l o r c h e m ic a l effects e n te r i n to th e p ic tu re . L e h m a n n fro m th e very b e g in n in g offered th e th e o r y t h a t u ltr a s o u n d h a s m ere ly a w ell lo c a liz e d th e r m a l effect. H e is s u p p o r te d in h is th e o r y by m a n y scientific e x p e rim e n ts. M e a n w h ile S c h m itz a n d a sso c ia te s , H a lb a c h , S tu h lfa u th , G o e lk e l a n d M e y e r c la im m e c h a n ic a l' p h y s ic a l effects, e sp e c ia lly o n th e m u sc le a n d its m e m b ra n e - R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Page Twelve P H Y S I O T H E R A P Y March, 1958. A c c o rd in g to th e o rie s e sta b lis h e d so f a r w e find t h a t th e de cisiv e f a c to r f o r re le a s e o f th e p rim a r y p ro c e s s e s w hich p r o d u c e th e r a d ia tio n lies in th e lo c a l a c c u m u la tio n o f e n erg y w h ic h re le a s e s c h e m ic a l re a c tio n s . C o m p re s s io n a n d d e c o m p re s s io n o f tis su e le a d s t o p o w e rfu l e n erg y - c o n c e n tr a tio n in lo c a lis e d a re a s w h ic h in t u r n re le a se v a rio u s re a c tio n s . N u m e ro u s p h y sic a l p ro c e ss e s ta k e p la c e s u c h a s d iv is io n , s y n th e sis, o x id a tio n , re d u c tio n a n d p o ly ­ m e riz a tio n . T h e X -ra y effect is e x p la in e d b y a m e c h a n is m w h ic h c a n b e e x p e rim e n ta lly c o n firm e d (W e is , D a le a n d o th e rs , B a rro n a n d h is c o lle a g u e s). W h e n i r r a d i a ti n g w a te r, b o th O H -ra d ic a ls a n d H - a to m s a r e g e n e ra te d w h ic h c o m b in e to H 20 2 (L angendorff])■ S u c h re a c tiv e g ro u p s le a d to o x i­ d a tio n o f th e S H -g ro u p in th e cell p r o te in s th e re b y b lo c k in g e n zy m es. I n se rio u s c ases, a d e n a tu r a tio r i o f a lb u m e n m a y s e t in . A s im ila r m e c h a n is m c o u ld b e r e s p o n s ib le f o r th e p r im a r y effect o f u l tr a s o u n d o n th e cell s tr u c tu r e . T h e t h e r a p e u tic effect, h o w e v e r, p rin c ip a lly r e s u lts fro m s e c o n d a ry e ffect w h ic h is tr a n s m itte d v ia th e a u to n o m ic n e rv o u s sy ste m . A p p lic a tio n f o r a n a p p r o p r i a te d o sa g e r e s u lts in r e la x a tio n o f th e s m o o th a n d s t r ia te d m u sc le s, in a n in c re a s e d b lo o d c irc u la tio n a n d a lo c a lly effective r e lie f o f p a in . O th e r lo n g k n o w n fa c to r s a re th e h e a tin g effect o f th e tis su e (P ohlm an), th e in c re a s e o f th e b lo o d c irc u la tio n o f th e s k in (S tu h lfa u th ) a n d t h e e le c tro m y o - g r a p h ic a lly re c o rd e d d e c re a s e o f th e m u sc le to n e (T schannen). Ultrasound combined with other therapeutic measures. S ince u l tr a s o u n d m u st n o t b e c o n s id e re d a p a n a c e a , p h y s ia tris ts c o m b in e d u ltr a s o u n d w ith o th e r th e ra p e u tic m e th o d s . K ow a rsch ic k c o m b in e s u ltr a s o u n d w ith m assa g e, H in tz e m a n w ith m a s sa g e o f th e c o n n e c tiv e tissu e , Ladeburg w ith u n d e rw a te r m assage, F o re sth r w ith th e rm a l b a th s, Gross w ith ste am b a th s, Koeppen w ith s h o rt w ave tre a tm e n t, th ere b y o b ta in in g m u ch b e tte r results. S o u n d tre a tm e n t a fte r lo ca l a p p lic a tio n o f o in tm e n ts, such as F in a lg o n (Ohlig) a n d V e nostasin (M aennel) c o n trib u te s to th e subjective relief o f pain. I n v e ry p a in fu l c o n d itio n s o f th e j o i n t a n d afflictio n s o f th e sp in e (su c h a s lu m b a g o a n d sc ia tic a ) w e e m p lo y a c o m b in a tio n o f se v e ra l m o d a litie s , e sp e c ia lly d e sig n e d fo r easy use by th e p r a c titi o n e r . H a lf a n h o u r p r i o r to th e firs t u ltr a s o u n d tr e a tm e n t a n Ir g a p y r in in je c tio n is given w h ic h a ssists in p ro c u rin g c e n tr a l a n a lg e s ia a n d re la x a tio n . S im u lta n e o u s ly , a se ries o f in je c tio n s w ith th e G T 50 (o n e v ial 1— 2 tim e s p e r w eek) is s ta rte d , th e h ig h v ita m in e D 2 c o n te n t in c o m b in a tio n w ith o t h e r e ffective s u b s ta n c e s (v a g o m im e tic a , h o rm o n e s ) e v id e n tly h e lp s to re g e n e ra te th e o s te o c h o n d r o tic a n d d e fo rm e d j o in t to a c e r ta in e x te n t. R e la x a tio n o f th e j o in ts , sim u lta n e o u s ly re s u lts in a tr o p h ic in flu e n ce o n th e r e g e n e ra tio n o f th e s u p p o rtin g c o n n e c tiv e tis su e . S uccess o f u ltr a s o n ic th e ra p y d e p e n d s o n c o r re c t in d ic a tio n a n d d o sa g e , c o m b in e d w ith p a tie n c e . I h a v e re ce iv e d e n th u s ia s tic r e p o r t s fro m m e d ic a l h u s b a n d - w ife te a m s w h e re th e wife a ssiste d w ith s k illfu l h a n d s a n d g r e a t p a tie n c e in th e tre a tm e n t o f p a tie n ts . N e rv o u s a n d ru s h e d p h y sic ia n s w h o h a rd ly h a v e th e tim e to su p e rv ise th e ir th c h n ic ia n s w ill n o t o b ta in g o o d re s u lts , a n d w ill th e n b la m e u ltra s o n ic s r a th e r t h a n its fa u lty a p p lic a tio n a n d te c h n ic f o r th e ir fa ilu re s . Conclusion D e v e lo p m e n ts in u ltra s o n ic th e ra p y d u rin g th e p a s t 7 y e a rs a re re v ie w e d in o r d e r to p r o m o te b e tt e r a p p re c ia tio n o f th is ty p e o f th e r a p y w h ic h m ay b e cla ssified u n d e r v ib ra to ry -m a s s a g in g p ro c e d u re s . A p e r io d o f g r e a t e n th u s ia s m w as s o o n fo llo w e d in G e r m a n y by a n a c tu a lly to o sc e p tic a l a t titu d e w hich la te r w as re v e rse d by in c lu d in g u ltr a s o n ic th e r a p y in to th e list o f tr e a tm e n ts a c c e p te d b y H e a lth I n s u r a n c e C o m p a n ie s. I n c o n tr a s t to X -ra y th e ra p y w h ic h in th e 1920’s u n d e r­ w e n t a s im ila r c o u rs e o f d e v e lo p m e n ts , u ltr a s o n ic th e ra p y is n o t k n o w n y e t to h a v e c a u s e d a n y d a m a g in g e ffect. R e a c tiv e effects, su c h a s p a in , e x a c e rb a tio n s , sp a sm o f b lo o d v essels d is a p p e a re d a f te r p r o p e r a d ju s tm e n t o f th e d o sa g e . W h e re a s d u rin g t h e p a s t few y e a rs p ra c titio n e rs in G e r m a n y re fra in e d fro m u s in g u ltr a s o n ic th e ra p y , it has n o w b e c o m e w id ely a c c e p te d a ll o v e r E u r o p e , in S o u th A m e ric a a n d fin a lly in N o r t h A m e ric a w h e re it is c o n si­ d e re d a n effective m e th o d o f t r e a tm e n t f o r rh e u m a tic a n d tr a u m a ti c d is o rd e rs a n d in r e h a b ilit a ti o n p ro c e d u re s . E x te n siv e E u r o p e a n a n d I n t e r n a tio n a l C o n g re sse s a n d re p o rts fro m A m e ric a testify to th is effect. G e r m a n I n s ti­ tu te s o f p h y s ic a l th e ra p y , c lin ic s a n d h o s p ita ls a s well as p r a c titio n e r s h a v e n o w fa m ilia riz e d th em se lv es th ro u g h ly w ith t h e m a n u a l m e th o d o f t r e a tm e n t a n d h a v e re p o rte d v e ry f a v o u ra b le re s u lts . B a se d o n G e r m a n s ta tis tic s ofj m o re th a n 1 2 0 , 0 0 0 tre a te d c ases a n d b a s e d o n s ta tis tic s re p o rte d by th e U .S .A ., a lis t o f in d ic a tio n s w as c o m p ile d . I n c o n c lu s io n , th e a u th o r d e m o n s tr a te s h o w o t h e r m o d a l­ itie s o f p h y s ic a l a n d d ru g th e r a p y in c o m b in a tio n w ith u ltr a s o n ic th e ra p y sp e e d u p re c o v e ry , e sp e c ia lly in cases o f c h r o n ic rh e u m a tic d ise ases a n d in r e h a b i lita tio n p r o ­ c e d u re s . S u c h a c o m b in e d m e th o d n o t o n ly a c c e le ra te s the p ro c e s s o f h e a lin g , b u t a t th e s a m e tim e p re v e n ts any p o s s ib le re la p se s. D elivera n ce . . . from pain . . . . the humanitarian function of of the p r a c titio n e r now accomplished with greater speed, more economy and with a higher degree of safety than ever before. Full details and clinical notes on the use of R E N O T I N in the treatment of Migraine, N euritis, Lumbago, Sprains and Myalgia may be obtained from E xclusive D istributors f o r Southern A fric a P H A R M A C E U T I C A L S L T D . P . O . B O X 7 7 9 3 J O H A N N E S B U R G R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )