There is no need to talk about classic
treatments well known to all such as:
-
Complete rest, partial rest, changes in training
-
Ice application
-
Locals Anti-inflammatories
-
Non Steroid AI, or even general corticotherapy
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Physiotherapy, especially : MTP,
ultra-sounds, electrotherapy, rehabilitation, stretching
-
Mesotherapy, almost completely accepted in
classical protocol
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Heal piece , insole of shoe
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Metabolic disorder correction, diet and hygiene
rules
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Eradication of iatrogenic causes
(fluoroquinolones, statines…)
We will talk about CO2 Laser therapy...
This technique has
been used for more than 17 years, now and although very undeveloped and even
discredited, it deserves our attention.
Its bad reputation
has been caused by certain types of apparatus called « soft-lasers »
sold between 1985-90.
Its definition is
included in the word Laser :
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Light
Amplified
by Stimulated
Emission
of Radiations
This
light has 3 main characteristics :
Monochromaticity,
Coherence, Directivity
A
Laser has basically 3 main elements :
-
A resonance cavity (a glass tube closed at each
end by a mirror, one of which is semi-transparent to allow the exit of the
rays)
-
An active medium (gas, solid, or liquid)
-
A pumping system (electrical, optical)
Each
active medium corresponds to a different wavelength.
THE BIOLOGICAL EFFECTS OF
THE LASER :
These
depend on the wavelength, the power, and on the use of continuous or pulsed
mode of emission.
3 TYPES OF LASERS ARE USED
IN THERAPY :
The Hélium-Néon laser (HeNe) emits in the
visible red, at a very low power, a few mW and penetrates to a depth of 20-30 mm.
Diode infrared lasers (AsGa), emit in the
invisible spectrum between 800 et 1100 nm, have roughly the same penetration as
HeNe, have an some Antalgic and anti-inflammatory effects.
This
makes it useful for benign recent pathologies when they reach 3-4 W output
power.
These 2 types are called « soft-lasers ».
The CO2 Laser is a surgical Laser (Surgery
in ENT, dermatology, gynaecology). It is converted into a therapeutical Laser by a dispersion system with mirrors that create
a scanning..
Its
wavelength is 10600 nm (Far IR, invisible), Its penetration is only 2mm, But
its power can reach up to 50 Watts in therapeutic use. It has been used in
France since 1983 in Rhumatology and Traumatology.
Its
Benefits :
- Antalgic
- Anti-inflammatory
- Relaxing
- Regenerative
- Anti-Fibrining
make its interest into the treatment
of musculo-tendons chronic and acute
pathologies.
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300 CASES OF ACHILLE’S TENDINITIS have been treated in CO2 Laser
Monotherapy
This
study was presented at the Sports Medicine Days at Bichat Hospital Paris 1994.
We
Used a 30W Laser with scanning, which emits in continuous or pulsed mode with a
variable frequency from 50 to 500 Hz, coupled with an HeNe Laser of 3 mW for
visibility.
We
can also use an handpiece, which can be used directly on the target area.
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Protocol : 10 mn exposure
3 times a week, for
recent tendinites
2 times a week for
chronic tendinites
Total 5 to 15 sessions,
about 10 days to 8 weeks of treatment.
The results were judged
after 3 months
Results in 3 categories :
VG very good results: complete disappearing of pain, total recovering of
anterior sport activity
G, good results : normal resumption of activity, slight persistence
of pain in use or touch and/or nodule.
B or I, Bad or Insufficient : Resumption of sport activity impossible,
even if there is improvement in everyday life.
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VG : 81
B or I : 24 143 G and VG : 85 % of success.
43
of the 95 nodules were completely eradicated during or by the end of the
treatment.
122
cases were failure of habitual methods mentioned above, with the average
pathology being 7 months old. The effect is residual over 4 to 8 weeks, without
associated treatments and with progressive resumption of training.
VG : 27
G : 12
B or I : 7 39
G and VG : 85 % of success.
The average length of time since the beginning of these pathologies is 3
months and 7 to 8 sessions in 3 to 4 weeks
VG : 39
G : 13
B or I : 16 52 G and VG : 76 % of
success.
These
results inferior to those above seem in fact to be improved nowadays with the
use of the handpiece, which concentrate the laser on the painful area.
VG :
10
G : 4
B or I : 5 14 G and VG : 65 % of success.
This
group is a mixture of nodular recurrence, bursitis and/or secondary
enthesopathisis after combing, for which the results are equivalent to the
chapters concerned. The laser is quite inefficient with algodystrophisis. The
most spectacular success of the CO2 laser is with cases of fibrosis and scar
adherences even years after surgery
Note also the regeneration in a few weeks and
3 to 5 sessions of post-cortisone atrophisis after depigmentation and
infiltration of the bursitis.
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PRECAUTION OF USE:
This
Laser is very powerful, danger of burns is real especially using the handpiece,
but used in the proper way, provokes an enjoyable worth and painful effects
begins at the end of the session.
Even
if a burn occur, it will be very
superficial because of the weak penetration of the rays.
SECONDARY EFFECTS :
The
only undeniable secondary effect is the few outback of pain which can appear
just as easily at the beginning at or the end of the treatment
We
can in this case:
-
Spread out the sessions over more time
-
Decrease the energy level delivered during the
session by diminution of the exposure time or the power level
It
can happen that the Laser treatment must be stopped and it is not rare to see
in the following days an improvement which would not have been possible if the
treatment had continued.
CONCLUSION :
The CO2 Laser should be bent of the therapeutic
arsenal for the Achilles’ tendinitis treatments but also in all others areas.
In a next study I will propose you Rotulian's tendinitis.
Unhappily the Therapeutical Laser image has
been tarnished by the poor results of the « Soft Lasers ». This fact
made this technique abandoned ; there is only a few machine installed in
France. Less than 10 machines still in work today.
Docteur Tania Bellot
Centre Médical « les 4 Temps » Nov 94