«Epicondylitis» and tecar: five key steps to define an effective therapeutic strategy
In this article we start from the so-called “epicondylitis” to frame the wider application field of tendinopathies, indicating five basic points to follow and five common errors to avoid in the case of “epicondylitis” treated with a tecar device.
“Epicondylitis” in a few words
Despite what the term epicondylitis should suggest, it is often used to generally identify a painful state localized in the epicondyle area. In fact, referring to “epicondylitis” generically can be misleading as it does not sufficiently describe what is really happening in the tissues next to the epicondyle. To define a precise treatment, it will therefore be useful to identify which tissues or areas are generating the painful symptoms and in particular to understand whether an inflammatory process is actually taking place.
The etiology (origin) is multifactorial and can therefore depend on various causes that are difficult to separate. Usually, identification of this syndrome is clinical, i.e. it is based on a specialist visit that outlines its condition. An ultrasound examination may be useful to better understand the causes of the symptoms and therefore identify a more precise treatment program.
Should you wish to look further into the definitions and classification of the various clinical conditions in which an epicondylitis may occur, we recommend you consult these studies available on PUBMED:
- Lateral epicondylitis of the elbow; Vaquero-Picado A, Barco R, Antuña SA. 2016
- Lateral epicondylitis of the elbow; Tosti R, Jennings J, Sewards JM. 2013
- Medial epicondylitis: evaluation and management; Amin NH, Kumar NS, Schickendantz MS; 2015
- Diagnosis and treatment of medial epicondylitis of the elbow; Ciccotti MC, Schwartz MA, Ciccotti MG; 2004
- Tendon injury and tendinopathy: healing and repair. Sharma P, Maffulli N. 2005
“Tecar” explained in a few words
The capacitative resistive energy / electrical transfer is an instrumental physical therapy instrument that uses an electromagnetic field of around 0.5 Mhz to transfer energy to the body tissue. The energy transferred is intended to trigger endogenous and physiological responses within the tissue that are potentially useful in many clinical conditions.
Based on scientific literature, the responses that this instrument is able to generate can be grouped into thermal and non-thermal.
We list them briefly here: increase in blood perfusion and microcirculation, vasodilation, temperature increases, support for the drainage of excess liquids, support for the regeneration of functional tissue.
The operator, in most cases the physiotherapist, decides which reaction to stimulate based on the clinical condition he is addressing and can do so based on the amount of energy transferred, more precisely on the basis of the density of energy transferred per quantity of tissue treated . This is an element to consider for both the five points to follow and the five errors to avoid when treating “epicondylitis” with a tecar device.
Tecartherapy and Tecar device
The term “Tecartherapy” is a customary word for identifying the therapy performed through a Tecar instrument. In reality, the concept of Tecartherapy is generic and can be misleading.
Since the instrument is able to stimulate different reactions based on energy densities, the actual therapy is carried out by the operator who decides which tissue response to trigger, in accordance with the clinical condition. In fact, not all answers are always indicated for all clinical conditions. A typical example is the increase in temperature, sometimes very effective in reducing certain types of pain, while it is contraindicated in conditions of acute inflammation where, instead, it would be more useful to accelerate thermal homeostasis and drainage.
Fortunately, certain Tecar models give the operator the ability to choose which reaction to apply. Talking for example of 3 sessions of Tecartherapy is therefore very general. To describe the therapy, specific responses should be associated with the portion of tissue they treat. It would be better to describe “the tecar” as an instrument used to trigger endogenous responses and not as a therapy in itself.
Five common mistakes in “epicondylitis” treated with tecar
Tecar and epicondylitis: five common mistakes
Even before talking about the key steps, let’s start by listing five common mistakes to avoid when dealing with an epicondylitis case using a tecar device:
1- Thinking that ” tecar” or “tecar therapy” replaces the therapist:
The operator’s role is essential to understand the diagnosis, complete the clinical picture and create a complete therapy. Mobilizations and manual orthopaedic and myofascial techniques are useful for combining with the effects of the device to speed up resolution of the problem.
2- Transferring energy indistinctly without considering the different reactions available:
Depending on the clinical condition, it will be necessary to support drainage in case of edema, use the increase in temperature to reduce peripheral muscle tone and interrupt circulatory stasis, support tissue regeneration if we are in a degenerative condition. If we transfer the same energy levels to all the tissue portions we will trigger inaccurate responses and at best we will arrive at a suboptimal clinical result.
3- Triggering the response in the wrong place:
If in addition to not considering the different responses needed in the different portions of fabric, we just increase the temperature and do so in an inflamed area, we run the risk of a rebound effect. It would be like suggesting to a patient suffering from lateral epicondylitis with acute inflammation of the peritenonium in the short radial extensor of the carpus, to have a good game of tennis …
4- Not transferring sufficient energy to trigger the desired response:
In physics, and not only in the tecar field, to trigger a response you need to apply enough energy to do so. If we have to lift a 40kg table off the ground by 50cm, we will need a certain amount of energy to do it. If we are unable to apply a force that exceeds 40kg and we are unable to maintain this force for the time necessary to lift the table 50cm from the ground, we will not be able to reach the goal.
In therapy, this translates into a certain amount / threshold of energy to be transferred to the tissue to trigger the reaction we need. For example, if we want to increase the temperature of 1kg of tissue, by 1 degree centigrade, we will need about 3,600 Joules. Therefore, not applying enough energy to trigger the desired response is equivalent to not performing the therapy.
5- Allowing a lot of energy to be be dissipated in heat at skin level without reaching the deeper tissue
In addition to the amount of energy per quantity of tissue, it should be considered how this energy is distributed within the tissue itself.
Without having to make unreliable obscure calculations, there is a fundamental element to notice if something is not going as it should: the excess of surface heat. When we notice that the temperature of the skin increases greatly and the patient complains because the electrode (or even worse the return plate) “burns”, it is an alarm signal that we must take into consideration. It means that the energy that we are transferring via the instrument “dissipates” excessively on the skin and is only reaching a small part of the deeper tissue portions.
Fortunately, there are tecar models that allow you to avoid this problem even when transferring a large amount of energy.
Five key steps to define an effective treatment strategy in case of “epicondylitis” treated with tecar
One of the most common mistakes made in defining a treatment program is to skip one of the fundamental steps of defining the therapeutic strategy.
In fact, if the treatments are based on wrong assumptions it is very difficult that they will lead to an improvement in the patient’s condition, regardless of the type of therapy applied.
Below you will find a simple ladder that will be useful to you to avoid the most common “path errors” that are committed in the definition of treatments with tecar technology in the event of epicondylitis. We created it together with the specialists in our network and find it useful when we have to define an application program.
1- WHERE SHOULD WE GO? THE DIAGNOSIS INDICATES THE DIRECTION
It seems obvious to say so, but we still say it … Let’s start from the diagnosis! Read it carefully and imagine the therapeutic path that you could follow. If there is no diagnosis, we must find a way to obtain one.
2- BEFORE RUSHING AHEAD, WE MUST UNDERSTAND WHICH ROAD WE ARE ON
A fundamental first step to “spot” the most suitable treatment for the patient in front of you is to understand where the painful symptom is generated from:
is it actually an ongoing inflammation or is it more simply linked to a mechanoceptic response induced by receptors located in the deep muscle band that runs along the elbow joint? It seems a foregone question but this is the first useful indication of our imaginary clinical “navigator” that will tell us which treatment path to take at the first crossroads we encounter.
Performing a “pain provocation test” package to reproduce the patient’s symptoms may be a good idea to understand if there is a particular muscle that causes pain if activated or compressed.
Even measuring or perceiving the temperature in the epicondyle area by comparing it with the adjacent areas can give us useful indications. Hands are equipped with very sophisticated thermoreceptors but for those who are passionate about technology, there are now thermographic cameras that can be integrated with your smartphone at affordable costs and that have sufficient sensitivity to provide us with additional information that is useful for identifying an acute or sub-acute inflammatory state in situ.
3- IF WE HAVE THE SUSPICION THAT THERE IS ACTUALLY A CURRENT INFLAMMATORY PROCESS, IT IS A CASE OF INVESTIGATING (EVEN MORE)
In this case, an ultrasound and colordoppler may help us not only to better outline the diagnosis but also to more about the condition of the tendons that originate from the epicondyle.
Is peritendinous edema visible? How is the ecogeneity of the peripheral and deep tissue outlined? How are the tertiary and secondary bundles of the tendon aligned? Do you see intratendinous vascularization? The answer to these questions gives us an indication of several elements: how much energy will be needed? Can we afford to increase the temperature of the tissue or do we have to avoid any thermal increase in the inflamed area? Will mobilizations be necessary? Will friction techniques be needed to “unstick” the peritoneum from the actual tendon? Can we subject the tendon to heavy loads or are we in a situation where it is better to avoid overloads?
4- START … BUT HOW LONG DO WE HAVE TO FINISH?
If we have made the right calculations so far, it will be difficult to go wrong now, but we have to deal with the time available … How much will we dedicate to the patient for each session and for how many sessions is he willing to see us?
This information is essential to define the parameters of the equipment. Will we have to accelerate as much as possible as we have limited time or can we take it a little more comfortably? This is an important point to understand: standard protocols that are defined a priori do not usually take into account the patient’s personal situation and the clinic’s organization .
What if the protocol says I have to perform 3 treatments this week but the patient can only come twice? What happens if the protocol tells me to apply a certain amount of energy at the fourth session but in the meantime the patient has undergone an exacerbation not due to therapy? If you have instruments that allow you to measure, control and modulate the transferred energy, you can instead contextualize the protocol … This is how a protocol becomes a “tailor-made” treatment program for the person in front of us.
5- ALONG THE WAY
Treating epicondylitis in a generic way with “tecartherapy” without considering the previous points, in a single protocol, would be like putting a blindfolded person behind the wheel while following the instructions on what to do on the phone. During therapy and between treatments, it will be essential to check the patient’s feedback and in the absence of results, reconsider the treatment strategy. If the diagnosis is correct and the treatment strategy is consistent, there will definitely be clear improvements between one session and another. Otherwise it means that we are not considering some important variable.
Some references for comparison
Once that you have verified:
- that it is actually a tendinopathy of the tendons anchored to the epicondyle (for example, the short radial extensor of the carpus);
- at what stage of degeneration is the “indicted” tendon;
- how much available time we have for each treatment;
we have all the information necessary to define a treatment program that can reverse the degenerative process of the tendon, support tissue repair, and reduce painful symptoms.
By way of example only: based on clinical data provided by specialists who use our equipment, for 3 peritendinitis with start of tendinosis without structural damage to the fibrillary fascicles, in 3 sessions in one week we should already be able to reduce the patient’s pain by 70% and see the peritendinous edema almost completely reabsorbed. In the event of advanced tendinosis, the number of sessions and the times are longer but we are still able to reverse the degenerative process within 4-6 weeks, taking care to schedule “recall” sessions in the following period after 2 weeks, covering an overall period of 8 weeks.
The content of this article presupposes the use of a tecar tool capable of:
- transferring energy at a deep level without overheating the skin;
- measuring the energy actually transferred in the unit of time;
- measuring the current actually applied;
- guaranteeing modular and potentially high quantities of energy both in capacitive and in resistive;
- concentrating the energy in clearly identifiable points or in large areas as needed;
- stimulating the fabric even in the absence of thermal increases;
- avoiding the loss of energy due to overheating of the return electrode.
If you want to learn more about what features a tool must have to guarantee results that live up to your expectations, you can fill the following form and our team will be back to you as soon as possible.
Our sections dedicated to the rehabilitation of pathological states have the objective of sharing the scientific rationale of treatments that can be implemented through medical technologies that we develop with doctors, physiotherapists and health professionals, for dissemination purposes, giving useful food for thought to understand the cause / effect relationship of our instruments.
The contents of these articles are the result of the scientific research that we promote directly, the analysis of the available bibliography and the summary of clinical data that the specialists belonging to our network provide us.
Any useful information that you can find in these pages must NEVER replace an in-depth clinical analysis compatible with the degree of severity of the pathology you are addressing for your patient and must NOT be intended as a substitute for the doctor’s opinion.
WINTECARE cannot be held responsible for adverse events resulting from the improper use of the information contained in these pages.