INVASIVE PHYSIOTHERAPY
What do we call
Invasive physiotherapy?
Physiotherapy is a profession that has undergone a tremendous evolution over the years, this evolution is translated into the expansion and search for new techniques that help in the complex task of diagnosis and treatment of the different neuromusculoskeletal problems adding value and efficiency to our profession.
This evolution in techniques gave rise to the invasive physiotherapy, this being a a speciality of physiotherapy that directly treats injured tissue using a set of percutaneous (through the skin) techniques. which aim to stimulate tissue regeneration, and/or a reduction in pain.
Basically the 3 invasive techniques we use at Physio Athlete are the following: dry needling, percutaneous ultrasound-guided percutaneous neuromodulation and percutaneous electrolysis. What these techniques have in common is that they all require the use of needles and in the case of 2 of them they will be combined with currents, although of different types. These techniques allow us to work on most of the body's tissues: muscles, nerves, tendons and ligaments.
Accuracy Extra
State-of-the-art equipment
These techniques are minimally invasive and very safe, and at Physio Athlete we can add extra precision to these techniques with the help of a state-of-the-art ultrasound scanner. Vinno E35 and an electrostimulation system EPTE® Bipolar System.
This ultrasound machine Vinno E35, the needle point, as well as being indispensable for the diagnosis of certain conditions, helps to direct the needles towards the tissue we are interested in working on. While EPTE® Bipolar System, provides us with a variety of therapeutic current programmes which are scientifically proven and allow us to treat an infinite number of pathologies of the neuromusculoskeletal system.
EPTE Bipolar System is a medical device for health professionals that combines several techniques that broaden the therapeutic range of electrostimulation for the treatment of different pathologies of the musculoskeletal system and the peripheral and central nervous system.
This device is manufactured in Spain and meets all quality standards, making it the perfect tool for the application of techniques such as tDCS. It is a versatile, compact, portable and easy-to-use device with the capacity to adapt the parameters to achieve any protocol established by scientific evidence to treat different pathologies.
The EPTE® Bipolar System device has the following features EC health certificate.
learn more about Our Techniques of
Invasive physiotherapy
Dry needling
What is Dry Needling?
Dry needling is based on the introduction of a fine needle into the muscle, through the skin, of different lengths (depending on the depth of the muscle to be treated), causing a mechanical stimulus with the aim of relaxing a muscle or muscle group, thus reducing pain or other symptoms and restoring the ability to function properly.
This evolution in techniques gave rise to the invasive physiotherapy, this being a a speciality of physiotherapy that directly treats injured tissue using a set of percutaneous (through the skin) techniques. which aim to stimulate tissue regeneration, and/or a reduction in pain.
Muscles are made up of muscle fibres which, in order to contract, need a connection with the nerve through the so-called motor plate. Sometimes, for reasons still unknown to science, these motor plates cause continuous activation of the muscle, increasing the tension in the muscle and triggering a physiological process that causes pain and the loss of the ability to stretch and contract the muscle correctly.
Those areas in which muscle fibres are abnormally activated are known as Myofascial Trigger Points (MTPs). These points, when touched, cause pain in the area where the muscle is located, and sometimes even cause pain to be felt in areas away from this point, which is known as referred pain.
The use of the PS aims to achieve these PGMs, this action produces a Local Spasm Response (REL), this is an involuntary contraction of the muscle, which at a physiological level, together with other changes, results in a disappearance of pain and a decrease in muscle tension, thus recovering its capacity to function correctly.
Virtually all the muscles in the body, as any muscle is susceptible to these PGMs. Those that present some kind of difficulty due to their location in the body will be approached with the help of an ultrasound scanner that will serve as a guide in the process.
This depends very much on the number of PGMs, but in general up to a maximum of 6 sessions, although if after the 3rd session there is no improvement, it is recommended to stop using this technique. It is often and perfectly possible to obtain a great improvement after 1 session.
- Complications (all reversible): muscle spasm or momentary post-puncture pain. They usually disappear after a few hours.
- Dizziness during the puncture in very sensitive people.
- Insurmountable fear of needles that makes it impossible to apply the technique.
- Side effects such as contact dermatitis, bruising, muscle spasm, infection... although rare.
- The hazards of the technique are limited, unlikely to occur and mostly avoidable if precautionary measures are taken: pneumothorax (treatment of chest muscles), myoedema, haemorrhage, vaso-vagal syncope and nerve injury. In the latter case, the physiotherapist should be notified if an unpleasant electrical sensation occurs so that the needle insertion site can be modified to avoid nerve injury.
Other risks arising from the patient's previous state of health:
- In case of metal allergies, especially to nickel, the usual acupuncture needles cannot be used.
- Patients treated with anticoagulants are more prone to bleeding.
- Immunosuppressed patients or patients with lymphadenectomies are more prone to infections.
- Patients with hypothyroidism may suffer from oedema in the treated muscle.
- Dry needling should be avoided on areas of skin with wounds or scars, as well as skin diseases such as psoriasis or infections. It should also be avoided on tattoos.
- Deep puncture should be avoided in pregnant women, especially during the first three months of pregnancy, and after this period whenever the area to be treated may affect the foetus.
- It is advisable not to treat patients with chronic widespread pain, such as fibromyalgia, if the technique has been used previously without benefit.
PERCUTANEOUS THERAPEUTIC ELECTROLYSIS
EPTE®
What is Dry Needling?
The EPTE® Percutaneous Electrolysis Therapy is a revolutionary technique for the treatment of different musculoskeletal dysfunctions. The technique is applied by introducing a medical needle into the musculoskeletal tissue in dysfunction, mainly in a tendon for the treatment of "tendinitits", "tendinopathies" or "tendinosis". This needle is connected to a medical device of electromedicine (EPTE® Bipolar System), in the case of a galvanic current, a low-intensity current is applied with a therapeutic objective.
The revolutionary thing about this technique is that, combined with exercise, it reduces recovery times for different injuries, as the application of the current sets in motion different processes that help the affected tissue to recover and causes a controlled inflammation, which is necessary for recovery. Low intensity currents only produce a slight itch in the patient. In 48 hours, mobility is recovered and the pain generated by the injury is reduced.
As mentioned in the previous section, the main use of this technique is in tendon injuries. There are cells in the tendon that regenerate it and others that destroy it. The destruction or regeneration will depend on the stimuli given to the tendon.
Destruction will be favoured by not using it (sedentary lifestyle) or by a sudden and/or constant increase in load (carrying out a sporting or work activity in which too much is demanded of it, too soon and with hardly any rest). Regeneration will be achieved by modifying the activity that is favouring the destruction and the application of specific exercises.
To enhance or accelerate the regeneration process we rely on the Therapeutic Percutaneous Electrolysis EPTE®, this consists of a galvanic current applied by means of a needle that is introduced into the tendon, in such a way that it will favour an increase in metabolism and destroy certain substances that are related to pain. This results in favouring the regeneration of the tendon.
Yes, it is also used on muscle ruptures or micro-tears to promote the healing process, and on ligament injuries and scars for the same purpose.
This question will always depend on the complexity of the injury which is affected by various factors. In general, benefits are seen between the 1st and 3rd session. Sessions are usually spaced 7-10 days apart.
- Pregnancy
- Pacemaker wearer (relative contraindication)
- Psoriasis
- Cardiopathies
- Fibromyalgia
- Infectious arthropathies
- Osteoporosis
- Fracture
- Oncology
- Coagulative pathology
- Lymphoedema
PERCUTANEOUS NEUROMODULATION
NMP ECoguided
What is Dry Needling?
The Percutaneous Neuromodulation (PNM) is an invasive technique, which combines the use of medical needles, such as those used in EPTE and Dry Needling with currents applied with our electrotherapy equipment. EPTE® Bipolar System. This technique seeks to stimulate the peripheral nerves and can perform two very different actions: one would be the reduction/elimination of pain through neuromodulation and the other would be to activate or boost nerve conduction to a muscle or muscle group that is dysfunctional due to a nerve injury through potentiation. Echoguided refers to the fact that the needle will be ultrasound-guided at all times.
Our nervous system can be divided into two according to the location of the nerves: the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). In the CNS, the nerve structures are located in the medulla and the encephalon (brain), while in the PNS they extend from the brain and medulla to the rest of the body. The transport of signals between the PNS and the CNS is made possible by a process that takes place in nerve cells called depolarisation, which consists of electrical changes that occur in the cells' membranes.
The SNP has several functions, two of which are of interest to us:
- Sensory function: transports the stimuli it receives from the organism, both external (from the environment) and internal (within our body), to the CNS for processing. These stimuli include pain.
- Motor function: this function refers to the transport of signals from the CNS for the control of voluntary and involuntary movements of the body through muscle contractions.
We are going to affect one function or another depending on what the problem is. If the problem is that there is pain in a region, we identify the nerve responsible for carrying the pain information from this area to the CNS and we will introduce a needle that will remain very close to the nerve and we will apply a current with certain parameters of intensity, frequency and time, thus interrupting the transport of the pain signal.
If the problem is that there is a specific muscle or muscle group that has problems activating or contracting due to some neuromuscular dysfunction, the needling process will be identical to the previous system, the difference being in the parameters of frequency, time and intensity of the current.
In summary, NMP works by interrupting pain signals to the brain and activating the body's own mechanisms involved in deactivating pain, making it an ideal technique for reducing pain and improving function in patients with acute or chronic problems of the neuromusculoskeletal system.
Any nerve can be treated, some examples are the sciatic nerve, the tibial nerve, the common peroneal nerve, the median nerve, the circumflex nerve, etc....
Sessions are difficult to calculate in this case, because it will depend on the objective and the problem presented, the physiotherapist will indicate the approximate number according to the evaluation.
- Alterations in the immune system
- Patients with previous adverse reactions to needles.
- Treatment with anticoagulants or antiplatelet agents.
- Infectious diseases.
- Epilepsy
- Neoplasms.
- Puncture on areas with lymphoedema, skin diseases (psoriasis, infections...), wounds, erosions or scars.
- Allergy to metals (especially nickel) and latex gloves.
- Avoid puncture during the first 3 months of pregnancy and thereafter in areas that may affect the foetus.
- In patients with acute processes, fever or circulatory problems.
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