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Physical Rehabilitation Consultation

Physical Rehabilitation Medicine or Rehabilitation Medicine is a medical specialty focused on diagnosing, treating and managing physical impairments or disabilities caused by injury, disease or disorders. Its primary goals are to enhance functional ability and reduce or alleviate chronic or movement-related pain.

A consultation with a Rehabilitation Consultant (Rehabilitation Specialist) involves a detailed assessment of a patient’s condition, particularly addressing the musculoskeletal injuries, movement related or chronic pain conditions.

Initial consultation will include review of previous diagnostic and imaging tests.

Further diagnostic evaluations, including imaging and laboratory tests, may be necessary to confirm a diagnosis and develop an appropriate treatment plan.

Medical Acupuncture

What is Western Medical Acupuncture?

Medical Acupuncture is a therapeutic treatment that adapts traditional Chinese acupuncture using modern scientific knowledge of anatomy, physiology, neurobiology and evidence-based medicine principles.

Differences from Chinese Acupuncture

Traditional Chinese medicine explains acupuncture as a technique for balancing the flow of energy or life force — known as chi or qi — believed to flow through pathways (meridians) in your body. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance. 

Medical acupuncture, also known as Western medical acupuncture, does not adhere to traditional Chinese concepts such as yin/yang and qi circulation, but focuses on the physiological and neurological processes. Through the lens of neurophysiology, acupuncture points can be stimulated to trigger the release of various hormones and chemicals, including neurotransmitters.

 Neurotransmitters act as chemical messengers responsible for signally between the nerve cells to help regulate bodily functions. Neurotransmitters include Endorphins, the body’s natural pain killers; Serotonin and Dopamine, which have roles in regulating mood sleep and appetite; Norepinephrine which plays a role in the body’s stress response; Gamma-Aminobutyric Acid (GABA) which helps promote relaxation; Acetylcholine which plays a vital role in memory, learning and muscle contraction; Glutamate – brain function; Oxytocin –a neurotransmitter involved in stress reduction. 

Acupuncture has been found to influence the activity of the Autonomic Nervous System, particularly the parasympathetic nervous system which promotes recovery.

Additionally, acupuncture has been found to have to influence the release of hormones in the endocrine system.

Integration of Best Evidence

Dr Peter T. Dorsher, a renowned physical medicine and rehabilitation specialist at the prestigious Mayo Clinic, with over 38 years medical experience specialising in musculoskeletal medicine and pain management, has published extensively on the mechanisms and scientific basis of acupuncture. He summaries:
“Ever since acupuncture’s tenets were first delineated in the Huangdi Neijing treatise ~200 BCE, theorists and researchers have sought to define the anatomic and physiologic bases for acupuncture’s beneficial clinical effects in treating pain and non-pain medical conditions. In the last century, technical advances in both the basic biomedical sciences (including anatomy, biochemistry, pharmacology, electrophysiology, and radiology) and clinical research methodologies have led to publication of an extensive body of basic science and clinical research publications on the topics of acupuncture anatomy, physiology, and clinical effects. This body of literature demonstrates that the beneficial clinical effects of acupuncture derive from the activation of peripheral nerves by needling, with resulting secondary modulatory effects on the peripheral nervous system, the central nervous system (CNS) (including the limbic system), the autonomic nervous system, and the immunologic and endocrinologic systems.”

In conclusion:
“The acupuncture literature provides overwhelming anatomic and physiologic evidence that all of acupuncture’s beneficial analgesic and non-analgesic effects can be explained through neuroanatomic and neurophysiologic mechanisms—that is, acupuncture stimulation of specific peripheral nerve locations (acupoints) produces its clinical effects. A neural based model of acupuncture is the only model that is consistent with acupuncture basic science and clinical literature.”

The Importance of Clinical Expertise

Dr Kevin Lowe’s medical expertise, his over 48 years of clinical experience and his extensive knowledge of neuroanatomy, contribute to ensuring an accurate diagnosis and effective treatment.

Reference:

“Acupuncture’s neuroanatomic and neurophysiologic basis”

Peter T. Dorsher, Marco Antonio Helio da Silva

Department of Physical Medicine and Rehabilitation, Mayo Clinic in Florida, Emeritus, USA; Department of Health and Society, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil

Photobiomodulation

(Low-level light therapy)

Photobiomodulation (PBM)  previously known as Low Level Laser Therapy (LLLT) has been evolving since the 1960s. Is a therapeutic technique which primarily utilises red and near infrared light to stimulate healing and reduce pain in the body. This noninvasive treatment applies light in the wavelength range of 600-1100nm to injuries, lesions or other areas of concern. 

More recently other frequencies have been shown to have antibacterial and antiviral effects.

When used by highly trained medical professionals PBM is a safe and drug free method for pain relief and healing in both acute and chronic conditions. Its ability to reduce inflammation, promote tissue healing and alleviate pain makes it a versatile option in rehabilitation medicine, orthopedics, dermatology and neurology. The sophisticated Class IV lasers approved by the TGA for medical use, reflect decades of research and innovation.

Mechanism of Action

PBM works at the cellular level, primarily targeting the mitochondria:
Cytochrome C Stimulation: the light is absorbed by cytochrome c oxidase in the mitochondrial membrane.
ATP Production Increase: this stimulation enhances the electron transport chain, leading to increase production of adenosine triphosphate ATP
Cellular Metabolism Boost: the increased ATP production helps restore normal cellular function and metabolism

Therapeutic effects of PBM

PBM offers a range of therapeutic effects:

  • Inflammation Reduction: reduces inflammatory responses
  • Pain relief: provides short term and long-term pain relief
  • Improved circulation: Triggers increased blood flow to treated areas
  • Accelerated healing: enhances tissue repair

Musculoskeletal Conditions treated

  • Osteoarthritis
  • Non-specific knee pain
  • Lower back pain
  • Neck pain
  • Fibromyalgia

Pain Management

  • Chronic pain conditions
  • Nerve pain and neuralgia
  • Sciatica
  • Temporomandibular disorders

Wound healing and Tissue Repair

Post surgical recovery

Sports Injuries

References:

Low-intensity LASER and LED (Photo biomodulation therapy) for pain control of the most common musculoskeletal condition Eur J Phys Rehabil Med. 2021 Dec 16;58(2):282-289


Marcelo F DE OLIVEIRA, Douglas S JOHNSON, Tomothy DEMCHAK, Shaane S TOMAZONI, Ernesto C LEAL-JUNIOR
The Hamblin article

Platelet Rich Plasma Therapy

What is Platelet-Rich Plasma (PRP)?

Platelet-rich plasma (PRP) therapy has widespread use in the fields of Orthopaedics, Rehabilitation, and Sports Medicine as a non-surgical approach to treating acute and chronic musculoskeletal injuries. This innovative treatment is used in both elite athletes and the general population due to its potential to accelerate healing and provide relief from various conditions.

Platelet-rich plasma (PRP) therapy is an autologous treatment that uses a patient’s own blood to promote healing. The process begins with a small blood sample, which is spun in a centrifuge to separate and concentrate the platelets within the plasma. This concentrated plasma, rich in platelets and bioactive substances, is then reintroduced into the patient, typically at the site of injury or damage, to accelerate healing and tissue repair.

How PRP Works

Blood is composed of Red Blood Cells, White Blood Cells, Platelets and Plasma.

Platelet-rich plasma (PRP) is composed of two main elements: plasma and platelets. Plasma is the liquid component of blood, primarily consisting of water and proteins. Platelets are specialised blood cells crucial for clotting and healing processes.

While platelets are known for their clotting function, they also contain numerous growth factors and proteins that play a vital role in tissue growth and healing.

These growth factors include platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1).

When concentrated in PRP, these growth factors can:

  1. Stimulate cell reproduction
  2. Enhance tissue growth
  3. Accelerate healing processes
  4. Promote angiogenesis (formation of blood vessels)

Preparation

To create platelet-rich plasma, the doctor takes a sample of blood from the patient and places it into a TGA and FDA approved medical device. 

Most proprietary machines are simple centrifuges that separate cells based on density creating a “buffy coat” at the surface. Lower volumes of blood are usually taken. This has relatively low concentrations of platelet concentrations in the plasma. 

This clinic uses high concentration PRP using The Angel® Concentrated Platelet Rich Plasma (cPRP) System. 

The Angel system uses a proprietary platelet sensor and 1-button automation to prepare customized platelet-rich plasma (PRP) formulations. The Angel system is the only PRP device that can deliver platelet concentrations up to 18x baseline, with adjustable leukocyte concentrations.

The Angel system incorporates 3 sensors to accurately separate blood components using cell- specific wavelengths of light to increase cellular yields. Absorption of 470 nm light detects platelets and leukocytes, 940 nm detects erythrocytes, and the 1300 nm wavelength corrects for ambient light and the presence of air bubbles.

The Processing Set is sterile and designed for single-patient use.

Higher volumes up to 180ml of blood are processed.

The highly concentrated blood cells (i.e. Platelet Rich Plasma), are then injected into the tendon or joint using ultrasound guidance. The concentration of specific bioproteins or “growth factors” in the treated area, accelerates the healing process. This ensures maximal delivery of growth factors and cytokines to the injured area, as well as improved retention and distribution in the tissue.

The injection is performed under aseptic techniques to minimise infection risks. The procedure equipment and injection site are all prepared to maintain sterility. Skin is sterilised with Povidine Iodine followed by 2% Chlorhexidine in Alcohol SurgiPrep. Sterile gloves, Sterile Ultrasound Probe Covers, sterile ultrasound gel, sterile drapes and dressings are used.

. Ultrasound guidance is used to ensure accurate placement of the PRP into the appropriate location for optimal healing

.To further enhance the effectiveness of the treatment, patients are advised to follow certain guidelines, such as stopping agents which diminish platelet function such as anti-inflammatory medications and fish oil up to two weeks before and after the procedure, and patients informing the clinic of any blood-thinning medications or current infections.

. These precautions help to maximise the benefits of the PRP therapy and ensure patient safety.

Prolotherapy

Prolotherapy has been used in clinical practice for more than 80 years to treat various chronic musculoskeletal conditions. The American Academy of Orthopaedic Medicine teaches and certifies practitioners to perform Platelet Rich Plasma and prolotherapy procedures. Dr Lowe is Board Certified with the AAOM.

Prolotherapy is a practical and efficacious therapeutic strategy to treat ligamentous laxity and related musculoskeletal and arthritic conditions. It is minimally invasive and involves the injection of an irritant such as a sterile dextrose solution, into the damaged or painful area.

The sterile dextrose solution (which mimics the naturally occurring sugar solution in our bodies) is thought to strengthen the ligaments over time, helps to stabilise the joint and reduce pain.

Prolotherapy is mainly used to treat injured joints and ligaments. While it is often used for treating the back, doctors may also use prolotherapy in the following areas of the body:

  • knees
  • hips
  • shoulders
  • other joints and ligaments
bottle of glucose 50% for Prolotherapy

Schedule Your Appointment with Dr. Lowe Today

A referral from your GP or another Specialist Doctor is required for your initial consultation

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