Bilateral Calcification of Achilles’ Tendons, and Acetic Acid Iontophoresis Plus Ultrasound Effectivenness

Marcos Edgar Fernandez-Cuadros,1,2,* Olga Susana Perez-Moro,1 Maria Jesus Albaladejo-Florin,1 Luz
Otilia Casique-Bocanegra
,2 and Ruben Algarra-Lopez1
1Rehabilitacion y Medicina Fisica, Hospital Universitario Santa Cristina, Madrid, Spain
2Rehabilitacion y Medicina Fisica, Fundacion Hospital de la Santisima Trinidad, Salamanca, Spain
*Corresponding author: Marcos Edgar Fernandez-Cuadros, Calle del Ansar 44, piso Segundo, CP 28047, Madrid, Spain. Tel: +34-620314558, E-mail:

Introduction: Calcifying tendonitis is the deposition of hydroxyapatite within tendons. It could affect different tendons. In the current case report, bilateral Achilles’ tendons were affected. The etiology is multifactorial. The treatment is conservative and surgical. Iontophoresis is a conservative technique that favors the penetration of 5% acetic acid, based on the attraction and repulsion of charges with the help of continuous electric current.
Case Presentation: A 57-year-old female presented a 12-month experience of bilateral Achilles’ tendon pain. Conservative treatment (nonsteroidal anti-inflammatory drugs (NSAIDs), laser therapy, and physiotherapy) and advanced treatment (shock waves) did not alleviate her pain. Radiography and ultrasound scan showed bilateral insertional formative calcification on both Achilles’ tendons, 9.3mmon left Achilles’ tendon and 6.6mmon right one. After 15 sessions of 5% acetic acid iontophoresis (2 mL, 4.7 mA10 minutes) and continuous ultrasound (1 W/cm2,1 MHz5 minutes) over the calcification area, calcification sizes decreased from 9.3 to 4.3 mm (left
Achille’s tendon) and disappeared on right Achille’s tendon. Pain also decreased from 9/10 to 4/10 on left Achille’s tendon and from 5/10 to nothing on right tendon.
Conclusions: Based on the authors‘ best knowledge, the current study was the first case report that confirmed the effectiveness of 5% acetic acid iontophoresis plus ultrasound to treat bilateral Achilles’ calcifying tendonitis.

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Calcifying Tendonitis of the Ankle, Effectivenness of 5% Acetic Acid Iontophoresis and Ultrasound over Achiles Tendon: A Prospective Case Series

Marcos E Fernández-Cuadros1,2*, Olga S Pérez-Moro2, María Jesús Albaladejo-Florin2, Ruben Algarra-
2 and Luz Casique-Bocanegra1
1Rehabilitation Department, Santísima Trinidad’s General Foundation Hospital, Salamanca, Spain
2Rehabilitation Department, Santa Cristina’s University Hospital, Madrid, Spain
*Corresponding author: Marcos E Fernández-Cuadros, PhD, Rehabilitation Department, Santa Cristina’s University, Santísima Trinidad’s General Foundation Hospital, Salamanca, Spain, Calle Maestro Vives 2, CP 28009, Madrid, Spain

Objective: To conduct a prospective Multicentre Quasiexperimental
before-and-after study (Non-Randomized Control Trial) to demonstrate the effectiveness of Acetic Acid Iontophoresis and Ultrasound in the treatment of Calcifying Tendonitis (CT) of the ankle.
Material and methods: Prospective, multicentre, quasiexperimental
before-after intervention study, to 10 patients who attended to both Rehabilitation Departments, at Santísima Trinidad’s General Foundation Hospital, Salamanca-Spain and at Santa Cristina’s University
Hospital, Madrid-Spain, from June-2014 to December-2018.
Outcome measures: 1) Pain: Measured by Visual Analogical Scale (VAS); 2) Calcification size: In millimetres (mm), both measured radiologically at the beginning/end of treatment.
Intervention: Iontophoresis with 5% acetic acid at 4.7 mA × 10 minutes and continuous Ultrasound 1 W/cm2 /1MHz × 5 minutes over calcification.
Results: Mean age 49.2 ± 7.28-years (n = 10). Female 50% (n = 5). Average number of sessions was 21.7 ± 7.22. Treatment showed a significant amelioration of pain measured by VAS from 7.9 ± 1.66 to 2.8 ± 2.09 points (p = 0.0002). Calcification size diminished significantly from 10 ± 5.3 to 5.3 ± 5.22 mm (p = 0.0186).
Conclusions: CT is more common in middle-aged people. In our study, CT affects similarly both male and female. Iontophoresis with 5% Acetic Acid and Ultrasound is a safe, simple and inexpensive technique. Twenty sessions of 5% acetic acid iontophoresis plus Ultrasound are capable of reducing significantly pain and size of calcification on Achilles’ tendon at the ankle.
This study shows a level of evidence II-1 and grade of recommendation B that allows us to postulate Acetic Acid iontophoresis and ultrasound as an effective treatment in CT.

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Acetic-Acid Iontophoresis and Ultrasound Effectiveness on Calcifying Tendonitis of the Elbow

Marcos E Fernández Cuadros1,2*, María J Albadalejo-Florín1, Rubén Algarra-López1, Luz O Casique Bocanegra2
and Olga S Pérez-Moro1
1Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Spain
2Rehabilitación y Medicina Física, Fundación Hospital de la Santísima Trinidad, Spain
Received: August 09, 2017; Published: August 22, 2017
*Corresponding author: Marcos E Fernández-Cuadros, Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Fundación Hospital de la Santísima Trinidad, Madrid, Spain

Case Report
Calcifying tendonitis (CT) is the deposit of hydroxyapatite within tendons. CT is multifactorial and it could affect the rotator cuff, Achilles, patella, forearm extensors biceps brachi and tibialis posterior tendons. The etiology is unclear, playing degeneration and important role. Three stages with clinical/histological and radiological correlation are described:
A. Pre-calcification: tenocyte metaplasia/chondrocyte transformation;
B. Calcification: a)formative, b)resorptive (spontaneous resorption/phagocytosis);
C. Post-calcification: collagen remodeling/tendon repair. The diagnosis is clinical and radiological. Conservative treatment includes NSAIDs, physiotherapy, electrotherapy (micro-waves, short-waves, TENS, ultrasounds, iontophoresis, interferential and pulsed electromagnetic therapy). Advanced treatment includes shock-waves, eco-guided aspiration and arthroscopy [1-3].
Iontophoresis is a non-invasive technique that increases the penetration of transdermal substances through the skin with the help of electric current, based on physical-chemical properties of attraction and repulsion of charges. Psaki and Carroll introduced acetic acid iontophoresis as an effective treatment for shoulder
CT [4]. However, there are controversial results on CT, and limited case reports on effectiveness in other tendons such as gluteus medium and minimum and Achilles’ tendon [5]. To the best of our knowledge, there is no report on the effectiveness of acetic acid iontophoresis and ultrasound in calcific tendonitis of the elbow.
We present the case of a 48 years old woman, who presented a 2-months history of elbow pain which increased with hand movements. She was a right-handed nurse, with no important medical history, but used to smoke 10 cigarettes/day. NSAIDs did not alleviate pain and the use of an elbow orthosis decreased pain slightly, so she decided to quit. Radiography showed a formative calcification of 12 mm length in its longer axis, at the insertion of the forearm extensor tendon at the elbow (Figures 1 & 2).
After 30 sessions of 5% acetic acid iontophoresis (2cc, 4.7mA x 10 minutes) and continuous Ultrasound (1W/cm2/1MHz x 5 minutes) over the calcification, pain decreased from 10/10 to 4/10 on Visual Analogical Scale (VAS), and calcification disappeared after treatment (from 12 mm to 0mm), evaluated by a 100%-size posterior/ anterior radiography of the elbow.

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Calcific Tendinopathy of the Rotator Cuff Treated With Acetic Acid Iontophoresis

MARYCRIS MEDINA-GANDIONCO, PT, DPT, Physical Therapy Service, Brigadier General Crawford F. Sams US Army
Health Clinic/Medical Department Activity-Japan, Camp Zama, Japan.
ROBERT A. BRIGGS, PT, DPT, PhD, OCS, Army-Baylor University/US Army Medical Center of Excellence, Fort Sam Houston, TX.

A 62-year-old right hand–dominant man with a 20-year history
of left shoulder pain and 6-month insidious, progressively worsening symptoms was referred to physical therapy with clinical and radiographic evidence of left supraspinatus tendon calcification. The patient enjoyed tennis, push-ups, and resistance training but had discontinued these activities because of his increasing shoulder symptom severity.

At evaluation, the patient reported pain ranging from 7/10 to 9/10 on the visual analog scale, and scored 54% on the Shoulder Pain and Disability Index (SPADI). Left shoulder active range of motion was limited to 60° of flexion and abduction, with empty end feel due to muscle guarding. Passively, the patient tolerated 90° of shoulder flexion with increasing pain.
Due to severity and irritability of pain, the patient was prescribed rest, isometrics, and pain-free range of motion. He was treated with iontophoresis, utilizing 3% acetic acid, for 3 visits per week for 5 weeks. Radiographs, repeated 1 week post treatment and 9 weeks since his initial
radiographs, demonstrated marked resorption of the calcific deposit. At that point, the patient demonstrated 160° of active left shoulder flexion, 2/10 pain, and a SPADI score of 28% disability. A progressive resistive exercise
program was initiated.

At 16 weeks post evaluation, the patient demonstrated full active range of
motion of the left shoulder, 4+/5 shoulder girdle strength, a SPADI score of 5% disability, and reported a pain-free return to prior activities.

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Cochrane Researchers ‘Confident’ in Pelvic Floor Muscle Therapy as Effective UI Treatment

Pelvic floor muscle therapy (PFMT) “could be included in first‐line conservative management programs” for women with urinary incontinence (UI), according to the authors of a recently updated Cochrane systematic review. While the conclusion itself isn’t new, the revision includes more evidence that makes the case for PFMT even stronger.

Authors analyzed data from 31 trials including a total of 1,817 women. The studies examined whether women were “cured” or “cured or improved” as a result of treatment for stress urinary incontinence (SUI), urgency urinary incontinence (UUI), or mixed urinary incontinence (MUI). Researchers also looked at the effects of PFMT on quality of life.

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Researchers link osteopenia to fecal incontinence

T-Score is a representation of how a patient’s bone mass density compares to an average 30 year old male. Patients are considered to have osteoporosis when their T-Score drops below -2.5 (25% less dense than average)

According to a 2013 study in the International Urogynecology Journal, women with osteopenia are at an increased risk of fecal incontinence. Researchers conducted a survey of 1,655 postmenopausal women who had undergone an osteoporosis evaluation. Of the respondents, 362 were diagnosed to have osteoporosis (T-score less than -2.5), 870 had osteopenia (T-score between -1 and -2.5), and a control of 423 women had a normal bone mass density.

The authors’ goal was to see which common pelvic floor conditions are associated with a loss in bone mass density. The survey found that “[o]verall prevalence of any urinary incontinence (UI) was 1,226/1,640 (75 %), with UI ≥2–3 times/week in 699/1,197 (58 %), fecal incontinence over the past month in 247/1,549 (16 %), and prolapse in 162/1,582 (10 %).”

A multivariate analysis showed that the women with osteopenia had increased risk of fecal incontinence compared to the other two groups. Women with osteoporosis were found to be at higher risk of urinary incontinence.

Bone density issues can complicate every part of a patient’s life, and pelvic health practitioners will benefit by understanding conditions like osteoporosis. The Meeks Method for Osteoporosiscourse offers clinicians a new set of tools to evaluate and treat osteoporotic patients. Join instructor Deb Gulbrandson, PT, DPT this September 22-23, 2018 in Detriot, or instructor Frank J Ciuba DPT, MS in Fairfield, CT on October 12-13, 2018 to expand your osteoporosis treatment skill set.

Exercise Can Be a Boon to People With Parkinson’s Disease

Breast Reconstruction

By: Frank J. DellaCroce, MD, Emily T. Wolfe, MD

An estimated 300,000 women are affected by breast cancer every year in the United States, and another 2.6 million are living posttreatment. As diagnostic technology has progressed and the understanding of the disease process has evolved, the number of mastectomies performed in the United States has increased. Breast reconstructive techniques have commensurately become more sophisticated along the same time- line. The result is that those facing mastectomy have the potential to simultaneously retain physical beauty and wholeness. Despite these advances, only 33% of women who are otherwise candidates for immediate reconstruction at the time of mastectomy choose reconstruction. The 2 reasons most attributed to this remarkable statistic are failure of the treatment team to refer the patient to a plastic surgeon at the time of diagnosis/decision for mastectomy and the resultant lack of understanding on the patient’s part regarding her reconstructive options.

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New Role Found For The Immune System

It’s a stunning discovery that overturns decades of textbook teaching: researchers at the School of Medicine have determined that the brain is directly connected to the immune system by vessels previously thought not to exist. “I really did not believe there were structures in the body that we were not aware of. I thought the body was mapped,” said Jonathan Kipnis, a professor in the Department of Neuroscience and director of the University’s Center for Brain Immunology and Glia. How these vessels could have escaped detection when the lymphatic system has been so thoroughly mapped throughout the body is surprising on its own.

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A Brief History of AlterG’s NASA Technology – The Early Years

NASABy BRIAN GILLIS | Published: APRIL 22, 2015

First there was space…

This is how to run in space.

This is how you run in space.

In the 1960s, NASA started sending astronauts into space. At first, people spent only a short period of time outside the earth’s gravitational pull.

However, after the International Space Station was introduced, astronauts started extending their stay. The zero gravity environment began causing weight loss, muscle atrophy, and decreased bone density.   NASA was learning that exercising is hard when you can’t keep your feet on the ground!

To solve this problem, Dr. Robert Whalen, a NASA engineer, was tasked with developing a way for astronauts to exercise in space. He came up with a few options for NASA to consider, including a concept with a pressurized bubble that held astronauts down on a treadmill using air-pressure.

Just flip the pump!

All great ideas start in a garage!

While NASA decided to pursue one of Robert’s other ideas, his son Sean took a liking to his father’s concept of an air-pressure controlled treadmill. However, instead of adding gravity to run in space, he wanted to defy gravity to run on earth. By simply flipping the air pump, Sean created the concept for the Anti-Gravity Treadmill. While his father’s treadmill pulled the user onto the treadmill with a pressure-vacuum, Sean’s idea used air pressure to gently life the user off of the treadmill!

Sean and his father decided to make this idea a reality and went to work in their family’s garage in Palo Alto to develop the technology for what would become the AlterG Anti-Gravity Treadmill. After many months of trial and error, Sean created the first working prototype in 2005.

Time to bring in the professionals

Alberto Salazar was the first to adopt AlterG technology with his Olympic athletes

Before the first prototype was even finished, Alberto Salazar (an Olympic runner and coach of the best runners in the world) heard about the technology and wanted to help develop it for his athletes to use. He saw the ability to unweight a runner and reduce the impact of training as an invaluable tool for any competitive long distance runner.

Alberto Salazar began using the prototype with his athletes, including 10,000m Olympic silver medalist Galen Rupp (see picture). After Salazar and his athletes got on board, local Bay Area teams like the Oakland Raiders and Golden State Warriors started using the prototype in their training rooms.

AlterG becomes AlterG

In 2007, AlterG sold its first commercial unit to the Washington Wizards. Soon after, other NBA, NFL, and universities started defying gravity, too.

While today’s Anti-Gravity Treadmills look different than the prototype, the concept behind the magic remains the same. By creating a pressurized lifting force around the lower half of the body, the “differential air pressure” can be controlled to produce a variable lifting force for someone to walk, run, and exercise with reduced and adjustable impact.