1 4 . H O W T O U S E T H E W I R E L E S S P R O F E S S I O N A L O N S P E C I F I C
I N D I C AT I O N S
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WIRELESS PROFESSIONAL
Depending on the stage of development, other signs may appear:
- The skin becomes cold with sweating, oedema and cyanosis developing in the more advanced stages.
- The muscles in the affected area become atrophied.
- The underlying bone develops osteoporosis (Sudeck’s atrophy).
The precise mechanism of development of RSD is not yet exactly known. However, it is well established
that the sympathetic nervous system plays a major role.
Indeed, vasomotor disorders associated with hyperactivity of the orthosympathetic system innervating the
region concerned have been observed.
treatment
There are two aspects to the treatment of RSD: the relief of pain and the reduction in the activity of the
orthosympathetic system.
However, mobilisations, massages and all techniques likely to cause or accentuate the pain must be ruled
out, as they could potentially aggravate the RSD.
Few therapeutic methods meet these criteria, which makes transcutaneous electrical nerve stimulation
(TENS) the first treatment of choice available to physiotherapists for treating RSD.
However, it is essential here to limit the stimulation to the myelinated nerve fibres of the tactile sensory
system only, the type Aß fibres, as these are the only fibres which have an inhibiting affect on the
orthosympathetic system. This is not the case for the other nerve fibres (Aδ, B, C), as these activate this
orthosympathetic nervous system.
This selective targeting of the Aβ fibres, which are the most excitable nerve fibres (tactile sensory system),
is possible if very short pulse widths (≤ 50 µs) are used, i.e. the TENS programme.
14.9.1 Protocol
teNS 1:
for very sensitive or hyperalgesic patients
teNS 2:
for all other patients
14.9.2 treatment frequency
A minimum of 20 to 40 minutes of treatment every day.