RSL sculpting in rehabilitation of patients with musculoskeletal injuries

Introduction

Traumatism is a serious medical and socio-economic problem as it increases the disability rate, causes health and social consequences such as incapacity and mortality, and has an impact on demographic factors. In this context, effective and safe trauma therapy and fast rehabilitation methods are increasingly important [1, 2]. Among these methods, physical factors are of crucial importance since they affect different components of etiopathogenesis in the development of trauma and its complications. Multiple studies showed that early use of physical factors in patients with injuries of various origins helped optimize adaptation and compensation processes. Musculoskeletal injuries are based mostly on microcirculation and tissue metabolism dysfunctions, hypoxemia, tissue hypoxia, hypodynamia, etc. [3].

Thus, the main tasks in case of injuries include[4]:

• Eliminate swelling and improve blood circulation
• Make analgesic action
• Relieve muscle tension
• Speed up the wound healing and formation of callus
• Take preventive action on the development of myatrophy and contracture of joint
• Speed up the recovery of the limb function

Currently, many specialists adhere to the approach of combined therapy and disease prevention. This approach corresponds to the integrated use of physical treatment methods. Numerous studies have shown that the rational combination of two or more physical treatment methods has greater physiological and therapeutic effectiveness compared to the mono-factor effect. The most important principle of the integrated use of physical factors, which substantiate the possibility and feasibility of combining therapeutic physical factors, is the principle of synergism [5-8].

The Beautylizer Therapy Cosmospheres device complied with the approach of the integrated use of several physical factors and the principle of synergism. The procedure performed on this device is called RSL sculpting. It combines the effects of vibrocompression with rotating silicone spheres and high-brightness red light (LED). Through a combination of the above-mentioned physical factors, different effects occur in tissues:

• Vasodilating effect due to compression and subsequent restoration of tissue volume
• Draining effect due to rhythmic pulsation
• Relaxing effect - device has a stretching effect on muscles
• Analgesic effect - exposure of the skin mechanoreceptors
• Improving the mechanical properties of the skin and tissue healing - LED therapy.

The multifaceted effect of the procedure is based on complex reflex, neurohumoral, and metabolic processes regulated by the central nervous system. The flow of nerve impulses, which enter the central nervous system along sensitive nerve fibers, occurs as a result of mechanical irritation of numerous and varied receptors of the skin, muscles, tendons, ligaments, and vessel walls.

Consequently general complex response of the body developed in the form of functional shifts in various organs and systems. The nature of the body's response will depend on the functional status of the higher parts of the central nervous system and the functional status of the receptive field that is exposed to [9].

Mechanical irritation of tissues triggers a humoral response in the form of the release of histamine, heparin, acetylcholine, and other bioactive substances, causing certain effects, from cells. In particular, histamine dilates capillaries, improves local and systemic blood flow, and promotes temperature increases. Heparin thins the blood and improves blood supply to all body parts, regardless of exposure spot. Acetylcholine performs a mediator function and increases the rate of nervous impulse transmission from nerve cells to skeletal muscle cells, which has a positive effect on muscle activity.

In addition, the mechanical effect of the procedure on the human body helps increase blood flow and lymphokinesis, decongest, increase the temperature of the massaged body area, and boost metabolic processes. Under the influence of RSL sculpting, the excretory function of the sebaceous and sweat glands involved in the process of heat transfer is stimulated; the expansion of functioning capillaries and the opening of reserve capillaries occurs, the work of the heart is facilitated, myocardial contractility increases, the outflow of venous blood and lymph increases, congestion in both circles of blood circulation decreases, the absorption of oxygen by tissues improves; the flow of oxygen and nutrients to the tissues of the massaged area increases and at the same time the removal of metabolic products from them, including lactic acid, is accelerated; muscle elasticity, their contractility, strength and performance increase, muscle fatigue decreases, and the speed of muscle recovery increases; muscular atrophy decelerates [9-12].

The analgetic effect of the procedure is based on vibration. Adaptation of the peripheral receptor to mechanical vibrations is significant in the analgesic effect mechanism. An increase in the stream of impulses leads to the development of protective inhibition in cortical cells and suppression of the dominant pain in the central nervous system. [13-15].

The efficacy of RSL sculpting procedure has been clinically proved. For example, the work of S.L. Zhaboeva has shown that after the 6th procedure of RSL sculpting changes in the form of a significant blood flow acceleration, mainly in the surface vessels, were recorded in all patients according to the veins and arteries of the lower limbs color duplex ultrasound[16]. An increase in venous tone was also reported thus improving microcirculatory perfusion. Several other studies have shown that the procedure leads to a decrease in extracellular fluid volume [17, 18].

LED therapy improves the mechanical properties of the skin by optimizing tissue healing processes and recovering cellular metabolism through stimulation of TGF-β production by fibroblasts, that has been demonstrated in numerous foreign studies [19-22].

Potential uses of RSL sculpting procedure in musculoskeletal injuries

Musculoskeletal injuries are always accompanied by severe edema and lymphostasis, which lead to compression of small vessels. That in turn leads to microcirculatory dysfunction, deterioration of metabolic processes in tissues, and increased tissue hypoxia [3,26]. Due to the above-mentioned mechanisms, RSL sculpting helps to increase lymphokinesis and blood flow, decongest, and accelerate angiogenesis. It should be noted that the procedure has not only mechanical but also reflex action. For instance, lymphokinesis and blood flow in certain body parts are increasing, although to a lesser extent, during exposure to another. Therefore, when it is impossible to perform the procedure on an injured area, it is necessary to use segmental reflex action by performing the procedure on uninjured body parts [23].

Contusions are not accompanied by violations of integrity of the skin, but with severe contusion there may be ruptures of muscles, small blood vessels, and nerves rupture. Usually there are pain, hemorrhage, increased temperature, and swelling in the contusion area [3, 26]. RSL sculpting procedure helps relieve the pain in the injured area, improve metabolism, and reduce swelling, resulting in more intense muscle contraction, which helps eliminate muscle atrophy, resorption of infiltrates, and hemorrhages. The course of procedures can be started on the 2nd or 3rd day after the contusion if there are no thromboses or ruptures of large vessels and muscles.

When muscles are damaged, it is recommended to start the procedures on the uninjured area, located above the injury site. In this case the procedures can be started within 7-8 hours after the contusion. After 4-6 sessions of such exposure, you can start to perform the procedures within the injured area with a gradual increase in the intensity of the procedures and individual adjustment of parameters depending on the patient’s sensations. It should be noted that to achieve more profound results, the procedure should be performed not only on the injured limb but also on the other, symmetrically located limb. For optimal results, 12 to 16 procedures with 2–3 day interval are normally required [24, 26].

Sprains, as well as contusions, are one of the most common types of injuries that are accompanied by displacement and disruption of the integrity of the joints. The insertion site of sprains, tissues surrounding the joint, synovial sheath of joints, tendons, muscles, vessels, and nerves can be damaged as a result of injury [3]. In case of sprains, the patient suffers from acute pain when moving together with swelling and inflammation of the joint, formed at the injury area.

RSL sculpting procedure helps relieve the pain, increase blood flow and lymphokinesis at the injury site, and restore joint functionality. RSL sculpting for sprains can be started 24 hours after the injury. The procedure should be performed in such a way as to avoid causing any pain that can lead to deterioration in the patient’s condition. Prior to exposure to the injury area, RSL sculpting should be performed on the above-located sites, and then the injury site needs to be warmed up before the procedure.

As well as with contusions, in the case of sprains, it is recommended to perform several procedures on the uninjured area and then expose it to the injury site with gradually increasing time and intensity [24-26].

Bone fractures are normally accompanied with pain, swelling, and the inability to move normally. In case of open fracture violations of the integrity of the skin, damage of nerve, vessels, and soft tissues (tissue and muscles) are observed. Over time, a bone callus usually appears at the fracture site, which ensures bone fusion [27].

RSL sculpting procedure can be applied only to closed fractures. The procedure is contraindicated for open fractures since they may be complicated by a local or generalized infection. In closed fractures, the procedure should be started 2-3 days later. RSL sculpting at the early stage of fracture healing helps relieve pain, promotes the resorption of haemorrhages in the fracture area, improves tissue trophic at the fracture site, reduces the time for callus formation and restoration of injured limb function, and prevents muscle atrophy.

The procedure can be started when the injured limb is in a plaster cast or when any type of draw is applied, but only in adjacent areas and in the area of an uninjured symmetrical limb[27-32]. In case of fractured limbs, it is recommended to perform RSL sculpting on the abdomen and chest and massage areas located below and above the fracture site. After removing the cast, the procedure can be performed over the entire surface of the limb [32].