Phototherapy indications and contraindications. “physical foundations of light therapy” cycle of improvement “physiotherapy

Phototherapy in physiotherapy is a procedure of dosed effects on the body various types light radiation. Moreover, each of the types used causes only its own inherent changes and processes in the body, which determines the indications and contraindications for the procedures. The longer the wavelength, the deeper the light will penetrate into the tissue.

Infrared irradiation

When exposed to this type of radiation on the body, three things happen at once: positive effects- anti-inflammatory, lymphatic drainage and vasodilator. The peculiarity of the procedure is that under the influence of these rays a short-term spasm of blood vessels occurs, which lasts no more than 30 seconds, after which there is an increase in blood flow to the irradiated part of the body. The generated heat accelerates metabolism in tissues. Increased vascular permeability helps cope with soft tissue swelling. This causes fast healing wounds and trophic ulcers. Positive Impact It turns out that it affects all internal organs.

The main indications for the use of this treatment method are considered to be:

Almost everything chronic diseases, inflammatory processes internal organs without the formation of pus.
Burns.
Frostbite.
Poorly healing wounds.
Pathologies of the peripheral nervous system with pain.

Like any method of light therapy, infrared irradiation has its contraindications, so before starting therapy, you must consult your doctor. Contraindications that do not allow this type of therapy include:

Any tumors.
Acute inflammatory pathologies.
Chronic diseases in the acute stage.
Bleeding.
Active tuberculosis.

To obtain this type of light rays I use special lamps. Any thermal effect on the body causes molecules to move faster, which leads to accelerated cell reproduction, enzymatic processes and regeneration. Most often, this type of radiation is used in combination with massage and gymnastics.

Ultraviolet irradiation

Ultraviolet irradiation penetrates the skin to a depth of only 1 mm, while causing the most high energy. The skin on the torso is most sensitive to these rays, the skin on the extremities is the least sensitive.

The use of this method with the correct dosage and good control gives high therapeutic effect. In this case, rapid healing of wounds and regeneration of nerve and bone tissue occurs.

The main indications for the use of this method of light therapy are:

Acute joint pathologies.
Chronic joint diseases.
Respiratory diseases.
Problems with female genital organs.
Diseases of the peripheral nervous system.
Hardening.

This method of light treatment has not only indications, but also contraindications. These include:

Tumors.
Exacerbation of any pathologies.
Bleeding.
High blood pressure.
Active tuberculosis.

It should be remembered that such treatment must be strictly dosed and carried out only under the supervision of a doctor. An overdose can lead not only to premature aging skin and a decrease in its elasticity, but also the development of skin and various oncological pathologies.

Quantum therapy

This type of light therapy involves the use of devices for laser therapy. These devices emit monochrome coherent non-scattering beams of radiation. In surgery, such rays are used in the form of a light scalpel, and in ophthalmology - to treat retinal detachment.

Such radiation can be used in the treatment of degenerative diseases of the spine, rheumatoid arthritis, long-term non-healing wounds, ulcers, polyneuritis, arthritis, stomatitis and bronchial asthma.

Chromotherapy

This treatment involves the application of a different spectrum of visible examination. So, for example, white light used for treatment seasonal depression, which occurs in the autumn-winter period, when daylight hours shorten.

In the treatment of jaundice in newborns, it is best to use blue and blue radiation, which leads to the destruction of hematoporphyrin, which makes up bilirubin. And red color is successfully used in the treatment of acne.

Any type of light therapy must be strictly dosed and used only as prescribed by a doctor. If such treatment is used without control, it can cause significant harm to the body. Therefore, you should definitely visit a doctor and find out all the available contraindications for each type of light therapy.

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Phototherapy, or phototherapy (Greek phos, photos - light + therapeia - treatment), is the use of infrared, visible and UV rays from artificial sources for therapeutic or preventive purposes.
Like many others physical methods treatment, phototherapy was born in ancient times electromagnetic vibrations used in phototherapy based on human communication with factors environment, in particular the sun's rays. It originated as sun treatment, or heliotherapy. Written instructions about the therapeutic effect sunlight can be found in the “father of history” Herodotus (484-425 BC). However, reading the inscriptions on the walls of the ancient temples of Egypt and Rome suggests that healing effect sunlight was known much earlier. For example, the inscription on the Temple of Diana in Ephesus reads: “The sun gives life with its radiant light.” The first doctor to recommend the use sunbathing for medicinal purposes, was Hippocrates (460-377 BC). IN Ancient Greece And Ancient Rome on the roofs of houses they set up special platforms - solariums, on which health and medicinal purposes sunbathing.
In the Middle Ages, doctors stopped using light as healing factor. A pleasant exception was the famous Avicenna, who during this period was an ardent supporter and promoter of sun treatment.
And only at the end of the 18th century. The revival of light therapy began. In 1774, the French doctor Faure suggested using sun rays for treatment open sores legs, after which a number of works appeared on phototherapy. First scientific work(dissertation), concerning the study of the effects of light on the human body, was published by Bertrand more than 200 years ago. In 1801, I. Ritter and W. Wollaston discovered UV rays. A year earlier, Herschel discovered infrared rays. In 1815, Lebel designed a special apparatus that made it possible to concentrate the sun's rays for the treatment of patients. Since then, the idea of using concentrated light has been one of the most important areas in light therapy.
In 1816, professor of chemistry I. Debereiner in Vienna published a work in which light therapy was first considered from a scientific point of view and indicated the value of the wavelength of light. This is how chromotherapy (visible light treatment) was born, which today is being revived in the form of biotron color therapy. new basis. In 1855, the Swiss A. Rikli founded the first sanatorium for solar treatment in Oberkrain, and Walde (Australia) founded the first institute for heliotherapy. After Herschel's discovery chemical action UV rays, and Doyun and Blount - their bactericidal effect, UV rays began to quickly spread in medical practice. In the widespread introduction of phototherapy in medical practice Swiss doctors A. Roll and F. Bernhard played a major role. The use of incandescent light bulbs in therapy also dates back to this period (Stein, 1890; Gachkovsky, 1892).
The golden page in the development of phototherapy was written by the Danish physiotherapist Niels Finsen, who is rightfully considered the founder of modern phototherapy. In 1896, he founded the Institute of Light Therapy in Copenhagen, where he developed scientific foundations phototherapy, primarily treatment with natural and artificially produced UV rays. He was the first to develop an apparatus for producing artificial UV rays, and proposed a number of techniques for enhancing them. therapeutic effect. In 1903 Finsen was awarded Nobel Prize in the field of medicine and physiology for work on studying the effect of UV rays on the human body. Along with the desire to put into service natural forces man has always tried to become independent from nature and help himself (especially in the fight against illnesses) with technical devices that replace natural light. Among these ascetics, in addition to the already mentioned Lebel and Finsen, one should name a galaxy of doctors and engineers who contribute to the achievement modern level phototherapy. Here are just a few of these names: American doctor Kellogg - inventor of the first electric light bath; Russian doctor A.I. Minin is the author of the reflector with a blue light bulb, familiar to every family today; Kromayer (1906), Nagelschmidt (1908), Bach (1911) and Iezionek (1916) were the developers of quartz lamps, who opened the way for artificial UV rays into medical practice.
By the end of the 1920s, medicine, along with heliotherapy, began to use all ranges of light - infrared, visible and UV rays. From that time on, light therapy began to develop extremely rapidly. Research has been carried out both in the field of studying the mechanisms therapeutic action various parts optical spectrum, and in the field of methodology for treating various diseases. During this period, the development of phototherapy greatest influence provided by domestic researchers (A.N. Maklakov, S.B. Vermel, P.G. Mezernitsky, S.A. Brushtein, I.F. Gorbachev, etc.).
Phototherapy is based on the interaction of light with biological structures(primarily molecules) tissues, accompanied by photobiological reactions. The nature and severity of the latter depend on the physical parameters of the active light, its penetrating ability, as well as the optical and other properties of the tissues themselves. Crucial in this case, it has a wavelength of optical radiation, on which the energy of the quanta depends.
In the infrared region, photon energy (1.6-2.4 10-19 J) is only sufficient to increase the energy of vibrational processes of biological molecules. Visible radiation, which has photons with higher energy (3.2-6.4 10-19 J), can cause their electronic excitation and photodissociation. UV radiation quanta with an energy of 6.4-9.6 10-19 J are capable of causing various photochemical reactions due to the ionization of molecules and the destruction of covalent bonds. Typical photochemical reactions are: photoionization, the knocking out of an electron by a radiation quantum outside the molecules; Photoionization produces ions or free radicals; photoreduction and photooxidation - transfer of an electron from one molecule to another; one molecule is oxidized and the other is reduced; photoisomerization - a change in the spatial configuration of a molecule under the influence of light, a change in the structure of the molecule; photodimerization - the formation of a chemical bond between monomers under the action of light.
Subsequently, the energy of optical radiation is transformed into heat or primary photoproducts are formed, acting as activators and initiators of physicochemical, metabolic and physiological reactions that form the final therapeutic effect.
The first type of energy transformations is inherent to a greater extent in infrared, and the second - in UV radiation. The physical and chemical processes inherent in each type of optical radiation determine the specificity of their therapeutic effects and methods of use in light therapy (Table).
Indications. The main therapeutic effects of infrared rays are anti-inflammatory, metabolic, local analgesic and vasoactive, which allows their use in chronic and subacute inflammatory diseases, consequences of injuries to the musculoskeletal system, pain neurological syndromes etc. (see Infrared irradiation).
Visible rays, which have psychoemotional, metabolic and anti-inflammatory effects, are used in the treatment of wounds and trophic ulcers, neuroses, sleep disorders, and some inflammatory processes.
UV rays, depending on their wavelength, have different and very diverse effects, and therefore they have quite a wide indications for use.
Contraindications for phototherapy, in addition to general ones, are active tuberculosis, thyrotoxicosis, generalized dermatitis, malaria, Addison's disease, systemic lupus erythematosus, photosensitivity.

Light therapy is a method of physiotherapy that involves dosed exposure of the patient’s body to infrared (IR) or ultraviolet (UV) radiation.

Light is a stream of electromagnetic vibrations in the optical range, i.e., having a wavelength from 400 microns to 2 nm. Such vibrations are emitted in separate portions - quanta or photons with different energies.

The biological action of light is based on absorption physical energy its quanta by tissues and its conversion into other types of energy, primarily thermal and chemical, which in turn have a local and overall impact on the body. It is known that the energy of a quantum is inversely proportional to the wavelength, i.e. the shorter the wave, the higher the energy potential. The luminous flux only appears uniform. A ray of light passed through the prism of a spectroscope breaks up into a number of spectral stripes of red, orange, yellow, green, cyan, indigo and purple. The phenomenon of decomposition of white sunlight, which underlies the multicolored rainbow after rain, is widely known. A rainbow occurs as a result of the refraction of the sun's rays in tiny droplets of water, as in the prism of a spectroscope.

Radiant energy is emitted by any body at a temperature above absolute zero(-273 °C). A further increase in temperature causes the emission of visible light - everyone knows red and white heat. At temperatures above 1000 °C, UV radiation begins.

Biological action light radiation depends on the depth of its penetration into the tissue. The longer the wavelength, the stronger effect radiation. IR rays penetrate tissue to a depth of 2-3 cm, visible light - up to 1 cm, UV rays - 0.5-1 mm.

INFRARED RADIATION

Infrared radiation (thermal radiation, infrared rays) is a section of the general electromagnetic spectrum. IR rays penetrate deeper into body tissues than other types of light energy - up to 2-3 cm, which causes heating of the entire thickness of the skin and partly subcutaneous tissues. Deeper structures are not directly heated.

Direct action IR rays are limited to the irradiated area, but they indirectly spread to the entire body. Irradiation of large areas of the body (light baths) causes general overheating, accompanied by increased sweating. Therefore, local hyperthermia causes general reaction body.

Local heating in the irradiation zone primarily affects the thermoreceptors of the skin and almost immediately causes a reaction in its blood vessels. First, a spasm occurs, occurring reflexively in response to irritation of thermoreceptors. It is quickly replaced by dilation of skin vessels and increased blood flow in them. Biological entity This phenomenon is the thermoregulation of tissues due to increased peripheral circulation caused by the difference in blood temperature in heated and unheated tissues. The phase of active skin hyperemia is characterized by redness of the irradiated area; erythema appears during the procedure, gradually disappearing after cessation of irradiation. This distinguishes it from persistent ultraviolet erythema, which occurs after a certain latent period. In addition, after erythema with infrared irradiation there is usually no age spots

Active hyperemia in the skin irradiation zone is accompanied by an increase in the permeability of the capillary walls. There is an increased effusion of the liquid part of the blood into the tissue and a simultaneous increased absorption tissue fluid. In this regard, tissue metabolism increases and redox processes are activated.

Intense heating of the skin leads to the breakdown of its protein molecules and the release of biologically active substances, including histamine-like substances, which contributes to the dilation of blood vessels and increased permeability of their walls.

Violation of the rules for carrying out infrared irradiation procedures can lead to dangerous overheating of tissues and the occurrence of thermal burns I and even II degrees, as well as circulatory overload, which is dangerous in cardiovascular diseases.

Therapeutic effect infrared irradiation is determined by the mechanism of its physiological action. Light therapy procedures with infrared irradiation are used mainly for local action even over large areas of the body. Strengthening local microcirculation has a pronounced anti-inflammatory effect, accelerates the reverse development of inflammatory processes, increases tissue regeneration, local resistance and anti-infective protection. The generalized effect of infrared irradiation is manifested by an antispastic effect, in particular on smooth muscle organs abdominal cavity, which is often accompanied by suppression pain, especially in chronic inflammatory processes.

Region therapeutic use IR radiation is quite broad. It is indicated for non-purulent chronic and subacute inflammatory local processes, including internal organs, burns and frostbite, poorly healing wounds and ulcers, various adhesions and adhesions, myositis, neuralgia, consequences of injuries to the musculoskeletal system.

Infrared irradiation is contraindicated in malignant neoplasms, tendency to bleeding, acute purulent-inflammatory diseases.

Equipment

In most physiotherapeutic devices, the source of infrared and visible radiation is incandescent lamps. The temperature of the filament in them reaches 2800-3600 °C. The small amounts of UV rays they emit are almost completely absorbed by the glass of the lamp.

The Minin lamp consists of a parabolic reflector with a wooden handle, which houses a 25 and 40 W emitter. A lamp is often used blue. The simplicity and portability of the device allow it to be used at home. The irradiation distance is 15-30 cm, it is adjusted according to the feeling of pleasant warmth. The duration of the procedures is 15-20 minutes, daily. The course of treatment is 10-15 procedures.

The Sollux lamp is a significantly more powerful radiation source with a power of 200-500 W. The lamp is enclosed in a parabolic reflector with a removable tube, mounted on a stationary or portable tripod. The irradiator is installed at a distance of 40-80 cm from the surface of the patient’s body. The duration of the procedure is 15-30 minutes, daily or every other day. The course of treatment is 10-15 procedures.

The light-thermal bathtub is a frame with plywood walls, on inner surface in which incandescent lamps with a power of 25-40 W are located in several rows (Fig. 56). Depending on the purpose of the bath, 12 (body bath) or 8 (limb bath) lamps can be used. During the procedure, the patient, partially or completely naked, is in a lying position on the couch, the bath frame is installed over the corresponding part of the body, covered with a sheet and a woolen blanket. During the procedure, the patient is exposed to visible and infrared radiation and air heated to 60-70 °C. The procedure lasts 20-30 minutes, carried out 1-2 times a day. The course of treatment is 12-15 procedures.

Minin lamp Sollux stationary lamp.

The bath is light and thermal.

Methodology

During the procedure nurse must strictly follow the doctor’s prescription, which should indicate the type of device, the area of irradiation, its duration, the number of procedures per course, and the intervals between them. The intensity of radiation can be determined according to the patient’s feelings. The irradiation area is marked graphically on the destination diagram.

Destination examples. 1. Irradiation of the epigastric area with a Sollux lamp. Intensity - up to a feeling of pleasant warmth. Duration 20-30 minutes, daily. Course of 15 procedures.

2. Light-thermal bath for the kidney area. Intensity - up to a feeling of pronounced heat (cause intense sweating). Duration from 30 minutes to 1 hour, daily. Course of 15 procedures.

Preparing the patient for the procedure consists of examining the irradiation area, exposing it, and engaging the patient the desired pose, warning him about the intensity of the heat he should feel during the procedure. When radiation spreads to the facial area, the patient's eyes must be protected with special glasses. During the procedure, it is necessary to ensure that the irradiator is not located directly above the irradiated surface, in order to avoid contact of its hot parts with the patient’s body in case of damage to the device. After the procedure is completed, it is necessary to turn off the device, wipe the irradiated area of the body dry, inquire about the patient’s condition and invite him to rest for 20-30 minutes in the rest room. Rest should be longer if the patient has to go outside during cold weather. The stages of the procedure are shown in Diagram 10.

Treatment with infrared and visible radiation

Infrared (IR) rays are heat rays that, when absorbed by body tissues, are transformed into thermal energy, excite skin thermoreceptors, impulses from them enter thermoregulatory centers and cause thermoregulatory reactions.

Mechanism of action:

1. local hyperthermia - thermal erythema, appears during radiation and disappears after 30-60 minutes;
2. spasm of blood vessels, followed by their dilation, increased blood flow;
3. increasing the permeability of capillary walls;
4. strengthening of tissue metabolism, activation of redox processes;
5. release of biologically active substances, including histamine-like ones, which also leads to an increase in capillary permeability;
6. anti-inflammatory effect - increased local leukocytosis and phagocytosis, stimulation of immunobiological processes;
7. acceleration reverse development inflammatory processes;
8. acceleration of tissue regeneration;
9. increasing local tissue resistance to infection;
10. reflex decrease in the tone of striated and smooth muscles
- reduction of pain associated with their spasm.
11. Itching effect, because The sensitivity of the skin changes - the tactile sense increases.

Contraindications:

1. malignant neoplasms;
2. tendency to bleeding;
3. acute purulent-inflammatory diseases.

Visible radiation penetrates the skin to a shallower depth, but has slightly higher energy; in addition to providing a thermal effect, they can cause weak photoelectric and photochemical effects.

In the treatment of skin diseases, visible radiation is used together with infrared radiation.

Sources of IR radiation and visible rays are irradiators with incandescent lamps or heating elements (Minin reflector, Sollux lamp, light-thermal baths, etc.).

The procedures are carried out daily or 2 times a day for 15-30 minutes, for a course of treatment up to 25 procedures.

Ultraviolet light treatment

Species ultraviolet radiation:

- UV-A (long wavelength) - wavelength from 400 to 315 nm;
- UV-B (medium wave) - from 315 to 280 nm;
- UV-C (short wave) - from 280 to 100 nm.

Mechanism of action:

1. neuro-reflex: radiant energy as an irritant acts through the skin with its powerful receptor apparatus on the central nervous system, and through it to all organs and tissues of the human body;
2. part of the absorbed radiant energy is converted into heat, under its influence, physical and chemical processes in tissues are accelerated, which affects the increase in tissue and general metabolism;
3. photoelectric effect - electrons split off and positively charged ions appearing entail changes in the “ionic environment” in cells and tissues, and consequently a change in the electrical properties of colloids; as a result, permeability increases cell membranes and the exchange between the cell and the environment increases;
4. occurrence of secondary electromagnetic radiation in tissues;
5. bactericidal effect light, depending on the spectral composition, radiation intensity; the bactericidal effect consists of the direct effect of radiant energy on bacteria and an increase in the body’s reactivity (formation of biologically active substances, increase in the immunological properties of the blood); coolant ozokerite treatment sand radiation
6. photolysis - the breakdown of complex protein structures into simpler ones, down to amino acids, which leads to the release of highly active biological substances;
7. when exposed to ultraviolet radiation, skin pigmentation appears, increasing the skin’s resistance to repeated irradiation;
8. change physical and chemical properties skin (decrease in pH by decreasing the level of cations and increasing the level of anions);
9. stimulation of vitamin D formation.

Under the influence of intense ultraviolet radiation, erythema appears on the skin, which is an aseptic inflammation. The erythematous effect of UV-B is almost 1000 times greater than that of UV-A. UV-C has a pronounced bactericidal effect.

Selective phototherapy (SPT)

The use of UV-B and UV-A rays in dermatology is called selective phototherapy (SPT).

Prescription of photosensitizers for this type of phototherapy is not required.

Medium-wave UV radiation has a photosensitizing effect on the long-wave region A.

Two main methods of ultraviolet radiation are used: general and local. Sources of selective UV radiation include:

1) Fluorescent erythema lamps and fluorescent erythema lamps with a reflector of various powers. Designed for treatment and prevention.
2) 60 W germicidal uveolar lamps and germicidal arc lamps emitting predominantly UV-C.

For the treatment of psoriasis, the use of the range from 295 nm to 313 nm of UV-B radiation, which accounts for the peak of antipsoriatic activity, and also practically eliminates the development of erythema and itching, should be considered promising and advisable.

The dose of SFT is determined individually. In the vast majority of cases, treatment begins with a dose equal to 0.05-0.1 J/cm2 according to the method of 4-6 single irradiations per week, with a gradual increase in the UV-B dose by 0.1 J/cm2 for each subsequent procedure. The course of treatment is usually 25-30 procedures.

Mechanism of action of UV-B rays:

decreased DNA synthesis, decreased proliferation of epidermocytes o influence on the metabolism of vitamin D in the skin, correction of immune processes in the skin;

“photodegradation of inflammatory mediators;

keratinocyte growth factor.

SFT can be used as a monotherapy option. The only necessary addition in this case is external preparations - softening, moisturizing; products with a mild keratolytic effect.

Local side effects SFT:

- early - itching, erythema, dry skin;
- long-term - skin cancer, skin aging (dermatoheliosis), cataracts?

Contraindications:

1. benign and malignant neoplasms;
2. cataract;
3. pathology of the thyroid gland;
4. insulin-dependent diabetes mellitus;
5. acute heart attack myocardium;
6. hypertension, stroke;
7. sub- and decompensated liver and kidney diseases;
8. active tuberculosis of internal organs, malaria;
9. increased psycho-emotional excitability;
10. acute dermatitis;
11. lupus erythematosus, pemphigus vulgaris;
12. increased photosensitivity;
13. photodermatosis (solar eczema, prurigo, etc.)
14. psoriatic erythroderma.