title: Sustained acoustic medicine: wearable, long duration ultrasonic therapy for the treatment of tendinopathy.
abstract: OBJECTIVE
  The effectiveness of sustained acoustic medicine to alleviate pain and improve function in subjects with elbow or Achilles tendinopathy was evaluated through a level IV case series study. Subjects were trained to self-apply the wearable, long-duration, low-intensity ultrasonic device on their affected body part at home for 4 hours a day, at least 5 times per week over 6 weeks. Twenty-five subjects with clinician-diagnosed tendinopathy of the elbow (medial or lateral epicondyle) or Achilles tendon were enrolled.
  
  
  METHODS
  Pain measurements were recorded before, during, and after daily intervention using an 11-point numeric rating scale (NRS). Function of the injured limb was assessed biweekly using dynamometry. Repeated measures ANOVAs and paired-samples t-tests were used to examine the effect of treatment over time.
  
  
  RESULTS
  Among subjects with elbow tendinopathy (n = 20), a 3.94 ± 2.15 point reduction in pain (p = 0.002) was observed over the 6-week study and a 2.83 ± 5.52 kg improvement in grip strength (p = 0.04) was observed over the first two weeks. In addition, a significant reduction in pain was observed within the 4-h treatment sessions (p < 0.001). Among 5 subjects with Achilles tendinopathy, a reduction in pain and improvement in strength was also observed.
  
  
  CONCLUSIONS
  Daily multi-hour ultrasonic therapy was associated with improved pain and increased function in subjects with chronic tendon injuries. This trial showed the safety and feasibility of self-administration of sustained acoustic medicine, and suggests that this therapy may be clinically beneficial in the treatment of tendinopathies of the elbow and Achilles tendon. A randomized controlled trial appears warranted to more definitively investigate the therapeutic potential of this treatment modality. Registered at www.ClinicalTrials.gov, NCT02466308.
authors.affiliation: a Division of Sports Medicine, Department of Family Medicine , The Ohio State University , Columbus , OH , USA.|b Biomedical Engineering , The Ohio State University , Columbus , OH , USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Best
authors.affiliation: c Moore PT , Darien , CT , USA.
authors.forename: Bob
authors.initials: B
authors.lastname: Moore
authors.affiliation: d Sport and Orthopaedic Physical Therapy , Fairfield , CT , USA.
authors.forename: Paddy
authors.initials: P
authors.lastname: Jarit
authors.affiliation: e Department of Orthopaedic Surgery, Duke Sports Medicine Center, Duke University , Durham , NC , USA.
authors.forename: Claude T
authors.initials: CT
authors.lastname: Moorman
authors.affiliation: f ZetrOZ, Inc ., Trumbull , CT , USA.
authors.forename: George K
authors.initials: GK
authors.lastname: Lewis
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D004550:Elbow; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D010146:Pain; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D052256:Tendinopathy / Q000628:therapy*; D013716:Tennis Elbow / Q000628:therapy; D014464:Ultrasonic Therapy / Q000379:methods*; D055815:Young Adult; D000092464:Elbow Injuries
keywords: LITUS; Pain; Sustained acoustic medicine; Tendinopathy; Therapeutic ultrasound