Everything you need to know about Intratissue Percutaneous Electrolysis (I.P.E.), why use it, how to use it, on which pathologies and with what advantages for the patient, without forgetting the contraindications.
What is Intra-tissue Percutaneous Electrolysis ?
First of all, it is important to know that Intra-tissue Percutaneous Electrolysis or IPE is an invasive technique used by massage therapists. Indeed, it consists of applying a direct current, otherwise known as galvanic current, through acupuncture needles guided by ultrasound. In fact, this technique induces a controlled and localized inflammatory response allowing phagocytosis and tissue repair of the affected soft tissue.
What are its benefits ?
Firstly, during the healing of a muscle, tendon or ligament, fibrous scars can frequently be found, causing an alteration in motor control, also known as neuromuscular control, atrophy and even a decrease in viscoskeletal properties. Moreover, it has been observed that 14% of hamstring injuries in athletes are associated with the formation of fibrous tissue following an injury. Therefore, recurrences of hamstring, adductor, quadriceps and calf injuries are often found in these athletes.
In this case, the factor responsible for fibrous tissue is TGF-B1, which is the starting point of tissue fibrosis, and EPI has the advantage of cancelling this effect. Indeed, its aim is to restore the recovery mechanisms of tendinopathies thanks to the galvanic current. This allows the proliferation of inflammatory mechanisms (cytokines) to be stimulated at the level of the lesion.
In summary:
- Reduction of pro-inflammatory cytokines
- Decrease in pain
- Increase in pro-regenerative cytokines
- Restore the physiological mechanisms of the tendons
- Optimize the healing mechanisms of muscle injuries
Tissue healing
During healing, local inflammation occurs to create new fibrous connective tissue that is in no way the normal tissue destroyed by the injury or disease. In fact, it is a tissue repair and not a regeneration of the damaged tissue.
To go further…
Firstly, it is the cytokine, TGF beta 1, which is responsible for the regeneration of fibrous connective tissue. In fact, TGF beta 1 promotes the differentiation of macrophage 1 and 2 phenotypes. Since one study found that TGF-B induces an M2 phenotype due to an increase in the anti-inflammatory cytokines IL-10 and a downregulation of the pro-inflammatory cytokines TNF-A and IL-12.
Secondly, this M2 phenotype compresses and represses the cellular element of the elastic fiber to fulfill the mechanical role of the injured structure only. This is why we often find affected muscle, ligament or tendon cords. This results in multiple fragilities such as an alteration of neuromuscular control, atrophy or even a decrease in visco-skeletal properties. Hence the relatively high percentage of recurrences in athletes.
The role of Intra-tissue Percutaneous Electrolysis in wound healing
Firstly, the aim of the creators of Intra-tissue Percutaneous Electrolysis was to stop TGF beta in the healing process in order to avoid the accumulation of fibrous tissue. Specifically, the primary goal was to restore the recovery mechanisms of tendinopathies through galvanic current. By applying intra-tissue current in patients with tendinopathies, the number of cytokines would increase significantly by invalidating the differentiation of M1 (macrophage) phenotype from M2 phenotype. Thus, the structural change of M1 macrophage phenotypes would optimize endogenous regeneration, avoiding fibrous scarring.
Finally, the interest was to restore the best function of the tissue-muscle. This induces an acceleration of the movement and maintains the joint stability structure.
Where can we find this technique ?
To date, this technique can be found frequently in Spanish physiotherapy practices. However, in France, the practice is not yet authorized. However, recently the French Order of Physiotherapists has authorized us to practice dry needling. Knowing that it is an invasive therapy that allows to treat the muscular system with more precision without ultrasound.
Why treat with Intra-tissue Percutaneous Electrolysis ?
- The CEA, accumulated electrical charge, depends on the type of tendinopathy
- Intensity from 0,1 mA to 15 mA
- Advantages:
- We can intervene on patients, without pain for them
Optimizes the biological mechanisms of regeneration in time and quality - The EPI device that is in contact with the needle is anti-corrosive
- Guarantees maximum electrical flow through the negative pole
- Guarantees maximum safety for the physiotherapist avoiding ETS, HIV, VIB…
Effects on tendinopathy
- Reduction of the inflammatory cellular response promoting fibrous tissue
- Improving the differentiation, migration and proliferation of both phagocytosis and tenoblastos cells
- Improvement of remodeling processes and tissue homoestosis
Contraindications
- Blood clotting problems or taking anti-coagulant drugs
- Psoriasis
- Cancer
- Heart problems
- Osteosynthesis
- Severe osteoporosis
- Bone and osteochondral fractures
- Fibromyalgia
- Anxiety generated by needles
- Pace maker
- Pregnant women
- Generalized and severe
- lymphoedema