Monday, May 17, 2010

Botox and Rehabilitation Medicine

Botulinum toxin A, or Botox as it is commonly called, is used in
medicine to block unwanted, awkward and painful muscle contraction,
such as in childhood spasticity, wry neck or eye lid twitching. In
1989 it was FDA approved for medical purposes, and its early use
was in children with a "wandering" eye strabismus, where one eye
does not look at the object being viewed. The botox molecule
interferes with muscle receiving nerve signals to contract. The
muscle paralyzing feature of Botox , when used beneficially, has
proven to be useful in more than 50 pathological conditions, and in
2002 received FDA approval for cosmetic use.
The injection technique guides a slender needle toward the belly of
the muscle where nerve endings are known to enter. The more botox
molecules deposited the more effective the block. Its therapeutic
qualities led to its being used for muscle problems seen in later
life, such as spasticity after stroke; and its therapeutic benefits
were expanded to relieve neck and back spasm, headaches due to
muscle tension, and to control spasticity following spinal cord and
brain injuries. The doctor, who trains in Physical Medicine and
Rehabilitation to become a Physiatrist, Pain or Sports Medicine
specialist encounters these injuries frequently and is in the front
line helping the person to manage pain and recover function. The
Rehabilitation physician is first and foremost trained in the
anatomy of the body in motion -- a functioning, moving entity,
which means muscles and nerves as well as joints, tendons and
ligaments. And Botox is an essential tool she learns to handle. To
skillfully identify the problem muscle and direct the needle to the
optimal site are essential skills and take time to develop.
Successful practice of Rehabilitation also requires the ability to
understand the person with the problem; ability to listen and to
assess that person's wishes, and potential to meet them. In
Rehabilitation one frequently must make aesthetic recommendations
for a patient, for example whether a surgical procedure is needed,
not only for pain relief, but also, as in rheumatoid hand deformity
or a bent arthritic knee, for cosmetic reasons. It is a natural
and a short step to offer this capability to patients concerned by
their facial appearance. A detailed interview to understand the
person's wishes and a careful examination of the facial bone and
soft tissue structure leads to a treatment plan. Injected into
certain small muscles of the face Botox can soften, even remove
unwanted deepened expression lines. This particular therapeutic
application, is now commonly called aesthetic Botox. Practitioners
of this often do not have background in its medical therapeutic
uses, and have trained recently and exclusively in its aesthetic
use. By contrast, the pain management and sports medicine and
rehabilitation medicine physician has familiarity with the placement
of needles for all parts of the body, and known dexterity. In my
case, I have more than twenty years experience with muscle, joint
and ligament injections. This experience, with my knowledge of
anatomy, empathy and aesthetic sense, greatly enhance my ability to
provide aesthetic Botox.