Abstract:
Method for at least ameliorating the symptoms of fibrotic tissues, scars, cording or myofascial pain, comprising obtaining a preferably both electrically powered and portable treatment apparatus capable of contacting, via a treatment head, a target area on the skin of a patient and introducing low-pressure suction thereto, configuring the treatment apparatus so as to introduce predefined, advantageously, pulsating pressure variation to a suction opening arranged at the treatment head, and applying the suction opening of the treatment head on the target area while the treatment apparatus is on and providing the suction effect corresponding to the configuration.

Description:
PRIORITY 
       [0001]    This application claims priority of U.S. provisional application No. 62/275,809 which was filed on Jan. 7, 2016 and the contents of all of which are incorporated herein by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention generally relates to medical methods. Especially, however not exclusively, the invention pertains to methods of tissue therapy, such as for treating cording and fibrosis related to lymphedema, utilizing an apparatus producing low pressure suction, i.e. negative pressure flow, on a target area of a patient. 
       BACKGROUND 
       [0003]    Lymphedema refers to a medical condition where lymphatic system comprising lymphatic vessels for carrying lymph fluid towards the heart is functioning inadequately, which causes fluid retention and tissue swelling. Such condition triggered by lymphatic dysfunction may be inherited due to initially inferior number or nature of lymph nodes or channels in the body, or caused by trauma. 
         [0004]    Most typically the lymphedema occurs at limbs, but also incidents of head and neck lymphedema are known, which may be due to radiation treatment or surgical operations performed for treating associated cancer, for example. 
         [0005]    Treatment of lymphedema is difficult and genuinely permanent results are seldom achieved without really extreme measures such as surgery. Nevertheless, the symptoms may be relieved and condition at least momentarily improved by various means such as compression gear including garments, bandages and a related therapy called as ‘intermittent pneumatic compression’ therapy (IPC). Also appropriate physical exercises and skin care may be used to reduce the magnitude of lymphedema through stimulation of the lymphatic system and related supporting measures. Pain medication may be used for alleviating the discomfort or pain due to, for example, tightness in any of the areas affected by the lymphedema. 
         [0006]    One further problem caused by lymphatic dysfunction, in addition to lymphedema, is tissue fibrosis. Stagnant lymph turns fibrotic resulting in a scar-like hard and fibrous connective tissue, which in turn increases the risk of infections and may induce pain, for example. Yet, if somewhat similar fibrous tissue is formed in particular responsive to injury, the phenomenon is called scarring, which is a basically a standard biological part of wound repair in the skin and other tissues. 
         [0007]    Still, so-called ‘cording’, also known as AWS (Axillary Web Syndrome), refers to both painful and functionally limiting condition, where cord-like tender structures are sensed by the patients to extend below the skin inside e.g. arm, armpit and occasionally even thumb. Often AWS is detected to evolve as a complication of e.g. sentinel lymph node biopsy or axillary lymph node dissection, both relatively commonly used in treating breast cancer, or following e.g. axillary staging for melanoma. For instance in these different surgical procedures the lymphatic vessels or small veins may obviously be damaged, potentially causing inflammation or hardening of connective tissues, and then cording, which may cause pain. As with lymphedema, it is believed that the stasis of lymph may indeed at least contribute to the emergence of cording. 
         [0008]    As a further tissue related condition, myofascial pain may be set forth. Fascia refers to tough, thin, elastic and web like of connective tissue that surrounds and supports e.g various skeletal muscles (particularly in the case of myofascia) throughout a human body. Sensitivity and tightness of myofascial tissues, especially at specific points called ‘trigger points’, cause potentially chronic pain to many. MFR (Myofascial release) is a type of tissue therapy for treating such condition. In MFR, the practitioners such as massage therapists, chiropractors or medical practitioners may use their hands or other tools to stretch or elongate the fascia, or mobilize adhesive tissues, until the tension indicative of myofascia feels released or at least reduced. 
       SUMMARY 
       [0009]    The objective is to provide a method for treating any of the aforementioned conditions of fibrotic tissues, scars, cording and myofascial pain so as to provide at least temporary relief from the symptoms thereof while still preferably alleviating or overcoming one or more problems of the various existing prior art solutions to the same. 
         [0010]    Therefore, according to an embodiment, a method for at least ameliorating the symptoms of fibrotic tissues, scars, cording or myofascial pain comprises
       obtaining a preferably both electrically powered and portable treatment apparatus (device) capable of contacting, via a treatment head, a target area on the skin of a patient and introducing low-pressure suction, i.e. negative pressure flow, thereto,   configuring the treatment apparatus so as to introduce predefined, advantageously, pulsating pressure variation to a suction opening arranged at the treatment head, and   applying the suction opening of the treatment head on the target area while the treatment apparatus is on and providing the suction effect corresponding to the configuration.       
 
         [0014]    In various embodiments, said configuring may include determination of at least one feature selected from the group consisting of: size of the opening at the treatment head, shape and/or dimensions of a treatment cup located at the treatment head, used treatment cup among multiple options of different material, shape, opening and/or dimensions, pulse duration, duty cycle, signal period, signal (repetition) frequency, pulse pressure, minimum, maximum or optimum duration of subjecting the treatment head to an area at a time, and minimum, maximum, or optimum duration of a treatment session. The beginning or end of any aforesaid duration may be optionally indicated audibly, tactilely (e.g. vibration) and/or visually to the patient or other operator of the apparatus during use for guidance. 
         [0015]    In various embodiments, the apparatus may incorporate a central unit and a functionally connected treatment head that is preferably configured as hand-held by the patient or other operator of the apparatus. The connection may be established via a hose between the unit and head. The internal wall of said hose may define an air duct between a pressure chamber of the central unit and opening of the treatment head preferably provided by a treatment cup of the head. Further, an electrical connection between the two may be established via electrical wiring or wirelessly e.g. via electromagnetic coupling. The hose may transport gaseous matter, typically air, and thus cause the pressure pulsation due to a pulsating pumping action executed by pumping mechanism of the central unit. The central unit may include a vacuum pump for the purpose. In some embodiments, a fan could be alternatively utilized. 
         [0016]    In various embodiments, said applying incorporates maintaining the portion, such as a cup, of the treatment head defining the opening substantially in contact, typically skin contact, with location at least partly defining the target area for a predefined time period, which may optionally refer to duration of few seconds, or e.g. about 3-5 pulsations. 
         [0017]    Thereafter, the head may be re-positioned to a new location that may optionally overlap with the previous one. Such procedure may be continued until the target area as a whole has been treated at least once. In some embodiments, the treatment may be alternately directed to the same locations constituting the target area, e.g. as a repeated treatment pattern of several (sub-)areas with potentially overlapping portions, until a predefined overall period set for a treatment session, for instance, has lapsed. 
         [0018]    The application technique in terms of motion may include stationary treatment. In stationary treatment, a certain target area or location, i.e. ‘sub-area’ therewithin in case the overall target area is too large for treatment by the treating head at a time (very typical scenario), is subjected to the low pressure suction treatment at a time by maintaining the treatment head thereon for some time, e.g. the aforementioned period of few seconds or few pulsations, prior to switching over to a next location. The switch over thus involves lifting the treatment head first away from the skin contact prior to moving it. 
         [0019]    Alternatively or additionally, a so-called lift&amp;twist type technique may be utilized. While a certain location is treated and the treatment head is lifted from the skin, simultaneous rotating, or ‘twisting’, action is performed. 
         [0020]    Further, substantially continuous sliding type treatment technique may be applied by moving the treatment head over the locations of the target area while maintaining the contact of the treatment head. As one variation, knitting style sliding with twisting motion (rotation) may be tried. 
         [0021]    Still further, a hybrid approach may be selected implying keeping the treatment head substantially stationary relative to one location accommodating the treatment head while during the switchover to a next location the contact is still maintained instead of lifting the head away. As being mentioned above, the subsequent location may overlap with the previous one. 
         [0022]    In various embodiments where switchover between the locations of stationary treatment occurs, at least the two subsequent areas may have some overlap, e.g. about 20-50% overlap. 
         [0023]    The utility of the present invention arises from a variety of factors depending on each particular embodiment thereof. Relief of the symptoms of fibrotic tissues, even radiation induced fibrosis, scars (e.g. softening scar tissue), wounds (enhancing healing through stimulation of neighboring areas, for instance), cording or myofascial pain may be generally obtained by the suggested therapeutic method applying a low pressure suction apparatus. These may include the reduction of pain in patients and may, thus, even facilitate reduction in pain medication use. Relief of the symptoms after radiation treatment and/or mastectomy may be achieved by soft tissue massage, for example, by lifting the tissues of the chest wall. Further symptoms, such as limited range of motion associated with GVHD (graft-versus-host disease) or certain other conditions, could be reduced as well. 
         [0024]    The generated pulsation generally stretches and mobilizes the skin, therefore stretching fascia and affecting the related structures of myofascia (i.e. soft tissue manipulation), thus typically making additional clearance below it and reducing the related pressure subjected to tissues, organs, veins, lymphatic vessels, etc., while further activating them and e.g. the lymphatic system in general. In addition to negative/low pressure, i.e. suction, the pulsation may introduce certain amount of positive pressure to the tissues considering e.g. the areas opposite or adjacent to the target area under suction, or even to the target area itself due to the undulating nature of the pulsation and resulting skin motion. Accordingly, some benefits of positive pressure may be realized as well. 
         [0025]    In particular, the feeling of cording may just disappear or ‘snap’, as being described by test patients during clinical testing. Tissue fibrosis may be reduced and scars softened, occasionally also visually blotted out, while the lymphatic drainage is improved. Myofascial pain may be relieved as the fascia is released. Generally, skin elasticity may be increased and general condition of the patient improved. 
         [0026]    Yet, the condition in question may with some patients improve also in a longer term, even permanently. In other cases, the suggested treatment may be given more or less regularly, e.g. repeated once a week or every second week, to ascertain the permanency of the effect thereof. 
         [0027]    The embodiments of the present invention are considered both non-invasive and safe. The apparatus or generally equipment used to execute the treatment is affordable, portable, reliable, quiet and easy to service or use either by a patient or separate operator. The user, either being the patient himself/herself or dedicated operator, is not required to take extensive training to be able to apply the apparatus although at least basic understanding of human anatomy and related mechanisms such as lymphatic system and operation of the apparatus is naturally considered advantageous in favor of the effectiveness of the therapy. 
         [0028]    Accordingly, the therapy may be provided flexibly at different premises such as the home of a patient, at a physical therapist, or at some other desired location. There is no need to visit a doctor, hospital or some specialized therapy center to receive the treatment, which may facilitate the life of the patient considerably in terms of reduced travelling and associated cost, and gained time savings among other factors. 
         [0029]    Finally, use of the apparatus is practically completely painless as the pulsation pressure may be adjusted to suit each use scenario such that the effect of the treatment is achieved while the suction effect remains moderate only causing gentle draft and pull type stretch sensations on the skin in contrast to different prior art methods and apparatuses, the effect of which is at least partly based on harsh, mechanical skin stretching and actually pinching activity due to the use of gripping elements such as rollers, which may be rather painful on sensitive swollen and potentially infected skin. 
         [0030]    Relying on an apparatus according to an embodiment of the present invention may in many cases turn out advantageous also to the operator in contrast to e.g. manual therapy. The elbows, wrists, and hands of the operator may be spared from fatigue and pain, which are commonly induced by lengthy days of manual therapy. 
         [0031]    Various other advantages will become clear to a skilled person based on the following detailed description. 
         [0032]    The expression “a number of” refers herein to any positive integer starting from one (1), e.g. to one, two, or three. 
         [0033]    The expression “a plurality of” refers herein to any positive integer starting from two (2), e.g. to two, three, or four. 
         [0034]    The exemplary embodiments of the invention presented in this patent application are not to be interpreted to pose limitations to the applicability of the appended claims. The verb “to comprise” is used in this patent application as an open limitation that does not exclude the existence of also un-recited features. The features recited in depending claims are mutually freely combinable unless otherwise explicitly stated. 
         [0035]    The novel features which are considered as characteristic of the invention are set forth in particular in the appended claims. The invention itself, however, both as to its construction and its method of operation, together with additional objectives and advantages thereof, may be best understood from the following description of specific embodiments when read in connection with the accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0036]      FIG. 1  illustrates schematically an embodiment of a treatment apparatus in accordance with the present invention. 
           [0037]      FIG. 2  illustrates schematically an embodiment of a treatment apparatus in accordance with the present invention. 
           [0038]      FIG. 3  illustrates embodiments of a treatment cup of the treatment head in connection with the treatment apparatus in accordance with the present invention. 
           [0039]      FIG. 4  illustrates embodiments of a sealing part of the treatment head in accordance with the present invention. 
           [0040]      FIG. 5  depicts an embodiment of a treating head and treatment cup thereof positioned against the skin of a patient on a desired target area during therapy. 
           [0041]      FIG. 6A  depicts suction based treatment of potential shoulder area condition, e.g. cording. 
           [0042]      FIG. 6B  illustrates the activation of armpit lymphatic nodes. 
           [0043]      FIG. 6C  depicts a further therapeutic use scenario of a low pressure suction apparatus. 
           [0044]      FIG. 7  is a flow diagram disclosing an embodiment of a method in accordance with the present invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0045]    With reference to  FIGS. 1 and 2 , two embodiments of a treatment apparatus, or ‘device’, for use in connection with a therapeutic method in accordance with the present invention are illustrated. 
         [0046]    Embodiments of the treatment apparatus comprise a treatment head  2 , a central processing unit  1 , a treatment cup  3 , a sealing part  4 , low pressure chamber  6  and means for producing the low pressure in the low pressure chamber  5 . The central processing unit  1  may be arranged in connection with the treatment head  2  or in connection with a central unit  8  as shown in  FIG. 2 . The low pressure chamber  6  and the means for producing low pressure in the low pressure chamber  5  are shown schematically by dashed lines in  FIGS. 1 and 2 . The means for producing the low pressure  5  (negative pressure flow/suction effect), e.g. with a vacuum pump, may be in the treatment head  2  or in the central unit  8  in which case the means for producing the low pressure  5  is arranged in connection with the treatment head  2 , e.g., by a hose  9 . There may be a display in the treatment head  2  and/or  10  in the central unit  8 . The central unit  8  may further incorporate an interface for an external display. In some embodiments, the features of a central unit  8  could even be combined with the treatment head  2  into an integral apparatus. In some embodiments, the pump or fan  5  could be included in the treatment head  2  while there is still provided a central unit  8  or similar element connected to the head  2  by a flexible element such as a cable or wiring for electricity and/or data transfer, for example. These types of embodiments would not obviously necessitate the use of a hose  9  for the suction flow between the elements  2 ,  8 . When the pump or fan  5  is located within a common housing with the chamber  6 , these two may still be connected via internal piping, hose(s) and/or duct(s), for example, for conveying the low pressure flow. 
         [0047]      FIG. 3  illustrates two embodiments of the treatment cup  3 , one end of which is arranged to be in connection with the low pressure chamber  6  and the other end of which is arranged to be pressed towards the skin tissue (meaning in this application a degree of contact or a magnitude of force from a gentle touch/contact to more intense pressing) to direct low pressure suction to the target area, typically skin tissue, thus producing a bulge in the skin tissue. The skin preferably refers herein to all skin layers i.e. epidermis, dermis, hypodermis or subcutis. 
         [0048]    In  FIG. 3 , the end of the treatment cup  3  that is arranged to be pressed towards (typically against) the skin tissue is the lower end of the treatment cup  3 . The treatment cup  3  is arranged to form a suction opening  7  (shown in  FIG. 4 ( b ) ).  FIGS. 3 ( a ) and ( b )  illustrates two different shapes of treatment cups. There may also be other shapes and, thus, the examples in  FIG. 3  are not shown to pose limitations to the treatment apparatus utilizable in connection with the method according to the present invention. The treatment cup  3  with an appropriate size, shape and/or material may be chosen based on the nature or size of the target area of the skin to be treated, for instance. 
         [0049]    The treatment cup  3  may further comprise a sealing part  4  advantageously made of a flexible material and arranged at the end of the treatment cup  3  that is configured to be pressed against the skin tissue and to adapt to the shape of the suction opening  7  formed by the treatment cup  3  and to seal the gap between the end of the treatment cup  3  and the skin tissue when the end of the treatment cup  3  is pressed against the skin tissue. 
         [0050]    The sealing part  4  may be made of any suitable flexible material, such as polyurethane or elastomeric material. The use of other plastic materials and silicon material is also possible. At the sealing part  4 , it is naturally also possible to use a suitable material that reduces or increases the friction between the sealing part  4  and the skin tissue, and/or a material that improves the sealing, depending on whether the objective is to achieve a good mobility for the treatment head or as high a friction force as possible. Mobility may also be increased by using a number rotating elements, such as rollers, which are in connection with the treatment cup  3 . The rotating elements, in addition to the sealing part  4 , may also provide sealing function between the skin and the treatment cup  3 . 
         [0051]    As the treatment head  2  of the treatment apparatus is moved against the patient&#39;s skin, most comfortably using a handle, the effect of the low pressure causes a fold of skin to be pulled up into the low pressure chamber  6 . 
         [0052]      FIG. 4  illustrates the shape of the sealing part  4  by side views from two substantially perpendicular directions. The sealing part  4 , which is to be pressed against the skin tissue, is arranged to be concave in the direction of at least one of the main axes A or B of the suction opening  7  formed by the treatment cup  3 . 
         [0053]    In an embodiment of the treatment cup  3  of the treatment apparatus shown in  FIG. 4 ( a ) , the surface of the sealing part  4  to be pressed against the skin tissue is concave in the direction of the main axis B of the suction opening  7  formed by the treatment cup  3 . The shape of the suction opening  7  may be elliptical or oval or round (some examples are shown in  FIG. 4 ( b ) ). However, these are not the only feasible embodiments but other shapes may be used as well. 
         [0054]    In the above examples, the sealing part  4  is shown as a separate part fastened to the end of the treatment cup  3 . The sealing part  4  may be a disposable part, which is detached after use and replaced by a new one in the beginning of the treatment of a new patient. Alternatively, the sealing part  4  may be reusable after washing or disinfecting. The fastening to the end of the treatment cup  3  may be achieved by means of various connections. At the end of the treatment cup  3 , which is to be pressed against the patient&#39;s skin, there may be a flange in the radial direction, which is used for fastening the sealing part  4  made of a flexible material to its place. Thus, the schematically shown connection of the sealing part  4  in figures is not to be understood as a factor limiting the embodiments of the treatment apparatus used in connection with the method according to the present invention. It is also to be noted in this context that the sealing part or portion  4  may be formed as an integral part of the treatment cup  3 , for instance. 
         [0055]    In various embodiments, an opening for subjecting the target tissue such as skin to the suction may be defined by a treatment cup  3  (part or portion) of the treatment head  2 . The treatment cup may be adaptable in size to best fit the shape of the treated body part. The adaptability may be implemented by a plurality of interchangeable cups of different size and/or by an adjustable cup. 
         [0056]    For example, the applicable size may range from about 10 or 20 mm to 80 or 90 mm in diameter depending on the dimensions and shape of the target area. As a general rule, a largest cup considered suitable for the area may be selected. For instance, 60-80 mm size may be more suitable for the neck than for facial areas that benefit from using a smaller diameter cup and related opening. 
         [0057]    The treatment apparatus is thus not restricted to the examples of the figures in any way, but the apparatuses may be varied entirely freely within the scope of the claims. Thus, it is clear that the invention is by no means restricted to any specific shape or dimension of the treatment cup  3  or other components, for instance, but the shape and/or dimensions of the different elements and parts of the invention may differ from one another freely between embodiments, if desired. The idea of the present invention may even be applied in connection with such treatment heads at which rotating elements such as rollers are employed, as mentioned hereinbefore. 
         [0058]    The low pressure in the low pressure chamber  6  is advantageously produced by using the aforementioned vacuum pump. Necessary adjusting valves are also advantageously mounted in connection with the vacuum pump. 
         [0059]    In addition, in case an embodiment of the treatment apparatus with a central unit  8  is utilized, the hose  9  may have a valve which is advantageously positioned near the low pressure chamber  6 . The speed of the system may further be improved by using the hose  9  as a low pressure reservoir. Thus, higher or lower pressure may be achieved in the hose  9  compared to the pressure desired in the low pressure chamber  6 , especially in case a central unit  8  is utilized. If, for example, change of pressure from 150 to 200 mmHg is desired, the pressure of the low pressure chamber  6  is 150 mmHg and if in the subsequent phase a pressure of 200 mmHg is desired, the pressure of the hose  9  may already be set for example to 500 mmHg, so that upon opening of the valve a pressure of 200 mmHg is achieved quickly in the low pressure chamber  6  and the valve may be closed. The valve may be arranged to be controlled by pulse width modulation for adjusting the low pressure in the low pressure chamber  6 . In some embodiments the valve may control higher frequency oscillation (described in more detail hereinafter) produced in addition to lower frequency suction pulses. Alternatively, higher frequency oscillation could be produced by other element(s), such as electric motor or ‘vibrator’. In some embodiments, the oscillation could be at least temporarily solely produced (i.e. no simultaneous lower frequency pulsation). 
         [0060]    Subsequently, if a pressure of 150 mmHg is again desired, in which case a pressure of for example 50 mmHg may be set in the hose  9  so that a change from 200 mmHg to 150 mmHg is quick. Furthermore, the low pressure chamber  6  when positioned against the target area (skin) may be either substantially sealed or it may have a controlled leakage, for example, through a small opening. 
         [0061]    The treatment apparatus utilizable in the method according to the present invention preferably comprises different sensors, one of which, for example, measures the composition of the skin tissue, such as the fluid content, fat content and/or oil content. Separate sensors may also be used for measuring fluid and fat contents. One sensor may, for example, measure the raised skin (bulge) produced by the suction effect and one other sensor may measure, for example, the suction force applied to the skin. The low pressure suction and suction force may be adjusted according to the results of the measurements. Therefore, the apparatus may be adaptive and especially dynamically adaptive. Yet, the treatment apparatus may comprise a sensor which measures the skin temperature. 
         [0062]    Still, the apparatus may in some embodiments comprise a sensor for measuring the skin&#39;s blood circulation, the measurements of which may be used to adjust of the operation of the treatment apparatus. Further, the adjustment may be based on measurement of transepidermal water loss and skin pH. 
         [0063]    Each sensor may be in connection with the treatment head  2  or to the treatment apparatus through a wired or wireless connection, such as, for example, a radio frequency signal, infrared signal or the like. Thus, the sensors may be an integrated or separate part of the treatment apparatus. 
         [0064]    The apparatus may have at least one sensor that registers a signal given by the patient for increasing/decreasing the suction effect, based on which the adjustment of the suction may be done. The patient may thus give a signal to the sensor (for example, based on the pain experienced) and the sensor then relays to the apparatus the wish for the increase/decrease of suction efficiency. The sensor, such as a touch-registering sensor (e.g. a button), may be included in a user interface of the apparatus. 
         [0065]    In one embodiment of the treatment apparatus, it may further comprise additional energy source(s) for warming the skin tissue and furthermore, means for automatically adjusting the energy source(s) to a set point value based on the measurements obtained by one or more sensors. Energy source may also be utilized to power up the apparatus for treating a patient. 
         [0066]    Measurement techniques utilized in the embodiments of the treatment apparatus may include measurement of different sound frequencies, such as ultrasound and infrasound, techniques based on radiofrequencies and different wavelengths of light, i.e. optical measurement such as laser and infrared measurement, bioimpedance spectroscopy, magnetic resonance spectroscopy, Raman spectroscopy, nuclear magnetic resonance spectroscopy, microsensor mapping, heat camera imaging, or spectrofotometric intracutaneous imaging. 
         [0067]    In some embodiments of the treatment apparatus, the potentially automated adjustment of the low pressure suction and/or suction force is based on mechanical characteristics and/or electrical characteristics and/or structure and/or composition of the skin. Mechanical characteristics include strength, flexibility, elasticity and resilience etc. Electrical characteristics include, for example, capacitance, impedance, resistance, reactance and inductance. 
         [0068]    In addition, the potentially automated adjustment of the apparatus may in one embodiment be based on measurements of the flow of lymphatic fluid, for example. The associated measuring techniques for the flow of lymphatic fluid may be selected from known techniques, such as, but not limiting to, isotope clearance technique. 
         [0069]    In one embodiment of the treatment apparatus, the adjustment may also be based on the measurement of the patient&#39;s experience of cutaneous pain. Based on the experience, either the patient him/herself, or the operator, or both together adjust the apparatus&#39;s running parameters. Skin characteristics, when mentioned in this text, also include the pain felt and experienced on the skin. 
         [0070]    In an embodiment of the treatment apparatus, a computer program guides in the application of the suction force by presenting the force level audibly, tactilely (e.g. vibration) and/or visually in the treatment head  2  and/or in the central unit  8  (e.g. via display  10  in case of visual information). Low pressure suction may be adjusted automatically using the computer program, and thus it is not necessary for the patient or operator to adjust the low pressure suction during the treatment. Advantageously, when the treatment force exceeds the permitted value, the program stops the apparatus or lowers the suction force. 
         [0071]    The computer program may be utilized to calculate the target value of one or more on-going treatment forces, such as suction force, based on the measurements obtained and/or on the desired value of the suction pressure. Therefore, the apparatus also comprises sensor/sensors as mentioned hereinbefore for measuring one or more ongoing treatment forces, such as the level of the suction force. A computer program may be configured to automatically calculate and adjust the level of low pressure suction to the target value, based on the measurements obtained. The parameters/results of the measurements, which may be taken into account in determining the target value of the low pressure suction, include e.g. fluid content of the skin tissue, fat content of the skin tissue, the bulge i.e. the lift of the skin tissue (the size of the fold in the skin) and/or the skin temperature. 
         [0072]    Furthermore, the computer program may be functionally connected to database, which contains the patient&#39;s treatment information. The database may be remote and hosted by a remote computer or computer system, which is accessed via a communications connection or network, e.g. the Internet. For the purpose the treatment may include a wired or wireless data interface, e.g. USB (Universal Serial Bus), Bluetooth™, NFC/RFID (Near-Field Communication/Radio Frequency Identification), cellular, wireless LAN (Local Area network) or wired LAN interface. 
         [0073]    In one embodiment of the treatment apparatus, it is desired to combine slow, pulsating low pressure to a faster impulse-like oscillation treatment. For instance, the oscillation treatment may be modulated by a pulsating low pressure treatment. 
         [0074]    In one embodiment of the treatment apparatus, the treatment apparatus is arranged to provide to the low pressure chamber  6  simultaneously a pulsating low pressure treatment, which preferably has a frequency of below 5 Hz, and an oscillation treatment, which for its part, preferably has a frequency of more than 5 Hz. In other embodiment, the threshold frequency between low pressure pulses and high frequency oscillation may be different. 
         [0075]    Moreover, a high frequency oscillation treatment may be particularly added to the suction phase of the low frequency pulsating low pressure treatment. The oscillation may extend over the whole duration of the low pressure pulse. In some embodiments, in addition to the duration of the pulse, the oscillation could be present also during the neutral portion of the signal period. In some embodiments, the duty cycle of 100% (i.e. continuous suction/pulse) may be applied, whereupon also the optional oscillation may be on all the time. High frequency in this instance may mean for example an impulse-like pressure change or oscillation with a frequency of more than 5, 10, 15 Hz or higher frequencies such as e.g. 90 Hz or even as high as 200 Hz. The hose  9  may be arranged in this case to be used as a pressure reservoir for accelerating pressure variations in the low pressure chamber  6 . 
         [0076]    When using the high frequency oscillation, higher frequencies affect the (skin) tissue closer to the surface of the skin while with lower frequencies the effect of the treatment ‘penetrates’ deeper into the tissue. Thus by varying the frequency of the high frequency oscillation, the depth of the effect of the treatment may be varied and problems at different depths of the (skin) tissue may be more effectively treated. 
         [0077]    In an embodiment, the pulsation frequency may range from about 0.1 Hz to about 5 Hz, or occasionally even up to 10 Hz depending on the particular embodiment of the apparatus (supported frequencies). For instance, it may be about 0.5 Hz that corresponds to a 2 second signal period and 1 second pulse duration with 50/50 duty cycle. The suction on the skin tissue when the treatment cup  3  is facing the skin is naturally introduced during the associated on-time (i.e. 1 second in case of 2 second total signal period with 50/50 duty cycle). 
         [0078]    Preferably the configured frequency is user-adjustable via a user interface of the apparatus. The user interface may include a number of control input elements in the form of a touch display, touch pad, button, mouse, Scrollpoint™, roller, voice input interface, keypad, etc. for the purpose. 
         [0079]    Accordingly, the UI (user interface) may include e.g. a display and/or audio response interface (typically buzzer or loudspeaker) for data visualization and feedback provision towards the apparatus operator. The operator may be the patient himself/herself or other person who preferably has adequate medical and technical skills to operate the apparatus in sufficient fashion. 
         [0080]    Typical pressure (suction, i.e. negative pressure) of the treatment apparatus may preferably be of the order of about 80 mmHg, falling e.g. within a range from about 5, 10 or 30 to about 250 mmHg, or even up to about 350 mmHg or higher, e.g. about 500 mmHg. As being clear based on this disclosure, the negative pressure is preferably user-adjustable or -selectable in at least most embodiments. However, use of fixed (user non-adjustable) pressure and potentially other fixed parameters is possible in some embodiments of the apparatus as well. Such embodiments could be targeted to certain very specific use scenarios or applications, for example. 
         [0081]    In some embodiments, the operator of the device is provided, via the UI of the device, a pressure setting and/or pressure readings in predetermined, optionally user-selectable, units such as mmHg or pascal. Alternatively or additionally, e.g. a numeric value in a predetermined scale, e.g. between one and five or one and ten, without any particular units could be used for adjustments and/or indicated to the operator. One end of the scale could represent predetermined minimum suction or zero suction, whereas the other end (e.g. maximum number) could represent predetermined maximum suction. The apparatus manages the conversion between the user-indicated pressure and corresponding real pressure established. 
         [0082]    Instead or in addition to numeric values, the pressure and/or other parameters could be indicated through other symbols, optionally using dot/circle, star, line, curve or rectangular shapes. 
         [0083]    The order of magnitude of high frequency oscillation may range, for example, from about 2 to about 200 Hz, preferably at least from about 5 or 10 Hz to e.g. about 100 Hz. 
         [0084]      FIG. 5  depicts, via a generic sketch, an embodiment of a treating head  2  and treatment cup  3  thereof. The head  2  is held by the hand  504  of an operator or a patient himself/herself and positioned against the skin  502  of the patient on a desired target area during a therapy session. In particular, the sealing part  4  of the cup  3  contacts the skin  503 . 
         [0085]    The patient may sit or stand in upright position during the treatment, for instance. Alternatively the patient may lay down on a treatment platform or e.g. bed. 
         [0086]    Optionally, lubricant such as massage oil may be initially smeared on the target area. Care shall be taken that the lubricant does not contain particles that could end up within the apparatus during the treatment to avoid clogging the internals thereof and related cleaning procedures. 
         [0087]    In various embodiments, the treatment head is located so that the associated contact portion, such as a preferably replaceable treatment cup, is in close contact with the skin area to be treated. 
         [0088]    The diameter of an optimum cup generally varies between patients and from a treating technique to another, but in many typical cases it may range from about 60 mm to about 80 mm, for example. As an applicable basic rule, one could consider to select the largest suitable treating cup for each target area. Fastening of the treatment cup having regard to the rest of the treatment head may incorporate grooves (in the cup or head) and matching lips (in the head or cup, respectively), snap fastener(s), threads, magnets, frictional and/or pressure contact (e.g. based on the elasticity (enabling stretching) and/or roughness of the contacting surface(s) yielding tight, secure fit), or any combination of the above or other feasible attachment technologies providing e.g. sufficiently secure and airtight fit between the connected elements. 
         [0089]    The treatment head/cup should be hold onto relatively lightly. 
         [0090]    Upon locally treating e.g. fibrotic tissue, stationary technique may be generally applied on the affected tissue areas. First the lymphatic pathways may be activated. The used negative pressure may be set between about 80 and 160 mmHg, for instance. The signal duration including a pulse and neutral portion free of the (low frequency) pulse may be about 2 two 5 seconds. Duty cycle may be about 80/20 meaning relatively long pulse duration in contrast to the neutral portion. High frequency oscillation may further be activated and gradually adjusted by starting with higher frequencies such as about 90 Hz and moving towards lower frequencies such as about 20 Hz. Lift&amp;twist may be optionally applied with or without oscillation. If the target tissue is particularly hard, longer pulse lengths may be applied. 
         [0091]    Having regard to (older) scars or adhesions (myofascia), while always remembering the fact the treatment is NOT meant to treat open wounds directly and, e.g. in case of fresh scars, the risk of damaging the tissue should be carefully evaluated before applying the low pressure suction directly on the target area, both the location and shape of a scar/adhesion may determine the applied pressure and e.g. the size of the treatment cup. 
         [0092]    The pressure may be raised gradually during the treatment when it is perceived how the tissue reacts. The treatment head and cup may be placed directly on the scar. The pressure may fall within a range of about 5 to e.g. about 350 mmHg. Typically it may be advantageous to utilized high pressures such as from about 150 mmHg to 350 mmHg. The duty cycle may be about 50/50 with again 2-5 seconds signal period. Oscillation is not necessary. 
         [0093]    Stationary technique and optionally lift&amp;twist or ‘knitting’ style sliding (sliding with twist) may be applied. With adhesions, the treatment cup diameter may be relatively small, e.g. about 35 mm in diameter. 
         [0094]    In case the area neighbouring the target area has stitches, open wounds, or fresh scars, care should be taken to ensure not accidentally damaging them by the treatment of the adjacent target area. Accordingly, application of (mere) stationary technique is preferred over e.g. lift/twist on such target areas. 
         [0095]    One may still consider applying an embodiment of the present invention in treating wounds. Even though the suction apparatus of the present invention is indeed not designed for direct contact with an area containing an open or fresh wound, it might find use e.g. as complementary technology. 
         [0096]    For example, when vacuum-assisted closure (VAC) is applied directly to the wound, such treatment could be enhanced by carefully and delicately treating e.g. the neighbouring areas using an embodiment of the apparatus and operation techniques presented herein. Suction of edema fluid through the VAC could be improved accordingly. 
         [0097]      FIG. 6A  illustrates the suction therapy of e.g. neck, shoulder, e.g. trapezius muscle, and/or spine area cording using an embodiment of a suction apparatus in accordance with the present invention. 
         [0098]    In treating cording, the cup size may again be between 60 and 80 mm. The pressure may fall within a range of about 50 to 80 mmHg. The duty cycle may be 50/50 (with pulse duration of e.g. about 1 sec, converting into two sec total signal period). High frequency oscillation (vibration) is not necessary. Stationary and optionally sliding technique may be applied. Treating e.g. the area of the spine, elevated pressure of about 50 to 150 mmHg may be applied. 
         [0099]    In various embodiments having regard to cording or other conditions, the cup may typically be kept on the same location for few, e.g. about three to five pulsations, whereafter it may be moved, optionally sideways, to adjacent skin area with e.g. 1/3 overlap. The total number of locations, or spots, that are treated depends on the overall coverage of the treated condition, which typically defines the target area of treatment, as well as the size of the cup and related suction opening. The area may encompass from about one, two or three to ten locations, for instance. 
         [0100]    With a sliding technique, e.g. s-shaped trajectory of the treatment head may be utilized on the skin over the spine or other target area. It may be easier to move the treatment cup when less manual pressure is applied to the front section of the cup, still maintaining the skin contact. 
         [0101]    Generally, in therapy utilizing an embodiment of a suction based treatment apparatus in accordance with the present invention either stationary, sliding or hybrid, or sometimes knitting style sliding, technique may be applied having regard to the lifting of the treatment head during the movement thereof on the skin between the different treated areas. The general direction of motion may be sideways and/or from the top to the bottom (e.g. along the spine). Thus the overall duration of treating a certain area or spot at a time commonly ranges from about one or few seconds to few tens of seconds depending on the utilized pulse duration and duty cycle and thus the overall signal period. 
         [0102]    One shall acknowledge the fact that also the neutral period (no suction) is usually treatment-wise important e.g. in a sense that during it the skin stretching stops and the skin recovers its relaxed position. The effectiveness of the treatment is in many respects due to the back-and-forth movement of the skin, not just due to suction-based stretching thereof. 
         [0103]      FIG. 6C  depicts a further use scenario of low pressure suction apparatus in treating cording (axillary web syndrome) on e.g. sternum area. However, with reference to  FIG. 6B , armpit axillary lymph nodes may be activated first using e.g. stationary technique, about 50-80 mmHg pressure (suction), and a signal period of 2 seconds with 50% duty cycle. 
         [0104]    Then the sternum area may be treated with generally similar settings. The treatment may be continued towards the armpits, for instance. Also sliding, lift&amp;twist, or knitting-type sliding techniques may be applied. Oscillation may be optionally utilized e.g. with 40-60 Hz frequency. 
         [0105]    The above parameters could be applied to other target areas as well. 
         [0106]    Having regard to various embodiments, typically one therapy session lasts for about 10-60 minutes at a time. A treatment period may include multiple sessions, e.g. about 10 sessions. As mentioned hereinbefore, in many cases the obtained results are not necessarily permanent, whereupon the therapy should be regularly practiced even after a more intensive therapy period, e.g. once a week. 
         [0107]    Considering the general direction of motion of the treatment head in the therapy sessions, one could conclude that typically the locations closer to the two subclavian veins may be treated prior to locations farther away therefrom, e.g. limb extremes, so that the main lymphatic channels are opened for the lymphatic flow first instead of trying to open the extreme conduits first while the flow is still blocked centrally. 
         [0108]    Activation of the lymphatic system and lymphatic flow as well as treating fascia(s) in the therapy sessions may also speed up recovering from an exercise due to the fact that lactic acid formed during the exercise in the muscles may be removed more rapidly thus contributing positively to the recovery. The use of low pressure suction may thus be beneficial in preventing or at least alleviating the symptoms, such as pain, of delayed onset muscle soreness (DOMS). 
         [0109]      FIG. 7  is a flow diagram disclosing an embodiment of a method in accordance with the present invention. 
         [0110]    Item  70  refers to a start-up phase. Decision to treat a patient in accordance with the principles of the present invention is made. 
         [0111]    At  71 , an embodiment of a treatment apparatus is obtained. It may be purchased, borrowed or rented, for example. Further gear, such as massage oil and treatment chair or table/platform may optionally be further acquired at this stage. 
         [0112]    At  72 , the apparatus and possible other equipment (e.g. chair/table) are configured, which may refer to adjusting, via the UI of the apparatus, desired parameters for the treatment including e.g. suction pressure, pulsation frequency, oscillation frequency, duty cycle, etc. A patient may himself/herself configure and subsequently utilize the apparatus. Alternatively, the apparatus may be operated by some other party, such as a professional operator such as a medical professional, a therapist, a nurse, a friend or a family member of the patient. Already for the configuration tasks, the apparatus may have to be turned on unless the configuration can be purely adjusted by using e.g. mechanical switches, sliders or other elements that continuously remember their state in contrast to e.g. touch pads or touch displays that have to be powered up first to register the user input. 
         [0113]    At  73 , the treatment head is (re-)positioned on a target area or sub-area thereof to be treated, which usually involves placing the head, or in practice the contact part of the associated treatment cup or similar element, in contact with the skin of the patient. Depending on the nature of the treatment, stationary, sliding or hybrid application technique may be selected. Also the use of knitting type sliding technique may be selectively considered. 
         [0114]    At  74 , the treatment is executed having regard to the target area by subjecting the area to the low pressure (suction) pulses and intervening neutral or passive periods. 
         [0115]    In practice, items  73  and  74  are usually simultaneously and/or sequentially repeatedly executed during a treatment session. Accordingly, their mutual execution order may be considered to vary. The treatment head/cup at a certain location usually covers only a small sub-area of the overall target area at a time, whereupon the head shall be moved along a desired route on the skin to cover the target area in its entirety using a preferred application technique. 
         [0116]    Method execution is ended at  75 . The suction and the apparatus in general may be turned off. Alternatively, at least some measurement results and/or other gathered statistics concerning the treatment, e.g. pressure, pulse characteristics, or various durations, may be inspected via a display or other feasible element of the treatment apparatus itself, or outputted therefrom via an available data communication interface either wirelessly or wiredly. The data may be transferred to a near-by apparatus or a remote system, optionally via the Internet, for storage, inspection (e.g. visualization) and/or analysis. The external apparatus or system may host a database for storing data from a number of treatment apparatuses. The patient may be instructed to drink water to prevent dehydration. 
         [0117]    In some variations of the treatment apparatus described herein, the treatment head and related elements, e.g. suction cups thereof, could be configured for enabling substantially contactless operation in addition to or instead of contact-based therapy. During the contactless therapy, the treatment head could be merely hovered close to the target area without actually contacting the skin, for instance. The apparatus could be provided with audible, tactile and/or visible guidance element such as loudspeaker, buzzer, vibration element, indicative lamps (e.g. LEDs) and/or a display, optionally touchscreen, The guidance element could indicate, in real-time fashion, current and/or proper distance between the target surface (e.g. skin) and the treatment head. In contact-based treatment, the cup/flexible element of the treatment head inherently provides such guidance for maintaining proper distance (in that case, contact) between the head and target surface.