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Re: Ultrasound intensity
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Re: Ultrasound intensity - May 24, 2005 7:05:00 AM
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Bournephysio
Posts: 585
Joined: April 25, 2002
From: Calgary
Status: offline
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First, the therapists/aides in question stopped when the patient experienced pain. There is nothing wrong with this and it really comes down to the therapists clinical judgement.
Look at the detail in all of the guidelines presented. Compare that to the number of good studies done. You never see 2.5W/cm2 in the recommendations even though it is one of the few well done studies. Why is that? Despite all of the recomendations we have for dosing ultrasound we really have very little idea what is effective. Many of our rules of thumb (ultrasound shouldn't hurt) is almost purely speculative or theoretical. Maybe ultrasound should hurt. An interesting note, the ache described with ultrasound is the same as the ache described with "chi" in acupunture and can radiate the same way. Needling the periosteum is a very sharp pain. Not that periosteum pain can't ache but it is an interesting comparision.
Personally, I often use 1.5-2.0 W/cm2 continuous without difficulty or pain. In reality all ultrasound is pulsed to some extent since you are moving the sound head.
Its hard to be dogmatic about the use of a modality (including other modalities such as manual therapy) when we have very little evidence.
Doug
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Re: Ultrasound intensity - May 24, 2005 10:23:00 AM
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steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
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Doug,
Very well put, particularly your last sentance - could be the topic of a whole new thread.
Steve
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Re: Ultrasound intensity - May 24, 2005 12:13:00 PM
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Yogi
Posts: 403
Joined: April 5, 2004
From: San Antonio, Tx., USA
Status: offline
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Doug, I imagine needling the periosteum is a very sharp pain. Is it standard in acupuncture to go to the bone? I still would be less concerned about needle tissue damage, (pain), than I would be about some degree of pain from an internal burn. Aide training wherever I worked included alleviating US pain, normally by turning the intensity down and moving the head more. So, PTnl, I think at least your aides are trained well. And good for opening the dialog. You see it happens alot here amongst all us Rehabedge friends.
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