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portable therapeutic ultrasound devices
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portable therapeutic ultrasound devices - September 27, 2008 9:24:33 PM
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imscotte
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Does anyone have any opinions to share as to the effectiveness (or lack thereof) of portable therapeutic ultrasound devices (e.g. "Sonic Relief") in treating muscle strains? Thanks!
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RE: portable therapeutic ultrasound devices - September 28, 2008 7:22:27 AM
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SJBird55
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Since the non-portable ultrasound units are ineffective, how do you propose the portable ultrasound units would be effective?
< Message edited by SJBird55 -- September 28, 2008 7:26:30 AM >
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RE: portable therapeutic ultrasound devices - September 28, 2008 10:19:16 AM
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imscotte
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i'm interested in your opinion. why do you say that it's ineffective? and how is it that it remains a standard modality if it is? thanks!
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RE: portable therapeutic ultrasound devices - September 28, 2008 11:00:39 AM
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kamryn
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Check the site below - there was a nice podcast done and reference list at the site that will back-up SJs point. They also speculate as to why PTs continue to use a modality that has not been shown to be effective for the vast majority of conditions it is used for.
http://www.ptjournal.org/cgi/content/full/87/8/986/DC1
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RE: portable therapeutic ultrasound devices - September 28, 2008 12:01:29 PM
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TexasOrtho
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There is actually some basic science evidence that pulsed ultrasound facilitates more uniform collagen distribution in injured achilles tendons. There is evidence out there supporting it's use, but some of it is pretty old and you have to keep things in perspective. Most of the encouraging research was performed on bunnies and puppies where other variables (like freedom) were easily controlled.
A recent study by Yeung in teh Journal of Orthopedic Research (2006) found that tensile strength and tendon stiffness were significantly improved after pulsed ultrasound applied for 5 minutes, 3 x per week, for 2-4 weeks. It's an animal model though and I haven't seen too much encouraging evidence for US in humans. That being said I've probably done 3-5 ultrasounds over the last year.
I'm not ready to burn my ultrasound unit, but I would like to see a bit more evidence backing it up before I'd consider dropping more money into a portable unit. Incidently, my US weighs about 5 pounds and is pretty portable.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: portable therapeutic ultrasound devices - September 28, 2008 9:39:34 PM
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Sebastian Asselbergs
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In all honesty, I really believe that the use of US is dictated by billing practices and by it easy delegation for use by PTAs. As Rod says, there is some evidence out there, but it is so slim, that its use is not really well-supported at all. 3X per week for 2-4 weeks is a lot of visits for some effects that don't seem to have been tested against a group who was well-taught (good self-care) and treated...
Mine has found a home in the local e-waste recycling company - all its little bits (including its plastic) have become part of something hopefully more useful. Reincarnation for US - mmmh, it may have come back as my iMac...
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RE: portable therapeutic ultrasound devices - October 29, 2008 10:41:48 PM
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zhuxiaonuan
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quote:
Since the non-portable ultrasound units are ineffective, how do you propose the portable ultrasound units would be effective? r u surely?
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ultrasound gel for wound
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RE: portable therapeutic ultrasound devices - October 30, 2008 6:59:14 AM
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SJBird55
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Yep, pretty sure... look at randomized controlled trials and systematic reviews - no effectiveness for muscle strains. It is only effective for companies by increasing their profits: 1) the company selling the device and 2) the physical therapy company using the device (and being paid for using the device by an insurance company or a patient).
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RE: portable therapeutic ultrasound devices - October 31, 2008 12:48:45 AM
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jlharris
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As a side note, isn't it funny how insurance companies continue to pay for US yet are now refusing to pay for effective treatment such as manual therapy? I take that back, it's not funny. IMO, it has to do w/ insurance companies knowing what US is and knowing what they are paying for, and not understanding the ambiguous term "manual therapy" which somehow our profession allows us to bill for when doing anything from mobs/manips to CST.
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Jason L. Harris, PT, DPT
My PT Blog
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RE: portable therapeutic ultrasound devices - October 31, 2008 6:20:50 AM
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SJBird55
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I'ts ridicoulous, Jason. I haven't heard an update on that manual issue either.
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RE: portable therapeutic ultrasound devices - October 31, 2008 7:32:48 AM
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TexasOrtho
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I still use it very sparingly, so I don't think it is totally ineffective. Animal studies have shown there is something to the use of ultrasound. However, I use it with the understanding that there is much more to the treatment episode.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: portable therapeutic ultrasound devices - October 31, 2008 8:00:46 AM
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kiwi PT
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20 min a day 5 days a week for bone healing right? I get orders for that all the time.
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Mark Twain
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RE: portable therapeutic ultrasound devices - October 31, 2008 8:22:39 AM
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TexasOrtho
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The animal studies I've seen use pulsed US for 5 minutes three times a week. A typical PT dose. Increased fibroblastic activity and improved healing time. Again...not using it all the time, but not throwing the baby out with the bathwater.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: portable therapeutic ultrasound devices - October 31, 2008 8:54:22 AM
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SJBird55
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Since men are pigs, I hope you selectively use ultrasound on them. Sorry, I couldn't stop my fingers at humor will be lost in translation due to this darn communication medium.
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RE: portable therapeutic ultrasound devices - October 31, 2008 9:52:41 AM
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Tom Reeves DPT ATC
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oink
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RE: portable therapeutic ultrasound devices - October 31, 2008 7:05:35 PM
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TexasOrtho
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Not trying to build a case for unbridled ultrasound usage but here is the abstract of the Yeung article. The DOI is 10.1002/jor.20020
Abstract. A rat tenotomy model was used to investigate the effect of combined conservative management and pulsed ultrasound (PUS) on the repair of tenotomized Achilles tendon. Hemitenotomy of right medial Achilles tendon was performed in 48 rats without suture, and patella tenotomy was performed to mimic immobilization and limb disuse of an injured limb. PUS and sham PUS were applied to the healing wound for the treatment group and control group for 5 min, 3 times per week for 2 or 4 weeks, respectively. Tensile tests showed that the ultimate tensile strength (UTS) and stiffness of the repaired tendon in the treatment group at 2 weeks reached 48.92 ± 18.39% and 62.48 ± 32.46% of the contralateral normal tendon strength, which were significantly higher than those of the control group (UTS, 30.36 ± 15.46%; stiffness, 33.90 ± 17.59; p < 0.05). At 4 weeks, UTS increased to 77.09 ± 15.31% and stiffness to 92.48 ± 31.12% in the treatment group, significantly higher than those in the control group (UTS, 54.33 ± 18.40%, p < 0.01; stiffness, 65.02 ± 25.48%, p < 0.05). Light microscopy revealed more regular, denser, and better aligned collagen fibers in the healing scar of the PUS-treated healing tendons. The findings suggested that PUS were able to accelerate the healing of the ruptured tendons.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: portable therapeutic ultrasound devices - October 31, 2008 7:07:57 PM
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TexasOrtho
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In an interesting juxtaposition see the following study. The DOI is: 10.1002/jor.20257
Physical activity modulates nerve plasticity and stimulates repair after achilles tendon rupture
In a rat model of tendon rupture using semiquantitative methodology, healing was assessed according to the diameter of newly organized collagen and the occurrence of the sensory neuropeptides (SP, CGRP) in relation to different levels of physical activity. Normally, innervation of the Achilles tendon is confined to the paratenon. After rupture new nerve fibers grow into the tendon proper, but disappear after healing. In a first experiment to establish peak tissue and nerve regeneration after rupture, tendon tissues from freely moving rats were collected consecutively over 16 weeks. A peak increase in organized collagen and nerve ingrowth was observed between week 2 to 4 post rupture. Therefore, in a second experiment week 4 was chosen to assess the effect of physical activity on tendon healing in three groups of rats, that is, wheel running, plaster treated, and freely moving (controls). In the wheel-running group, the diameter of newly organized collagen was 94% ( p = 0.001) greater than that in the plaster-treated group and 48% ( p = 0.02) greater than that in the controls. Inversely, the neuronal occurrence of CGRP in the tendon proper was 57% ( p = 0.02) lower in the wheel-running group than that in the plaster-treated group and 53% ( p = 0.02) lower than that in the controls, suggesting an earlier neuronal in-growth and disappearance in the more active group. Physical activity speeds up tendon healing, which may prove to be linked to accelerated neuronal plasticity. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:164-172, 2007
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Rats yes...but still interesting.
< Message edited by TexasOrtho -- October 31, 2008 7:14:53 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: portable therapeutic ultrasound devices - October 31, 2008 7:34:10 PM
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Sebastian Asselbergs
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Rod, those are interesting. I must admit not seeing a heck of a lot of ruptured tendons in my clinic - and looking at that second study, I know what my approach will be when I do get them.
(and no, I do not treat rats either.....Wait no, I do have a few politicians and lawyers in my care....)
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RE: portable therapeutic ultrasound devices - October 31, 2008 11:05:57 PM
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TexasOrtho
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Bas. I think tendon rupture is an easily studied model for tendon injury. The physiologic mechanisms are similar at many levels, and could be seen in individuals with some of the more common tendopathies we frequently encounter in the clinic. I agree. It's very interesting to see the integration of orthopedics and neuroscience. It seems to be increasingly present in the literature.
BTW I just looked up Barrie. Man it must be freezing up there.
< Message edited by TexasOrtho -- October 31, 2008 11:11:27 PM >
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: portable therapeutic ultrasound devices - November 1, 2008 8:14:33 AM
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SJBird55
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Rod, you might want to be careful in your thoughts on tendon rupture. Sure, there will be some younger individuals with nice "clean" ruptures due to extreme activities/sports or whatever that was the mechanism of injury. But more often than not, I would surmise that the patients we treat with tendon injuries don't have some nice "clean" rupture, but instead have degenerative changes to their tendons. The tendons with the issues aren't nice healthy tissues and haven't been nice and healthy for years. I think you also need to pull in some outcome studies too. Even if there is some physiological response, from an outcome perspective, poorer outcomes are achieved when ultrasound is used. In some cases, a negative relationship was found. (The outcomes were cost, disability and pain.) That information was shared in the early 2000's at a conference, but the Ohio Project never had their findings published. So what I think you need to ask yourself... are the supposed physiological changes with ultrasound use on animals clinically relevant? Do those strength and stiffness measures correlate to something important clinically to substantiate the value of using ultrasound?
The nerve stuff that you found interesting, we already knew from human studies and the Achilles tendon. That's where the eccentric training came into play and the normalization of the neovascular structures.
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