Guest guest Posted November 8, 2011 Report Share Posted November 8, 2011 Is there a good RCT of ultrasound with manual therapy and exercise vs. manual therapy and exercise alone? Adam P. Carson, DPT, OCS 3231 Main Street, Suite 3 , AR 72022 www.carsonphysicaltherapy.com On Nov 8, 2011, at 10:49 AM, " Steve Passmore " wrote: > These type studies contrasting Ultrasound to Traction or Manipulation bother > me. I suspect they overlooked the " art " of physical therapy. The thought > of Ultrasound as a " stand-alone " treatment for back pain sounds like an old > school medical prescription. I have 2 major concerns with condemning > ultrasound as an effective modality in the treatment of back pain. > > (1) Ultrasound is a modality with several useful effects. It can be used to > heat and area prior to treatment and stretching, partially break the pain > cycle with trigger point effects, and increase circulation to a damaged > area. This is used as a modality to allow improved treatment with stretch, > mechanical, mobility, exercise, etc. I hope PT moved past it being a > stand-alone treatment many years ago but should not condemn its useful > effects as an adjunct to treatment. > (2) More importantly, I think many therapist totally forgot how to actually > apply this modality. I have observed so many moving the sound head quickly, > too large of an area, in-appropriate site selection, inappropriate intensity > or mode, .... they just turn the darn machine on, chat with the patient or > day dream, as that sound head burns up the 7 minutes on a timer. In > observation, I fear the majority just run the motions and forget the > science. > > Ultrasound and other modalities are often considered " old-fashioned " or > " out-dated " treatments... however, I think they are still vital when > incorporated " correctly " into modern treatment plans. > I applaud anyone who goes takes the time and effort to build a research > study to improve therapy; and, I am speaking in general terms not specific > to this actual study. I believe in Evidenced Based Treatment; but, we must > also incorporate the Art of treatment into studies to improve the science of > PT. > > Steve Passmore PT, MS > Healthy Recruiting Tools > spass@... > Phone: > Fax: > > “What We Did For You Yesterday Is History… What Can We Do For You Today†> > Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card > Design ~ Recruiting Software > > New on PTManager Blog > > Your Daily Posterous Spaces Update October 23rd, 2011 Ultrasound, > Shock Wave Not Effective for Low Back Pain --Doctors > Lounge<http://ptmanagerblog.com/ultrasound-shock-wave-not-effective-for-low- > b> > > Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, > PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=76510365> > > Ultrasound, Shock Wave Not Effective for Low Back Pain Last Updated: October > 21, 2011. > > *Available evidence shows that different treatments of acute low back > pain give similar results* > > Share <http://www.addthis.com/bookmark.php?v=250 & username=doctorslounge> | > <http://www.doctorslounge.com/index.php/news/pb/23989#> > <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge > & source=tbx-250 & lng=en-US & s=myspace & url=http%3A%2F%2Fwww.doctorslounge.com%2 > Findex.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Ef > fective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/ > -/-/4ea2bdcb5c9ba72f/1 & frommenu=1 & uid=4ea2bdcbf3c30039 & pre=http%3A%2F%2Fnews > .google.com%2Fnwshp%3Ftab%3Dcn & tt=0> > <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge > & source=tbx-250 & lng=en-US & s=google & url=http%3A%2F%2Fwww.doctorslounge.com%2F > index.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Eff > ective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/- > /-/4ea2bdcb5c9ba72f/2 & frommenu=1 & uid=4ea2bdcb9620f2d2 & pre=http%3A%2F%2Fnews. > google.com%2Fnwshp%3Ftab%3Dcn & tt=0> > <http://www.doctorslounge.com/index.php/news/pb/23989#> > > Comments: (0) <http://www.doctorslounge.com/index.php/comments/page/23989> > > Tell-a-Friend <http://www.doctorslounge.com/index.php/site/recommend/23989> > > ------------------------------ > *Related* > *The available evidence does not support the effectiveness of ultrasound or > shock wave for treating low back pain, according to a review published in > the October issue of The Spine Journal.* > > FRIDAY, Oct. 21 (HealthDay News) -- The available evidence does not support > the effectiveness of ultrasound or shock wave for treating low back pain > (LBP), according to a review published in the October issue of *The Spine > Journal*. > > Jesús Seco, M.D., Ph.D., from the University of León in Ponferrada, Spain, > and colleagues reviewed available literature to July 2009 to assess the > evidence for efficacy, effectiveness, cost-effectiveness, and safety of > ultrasound and a shock wave device in treating LBP. A total of 13 randomized > controlled trials (RCTs) comparing vibrotherapy with placebo or with other > treatments for LBP were identified, of which four complied with the > inclusion criteria and included 252 patients. Additional data were obtained > from authors of original studies and the risk of bias of each study was > assessed using Cochrane Back Review Group criteria. > > The investigators found that ultrasound, traction, and low-power laser gave > similar results for acute patients with LBP and leg pain due to disc > herniation. Ultrasound was less effective than spinal manipulation in > chronic LBP patients without leg pain. In these patients, a shock wave > device and transcutaneous electrical nerve stimulation produced similar > results. Of the three RCTs on ultrasound, two had a high risk of bias. Only > one study compared ultrasound versus a sham procedure, but results were > unreliable due to inappropriate sham procedure, low sample size, and no > adjustment for potential confounders. > > " The available trials do not demonstrate the efficacy or effectiveness of > ultrasound and shock wave for treating LBP, whether acute or chronic, with > or without leg pain, " the authors write. > > Abstract<http://www.thespinejournalonline.com/article/S1529-9430%2811%290012 > 6-4/abstract> > Full Text (subscription or payment may be > required)<http://www.thespinejournalonline.com/article/S1529-9430%2811%29001 > 26-4/fulltext> > > via doctorslounge.com <http://www.doctorslounge.com/index.php/news/pb/23989> > > Does Anodyne Light Therapy Improve Peripheral Neuropathy in > Diabetes?<http://ptmanagerblog.com/does-anodyne-light-therapy-improve-periph > eral> > > Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, > PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=76510758> > > Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes? A > double-blind, sham-controlled, randomized trial to evaluate monochromatic > infrared photoenergy > > 1. Lawrence A. > Lavery<http://care.diabetesjournals.org/search?author1=Lawrence+A.+Lavery & so > rtspec=date & submit=Submit>, > DPM, MPH, > 2. P. > Murdoch<http://care.diabetesjournals.org/search?author1=+P.+Murdoch & s > ortspec=date & submit=Submit>, > MD, > 3. Jayme > <http://care.diabetesjournals.org/search?author1=Jayme+ & sort > spec=date & submit=Submit>, > MD and > 4. C. > Lavery<http://care.diabetesjournals.org/search?author1=+C.+Lavery & sorts > pec=date & submit=Submit>, > MD > > + <http://care.diabetesjournals.org/content/31/2/316.full#> Author > Affiliations > > 1. From the Department of Surgery, Texas A & M University Health and > Science Center College of Medicine, and White Hospital, Temple, > Texas > > 1. Address correspondence and reprint requests to Lawrence A. Lavery, 703 > Highland Spring Ln., town, TX 78633. E-mail: > lklavery@...<http://care.diabetesjournals.org/content/31/2/316.full/ma > ilto:lklavery@...> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2011 Report Share Posted November 8, 2011 I read the article in The Spine Journal as well as a commentary after the article (the commentary was the best part and was written by a DC/PHD). This article was a literature review… not an original study. Each study had up 35 to 120 subjects. I do not think the APTA article was not included. While they sounded impressive; they really just contrasted US to another form of treatment. Studies compared (1) US to traction, (2) US to TENS, (3) US to placebo US, and (4) US to a spinal manipulation. With the manipulation study, both groups also had a list of exercises also and appears to be a little closer to current treatment ideas (M. Mohseni-Bandpei, J. Critchley and T. Staunton, et al. A prospective randomized controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Physiotherapy, 92 (2006), pp. 34–42). I plan to read this article next. The reviewer pointed out some problems with the current studies and I love a line in his conclusion. “Rather than calling for a moratorium on therapeutic ultrasound, a more practical alternative would be to call for, then perform, the high-quality research that will address the deficiencies highlighted by Seco et al.†The article in 2006 Physiotherapy looks like a better article and does combine Exercise / US vs. Exercise / Manipulation. The goal of that study was to look at manipulation as effective treatment for LBP and US/EX was used as their control group. Steve Passmore PT, MS Healthy Recruiting Tools spass@... Phone: Fax: “What We Did For You Yesterday Is History… What Can We Do For You Today†Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card Design ~ Recruiting Software From: hammerpt@... Sent: Tuesday, November 08, 2011 5:03 PM To: spass@... Subject: Fwd: Art and Science of PT New on PTManager Blog Your Daily Posterous Spaces Update October 23rd, 2011 Ultrasound, Shock Wave Not Effective for Low Back Pain --Doctors Lounge<http://ptmanagerblog.com/ultrasound-shock-wave-not-effective-for-low- b> Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com <http://ptmanagerblog.com/> > [image: Like this post]<http://posterous.com/likes/create?post_id=76510365> Ultrasound, Shock Wave Not Effective for Low Back Pain Last Updated: October 21, 2011. *Available evidence shows that different treatments of acute low back pain give similar results* Share <http://www.addthis.com/bookmark.php?v=250 <http://www.addthis.com/bookmark.php?v=250 & username=doctorslounge> & username=doctorslounge> | <http://www.doctorslounge.com/index.php/news/pb/23989# <http://www.doctorslounge.com/index.php/news/pb/23989> > <http://www.addthis.com/bookmark.php?v=250 <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge> & winname=addthis & pub=doctorslounge & source=tbx-250 & lng=en-US & s=myspace & url=http%3A%2F%2Fwww.doctorslounge.com%2 Findex.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Ef fective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/ -/-/4ea2bdcb5c9ba72f/1 & frommenu=1 & uid=4ea2bdcbf3c30039 & pre=http%3A%2F%2Fnews ..google.com%2Fnwshp%3Ftab%3Dcn & tt=0> <http://www.addthis.com/bookmark.php?v=250 <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge> & winname=addthis & pub=doctorslounge & source=tbx-250 & lng=en-US & s=google & url=http%3A%2F%2Fwww.doctorslounge.com%2F index.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Eff ective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/- /-/4ea2bdcb5c9ba72f/2 & frommenu=1 & uid=4ea2bdcb9620f2d2 & pre=http%3A%2F%2Fnews. google.com%2Fnwshp%3Ftab%3Dcn & tt=0> <http://www.doctorslounge.com/index.php/news/pb/23989# <http://www.doctorslounge.com/index.php/news/pb/23989> > Comments: (0) <http://www.doctorslounge.com/index.php/comments/page/23989> Tell-a-Friend <http://www.doctorslounge.com/index.php/site/recommend/23989> ------------------------------ *Related* *The available evidence does not support the effectiveness of ultrasound or shock wave for treating low back pain, according to a review published in the October issue of The Spine Journal.* FRIDAY, Oct. 21 (HealthDay News) -- The available evidence does not support the effectiveness of ultrasound or shock wave for treating low back pain (LBP), according to a review published in the October issue of *The Spine Journal*. Jesús Seco, M.D., Ph.D., from the University of León in Ponferrada, Spain, and colleagues reviewed available literature to July 2009 to assess the evidence for efficacy, effectiveness, cost-effectiveness, and safety of ultrasound and a shock wave device in treating LBP. A total of 13 randomized controlled trials (RCTs) comparing vibrotherapy with placebo or with other treatments for LBP were identified, of which four complied with the inclusion criteria and included 252 patients. Additional data were obtained from authors of original studies and the risk of bias of each study was assessed using Cochrane Back Review Group criteria. The investigators found that ultrasound, traction, and low-power laser gave similar results for acute patients with LBP and leg pain due to disc herniation. Ultrasound was less effective than spinal manipulation in chronic LBP patients without leg pain. In these patients, a shock wave device and transcutaneous electrical nerve stimulation produced similar results. Of the three RCTs on ultrasound, two had a high risk of bias. Only one study compared ultrasound versus a sham procedure, but results were unreliable due to inappropriate sham procedure, low sample size, and no adjustment for potential confounders. " The available trials do not demonstrate the efficacy or effectiveness of ultrasound and shock wave for treating LBP, whether acute or chronic, with or without leg pain, " the authors write. Abstract<http://www.thespinejournalonline.com/article/S1529-9430%2811%290012 6-4/abstract> Full Text (subscription or payment may be required)<http://www.thespinejournalonline.com/article/S1529-9430%2811%29001 26-4/fulltext> via doctorslounge.com <http://www.doctorslounge.com/index.php/news/pb/23989> Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes?<http://ptmanagerblog.com/does-anodyne-light-therapy-improve-periph eral> Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com <http://ptmanagerblog.com/> > [image: Like this post]<http://posterous.com/likes/create?post_id=76510758> Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes? A double-blind, sham-controlled, randomized trial to evaluate monochromatic infrared photoenergy 1. Lawrence A. Lavery<http://care.diabetesjournals.org/search?author1=Lawrence+A.+Lavery <http://care.diabetesjournals.org/search?author1=Lawrence+A.+Lavery & so> & so rtspec=date & submit=Submit>, DPM, MPH, 2. P. Murdoch<http://care.diabetesjournals.org/search?author1=+P.+Murdoch <http://care.diabetesjournals.org/search?author1=+P.+Murdoch & s> & s ortspec=date & submit=Submit>, MD, 3. Jayme <http://care.diabetesjournals.org/search?author1=Jayme+ <http://care.diabetesjournals.org/search?author1=Jayme+ & sort> & sort spec=date & submit=Submit>, MD and 4. C. Lavery<http://care.diabetesjournals.org/search?author1=+C.+Lavery <http://care.diabetesjournals.org/search?author1=+C.+Lavery & sorts> & sorts pec=date & submit=Submit>, MD + <http://care.diabetesjournals.org/content/31/2/316.full# <http://care.diabetesjournals.org/content/31/2/316.full> > Author Affiliations 1. From the Department of Surgery, Texas A & M University Health and Science Center College of Medicine, and White Hospital, Temple, Texas 1. Address correspondence and reprint requests to Lawrence A. Lavery, 703 Highland Spring Ln., town, TX 78633. E-mail: lklavery@... <mailto:lklavery%40yahoo.com> <http://care.diabetesjournals.org/content/31/2/316.full/ma ilto:lklavery@... <mailto:lklavery%40yahoo.com> > No virus found in this message. Checked by AVG - www.avg.com Version: 2012.0.1869 / Virus Database: 2092/4604 - Release Date: 11/08/11 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2011 Report Share Posted November 10, 2011 With all due respect, I honestly don't believe ultrasound has any role in the " art " of physical therapy for low back pain. I know if I were the person with chronic low back pain, I'd say no to ultrasound. It's a waste of my time and my money. Research supports other interventions that give a lot more bang for my buck. From a business perspective, it's low end revenue. Selena Horner, PT ton, MI > > These type studies contrasting Ultrasound to Traction or Manipulation bother > me. I suspect they overlooked the " art " of physical therapy. The thought > of Ultrasound as a " stand-alone " treatment for back pain sounds like an old > school medical prescription. I have 2 major concerns with condemning > ultrasound as an effective modality in the treatment of back pain. > > (1) Ultrasound is a modality with several useful effects. It can be used to > heat and area prior to treatment and stretching, partially break the pain > cycle with trigger point effects, and increase circulation to a damaged > area. This is used as a modality to allow improved treatment with stretch, > mechanical, mobility, exercise, etc. I hope PT moved past it being a > stand-alone treatment many years ago but should not condemn its useful > effects as an adjunct to treatment. > (2) More importantly, I think many therapist totally forgot how to actually > apply this modality. I have observed so many moving the sound head quickly, > too large of an area, in-appropriate site selection, inappropriate intensity > or mode, .... they just turn the darn machine on, chat with the patient or > day dream, as that sound head burns up the 7 minutes on a timer. In > observation, I fear the majority just run the motions and forget the > science. > > Ultrasound and other modalities are often considered " old-fashioned " or > " out-dated " treatments... however, I think they are still vital when > incorporated " correctly " into modern treatment plans. > I applaud anyone who goes takes the time and effort to build a research > study to improve therapy; and, I am speaking in general terms not specific > to this actual study. I believe in Evidenced Based Treatment; but, we must > also incorporate the Art of treatment into studies to improve the science of > PT. > > Steve Passmore PT, MS > Healthy Recruiting Tools > spass@... > Phone: > Fax: > > " What We Did For You Yesterday Is History… What Can We Do For You Today " > > Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card > Design ~ Recruiting Software > > New on PTManager Blog > > Your Daily Posterous Spaces Update October 23rd, 2011 Ultrasound, > Shock Wave Not Effective for Low Back Pain --Doctors > Lounge<http://ptmanagerblog.com/ultrasound-shock-wave-not-effective-for-low- > b> > > Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, > PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=76510365> > > Ultrasound, Shock Wave Not Effective for Low Back Pain Last Updated: October > 21, 2011. > > > > *Available evidence shows that different treatments of acute low back > pain give similar results* > > Share <http://www.addthis.com/bookmark.php?v=250 & username=doctorslounge> | > <http://www.doctorslounge.com/index.php/news/pb/23989#> > <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge > & source=tbx-250 & lng=en-US & s=myspace & url=http%3A%2F%2Fwww.doctorslounge.com%2 > Findex.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Ef > fective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/ > -/-/4ea2bdcb5c9ba72f/1 & frommenu=1 & uid=4ea2bdcbf3c30039 & pre=http%3A%2F%2Fnews > .google.com%2Fnwshp%3Ftab%3Dcn & tt=0> > <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge > & source=tbx-250 & lng=en-US & s=google & url=http%3A%2F%2Fwww.doctorslounge.com%2F > index.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Eff > ective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/- > /-/4ea2bdcb5c9ba72f/2 & frommenu=1 & uid=4ea2bdcb9620f2d2 & pre=http%3A%2F%2Fnews. > google.com%2Fnwshp%3Ftab%3Dcn & tt=0> > <http://www.doctorslounge.com/index.php/news/pb/23989#> > > Comments: (0) <http://www.doctorslounge.com/index.php/comments/page/23989> > > Tell-a-Friend <http://www.doctorslounge.com/index.php/site/recommend/23989> > > > ------------------------------ > *Related* > *The available evidence does not support the effectiveness of ultrasound or > shock wave for treating low back pain, according to a review published in > the October issue of The Spine Journal.* > > FRIDAY, Oct. 21 (HealthDay News) -- The available evidence does not support > the effectiveness of ultrasound or shock wave for treating low back pain > (LBP), according to a review published in the October issue of *The Spine > Journal*. > > Jesús Seco, M.D., Ph.D., from the University of León in Ponferrada, Spain, > and colleagues reviewed available literature to July 2009 to assess the > evidence for efficacy, effectiveness, cost-effectiveness, and safety of > ultrasound and a shock wave device in treating LBP. A total of 13 randomized > controlled trials (RCTs) comparing vibrotherapy with placebo or with other > treatments for LBP were identified, of which four complied with the > inclusion criteria and included 252 patients. Additional data were obtained > from authors of original studies and the risk of bias of each study was > assessed using Cochrane Back Review Group criteria. > > The investigators found that ultrasound, traction, and low-power laser gave > similar results for acute patients with LBP and leg pain due to disc > herniation. Ultrasound was less effective than spinal manipulation in > chronic LBP patients without leg pain. In these patients, a shock wave > device and transcutaneous electrical nerve stimulation produced similar > results. Of the three RCTs on ultrasound, two had a high risk of bias. Only > one study compared ultrasound versus a sham procedure, but results were > unreliable due to inappropriate sham procedure, low sample size, and no > adjustment for potential confounders. > > " The available trials do not demonstrate the efficacy or effectiveness of > ultrasound and shock wave for treating LBP, whether acute or chronic, with > or without leg pain, " the authors write. > > Abstract<http://www.thespinejournalonline.com/article/S1529-9430%2811%290012 > 6-4/abstract> > Full Text (subscription or payment may be > required)<http://www.thespinejournalonline.com/article/S1529-9430%2811%29001 > 26-4/fulltext> > > via doctorslounge.com <http://www.doctorslounge.com/index.php/news/pb/23989> > > Does Anodyne Light Therapy Improve Peripheral Neuropathy in > Diabetes?<http://ptmanagerblog.com/does-anodyne-light-therapy-improve-periph > eral> > > Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, > PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=76510758> > > Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes? A > double-blind, sham-controlled, randomized trial to evaluate monochromatic > infrared photoenergy > > 1. Lawrence A. > Lavery<http://care.diabetesjournals.org/search?author1=Lawrence+A.+Lavery & so > rtspec=date & submit=Submit>, > DPM, MPH, > 2. P. > Murdoch<http://care.diabetesjournals.org/search?author1=+P.+Murdoch & s > ortspec=date & submit=Submit>, > MD, > 3. Jayme > <http://care.diabetesjournals.org/search?author1=Jayme+ & sort > spec=date & submit=Submit>, > MD and > 4. C. > Lavery<http://care.diabetesjournals.org/search?author1=+C.+Lavery & sorts > pec=date & submit=Submit>, > MD > > + <http://care.diabetesjournals.org/content/31/2/316.full#> Author > Affiliations > > 1. From the Department of Surgery, Texas A & M University Health and > Science Center College of Medicine, and White Hospital, Temple, > Texas > > > 1. Address correspondence and reprint requests to Lawrence A. Lavery, 703 > Highland Spring Ln., town, TX 78633. E-mail: > lklavery@...<http://care.diabetesjournals.org/content/31/2/316.full/ma > ilto:lklavery@...> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2011 Report Share Posted November 11, 2011 Selena, I would caution you to be careful what you wish for....or reference.....in my 25 year PT history of a provider of care....I always witnessed the benefits from US and other modalities as needed, along with a thorough exercise, stretching, posture and strengthening program for my clients. Then, I suffered a low back injury after slipping on ice and snow , and truly appreciated my profession more after receiving US delivered in a slow massage motion, in conjunction with a complete care regimen. If you were in pain, you would be surprised what you would be compelled to consider. Evidence based practice is just one component of our care benchmarks, research has it's role, but business and personal experiences: priceless! E. Lynn MS PT Director of Rehabilitation Marlton Rehabilitation Hospital 92 Brick Rd. Marlton, NJ 08055 ext 4204 From: PTManager [mailto:PTManager ] On Behalf Of selenahorner Sent: Thursday, November 10, 2011 10:15 PM To: PTManager Subject: Re: Art and Science of PT With all due respect, I honestly don't believe ultrasound has any role in the " art " of physical therapy for low back pain. I know if I were the person with chronic low back pain, I'd say no to ultrasound. It's a waste of my time and my money. Research supports other interventions that give a lot more bang for my buck. From a business perspective, it's low end revenue. Selena Horner, PT ton, MI > > These type studies contrasting Ultrasound to Traction or Manipulation bother > me. I suspect they overlooked the " art " of physical therapy. The thought > of Ultrasound as a " stand-alone " treatment for back pain sounds like an old > school medical prescription. I have 2 major concerns with condemning > ultrasound as an effective modality in the treatment of back pain. > > (1) Ultrasound is a modality with several useful effects. It can be used to > heat and area prior to treatment and stretching, partially break the pain > cycle with trigger point effects, and increase circulation to a damaged > area. This is used as a modality to allow improved treatment with stretch, > mechanical, mobility, exercise, etc. I hope PT moved past it being a > stand-alone treatment many years ago but should not condemn its useful > effects as an adjunct to treatment. > (2) More importantly, I think many therapist totally forgot how to actually > apply this modality. I have observed so many moving the sound head quickly, > too large of an area, in-appropriate site selection, inappropriate intensity > or mode, .... they just turn the darn machine on, chat with the patient or > day dream, as that sound head burns up the 7 minutes on a timer. In > observation, I fear the majority just run the motions and forget the > science. > > Ultrasound and other modalities are often considered " old-fashioned " or > " out-dated " treatments... however, I think they are still vital when > incorporated " correctly " into modern treatment plans. > I applaud anyone who goes takes the time and effort to build a research > study to improve therapy; and, I am speaking in general terms not specific > to this actual study. I believe in Evidenced Based Treatment; but, we must > also incorporate the Art of treatment into studies to improve the science of > PT. > > Steve Passmore PT, MS > Healthy Recruiting Tools > spass@... > Phone: > Fax: > > " What We Did For You Yesterday Is History... What Can We Do For You Today " > > Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card > Design ~ Recruiting Software > > New on PTManager Blog > > Your Daily Posterous Spaces Update October 23rd, 2011 Ultrasound, > Shock Wave Not Effective for Low Back Pain --Doctors > Lounge<http://ptmanagerblog.com/ultrasound-shock-wave-not-effective-for-low- > b> > > Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, > PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=76510365> > > Ultrasound, Shock Wave Not Effective for Low Back Pain Last Updated: October > 21, 2011. > > > > *Available evidence shows that different treatments of acute low back > pain give similar results* > > Share <http://www.addthis.com/bookmark.php?v=250 & username=doctorslounge> | > <http://www.doctorslounge.com/index.php/news/pb/23989#<http://www.doctorslounge.\ com/index.php/news/pb/23989>> > <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge > & source=tbx-250 & lng=en-US & s=myspace & url=http%3A%2F%2Fwww.doctorslounge.com%2 > Findex.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Ef > fective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/ > -/-/4ea2bdcb5c9ba72f/1 & frommenu=1 & uid=4ea2bdcbf3c30039 & pre=http%3A%2F%2Fnews > .google.com%2Fnwshp%3Ftab%3Dcn & tt=0> > <http://www.addthis.com/bookmark.php?v=250 & winname=addthis & pub=doctorslounge > & source=tbx-250 & lng=en-US & s=google & url=http%3A%2F%2Fwww.doctorslounge.com%2F > index.php%2Fnews%2Fpb%2F23989 & title=Ultrasound%2C%20Shock%20Wave%20Not%20Eff > ective%20for%20Low%20Back%20Pain%20--Doctors%20Lounge & ate=AT-doctorslounge/- > /-/4ea2bdcb5c9ba72f/2 & frommenu=1 & uid=4ea2bdcb9620f2d2 & pre=http%3A%2F%2Fnews. > google.com%2Fnwshp%3Ftab%3Dcn & tt=0> > <http://www.doctorslounge.com/index.php/news/pb/23989#<http://www.doctorslounge.\ com/index.php/news/pb/23989>> > > Comments: (0) <http://www.doctorslounge.com/index.php/comments/page/23989> > > Tell-a-Friend <http://www.doctorslounge.com/index.php/site/recommend/23989> > > > ------------------------------ > *Related* > *The available evidence does not support the effectiveness of ultrasound or > shock wave for treating low back pain, according to a review published in > the October issue of The Spine Journal.* > > FRIDAY, Oct. 21 (HealthDay News) -- The available evidence does not support > the effectiveness of ultrasound or shock wave for treating low back pain > (LBP), according to a review published in the October issue of *The Spine > Journal*. > > Jesús Seco, M.D., Ph.D., from the University of León in Ponferrada, Spain, > and colleagues reviewed available literature to July 2009 to assess the > evidence for efficacy, effectiveness, cost-effectiveness, and safety of > ultrasound and a shock wave device in treating LBP. A total of 13 randomized > controlled trials (RCTs) comparing vibrotherapy with placebo or with other > treatments for LBP were identified, of which four complied with the > inclusion criteria and included 252 patients. Additional data were obtained > from authors of original studies and the risk of bias of each study was > assessed using Cochrane Back Review Group criteria. > > The investigators found that ultrasound, traction, and low-power laser gave > similar results for acute patients with LBP and leg pain due to disc > herniation. Ultrasound was less effective than spinal manipulation in > chronic LBP patients without leg pain. In these patients, a shock wave > device and transcutaneous electrical nerve stimulation produced similar > results. Of the three RCTs on ultrasound, two had a high risk of bias. Only > one study compared ultrasound versus a sham procedure, but results were > unreliable due to inappropriate sham procedure, low sample size, and no > adjustment for potential confounders. > > " The available trials do not demonstrate the efficacy or effectiveness of > ultrasound and shock wave for treating LBP, whether acute or chronic, with > or without leg pain, " the authors write. > > Abstract<http://www.thespinejournalonline.com/article/S1529-9430%2811%290012 > 6-4/abstract> > Full Text (subscription or payment may be > required)<http://www.thespinejournalonline.com/article/S1529-9430%2811%29001 > 26-4/fulltext> > > via doctorslounge.com <http://www.doctorslounge.com/index.php/news/pb/23989> > > Does Anodyne Light Therapy Improve Peripheral Neuropathy in > Diabetes?<http://ptmanagerblog.com/does-anodyne-light-therapy-improve-periph > eral> > > Posted about 22 hours ago by [image: _portrait_thumb] Kovacek, > PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to > PTManager<http://ptmanagerblog.com> > [image: Like this > post]<http://posterous.com/likes/create?post_id=76510758> > > Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes? A > double-blind, sham-controlled, randomized trial to evaluate monochromatic > infrared photoenergy > > 1. Lawrence A. > Lavery<http://care.diabetesjournals.org/search?author1=Lawrence+A.+Lavery & so > rtspec=date & submit=Submit>, > DPM, MPH, > 2. P. > Murdoch<http://care.diabetesjournals.org/search?author1=+P.+Murdoch & s > ortspec=date & submit=Submit>, > MD, > 3. Jayme > <http://care.diabetesjournals.org/search?author1=Jayme+ & sort > spec=date & submit=Submit>, > MD and > 4. C. > Lavery<http://care.diabetesjournals.org/search?author1=+C.+Lavery & sorts > pec=date & submit=Submit>, > MD > > + <http://care.diabetesjournals.org/content/31/2/316.full#<http://care.diabetesjou\ rnals.org/content/31/2/316.full>> Author > Affiliations > > 1. From the Department of Surgery, Texas A & M University Health and > Science Center College of Medicine, and White Hospital, Temple, > Texas > > > 1. Address correspondence and reprint requests to Lawrence A. Lavery, 703 > Highland Spring Ln., town, TX 78633. E-mail: > lklavery@...<http://care.diabetesjournals.org/content/31/2/316.full/ma > ilto:lklavery@...> > Quote Link to comment Share on other sites More sharing options...
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