Hamish,

You have mentioned a few very important issues, but with the article that I
saw (and I am not sure whether you picked it up to have a look), they
actually looked at studies (3-4 per condition) which examined US
effectiveness. They themselves only underwent the study for lat.
epicondylitis, and not other conditions; they simply summarized other
findings under different conditions.

I believe the heating effect for US on muscles is useful personally in the
field of trigger points, since trigger points is an area of anamia and
hypoxia (hence, increasing blood flow to the trigger point is useful - this
is my rationale anyway). As I said, i always use it after acupressure or
spray and stretch. However, the dosage and intensity is still under
contraversy and will probably need research.

Henry***


>From: "Hamish Ashton" <[log in to unmask]>
>Reply-To: "Hamish Ashton" <[log in to unmask]>
>To: <[log in to unmask]>, "electro group" <[log in to unmask]>
>Subject: Electrotherapy
>Date: Sat, 21 Oct 2000 15:19:49 +1300
>
>Dear All
>
>I am sure that EBM is a big topic in most countries as funding becomes
>limited, as it is in NZ at present. There are some key points when one
>looks at the evidence on electrotherapy research that I feel need to be
>considered.
>
>Sorry for the length but......
>
>Firstly what does it mean for a modality to work? If we talk about US are
>you using it for heating, or healing or to decrease swelling or resolve
>inflammation. anyone who has applied continuous US to a muscle area at >
>1W/cm2 knows that there is a heating effect therefore US works if you want
>to use it as a heating modality. As mentioned previously there is a good
>meta-analysis that shows US has a positive effect on ulcer healing
>(Johannsen, F., Gam, AN., & Karlsmark, T. 1998. Ultrasound therapy in
>chronic leg ulceration: a meta-analysis. Wound Repair & Regeneration, 6(2),
>121 - 126.). I also know (no references) that a study on the effect of US
>on tumours in rats or mice had to be stopped early on ethical grounds due
>to the increased size of the tumours. Not the effect we are looking for but
>definitely an effect. El Hag (El-Hag, M., Coghlan, K., Christmas, P.,
>Harvey, W., & Harris, M. 1985. The anti-inflammatory effects of
>dexamethasone and therapeutic ultrasound in oral surgery. British Journal
>of Oral and Maxillofacial Surgery, 23, 17-23.) shows on human subjects that
>US can have an effect on swelling/ inflammation.
>that US has an effect I feel is not in question but can we use it
>clinically to help us treat patients.
>
>Henry mentions a recent study in Pain 1999 that concludes that US has
>limited or no effect. this is common of the literature and I feel it has
>one major flaw. in what other research would you see the comparison of not
>only multiple conditions, multiple diagnoses, and multiple doses in
>treatment. Can you imagine trying to get ethical approval to trial a drug
>on chest and abdominal pain of indiscriminate origin, without even deciding
>on the dose or frequency you are going to use. This is what most of these
>studies have done. Doses are inconsistent not only between studies but also
>within studies. how any conclusions can be drawn I do not know. One might
>argue that we don't use drugs but if we are treating patients why isn't our
>research as strict. Of not the most consistent dose in the literature for
>positive effect on healing / inflammation is 0.1 - 0.5 pulsed 1:4 Satp.
>
>Finally for those who feel that the delivery of US only 2 - 3 times a week
>won't help. in El hags study US was delivered twice 12 hours apart and the
>effect was still present 7 days post treatment. Fyfe in studies in rats
>have shown that 1 minute of US has an effect 96 hours after its been
>delivered (Fyfe, M. & Chahl, L. 1985. The effect of single or repeated
>applications of "therapeutic" ultrasound on plasma extravasation during
>silver nitrate induced inflammation of the rat hind paw ankle joint in
>vivo. Ultrasound in Medicine and Biology, 11(2), 273 - 283.). This suggests
>to me that treatment once or twice a week can have a significant effect if
>we get it right.
>
>In conclusion for us to what to provide EBM we need to not think of a
>modality and its effect but think of a dose of a modality and its effect.
>Amatryptaline (sp) is an antidepressant but when used in a low dose is a
>good membrane stabiliser for chronic pain. Some thinks have more than one
>effect if used differently
>
>The END
>Hamish Ashton
>Physiotherapist trying to improve in my delivery of EMB
>

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