Douglas,
MY COMMENTS ARE IN CAPITAL LETTERS.
>A few comments on EBP. We do not have all the answers to our research
>questions
>by a long shot, but we do have a wealth of evidence that is available to us
>now.
>Do we not agree that it is our responsibility to synthesize the evidence
>that
>exists and incorporate that evidence into our current practice? I believe
>we
>should practice according to the best evidence that is available to us at
>the
>time. While there is an important place for "intuitive" approaches in
>practice,
>that "intuitiveness" should be based on the best available evidence. This
>is
>what truly makes us experts and skilled clinicians. PT educational programs
>and
>continuing education providers should present in the context of the
>research
>that is currently available.
WE DO HAVE A LOT MORE KNOWLEDGE AT THE MOMENT THAN BEFORE, AND THERE IS MORE
RESEARCH IN THE LAST 20 YEARS ON PHYSIOTHERAPY INTERVENTION. HOWEVER, MORE
STILL NEEDS TO BE DONE. FOR INSTANCE, McKENZIE EXTENSION EXERCISES... WE
STILL DO NOT KNOW WHAT IT DOES EXACTLY - THE OLD THEORY IS THAT YOU PUT THE
NUCLEUS PULPOSIS INTO THE DISC, BUT THIS WAS DISPROVEN. WITH THE
INTRODUCTION OF DYNAMIC MRI, WE SHOULD SEE A BIG STEP FORWARD IN THIS.
>Henry: Lateral epicondylitis has been shown to be a misnomer. The
>literature
>shows there is no inflammatory process with this condition. Hence many
>authors
>now use tendinosis. [Tendinosis of the elbow (tennis elbow). Clinical
>features
>and findings of histological, immunohistochemical, and electron microscopy
>studies. Kraushaar BS, Nirschl RP, J Bone Joint Surg Am.1999
>Feb;81(2):259-78.
>Review.] However, there is clearly no consensus as to treatment approaches
>as
>the citation below articulates. From the studies I have read, and I haven't
>read
>them all, exercise seems to be the only PT intervention that has been shown
>to
>be effective.
I WILL GO AND READ THE ARTICLES YOU HAVE SUGGESTED. FROM WHAT I KNOW,
LATERAL EPICONDYLITIS PERSISTS BECAUSE THERE IS LITTLE OR NO INFLAMMATORY
PROCESS. THEREFORE, IF ONE CREATES INFLAMMATION, THEN IT HELPS THE BODY TO
HEAL ITSELF.
I WOULD ALSO SUGGEST YOU READ THE FOLLOWING ARTICLE WITH REGARDS TO
ELECTROTHERPY:
Manual Therapy(2000) 5(3), 132-141
"The Role of electrotherapy in comtemporary physiotherapy practice."
T. Watson
SEVERAL THINGS TO NOTE ABOUT MOST RESEARCH ON ELECTROTHERAPY:
1. MOST OF THE STUDIES DONE ON ELECTROTHERAY ARE NOT RCT.
2. THE RESEARCH DONE ON ULTRASOUND AND INTERFERENTIAL THERAPY DO NOT SPECIFY
WHAT "DOSES" WERE USED. WITH ULTRASOUND, MOST PEOPLE TEND TO USE THE SAME
SETTINGS WITHOUT CONSIDERING WHAT THEY ARE TREATING.
AS I SAID, WHAT WE NEED IS SPECIFIC STUDIES WHEREBY ONE SET THE OPTIMAL DOSE
FOR THE PERSON.
"SELECTING THE MOST APPROPRIATE MODALITY IS NOT A MATTER OF LEARNING A
SERIES OF RECIPES, BUT OF CLINICAL DECISION MAKING BASED ON PHYSICS,
PHYSIOLOGY, PATHOLOGY, ASSESSMENT, AND PATIENT TREATMENT SKILLS." - AS A
PHYSIOTHERAPIST, I KNOW THAT I LACK BASIC PHYSICS AND PATHOLOGY, AND I
BELIEVE WE SHOULD BE STRONG IN THIS FIELD TO FULLY UNDERSTAND THE EFFECTS OF
ELECTROTHERAPY.
>I am curious as to why you choose to use US. Was the increase in strength
>temporary?
FROM WHAT I KNOW, LATERAL EPICONDYLITIS PERSISTS BECAUSE THERE IS LITTLE OR
NO INFLAMMATORY PROCESS. THEREFORE, IF ONE CREATES INFLAMMATION, THEN IT
HELPS THE BODY TO HEAL ITSELF. I WORK A LOT WITH MYOFASCIAL TRIGGER POINTS,
AND FOUND THAT WITH "LATERAL EPICONDYLITIS," THERE IS ATTACHMENT TRIGGER
POINTS (IE, TrP AT MUSCULOTENDINOUS OR OSSEUS ATTACHMENT). THERE IS A STUDY
IN THE AMERICAN JOURNAL OF REHAB MEDICINE THAT EXAMINED THE USE OF U/S ON
ATTACHMENT TRIGGER POINTS OF THE ELBOW(THIS IS THE TYPE OF STUDIES THAT WE
NEED MORE OF - VERY SPECIFIC AND RCT), AND FOUND THAT IF IT IS DONE WITH
STRETCHES, THE EFFECT IS SIGNIFICANT. CLINICALLY, I SEE GREAT RESULTS JUST
FROM USING U/S ON LATERAL OR MEDIAL EPICONDYLITIS (3MHZ, 0.6-0.8W/CM2,
CONTINUOUS), AND THE STRETCHES ENHANCE AND MAINTAINS THE IMPROVEMENT (SO THE
EFFECT IS NOT TEMPORARY). AS I SAID, TRY IT FOR YOURSELF!
Henry***
>
>Douglas M. White, PT, OCS
>Physical Therapist, Consultant
>191 Blue Hills Parkway
>Milton, MA USA 02186
>P: 617.696.1974
>[log in to unmask]
>http://DouglasWhite.tripod.com
>
>
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