David,

I spent an entire year on electrotherapy, and the place I work at has
patients seen by previous physio who come in and say "the other physio was
great because she'd put the tingling machine on me." These patients are what
I called trained, and respond only to general joint mobilisations and
massive bombardment of electrotherapy. In private practice, you learn to
either re-educate the patient or give them what they want, and the former is
not always possible, especially when the patient has been coming in for a
long time!

Henry***


>From: "RIDDELL, David" <[log in to unmask]>
>Reply-To: - for physiotherapists in education and practice
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: ultrasound
>Date: Wed, 22 Aug 2001 11:15:32 +0100
>
>Henry
>
>" ...I feel that I too am slowly discarding U/S and even the
>interferential."
>
>you mean you're still using interferential - what's the evidence like on
>that?!?
>
>cheers
>
>dave riddell
>
>
>-----Original Message-----
>From: Henry Tsao [mailto:[log in to unmask]]
>Sent: 22 August 2001 09:18
>To: [log in to unmask]
>Subject: Re: ultrasound
>
>
>Scott,
>
>Good point and something I thought about after I posted the previous
>message. What about the coldness (or warmth if you have time to warm it up)
>of the U/S gel?? Perhaps all we need is the U/S gel and not the actual
>machine :D Also, does U/S really target the tissue that is damaged, or does
>it just target everything??
>
>  I
>think I am just still at a loss to think why it was so emphasized in my
>undergraduate course not that long ago!
>
>Thanks for bringing this point up.
>
>Henry***
>
> >From: Scott Epsley <[log in to unmask]>
> >Reply-To: - for physiotherapists in education and practice
> ><[log in to unmask]>
> >To: [log in to unmask]
> >Subject: Re: ultrasound
> >Date: Wed, 22 Aug 2001 13:43:25 +1000
> >
> >Henry,
> >Just curious mate - ever tried an ice pack for 20 mins on subacute tennis
> >elbow (whatever that is) and retested grip strength?  What about a hot
> >pack?  Dencorub?
> >Or a 5 minute massage?
> >
> >I'm curious as to what the ultrasound is doing here.  It could be
> >stimulation of sensory receptors (thermal and pressure) that creates a
>pain
> >gate.  Certainly our best physiological understanding of "tennis elbow"
>(I
> >hate that Dx)is one of tendinosis in ECRB with associated neural
>irritation
> >and local muscular trigger points, +/- radioulnar joint, or cervical
> >referral.  None of these I can see would be significantly effected by US.
> >Now a muscle tear with scar contracture maybe - even a ligament as you
> >suggest I suppose (I too have use US on subacute ligs in the past but
>only
> >in high doses - incedentally I don't have one in my practice now and
>don't
> >feel it affects my treatment), but not tennis elbow.
> >
> >Just my opinion.
> >---
> >Scott Epsley
> >BPhty., MAPA, SPG.
> >PRINCIPAL PHYSIOTHERAPIST
> >Clifford Chambers Sports Medicine
> >Suite 4, 120 Russell Street
> >Toowoomba QLD 4350
> >Australia
> >
> >e-mail: [log in to unmask]
> >
> >
> >On Tue, 21 Aug 2001 23:49:06
> >  Henry Tsao wrote:
> > >Frank,
> > >
> > >I understand your point, but I guess where I am coming from is that the
> > >majority of RCT's on U/S show significantly no effect. However, we have
> >to
> > >ask ourselves the question, why are there a small proportion of RCT's
> >that
> > >do show some significant effect if it doesn't work?? Is there something
> >that
> > >we have forgotten to take into account between these studies?? I think
> >this
> > >is an important question to ask ourselves, and not just take the
>article
> >for
> > >what it has to say.
> > >
> > >>There is a big difference between matters not having been proven to
> >work,
> > >>and matters having been proven to not work. The first we can still use
> > >>(things do not have to be proven to work, for them to work), but the
> >second
> > >>is not exactly a credit to our profession, in my opinion.
> > >
> > >***I sort of agree with you. But I think there is also a difference
> >between
> > >proof and effectiveness. U/S has been proven not to have an true effect
> >in
> > >human subjects according to this study, but some time it does seem to
> >have
> > >an effect. Best example is subacute tennis elbow - U/S 1.5 W/cm2 and
> >retest
> > >their grip strength - it is amazing the improvement(this and subacute
> >ankle
> > >sprains are about the only time I use the U/S). I would be cautious in
> > >saying that something that has not been proven to work we can still use
>-
> > >things such as Bowen Therapy and reiki have not undergone strict RCT
> > >studies, but should we still use this?? (Now I will probably have these
> > >therapists lash out something at me :o
> > >
> > >As I said, I am not tending towards or against U/S. I went through a
>uni
> > >where a whole year was devoted to electrotherapy (and I hated it!). I
> >just
> > >think we have to be selective, like all techniques, in their
>application.
> > >
> > >Very winding but sunny day 15 degrees in early morning Brisbane,
> > >
> > >Henry***
> > >
> > >_________________________________________________________________
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