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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