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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*** > > > > > >_________________________________________________________________ > > >Get your FREE download of MSN Explorer at > >http://explorer.msn.com/intl.asp > > > > > > > > >Get 250 color business cards for FREE! > >http://businesscards.lycos.com/vp/fastpath/ > > >_________________________________________________________________ >Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp > > >...................................................................... >BUPA >the personal health service >..................................................................... > >BUPA House, 15-19 Bloomsbury Way, London, WC1A 2BA > >Visit: http://www.bupa.com >---------------------------------------------------------------------- >Internet communications are not secure and therefore BUPA does >not accept legal responsibility for the contents of this message. Any >views or opinions presented are solely those of the author and do >not necessarily represent those of BUPA. >----------------------------------------------------------------------- _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp