Josh you raise a very important point, however, I believe that the patients autonomy will remain after you give them a brief explanation (in which you wouldn't be as negative about) and get consent. Your brief explanation can include that ultrasound has been proven to have beneficial effects for some people, but not others (because it has), and so to say that we will monitor the effects (explain effects) and see if it is something we should continue with. I realize that this may decrease the benefits of the placebo effect, but saying this would be the honest/autonomy provoking/honest approach?

Also, in terms of relationship building with other methods.. what other methods work better than this? Sure you can stand beside them while they have NMES on.. but you also have a million other things on the go. U/S forces you to sit down. If you are teaching exercises then you are teaching exercises/focusing on technique, and aren't able to get into much conversation.

Ps.--> I am ALL about the placebo effects. If U/S has other physiological effects on the tissues, that's great. But if it allows me or my PTA time to chat with the patient, build that relationship, and if the patient leaves feeling more comfortable with my practice, even better. Jorge has proven this beneficial effect as we all saw in lecture.

---> EXAMPLE- my Mom tore her peroneus brevis tendon a couple of months ago, went to physio, did all of her exercises, iced, said that the physio did a frictioning technique and didn't think it was getting any better. Then a couple of weeks ago she called me and said that she was finally starting to feel an improvement. What did she think it was from?= the therapist had started using ULTRASOUND! Now she just claims she is going in for the ultrasound. Ironic?