Thus far I don't really support U/S. Yes there is evidence in animal studies that it can work but so far in humans I haven't seen any supporting evidence. To me animals and humans are not the same. Personally I need more supporting human evidence. Also, it is practical to use U/S on a patient for 20 minutes in a clinic? I think not.

It is inaccurate to suggest that there is no evidence. Evidence is a spectrum, varying in applicability and quality. There may not be lab controlled high quality evidence but there is in fact sufficient and new evidence to support the use of ultrasound in certain cases.

The key is whether a therapist can clinical rationalize and reason its use, i.e. apply it where it will actually make a difference.

Many US machines are much too big to effectively be used on a desk without running you out of room. They also fail in this regard.

I have been wondering the same thing as Keira; why are there not more human studies on ultrasound? Especially since US is so commonly used in clinic and relatively easy to have the therapist and patient blinded.

I would agree that this tends to require a certain level of deception on the part of the PT, which could potentially be considered unethical as well.

Note: a lack of supporting evidence is very different from having evidence against something. This is why the debate exists at all. There is also a lack of information suggesting is doesn't work as well.

I completely agree with this statement. I think it kind of goes along the lines of 'dont perform a treatment only for the placebo effects', as we have been told a number of times.

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?

Is it possible that one can limit patient's autonomy by providing less treatment options? We know some modalities have no evidence, but clinicians seem to be aware of the positive effect of the modalities.

This is an excellent question! If we were talking about a medication and not ultrasound then animal studies would certainly not cut it. So why is it that we are ok with proceeding just on scientific theory or animal studies? I would be interested in getting peoples thoughts on this.

This question raises a valid point. However since therapeutic ultrasound has been around since the 1940’s and no deleterious effects have been observed it doesn’t seem to be a major concern. In the case of thalidomide it was only around for about 5 years before they stopped selling it. So if therapeutic ultrasound was a major health concern with serious and common side effects I think it would have been removed from use a long time ago. As well keeping in comparison to thalidomide there are contraindications against using U/S for pregnant women because of the unknown effects it has on the growing fetus.

I would stress caution when reading this post. As consumers of evidence, we have a responsibility to analyze and evaluate the quality of studies before using them to influence our practice. When reviewing the psychometric properties of this study we can see several areas of concern that should make us question the weight we put in this conviction. To name a few, this study is from 1986 and included only 20 patients. Further more, we risk misinterpreting data when saying a treatment 'doesn't work' when it is being compared to another treatment control. i.e. if both groups are getting other treatment then non significant change allow us to say there is no difference, not that one is necessarily ineffective. Hopefully that makes sense to people.

My light-hearted illustration of exercising caution and analysis of results would be if i present to you a research study that suggests healthy people cost more than overweight people over their lifespan (actual research) yet as consumers (excuse the pun!) of this evidence we would clearly read between the lines and evaluate the quality and applicability of said outcomes before encouraging each other to be overweight.

I'm not sure what "covered the controls" means, but it doesn't appear to be a true sham. The dosage was set to 10% lower than patient tolerance, but how could they set this if the machine wasn't on? Also, not enough info on their "prestudy" to accept their unpublished finding of the volunteers being "unable to guess accurately" which patients were receiving the true US. I'm more worried about the patient guessing anyways. I'm not totally discounting their method, but I wonder about the level of rigour in this study. This looks more like a pilot anyways as 20 patients seems a bit low given the person-to-person variability in PT treatment. The authors themselves suggest a widespread randomized controlled double blind study of US is warrented, so even they are not convinced. A single (less than perfect) RCT is not enough evidence. I would look for a systematic review, much more recent than 1986 if possible.