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ADMIN NOTE: This thread has been split off from the thread in the Australia forum on 3 or 4 years for UG degree?
Quote:
Originally Posted by Podiatry777
Why is the ultrasound modality not used on the myriad ankle sprains each year by Podiatry?
I assume by the term "used", you refer to therapeutic ultrasound...which continues to slide out of favour with all involved with rehabilitation medicine.
Generally has no evidence to support its use in acute injury. Don't know why I bought one years ago...
If you are referring to diagnostic ultrasound, this harks over to our discussion on ankle sprain and x-ray. One should be able to clinically assess ATF +/- CFL ligament attenuation or tear with reasonable accuracy, or perhaps defer to stress inversion x-ray views if you feel it is required (assuming no other hint of related bony pathology). Its a useful toy, but adds little to thorough clinical examination for recurrent lateral ankle instability in my mind - let alone changing treatment objectives.
LL
Last edited by Admin : 23rd January 2007 at 01:47 AM.
Reason: added admin note
assume by the term "used", you refer to therapeutic ultrasound...which continues to slide out of favour with all involved with rehabilitation medicine.
Yes,Therapeutic ultrasound, please elaborate who concluded and why its going out of favour. Have physios stoped it, how many Pods find negative results. So far I continue to refer to physios and they stil use it in conjunction with stretches and sometimes TENS, I must admit.
I started to research and even self treatment cheap units are on market in USA, along with practitoner models stil out there.
When you bought one years back- was it not effective helping faster recovery than without in your practice? Or has the clientelle died down for its usage and you never noticed any benefits due to follow up/ right dosage or technique? Sorry to sound like I'm questioning your Professional skills, but please tell me if you got a fair chance to test its worth. Is it out of fashion with PODS only??
Thanks
Pod777
Last edited by Admin : 23rd January 2007 at 12:35 AM.
Reason: fixed faulty quote
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Yes,Therapeutic ultrasound, please elaborate who concluded and why its going out of favour.
The preponderance of evidence is that its no better than placebo.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
When you bought one years back- was it not effective helping faster recovery than without in your practice? Or has the clientelle died down for its usage and you never noticed any benefits due to follow up/ right dosage or technique? Sorry to sound like I'm questioning your Professional skills, but please tell me if you got a fair chance to test its worth. Is it out of fashion with PODS only??
Thanks
Pod777
I don't believe it made much difference at all, and was less effective than other simpler (and cheaper) techniques. A little reading around the topic confirmed my suspicions that it is little better than the flashing lights and sleek design would suggest.
You will find most critical thinking physio's would probably agree with this, as there is a limited evidence base to support its use.
Other podiatrists in my practice still use it, so it still gets a workout...just not from me.
I have replaced the use of ultrasound with low level laser. I have had some significant successes as well as some epic failiures but is does seem to work particularly well with rheumatoid pain which has been resistant to all other forms of treatment.
Hello again, and thanks for the continued discussion on the therapeudic ultrasound. I understand from my podiatry lecture notes that the vibrations produce a message of tissue and I suppose maybe loosen the scar tissue/ at least prevent formation of it by increased bloodflow etc.
If you fall asleep and your ultrasound head contact is interrupted-perhaps uneven surfaces at lat ankle sprain site (malleolus)= then it delivers zero pulse. Considering the gel melts fast and head contact interruption is probable- a quality gel could help. That's what I wondered Lisfranc encountered, before in my questions? Do your staff claim success or you don't discuss it any longer since you lost interest in it,LL?
Also, I have ordered Huridoid cream and elastic bandage for my clinic as cheap current alternatives.
So from those references- its stil a debate on evidence. Craig, I've been to your Uni site before, and which of the writings are you asking me to view- I need better directions than your portfolio, please, as I just read your article titles again. Where is the "Prepondarance" evidence, please?
Plain language summary Ultrasound is probably not effective in aiding the healing of ankle sprainsUltrasound, or the use of high frequency sound pulses, is commonly used for treating acute ankle sprains. It is thought that the increase in temperature caused by ultrasound helps soft tissue healing. This review of trials found that ultrasound therapy does not seem to help to reduce pain and swelling, or to improve the ability to stand on the affected foot. Most injuries heal quickly within about two weeks, and ultrasound does not seem to hasten recovery. Most trial results do not support the use of ultrasound, as any differences in effect are very small.
A simple Medline search or seach at Cochrane database (as LL suggests) turns up all the evidence that mostly points to it not working, thou a small number of studies do show it is effective - hence my use of the term "prepondarance of evidence".
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
That'll be the end of the discussion then, Craig and LL, thanks for your time.
I believe Aristotle said something very close to these words, " It is the act of an instructed mind to rest satisfied with a subject to the degree the subject reveals itself".
I'll accept that no more will come out of this discussion, hence.
If you fall asleep and your ultrasound head contact is interrupted-perhaps uneven surfaces at lat ankle sprain site (malleolus)= then it delivers zero pulse. Considering the gel melts fast and head contact interruption is probable- a quality gel could help. That's what I wondered Lisfranc encountered, before in my questions? Do your staff claim success or you don't discuss it any longer since you lost interest in it,LL?
Our machine has some fancy thing that tells us if the head is not in contact with the relevant anatomy, and autocalibrates etc.
Most patients say the area feels "nice and warm" after treatment. Then again, they say the same thing about some good deep tissue massage or a heat pack.
To be honest we havent discussed use of (therapeutic) ultrasound in the practice lately, I try not to dictate to others that work here - everyone has there own beliefs about what 'works' and what doesn't which I try to respect, despite any evidence to the contrary.
One of the fathers of physiotherapy, Brian Maitland, once proposed that every physiotherapist turn off the electricity during business hours. The problem with that is that if one turns off the electricity, then you are forced to turn on your brain.
I have always thought that mechanical problems have mechanical solutions...full stop. Electrotherapy is a farce. It is the 'bottom of the barrell'. If you use it, you have run out of ideas. And, if you use it from the get go, you probably never had any to begin with.
The hard fact is, you can teach a monkey to use ultrasound.
To be honest we havent discussed use of (therapeutic) ultrasound in the practice lately, I try not to dictate to others that work here - everyone has there own beliefs about what 'works' and what doesn't which I try to respect, despite any evidence to the contrary.
LL
Thanks, That's a reasonable tip for employing staff, which usually think they know everything, and learning from an experienced practitioner just won't taKE PLACE. yOU WON'T GET SUED SINCE THEY HAVE INSURENCE, I ASSUME, even if they are your employee not a contractor?
One of the fathers of physiotherapy, Brian Maitland, once proposed that every physiotherapist turn off the electricity during business hours. The problem with that is that if one turns off the electricity, then you are forced to turn on your brain.
I have always thought that mechanical problems have mechanical solutions...full stop. Electrotherapy is a farce. It is the 'bottom of the barrell'. If you use it, you have run out of ideas. And, if you use it from the get go, you probably never had any to begin with.
The hard fact is, you can teach a monkey to use ultrasound.
I bought one 15 years ago. I too was a monkey.
Ooo Ooo
Ron.
Ron, are you a physio and a Pod? I must say I never liked any machines used and specified that a good physio will use hands to message , and employ ultrasound for all that scar tissue STUFF, as well. If that part of ultrasound is under par- then I see no use in it either. I am sceptical of new machines, and expect that are toys for the b... ( you men can have all the vehicles, harley, old holden etc, with any trimmings you like- doesn't bother me in the least)-but cost to patients and unethical treatments do.
I learn alot more from long history taking then anything else-costs me more than the patient-but my job is more satisfying.
Definitelly agree that going back to basics is the key to good treatment, and ankles did heal before any machine came on the market. If it just fools the patient to fork out more $$$- then that's not my kind of ethics!
Like Ron, I am both a pod and physio (the combination, at times, leaves me doubly confused, as with US).
The modality has definite local effects but how this ultimately changes things in the big picture is unknown to me. But let me share the biggest advantage to US....communication.
I have found, for some reason unknown to me, that patients listen better when receiving an US. Whenever I would give an US, I would take the 8 minute opportunity to education the patient on a topic relevant to their care and answer questions. I would do the US in a private area away from the other patients. (If the patients strayed off topic, I would burn their periosteum.) I think this had more clinical value than the US itself.
There are some things that can't be described by RCTs.
Love your humour! Communication value noted. I'd like to do post grad physio now, but I pased the 10 year of original degree entry requirement. Researched my options a week ago on internet. You have all the info for a conservative Lower Limbs specialist- what is the confusion about re your work?Or is that another pun only?
You would argue correctly, however I aim to learn more in physical therapies from experienced clinitians-physio or otherwise. Have you seen Musmed's UK workshops- sadly I don't see much in Australia as common place yet in joint manipulation etc. Please refer me to great sports podiatry resources, books with pictures on techniques-I know you referred me to Cochrane, and I humbly looked it up.
Please refer me to great sports podiatry resources, books with pictures on techniques-
So many resources, so little time...thank God for Google.
Don't necessarily look within "podiatry" for the knowledge you seek. Just as a rheumatologist might consult a pathology textbook for information on a new blood test, look outside your own the professional 'boundaries' for skills to acquire.
Practical training though requires some hands on time with people that practice the skills you seek. Seek out people in your local network, attend courses, and look outside podiatry - we are too small a profession to run the hands on skill acquisition you are looking for. Go to physio workshops, join SMA, etc etc...
Thanks for the quick references.
Looking outside Podiatry is clear to me, attending physio workshops- a little apprehensive as to the reception I may receive?? How did you go in the practicum side of things??
Love your humour! Communication value noted. I'd like to do post grad physio now, but I pased the 10 year of original degree entry requirement. Researched my options a week ago on internet. You have all the info for a conservative Lower Limbs specialist- what is the confusion about re your work?Or is that another pun only?
Pod777
Pod777,
The confusion has more to do with refuting dogma. Having the dual degree without question has broadened my outlook and given me skills that I would not (I'm NOT saying "could not") possess. It also makes me look at some of the practices and belief of both professions with a more critical eye.
Sometimes further knowledge can answer one question, but brings up two.
The confusion has more to do with refuting dogma. Having the dual degree without question has broadened my outlook and given me skills that I would not (I'm NOT saying "could not") possess. It also makes me look at some of the practices and belief of both professions with a more critical eye.
Sometimes further knowledge can answer one question, but brings up two.
Nick
Brilliant post Nick; couldn't agree more. More knowledge doesn't necessarily empower you with greater healing powers, but probably allows you to think more simply; that is the key. And I think the penny drops earlier with presentations that will not respond to conservative therapy.
What can/does a physio do with the lower limb that a podiatrist can't?
I would argue there is a greater scope of practice in podiatry than physio (for this anatomical region).
LL
I rarely disagree with you LL, but I must on this occasion. The further away from the big toe (proximally), the less faith I would have in the typical podiatrist to understand, assess and treat lower-limb musculo-skeletal conditions. Conversely, the more distal the location, the less faith I would have in the typical physiotherapist.
If you had inserted foot instead of lower-limb, I would entirely agree.
Thank you for your resposes. May I boldly ask if either of you trained in Australia? Since i cannot do prac oversees.
Also, boldly, would you be willing to supply good VISUAL (pictures of techniques)references to text or otherwise on lower limb muscle/ligament treatment-stretch/strengthen. I have a couple pictures from UNI days I use, but limited in range. Ankle and foot will suffice for me at this stage, Atlas- I'll leave the knee etc alone til I'm proficcient in the 1st step in improving my Podaitry skills-Keen to start Distally in the body. What says though?
I trained and practice in the States. A good place to start is Slacks books. They have excellent books and videos on PT related topics and manual therapy. The traveling road shows (ie "continuing education") are good, but many push a weakly founded "school of thought" in cult-like fashion. Be sure to not drink the Kool-Aid.
Re:
Re: 3 or 4 years for UG degree?
doesn't bother me in the least)-but cost to patients and unethical treatments do.
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