Dear Colin: My physical therapist uses ultrasound on my shoulder at every therapy session. When I ask her what it’s supposed to accomplish, she tells me it “helps tissues heal.” It feels OK while she’s doing it, but after three months of this and manual therapy I wonder if it’s really worthwhile. Do you think it is?
— Mona, Clackamas
Therapeutic ultrasound has been around for more than 60 years and is one of the most common modalities used by physical therapists (Journal of Physiotherapy 1998). Anecdotally, it helps injured tissues heal, particularly tendons, ligaments and certain types of wounds.
To answer your question, I’ll minimize my bias and base answers primarily on scientific principles and quality research. Quality research means studies that take into account the wide range of variables inherent in human beings and have a design that yields reasonably reliable and valid results. Some of the research on therapeutic ultrasound suffers from poor study design, producing results that just aren’t very useful. For example, some do not include a control group (people who didn’t receive any treatment) while others don’t establish consistent ways to measure treatment results (Pain 1995).
Consequently, those studies aren’t very influential when forming a collective opinion on therapeutic ultrasound.
Probably the biggest problem for therapeutic ultrasound is that the majority of quality research just doesn’t support it.
For example, reviews have found that therapeutic ultrasound is no better than placebo treatment in treating people with shoulder pain (Journal of Occupational Rehabilitation 2006; British Medical Journal 1997), knee pain (Cochrane Database of Systematic Reviews 2001), carpal tunnel syndrome (Cochrane Database of Systematic Reviews 2012; Clinical Evidence 2010; Clinical Rehabilitation 2007), low back pain (The Spine Journal 2011; Pediatric Physical Therapy 2008), tendon damage (Clinical Orthopaedics and Related Research 2008), plantar fasciitis (Clinical Orthopaedics and Related Research 2003), ankle sprains (Cochrane Database of Systematic Reviews 2011) and venous leg ulcers (Health Technology Assessment 2001 2011).
While there is some research supporting therapeutic ultrasound in carpal tunnel syndrome (Archives of Physical Medicine and Rehabilitation 2010), tennis elbow (Clinical Rheumatology 2012) and bone healing (Z Rheumatol 2009), these studies are countered with those showing little benefit for these conditions (Journal of Hand Therapy 2008; Physical Therapy 2006).
However, many health care providers and consumers dismiss medical research, usually citing strong opinions based on personal experience. The main problem with this is that less time becomes available for more effective, less controversial and more supportive (both scientifically and research-based) treatments (exercise, stretching) that have the ability to address the root cause of the problem.
For example, therapeutic ultrasound and other passive treatments (massage, acupuncture, hot packs) can only temporarily control symptoms as opposed to treating the actual health problem.
Carefully prescribed exercise, on the other hand, has been shown in hundreds of research articles to be one of the most cost-effective treatments for some of the most costly diseases (Journal of the American Medical Association 2011).
A key question: How critical are you of your medical care? There are pros and cons to every medical treatment –it’s up to you and your health care provider to choose treatments that are most likely to yield the most benefit per unit of resources invested.
So when it comes to therapeutic ultrasound, perhaps choosing more cost-effective, scientifically supported treatments is a better way to spend your time and insurance money.
Dr. Colin Hoobler presents “Overcoming Back Pain,” 10 a.m.-noon Oct. 13 at c.h. Beaverton. For details, visit chpt.org and click “Next Event.”