Ultrasound, laser and magnetic therapy, is often frequently used by many Physical therapists with the reasoning of reducing pain and improve rehabilitation outcomes. The problem however is that properly conducted studies are categorically showing that it makes no difference at all, and it is wasted time from your session. Indeed, if your physical therapist is using all of these modalities and rotating the patient from machine to machine, the efficacy of the treatment is about as good as throwing your money down the drain.
Physical Therapists need to follow evidence-based care. Physiotherapists are now allied health care professionals. The profession is somewhat a newer entry into a respected health care professional, and as physiotherapists are producing their own research in the best modalities for treating musculoskeletal conditions, the era of “Guru’s” as well as companies driving sales on inefficient machines must come to an end. It is absolutely criminal at this stage to sell patients this type of snake oil interventions, when the research absolutely does not support their use. Its time for a new generation of Physical Therapists to bring back the evidence into physical therapy. The good news is that new graduates are now aware of the importance of exercise, as a primary driver of rehabilitation, but we also need to address the lingering effects of a profession that all too often is guided by dinosaurs, and for-profit marketeers of non-scientific machines.
Ultrasound:
There is now a plethora of research and systematic reviews showing ultrasound to be non-evidence-based practise with no benefit.
| musculoskeletal disorders | strongly negative review of 13 “adequate” trials did not support “the existence” of therapeutic effects (van der Windt, 1999 #372) | ||
| pain and injury | “little evidence” of therapeutic benefit in 10 “acceptable” trials out of 35 candidates; 2 positive trials, 8 negative (Robertson, 2001 #373) | ||
| biological effects | “insufficient biophysical evidence” to justify therapeutic use for pain and injury (Baker, 2001 #374) | ||
| tennis elbow | nine studies produced “platinum” level (better than gold!) evidence of “little or no benefit” (for ESWT)(Buchbinder, 2006 #375) | ||
| tennis elbow | conflicting, “unconvincing” evidence of efficacy from a few trials (of ESWT again) (Ho, 2007 #376) | ||
| rotator cuff tendinopathy | limited evidence “supports … ESWT for chronic calcific rotator cuff tendinitis,” but no non non-calcific (Ho, 2007) | ||
| osteoarthritis of knee | a positive update to a previously negative review, which is strange because it’s based on just 5 small, poor quality trials with trivial “positive” results (Rutjes, 2010 #378) | ||
| lower limb conditions | inconclusive review of 10 of 15 candidates: “no high quality evidence available” (Shanks, 2010 #379) | ||
| ankle sprains | inconclusive but discouraging review of “five small placebo-controlled trials”; the “potential treatment effects of ultrasound appear to be generally small” (van den Bekerom, 2011 #380) | ||
| carpal tunnel syndrome | inconclusive but slightly encouraging review of “only poor quality evidence from very limited data” from 11 trials (Page, 2013 #381) | ||
| chronic low back pain | inconclusive and underwhelming review of 7 small trials, none of them good quality (Ebadi, 2014 #382) | ||
| rotator cuff tendinopathy | negative review “does not provide any benefit … based on low to moderate level evidence” from 11 weak trials(Desmeules, 2015 #383) | ||
(Ingraham, 2018)
HO, C. 2007. Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain). Issues Emerg Health Technol, 1-4.
INGRAHAM, P. 2018. Does Ultrasound Therapy Work? [Online]. Available: https://www.painscience.com/articles/ultrasound.php[Accessed 2022 2022].
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