Knee Mice + Marathon training. Good idea? Bad Idea?

[Wahine]

Please no ultrasound to the joint. Ultrasound is worse than useless to joints. It causes cavitation in the synovial fluid. Little explosions that damage your cartilage. Also the US waves are reflected off the surface of the bone and cause superheating of the first thing they encounter next: the periosteum or the cartilage.

I knew there was a reason why I never use ultrasound!!

Seriously Knot, I hadn't heard about damage to cartilage or periosteal effects when ultrasound was applied properly. I don't pay attention to US research, because I don't really use it but I'd be interested in a reference if you've got one. I'm probably pretty out of date in this realm.

TIA.

[KnottedYet]

I knew there was a reason why I never use ultrasound!!

Seriously Knot, I hadn't heard about damage to cartilage or periosteal effects when ultrasound was applied properly. I don't pay attention to US research, because I don't really use it but I'd be interested in a reference if you've got one. I'm probably pretty out of date in this realm.

TIA.

We had it DRILLED into our heads in school: no US over joints, no US over the spinal cord. (cavitation in the cerebrospinal fluid, just like in synovial fluid). US only over muscle, never over bone less than 1/2 inch deep to the skin.

Of course, US is only recognized as a heat modality at 8x the cost of a hot water bottle... but because of the increased transport over the cell membrane it causes we also had it drilled into our heads that we could cause tumor formation if we used US over questionable tissue.

The periosteal heating is one way you can find stress fractures, and I watched a PT use US once to cause extraordinary pain in a young man's shin: "Yup, there's a fracture there!" and send the kid back to his orthopod.

US is scarey stuff, and I only use it if directly ordered by an MD. Otherwise I tell folks to get a hot pack. The effect is the same and the risks are so much less.

"Manual for Physical Agents" by Karen Hayes talks about the cavitation and periosteal heating. This book is from 2000, so not quite up to date.

"Physical Agents; Theory and Practice" by Behrens and Michlovitz (1996) gets more into the physics of cavitation and reflection, and into some of the other nasties US can do, like degranulating mast cells, producing excess histamine (which isn't always a bad thing) and such. Also out of date, but the physics is nice.

I don't have current research, just anecdotes from other clinicians who read current research and told me about it. I pretty much gave up US a few years ago.

I used to love US, it made me feel so sexy and powerful "oooh, look at me wielding this magic wand, and I get to bill $60 for it!"

Now I see it as a waste of my time, my patients' time, their money, their insurance company's money; and unnecessarily creating dependence on me when all I'm providing is warmth (with added risks) that the patient could achieve for free on their own.

[Wahine]

Knot - I graduated from PT school in 1995 and took my physical agents class in 1993. So that's more current than what I've got. I've just never liked modalities in general and tend to stick to manual and therapeutic exercise stuff, so I never really bothered to try to stay current on US. I do use it occasionally to help diagnose fractures, especially stress fractures. Thanks for the info.

[KnottedYet]

Knot - I graduated from PT school in 1995 and took my physical agents class in 1993. So that's more current than what I've got. I've just never liked modalities in general and tend to stick to manual and therapeutic exercise stuff, so I never really bothered to try to stay current on US. I do use it occasionally to help diagnose fractures, especially stress fractures. Thanks for the info.

I can photocopy and mail the textbook pages if you want them, but they are out of date. We make a point of avoiding modalities at our clinic, so I really haven't kept up on recent stuff.

We did have a minor group heart attack when we heard that diathermy is coming back into vogue. WTF!?!?! DIATHERMY!?!?!

[Trek420]

Speak English you PT's What's diathermy?

[KnottedYet]

Speak English you PT's What's diathermy?

Essentially sticking body parts into a microwave to warm them up.

Insanely stupid and dangerous and was disproved and discarded decades ago.

Trust me, go buy a hot water bottle instead.

[Trek420]

Why not bring back leeches? I hear letting out blood is good.

[Zen]

diathermy
Sure, and after that how about some nice soothing electroshock therapy?
I like getting US, it feels so good

[Trek420]

I like getting US, it feels so good

That's the idea I think. It feels good, so your PT is doing a good job for you because you feel goooood. As opposed to in agony but actually putting the injury back in place.

[Crankin]

Actually, (totally off topic) ECT is being used again, quite successfully to patients who have severe mental illnesses that have not been helped by medication. It's changed a lot since it was used in the '50s and '60s. I have a client that underwent it in September and is doing well, with no side effects.