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It can be used effectively to eliminate plantar
warts.
It can reduce inflammatory pain in certain cases of
bursitis.
Specificity is Key.
Part of the issue I believe many people deal with is that
they expect a miracle out of the device and don't put the
device into proper (or even reasonable) context.
I recently had a patient stumble into my office with an
acute low back injury (four days) and a lateral shift, acute
spasm, unable to get off toilet, put on socks and
shoes. He couldn't bend much less get dressed
normally.
Was I gonna start "stabilizing" him?
Pffft. Come on.
I treated him for a week and a day.
Straight.
I simply gave him some sitting posture education to protect
the lumbar spine, some advice and restrictions on work and home
ADLs, and coached him on a resting position to alleviate
symptoms and gradual restoration of motion. I
also encourage him to use his medications appropriately.
And I did daily ultrasound for one week. I
didn't, however, blast his low back at 1.5
w/cm2 every day. I
started around 0.6 to 0.8 and 20% duty cycle for 12
minutes with him resting in a position of
alleviation. Could irritated tissue handle
more? Later in the week, yes. On day one: no
way. I progressed the intensity and duty as per his
symptom progression and lo and behold in seven days time,
he was dressing again, had achieved nearly full
ROM, almost pain-free and his lateral shift had nearly
fully reversed. And he discontinued his
meds.
Do I do this with every patient? No. The
patient's situational context predicated its use.
It wouldn't have worked with an obese patient. He was
rather mesomorphic, with little adipose in his back.
It may not have worked (likely) if I had seen him 5 weeks
after the injury started. But he came in while still
in an acute phase, and lower doses of ultrasound intelligently
applied (in his case, daily) work well to reduce acute
irritability, especially if other parts of the patient's
program are working properly. Thus this modality
(and others) can be a useful adjunct in the care plan.
Now, before you run back to the office and turn on that
ultrasound that hasn't been turned on in seven years, do
yourself a favor, have it calibrated. A recent
study suggests a rather notable degree of variability can occur
between different devices (manufacturers) and even within a
device itself---i.e. just because the meter says it's putting
out 1.2 w/cm2
doesn't necessarily mean that's what's coming out of the
device.
Bottom line: know what you are doing. Use it
intelligently or don't use it at all.

Take Your Ability to
Treat Shoulder Pain to the Next
Level!
How do you stop "chasing pain" with your
shoulder patients?
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