Evidence Based Physical Therapy Practice Articles

Ultrasound: Use It (Correctly) or Lose It.

Michael Rinaldi, PT, OCS

I recently gave a seminar where afterwards, one of the attendees stayed after the course and talked with me for about 10 or 15 minutes.   He's been out almost as long as I have and I could tell he was really into the seminar as I was challenging his earlier beliefs and practices, which had been based on things that he had learned from the Grimsby Institute, the McKenzie Institute, and others.  

He complemented me on the amount of information and the quality of the content of the course, and said that some of what I teach cuts against the grain of what others vehemently teach.  Interestingly, he noted that although he found some others' philosophies and methods useful, he wasn't able to get success with all of it.  I find that interesting because if what I do doesn't work, it doesn't appear in the course.   Everything I teach, I do in the clinic, and if it doesn't work in the clinic or isn't substantiated by quality research, you don't get it.  

Period.  

That's why I teach a "How To" course where you pay about $30 more and actually learn processes for handling a problem, and not a "Current Concepts" or "Recent Advances" type of seminar where you get information only.

The other interesting thing he mentioned was that it was nice to see that I have some proposals for certain conditions where ultrasound is not only indicated, but sets up the rest of the treatment to go better.   He said he's never seen anyone teach that before, and that most of the other courses he goes to, modalities are at times scoffed at. 

Yeah, scoffed at.  And most of us have done it.   We've scoffed at modalities and have conveniently blamed them when our patients don't get better.   Since the 90's, when manual therapy began to rise in its prevalence, courses proudly touting a "zero modality approach" have risen.   Nothing wrong with that as you consider the paucity of high-quality research that supports their use.  However, I believe we've thrown the baby out with the bath water.

We have others citing the Philadelphia Panel's work on trying to guide us into what treatments are supported by research.   The Panel's conclusion on ultrasound was not very supportive.  But on closer examination, the Panel's data pool is far from adequate enough to draw many useful conditions.

So, what's the deal? 

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