The REHAB DEPARTMENT => General rehab issues and pain problems => Topic started by: UCIGimp on October 27, 2004, 09:57:11 AM

Title: Ultrasound at PT
Post by: UCIGimp on October 27, 2004, 09:57:11 AM
Has anyone else used ultrasound at PT?  I am currently doing rehab 2xday 5 days a week to "decrease pain and improve mobility" (they are actually increaseing pain but thats another story).  Anyway, my trainer has been trying ultrasound on my knee and quads and as he is doin it the pain makes me want to scream but afterwards I have much better flexibility and loose that constant tight feeling I have in my knee.  They use the ultrasound prior to my exercises, then I exercise/stretch/strengthen my knee and quads, then massage, then a few more strengthing exercises and ice with e-stem (I don't know about the rest of you but I love e-stem, it is so relaxing when I am icing at the end of PT).  
What I really want to know is if anyone else has used ultrasound, their results, and what they thought of it.

~_/)_~ Danielle
Title: Re: Ultrasound at PT
Post by: Heather M. on October 27, 2004, 11:19:25 AM
First of all, the ultrasound shouldn't hurt.  If it does, ask the PT to dial back the strength and to move the wand more quickly over your skin.

Second, I love ultrasound.  If I could go have it done every day, I would.  The BEST ultrasound treatment for me is called phonophoresis--it's ultrasound, but instead of that cold, ooky gel, they use a cortisone cream.  The sound waves push the cortisone deep into your tissue, and for me it was the first relief I got from relentless pain and tightness in my quads and IT band.  It only lasts a couple of hours, unfortunately, but I loved it.

My last PT in Colorado did something cool with the ultrasound--he used this gel called Bio-Freeze, which is kind of like Ben Gay in that it makes your skin feel very cool.  It helps distract you from pain by giving the nerves other sensations to concentrate on, I guess.  Anyway, this PT would use the Bio-Freeze instead of the regular ultrasound gel---AWESOME.  Sometimes he'd even mix the cortisone cream with the Bio Freeze and I tell you during the four to five hours after that treatment I really forgot that I'd had knee surgery.  It was awesome.

Unfortunately for me, the treatment was purely palliative (pain relieving) rather than therapeutic (healing).  Still, I would do it again, and will as soon as I find a good PT here.  Anything is worth it to get some hours of relief.

As for whether there are long term benefits of ultrasound--I can't say for sure.  I know it reduces swelling and inflammation, and can be used to help keep scar tissue from forming and/or break it down.  

Hope this information helps a bit.  I say anything that makes you feel better should be used.  Just ask your PT to dial back the intensity a bit--it shouldn't hurt at all during the treatment.  I found it very soothing, except when they went over this big wad of scar tissue on the side of my knee--that made me jump.  So they were always careful to keep the wand moving quickly there.


PS Have you been evaluated for scar tissue?  It sounds like you don't have a real diagnosis right now, and with your plica syndrome and lateral release, you could have a really serious alignment problem.  Or you could have an overgrowth of scar tissue (perhaps accompanied by patella baja/infera--a nasty little complication).
Title: Re: Ultrasound at PT
Post by: ATsoccergirl on October 27, 2004, 05:16:18 PM
Are they doing ultrasound everytime you go to rehab?

I'm not a huge fan of ultrasound since there is not alot of postitive reasearch that the settings available to use have any effect.  I prefer more active warm ups rather than artificially heating the tissue.  And when you begin to alter the coupling medium it is even less effective.

It should not be painful.  Ask your ATC to try decreasing the intensity or changing the frequency.  You could also just be more sensitive to ultrasound.  The most common cause of US pain occurs when the head isn't being moved fast enough and it heats up the periosteum (covering of the bone).  Some people have a more sensitive periosteum which cannot tolerate US, and causes pain.  
Title: Re: Ultrasound at PT
Post by: chris-oregon on October 27, 2004, 07:06:40 PM
Hey Danielle,

I just got done with PT 5 days a week for 5 weeks. I feel for you!! My PT uses ultrasound and I completely agree with the two pervious posts. I am one of the people that are very sensitive to ultrasound, even if they move it around. One of the PTs that work with my PT said that it had to do with pain tolerance. I think that is bull****. I have chicken legs and there is just not a lot of meat on my legs, so it makes sense that I would need less intensity to get the job done right. But even if you aren't blessed with chicken legs, everyone is different. And Heather is right on with the Biofreeze.... It is awesome!! I am going to ask about the cortisone cream when I go back.
I can not say what I think is the overall result of ultrasound, but I am not sure that it can hurt. I think that it definately helps with muscle tightness and soreness. hope that this helps!!

But honesly......e-stem was the reason that I got up and went to therapy everyday. It is almost better than chocolate!! ;D

Take Care,
Title: Re: Ultrasound at PT
Post by: gimpybecks on October 27, 2004, 11:09:16 PM
They've never used ultrasound at therapy with me...I never even knew it was something that was done, but when I was there on Monday, someone did ask me if they did ultrasound yet.  I said no, and never thought about it again until I read this post.  So thanks to the people for randomly talking about this at this time so that I kind of know what might be going on.  

To UCI gimp, I hope that the pain and such gets better from it!
Title: Re: Ultrasound at PT
Post by: Heather M. on October 28, 2004, 01:27:09 AM
I did want to say that I have significant localized swelling--what is called pre-patellar bursitis.  It comes out as a giant goose egg shape of swelling at the top of my knee.  Basically, there is a lot of swelling and pressure inside my knee, and the fluid bulges out at the weak part of the knee capsule.

Anyway, my old PT in 2002 was of the same mind as Sarah/ATSoccergirl--that there was no clinical proof of long-term benefits of ultrasound.  However, he did the phonophoresis as instructed, and even he was blown away by how dramatically reduced the pre-patellar bursitis was after 7 minutes of ultrasound.  He said he was a believer after that in ultrasounds temporary anti-inflammatory benefits.  I agree.  What's more, my knee always felt fantastic after the phonophoresis, especially when the Bio Freeze was added to the mix.  The knee just felt warm and loose and limber, and the swelling was gone.  Perhaps that explains the reduction in pain.

However, within 24 hours or earlier if I did weight-bearing activities, the swelling came back.  That's because I have ongoing pathology in the knee.  If my knee were fine except for some lingering swelling, I would think phonophoresis (ultrasound with cortisone cream) would be just the thing to knock back the swelling.  The trick would be to keep it from coming back.

There are a number of things out there which make my knee feel better--and liveable.  Phonophoresis is one of them.  The others include Lidoderm patches, home e-stim unit, patellar taping (from below to correct the patella baja), and my beloved Celebrex.  It truly makes the most difference--I would give up everything else in my arsenal before I'd stop taking the Celebrex.  I do liver and kidney function tests every six months, BTW.

Title: Re: Ultrasound at PT
Post by: maxfactor on October 28, 2004, 02:11:02 AM
I haven't had ultra sound since the old days, but if it's the same (hard thing rubbed on the knee after applying gel) I absolutely couldn't tolerate it. I can't have anything touching my knees! Not even a razor. My nerves are so screwed up that if someone touches the knee with any amount of pressure it's like white hot pain. I don't know how to explain it. If you had an ingrown toenail, and whacked it on a couch, it's like that. I can barely see. This has nothing to do with pain tolerence. If I have an itch on the knee, I can't scratch it cause I can't feel the scratch. Very frustrating. Good thing I have blond hairs on my knees and quads! I only shave from just below the knee down. Hey, can I get bio freeze anywhere?

Title: Re: Ultrasound at PT
Post by: mainegal on October 28, 2004, 06:40:15 AM
I just had this today for the first time. I prefer my estim. I didn't notice any difference after the ultrasound. Knee was still tight feeling. Oh well, PT wants to try different things and heck, it is kinda funny to have an ultrasound on your knee.. Adds to my amusement with this all..

Title: Re: Ultrasound at PT
Post by: ATsoccergirl on October 28, 2004, 04:21:26 PM
I don't know what your team physician has set up for modality guidelines, but in my opinion you are past the point where US is going to effective.  Most protocols and research sets a number of treatments that US can be used before it's discontinued.  Typically it's only between 10-14 treatments.  Then you need to take a break from it.  It looses effectiveness after multiple treatments, and there is not a lot of postitive research on the safety of long term treatments.  
Title: Re: Ultrasound at PT
Post by: BuffettBarbie on October 28, 2004, 04:52:46 PM
I LOVE the Ultrasound!  It feels good during, and afterward, my knee feels like a champ!  However, my PT said I don't need it- since I am progressing so well, they are going to up my E-Stim instead!  (I don't think it is fair that you get MORE PT for good progress!)  Maybe I can convince them to give me a back massage at my next PT session!  Ha ha ha....

Many hugs,

Chris  :)