caroline cantera

#PT852 #CC

@LukasBarker I have gotten a lot of responses that US should not be used due to the lack of research and effectiveness, but no one has brought up the point that it could be used as a supplement. Cool thinking outside the box!

@HaydenHoekstra What kind of exercises do you think would be a better alternative? I also think that movement conquers all and it is an amazing way to help our patients stay motivated.

#PT582 #CC I think US is interesting and I can honestly say I have never seen it used before this week in lab. This makes me think there is other treatments to achieve the same outcome that may work better. I think I would steer my patients from using it rather promote exercise.

@MorganDrew16 Hi Morgan! Thanks for this insight, I am wondering if you think it would be beneficial to treat a patient with something they perceive to be helpful even if research does not support it? This is definitely a tricky topic. Thoughts? #PT582 #CC

#PT582 #CC In certain situations, ultrasound could be used. While evidence may not clearly supports its healing effects, if the patient believes it provides them with relief, then we could provide that modality as long as it is not the only part of their treatment.

@JordynMaxwell2 Awesome thanks for this article Jordyn! It really is interesting to think that some modalities really might not be any better than a placebo. It really makes you think about how people perceive pain relief. Why do you think this is?? #PT582 #CC

I found a handful of double-blind RCTs on the efficacy of therapeutic ultrasound for adhesive capsulitis. The studies all concluded that there was no additional effect with the use of ultrasound versus the placebo. #PT582 #CC pubmed.ncbi.nlm.nih.gov/29037627/

@TsaiJames_ Thank you for your response! I like the idea of the hotpack because this is something that can be taken with the patient to their home to use whenever they need it. #PT852 #CC

@CanteraCaroline (2/2) acute ankle sprains, (bit.ly/3cFM5Me), & carpal tunnel syndrome (bit.ly/39BYuPb). If I desired to use heat as a modality, I would use a hot pack in order to not take away any time from other interventions. #PT582 #CC

tonight in #PT582 we will be discussing the benefits of ultrasound..etc. Excited to see you all there!! Remember to hashtag #PT582 and #CC in your reply :))

@EmilioA43040616 Cool idea Emilio! How long would you use heat/ice/percussion for? What specific treatments would you use each for?? I'd love to hear more about this idea.

#PT582 #CC Going into this profession, I wanted to fix the root of the problem, not put a bandaid on the symptoms. The research on the effects of US is mixed, so I'd use heat/ice/percussion therapy then moving into active tx for pts.

#CC #PT582 This SR shows little evidence of US being better than a placebo. Due to this, we shouldn't be overusing US. The placebo effect is good, but it's only short term. As DPTs, we need to strive to make lifelong changes. That starts from the inside, not from a wand.

@Riley_shae98 Thanks for this response! We should not be using US excessively on our patients, because this could lead to laziness and decreased motivation. If we use US it should be for proper use and then we can move forward to making lasting changes. #PT582 #CC

@RyanOli22855873 Interesting thought! I feel like unmotivated patients may feel like having this modality is the only intervention, so it is up to us to use our tools when needed, but also teach our patients that motion is the potion, not always modalities. #PT582 #CC

#CC #PT582 (1/2) Due to the mix evidence, I would steer my Pts away from this & focus more on treatment time & functional exercises. The hard part is empowering individuals to develop willingness to adhere to such a program compared to the use of a modality that "does the work

@jacquedompier Yes it is up to us to determine what would benefit our patients the most. US has helped different people, but this does not mean it should be our first choice for everyone (along with all modalities). Thanks for your response!

@CanteraCaroline #CC #PT582 3/3 clinical interventions can do. We have such a large toolbox, and I think we should use it! Some patients might have really profound results, but if we can really apply movement and other clinical skills, I think that is extremely valuable--and a huge role for us!

@SptTaryn I agree that excessive use could cause some adverse effects because of this lack of research. #PT582 #CC

#PT582 #CC (2/2) I would choose to direct away from using this modality excessively. Due to lack of research on the effectiveness, I would maybe consider using it as a placebo for a patient who has chronic problems and needs to try something new.

@SptTaryn Oh I love how you thought about things patients could take with them to do at home. As PTs we should be thinking of the best intervention for our patient, and teaching them something they can use by themselves is definitely a way to do that. #PT582 #CC

#PT582 #CC (1/2) I would choose other modalities over US, such as heat and ice. A patient can’t take the US home with them to help with pain but they can do ice or heat at home to help with pain, inflammation, and blood flow.

@HubbertKaytlin Yeah I think that is smart, it would definitely be smart to weigh out the pros and cons of US before taking the time to use it if it doesn't even work. Thanks for your response! #PT582 #CC

#PT582 #CC Based on what we’ve learned & what we have felt through our own experience, I would probably not advocate much for US in clinic. I think the use & effects of US vary person-person & injury-injury. It may work better in specific tx zones over others.

#PT582 #CC It my pt asked for it & had found use from it previously, I would definitely allow the use of US to be used. If it didn't work how they were anticipating it to, I would talk to them about other modalities we could use that may benefit them more. (1/2)

@ColleenDrisSPT Thanks for this insight Colleen, I have definitely thought about this and have wondered to myself if this could effect people differently depending on how they perceive what actually relieves their pain. Very interesting! #PT582 #CC

#CC #PT582 I have found very little research that supports the effectiveness of US and I think like a lot of modalities you are taping more into a patient's psych. If the pt likes it and gets relief I do not see the hurt in doing it but it probably will not be my first choice.

@abigail_lue Great insight, there are totally different times and circumstances where ultrasound should be used over another intervention. It is probably easier to stretch tissues this way than manually, what do you think? #PT582 #CC

I don't think I would completely steer pts away from US bc there are certain times where it can be effective. For example, if a pt needs to inc length of a tissue via stretching, using US can be a good way to inc the pliability of the tissue beforehand #PT582 #CC

@MeganNAUDPT #PT582 #CC Oh I didn't even think of frozen shoulder, what a great insight Megan! Here is an article I found that talks about how U.S. introduces energy into the shoulder to prep for movement pubmed.ncbi.nlm.nih.gov/29037627/

I think US can be useful for something like a frozen shoulder. I would consider using the thermal effects of US, but I don't think the non-thermal effects are very useful. There are much better treatment methods so it wouldn't be my top choice #CC #PT582

@KristenD_SPT awesome insight Kristen! It is interesting that you said you would use US primarily for tendinopathies, and this study goes to show it can be extremely beneficial for this population. Thanks for the response!

#CC #PT582 I find the benefits of ultrasound to be beneficial, however I find that I would prefer using other forms of treatment prior to resulting to ultrasound. I think I would commonly use ultrasound primarily for tendinopathies. pubmed.ncbi.nlm.nih.gov/21552108/

#PT582 #RO (2/2) Cons: -patient is not actively practicing resistance, less plasticity -cords could get in the way -patient could be distracted by the sensation of the NMES and not focus on the patterns -more contraindications so wouldn’t work for all populations