I would be there is no argument that US and other techniques in PT are not utilized in the most efficacious and effective ways. I believe to make a statement that :US has minimal to no effect in improving patient outcomes" needs to be qualified with a list of RCTs that have shown it has no effect. US should not be used for everything. It has a small role in selected conditions e.g. in calcific tendinitis of the shoulder. Certainly it does not work for an entire laundry list. Unfortunately there are too many who aimlessly continue its use often in combination with ES for "sprains and strains", chronic LBP etc. Responsible use of all techniques we use is the issue.

I use it mainly with plantar fasciitis and lateral epicondylitits that hasn't responded to other treatments. Overall, I rarely use it. Just not that much evidence for its wide use.

The last issue in JOSPT, about adhesive capsulitis, and other RTC demonstrate that US is not effective.

I must admit that I find myself using less and less modalities overall. My clinic does not utilize aides or PTA's so I am typically strapped for time. From time to time I will "try" US on something that does not respond... the crazy thing is I just had a pt who struggled with a bursitis (knee) and after about 4wks of no change we tried US. 3 visits later she was pain free. Difficult NOT to say US had an impact since that was the only change in her POC. Lit reviews seldom ever show its efficacious, but don't tell that to my pt.

Chris Strapped for time? How long do you have with each patient?

I find US as a very useful tool. Nothing beats US on an anterior neck immediately after MVA. It takes the edema down in one treatment. Us is just another tool that should be used as a minor portion of your treatment. It can save time and pain. It is not needed on every patient, but when it is indicated it can really help. ( I am a manual therapist.)

David Lake presented a thorough review of the literature on the clinical effectiveness of ultrasound at the APTA Annual Conference in Baltimore on June 12. The bottom line is that therapeutic ultrasound may be effective for carpal tunnel syndrome, calcific tendonitis, reduction of pain when applied to myofascial trigger points and for patients with fibromyalgia (these studies used both ultrasound and electric stimulation), osteoarthritis of the knees, and possibly lateral epicondylitis. Many studies of ultrasound have methodological flaws, so it is difficult to interpret its effectiveness based on the literature. My opinion is that we need to change our clinical techniques when using ultrasound. It is designed for treatment of small areas of soft tissue, within about 1 to 3 cm depth. Any heating that occurs in the tissues quickly dissipates. If we are heating tissue with ultrasound to facilitate stretching, we need to stretch the tissue during or immediately after the treatment because the tissue quickly cools. And we need to carefully document the effects of ultrasound treatments and publish our outcomes.