therapeutic modalities

[runpt88]

I was wondering if any current PT students or PTs had any input into what they thought about the different modalities available. My track coach is very persistant in believing that electrical stimulation and ultrasound really don't do anything for soft tissue injuries. He thinks that they only really work if you have 6 months to heal and stop all activity. He thinks that active release and graston and much more effective...any opinions?

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[Akiramay]

There really isn't any evidence behind ultrasound from articles I've read.

What kind of injury are you talking about? Neuromuscular electrical stimulation can be used to strengthen muscles if they are weak, but it doesn't 'heal' anything. But it can be used to stimulate a muscle contraction to decrease edema at an injured site. Healing of injured tissues can occur using iontophoresis (for example, DMSO to treat tendonitis) or high volt pulsed current (also can decrease edema at an injured site or help heal a chronic ulcer by promoting tissue granulation and re-epithelialization). There is evidence for this from many studies.

I've never heard of active release or graston. What are those and how do they play into tissue healing?

 

[jesspt]

There really isn't any evidence behind ultrasound from articles I've read.

What kind of injury are you talking about? Neuromuscular electrical stimulation can be used to strengthen muscles if they are weak, but it doesn't 'heal' anything. But it can be used to stimulate a muscle contraction to decrease edema at an injured site. Healing of injured tissues can occur using iontophoresis (for example, DMSO to treat tendonitis) or high volt pulsed current (also can decrease edema at an injured site). There is evidence for this from many studies.

I've never heard of active release or graston. What are those and how do they play into tissue healing?

Active Release Technique and the Graston Technique are both soft tissue mobilization techniques originally developed by Chiropractors. Active Release Technique (ART) uses the therapists hands occasionally with specific patient movements to address soft tissue dysfunction. I have seen little data supporting its efficacy, but I haven't looked very hard, either.

Graston is a type of instrument-assisted soft tissue moibilizaiton tehcnique that is similar to Augmented Soft Tissue Mobilization (ASTYM) which was devleoped (at Ball State, I think) by an MD and a PT. Both techniques use insturments (metal for Graston and ceramic/acrylic for ASTYM) to deliver pressure to soft tissue to promote proliferation of fibroblasts and also to help with fiber orientation. Here is a link to a review of literature regarding soft tissue mobilization. It was done by Don Strack, a Regis University OMPT Fellow.

https://connect.regis.edu/p78856226/

 

[facetguy]

Warren Hammer, DC's text is excellent for soft tissue treatments: http://www.amazon.com/Functional-So...3105/ref=sr_1_1?ie=UTF8&qid=1302531412&sr=8-1

 

[Akiramay]

Active Release Technique and the Graston Technique are both soft tissue mobilization techniques originally developed by Chiropractors. Active Release Technique (ART) uses the therapists hands occasionally with specific patient movements to address soft tissue dysfunction. I have seen little data supporting its efficacy, but I haven't looked very hard, either.

Graston is a type of instrument-assisted soft tissue moibilizaiton tehcnique that is similar to Augmented Soft Tissue Mobilization (ASTYM) which was devleoped (at Ball State, I think) by an MD and a PT. Both techniques use insturments (metal for Graston and ceramic/acrylic for ASTYM) to deliver pressure to soft tissue to promote proliferation of fibroblasts and also to help with fiber orientation. Here is a link to a review of literature regarding soft tissue mobilization. It was done by Don Strack, a Regis University OMPT Fellow.

https://connect.regis.edu/p78856226/

Thanks for the explanation, and what a great link! Very interesting studies and findings. I feel like we won't learn about this in school, just in continuing ed. Do you perform Graston or ASTM on your patients and find it an essential addition to treatment for the reasons the studies provided?

 

[Yohan]

Thanks for the explanation, and what a great link! Very interesting studies and findings. I feel like we won't learn about this in school, just in continuing ed. Do you perform Graston or ASTM on your patients and find it an essential addition to treatment for the reasons the studies provided?

Although I'll be starting DPT this fall and have limited knowledge regarding this issue, I thought I would jump in with a comment. I work as an aide at a large clinic that has many therapists with different specialties and our ASTM tools get used all the time by both PT's and PTA's (so much that the clinic might buy another set so there are enough to go around). Some therapists even have their own tool. When I first started here I inquired about the use of ASTM because it was the first time I had seen it and most of the therapists here think that ASTM is an essential addition to treatment.

(btw, I'm attending Regis in the fall, so I have a feeling I'll be learning more about this 😉)

 

[atstudent]

Thanks for the explanation, and what a great link! Very interesting studies and findings. I feel like we won't learn about this in school, just in continuing ed. Do you perform Graston or ASTM on your patients and find it an essential addition to treatment for the reasons the studies provided?

I am interested to learn Graston because I think it can be a useful tool. Like anything else, it can easily be abused and by some clinicians, it is. I think one reason it is used so often by those who have the training and tools is because it is so expensive. A set of Graston tools will cost you about $2k!

I was looking at a Masters in Athletic Training program that taught Graston as part of its manual therapy class. I could see PT schools teaching it too although it's a good 12 CEU hours 😉

 

[jesspt]

Thanks for the explanation, and what a great link! Very interesting studies and findings. I feel like we won't learn about this in school, just in continuing ed. Do you perform Graston or ASTM on your patients and find it an essential addition to treatment for the reasons the studies provided?

I have yet to take either teh Graston or ASTYM course work. I have used a modified Instrument Assisted STM using things typically found around the clinic such as a reflex hammer, which I am sure would make more than a few Graston or ASTYM practitioners cringe.

 

[Danae00]

I was wondering if any current PT students or PTs had any input into what they thought about the different modalities available. My track coach is very persistant in believing that electrical stimulation and ultrasound really don't do anything for soft tissue injuries. He thinks that they only really work if you have 6 months to heal and stop all activity. He thinks that active release and graston and much more effective...any opinions?

When you say "does nothing for soft tissue injuries" what type of effects are you talking about? Tissue healing? Pain? Mobility? Reducing spasm? Reducing inflammation? Breaking up adhesions? Return to function? And what type of soft tissue injuries? Hard to dispute or agree with what your track coach is saying unless I know what he is referring to.


That said, my general thoughts on electrical stimulation and ultrasound.

I doubt I will ever use ultrasound in practice unless new research studies are done to show that it is effective when applied in a manner than makes clinical sense.

I think TENS and IFC can have their place for pain relief if used as an adjunctive treatment. And patient satisfaction tends to be high (this last point is anecdotal).

Evidence seems to support the use of NMES post rotator cuff surgery and after an ACL repair to increase strength (again, always used as an adjunctive treatment).

To be honest I think one of the main reasons why electrical stimulation is so often used because it let's the PT tend to another patient while it is being applied. This isn't a bad thing per say. It's just a matter of time management.