why SWD and IFT in sciatica?

[SURESH BABU BODDU]

i agree with u mr.alophysio

what u said is true, god gave us hands to help others
as physiotherapists we must use our hands than depending on electro therapy equipment. even an child can apply electro therapy equipment if he look at it once.


can we mix up all the above to get best result
i mean 1st thorough assessment, find the root cause for the pain
after having a session of short wave diathermy for 25 minutes can we go for traction along with manipulations.
i think it will be more stressful to the patient to have long session
please tell me your opinion

[Baby_Physio_Kieran]

Personally, I agree with those advocates of manual therapy and exercise prescription to maintain and enhance the treatment effects. Although I do also believe, as has been mentioned in previous posts, that electrotherapy has a part to play with some patients regarding "getting their money's worth", and, to a certain extent (and quite ironically), gaining the patient's trust such that they will return.

I was trained in the UK, and we spent a module studying electrotherapy, it's supposed effects, and it's application. Interestingly the lecturer who taught this module was very sceptical about the effects of most of the modalities, and often rubbished the effects of electrotherapy moments after teaching them...

This lead to many of my cohort, including myself, having a (some would say 'healthly-) scepticism towards electrotherapy.

Despite this (and to my shame), I often found myself applying ultrasound (U/S) to ankles merely to appease the watchful eye of clinical educators who were particularly fond of electrotherapy. - and this was a common story amongst my cohort.

I think it is unfortunate in many ways that the new blood coming through (such as myself) are being swayed so significantly towards the common use of electrotherapy modalities by the seniors under whom we work. Obviously we can learn a lot from the experience and extended knowledge of these clinicians, but personally I think their outdated habits are something that we don't need. (?contraversial)

[rabia]

you dont give the rt answer which machine is best and why so and what manual treatment is more benificial

[Physio-Oms]

Hello everybody, loving this very HOT discussion.
In the 1st page of this discuss. Briganjo and Jebapt have said it well, and i agree with them.
As for the electro therapy modalities, where ive been studyin ie. UAE.....the whole treatment is basic electrotherapy. I was a bit disappointed with this since, its NO communication with patient and personal interaction. But, as much as it stings.....ET does help in some cases.....
as for sciatica, Ive found my patients to respond more to IFT which is a wonderful breakthrough.
Thanks!

[AltoHealth]

In our experience with the public who purchase our IF machines, their biggest complaint has been that the physiotherapists do not seem to really understand the application of the IF.

When we explain to them, what we believe to be the correct frequencies and placements, they are then directed back to their physiotherapist and educates them.

We have found that many pain sufferers have tremendous relief from IF for sciatica, its just a matter of learning more about the equipment and applying the correct placements and frequencies.

[monkey]

Hi Alo,
May I first take exception at your offensive statement against a monkey in your first reply to this, but then I do agree with a lot of what you are saying, but with some exceptions.
My feeling is that as far as sciatica and back pain are concerned pain is everything, get rid of the pain and you get rid of the problem. As you mentioned there are plenty of people walking around with large disc prolapses, severe degenerative change and stiff facet joints that are not effecting them in any way. We also scan plenty of people who have severe sciatica and no changes what so ever on the MRI film (OK to use this abbreviation?).
My impression is that the pain is often due to a sensitized nerve root which may be due to both mechanical and chemical irritation. Manual techniques often aggravate those sciaticas which are "chemical" in origin and these respond best to pure pain control. Are the effects of manipulation purely mechanical? There are schools of thought that suggest manipulations greatest effect is pain modulation.
What I would suggest is do anything that you can to get rid of the pain to allow the person to return to activity. This can be anything from manipulation, medication, advice (yes, just talking sometimes helps best), exercises, acupuncture and if you live in the dark ages use electrotherapy. Usually a combination tailored to the individual works best (treat the person not the condition), and that surely is what the initial assessment is all about.

[alophysio]

Hi Monkey,

Sorry, i didn't know that there actually were people called "monkey" working as physiotherapists - so i retract my statement about monkeys

Secondly, I agree with what you have written - and just so that you know that i have a balanced and fair perspective, i will let you know that there was a recent study that showed that LASER with MT/x was better than MT alone or x alone or something like that (don't have reference on me - on a different computer at the moment).

My main point is that as physiotherapists, our perception in the community is that all we do is massage and put people on machines. Every week, i have lots of new patients asking if what i just did for their treatment was 'physiotherapy' because many other physios that they had seen in the past just gave them some heat, massage and put on I/F (and some home exercises).

THe main point of the assessment IS to provide a provisional diagnosis and then provide appropriate treatment based on your assessment. And in some cases, all you can do is put someone on a machine for pain relief. HOWEVER, in my experience, this is the exception rather than the rule. Most people will try to put up with their pain for a little while so it is not often that you have someone fall in your doorway just from the pain (which has happened to me recently - i helped him across the road to see the GP because there was nothing i could do for him).

In some ways i am happy for the physios in my area to keep doing the same thing because i will then have a clear point-of-difference which will give me a competitive advantage however for the profession of physiotherapy, i would much rather a more sophisticated, multimodal, personally modifed, holistic approach to treatment.

I kid you not, people actually say that physios just work on the muscles, chiros work on your spine and joints. We are not very good at marketing ourselves!

[monkey]

Thanks Alo,
I think we are actually using similar approaches, my intention was just to remind people that it is possible to develop genuine sciatica without any compression or even narrowing of the nerve root canal.

[alophysio]

Hi monkey - i had a reread of my posts - i didn't see a monkey reference in there but i might have missed it - i did however see the reference to chemical stimulation on my 1.05.2006 post - scary that this thread has been going on for so long! haha - indeed i believe that chemical sensitisation is usually the main cause of the sciatica.

[monkey]

Hi Alo, 06-04-2006 you referred to a monkey treating back pain. But I will forgive you, how were you to know that there is a monkey working with Back Pain.

[alophysio]

Haha

Sorry my friend. I completely missed it! I did say however that a monkey can help with their symptoms... i just didn't realise that monkeys had developed such good manual therapy skills and improved knowledge of the anatomy and physiology of the spine-perhaps a journal article in Nature is in order??

I ask for forgiveness and pray that you take it easy on me should we ever meet - i heard that monkeys have 5 times the arm strength of humans...your poor patients!

Thanks for your humour