Credit: Trimbio.co.uk Shockwave
Many years ago, I worked alongside a physio who would treat all his patients the same way. He would welcome them, ask about their problem, make detailed notes, but then his treatment of choice was always the same. He would use a mega-pulse machine for 15 minutes, positioned over the area of the patients pain.
This machine produced a field of electro-magnetic energy over the patient's limb. The theory was that the energy would produce a gentle heating effect in the deeper tissues through the gentle oscillation of molecules in the magnetic field.
He would actually explain to patients that he was going to apply a "magic lamp." After the 15 minutes he would book them in for the next session - rinse and repeat. No exercises, no stretching, no soft tissue mobilisation. Just a machine. And yet some people kept on coming back thinking that this was physiotherapy.
Even though I was a relatively new physio, I knew that this was substandard treatment. We had been trained in the use of various electrotherapy machines at university. However, the use of them was only encouraged in the context of a wider treatment intervention.
In recent years, the use of therapeutic machines has fallen out of favour in the NHS setting. Various research studies have been done that demonstrate that other forms of intervention are far more efficient and cost effective. Sadly, I still hear of situations in the private sector where the use of therapeutic machines forms the main part of the treatment. I recently saw a lady who had received 12 sessions on a traction machine at another clinic for her sciatica. She had experienced zero benefit from it.
Types of Electrotherapy
Here are a few types of Electrotherapy which are used in clinic settings:
- Ultrasound
- Laser
- Shockwave
- Infra red
- Traction
- Pulsed Shortwave
I personally sometimes use Ultrasound therapy - it is the only machine that I choose to have. I use it exclusively for some tendon problems as an adjunct to the main treatment which is appropriate loading. It is a very small part of the overall treatment, and I only use it when I believe it is indicated.
Shockwave therapy is currently "on trend," and there is some evidence to suggest a benefit regarding tendons. Basically it is a small probe that provides high frequency oscillations to the site of the tendon pain. I will not go too much into the theory here, but the idea is to give a kick start to the healing response.
For me, it is an unnecessary piece of equipment, because I have found an incredibly high success rate in a combination of manual therapy and progressive loading, developed through years of experience. So why should I spend 10 grand on a shockwave machine?
The other types of electrotherapy are similar in that they provide more energy to the tissues. Theoretically, increased energy will increase the speed of healing. Traction does not impart energy, but is basically used for spinal issues by stretching you, and there is very limited data to support its use.
The Cost-Benefit Analysis
One of the reasons that the NHS rarely use machines for treatment is the fact that they cost thousands of pounds to buy, and yet they are very much (at best) an adjunct to treatment. The bulk of great therapy is a thorough knowledge and application of rehabilitation.
This is not to say that electrotherapy machines are completely useless. Many have good evidence of a therapeutic effect. (For further information visit www.electrotherapy.org). Anything that provides more energy to the healing tissues should be a benefit to recovery. However, if you never deal with the underlying cause of the problem, simply treating the inflammatory process is not going to result in a complete recovery.
In terms of marketing, exciting sounding therapeutic machines are a real winner. They also demand little from the patient in terms of accountability for their recovery. The patient can simply lie back and relax while the machine does its thing. Same again next week then?
On the skeptical side, these expensive machines need paying for, so a model which dictates many repeated visits is a fantastic business model.
Conclusion
In my opinion, the use of therapeutic machines in the private sector is largely just gimmick. That said, I haven't got too much of an issue with them if they are a small part of an overall comprehensive treatment plan. The problem comes when they are the only treatment provided.
At Honiton Physiotherapy we have a structured treatment approach that deals with the cause of problems as well as the symptoms. Our treatment approach includes the appropriate use of manual therapy, exercises and rehabilitation.
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