Ultrasound and TENS for Back Pain

I have found home ultrasound helpful in chronic back pain but there has been little research in its effectivenesss. Now there is a study in low back pain combining it with exercise that found it useful. TENS worked well to but I find if there is any instability, TENS might aggravate the problem so ultrasound is safer.

Rheumatol Int. 2009 Jul 31. [Epub ahead of print] Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial. Durmus D, Durmaz Y, Canturk F.

abstract here

• ultrasond involved ” continuous US … 1 MHz frequency and 1 W/cm2 intensity and a transducer head with an area of 5 cm, an ERA of 4 cm, and a BNR of 1:5. Slow circular movements were applied by the transducer head over the paravertebral low back region. The treatment duration was 10 min.”
• Electrical stimulation
  • (15 min).
  • four electrodes were placed on L2–L4 levels over the erector spinae muscles bulks motor points symmetric biphasic wave was applied with the frequency of 50 Hz and 50 ms of
    phase time.
  • intensity of the current was arranged separately one by one for each patient until apparent muscle contraction was established (60–130 mA).
  • The stimulation was applied as 10 s of contraction and 10 s of relaxation

Exercises involved:

4 exercises:

• Motion, flexibility, and back strengthening exercises of the cervical, thoracic, and lumbar spine; stretching of the erector spine muscle, hamstring muscles, pelvic muscles, and abdominal muscles:

(1) pelvic tilt,

(2) knee to chest,

(3) lower abdominal exercises,

(4) cat and camel,

(5) back extension exercises.

• Special exercises to correct mobility of the spine andhip joints, activate the stabilizing muscles of the spine,and increase flexibility of the lower limb muscles.

• Functional exercises to improve postural control,dynamic body balance, and coordination.

• Progressive relaxation exercises to normalize muscle tension.

Results:

This study showed a doubling of the effects of exercise program. However, it should be noted that the “exercise program” was a necessary component of their results and actually included a relaxation program (progressive muscular relaxation)

Comment – I find ultrasound to be helpful in chronic back pain – even for the more upper back pains – but may have a short lived effect so best given at home by a partner. Cost outlay is an issue though.

Any comments?