why SWD and IFT in sciatica?

Is it a science at all?

I have re-read the posts above.

I accept that others like electrotherapy and others (like me) don't.

In context, I think a thorough assessment, examination, diagnosis and classification will lead you towards the most appropriate treatments.

Next, how many of us have actually done post-graduate training (e.g. Masters in Sports pHysiotherapy or Manipulative Therapy)? Perhaps we all should consider improving our skills in this way - i started my masters last year after 10 years of clinical practice. I should have started a little sooner!

Lastly, it is hard to provide research in a double blind RCT for manual therapy because a good manual therapist doesn't apply the one treatment in isolation, nor do they apply only one treatment technique to ALL subjects. Also, you cannot "blind" the therapist to what treatment technique the patient is having. Nor can you have a manual therapist provide a placebo without being blinded.

Obviously for electrotherapy, it is not used in isolation (although you do hear lots of stories about electro without much else...), it forms part of the overall management of the patient. But with these studies, you can have both the patient and therapist blinded because you can just make the machine LOOK like it is working when it is not, especially U/S. So theoretically, the studies on electro should be of a higher standard because the therapist never knows if the machine they are using is actually working or not.

Anyway, more food for thought!

After reading through all the posts, I totaly agree that it not science at all to depend on swd/ift in sciatica. If we were to concentrate on finding the cause of sciatica and release the patient of it, pain relief automatically follows.
As someone has written in one of the posts,

Quote:

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I am often frustrated by physios who look down on certain modalities, while maintaining that their particular approach minus modalities is the only one that promotes "professional status". These people, in my opinion, are focused on the diagnosis and not on the holistic treatment of the human being in their care.

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it is not looking down on certain modalities, nor is it that our particular approach minus modalities is the only one that promotes "professional status". It is not that we are focused on the diagnosis and not on the holistic treatment of the human being in our care. If my treatment is backed by a good assessment, I do not need any modality to bring relief of pain to any patient. In fact since most of my patients are direct contact patients,I make it a point to tell them to come for their assessment & their sessions without taking any NSAIDS. This lets me know exactly what effect my treatment has had on the patients symptoms. I emphasise on modality on those patients who are a little sensitive and equate the time spend at the clinic to the price they are paying , and do not concentrate on the relief obtained. In these patients again I give the modality according to what is most convenient to me at that point of time.
Regarding alophysio's comment that the therapist never knows if the machine they are using is actually working or not, I think that would be unforgiving. If I do not use my U/S for a period of time, I always make it a point to test it before administering it on a patient. Even if we use the modality for a placebo effect, one must see that they in working condition.

Hi,

Thanks for your comments asha.

My point about the electro machines not working is that when you design a study, it is more likely to be of a higher quality for electrotherapy because you can blind the therapist.

That is, the therapist doesn't actually know whether the machine is working or not and so that level of bias is taken out of the equation.

Therefore, if there is equivocal research on the use of electrotherapy, then it is stronger evidence that it may not work that for manual therapy simply because the research design is different. Because Electro studies can be DOUBLE BLINDED (MT cannot be for reasons discussed earlier), it is more rigorous evidence that is works or not works.

Obviously in the clinic, you would test your equipment and make sure it is working before using it!

I hope that helps!

In modern physiotherapy we do many stupid things. For sciatica why should we use SWD and IFT or such electro theraputic modalities. Is those going to reduce the cause of Sciatica? Is those going to reduce the postero-lateral disc protrution?

Modern Orthopaedic medicine discovered that, There is a period of spontenious cure for Sciatica or pure postero-lateral disc protrution. That is 3-4 month. In this time the protrud disc is reduced automaticly.

So, we have to perform manipolation (Under traction) to reduce the disc protrution. Only SWD and IFT can be used for reduce the protective muscle spasm induced by pain if there is any.

Osman Gony
BPT; PG. Dip. Orthopaedic Medicine

I fully agree with you , SWD and IFT cannot treat the root cause of pain in sciatica . It can be done only to reduce the pain induced muscle spasms. The key in every treatment is the proper diagnosis and treating the root cause instead of trying to mask the pain using any modalities.

Thanks alophysio, You are right. Guess I was reading through it through my ambience vision.
asha

Thanks alophysio. You are right. Guess I was reading through it with my ambience vision.

Hi,
Can anybody please explain how SWD or IFT would treat the root cause of sciatica..?
I guess its just gonna give u temporary relief..n not treat the cause...instead manipulations would help..

have a read of the posts above...

Hello Sir.. great effort on your part to post such a long answer. Really good notes.. but why not to-the-point answer. I am new to the physio forum.. its interesting to read and share the views on all queries and doubts..
thanks for the information provided..

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

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)

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

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!

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.

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!

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.

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.

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.

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 :D

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