Low back pain (LBP) is the most frequent self‐reported type of musculoskeletal pain. It is often recurrent and has significant psychosocial and socioeconomic consequences. Estimates of the prevalence of LBP vary considerably between studies and reach 33% of population at any given time, 65% for any individual in one‐year and 84% for lifetime prevalence (Henschke 2015).
Chronic non‐specific LBP and its impacts have become an enormous health and socioeconomic problem (Maher 2017).
Recommendation:
- Continuous 1mhz
- 1 -2.5 W/cm2
- 5-10 mins (dependent on siaze of affected area)
- Frequency = 1x per day down to 1 x per week
- Session 6-18 as required
- Combine with =
- Mobilisations/manipulation
- Heat
- Home exercises (including posture correction)
- Acupuncture
Noori et al. (2020) reviewed the current literature assessing the effectiveness of US in back pain. They said three studies in LBP reported that both therapeutic and sham (placebo) ultrasound provided significant improvement in pain intensity. In each of these studies, ultrasound was found to be more effective than placebo. They concluded that ultrasound was best used as an adjunct to treatment (most studies combine it with exercises) and should not be used as a stand alone treatment for back pain.
In 2006 Mohseni-Bandpei et al. conducted a trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. They found both US and manipulation worked to reduce back pain but at 6 month follow up manipulation had had the greater results.
Durmus et al. (2010) compared the effects of electrical stimulation (ES) program and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). They found that US treatment and ES treatment were effective in improving pain, isometric extensor muscle strength, and QOL in patients with CLBP. US and ES groups showed equal results.
Khan et al. (2012) in a study using US and exercises vs sham US and exercises (essentially exercises only) found that ultrasound and exercise combined improved the symptoms of chronic back pain. Exercise alone improved the pain symptoms but was too small to reach satisfactory outcome for patients. They said “Based on these results Ultrasound and Exercise should be the treatment of choice for chronic back pain rather than Exercise alone.”
In a randomised control trial Licciardone et al. (2013) found moderate improvement was observed in 128 (55%) UST patients vs 120 (54%) sham UST patients. Substantial improvement was observed in 103 (44%) UST patients vs 90 (41%) sham UST patients. This lead the authors to suggest US had a large placebo element (although the patients in the US group still had significantly more improvement than the control).
Ebadi et al. (2012) took 50 patients and divided them into two groups in order to investigate the efficacy of continuous US in chronic lumbar pain. The first group received continuous US and exercise, and the second group received placebo US + exercise. They performed a total of ten sessions of therapy for four weeks. They evaluated the patients before and after the therapy using FRI (functional rating index), VAS score, ROM, and endurance time. They found significant improvement in the FRI index in the continuous US group. The decrease in VAS scores, increase in lumbar ROM, and endurance time were more prominent in the continuous US group compared to the placebo US group. Unfortunately they did not include an exercise only group.
Doğan et al. (2008) divided 60 patients into three groups in order to evaluate three different approaches in the treatment of chronic lumbar pain.
- received home exercises + aerobic exercise,
- received physical therapy (hot-pack, TENS, and US) and home exercises,
- received home exercises alone.
They found a significant reduction in the pain level and an increase in aerobic capacity, but there was no significant difference between the groups. They stated that the rate of functional disability and physiological disturbances were lower in the physical therapy and home exercise group.
Grubisić et al. (2005) that evaluated the therapeutic efficiency of US in the treatment of chronic lumbar pain, 16 out of 31 patients received US therapy. Ongoing medical therapies of the study participants were not changed and the patients were only allowed to take paracetamol during painful periods. In the control group, a US device was switched off while performing physical therapy. At the end of the treatment period, US was found to be more effective in providing pain relief; however, US was not found to be superior to the control group in providing functional improvement.
What about Low Intensity Pulsed Ultrasound (LIPUS)?
In a recent study Low-intensity pulsed ultrasound has shown significantly reduced pain and functional disability in patients with early-stage lumbar spondylolysis and could be preferred as a safe non-invasive treatment method for early bone healing according to Tanveer et al. (2021)