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Icing after ultrasound?

Posted by Sharon W on 4/18/02 at 07:55 (080111)

I went to my firt PT yesterday and they did therapeutic ultrasound. Please correct me if I'm wrong -- but my understanding of how ultrasound works, it that it brings new blood and capillaries, etc. to the PF area, helping it to heal. The ultrasound didn't hurt at all, while she was doing it, but my feet started hurting after I got home...

Anyway, afterwards I REALLY wanted to ice my feet, but I was afraid to because I thought it might reduce the blood flow to the feet and impair the effectiveness of the ultrasound. I don't know whether it could be a problem, or not, so I'm hoping that 'voices of experience' who have been through this before, will help steer me in the right direction!

-- Sharon

Re: Icing after ultrasound?

Rich on 4/18/02 at 07:59 (080112)

Hi Sharon,

I can't say that ultrasound alone caused any soreness from PT. I enjoyed the massaging that went with it. My ultrasound was always followed by deep massage and then ice massage. I usually limped a little more afterwards, but think the walk out to the parking lot caused more pain than the lingering PT effects.

Rich

Re: Icing after ultrasound?

Sharon W on 4/18/02 at 08:06 (080115)

Thanks, Rich,

If your ultrasound was always followed by icing, I guess that answers my question... they certainly wouldn't do THAT if it interfered with the healing effects!

My PT didn't do any massage at all. She did an evaluation, then gave me some stretches to do, printed out on a sheet of paper, and asked if I wanted to do ultrasound or iontophoresis. She said she had treated patients with PF before but had never had anyone with TTS -- and it really didn't sound like she even knew what TTS WAS! I ended up explaining it to her... LOL

-- Sharon

Re: Isn't that so typical!

Rich on 4/18/02 at 08:21 (080117)

My first foot, we started PT with a parrafin wrap, then iontophoresis followed by ultrasound and massage. Second foot was iontophoresis followed by ultrasound, deep massage, then ice massage.

For the first visit, the pt evaluated me and gave me printouts of wall stretches and a diagram for a wooden wedge for stretching. My hubby made me two, one for home and one for the office. The wall stretching was too much but the wedges really helped. I think you can find a picture in Scott's Heel Pain Book? As for the rest, it wasn't my choice but the Pod's prescription that they had to follow. It took three visits before I found a therapist I really liked and I had all visits with him after that. Some seem more experienced with different techniques and/or more caring and that makes a huge difference too.

You might need to just try someone else...hopefully there is more than one therapist employed where you were sent!

Hang in there....

Rich

Re: That's my OTHER Problem...

Sharon W on 4/18/02 at 08:50 (080119)

Rich,

Your pod was very explicit about what he/she wanted PT to do. My pod, when I asked her what PT would do, said, 'Well, they'll evaluate you and then decide what treatments to use... I really don't know too much about it, but they'll take care of you...'

Another thing I noticed while I was there: I saw my pod's scrip for PT in the chart, and being a nurse (although not currently working, for obvious reasons), I know how to read scrips. Her scrip said my diagnosis was bilateral PF and BILATERAL TTS. This is an important point because I have NOT been diagnosed with TTS in my left foot before, only the right. I had pretty much assumed the TTS had moved into my left foot, too, because my left foot now shows TINEL'S SIGN (it didn't, before). But it BOTHERS me that my pod didn't mention that rather important change of diagnosis to me!

Obviously, it's time to change pods. I was already planning to ask my family Dr. for a new referral. But I can't even get in to see her for another couple of weeks...

Sorry, guess I'm rambling, venting my frustration...

-- Sharon

Re: Icing after ultrasound?

Ed Davis, DPM on 4/18/02 at 12:21 (080145)

We almost always apply ice to an area after ultrasound. Ultrasound is a powerful modality that temporarily increases inflammation of an area.
Ed

Re: Icing after ultrasound?

Sharon W on 4/18/02 at 12:29 (080147)

Thanks, Dr. Ed.

-- I guess the inflammation is why it HURTS?

-- Sharon

Re: That's my OTHER Problem...

Rich on 4/18/02 at 15:48 (080172)

No, not at all...ramble away! It's not like I'm going anywhere! LOL

Have you tried to ask for a referral over the phone? Then you waste your time or the doc's. Just a thought.

I would definetly question that diagnosis...and a pod who doesn't know much about physical therapy??????

Hello?????

Hang in there...
Rich

Re: Icing after ultrasound?

Mahatmelissama on 4/18/02 at 16:25 (080182)

Sharon,

Ultra sound is intense heat...maybe you could tell him to put it on a low setting next time? I had my pt put it on a low setting since i was scared of it. the Ultra sound didn't hurt but the stretches he has me doing today
DO HURT (why did I listen to him)? ;)

Re: PT and unexplained phenomenon

Sharon W on 4/18/02 at 17:36 (080193)

Mahatmelissama:

Sounds like a good idea. My feet are STILL burning after yesterday's treatment, and I have another one in the morning. It does not feel like it's because of the stretches.

But it may not be because of the machine. I don't know why, and I haven't seen other people post about this problem so it must be JUST ME, but every single time someone (who even SORT OF knows what they're doing) pokes at the nerves in my foot, I am MISERABLE that night, and often the following night as well. At first I thought this was some kind of coincidence, but it happens EVERY SINGLE TIME and the same thing happened (only worse) when I had the nerve conduction tests done. So I think it has something to do with those nerves being stimulated, but I don't understand it at all, and my pod cannot explain it -- I don't even think she BELIEVES me, to tell you the truth...

Oops, didn't mean to carry on like that. It just frustrates me because I don't understand it.

-- Sharon

Re: That's my OTHER Problem...

Sharon W on 4/18/02 at 17:41 (080194)

Rich,

Thanks, I appreciate the support.

Actually, I think her diagnosis that I now have TTS on BOTH sides instead of just on the right is probably correct. I have been noticing those familiar symptoms showing up on the 'wrong' side, increasingly, for a couple of months. But I think my pod should have TALKED to me about it... that's what got me mad!

-- Sharon

Re: That's my OTHER Problem...

Carole C in NOLA on 4/18/02 at 17:52 (080196)

Maybe your pod was concerned that you might get depressed and discouraged, but I still think it's her duty to inform you of any changes she sees in your condition.

If/when you see her again, I think you should bring this up.

Carole C

Re: PT and unexplained phenomenon

Carole C in NOLA on 4/18/02 at 17:54 (080197)

I hope you are not getting RSD. I don't know anything about it except that there is a lot of pain when anything even touches your foot. Several people her on the message board have it.

Carole C

Re: PT and unexplained phenomenon

Sharon W on 4/18/02 at 18:03 (080200)

Carole,

Wouldn't RSD show up on NCV studies, or an EMG? Because, all mine showed was TTS.

-- Sharon

Re: PT and unexplained phenomenon

Carole C in NOLA on 4/18/02 at 19:06 (080208)

Well, I was thinking maybe it was an early stage of RSD. I have no idea how bad it has to get before it shows up. My, aren't I just sunshiny and smily? Sorry for the gloomy thoughts and I WILL knock on wood now. LOL

Carole

Re: Knock on wood!

Sharon W on 4/18/02 at 19:50 (080215)

Carole,

I DON'T think it is RSD. I don't have THAT level of pain, at least not very often, THANK GOD. And my feet and ankles are never hyper-sensitive to the slightest touch, and I don't have the temperature & color changes. But the phenomenon I mentioned in my previous post is CONSISTENT, it always happens, and I don't think it is a coincidence.

You commented once that it is always easier to deal with something, when you understand it. I feel the same way -- and this, I do not understand!

-- Sharon

Re: PT and unexplained phenomenon

Sharon W on 4/18/02 at 20:02 (080216)

Carole,

When I change pods I will avoid mentioning this 'phenomenon' to the new one.

-- Sharon

Re: PT and unexplained phenomenon

wendyn on 4/18/02 at 21:10 (080225)

I don't belive that RSD is something that would show up on a nerve conduction study - it's not really a nerve entrapment.

RSD doesn't mean that the nerve doesn't work, it means that the nerve sends inaccurate messages and it causes inappropriate sympathetic nervous system responses.

How's that for mudding up the waters?

Re: Keeping you in prayer Sharon W for a great new POD

Mahatmelissama on 4/19/02 at 11:18 (080301)

I will add you to my prayer list, Sharon, for a GREAT pod.

My heart goes out to you, having to endure so much. I wish I
could beat some of them up for you, when I read that, like Xena
the Warrior princess.

Anyway, may you be blessed with a wonderful, SMART WISE podiatrist.

Re: Keeping you in prayer Sharon W for a great new POD

Sharon W on 4/19/02 at 11:50 (080305)

Thanks, I appreciate that. In the meantime, I am continuing ultrasound with PT. Today I came home and IMMEDIATELY iced, thanks to Dr. Ed's comments (and yours) and my feet aren't bothering me anywhere near as much this time. :) Oh, and the therapist went through all the streches with me... and didn't push me too hard, so I was happy with that.

By the way, I used to be a BIG FAN of Xena, the Warrior Princess!

-- Sharon

Re: Icing after ultrasound?

Ed Davis, DPM on 4/19/02 at 18:08 (080358)

Ultrasound is a high frequency sound wave and has no heat, nor any particular temperature. The sound waves pass through skin, fatty tissue and are absorbed by the denser tissues such as the fascia and bone. The sound vibrations when absorbed cause the deeper tissues to heat up and re-radiate the mechanical energy absorbed from the ultrasound as heat to the more superficial tissues. The therapist must rapidly move the ultrasound applicator head to prevent build up of excessive heat in one area.
Ed

Re: Icing after ultrasound?

Sharon W on 4/19/02 at 22:21 (080405)

Thanks, Dr. Ed,

That makes sense.

-- Sharon

Re: Keeping you in prayer Sharon W for a great new POD

Mahatmelissama on 4/20/02 at 16:15 (080486)

hehe...someday Sharon, you and I will be able to chase villians through the jungle and sling them with arrows. ;)
I also like watching RELIC HUNTER too.

Ice is a big blessing Good for you! :D

Re: Icing after ultrasound?

Rich on 4/18/02 at 07:59 (080112)

Hi Sharon,

I can't say that ultrasound alone caused any soreness from PT. I enjoyed the massaging that went with it. My ultrasound was always followed by deep massage and then ice massage. I usually limped a little more afterwards, but think the walk out to the parking lot caused more pain than the lingering PT effects.

Rich

Re: Icing after ultrasound?

Sharon W on 4/18/02 at 08:06 (080115)

Thanks, Rich,

If your ultrasound was always followed by icing, I guess that answers my question... they certainly wouldn't do THAT if it interfered with the healing effects!

My PT didn't do any massage at all. She did an evaluation, then gave me some stretches to do, printed out on a sheet of paper, and asked if I wanted to do ultrasound or iontophoresis. She said she had treated patients with PF before but had never had anyone with TTS -- and it really didn't sound like she even knew what TTS WAS! I ended up explaining it to her... LOL

-- Sharon

Re: Isn't that so typical!

Rich on 4/18/02 at 08:21 (080117)

My first foot, we started PT with a parrafin wrap, then iontophoresis followed by ultrasound and massage. Second foot was iontophoresis followed by ultrasound, deep massage, then ice massage.

For the first visit, the pt evaluated me and gave me printouts of wall stretches and a diagram for a wooden wedge for stretching. My hubby made me two, one for home and one for the office. The wall stretching was too much but the wedges really helped. I think you can find a picture in Scott's Heel Pain Book? As for the rest, it wasn't my choice but the Pod's prescription that they had to follow. It took three visits before I found a therapist I really liked and I had all visits with him after that. Some seem more experienced with different techniques and/or more caring and that makes a huge difference too.

You might need to just try someone else...hopefully there is more than one therapist employed where you were sent!

Hang in there....

Rich

Re: That's my OTHER Problem...

Sharon W on 4/18/02 at 08:50 (080119)

Rich,

Your pod was very explicit about what he/she wanted PT to do. My pod, when I asked her what PT would do, said, 'Well, they'll evaluate you and then decide what treatments to use... I really don't know too much about it, but they'll take care of you...'

Another thing I noticed while I was there: I saw my pod's scrip for PT in the chart, and being a nurse (although not currently working, for obvious reasons), I know how to read scrips. Her scrip said my diagnosis was bilateral PF and BILATERAL TTS. This is an important point because I have NOT been diagnosed with TTS in my left foot before, only the right. I had pretty much assumed the TTS had moved into my left foot, too, because my left foot now shows TINEL'S SIGN (it didn't, before). But it BOTHERS me that my pod didn't mention that rather important change of diagnosis to me!

Obviously, it's time to change pods. I was already planning to ask my family Dr. for a new referral. But I can't even get in to see her for another couple of weeks...

Sorry, guess I'm rambling, venting my frustration...

-- Sharon

Re: Icing after ultrasound?

Ed Davis, DPM on 4/18/02 at 12:21 (080145)

We almost always apply ice to an area after ultrasound. Ultrasound is a powerful modality that temporarily increases inflammation of an area.
Ed

Re: Icing after ultrasound?

Sharon W on 4/18/02 at 12:29 (080147)

Thanks, Dr. Ed.

-- I guess the inflammation is why it HURTS?

-- Sharon

Re: That's my OTHER Problem...

Rich on 4/18/02 at 15:48 (080172)

No, not at all...ramble away! It's not like I'm going anywhere! LOL

Have you tried to ask for a referral over the phone? Then you waste your time or the doc's. Just a thought.

I would definetly question that diagnosis...and a pod who doesn't know much about physical therapy??????

Hello?????

Hang in there...
Rich

Re: Icing after ultrasound?

Mahatmelissama on 4/18/02 at 16:25 (080182)

Sharon,

Ultra sound is intense heat...maybe you could tell him to put it on a low setting next time? I had my pt put it on a low setting since i was scared of it. the Ultra sound didn't hurt but the stretches he has me doing today
DO HURT (why did I listen to him)? ;)

Re: PT and unexplained phenomenon

Sharon W on 4/18/02 at 17:36 (080193)

Mahatmelissama:

Sounds like a good idea. My feet are STILL burning after yesterday's treatment, and I have another one in the morning. It does not feel like it's because of the stretches.

But it may not be because of the machine. I don't know why, and I haven't seen other people post about this problem so it must be JUST ME, but every single time someone (who even SORT OF knows what they're doing) pokes at the nerves in my foot, I am MISERABLE that night, and often the following night as well. At first I thought this was some kind of coincidence, but it happens EVERY SINGLE TIME and the same thing happened (only worse) when I had the nerve conduction tests done. So I think it has something to do with those nerves being stimulated, but I don't understand it at all, and my pod cannot explain it -- I don't even think she BELIEVES me, to tell you the truth...

Oops, didn't mean to carry on like that. It just frustrates me because I don't understand it.

-- Sharon

Re: That's my OTHER Problem...

Sharon W on 4/18/02 at 17:41 (080194)

Rich,

Thanks, I appreciate the support.

Actually, I think her diagnosis that I now have TTS on BOTH sides instead of just on the right is probably correct. I have been noticing those familiar symptoms showing up on the 'wrong' side, increasingly, for a couple of months. But I think my pod should have TALKED to me about it... that's what got me mad!

-- Sharon

Re: That's my OTHER Problem...

Carole C in NOLA on 4/18/02 at 17:52 (080196)

Maybe your pod was concerned that you might get depressed and discouraged, but I still think it's her duty to inform you of any changes she sees in your condition.

If/when you see her again, I think you should bring this up.

Carole C

Re: PT and unexplained phenomenon

Carole C in NOLA on 4/18/02 at 17:54 (080197)

I hope you are not getting RSD. I don't know anything about it except that there is a lot of pain when anything even touches your foot. Several people her on the message board have it.

Carole C

Re: PT and unexplained phenomenon

Sharon W on 4/18/02 at 18:03 (080200)

Carole,

Wouldn't RSD show up on NCV studies, or an EMG? Because, all mine showed was TTS.

-- Sharon

Re: PT and unexplained phenomenon

Carole C in NOLA on 4/18/02 at 19:06 (080208)

Well, I was thinking maybe it was an early stage of RSD. I have no idea how bad it has to get before it shows up. My, aren't I just sunshiny and smily? Sorry for the gloomy thoughts and I WILL knock on wood now. LOL

Carole

Re: Knock on wood!

Sharon W on 4/18/02 at 19:50 (080215)

Carole,

I DON'T think it is RSD. I don't have THAT level of pain, at least not very often, THANK GOD. And my feet and ankles are never hyper-sensitive to the slightest touch, and I don't have the temperature & color changes. But the phenomenon I mentioned in my previous post is CONSISTENT, it always happens, and I don't think it is a coincidence.

You commented once that it is always easier to deal with something, when you understand it. I feel the same way -- and this, I do not understand!

-- Sharon

Re: PT and unexplained phenomenon

Sharon W on 4/18/02 at 20:02 (080216)

Carole,

When I change pods I will avoid mentioning this 'phenomenon' to the new one.

-- Sharon

Re: PT and unexplained phenomenon

wendyn on 4/18/02 at 21:10 (080225)

I don't belive that RSD is something that would show up on a nerve conduction study - it's not really a nerve entrapment.

RSD doesn't mean that the nerve doesn't work, it means that the nerve sends inaccurate messages and it causes inappropriate sympathetic nervous system responses.

How's that for mudding up the waters?

Re: Keeping you in prayer Sharon W for a great new POD

Mahatmelissama on 4/19/02 at 11:18 (080301)

I will add you to my prayer list, Sharon, for a GREAT pod.

My heart goes out to you, having to endure so much. I wish I
could beat some of them up for you, when I read that, like Xena
the Warrior princess.

Anyway, may you be blessed with a wonderful, SMART WISE podiatrist.

Re: Keeping you in prayer Sharon W for a great new POD

Sharon W on 4/19/02 at 11:50 (080305)

Thanks, I appreciate that. In the meantime, I am continuing ultrasound with PT. Today I came home and IMMEDIATELY iced, thanks to Dr. Ed's comments (and yours) and my feet aren't bothering me anywhere near as much this time. :) Oh, and the therapist went through all the streches with me... and didn't push me too hard, so I was happy with that.

By the way, I used to be a BIG FAN of Xena, the Warrior Princess!

-- Sharon

Re: Icing after ultrasound?

Ed Davis, DPM on 4/19/02 at 18:08 (080358)

Ultrasound is a high frequency sound wave and has no heat, nor any particular temperature. The sound waves pass through skin, fatty tissue and are absorbed by the denser tissues such as the fascia and bone. The sound vibrations when absorbed cause the deeper tissues to heat up and re-radiate the mechanical energy absorbed from the ultrasound as heat to the more superficial tissues. The therapist must rapidly move the ultrasound applicator head to prevent build up of excessive heat in one area.
Ed

Re: Icing after ultrasound?

Sharon W on 4/19/02 at 22:21 (080405)

Thanks, Dr. Ed,

That makes sense.

-- Sharon

Re: Keeping you in prayer Sharon W for a great new POD

Mahatmelissama on 4/20/02 at 16:15 (080486)

hehe...someday Sharon, you and I will be able to chase villians through the jungle and sling them with arrows. ;)
I also like watching RELIC HUNTER too.

Ice is a big blessing Good for you! :D