Combination Therapy
In general terms, combination therapy involves the simultaneous application
of ultrasound with an electrical stimulation therapy.
The main advantages of such a combination are said to be in:
• localising lesions (especially chronic) ie. diagnostic use.
• ensuring accurate localisation of ultrasound treatment to
provide increased accuracy/effectiveness in treating deeper
lesions.
• treating trigger points.
Possible explanations of effects
It would appear that by applying ultrasound to peripheral nerves their
threshold of stimulation is reduced, thus making them more sensitive or
excitable. It is likely that this effect is brought about by the alteration of the
ion pump activity, predominantly Na
+
and K
+
, but also Ca
++
. By altering the
transport of these ions across the cell membrane the resting potential will be
altered and, in this case, it would seem that it results in a reduced threshold
for depolarisation.
It is reasonable to expect that this effect occurs in other tissue (apart from
nerve) although no direct evidence has been noted to date.
When electrotherapy is applied simultaneously with ultrasound through the
same tissues a reduced intensity is required in order to achieve the same
physiological/therapeutic effects when compared with electrotherapy in
isolation. This can easily be demonstrated by turning off the ultrasound
component whilst continuing with the electrotherapy. The patient very soon
becomes aware of a much reduced sensation/effect which can be restored
by restarting the ultrasound.
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