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Use of ultrasound for QL strain

I have a question about using continuous ultrasound on a QL strain for a 17 yr old who injured his back when playing football in the snow about 6 weeks ago. Pulling in this area is felt with all hamstring stretching on that side. Neural tension test is negative for that LE and radiculopathy is not present. Are US with parameters- continuous, 1 MHz 0.8w/cm2 for 4 min appropriate? I would like to use it for thermal effects and for the purpose of helping to stretch this muscle after US treatment and subsequently decreasing strain felt in this area during hamstring stretching. He is slender, I was concerned about depth of transmission and thermal effects on kidneys. Any thoughts or experience with US for QL and parameters used?

LeeAnn Gonzalez

7 months ago

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Prof Alison Hoens
Prof Alison Hoens

I concur with the discussion regarding the need to lengthen treatment time from 4 minutes if the desired effect is heating and the area to be insonated is greater than the size of the transducer head (thus 5-10 minutes may be more appropriate - 10 minutes if the area being treated is twice the size of the ultrasound transducer head). I wonder whether this may be more efficiently achieved with a hotpack. However, as articulated previously, the fundamental question is whether the 'cause' is truly related to muscle 'tightness' of the QL and/or hamstring that is amenable to heating tissue at the spine (given that you are concerned about heating the kidney - which is highly unlikely to occur given the depth of the kidneys relative to the overlying muscle).

Prof Richard Liebano
Prof Richard Liebano

Hi LeeAnn. Prof David Draper has performed some studies on thermal effects of US in muscle tissue. When using 1MHz therapeutic heat was observed when using intesities over 1 W/cm2 (~1,5 to 2,0 W/cm2). When using 3 MHz intensities around 0,5 W/cm2 were enough to get similar effects. It is noteworthy that treatment area should not be larger than twice the ERA of transducer. Treatment time for thermal effects should be longer than 5 minutes (~5 to 10 min) depending on the treatmente area. I hope this helps.

wendy226
wendy226

Hi LeeAnn I entirely agree with all that has been said so far and would add that a detailed exam of the SIJs should be added into the mixture. I have yet to be convinced that back pain is ever muscle pathology/imbalance as a primary cause. Was there any bruising in evidence in the QL? What was the nature of the injury? (A bit of a side salad to think about!)

Prof David Selkowitz
Prof David Selkowitz

Hi, LeeAnn. I think that the parameters are OK, depending on the area you will treat and the amount of heating needed. I will let my colleagues who are better versed in that area comment more on that. Actually, I am interested in the results of the exam, and I hope you don't mind me brainstorming about it. We know that the hams don't extend to the area of the QL, so it seems that something else must be going on if the patient feels the pulling in the low back with hams stretching. You don't state how the neural tension test was determined to be negative. However, if it is negative, then perhaps the pelvis moved into a posterior tilt when the hams were tested, bringing the iliac crest more caudalward. This would pull on the distal attachment of the QL and could cause the pulling sensation. Another possibility could be that the patient was contracting the QL to guard during the hams stretching, causing the pulling sensation. Just some bits of food for thought (not enough for dinner).

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