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Low-intensity pulsed ultrasound in lower limb bone stress injuries: a randomized controlled trial
Thomas Y Gan1, Donald E Kuah, Kenneth S Graham
1*Australasian College of Sports Physicians, Sydney, New South Wales, Australia; †Medical Consultant to NSW Institute of Sport, Sydney Olympic Park, New South Wales, Australia; ‡Applied Research Program,New South Wales Institute of Sport, Sydney Olympic Park, New South Wales, Australia; and §Ultrascan Radiology I-Med Network, Campbelltown, New South Wales, Australia.
Objective:
To evaluate the effectiveness of low-intensity pulsed ultrasound (LIPUS) for the improvement of lower limb bone stress injuries in a civilian population.
Design:
A prospective, randomized, double-blinded, placebo-controlled trial to compare LIPUS with placebo.
Setting:
Civilian private practice population in Sydney, Australia.
Participants:
Subjects were recruited if a grade II-IV bone stress injury was diagnosed on magnetic resonance imaging (MRI) of either the postero-medial tibia, fibula or second, third, or fourth metatarsal. Subjects of all levels of sporting activity were included. Thirty subjects were initially recruited, and 23 subjects were included in the final analysis.
Interventions:
Subjects were randomized into either the treatment or placebo arm and matched to the site of injury (tibia, fibula, or metatarsal). Subjects in both arms used either treatment or placebo devices for 20 minutes daily for 4 weeks.
Main Outcome Measures:
Six clinical parameters (night pain, pain at rest, pain on walking, pain with running, tenderness, and pain with single leg hop) were compared before and after intervention. The changes in MRI grade and bone marrow edema size were also compared.
Results:
There were no significant differences between the treatment and placebo conditions for changes in MRI grading (2.2 vs 2.4, P = 0.776) or bone marrow edema size (3 vs 4.1, P = 0.271). There were no significant differences between the treatment and placebo conditions for the 6 clinical parameters.
Conclusions:
Low-intensity pulsed ultrasound was found not to be an effective treatment for the healing of lower limb bone stress injuries in this study. However, this was measured over a relatively short duration of 4 weeks in a small, mostly female population.
Clinical Relevance:
This double-blinded, randomized, placebo-controlled trial has shown that LIPUS is not an effective treatment for lower limb bone stress injuries.
