Do i need ultrasound and electrolysis when I goto physical therapy for acl recovery?

Question

It's been 4 months since I had a acl reconstruction sergery and the therapist I goto, they still do ultrasound on my knee after the heat pack and then when they place a cold pack at the end of the exercise, they place electrolysis (i think that's what it's called..) pads on my knee and they charge extra for those two. Do I need them? Or can I stop getting those?

Answer 1

I am not sure of when you started therapy or for that matter what condition the knee is.  So without that information it is going to be difficult to truly answer the question.  In general the use of heat, be that hot pack or ultrasound is for a specific reason.  Usually they are used to increase blood flow to an area to facilitate the ease of an activity or exercise.  The use of ultrasound may also be used to breakup scar tissue.  Having said that by now you should be off of those modalities unless there is a specific reason for it.  The use of electric stimulation can be multipurpose.  One reason is to reduce any swelling that might still be there and perhaps this is the reason that it still is being used, if they are using it to augment the muscular response.  By that sometimes after surgery the muscles seem to lose the ability to contract completely.  To override this inhibitory response electrical stimulation is used.  Now if none of this is true in your specific case then yes it is time that the use of modalities are stopped except for the use of ice.  The use of ice and heat can be billed for but in almost every case no insurance company pays for it.  Check with your Explanation of Benefits on the payment sheet to see what was paid for and what was not.  To me the work should be centered on regaining any lost strength and knee proprioception, regaining of the sense of where the joint is in space.  Not knowing what procedure has been done is also a factor but at this stage barring any specific problem you should be getting close to full functional patterns.  The work done now should be in a weight room and hands on therapy.  Talk to your therapist about this.  Also ask who owns the practice that you are receiving care in.  If it is owned by the therapist then definitely express your concerns about this situation.  They should be very responsive to your concern.  If it is owned by a corporation or a doctor the same level of concern may not be there.

Answer 2

No, they do not need to be done, nor have they proven to facilitate better or faster outcomes.  

Multiple systematic reviews of the literature exist that demonstrate that there is little, if any, benefit to ultrasound.  Electical stimulation can be done for pain and edema control, but doesn't result in any better outcomes.  Neuromuscular stimulation (stimulation to the point of sustain contraction) can be done if the quad is exceptionally weak, but I doubt this would have any effect by 4 months.

...they are bulking up your charges.  It's certainly acceptable for you to say you are only interested in the theraputic exercise.