Original Research

A randomised controlled trial of ‘clockwise’ ultrasound for low back pain

Adriaan Louw, Kory Zimney, Merrill R. Landers, Mark Luttrell, Bob Clair, Joshua Mills
South African Journal of Physiotherapy | Vol 72, No 1 | a306 | DOI: https://doi.org/10.4102/sajp.v72i1.306 | © 2016 Adriaan Louw, Kory Zimney, Merrill R. Landers, Mark Luttrell, Bob Clair, Joshua Mills | This work is licensed under CC Attribution 4.0
Submitted: 12 November 2015 | Published: 28 July 2016

About the author(s)

Adriaan Louw, International Spine & Pain Institute, United States
Kory Zimney, University of South Dakota, United States
Merrill R. Landers, University of Las Vegas Nevada, United States
Mark Luttrell, Bird Physical Therapy, United States
Bob Clair, Clair Physical Therapy, United States
Joshua Mills, Wasatch Peak Physical Therapy, United States


Aims: To examine how the choice of words explaining ultrasound (US) may influence the outcome of physiotherapy treatment for low back pain (LBP).
Methods: Sixty-seven patients with LBP < 3 months were randomly allocated to one of three groups – traditional education about US (control group [CG]), inflated education about US (experimental group [EG]) or extra-inflated education about US (extra-experimental group [EEG]). Each patient received the exact same application of US that has shown clinical efficacy for LBP (1.5 Watts/cm2 for 10 minutes at 1 Megahertz, pulsed 20% over a 20 cm2 area), but received different explanations (CG, EG or EEG). Before and immediately after US,measurements of LBP and leg pain (numeric rating scale), lumbar flexion (distance to floor) and straight leg raise (SLR) (inclinometer) were taken. Statistical analysis consisted of mixed-factorial analyses of variance and chi-square analyses to measure differences between the three groups, as well as meeting or exceeding minimal detectable changes (MDCs) for pain, lumbar flexion and SLR.
Results: Both EG and EEG groups showed a statistically significant improvement for SLR (p < 0.0001), while the CG did not. The EEG group participants were 4.4 times (95% confidence interval: 1.1 to 17.5) more likely to improve beyond the MDC than the CG. No significant differences were found between the groups for LBP, leg pain or lumbar flexion.
Conclusion: The choice of words when applying a treatment in physiotherapy can alter the efficacy of the treatment.


Back Pain; Ultrasound; Words; Placebo; Alliance


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Crossref Citations

1. The influence of verbal suggestions in the management of musculoskeletal pain: a narrative review
Iván Cuyul-Vásquez, José Aguilar Barría, Natalia Foitzick Perez, Jorge Fuentes
Physical Therapy Reviews  vol: 24  issue: 3-4  first page: 175  year: 2019  
doi: 10.1080/10833196.2019.1639011