After reading your articles on ultrasound treatment of trigger points, I thought ultrasound treatment might help. He had treatment with an ultrasonic instrument for 10 days, and he immediately had vast improvement. All the problems I mentioned above have vanished, and my father is feeling quite normal again. He does not feel loss of balance or weakness etc. Is there any reason that he shouldn’t have ultrasound treatment again if the symptoms reappear?

In general, there are no contraindications to repeated sessions of ultrasound treatment. Unless your father has some unusual contraindication to its repeated use, I encourage him to undergo ultrasound treatment any time that his trigger point pain returns. Please give him my best wishes for a very long, symptom-free life.

The only body sites where I wouldn't use ultrasound under any condition are the testicles and eyes. In 1979, David Ramby, DC taught me to treat myofascial trigger points with ultrasound. Shortly afterward, through experimenting, I learned that when properly applied, continuous ultrasound is more effective in desensitizing trigger points than is ultrasound in the pulsed mode. At first, I was concerned about using continuous ultrasound to treat trigger points in the anterior and middle scalene muscles. The obvious reason is the baroreceptors in the carotid arteries; these receptors might (so I was taught in chiropractic college) be adversely affected by ultrasound energy. Being experimentally oriented, I cautiously tested the effect of ultrasound over the baroreceptors. I found no adverse effects. After considerable testing, I used continuous ultrasound over the scalenes of hundreds of patients with no adverse effects in any of them.

Years ago, some chiropractors taking neurology diplomate courses under chiropractic neurologist Fred Carrick expressed concern that I’d use ultrasound at all in my clinical practice. According to them, Dr. Carrick had advised them not to use ultrasound because it supposedly destroys small, unmyelinated nerve fibers. I was unable to get Carrick to return my phone calls and tell me the source of his statement. (I wasn’t surprised, considering that Carrick is so notorious arrogant and dogmatic that his conduct has been the subject of scholarly analysis. See reference below.) Ultrasound had been shown to cause damage to spinal cord tracts in rats—but only when researchers surgically opened the spinal canal and blasted the rats’ spinal cords with an ultrasound wattage over a hundred times that used in clinical practice. I combed through the research literature but turned up nothing to support Carrick’s warning. Further, nothing in my extensive clinical experience with ultrasound suggested damage to any tissue, including nerve fibers. I thought at the time—and still do—that it’s tragic that some chiropractors might listen to Carrick and decline to use this extraordinarily effective and safe modality because of his false claim.

Hopefully, from these comments, you’ll feel comfortable using ultrasound with reasonable precautions, such as avoiding the testicles and eyes. We have two articles on drlowe.com that describe ultrasound technique. In one, Courtney Taylor-Robbins, P.T. describes the technique she uses, based on my teaching. And Dr. Gina Honeyman-Lowe explains our slightly modified ultrasound technique to treat fibromyalgia patients’ trigger points. I am sure you’ll find that your use of both Nimmo technique and continuous ultrasound is a highly effective protocol for desensitizing most myofascial trigger points.