Diagnostic ultrasound is a hand-held imaging modality utilized to evaluate musculoskeletal injuries. In recent years, diagnostic ultrasound has found its way into the profession of physical therapy. Using diagnostic ultrasound, a trained physical therapist can look for joint effusion, tendon and ligament injury, inflammation and bone fractures. Extensive training is needed in order for a physical therapist to be able to confidently perform diagnostic ultrasound, which is why it is not a common practice in all clinics. It is anticipated, however, that it will become more prevalent over time. The information gleaned through diagnostic ultrasound can be used to guide a physical therapy treatment plan and make decisions about referrals to other medical professionals.

Therapeutic ultrasound is a treatment modality found commonly in physical therapy clinics. Ultrasound uses mechanical energy to affect localized tissues. When placed over inflamed, injured or scarred tissues, ultrasound can help promote healing. If inflammation is present without injury, ultrasound may help resolve this inflammatory process. When placed over a tissue that is injured or has undergone incomplete healing, the ultrasound waves can promote the inflammatory, proliferation and remodeling phases of healing to facilitate good tissue recovery.

Ultrasound uses sound waves that are conducted through a transducer head which then pass through the body tissues while being absorbed and attenuated by those tissues. Therapeutic ultrasound in physical therapy uses 1MHz and 3MHz frequencies to reach tissues of different depths. Both thermal (heat) and nonthermal effects can be produced. The density and elasticity of a tissue will determine how much it interferes with the passage of sound waves. Ultrasound creams and gels are utilized to maximize the passage of the ultrasound waves from the transducer head into the body tissues. Tissues such as tendons, ligaments, joint capsule, fascia and scar tissue have better ultrasound absorption capacities than tissues like blood or fat which makes this modality well-suited to treating musculoskeletal conditions.

Ultrasound has both thermal and nonthermal effects. While it is likely that both are always happening to some degree, the therapist can help maximize one effect or the other based on the settings they choose on the ultrasound machine. Thermal effects caused by a warming of the tissues includes increasing the blood flow to those tissues and helping to resolve chronic states of inflammation. Nonthermal effects of ultrasound are attributed to two phenomena caused by the passage of ultrasound waves through the tissues–stable cavitation and acoustic streaming. These phenomena, the formation of gas-filled voids and small scale eddying of fluids near these voids, are thought to excite the tissue cell membranes causing an upregulation of the activity of the cell which includes its role in tissue healing.

If you decide to work with a physical therapist to help correct your MSK issues, your entire treatment plan could consist of around 8-20+ different ultrasound physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

WHAT CONDITIONS MIGHT BENEFIT FROM ULTRASOUND?

Your therapist may opt to apply therapeutic ultrasound over an area that could benefit from accelerated healing and reduction in inflammation. While this is not a complete list, here are some of the conditions that may be indications for the use of ultrasound:

• Bursitis
• Tendonitis (example: tennis elbow, achilles tendonitis)
• Ligament sprains and injuries
• Muscle strains and tears
• Frozen shoulder

HOW DO I KNOW ULTRASOUND IS RIGHT FOR ME?

As mentioned above, ultrasound may be helpful in accelerating tissue healing and decreasing pain and inflammation in a number of conditions but is not always necessary or indicated. Ultrasound is just one part of a comprehensive physical therapy treatment plan and you should discuss your interest in this modality when you meet with your therapist for the initial evaluation. At that time they can advise you on whether they feel you are a good candidate for this treatment technique and how it will fit into the larger treatment plan. If you are experiencing pain, injury or difficulties moving, call our clinic today to learn how our physical therapists can help.