Effective physiotherapy treatments with ultrasound therapy

Ultrasound therapy has been a tool of the physiotherapy trade for a long time. It has become fully integrated and widely accepted as an easily available, straightforward and uncomplicated type of electrotherapy. Ultrasound therapy is known for its pain-relieving and restorative effects, but how does it work?

What is ultrasound therapy?

Ultrasound therapy is a safe treatment method that involves a physiotherapist administering high-frequency ultrasound waves (i.e. a frequency higher than 20 kHz) to achieve specific therapeutic effects. Treatment parameters such as frequency, intensity, duty cycle, and time can be altered to tailor ultrasound therapy to a patient's requirements. Furthermore, physiotherapists can make their choice from a variety of available multi-frequency treatment heads of various sizes.

Most ultrasound devices allow users to choose between a 1 MHz or a 3 MHz treatment frequency. At a frequency of 1 MHz, the ultrasound waves can penetrate deeply into the tissue (to a depth of 3 to 5 cm), but they will do so in a less focused manner. Nevertheless, this frequency is ideally suited for treating deeper-lying injuries and patients with more adipose or fatty tissue. A frequency of 3 MHz can only penetrate the tissue up to a depth of 1 to 2 cm, which is why this frequency is often used for superficial injuries.

Ultrasound therapy can bring thermal or athermal therapeutic effects depending on the selected settings.

Thermal effects

When the treated tissue absorbs ultrasound waves, these waves generate friction between the tissue particles, which causes the temperature in the treated area to rise. If a sufficiently high dose of ultrasound waves is administered to a specific area for a reasonably long time, a thermal effect occurs that can lead to:

• Pain relief
• Improvement of local blood circulation
• Reduction of joint stiffness

To achieve these particular physiological effects, it’s crucial that the ultrasound device that is used can deliver the required dose of ultrasound waves. The average ultrasound device is, more often than not, insufficiently potent to generate the desired warmth.

Athermal effects

It is also possible to generate athermal effects with ultrasound therapy. In light of this, professor Tim Watson points to the aspect of cavitation, meaning the formation and breakdown of microscopic bubbles in the tissue. These bubbles produce vibrations that stimulate cell activity and cell membrane permeability. Cavitation facilitates the absorption of nutrients and medications into cells (also called sonophoresis), accelerates the healing process, and reduces inflammation. That is why ultrasound is mainly used during the recovery period of musculoskeletal injuries or in cases of irritation.¹

Low-Intensity Pulsed Ultrasound (LIPUS)

As explained above, ultrasound can generate thermal and athermal effects on human tissue. Nevertheless, in the last ten years, the focus has been on its athermal effects due to a particular form of ultrasound called Low-Intensity Pulsed Ultrasound or LIPUS in short. Because of its low intensity, LIPUS can induce therapeutic changes without producing biologically significant temperature increases.² LIPUS typically uses frequencies ranging from 1 to 3 MHz, with an intensity fluctuating between 0.02 to1 W/cm², and employs a duty cycle of 20% with a treatment time of 5 to 20 minutes per day. Likewise, in his most recent reference work, Professor Watson concentrates on LIPUS, to be precise, on its anti-inflammatory effects.³

Which conditions respond successfully to ultrasound therapy?

Ultrasound improves the efficiency of all phases of tissue healing, making it a broadly applicable treatment option for lesions of:

• Periosteum
• Ligaments
• Tendons
• Fascia
• Muscles

Besides, LIPUS is an established and certifiably effective therapeutic approach for fracture repair, both early on and later on in the tissue repair process. In the United States, LIPUS is even an FDA-approved treatment method. Moreover, LIPUS can be advantageous for regenerating soft tissues such as tendons, ligaments, intervertebral discs, and cartilage. For now, ultrasound therapy will remain the subject of scientific research, which means that it is possible and likely that new applications will rapidly emerge.

Benefits of ultrasound for the patient

Ultrasound therapy is more advantageous for patients than other treatments. Ultrasound treatment is / causes:

1. Safe, painless and non-invasive: Unlike surgeries or injections, ultrasound therapy is a safe, non-invasive, and painless treatment method.
2. Improved healing and functional recovery: As ultrasound therapy improves local blood circulation, diminishes inflammation and stimulates tissue regeneration, the healing process accelerates, which speeds up the patient’s overall recovery.
3. Pain relief: The ensuing manual treatment will be more effective if a patient experiences less pain thanks to an ultrasound treatment. Moreover, the patient will be better able to carry out their exercises. That way, ultrasound directly accelerates the recovery through its physiological effects and indirectly through exercise therapy. This means that treatment goals can be rapidly achieved.
4. Complementary treatment: Ultrasound therapy is an easy, straightforward and effective way to supplement other physiotherapy treatments, such as exercise therapy, mobilisation techniques, and rehabilitation programs. Experience tells us that this will increase the effectiveness of such interventions and boost their combined treatment results.

Benefits of ultrasound for the therapist

Offering ultrasound therapy can also have a plethora of benefits for therapists:

1. Targeted treatment: The physiotherapist can precisely target the specific problem area during treatment, maximising the therapy's effectiveness.
2. Versatility: Ultrasound therapy can be effectively administered to different tissue structures such as muscles, tendons, joints and ligaments. This makes ultrasound perfectly suited for a physiotherapy practice, where many patients with various musculoskeletal issues seek treatment.
3. Beneficial therapeutic effects: Ultrasound therapy stimulates local blood circulation and elevates the metabolism in the treated area. This accelerates the regeneration of damaged tissue. On top of that, ultrasound therapy can reduce inflammatory processes, which makes it an appropriate treatment for various inflammatory conditions such as tendonitis and arthritis.
4. Uncomplicated and straightforward: Ultrasound therapy is a very straightforward treatment method. Every therapist, regardless of their specialisation, can work with ultrasound therapy. While ultrasound therapy brings many possibilities and combinations, it remains a user-friendly and easy-to-use treatment method.

To cut a long story short, ultrasound therapy has a lot to offer, from its positive effects on the patient's recovery process to its optimistic influence on patient satisfaction and overall well-being. Not to mention that non-invasive ultrasound is completely safe for both patient and therapist, making it the perfect companion for every practice.

Implementing ultrasound in your practice?

Are you ready to take the plunge with ultrasound and looking for a (new) ultrasound device? Don’t forget to double-check if your most recent investment piece uses the latest state-of-the-art technology. Even the most unique features can be minor details, but those details make a big difference. Consider exclusive features like efficient and user-friendly ultrasound treatment heads that will optimally guide you during the treatment process or a simple and straightforward user interface that gives you the correct information at the right time, making finding that particular protocol a piece of cake.

Gymna's ultrasound devices are fully equipped and will optimally support you in your professional activities. If you have any questions regarding our range of products, don’t hesitate to get in touch. We will be happy to advise you on the perfect ultrasound device for you and your practice.

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¹ Watson T. (2008). Ultrasound in contemporary physiotherapy practice. Ultrasonics, 48(4), 321–329. https://doi.org/10.1016/j.ultras.2008.02.004

² Jiang, X., Savchenko, O., Li, Y., Qi, S., Yang, T., Zhang, W., & Chen, J. (2019). A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications. IEEE Transactions on Bio-Medical Engineering, 66(10), 2704–2718. https://doi.org/10.1109/TBME.2018.2889669

³ Watson T; Nussbaum EL. Electrophysical Agents: evidence-based practice. Thirteenth edition (2021). Elsevier  

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