Therapeutic ultrasound has been a staple in physiotherapy clinics for decades. While its role has evolved as research has advanced, ultrasound remains a tool that can support treatment in certain situations. At M.O. Therapy in Markham, we use evidence-informed approaches to determine when ultrasound may be beneficial.
What Is Therapeutic Ultrasound?
Definition
Therapeutic ultrasound uses high-frequency sound waves to treat soft tissue injuries. Unlike diagnostic ultrasound (for imaging), therapeutic ultrasound is designed to create biological effects that support healing.
How It Works
The Device:
- Generates sound waves
- Transmitted through gel
- Penetrates into tissue
- Creates thermal and non-thermal effects
Sound Waves:
- Frequency: Typically 1-3 MHz
- 1 MHz for deeper tissues
- 3 MHz for superficial tissues
- Intensity varied by condition
Mechanisms of Action
Thermal Effects
Heating:
- Increases tissue temperature
- Improves blood flow
- Enhances tissue extensibility
- Reduces muscle spasm
- Accelerates metabolism
Benefits:
- Prepares tissue for stretching
- Reduces pain
- Supports healing
- Increases flexibility
Non-Thermal Effects
Mechanical:
- Acoustic streaming (movement of fluids)
- Cavitation (bubble effects)
- Cellular stimulation
- May affect tissue healing
Proposed Benefits:
- Tissue repair enhancement
- Reduced inflammation
- Cellular activity stimulation
- Bone healing (pulsed)
How Ultrasound Is Applied
The Treatment
Process:
- Gel applied to skin (coupling medium)
- Ultrasound head moved over area
- Continuous motion maintained
- Duration: 5-10 minutes typically
- Parameters adjusted to condition
Why Movement Matters:
- Prevents hot spots
- Ensures even distribution
- Safety requirement
- Optimal treatment delivery
Parameters
Frequency:
- 1 MHz: Deeper penetration (2-5 cm)
- 3 MHz: Superficial penetration (1-2 cm)
Mode:
- Continuous: More thermal effect
- Pulsed: More non-thermal effect
Intensity:
- 0.5-2.0 W/cm² typical
- Lower for acute conditions
- Higher for chronic conditions
Traditional Uses
Historical Applications
Commonly Used For:
- Tendinitis
- Bursitis
- Muscle strains
- Ligament sprains
- Scar tissue
- Joint contractures
Contemporary View
Current Understanding:
- Role more limited than previously thought
- Evidence mixed for many conditions
- Still useful in certain situations
- Part of comprehensive care
Current Evidence
What Research Shows
Some Support For:
- Bone healing (pulsed ultrasound)
- Calcific tendinitis (with other treatment)
- Wound healing (some evidence)
- Tissue extensibility
Limited Evidence For:
- Soft tissue healing acceleration
- General pain relief
- Many traditional uses
The Reality
Important Points:
- Not a primary treatment
- Adjunct to active treatment
- Some conditions may benefit
- Others may not
- Individual responses vary
When Ultrasound May Help
Appropriate Situations
Consider For:
- Calcific tendinitis
- Tissue heating before stretching
- Bone healing support (fractures)
- Chronic tissue tightness
- As part of treatment plan
When Other Options May Be Better
Consider Alternatives When:
- Active treatment is priority
- Exercise-based approach indicated
- Manual therapy more appropriate
- Evidence supports other methods
Conditions and Evidence
Bone Healing
Best Evidence:
- Low-intensity pulsed ultrasound (LIPUS)
- May accelerate fracture healing
- Specific devices/protocols
- Most supported application
Calcific Tendinitis
May Help:
- Break down calcifications
- Combined with other treatments
- Not standalone treatment
- Variable results
Soft Tissue Injuries
Limited Evidence:
- Traditional use
- Mixed research results
- Not primary treatment
- May support other therapies
Safety Considerations
Contraindications
Do Not Use Over:
- Malignancy/cancer
- Pregnancy (abdomen/pelvis)
- Pacemakers
- Thrombophlebitis
- Active infection
- Eyes
- Reproductive organs
- Growth plates (children)
- Metal implants (deep)
Precautions
Use Caution:
- Impaired sensation
- Vascular insufficiency
- Acute inflammation
- Recent radiation therapy
- Near spinal cord after laminectomy
Side Effects
Rare With Proper Use:
- Burns (if applied incorrectly)
- Discomfort
- Skin irritation
Ultrasound vs. Other Treatments
Ultrasound vs. Manual Therapy
Ultrasound:
- Passive modality
- Specific thermal/non-thermal effects
- Limited evidence for many uses
- Adjunct treatment
Manual Therapy:
- Active assessment and treatment
- Skilled hands-on approach
- Strong evidence for many conditions
- Primary treatment option
Ultrasound vs. Exercise
Exercise:
- Active approach
- Strong evidence
- Long-term benefits
- Addresses cause
Ultrasound:
- Passive
- Supportive role
- Symptomatic effects
- Adjunct to active treatment
The Modern View
Evidence-Based Practice
Current Approach:
- Use when evidence supports
- Part of comprehensive plan
- Not primary treatment
- Patient-centered decision
When We Use Ultrasound
At M.O. Therapy:
- Appropriate conditions
- Combined with active treatment
- Based on evidence
- Individual assessment
Alternative and Complementary Modalities
Other Options
May Consider:
- Shockwave therapy
- TENS for pain
- Heat therapy
- Manual techniques
- Exercise therapy
Comprehensive Care
Best Approach:
- Multiple treatment components
- Active rehabilitation focus
- Modalities as support
- Individualized plan
Ultrasound at M.O. Therapy
Our Approach
Evidence-Informed:
- Use appropriately
- Not as standalone
- Combined with active treatment
- Honest about evidence
When We Recommend
May Be Suggested For:
- Specific appropriate conditions
- Tissue preparation for stretching
- As part of comprehensive plan
- When evidence supports use
Frequently Asked Questions
Does ultrasound therapy hurt? No, therapeutic ultrasound should not hurt. You may feel slight warmth. If you feel discomfort, inform your practitioner immediately.
How many ultrasound treatments will I need? If ultrasound is used, it's typically part of a treatment plan spanning multiple sessions. The number depends on your condition and response.
Can ultrasound heal my injury? Ultrasound alone is unlikely to heal an injury. It may support healing as part of a comprehensive treatment plan that includes exercise and other interventions.
Why doesn't my physiotherapist use ultrasound? Modern physiotherapy emphasizes active treatments with stronger evidence. Your physiotherapist may determine other approaches are more effective for your condition.
Is ultrasound outdated? While ultrasound is used less than historically, it still has a role in certain conditions. Evidence-based practice guides appropriate use.
Get Comprehensive Care
For evidence-informed treatment of your condition, contact M.O. Therapy in Markham. We'll assess your needs and develop an appropriate treatment plan.
Contact Us:
- Call (905) 201-5827
- Book online
- Direct billing available
Experience care based on evidence and your individual needs.