Ultrasound Therapy in Physical Therapy

Ultrasound is mostly known for its imaging use. The use of ultrasound waves for imaging is called “ultrasonography” or simply USG. Ultrasound energy is also used for therapeutic purposes. Ultrasound therapy is one of the most commonly used treatment methods in physical therapy.

What is Ultrasound?

Ultrasound is sound waves of frequencies that the human ear cannot hear. Sound is a form of energy in the form of waves. Sound waves cause the vibration of molecules in the air, liquid or solid they pass through. The frequency (Hertz) is the number of times a sound wave makes molecules vibrate per second. The human ear can hear sounds that vibrate 50 to 20,000 times per second. Ultrasound waves used in physical therapy are generally between 800,000 – 3,000,000 Herz. In short, it can be expressed as 0.8 – 3 MHz (megahertz). As the ultrasound frequency increases, its penetration into deeper tissues decreases. For example, 1 Mhz ultrasound waves penetrate approximately 3 times deeper than 3 Mhz.

Another parameter of the ultrasound treatment watts / cm 2  expressed in terms of the energy density. The size of the ultrasound head used is affected by variables such as the size of the treatment area and energy density.

The ultrasound device has a small crystal in its head. When this crystal is exposed to an electric current, it produces fast vibrations called piezoelectric waves. Vibrations are emitted from the head of the device as ultrasound waves.

For Which Problems Is Ultrasound Used in Physical Therapy?

In physical therapy, ultrasound is used in various problems related to the musculoskeletal system such as herniated disc, neck hernia, muscle tendon compression in the shoulder , frozen shoulder , carpal tunnel syndrome , bursitis, tendonitis, muscle strain, ligament injury, meniscus damage .

What are the situations in which ultrasound is objectionable?

Ultrasound therapy is generally a safe method. However, in some cases, its use may be inconvenient. It is not applied on open wounds, pregnant women and those with a pacemaker. It is also not used in cases such as cancer, infection, bleeding disorder. It should not be used in growing children in areas containing growth cartilage of bones. It should be used with caution in people with sensory disorders (neuropathy due to diabetes, nerve injury, etc.).

How Does Ultrasound Therapy Work?

Ultrasound therapy has two main physical effects. These are the deep heating effect and the cavitation effect. In physical therapy, the treatment methods that can heat the tissues deeper than 1 cm of the skin are called deep heaters. Ultrasound therapy, short wave diathermy and microwave diathermy are physical therapy techniques with deep heating properties.

With the heating effect of ultrasound on deep tissues, blood flow in the tissue increases. As a result, it is accepted that healing is accelerated and pain is reduced. With the warming effect, the flexibility of soft tissues increases and helps to relieve muscle-joint stiffness.

The cavitation effect of ultrasound is the formation of microscopic bubbles in liquids. This effect is also thought to accelerate healing. Another effect is to increase the permeability of cell membranes. In this way, it can be used to increase the absorption of some drugs from the skin (phonophoresis).

If it is desired to benefit only from the effect of increasing cavitation and membrane permeability without creating a deep heating effect, the intermittent ultrasound (low-intensity pulse ultrasound) method can be used.

How is Ultrasound Treatment Performed?

A physical therapy technician or physiotherapist applies a transmitting gel to the area where the ultrasound will be applied. By turning on the device, the frequency, intensity and application time of the ultrasound waves are determined. Optimal parameters vary with target tissue and disease. Then the ultrasound head is slowly moved over the skin of the treated area. The head is moved with circular or back-and-forth movements according to the treatment area. It doesn’t stay in one place for long. Treatment time is usually 3-10 minutes. It is applied once a day. 15-20 sessions are continued.

The treatment can be applied in water for very recessed places that do not allow full contact of the ultrasound head, such as hands and feet.

During ultrasound treatment, the person usually does not feel anything. Sometimes there may be a slight feeling of warmth and tingling in that area. If the ultrasound head is left fixed in one spot without being moved, it can cause pain and tissue damage. Therefore, the head must be constantly moved.

Is Ultrasound Therapy Effective?

The effectiveness of ultrasound therapy is a controversial issue. Although there are studies supporting the effectiveness of the treatment, there are also scientific publications suggesting that there is no benefit. Ultrasound is almost always used in combination with other methods of physical therapy and exercise.

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