Therapeutic Ultrasound

What is Ultrasound (US)? The use of sound waves above the range of human hearing to treat musculoskeletal problems,

especially inflammation (tendinitis, bursitis), by stimulating tissue beneath the skin’s surface. The heat generated by the sound head will increase blood circulation.

Why do we use Ultrasound? Decreases soft tissue inflammation Increases tissue extensibility Enhances scar tissue remodeling Increases soft tissue healing Decreases pain

History of Ultrasound 1st used in the 1940s Has had few studies conducted to confirm therapeutic value Non-invasive and inexpensive 35 RCTs conducted between 1975 and 1999

Ultrasound EffectsStudies have shown:

The warmth felt by the patient is mostly in the thermal skin receptors and does not create a significant thermal affect in the deeper tissues.

No advantage between ordinary heat therapy and ultrasound with regard to tissue extensibility and stretching.

The effect of ultrasound on extensibility lasted only 3 minutes immediately following treatment. Tissues with a higher protein content can absorb ultrasound more than tissues with high water

content and low protein content. Aids in the remodeling scar-tissue phase by influencing collagen fiber orientation.

Rationale behind using Ultrasound The “gate control” mechanism

Issues with Ultrasound Not a promising therapy for most musculoskeletal conditions Lack of research Useful for some patients, some of the time — but it is not a reliable or evidence-based therapy

Research Findings 10 of 35 RCTs were judged to have acceptable methods 2 of these 10 trials suggested that ultrasound was more effective for calcific tendinitis of the

shoulder and carpal tunnel than placebo 8 trials did not recommend its use In a systematic review of 38 studies, authors concluded that there seemed to be little evidence to

support the use of ultrasound in the treatment of musculoskeletal disorders. Conclusions from the reviews

I. "None of the methods gave evidence that pain relief could be achieved by ultrasound treatment …. We conclude that the use of ultrasound in treatment of musculoskeletal disorders is based on empirical experience, but is lacking firm evidence from well-designed controlled studies.”

II. “The large majority of 13 randomized placebo-controlled trials with adequate methods did not support the existence of clinically important or statistically significant differences in favor of ultrasound therapy.”

Referenceshttp://www.dynamicchiropractic.com/mpacms/dc/article.php?id=55179http://www.ncbi.nlm.nih.gov/pubmed/10431713http://www.chiroaccess.com/Articles/Therapeutic-Ultrasound-A-Review-of-the-Literature.aspx?id=0000210http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/03_04/nov03/robertson.pdf

III. “Eight studies showed that active ultrasound is no more beneficial than placebo ultrasound for the treatment of people with pain or soft tissue injury. Few generalizations can be drawn from the 2 trials in which active ultrasound was found to be superior to placebo ultrasound, given their heterogeneity and omission of important details.”

IV. “Increased muscle temperature [by ultrasound] failed to provide significant prophylactic effects on the symptoms of DOMS.”

An Example Study Osteoarthritis patients received therapeutic ultrasound for 2-8 weeks. People who used therapeutic ultrasound had an improvement in their pain of about 3 on a scale

from 0 (no pain) to 10 (extreme pain) after using it up to 2 months. ◦ 37 people out of 100 who use therapeutic ultrasound respond to treatment (37%).

People who used a fake therapeutic ultrasound (inactive ultrasound and inert gel) had an improvement in their pain of about 2 on a scale from 0 to 10 after using it up to 2 months. ◦ 31 people out of 100 who use fake therapeutic ultrasound respond to treatment (31%).

6 more people respond to treatment with therapeutic ultrasound than with fake therapeutic ultrasound (difference of 6%).

This review indicates that the biophysical effects of ultrasound are unlikely to be beneficial. This conclusion is based on the absence of evidence for a biological rationale for the use of therapeutic ultrasound.

Ultrasound treatment for certain conditions Carpal tunnel Syndrome

◦ One randomized controlled trial (RCT) showed US was effective in the treatment of mild to moderate CTS. The protocol utilized was 0.5 W/cm2 for 10 minutes daily for 4 weeks.

◦ However, there is at least one other study has been published that found US to be no better than placebo

Lateral Ankle Sprain◦ A 2002 Cochrane review located 5 clinical trials relating to ultrasound therapy in the

treatment of ankle sprains. ◦ Of the 5 trials, 4 showed no difference in sham and regular ultrasound while one showed

improvements in pain and swelling. Myofascial Pain Syndrome

◦ In a 2007 RCT of 44 subjects, an ultrasound, massage and exercise group was compared to a sham ultrasound, massage and exercise group.

◦ Ultrasound conferred no additional benefit to the treatment regimen. Lateral Epicondylitis (LE)

◦ Performed in 1985, this randomized controlled trial utilized ultrasound and showed statistically significant improvement at completion of treatment and at the 1 year follow-up.

My ConclusionThere is still little evidence of the clinical effectiveness of therapeutic ultrasound as currently used by Physical therapists to treat people with pain and musculoskeletal injuries and to promote soft tissue healing. However, it has proven to be just as effective as manual hand therapy and can apply the same heat to increase blood circulation in a smaller amount of time. Even though it is hard to find evidence to support the use of ultrasound; just like other modalities, ultrasound therapy works well for some patients some of the time. This leads me to conclude that ultrasound should be used when a physical therapist believes that it will help the patient recover.

Referenceshttp://saveyourself.ca/bibliography.php?gam95http://ptjournalonline.org/content/81/7/1339.fullhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003132.pub2/abstracthttp://www.physicaltherapyonline.net/content/81/7/1351.full