Ultrasonography: Physical Therapy Care

Ultrasonography is a therapeutic treatment that utilizes ultrasound waves; developed in the 1940s. Today, physical therapists often use ultrasonography as part of their treatment plans. Ultrasonography increases recovery rates by assisting in tissue relaxation, stimulating blood flow, and by enhancing the body’s breakdown of scar tissue. Physical therapist assistants will use the head of the ultrasound probe and place it in direct contact with the patient’s skin. A transmission coupling gel will also be applied onto the skin of the patient. 

The head of the probe has a crystal that generates ultrasound waves upon vibration. The ultrasound waves then pass through the skin causing vibrations in the soft tissues. Furthermore, this vibration causes the deep tissue of the body to heat up. Typically, patients will not feel any sensation of heat. This technique of deep heating can increase blood circulation as well as decrease pain. By increasing blood flow, nutrients are more readily available to the injured area, speeding up the recovery process.

When to Avoid the Use of Deep Heating

  • Fresh Injuries
  • Acute Inflammation 

In these situations, the assistant can pulse the ultrasound waves rather than continuously transmit them which enables them to continue the use of this treatment.

During the treatment, the physical therapy assistant will keep the head of the ultrasound probe moving in constant circular motion. If the probe is kept stationary, it may cause pain for the patient.  

Typically the hand-held transducer, or probe, is moved in a circular motion over the injured area; this technique can treat conditions such as bursitis, frozen shoulder, muscle strains and tears, sprains, and ligament tears, or tendonitis. 

Additionally, ultrasound waves can reduce swelling and chronic inflammation, and promote bone fracture healing. Depending on the desired effect, the physical therapist may adjust the intensity or power density of the ultrasound waves. For example, the therapist may choose a greater power density to breakdown scar tissue surrounding the patient’s injury. 

Ultrasound treatment may achieve phonophoresis. Phonophoresis is a noninvasive way of administering medications through the skin. In some cases, phonophoresis may replace injections. Physical therapist assistants often utilize phonophoresis through ultrasonography and may apply cortisone this way. Cortisone reduces inflammation and may help reduce pain.

The most common conditions treated with ultrasound waves include soft tissue injuries such as tendonitis, non-acute joint swelling, and muscle spasms. Most muscle and ligament injuries can benefit from therapeutic ultrasound treatment.    

A typical ultrasound treatment will take from three to five minutes. In cases where scar tissue breakdown is the goal, the treatment time can be much longer.

Reasons to Avoid Ultrasound Treatment

hand with a bandage on the palm
  • Open Wounds
  • Malignancy (Tumors)
  • Infection
  • Vascular Abnormalities (Such as a Stroke or Aneurysm) in Children

Additionally, physical therapy assistants should not use ultrasonography treatment directly over the abdomen of pregnant women, over the eyes, skull, testes, growth plates in children, over metal implants or over the area of a laminectomy. Other areas to avoid include areas of decreased sensation, fractured bones, implanted electrical stimulation devices, pacemakers, or active areas of cancer.

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