Ultrasound – an additional evidence based approach to your treatment package

Ultrasound is widely used by Manual Therapists in clinics as a useful adjunct to soft tissue therapy and rehabilitation. Amongst other tools used the effects of ultrasound says Professor Tim Watson (PhD, BSc, MSCP, DipTP) are well established and evidenced for the enhancement of tissue repair.

What is Ultrasound?

It is a mechanical electrotherapy supplying energy to tissues for healing. The mechanical vibrations are sound energy, the normal range being 16Hz to up to 20,000Hz, beyond this is electrotherapy. The frequencies used in electrotherapy are between 1.0 and 3.0MHz, 1Mhz = 1 million cycles/vibrations per second. *1

The sound waves generate a combination of high and low pressure zones. It is these vibrations in the tissues that produce heat and therefore produces a thermal change in the tissues. These can also be non-thermal. Effectively Ultrasound is ‘instigating a change in cell behaviour’(International Therapist, issue 110, Autumn 2014, Tim Watson) or a change to how the cell reacts, known as cell ‘up regulation’, which is an increase to the amount of work the cell does.

The primary most evidenced based application to Ultrasound is the stimulation and promotion of tissue repair. During tissue repair, the sequence of phases from inflammation to proliferation to remodelling. At each phase, Ultrasound has a different role to promote repair of the tissue (where the cell has absorbed the US) and therefore has been shown to be effective in treating the following *1:

  • Muscle strains
  • Ligament damage
  • Tendonitis and tendinopathy
  • Scar tissue
  • Trauma presented in a joint capsule
  • At the musculotendinous junction
  • Retinacular tissues

Professor Tim Watson shares the latest from a clinical perpective:

  • ‘The previously held view that the effects of ultrasound were anti-inflammatory are not supported by the evidence. Ultrasound effectively works by encouraging the normal inflammatory sequence, and therefore helping resolution of the process - but this is not achieved by turning the process off’
  • ‘Again, the previously held view that ultrasound 'removes excess scar tissue' is not supported. Ultrasound can be employed as a means to promote tissue remodelling - and by doing so, will help to achieve the best possible quality scar tissue - but that is not achieved by removing it per se"

The most effective results for Ultrasound have been on well absorbing tissues that are high in collagen and are therefore appropriate as an adjunct to soft tissue therapy and rehabilitation *1.Professor Watson concludes, "The effects of ultrasound are well established and evidenced. What the evidence clearly says is that the effects that ultrasound is capable of achieving are dependent on the dose (machine settings) applied. There is not a 'one size fits all' dose - it needs to be worked out for individual cases".

Professor Tim Watson is with The Massage Training School on 6th and 7th June 2015 in Exmouth for an evidence based study day on Tissue repair followed by a day learning the concepts of therapeutic ultrasound, its theoretical principles through to practical application of this therapy. To join Professor Watson one or both of these days, please contact The Massage Training School on 01395 271610.

*1  International Therapist, issue 110, Autumn 2014, Tim Watson