The utilization of therapeutic ultrasound to
treat various conditions is fairly common in the physical therapy clinic. When
we were in physical therapy school we were taught that ultrasound could be
utilized in rehabilitation as an adjunct in the management of various soft
tissue dysfunctions including: joint contracture, scar tissue, tendonitis,
bursitis, skeletal muscle spasms and pain (1). It was noted that the thermal
effects of ultrasound could assist in increasing tissue pliability, increasing
circulation, increasing the threshold for activation of the free nerve endings
and reducing muscle spindle activity (1).
As physical therapists we should all strive to practice utilizing evidence based
physical therapy. However, if we were to examine the utilization of therapeutic
ultrasound by scrutinizing the research available, the evidence is insufficient
and questionable in regards to its use.
In a review by van der Windt, et al (2) that examined ultrasound therapy for
musculoskeletal disorders, they concluded that 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.
In a review by Robertson VJ & Baker KG (3) they considered 35 randomized
controlled trials (RCT) where ultrasound was utilized to treat people with pain,
musculoskeletal injuries and soft tissue lesions. Of the 35, they only found 10
RCT’s that had adequate methods and met their criteria. Of these RCT’s, they
found two trials which suggest that therapeutic ultrasound was more effective in
treating some clinical problems (carpal tunnel syndrome and calcific tendonitis
of the shoulder) then placebo ultrasound, and the results of the other 8 trials
suggest that it is not.
In another review by Baker at al. (4) which examined the biophysical effects of
therapeutic ultrasound, they found that the described biophysical effects of
ultrasound either don’t occur in vivo or have not been proven to have a clinical
effect under these conditions. Their findings further suggest that there is a
lack of biophysical evidence to provide a scientific foundation for the clinical
use of therapeutic ultrasound for the treatment of people with pain and soft
tissue injury.
The bottom line is that the evidence is lacking for the use of therapeutic
ultrasound in the treatment of pain and musculoskeletal injuries. Nevertheless,
as a clinician you may have found some instances where ultrasound may have been
helpful with treating a condition. However, further quality studies are
warranted to support this.
References
1. Michlovitz, S., (1996). Theraml Agents in Rehabilitation - third
edition. Wolf, S. (Ed). (pp. 177-188) Philadelphia, F.A. Davis Company.
2. van der Windt DA, van der Heijden GJ, et al., Ultrasound therapy
for musculoskeletal disorders; a systematic review. Pain. 1999
June;81(3):257-71.
3. Robertson VJ, Baker KG. A Review of Therapeutic Ultrasound:
Effectiveness Studies. Physical Therapy. 2001;81:1339-1350.
4. Baker KG, Robertson VJ, Duck FA. A Review of Therapeutic
Ultrasound: Biophysical Effects. Physical Therapy. 2001;81:1351-1358
Last revised: June 29, 2017
by Jennifer Hill, MPT, CSCS & Chai Rasavong, MPT, COMT, MBA |
