Therapeutic Ultrasound

What is Frequency ?
• Sound waves with a Frequency above 20,000
Hz
• The number of oscillations a molecule
undergoes in one second defines the
frequency of sound waves.
• Frequency is expressed in Hertz (Hz)
• 1MHz – deep penetration/deep heating/ 1-
5cm
• 3MHz– Superficial penetration/superficial
heating/1-3cm
 Duty cycle
• It is on time to total time= If I want to have a duty
cycle of 25%, then I might choose to have the sound
waves on for one second and off for three seconds;
on one second, off three, and total time is then 4
seconds.
• The duty cycle D is defined as the ratio between
the pulse duration, or pulse width PW and the
period To a rectangular waveform
 Clinical implications of Ultrasound
• Soft tissue healing and repairs
• Scar tissue and joint contracture
• Stretching of connective tissue
• Absorption of calcium deposits
• Bone healing
• Pain reduction
• Assessing stress fracture
• Chronic inflammation
 Therapeutic uses of ultrasound

o Recent injury and inflammation.

o Scar tissue.
o Chronic indurate edema (non thermal effect).

Contra indications of ultrasound therapy

•Vascular conditions; such as thrombophelibites, ultrasound may

cause emboli to broken off.
•Acute sepsis; an area which presents acute sepsis should be treated
cautiously with ultrasound because of the danger of spreading the
infection.
•Tumors (stimulate the growth or throw of metastases).
 Cont’d

•Pregnancy may produce fetal damage

consequently during pregnancy (the back and the
abdomen should not be treated).
•Radiotherapy; radiotherapy has a devitalizing
effect on the tissues; therefore ultrasound is not
applied to a radiated area for at least six months
after irradiation.
•Cardiac diseases; patients with cardiac diseases
are treated with low intensities in order to avoid
sudden pain, and area such as the cervical
ganglion and the vagus nerve are avoided because
the risk of cardiac stimulation. Patients fitted with
cardiac pacemakers are not usually treated with
ultrasound in the area of the chest.
 Dosage

Acute condition initial stage with low

dosage 0.25 -0.5W/cm for 2 to 3min.

Slightly increase the intensity of ultrasound

0.8W/cm for 4 to 5 min.

Chronic condition dosage used up to2W/cm

for 8 min.
 Types of application
Direct contact: -
If the surface to be treated is fairly regular then a coupling
medium is applied to the skin in order to eliminate air
between the skin and the treatment head and transmit the
ultrasonic beam from the treatment head to the tissues.
Water bath: -
A water bath filled with de-gassed water is used if possible
.Ordinary tap water presents the problem that gas bubbles
dissociate out from the water, accumulate on the patients skin and
the treatment head, and reflect the ultrasonic beam. If tap water
has to be used then the gas bubbles must be wiped from these
surfaces frequently .The technique of application is that the
treatment head is held 1 cm from the skin and moved in small
concentric circles.
Cont’d

Water bag on irregular bony surfaces:-

On irregular bony surfaces a rubber bag filled with de-gassed

water can be used. A coupling medium has to be placed both
between the rubber bag and the skin and between the rubber bag
and the treatment head to eliminate any air.
 Application of US
1. Evaluate the patient’s clinical findings and set the goals
of treatment.
2. Determine whether ultrasound is the most appropriate
intervention.
3. Confirm that ultrasound is not contraindicated for the
patient or the condition.
4. Apply an ultrasound transmission medium to the area to
be treated. Apply enough medium to eliminate any air
between the sound head and the treatment area. for the
application of ultrasound under water, place the area to
be treated in a container of water.
 Cont’d
5. Select a sound head with an ERA approximately
half the size of the treatment area.
6. Select the optimal treatment parameters, including ultrasound
frequency, intensity, duty cycle, and duration; the appropriate
size of the treatment area; and the appropriate number and
frequency of treatments. Parameters are generally determined
by whether the intended effect is thermal or non thermal.
7. Place the sound head on the treatment area.
8. Turn on the ultrasound machine.
9. Move the sound head within the treatment area. The sound
head is moved to optimize the uniformity of ultrasound intensity
delivered to the tissues and to minimize the risk of standing
wave formation.
10. When the intervention is completed, remove the conduction
medium from the sound head and the patient, and reassess
for any changes in status.