Therapeutic Ultrasound in

Physiotherapy
BY
O D US CHRISTIAN
P H Y H INYI
OTHERAPEY D P K R E T M NT
J$E N U E S T A T A U N I V B R R I T Y T E A C HG
I N HO S P I T R L ( B S U T H ) , M R K U R D I
 ‘
Ultrasound is used in medicine for:
= Diagnosis
= Destruction of tissue
= Therapy
= Ultrasound is a mechanical vibration at
any frequency above the audible sound
range
= Ultrasound therapy (UST) is the
application of ultra frequency sound waves
(1 — 3MHZ) to tissues in order to promote
- healing and reduce
Therapeutic pain
Us used and swelling. ranges from
in physiotherapy
o. s to sMHZ but most us machine are set at 1MHZ
and/or 3MHZ
Classified as a deep heating modality
 Production of ultrasound
...
= The inverse piezoelectric effect is uaed in production
of
ul4asonic sound waves.
= Examples of piezoelectic
materials are quartz,barium
titanate and lead
zirconate titanate (PZT).
« Application of high frequency alternating current to
the PZT crystal of the transducer transforms the
electrical energy into vibratory sound wave (ulaaaound)s
 4 i cii› «n› is « v › n ‹ › l I ' * › :»
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1. I,
= Through solid, liquid and gases in form of
compression and separation of molecule
= Normally cylindrical and longitudinal in
fashion
= Velocity higher in materials of high
density
• Air 34o m/s, water 141Om/s, muscle

1s4Om/S, Bone

35OOIR/S.
= Reflection
= Refraction Attenuation
=
Absorption
< Passing through the tissue US energy is dissipated =
attenuation
< Half Value Distance = 4cm for 1MHZ and 2cm for
3 HZ
< Acoustic
Impedance(Z)
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. .. _
• iMHZ= deeper tissues at 1 .I, Near and Far Field
depth 3 to sCm - Wave fonts Yom
diNerent paGs travel
3MHZ= superficial diNerent distances
Tissues at depth 1 tO causing interference
2CIR Depth of between adjacent
Penetration is fonts
inversely proportional to
frequency TraF\Rducor
(Xo) max

Near raid Fai fiuld

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The near field also , Frequency of US and
known as the Fransel ! radius of transducer
zone is the convergent , need to be considered
region for tissue depth above
= The far field known b•scm(shortest)
as the fraunhofer
zone is the divergent
region
= Length of Fresnel zone 15 1
= r2 / X where 15
10
3
1
r=radius of transducer. 65

= Therapeutic us utilizes
the near field
• %trasound waves are not transmitted by air, thus
some couplant which does transmit them must be
interposed
• Unfortunately no couplant afforo perfect
transmission & only a percentage of the
original intensity is transmitted to the patient.
Aquasonic gel 7
Glycerol .6%
67
Distilled water
Petroleum jelly s9 OF
o
2$iF
%
O
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i. Acoustic impedance similar to

tissue

«. Chemically inactive in nature

.s. A hypoallergic character
b. High viscosity
7 Cheap
8. Relative sterility
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- Mode type : continuous and pulsed. Pulsed Mark

Space(M:S) raê o: 1:1, 1:R, 1:4 PC.

- Power: amount of a cousô c ener›qr per unit ê me (watts)
- Intensity: power per unit area of the ultrasound head
(watts/cmz). Space average intensity and time
averaged/space average intensity(pulsed).
• Frequency: number of compression-rarefaction cycles
per unit of time, usually expressed in cycles per second
(HeGz)
- Effective radiating area (ERA): The area of the
transducer from which the US energy radiates
- Duty cycle: The proportion of total treatment
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Majority of the ultrasound generators used in

physiotherapy are set at a frequency of 1MHZ
and/or 3MHZ.
The depth of penetration of ultrasound beam is
inversely proportional to the frequency
1MHZ ultrasound beam has a depth of
penetration of
3 5cm and absorbed in deeper tissues
3MHZ ultrasound beam with a depth of penetration of
1-2cm and is absorbed in the superficial tissues
= Preparation of the
Machine
= Preparation of the Patient
• Set up the treatment
= Termination of treatment
= Documentation
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Preparation of the machine ' - 5et-up up the Rx

Position Secure pt.’s comfort and stability of Rx
Inspect P
Be assured of functionality Plug dead, supply and power on
Bring all accessofies closer: Select Rx programme
Aquasonic gel • Apply coupling media
Cokon wool Ensure the transducer is in contact with
Methylated spirit the coupling media on the slfin
Water in a bowl
Start now
• Preparation of the patient Keeping asking how the pt.’s feels
Inform your patient
Remove metals
› Expose the Rx part
Rem ove hair if necessary
Wash or swab
Inspect the Rx part
Check for intact
sensation
Demand co-operation
• Termination • Documentation
^ Remrn intensity to * Date
zero * Machine
* Remove transducer < Intensity
< Cut the mains supply Frequency
* Clean the skin and the Mode
transducer < duration
^ Inspect > Coupulant
> Region
* Response
of Rx'
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Principles ;, Techniques of Application
i Direct contact
- Rx surface parallel to the skin
Water bath: degased water
Even pressuremaintained to of comfoGable temperature,
irregularities
exclude air andinbalance
sonic field transducer held icm
- Transducer moved parallel to the skin inside
the water keeping
continuously over the skin
Water bag
surface
- Rate of movement must
be

of overlapping parallel
strokes, circles or figure 8
- Factors to consider

^ Note: A dose of zwatts/cmz

Intensity:
watts/cmzo.=s or for 8minutes is maximum
^ Time: =-3minutes permitted
Fa?ure to improve progress to
o.8watts/cmz or increase
time to 4 Or sminutes
 ‘I’l›•. «i•›l‹›gic i1 c':l›
•‹‘fs
• Chemical Reactions
= Biological Responses
• Mechanical Responses
= Thermal Effects
- Chemical reaction - Biological responses
%trasound vibration > Increase membrane
stimulate tissue to permeability which
enhance chemical enhances transfer of ñuid
reactions and processes
and ensure circulation of and nutrients to tissues
necessary elements and AcousticStreaming: is
radicals for unidirectiond flow of
recombination. tissue components which
occurs particularly at the
cell membrane. Streaming
produce changes in the rate
of protein synthesis and
could thus have a role in
the stimulation of repair.
 ‘I'l›'. *i ‹› l‹› g i e s
,—
- Mechanical responses - Thermal effects:
^ micro massage: cells are as ultrasonic waves
dternately compressed and are absorbed they
then pulled fuGher apart. are conveGed to
This increase mobility of
intracellular fluids and thermal energy (heat)
thus helps to reduce
oedema.
Tendon extensibility:
ultrasound apparently
increases the exten5ibi1ity
of tendons, muscles and
scar tissues.
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- SoA tissue injuries
- Oedema
- Varicose ulcers
= Pain control
• Chronic rheumatoid and aHhritic conitions
Tendon injuries
= Resorption of calcium deposits
Bone fractures
Carpal tunnel syndrome
= phonophoresis
 (*‹› If i ‘i‘iirl 1c'at i‹›iis

= Vascular conditions
= Radiotherapy
= Tumours
= Pregnancy
Cardiac disease
= Implant
« Anaesthetic area
= Acute sepsis
Time to Demonstrate
contributions