Ultrasound Therapy

Therapeutic ultrasound in physiotherapy is the sending of high-frequency sound waves down into the tissue, in order to create a "deep thermal effect" and/or a "mechanical effect" that helps release the tightness of the muscles, reduce the irritation of the tendons and the fascia, and support the circulation of blood in the area that has a problem. It is therefore often used as a supplementary instrument together with therapeutic exercise, stretching, or a rehabilitation programme specific to a disease. It suits older people and those of working age who have pain in the joints, the tendons, and the muscles, such as degenerative knee, inflamed shoulder tendon, pain in the neck, shoulder blade and shoulder, or those who are in the period of recovery after surgery or an accident.

At PYONG Rehabilitation Penthouse Clinic (Gaysorn Tower, floor 11, near BTS Chit Lom), patients in every case receive history-taking, physical examination, and the design of a plan of treatment by a rehabilitation medicine physician together with the physiotherapy and multidisciplinary team, for the highest safety and effectiveness. It can also be integrated with other advanced rehabilitation technologies, such as PMS, High-Power Laser, Focused Shockwave and Dry Needling, according to what suits each individual.

What is therapeutic ultrasound in physiotherapy

Therapeutic ultrasound in physiotherapy (Therapeutic Ultrasound) is the use of a device head that sends high-frequency sound waves (in general 1–3 MHz) through a cool conducting gel down into the tissue beneath the skin. These sound waves make the cells and the fluid in the tissue vibrate safely, giving a result in two main directions, namely the thermal effect (thermal), which helps increase the elasticity of the tissue and reduce spasm and tightness, and the mechanical effect (non-thermal), such as acoustic streaming and cavitation, which has a part in helping the repair of the soft tissue and the healing of small wounds at the microscopic level. Both mechanisms usually arise together in clinical practice, with the doctor choosing the continuous mode (emphasising heat) or the pulsed mode (emphasising the mechanical effect) to suit the goal of treatment and the depth of the lesion (Physiopedia (opens in a new tab), Electrotherapy On Th (opens in a new tab), MDPI (opens in a new tab))

Why therapeutic ultrasound should be done at PYONG Rehabilitation

• The therapeutic ultrasound machine that PYONG Rehabilitation has chosen to use is the most modern therapeutic ultrasound from the United States, which has a dual-wave mode able to use waves of 1 MHz (deep) and 3 MHz (shallow) together in a single session, making the depth of treatment controllable with more flexibility, while also supporting work in several modes. It can send waves at a maximum power of 2 W/cm² (sending the waves continuously) and 3 W/cm² (sending the waves in pulses), for treatment suited to both acute pain and chronic pain
• A rehabilitation medicine physician supervises every step: assessing the root cause of the symptoms, choosing the parameters (1/3 MHz, continuous/pulsed) and ordering the accompanying instruments (PMS / high-power laser / shockwave / Dry Needling) to match the disease
• An integrated programme by a complete multidisciplinary team: done together with physiotherapy and occupational therapy, balance and gait training, and nutrition or clinical psychology (according to necessity), suiting older people and patients of the nervous system
• A convenient location: PYONG Rehabilitation Penthouse Clinic – Gaysorn Tower, floor 11 (BTS Chit Lom), easy to travel to
• Systematic follow-up of the result: setting monthly goals and adjusting the plan according to the actual response, for a result that is sustainable and safe

How ultrasound works, and the steps in receiving the service

High-frequency sound waves create vibration at the level of the cells, increase the temperature of the tissue in a controlled way (in the case of using the continuous mode), and stimulate the circulation at the microscopic level and stimulate the exchange of fluid around the cells (acoustic streaming), as well as stimulating stable cavitation, which is related to the release of tightness of the muscles and the repair of the soft tissue. When you arrive at the clinic, the doctor will assess the area that has pain or tightness and determine the parameters, such as a frequency of 1 or 3 MHz, the continuous or pulsed mode, the length of time, and the size of the area that will be treated.

The steps (in summary): (1) cleaning the skin and applying the conducting gel (2) placing and moving the device head in broad, even circles (3) adjusting the level of energy according to the feeling of the person receiving the service (it may be comfortably warm; it should not feel scalding) (4) following up the symptoms immediately after it is done, and designing a supplementary programme, such as stretching and strengthening, or another suitable technology. The length of time in doing it is in general ~5–10 minutes per one area. All of it is under the supervision of the doctor and the team of physiotherapists, for safety (OccupationalTherapy.com (opens in a new tab), PMC (opens in a new tab))

The symptoms and states that suit ultrasound

• Knee pain from a degenerative knee joint
• Inflamed shoulder tendon and frozen shoulder (Rotator cuff tendinopathy)
• Pain in the neck, shoulder blade and shoulder from posture (office syndrome)
• Back pain with tight muscles and thickened fascia
• Chronic inflamed tendons (such as the Achilles tendon, tennis elbow)
• After surgery during the period of recovery (according to the doctor's consideration)
• Pain and tightness around a surgical wound or fascia beneath the skin (when there is no contraindication)
• A state of swelling and tightness from overuse
• Pain at a particular point together with a trigger point (used in pair with dry needling as suitable)
• Older people who want a gentle instrument to relieve pain together with therapeutic exercise

Note: the effectiveness differs according to the individual and the kind of disease. The doctor will assess and order the suitable instruments, such as PMS / high-power laser / shockwave. In some cases shockwave may give a better result than ultrasound for tendons in some positions, such as the Achilles tendon at the heel (Frontiers (opens in a new tab))

Academic evidence concerning ultrasound

Research in the field of degenerative knee joint (knee OA) has found that ultrasound, both the continuous and the pulsed kind, may help reduce pain and increase the working of the joint when used as part of rehabilitation (it should be used together with exercise and the adjustment of behaviour) (Oarsijournal (opens in a new tab), PubMed (opens in a new tab), PMC (opens in a new tab))

In terms of mechanism, ultrasound gives rise to a thermal effect and a mechanical effect (acoustic streaming / cavitation) that may be favourable to the repair of the soft tissue (MDPI (opens in a new tab), Oxford Academic (opens in a new tab))

How often should ultrasound be done

The frequency of doing it depends on the goal and the stage of the symptoms. In general 1–3 times a week for a period of 2–6 weeks, used as a "supplementary instrument" in order to help release tightness and reduce irritation, so that stretching, strength training, and patterns of movement can be done better. The doctor will determine the frequency, the length of time, and the mode (continuous/pulsed) to suit the kind of tissue and the depth of the lesion, while following up the response every week. If the symptoms improve quickly, the frequency may be reduced and an exercise and movement-training programme emphasised instead.

The results that can be expected

Short term (the first session to the first week): many people receiving the service feel that the tightness is released, feel comfortably warm, and can move slightly better immediately after it is done, particularly when it is followed by stretching and training the muscles in particular postures. The treatment should be built upon with a supplementary rehabilitation programme.

Long term (4–6 weeks and beyond): when done alongside therapeutic exercise and the adjustment of behaviour, a reduction in pain and a clearer increase in the result of treatment may be found in some kinds of disease, such as degenerative knee, or an inflamed tendon in a particular position (Oarsijournal (opens in a new tab), PubMed (opens in a new tab))

Contraindications and precautions in carrying out the procedure

For safety, avoid the use of ultrasound on the abdomen and lower back of a pregnant woman, on an area that has cancer, acute infection, inflamed blood vessels or a blood clot, on the area of the eyes, the heart, the testicles and a child's growth plate. Take care in the case of joint cement or an implanted device, or abnormal skin or sensation; the doctor will consider it case by case. For those who have a pacemaker, doing it on the chest should be avoided and the doctor should screen strictly. Every case at PYONG will always receive history-taking, physical examination, and a test of skin sensation before it is done. If an abnormal signal is found, it will be stopped and the approach adjusted immediately (Government of Canada (opens in a new tab), PMC (opens in a new tab), Verywell Health (opens in a new tab))

The cost

The service charge for therapeutic ultrasound in physiotherapy starts at 2,000 baht per area, or is included in a physiotherapy or intensive rehabilitation programme according to the plan the doctor determines. If the cause is not yet clearly known, it is recommended to receive an assessment by a rehabilitation medicine physician (history-taking, physical examination, movement testing) in order to set the parameters and choose the suitable supplementary instruments.

Frequently asked questions (FAQ – 5 items)

Q1: How does therapeutic ultrasound in physiotherapy differ from ultrasound for examining disease?

A: The purpose and the parameters are different. Therapeutic ultrasound in physiotherapy is used in order to treat the tissue (a frequency of 1–3 MHz, continuous/pulsed) under a plan of treatment, not in order to diagnose by imaging the inside (Physiopedia (opens in a new tab))

Q2: How does it feel while it is being done?

A: It usually feels slightly comfortably warm, with no pain. If it is hot or scalding, tell the person carrying out the procedure immediately so that the level can be adjusted

Q3: Can it be used together with an applied medicine (phonophoresis)?

A: It can be done in some cases, in order to carry the medicine through the skin; it must be considered case by case (PMC (opens in a new tab), Oxford Academic (opens in a new tab))

Q4: What important contraindications are there?

A: Avoid the area of the abdomen and lower back in a pregnant woman, an area with cancer, acute infection, inflamed blood vessels or a blood clot, the eyes, the heart, the testicles, a child's growth plate, and avoid the chest in those who have a pacemaker. The doctor will screen every case (Government of Canada (opens in a new tab), PMC (opens in a new tab))

Q5: If there is metal or an artificial joint, can it be done?

A: The doctor must consider it with care, particularly in an area that has joint cement or certain materials, because more heat than usual may arise; it must therefore be assessed individually