USING THERAPEUTIC
MODALITIES
Ultrasound
ULTRASOUND
• Ultrasound uses inaudible, acoustic vibrations of high frequencies that can produce
thermal or non thermal physiological effects
• 1 MHZ (one million cycles per second)
• When sound scatters and absorbs while penetrating the tissues it will lose energy
• This is call ATTENUATION
• Absorption will increase with frequency
ULTRASOUND
• Frequency of 1.0 MHZ will go deeper into the tissue (3-5cm)
• Frequency 3.0 MHZ 1-2 cm
• Intensity will be determined by the amount of energy being delivered to the sound
head
ULTRASOUND
• Continuous: Sound intensity remains constant
• Pulsed: Intensity is periodically interrupted
• Duty-Cycle: Percentage of time that the ultrasound is being generated
PHYSIOLOGICAL EFFECTS
• Increased blood flow
• Increased metabolism and enzymatic activity
• Increased collagen extensibility
• Decreased viscosity
• Decreased pain
• Decrease of chronic inflammation
• Mild Heating: Accelerates metabolic rate
• Moderate Heating: Reduced muscle spasm, pain, chronic inflammation, increase blood flow
• Vigorous Heating: Increased elasticity of collagen
NONTHERMAL ULTRASOUND
• Separation of collagen fibers
• Increased fibroblastic activity
• Break up of metabolites and waste products
• Reduction of edema and pain
• Microstreaming
• The flow of the fluids and tissues creates mechanical pressure waves that change cellular permeability
• Cavitation
• Formation of gas bubbles that expand and compress due to pressure changes
• Stable: increased fluid flow around the bubbles
• Unstable: violent large bubble collapse that creates increased pressure and temperature that leads to tissue
damage
ULTRASOUND APPLICATION
• Direct skin
• The skin should be cleaned and a water soluble gel or topical analgesic applied to the
area as a coupling medium
• Under water
• Used for irregular bony surfaces, the ultrasound head will be positioned 1 inch from the
body part
• Bladder Technique
• Waves will be transmitted through a gel coated balloon filled with water
PHONOPHORESIS
• The acoustic energy of the ultrasound is used to transport molecules through the
skins surface into deeper tissues
• Most often used to introduce hydrocortisone and anesthetics into the tissues for
treatment of conditions such as
• Tendinitis
• Bursitis
• Chronic inflammation
CONTRAINDICATIONS
• Decreased circulation
• Acute conditions (thermal)
• Decreased sensation
• Over the eyes or reproductive organs
• Over malignant tissues (cancer) or epiphyseal (growth plates) areas in younger
people
• Over the spinal cord
• Over a total joint replacement (increased heat absorption)