Ultrasonic therapy

By
Faisal Mehboob

Introduction
Ultrasound use for three purposes
1. For diagnostic purposes (in pregnancy)
2. For destruction purposes (in cancer)
3. For therapeutic purposes (in physiotherapy)

In physiotherapy, it is classified as deep heating

modality
Use primarily as *repair soft tissue injuries and
*relieve pain.

Definition
Mechanical vibrations which are essentially the
same as sound waves but of higher frequency.
Such waves are beyond the range of human hearing
and therefor also termed as ultrasonic.

Frequency of ultrasound
Above the audible range(20-20000Hz)
At 1MHz , ultrasound absorbs primarily in the deeper tissue at depth of
3 to 5cm. Ultrasound applied at this freq are more useful the person with
high percentage of cutaneous body fat.
At 3Mhz, ultrasounds are more absorbs in the superficial tissue with the
depth of penetration b/w 1 and 2cm.

Properties of waves
1) Sonic waves are also called longitudinal waves because these
waves have series of mechanical and rarefactions in the
direction of travel.
2) Because sound waves can pass through any material , so their
energy can be dissipated.
3) Velocity
In air = 344m/s
In water = 1410m/s
In muscles = 1540m/s
In bones = 3500m/s

Production of ultrasounds

For 1MHz machine, a vibrating source, with

freq of one million cycles per second is needed.
(can be achieve by using , either
Quartz *barium titanate *lead zirconate *nickel
cobalt ferrite crystals. These crystals can
deform with varying potential . This process is
also know as piezoelectric effect)

Production method
Source of high frequency current
Conveyed by coaxial cable with a transducer or a treatment
head.
Inside transducer , high freq current applied to the crystal.
Any change in the crystal causes movement of metal front
plate.
This movement will produce ultrasonic waves.
Strict freq control of high freq current allow steady and regular
rate of deformation

Transmission of ultrasound
Treatment should be applied in perpendicular to the
interface between the media.

Attenuation of ultrasound
Gradual Dec in the intensity of the ultrasonic beam when it left the
treatment head.
Depends upon two factors.
1. Absorption
2. Scatter (half value distance for 1MHz is 4cm & for 3MHz is 2cm)

Ultrasonic field

Coupling media
Ultrasounds are not transmitted directly in the air , so need a coupling media.
Unfortunately no coupling media allow 100% transmission of ultrasounds.
Examples.
Aquastic gel =72.6%
Glycerol = 67%
Distilled water= 59%
Liquid paraffin =29%
Petroleum jelly =0%
Air =0%

Characteristics of coupling media

1)
2)
3)
4)
5)
6)
7)

Allow high transmission of ultrasound

High viscosity
low suspetibelity to bubble formation
Chemically inactive nature
Cheap
Acoustic impedance similar to tissue
Should act as a lubricant to allow movement of treatment head.

Treatment parameters
Used in two ways
1. Continuous mode(ultrasound produced continuously)
2. Pulsed mode (periods of ultrasounds are separated by periods of
silence)

Intensity
Intensity unit for ultrasound is WATT.
1. Space averaged intensity W/cm-2
2. Time averaged/space , used when there is an
application of pulsed mode of ultrasound in use.

Testing the apparatus

Place treatment head just below the water surface
in a suitable container and observing the
disturbance.
The apparatus should be on and off with the
treatment head below the water.

Techniques of application
Preparation of patient
Examination and testing
Preparation of the part to be relaxed
Setting up
Instructions and warning
Application (methods of applications are 1.concentric circles
2.overlapping circles 3.figure of eight 4.transverse strokes.
Termination
Recording( *machine used*intensity *freq*pulse mode
*insonation time*couplent *region & area of
insonation*response of treatment)

Direct contact method

If the treatment surface is fairly

regular
Then a coupling media will be
used to eliminate air
Transmit the ultrasonic beam
Move the treatment head
Avoid concentration at one
point
Tech is suitable for areas up to
three times the size of the
treatment head.
Large area should be divided

Water bath method

Water bag method

*Use for irregular surface

*Rubber bag filled with degassed water is used
*All visible air bubbles should be squeezed out.
*A coupling media should be placed both between the bag
and the skin to eliminate any air.
*Bag should be held by patient or others
*Apply the treatment head firmly on the bag so that
a layer of water about 1cm thick separates it from the body.

Part to be treated , immersed in

the water
This can be applied easily on
hands , foot and ankle .
Water bath filled with degassed
water is used.
Avoid to use tap water because
it will allow bubbles.
Patient should be well seated
Treatment head placed in water
and held 1cm from the skin
,and move in small concentric
circles.

Dosage
Three factors determine the ultrasound dosage
1. Size of treatment area
2. Depth of lesion
3. Nature of lesion

Parameters of ultrasound
1. Mode (continuous mode produce more heat. Used for muscular
spasm, joint stifness ,pain pulsed mode produce less heat, used
for soft tissue repair.e.g tendonitits)
0.5W/cm2 pulsed at 1:4 = 0.1 W/cm2 continuous
1. Frequency (3MHz for superficial tissue, 1MHz for deep)
2. Intensity (for acute=0.1 to 0.25W/cm2 ,, for chronic =0.25 to
1W/cm2)
3. Duration of treatment (1-2min for every cm2.
Minimum. 1-2min
Max. 8min
Average. 5min
For chronic. Longer treatment time
For acute. Lesser treatment time

Dosage in acute lesions

For initial stage
*Low dose 0.25 to 0.5wcm2
*Time 2-3 min
Failure case
*0.25 to 0.5wcm2
*Time 4-5min

Dosage for chronic conditions

2w/cm2 for mildly perceptible warmth.
Initially low dose tried
Intensity 0.8w/cm2
Time 4min

Physiological effects

Thermal effects
Ultrasound waves are absorb by
the tissue and converted into
heat. It depends upon
Absorption of tissue
Number of times treatment
head passes over the area
When using continuous mode ,,
amount of heat produce is
directly proportional to the
intensity and duration.
When using pulsed mode, there
is less thermal effect
Reflection of ultrasound
produces heating effect at a
specific point.

Uses of thermal effects

Accelerate healing
Extensibility of collagen inc
Stretching of scar and
adhesions

Non-thermal effects
Occur due to pressure of treatment head
Cavitation
1 Stable cavitation
When bubbles oscillate to and fro
But remain intact
Not dangerous
2. Unstable or transient cavitation
When volume of bubble changes rapidly then collapse
Dangerous
Can be prevent by moving the treatment head and keeping the intensity low
(3w/cm2) and frequency high(1 or 3MHz).

Mechanical effects
Occur by longitudinal
compression
Help in reducing edema
Combined with the thermal
effects the extensibility of scar
and adhesion occur
Also possible that it could
reduce pain.

Biological effects
Inflammatory
Proliferative
remodeling

Therapeutic effects
1.
2.
3.
4.
5.
6.
7.
8.

use after soft tissue injuries

dec adhesion formation
accelrate protein synthesis
scar tissue is made pliable
chronic endurated edema
varicose ulcers
bone injuries
placebo effect

Danger of ultrasound
Burns
cavitation
overdose
Danger to equipment

Contraindication

Vascular condition
acute sepsis
radiotherapy
tumors
pregnancy
cardiac disease
hemorrhage

severely ischemic tissue

nervous system
specialized tissue
implants
anesthetic area

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