“A STUDY OF APPLICATION OF PHYSICS IN

PHYSIOTHERAPY”
A PROJECT REPORT SUBMITTED

FOR PARTIAL FULFILMENT FOR THE AWARD OF THE DEGREE

OF

BACHELOR OF SCIENCE

IN

PHYSICS

AT

H.M.COLLEGE OF SCIENCE AND TECHNOLOGY

MANJERI

AFFILIATED TO UNIVERSITY OF CALICUT

APRIL 2013
 H.M COLLEGE OF SCIENCE AND
TECHNOLOGY, MANJERI

DEPARTMENT OF PHYSICS
2013

“A STUDY OF APPLICATION OF PHYSICS IN

PHYSIOTHERAPY”

Guided by: Submitted by:

Jose George Aslamiyya.KC

Amir.M Amrutha P Bhaskar

Rubeena.K Faisal.PC

Sanoop.VS

Ummul Khair.M

2
 CERTIFICATE

This is to certify that the project work entitled “A STUDY OF

APPLICATION OF PHYSICS IN PHYSIOTHERAPY” ,submitted to the
University of Calicut in partial fulfillments for the award of the DEGREE
OF BACHELOR OF SCIENCE IN PHYSICS is the record of original
project work done by Mr. FAISAL.PC during the period 2012-2013 of
his/her study in the department of physics in H.M.COLLEGE OF
SCIENCE AND TECHNOLOGY,MANJERI under my guidance and this
project work has not formed the basis for the award of degree of similar
title to any candidate of any university.

PROJECT GUIDE HEAD OF THE DEPARTMENT

Amir.M Jose George

EXAMINER

3
 ZUMER PHYSIOTHERAPY AND REHABILITATION
CENTRE, MANJERI

PROJECT COMPLETION CERTIFICATE

This is to certify that Mr.FAISAL.PC studying for Bachelor of Science

in Physics Degree Course at H.M.College of Science and Technology
Manjeri has done a project work entitled “A STUDY OF
APPLICATION OF PHYSICS IN PHYSIOTHERAPY” in this centre
for requirement of the partial fulfillment of his course. This bonafide
work has been carried out under my guidance and supervision.

Place: Manjeri Abdul Jaleel

Date: 20/03/2013

4
 DECLARATION

I, do hereby declare that the dissertation Entitled “A STUDY

OF APPLICATION OF PHYSICS IN PHYSIOTHERAPY “submitted to
the department of Physics of H.M. College of Science and Technology
Manjeri in partial fulfillment of the requirements for the award of the
Degree of Bachelor of Science in Physics is a record of original project
work done by me under the supervision and guidance of Mr.Amir.M and
Mrs.Rubeena kolothumthodi, Asst. Professors, Dept.of Physics, H.M.
College of Science and Technology Manjeri.

Place: VALAMANGALAM FAISAL.PC

Date: 23/04/2013

5
 ACKNOWLEDGEMENT

I express my deep sense of gratitude to the almighty blessed me to

complete the work in time and also to my parents to the intent support
and encouragement throughout the completion of this work

I owe my sincere gratitude to Jose George, HOD of dept. and our

guides Mr. Amir and Mrs.Rubbeena, lecturers of our dept. H.M College
of Science and Technology for the valuable guidance and suggestions in
accomplishing the work

I would like to express my deep gratitude and sincere thanks to

Mr. Abdul Jaleel, physiotherapist, Zumer Physiotherapy and
Rehabilitation Centre, Manjeri for his remarkable and inspiring guidance,
care and continuous encouragement during the period of my project
work.

My sincere thanks to my teachers Mr.Riyas.K, Mr.Muhammed

Shafeeque.M, Mrs.Sreeja and other staff members for their whole hearted
guidance and suggestions in the completion of this work.

I wish to thank all my team mates and the persons who help to
complete the work and help to collect the information.

I thank full to my best friend to her support, confidence and help

to make this study to a success

6
 ABSTRACT

The main objective of our study was to understand the

application of physics in physiotherapy along with basic principles and
application of ultrasound therapy and to understand the influence of
continuous mode ultrasound in human body for the reduction of painful
conditions such as Tennis elbow, Golfer’s elbow.

Ultrasound therapy is one type of electrotherapy. It is the use of

electrical energy as a medical treatment. From our study we could
understand that ultrasound therapy treatment device works under the
principle of piezo-electric effect. All equipments are used in
physiotherapy treatment have an underlying impact of the principle of
physics.

7
 CONTENTS

CHAPTER NO TITLE PAGE NO

1 INTRODUCTION 9-13

2 ULTRASOUND WAVE 14-19

3 BASIC COMPONENTS OF ULTRASOUND APPARATUS 20-30

4 TECHNIQUES AND METHODS OF APPLICATIONS 31-33

5 CONDITIONS AND CONTRADICTIONS OF APPLICATION 34-39

6 CONCLUSION 40

7 BIBLIOGRAPHY 41

8
 CHAPTER 1

INTRODUCTION

1.1 PHYSICS AND PHYSIOTHERAPHY

Physics is a fascinating, colorful and exciting branch of science,
which deals with nature and natural phenomena relating to matter and
energy. It is a versatile branch, which is incorporated all branches of science.
It finds application in all branches of science viz., chemistry, biology, and
mathematics etc. Physics is the backbone of science and engineering science.
It also explains ordinary matter as combination of dozen fundamental
particles (quarks and leptons), interacting through four fundamental forces. It
describes the many forms of energy such as kinetic energy, electrical energy
and mass way energy, can change from one form to another. It also finds
application in medical field especially in PHYSIOTHERAPHY

Physiotherapy is the branch of healthcare science that mainly

concentrates on the physical aspects of an individual’s healthcare treating by
physical modalities. It works towards this by maintenance and rehabilitation
of the individual's physical activity, which is nothing but bringing back the
lost activity to near normal perfection. Physiotherapy uses physical agents
for the treatment of patients

Physiotherapy Physical + Therapy

Therapy Treatment

The patient with physiotherapy means treatment given by

physical modalities (or) if physiotherapy is a way in which assess the
rehabilitation procedures or orthopedics neurology and cardio respiratory
diseases and the treatment given by physical modalities.

The main purpose of physiotherapy is to use the therapeutic effects,

which alters the abnormalities to the normal way of living.

It is mainly treated through,

9
  Exercise therapy

 Electro therapy

1.1.1. Exercise therapy

Exercise therapy mean treatment given by physical exercise. This

can be classified as,

 Passive range of motion

 Passive stretching

 Active exercise

 Resisted exercise

 Isotonic exercise

 Is kinetic exercise

1.1.2. Electro therapy

Electrotherapy is the use of electrical energy as a medical

treatment. In medicine, the term “electromagnetic therapy” has also has
been applied to a range of alternative medical device and treatments. Electro
therapy means given by electrical equipments namely

 Short-wave diathermy

 Interferential therapy

 Electronic traction

 Ultrasound therapy

 Electrical muscle stimulation

 Laser therapy

 Wax therapy

 Ultra violet radiations

10
 Physiotherapy aim to rehabilitate the patients with disabilities. It
accelerates the patients to recovery from injuries and diseases, which have
altered their normally way of living. Physiotherapy plays a major role in
every medical department such as

 Rheumatology,orthopeadies,orthosurgery and traumatology

 Neurology and neurosurgery

 Cardio respiratory

 Sports injuries and rehabilitation

 Burns and plastic surgery

 Obstetrics and gynecology

 Leprosy rehabilitation

 In emergency services like ICU<NICU etc

Out of the several therapies cited above, Ultrasound Therapy has been
taken as the field for the project work.

1.2 AIM OF THE STUDY

This project deals with basic principles application of ultrasound
therapy. This ultrasound machine works under the principle of piezo-elctric
effect. Patients having specific problems are treated using ultrasound therapy
in the presence of physiotherapist; the progress reports of various cases
subjected to this treatment are presented and the effectiveness of continuous
ultrasonic waves for the reduction of painful conditions such as Tennis
elbow, Golfers elbow, Plantar faciitis, Trigger finger and Bicipital tendonitis.

1.3 THERAPEUTIC ULTRASOUND

A basic knowledge of ultrasound physics is vital to the correct
application of ultrasound for diagnostic and therapeutic interventions.

11
 The sound waves used diagnostically in ultrasound have
frequency of more than 1MHz, whereas the audible range for humans is 20
Hz to 20 kHz. Therapeutic ultrasound is most widely used modalities in
physiotherapy department. It has been used as a valuable tool in
rehabilitation of many different injuries, to stimuli the repair of soft tissue
injuries and to relive pain. It has been traditionally classified as a deep
heating modality and used primarily to elevate tissue temperature.

Sound waves are propagated through a medium by the vibration

of molecules (longitudinal waves). Within the wave ,regular pressure
variations occur with alternating areas of Compression, which correspond to
areas of high pressure and high amplitude, and with areas of Rarefaction or
low pressure zones where widening of particles occurs.

Ultrasound consists of inaudible high-frequency mechanical

vibrations created when a generator produces energy that is converted to
acoustic energy through mechanical deformation of piezoelectric crystal
located with the transducer. The waves produced are transmitted the
propagation through the molecular collision and vibration, with a progressive
loss of the intensity of the energy during passage through the tissue
(attenuation),due to absorption, dispersion or scattering of the wave.

The total amount of energy in an ultra sound beam is its power,

expressed in watts. The amount of energy that reaches a specific site is
dependent upon characteristics of the ultrasound (frequency, intensity, and
amplitude, focus and beam uniformity) and the tissues through which it
travels. Therapeutic ultra sound has a frequency range of 0.75-3 MHz, with
most machines set at a frequency of 1 or 3 MHz. Low-frequency ultrasound
waves have greater depth of penetration but are less focused. Ultrasound at a
frequency of 1 MHz is absorbed primarily by tissues at a depth of 3-5 cm
and is therefore recommended for deeper injuries and in patients with more
subcutaneous fat. A frequency of 3 MHz is recommended for more
superficial lesions at depth of 1-2 cm.

The larger diameters of the effective radiating area of the transducer

face, the more focused the beam of ultrasound produced. Within this beam,
energy is distributed unevenly; the greatest non-uniformity occurring close to
the transducer surface (near zone).the variability of the beam intensity is
termed the beam non-uniformity ratio (BNR), the ratio of the maximal

12
intensity of the transducer to the average intensity across the transducer face.
This should optimally be 1:1 and certainly less than 8:1

Coupling media, in the form of water, oils and most commonly

gels, prevent reflection of the waves away at the soft tissue/air interface by
excluding air from between the transducer and patient. Different media have
different impedances. Any coupling medium should have acoustic
impedances similar to that of the transducer, should absorb little of the
ultrasound, remain free of air bubbles and allow easy movement of the
transducer over the skin surface.

Ultrasound dosage can also be varied by alteration of wave

amplitude and intensity [the rate at which it is being delivered per unit area
of the transducer surface (watts/cm)]. Therapeutic ultrasound can be pulsed
or continuous. The former has on/off cycle, each component of which can be
varied to alter the dose. Continuous ultrasound has a heating effect but either
from at low intensity will produce non-thermal effects.

13
 CHAPTER 2

ULTRASOUND WAVES

2.1. ULTRASOUND
Ultrasound (US) is a form of Mechanical energy, not electrical
energy. Ultrasound is generated by vibration of a Crystal mounted on a
special head. The human ear can hear sound waves that have a frequency
of 20-20,000 Hz. Ultrasound refers to waves that have a frequency higher
than 20,000Hz and are therefore outside our hearing range.

Sound waves must have a medium to pass through. The speed at

which a sound waves travel through a medium is called propagation
speed or velocity. It is equal to the frequency times the wavelength. In
ultrasound it measured in meters per second (m/s) or millimeter per
microsecond (mm/µs). The average propagation speed of sound in body
tissue is 1540 m/s or 1.54 mm/µs.

The intensity of the ultrasound field and the duration of

application determine the extent to which the thermal or the mechanical
effect prevails. From a clinical point of view ultrasonic energy has been
most effective in the treatment of painful conditions involving the
musculoskeletal and neuromuscular structures.

Sound waves are expressed as sine waves with the following properties:-

2.1.1. Wavelength

It is the distance between two areas of maximal compression or rare

fraction. The importance of wave length is that the penetration of the
ultrasound wave is proportional to wavelength and image resolution is no
more than 1-2 wavelengths

14
2.1.2. Frequency

It is the number of wavelength that passes per unit time. It is

measured as cycles (or wavelengths) per second and unit is hertz (Hz).It
is a specific feature of the crystal used in ultrasound transducer. It can be
varied by the operator within set limits-the higher the frequency, the
better the resolution but the lower the penetration.

2.1.3. Propagation Velocity

It is the speed that sound waves propagate through a medium and

depends on tissue density and compressibility. The relationship between
these variable is expressed by the wave equation

v= λf
In soft tissue propagation velocity is relatively constant at 1540
m/s and this is the value assumed by ultrasound machines for all human
tissue. Hence wavelengths are inversely proportional to frequency.
Velocity of Sound in various Materials:-

Material Velocity (m/s)

Air 331
Fat 1450
Water (50 c) 1540
Human soft tissue 1541
Brain 1549
Liver 1549
Kidney 1561
Blood 1570
Muscle 1585
Lens of eye 1620
Skull-bone 4080
Brass 4490
Aluminum 6400

15
2.1.4. Amplitude

It is the height above the baseline and represents maximal compression. It

is expressed in decibels which is a logarithmic scale.

2.1.5. Acoustic Power

It is the amount of acoustic energy generated per unit time.

Energy is measured in joules (J) with joules being the amount of heat
generated by the energy in question. The unit is the Watt (W) with
1W=1J/s. The biological effects of ultra sound in terms of power are in
the mill watt range.

2.1.6. Intensity

It is the power density or concentration of power within an area

expressed as W/m2 or mW/cm2.Intensity varies spatially within the beam
and is greatest in the centre .In a pulsed beam it varies temporally as well
as spatially.

2.2. PRODUCTION OF THERAPEUTIC ULTRASOUND

Piezoelectric transducers are used to achieve the high-frequency
ultrasound energy needed for surgery, imaging and therapy. These are
suitably charge. The piezoelectric effect was first described by Pierre and
Paul Jacques Curie in 1880.

They showed that certain crystals generated a small voltage

when subject to pressure. The reverse of this effect, first used in 1910 by
Lange in, is used to produce high-frequency oscillation of the crystal by
applying a high-frequency alternating charge to it. This effect is due to
the molecular configuration of the crystal being altered by the electric
charge. Many types of crystals can be used but the most favored are
quartz, which occurs naturally, and synthetic ceramic materials such as
barium titan ate and lead zircon ate titan ate (PZT).The crystal must be
cut to suitable dimensions. The most important being thickness, so that it
wills resonates at the chosen frequency and so achieve maximum
vibration. In order to apply the electric charges, metal electrodes must be

16
fixed to crystal. If a suitable metal plate is fixed to one surface of the
crystal while the opposite surface is in air, then almost all vibration
energy is transmitted from the crystal to the plate and hence to any solid
or liquid to which it applied. This is the Treatment Head, which is used to
transmit sonic to the tissues.

The other essential part of a therapeutic ultrasound generator

is a circuit to produce oscillating voltages to drive the transducer. It is
also necessary to provide a controlling circuit, base on an actable
multivibrator, which can turn the oscillator on and off to give pulses of
ultrasound output. The power supply from the mains needs to be rectified
and control circuits. Switches to turn the whole system on and off and to
charge from continuous to pulsed output are also needed most
importantly a means of controlling the output(or) intensity of ultrasound
and a meter to measure this are provided.

A basic oscillator circuit consists of an inductance and a

capacitor. If the charged capacitor is allowed to discharge through the
inductance a magnetic field will be set up. As the charge on the capacitor
falls this magnetic field collapses inducing a current in the coil which
recharges the capacitor with the opposite polarity.

The capacitor now discharge through the coil in the other

direction and the process is repeated over and over again .There is
therefore, a regular change from electrical energy in the form of charge
on the capacitor to magnetic in the form of the magnetic field .This is a
typical oscillating system in that there is a regular energy change
potential to kinetic energy and back again-like a pendulum swinging to
and fro.

For any given system the time taken for each cycle of events
is constant and depends on the size of the system, in the same way that
the frequency of the pendulum is inversely proportional to its length. The

17
time taken for an electrical cycle and hence its frequency depends on the
size of the capacitor (in farads) and the inductance to the coil (in
henries).Electrical circuits can be made to oscillate at any chosen
frequency by using the appropriate values for capacitance and inductance.
The smaller these values are the shorter each oscillation and higher the
frequency. The frequency is these inversely proportional to the product of
inductance and capacitance.

The frequency of this circuit is expressed as

f = 1 ⁄ 2π√LC

Where, f=frequency

L=inductance

C=capacitance

It will also be evident that some energy is bound to be lost at each

oscillation due to “friction” in the system. Energy is lost from the
capacitor and from the wires, appearing as heat in the circuit, and also
from the magnetic field around the inductance. Thus the oscillator is
damped note that it is the amplitude, (i.e.) the amount of energy, that
diminishes whereas the frequency remains the concert also note that the
energy loss is approximately exponential due to the fact that
proportionally less energy is lost as the current becomes less.

2.3. PIEZO-ELECTRIC EFFECT

“The production of a small e.m.f across certain substance when

they are subjected to external pressure”

Many regular, lattice- type structure such as the crystal used in

ultrasound equipment and protein molecules exhibit a piezo – electric
effect because the Mechanical distortion of strain displaces some
electrons towards the compressed surface (negative) and away from the
stretched surface (positive).The surface potential difference may either

18
potential (SRPS) or stress (or) strain-generated potential (SGPS).The
terms employed are usually defined in the particular text. It is consider
that the applied stress force should be considered as the primary cause of
these surface potential differences. Each individual distorted protein
molecule develops a potential difference and the surface tissue potential
difference is the resultant sum of these individual contributions.

Each time a bone, such as the femur takes a weight bearing

load it bends slightly. The compressed concave surface generates a
positive potential difference. The point charges are measured in pied
coulombs.

In tendons the tensile stress exerted by muscle concentration

against the external load carried by the tendon between the muscle and its
skeletal (or) facial insertion. Generate parallel planes of surface charge
along its stretched length and the same applies to all connective tissue.

CHAPTER 3

19
BASIC COMPONENTS OF ULTRASOUND APPARATUS

Different types of apparatus and methods of applications are used

in therapeutic ultrasound.

3.1. ULTRASONIC GENERATOR

20
 There is a source of high – frequency current, which is conveyed

by a coaxial cable to a transducer circuit, the high-frequency current is

applied to the crystal via a linking electrode, the crystal being fused to the

metal Front plate of the treatment head. Any change in the shape of the

crystal causes a movement of the metal front plate which in turn produces

an ultrasonic wave.

3.1.1. Transducers

Ultrasound waves are generated by piezoelectric crystals.

Piezoelectric means “pressure electric” effect. When an electrical current

is applied to a quartz crystal is shape changes with polarity. This causes

expansion and contraction that in turn leads to the production of

compression and rarefaction of sound waves. The reverse is also true and

an electrical current is generated on exposure to returning echoes that are

processed to generate a display. Hence the crystals are both transmitter

(small proportion of the time) and receiver (most of the time). The

frequency of the generated wave is a specific feature of the crystal used.

3.1.2. The Probe

Behind the crystal is backing material which dampens the sound

pulse. In front of the crystal is an acoustical lens which helps to focus

and cut down on the reflections of returning sound impulses.

Plating electrodes are placed on each side of the crystal. A

negative charge is induced on one side, a positive charge on the other.

21
This establishes an electric field between the plates, through the crystal.

The dipoles are rearranged because of this positive charge of the dipoles

shifts slightly closer to the negative side and the negative charge of the

dipole shifts slightly closer to the positive side. This realignment of the

dipoles results in a small decrease in the thickness of the crystal. When

the field is turned off, the dipoles return to their original position and the

crystal expands.

3.1.3. Piezo Electric Crystal

The piezo electric crystal is the heart of the instrument. This

crystal which is either natural (or) manmade has been processed to have

the piezo electric property of charging a mechanical sound to electric

current and vice versa. By the contracting and expanding of crystal

produces the sound waves.

3.1.4. Control of Output

22
 Strict frequency control of the high frequency current (1MHZ or 3

MHZ) ensures a steady and regular rate of deformation. The following

figures shows the effect of a change of potential applied to the crystal and

the effect this has on adjacent cells ultrasound is propagated in a linear

fashion up to of the near field at which point the beam starts to diverge.

3.2. ULTRASOUND TREATMENT PARAMETERS

Ultrasound may be used in a continuous mode where the treatment-

head continuously produces ultrasound i.e. energy, or pulsed where the

periods of ultrasound are separated by periods of silence. When using

ultrasound the following need to the specified.

3.2.1. Intensity

The energy in an ultrasound wave is characterized by intensify.

This is the energy crossing a unit area perpendicular to the wave in unit

time, the unit used is watt/m2. However for medical applications, the

square mater is an inappropriately large area in terms of regions of the

human body to be treated and son the unit used in medical ultra so in

watt/cm2.

In a continuous wave field her for, two intensities are defined,

a) Space averaged intensity where the average intensity is a

specified.

23
 b) In time averaged, space averaged intensity can be used when the

ultrasound is being applied in a pulsed mode and gives the average

intensity over the whole treatment time for a specified area.

3.2.2. Pulsed Mark: Space Ratio

When ultrasound is applied in its pulsed mode, the ratio of the time

on to time off should be expressed. This is the mark: space ratio, the

mark being the time ultrasound is on, and space being the silence, both

being the silence, both being measured in milliseconds. Some units have

a single fixed M.S. ratio, of 2.8, where as others have a variable range

1:1, and 1:4, 1:7.

3.2.3. Calibration

Ultrasound field can be calibrated using a number of methods

depending on the information required. The pressure distribution can be

mapped using a pressure sensitive P.V.D.F (Poly – Vinylidene –

Diffuoride) membrane hydrophone which process usually undertaken by

many factures (or) medical physics departments. It is always advisable to

have had transducers calibrated in this way before use and again when a

fault is suspected. It provides an easy way if identifying damaged

crystals.

24
3.3. INTERACTION OF ULTRASOUND WITH TISSUE

This can be described by reflection, scattering, refraction,

diffraction and attenuation.

3.3.1. Reflection

Ultrasound waves are reflected at tissue boundaries and interfaces.

The wave is turned form the surface of the new medium and the angle of

reflection is equal to the angle of incidence. These reflected echoes

return to the transducer and from the basis of all ultrasound imaging.

When an ultrasonic beam traveling through one medium encounters

another medium which will not transmit, it reflection takes place. Air

will not transmit ultrasonic treatment great care is taken to avoid leaving

air between and treatment head and the patient to minimize reflection.

Tissue offers resistance to the passage of ultrasound. This resistance is

called acoustic impedance.

3.3.2. Acoustic Impedance (Z)

This is a measure of how ultrasound traverses that tissue and

depends on density of medium (ρ) and propagation of velocity of

ultrasound through the (V) such that Z = ρc

Where ρ is the density and C is the velocity of sound

25
3.3.3. Refraction

Refraction is the bending of a wave beam, when it crosses at an

oblique angle the interface of two materials, through which the waves

propagate at different velocities.

When an ultrasound beam encounters media of different velocities,

the proportion of the beam that is not reflected but is transmitted

undergoes refraction or bending. If the ultrasonic beam encounters an

interface between two media and is transmitted, it may be reflected (or)

deflected from its original path. When traveling from a medium in which

its velocity is low into one in which its velocity is high it is refracted

away from the normal.

26
 Refraction of ultrasonic waves in passing from one medium into

another in which the speed of sound is greater. The direction of the

transmitted wave is determined by:

Sin (θ1) C1

Sin (θ2) C2

27
 Where θ1 is the angle of the incident wave, θ2 is the angle of the

transmitted (refracted) wave in relation to the normal line. C1 is the

sound velocity in the first medium, and C2 is the sound velocity in the

medium of the next layer. If C1<C2 the refraction occurs away from the

normal line, and when C1>C2 the wave refraction occurs towards the

normal line. The incident angle where total reflection occurs is called the

critical angle. It is specific to the combination of two materials and their

sequence. The critical angle only occurs when C1 < C2. It is found by

equation.

Critical angle = sin-1 (c1/c2)

3.3.4. Diffraction

Diffraction is the change in the directions and intensities of a group

of waves after passing by an obstacle (or) through an aperture. The

ultrasound beam spreads out with distance from the transducer. This has

the effect of lessening the intensity of the beam.

3.3.5. Attenuation

As ultrasound passed through tissue, some of the energy is

reflected by the structures in the path (scattering) and some of the energy

is absorbed by the medium itself, leading to local heating absorption.

28
  Absorption: - Ultrasound is absorbed by the tissues and converted

to eat at that point. This constitutes the thermal effect of

ultrasound.

 Scatter (to spread):- This occurs when the normally cylindrical

ultrasonic beam is deflected from its path by reflection at

interfaces, bubbles or particles in its path.

The overall effect of these two is such that the ultrasonic beam is

reduced in intensity the deeper it passes. This gives rise to the expression

“half-value distance” which is depth of soft tissue that reduces the

ultrasound beam to half its surface intensity. The half value distance for

soft tissue varies for 1MHz and 3MHz out put and is 4cm and 2cm

respectively. Attenuation is increased (and hence penetration of the beam

reduced) by-

 Increased distance from the transducer

 Less homogenous medium to traverse due to increased acoustic

impedance mismatch

 Higher frequency (shorter wavelength) transducers

3.4. COUPLING AGENT

Ultrasonic waves are not transmitted by air. Therefore, when a

patient is being treated, it is essential for an effective treatment that no air

29
comes between transducer and skin. There a number of methods by

which ultrasound are applied.

The most common method is to use a ‘contact’ application, where a

thin layer of oil (or) gel is applied to skin prior to treatment. The

requirement for the coupling medium is that it has similar acoustic

impedance to skin. Mineral oils and water – based gels are most

commonly used. Awkward geometries can most readily be treated in a

water bath, with both the limb to be treated and the transducer being

immersed.

The difference in impedance is greatest for the steel/air interface

which is the first one that the US has to overcome in order to reach the

tissues. To minimize this difference, a suitable coupling medium has to

be utilized. If even a small air gap exists between the transducer and the

skin the proportion of US that will be reflected approaches 99.998%

which means that there will be no effective transmission.

30
The coupling media used in this context include water, various oils,

creams and gels. Ideally, the coupling medium should be fluid so as to

fill all available spaces, relatively viscous so that it stays in place, have

impedance appropriate to the media it connects, and should allow

transmission of US with minimal absorption, attenuation or disturbance.

Percentage of the original intensity is transmitted to the patient, as

follows.

TABLE : Efficiency of Transmission of Ultrasound by Various Coupling media

Couplant % Transmission
Aqua sonic gel 72.6
Glycerol 67
Distilled water 59
Liquid paraffin 19
Petroleum jelly 0
Air 0

CHAPTER 4

31
TECHNIQUES AND METHODS OFAPPLICATION

4.1. TECHNIQUE OF APPLICATION

 Direct contact Method

 Water Bath Method

 Water Bag method

4.1.1. Direct Contact Method

If the surface to be treated is fairly regular than 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. The treatment head is moved in small
concentric circles over the skin in order to avoid concentration of at any
point, keeping the whole of the front plate in contact with the patient.
This technique is suitable for areas up to three times the size of the
treatment head. Large area should be divided and each area treated
separately.

4.1.2. Water Bath Method

When direct contact is not possible because of irregular shape or part

or because of tenderness, a water bath may be used. As the part to be

32
treated is immersed in water this can only responsible be applied to the
hand, ankle and foot.

A water bath filled with degassed water is used if possible.

Ordinary tap water present the problem that gas bubbles dissociate out
from water, accumulate on the patient skin and the treatment head, and
reflect the us beam . If tap water has to be used then the gas bubbles must
be wiped from this surface frequently. The patient is seated and part is put
in water of a comfortable temperature in such a portion that is suitably
supported.

4.1.3. Water Bag Method

Another method of applying ultrasound therapy to irregular surface

which cannot conventionally placed in a water bath is treated with a
plastic or rubber bag filled with water forming a water cushion between
the reaction head and the skin.

Rubber bag filled with degassed water can be used. All visible air
bubbles should be squeezed out before knotting the neck of the bag to
seal it. A coupling medium has to be placed both between the rubber bag
and skin and between the rubber bag and the reaction head to eliminate
any air.

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4.2. PHYSICAL EFFECTS OF ULTRASOUND
When ultrasound enters the body it can exert an effect on the cells
and tissues via to physical mechanisms, thermal effect.

4.2.1. Thermal Effects

As the tissues absorb the ultrasonic waves they are converted to

heat. The amount of heat developed depends upon,

 Absorption characteristics of the tissue protein absorb ultrasound

efficiently and therefore produce much heat.

 The number of times treatment head passes over the part.

 The efficiency of the circulation through the isolated tissue.

 When using continuous ultrasound the amount of heat developed is

directly proportional to the intensity duration of isolation.

 When using pulsed ultrasound there is less thermal effects than

with continuous and a mark: space ratio 1:4 produces less than 1:1.

 Reflection of ultrasound at a tissue interface produces a

concentration of heating effect at a specific point. As reflection
from bone occurs there is double intensity of ultrasound in the
period stealing region, which may cause localized overheating and
can manifest itself a preinstall pain. In practical terms this means
that it is the best to avoid passing the ultrasonic treatment head
over subcutaneous bony points if possible.

CHAPTER 5

CONDITIONS AND CONTRAINDICATIONS

OF APPLICATION

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 Therapeutic ultrasounds give to the patients in many conditions.

Some conditions are explained in this chapter, but some cases don’t give

therapeutic ultrasound.

1. Tennis elbow
2. Plantar fasciitis

5.1. TENNIS ELBOW (Lateral Epicondilitis)

Tennis elbow is inflammation, soreness or pain on the outside

(lateral) side of the upper arm near the elbow. There may be a partial tear

of the tendon fibers, which connect muscle to bone. The tear may be at

or near where these fibers begin, on the outside of the elbow.

5.1.1. Causes:

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 Overuse or repetitive strain caused by repeated extension (bending

back) of the wrist against resistance.

 This may be from activities such as tennis, but also in day to day

activities.
 Repetitive activities such as using a screwdriver, painting or

typing.

5.1.2. Symptoms:

 Elbow pain that gradually worsens

 Pain radiating from the outside of the elbow to the forearm and

back of the hand when grasping or twisting.

 Weak grasp

5.1.3. Treatment:

 Acute – Ice towel for 20 minutes.

 Rest
 Splint for wrist extension for 2 to 8 weeks

5.1.4. Modalities Used

 Friction for 5 -10 minutes for 4 days.

 Ultrasound 1w/cm2, in continuous mode for up to 8 minutes.
 Pulsed electromagnetic energy

5.1.5. Positioning of the Patient

Sitting with arm on the pillow placed over the couch.

Mode : Continuous/Pulsed

Duration: 5 – 8 minutes

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 Intensity: 0.75 – 1.5 W/cm2

5.2. PLANTAR FSCIITIS

Plantar fasciitis is inflammation of the thick tissue on the bottom of

the foot. This tissue is called the plantar fascine. It connects the heel

bone to the toes and creates the arch of the foot.

5.2.1. Causes:

 Foot arch problems (both flat feet and high arches)

 Obesity or sudden weight gain
 Long-distance running, especially running downhill or on uneven

surfaces
 Sudden weight gain
 Tight Achilles tendon (the tendon connecting the calf muscles to

the heel)
 Shoes with poor arch support or soft soles

5.2.2. Symptoms:

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 The most common complaint is pain and stiffness in the bottom of

the heel. The heel pain may be dull or sharp. The bottom of the foot may

also ache or burn. The pain is usually worse:

 In the morning when you taken your first steps

 After standing or sitting for a while
 When climbing stairs
 After intense activity

The pain may develop slowly over time, or suddenly after intense

activity.

5.2.3. Treatment

 Heel stretching exercises

 Resting as much as possible for at least a week
 Wearing shoes with good support and cushions

5.2.4. Modalities Used

 Friction for 5 -10 minutes for 4 days.

 Ultrasound 1 w/cm2 in continuous mode for up to 8 minutes.
 Pulsed electromagnetic energy
 Laser

5.2.5. Positioning of the Patient

Prone lying with knee flexed or supine lying’

Mode : Continuous/Pulsed

Duration: 5 – 8 minutes.

Intensity: 2 – 3 W/cm2

5.3. CONTRA INDICATIONS

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 As ultrasound is thought to affect the tissue repair process and so it

is also highly possible that it may affect diseased tissue in an abnormal

fashion. In addition the proposed increase in blood may also function in

spreading malignancies around the body. Therefore a number of

contraindications should be followed when using therapeutic ultrasound.

Do not use if the patient suffers from:

 Malignant or cancerous tissue

 Acute infections
 Risk of hemorrhage
 Recent history if venous thrombosis
 Exposed neural tissue
 Suspicion of a bone fracture
 If the patient is pregnant
 Do not use in the region of the gonads (sex organs), the active bone

growth plates of children, or the eye.

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 CONCLUSION

The application of physics in the treatment using

physiotherapy techniques are in number. The major finding is from this
study indicating that the application of physics in physiotherapy in using
continues ultrasonic waves. There is no medicine given to the patient but
only physical aspects of treatment mainly ultrasound using result in
significant improvement in relief pain. The treatment methodology is so
easy and doesn’t cause any pain to the patients. All equipment that is used
in treatment has an underlying impact of the principle of physics.

In modern world the treatment through physiotherapy is

gaining importance. If the devices used in physiotherapy treatment were
designed in such a way that they support portability and make use of the
many technological revolutions, based on principles of physics, the field
of physiotherapy will grow rapidly and the percentage of recovery of the
patient would also go high. These devices are useful to treat the problems
of common people at low cost.

40
 BIBLIOGRAPHY

SL.NO BOOK NAME AUTHOR(S)

1 Solid State Physics Gupta Kumar

2 Textbook of Electrotherapy Jagmohan Singh
3 Electrotherapy Explained Principles John Low and Ann Reed
And Practice
4 Text Book of Rehabilitation S.Sunder

Website:

www.physics.com
www.ultrasound therapy.com

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