PT Classroom - To Ultrasound or Not to Ultrasound? ׀ by Jennifer Hill, MPT, CSCS & Chai Rasavong, MPT, COMT, MBA


The utilization of therapeutic ultrasound to treat various conditions is fairly common in the physical therapy clinic. When we were in physical therapy school we were taught that ultrasound could be utilized in rehabilitation as an adjunct in the management of various soft tissue dysfunctions including: joint contracture, scar tissue, tendonitis, bursitis, skeletal muscle spasms and pain (1). It was noted that the thermal effects of ultrasound could assist in increasing tissue pliability, increasing circulation, increasing the threshold for activation of the free nerve endings and reducing muscle spindle activity (1).

As physical therapists we should all strive to practice utilizing evidence based physical therapy. However, if we were to examine the utilization of therapeutic ultrasound by scrutinizing the research available, the evidence is insufficient and questionable in regards to its use.

In a review by van der Windt, et al (2) that examined ultrasound therapy for musculoskeletal disorders, they concluded that the large majority of 13 randomized placebo-controlled trials with adequate methods did not support the existence of clinically important or statistically significant differences in favor of ultrasound therapy.

In a review by Robertson VJ & Baker KG (3) they considered 35 randomized controlled trials (RCT) where ultrasound was utilized to treat people with pain, musculoskeletal injuries and soft tissue lesions. Of the 35, they only found 10 RCT’s that had adequate methods and met their criteria. Of these RCT’s, they found two trials which suggest that therapeutic ultrasound was more effective in treating some clinical problems (carpal tunnel syndrome and calcific tendonitis of the shoulder) then placebo ultrasound, and the results of the other 8 trials suggest that it is not.

In another review by Baker at al. (4) which examined the biophysical effects of therapeutic ultrasound, they found that the described biophysical effects of ultrasound either don’t occur in vivo or have not been proven to have a clinical effect under these conditions. Their findings further suggest that there is a lack of biophysical evidence to provide a scientific foundation for the clinical use of therapeutic ultrasound for the treatment of people with pain and soft tissue injury.

The bottom line is that the evidence is lacking for the use of therapeutic ultrasound in the treatment of pain and musculoskeletal injuries. Nevertheless, as a clinician you may have found some instances where ultrasound may have been helpful with treating a condition. However, further quality studies are warranted to support this.

1. Michlovitz, S., (1996). Theraml Agents in Rehabilitation - third edition. Wolf, S. (Ed). (pp. 177-188) Philadelphia, F.A. Davis Company.
2. van der Windt DA, van der Heijden GJ, et al., Ultrasound therapy for musculoskeletal disorders; a systematic review. Pain. 1999 June;81(3):257-71.
3. Robertson VJ, Baker KG. A Review of Therapeutic Ultrasound: Effectiveness Studies. Physical Therapy. 2001;81:1339-1350.
4. Baker KG, Robertson VJ, Duck FA. A Review of Therapeutic Ultrasound: Biophysical Effects. Physical Therapy. 2001;81:1351-1358


Last revised: June 29, 2017
by Jennifer Hill, MPT, CSCS & Chai Rasavong, MPT, COMT, MBA

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