Therapeutic Ultrasound

A targeted treatment used alongside physiotherapy and rehabilitation

Therapeutic ultrasound is a treatment that uses high-frequency sound waves delivered through a handheld treatment head placed against the skin.

It may be used as part of physiotherapy for selected soft-tissue or musculoskeletal problems, depending on the condition and stage of recovery.

Therapeutic ultrasound is not the same as diagnostic ultrasound used for medical imaging. It does not create pictures of the tissues. Instead, it is applied as a treatment alongside other rehabilitation methods such as exercise, mobility work and activity progression.

The aim is usually to support rehabilitation rather than use ultrasound as a standalone treatment.

What is therapeutic ultrasound?

Therapeutic ultrasound uses sound waves at frequencies above the range of human hearing.

A treatment head is moved over the skin using a small amount of ultrasound gel.

Depending on the settings used, ultrasound may produce mechanical and mild thermal effects within the tissues beneath the treatment area.

The treatment is generally painless and is usually applied for a relatively short period.

What conditions may therapeutic ultrasound be used for?

Therapeutic ultrasound may sometimes be considered as part of treatment for selected problems involving:

• Muscles
• Tendons
• Ligaments
• Scar tissue
• Joint stiffness
• Soft-tissue injuries

Whether it is appropriate depends on the diagnosis, stage of healing and wider rehabilitation plan.

Not every injury or painful area benefits from therapeutic ultrasound.

Therapeutic ultrasound should be part of a wider rehabilitation plan

For most musculoskeletal problems, recovery depends on more than passive treatment.

Rehabilitation may also need to include:

• Strengthening
• Mobility exercises
• Gradual loading
• Balance
• Functional movement
• Return to work
• Return to exercise
• Return to sport

Ultrasound may sometimes be used to support these aims, but it does not replace the need to restore strength and physical capacity.

What happens during your first appointment?

Before treatment begins, the physiotherapist will assess the problem and determine whether therapeutic ultrasound is appropriate.

You may be asked about:

• Where you feel pain or stiffness
• How long symptoms have been present
• How the problem started
• Activities that make symptoms worse
• Previous injuries
• Previous surgery
• Medical conditions
• Medication
• Current exercise
• Treatment already tried
• Your rehabilitation goals

A physical assessment may also look at:

• Joint movement
• Muscle strength
• Tenderness
• Swelling
• Functional movements
• The way the area responds to loading

Ultrasound should be selected because it is relevant to the condition rather than simply because an area is painful.

What happens during treatment?

A small amount of ultrasound gel is applied to the skin.

The treatment head is then moved continuously over the selected area.

The physiotherapist can adjust the treatment settings according to factors such as:

• Tissue being treated
• Depth of the area
• Stage of recovery
• Treatment goal

The treatment usually lasts only a few minutes.

What does therapeutic ultrasound feel like?

Most people feel very little during treatment.

You may notice:

• The pressure of the treatment head
• The cool feeling of the gel
• Mild warmth in some situations

The treatment should not normally feel painful.

If you experience discomfort, burning or an unusual sensation, tell the physiotherapist immediately.

Is therapeutic ultrasound the same as an ultrasound scan?

No.

A diagnostic ultrasound scan is used to produce images of structures within the body.

It may be used to assess areas such as:

• Tendons
• Muscles
• Ligaments
• Other soft tissues

Therapeutic ultrasound uses sound waves as a treatment.

It does not provide diagnostic images.

The two procedures use similar terminology but have different purposes.

Is therapeutic ultrasound the same as shockwave therapy?

No.

Therapeutic ultrasound and shockwave therapy are different treatments.

Therapeutic ultrasound uses high-frequency sound waves and is usually experienced as a relatively gentle treatment.

Shockwave therapy delivers stronger mechanical pressure waves and is commonly used for selected persistent tendon and soft-tissue conditions.

The two treatments have different equipment, treatment sensations and clinical uses.

Therapeutic ultrasound for soft-tissue injuries

Muscle, ligament and tendon injuries may go through different stages of healing.

Depending on the injury and stage of recovery, treatment may focus on:

• Maintaining movement
• Gradual loading
• Strengthening
• Restoring function

Therapeutic ultrasound may sometimes be included alongside these approaches.

It should not be used as a substitute for appropriate rehabilitation.

Therapeutic ultrasound for tendon problems

Tendon problems generally require progressive loading to rebuild strength and capacity.

Depending on the tendon involved, rehabilitation may include:

• Isometric exercises
• Progressive resistance
• Heavy slow strengthening
• Running
• Jumping
• Sport-specific exercises

Ultrasound may occasionally be used as an additional treatment, but long-term tendon recovery usually depends on restoring the tendon’s ability to tolerate load.

Therapeutic ultrasound for muscle injuries

Following a muscle injury, rehabilitation may gradually progress through:

• Comfortable movement
• Strengthening
• Increasing range
• Faster movement
• Return to sport

Ultrasound may sometimes be considered within the overall programme.

A muscle strain should still be assessed properly, particularly if there is:

• Significant bruising
• Marked weakness
• Sudden severe pain
• Difficulty using the limb

Therapeutic ultrasound for ligament injuries

Ligament injuries commonly occur around areas such as the:

• Ankle
• Knee
• Wrist

Rehabilitation may require:

• Movement
• Strength
• Balance
• Stability
• Sport-specific training

Ultrasound may sometimes form a small part of early or intermediate treatment, but restoring stability and physical function remains important.

Therapeutic ultrasound for scar tissue

Following surgery or injury, scar tissue forms as part of normal healing.

Once healing is sufficiently established, rehabilitation may involve:

• Movement
• Scar mobility work
• Strengthening
• Gradual loading

Therapeutic ultrasound may occasionally be considered as part of treatment where scar-related stiffness is affecting movement.

An unhealed wound should not be treated with ultrasound in the same way as a healed scar.

Joint stiffness

Stiffness can develop after:

• Injury
• Surgery
• Immobilisation
• Reduced activity

Treatment may include:

• Mobility exercises
• Strengthening
• Manual therapy
• Functional movement

Therapeutic ultrasound may sometimes be used as an additional treatment where appropriate.

The main goal is usually to restore useful movement rather than simply change how the area feels temporarily.

Therapeutic ultrasound after immobilisation

After wearing a cast, brace or sling, the surrounding tissues may become:

• Stiff
• Weak
• Sensitive

Rehabilitation usually needs to progressively restore:

• Joint movement
• Muscle strength
• Normal physical activity

Therapeutic ultrasound may be used selectively, but exercise remains important for rebuilding function after immobilisation.

Therapeutic ultrasound after surgery

Following surgery, ultrasound should only be considered when:

• Healing is appropriate
• The wound is closed
• Surgical restrictions have been considered
• Treatment is suitable for the specific area

The physiotherapist should take account of the procedure before treating around a surgical site.

Any redness, wound opening, discharge or increasing pain should receive appropriate medical assessment.

Therapeutic ultrasound and pain

Ultrasound may sometimes be used when pain is limiting movement or rehabilitation.

However, pain can have many causes.

Repeatedly applying ultrasound without understanding why symptoms are continuing is unlikely to be useful.

If pain is persistent, rehabilitation should also consider:

• Strength
• Activity level
• Movement
• Work demands
• Exercise
• Training load

The treatment plan should address the wider physical problem.

Therapeutic ultrasound and swelling

Some injuries involve swelling.

The first step is understanding why the swelling is present.

Treatment may depend on whether swelling is related to:

• A recent injury
• Surgery
• Joint irritation
• Another medical condition

Significant unexplained swelling should be assessed before ultrasound or other physical treatments are used.

Therapeutic ultrasound for sports injuries

Athletes may sometimes receive ultrasound as part of treatment for a soft-tissue injury.

However, returning to sport normally requires much more than reducing local symptoms.

Sports rehabilitation may need to restore:

• Strength
• Running
• Jumping
• Landing
• Speed
• Change of direction
• Sport-specific movement

Ultrasound may be one small part of this progression where appropriate.

Returning to exercise

Most people can continue appropriate exercise while receiving therapeutic ultrasound.

Your rehabilitation programme may include:

• Strength exercises
• Mobility
• Balance
• Walking
• Gym work

Exercise should be selected according to your injury and stage of recovery.

There is usually no reason to avoid all physical activity simply because ultrasound is being used.

Can I exercise after therapeutic ultrasound?

Often yes.

The treatment itself does not normally require a prolonged recovery period.

Any activity restrictions are more likely to relate to:

• The underlying injury
• Surgery
• Current symptoms
• Stage of rehabilitation

Your physiotherapist can advise how much activity is appropriate.

How many sessions will I need?

There is no standard number of therapeutic ultrasound sessions for every condition.

If ultrasound is included within treatment, the amount may depend on:

• The diagnosis
• Stage of healing
• Response to rehabilitation
• Overall treatment plan

It should not be continued indefinitely simply because symptoms are still present.

If progress is limited, the treatment approach may need to be reviewed.

Is ultrasound enough on its own?

Usually not for most rehabilitation problems.

For example, ultrasound cannot by itself restore:

• Muscle strength
• Balance
• Running ability
• Lifting capacity
• Joint control

These require active rehabilitation.

Treatment may therefore combine ultrasound with:

• Exercise
• Strengthening
• Mobility work
• Manual therapy
• Functional training

The combination depends on your condition.

Evidence and realistic expectations

The usefulness of therapeutic ultrasound varies depending on the condition being treated.

For some musculoskeletal problems, research has not shown strong or consistent benefits from ultrasound alone.

For that reason, it is generally most appropriate when there is a clear clinical reason to use it and when it sits within an active rehabilitation programme.

Treatment should be reviewed according to whether your movement, strength and function are actually improving.

When therapeutic ultrasound may not be suitable

Therapeutic ultrasound may need to be avoided or modified in certain situations.

This may include treatment over or around:

• Active infection
• Suspected or known tumour
• Areas with significantly reduced sensation
• Certain vascular problems
• Active bleeding
• Unhealed wounds unless a specific specialist technique is being used
• Certain areas during pregnancy
• Sensitive anatomical structures

The exact precautions depend on the treatment area and medical history.

Your physiotherapist should review these before treatment.

Reduced sensation

If sensation in the treatment area is significantly reduced, you may not be able to accurately report heat or discomfort.

This can affect whether therapeutic ultrasound is suitable.

Tell the physiotherapist if the area feels:

• Numb
• Less sensitive
• Different from the opposite side

This is particularly important after neurological injury or surgery.

Pregnancy

Therapeutic ultrasound is generally avoided over areas where treatment could expose the developing baby.

If you are pregnant or think you may be pregnant, tell the physiotherapist before treatment.

Other treatment and rehabilitation options can be used where appropriate.

Metal implants

Having a metal implant does not automatically mean therapeutic ultrasound cannot be used.

However, treatment depends on:

• Location of the implant
• Surgical procedure
• Stage of healing
• Area being treated

Tell your physiotherapist about any implants or previous surgery before treatment begins.

What should I tell the physiotherapist before treatment?

Before treatment, mention if you have:

• Recent surgery
• Reduced sensation
• Circulation problems
• Active infection
• A known tumour
• Pregnancy
• Significant unexplained swelling
• Metal implants
• Blood-clotting problems
• Any important medical condition

This allows treatment to be selected appropriately.

When further assessment may be needed

Ultrasound should not simply be applied repeatedly when symptoms suggest another problem.

Further assessment may be needed if you experience:

• Severe or worsening pain
• Significant unexplained swelling
• Inability to use or put weight through a limb
• Persistent numbness
• New significant weakness
• Redness and heat associated with feeling unwell
• Pain after a significant injury
• Symptoms that are not improving as expected
• A new or changing lump

These symptoms may require further physiotherapy or medical investigation.

Treatment based on your goals

Therapeutic ultrasound may only represent one part of your rehabilitation.

Your wider goals may include:

• Reducing pain
• Restoring joint movement
• Improving muscle strength
• Returning to work
• Returning to gym training
• Returning to running
• Returning to sport
• Managing stiffness after surgery
• Recovering after a soft-tissue injury

Treatment should therefore progress towards these activities rather than focusing only on the treatment area.

How long does rehabilitation take?

The timeline depends much more on the underlying condition than on the ultrasound treatment itself.

Recovery may be influenced by:

• Type of injury
• Severity
• Stage of healing
• Surgery
• Current strength
• Physical activity
• Work demands
• Sport

Some problems improve over a relatively short period.

Tendon problems, significant injuries or post-surgical rehabilitation may require a longer programme.