Why we're writing honestly about our own equipment
Therapeutic ultrasound has been in rehabilitation clinics since the 1950s. It is also, according to systematic reviews, one of the most overused and misapplied modalities in the field. We use ultrasound in our Ipswich clinic — for specific indications — and we think patients deserve to know exactly where the evidence stands. A clinic that claims everything works for everything is a clinic selling sessions.
How it works — the actual mechanisms
Therapeutic ultrasound delivers high-frequency sound waves (typically 1 or 3 MHz) into tissue. Two effect types exist (Baker et al., 2001):
- Thermal: continuous ultrasound heats deep tissue — increasing local blood flow, tissue extensibility and metabolic rate. Unique advantage: it heats deep structures (2–5 cm) that hot packs cannot reach.
- Non-thermal: pulsed ultrasound produces mechanical micro-effects (cavitation, microstreaming) proposed to stimulate cellular repair activity.
Where the evidence is reasonable
- Preparing tissue for stretching and mobilisation — deep heating measurably increases short-term tissue extensibility (Draper, 2014). Used immediately before manual therapy or loading, it makes the follow-up work more effective. This is our main use.
- Localised soft-tissue conditions — some evidence in specific tendon and ligament presentations, particularly superficial ones like lateral epicondylitis, though effect sizes are modest.
- Calcific tendinopathy of the shoulder — one of the better-supported specific indications.
Where the evidence says no
- Chronic low back pain — the Cochrane review (Ebadi et al., 2020) found no convincing benefit. Back pain needs loading, education and graded activity, not sound waves.
- As a standalone treatment for almost anything — reviews consistently show that ultrasound alone changes little (van der Windt et al., 1999). It is an adjunct, never a plan.
- Large-area, vague application — the "wand waved broadly over the painful area for five minutes" ritual seen in many clinics has no evidential basis. Dose, location and parameters matter (Watson, 2008).
How we actually use it
In our programmes, ultrasound has a narrow, defined job: deep thermal preparation of restricted tissue immediately before manual therapy or loading work, and occasional non-thermal use in specific soft-tissue presentations. It occupies minutes of a session, never the session itself. If a clinic's treatment plan is built around ultrasound, ask what the actual plan is.
The takeaway
Ultrasound is neither miracle nor fraud — it is a modest tool with specific uses. The bigger lesson applies to all rehabilitation technology: the machine is never the treatment; the programme is. Machines create conditions. Progressive loading, movement correction and time build the result.
Want a treatment plan built on evidence rather than rituals? Book an assessment at Bruno Physical Rehabilitation, Ipswich.
References
- Watson, T. (2008) 'Ultrasound in contemporary physiotherapy practice', Ultrasonics, 48(4), pp. 321–329.
- Baker, K.G., Robertson, V.J. and Duck, F.A. (2001) 'A review of therapeutic ultrasound: biophysical effects', Physical Therapy, 81(7), pp. 1351–1358.
- van der Windt, D.A., van der Heijden, G.J., van den Berg, S.G. et al. (1999) 'Ultrasound therapy for musculoskeletal disorders: a systematic review', Pain, 81(3), pp. 257–271.
- Ebadi, S., Henschke, N., Forogh, B. et al. (2020) 'Therapeutic ultrasound for chronic low back pain', Cochrane Database of Systematic Reviews, 7, CD009169.
- Draper, D.O. (2014) 'Facts and misfits in ultrasound therapy: steps to improve your treatment outcomes', European Journal of Physical and Rehabilitation Medicine, 50(2), pp. 209–216.