Therapeutic Ultrasound Sports Medicine 6/11/2016 1

Objectives 1.Explain how ultrasound works 2.List the indications and contraindications for using ultrasound 3.Justify the need for an ultrasound treatment 6/11/2016Property of CTE Joint Venture 2

Bellwork A high jumper from the track team has been experiencing R knee pain. She visited the doctor and brought back a note clearing her for activity. She also brought back a script for ultrasound treatments 3 times a week. She asks: Why would the doctor prescribe ultrasound? What is ultrasound used for? 6/11/2016Property of CTE Joint Venture 3

Terminology therapeutic ultrasound – a modality that is used for deep heating or tissue repair 6/11/2016Property of CTE Joint Venture 4

Therapeutic Ultrasound Ultrasound machine Sound head 6/11/2016Property of CTE Joint Venture 5

Predict PROPERTY OF PIMA COUNTY JTED, Work with your group to predict how an ultrasound machine works.

How Ultrasound Works The ultrasound unit contains a generator, which provides an electrical current that is transmitted to a crystal located in the sound head The electrical current causes the crystal to vibrate, producing a high-frequency sound wave ◦ Humans can hear 18,000 – 20,000 Hz (cycles/second) ◦ Ultrasound is either 1 million (1MHz) or 3 million (3MHz) 6/11/2016Property of CTE Joint Venture 7

How Ultrasound Works (cont.) The sound wave is absorbed by tissues with a high protein content (tendons, ligaments, joint capsules, and muscle) The sound wave is poorly absorbed by bone tissue; the majority is reflected or refracted 6/11/2016Property of CTE Joint Venture 8

Think-Pair-Share Explain how an ultrasound machine works. Then, switch roles and repeat the process. PROPERTY OF PIMA COUNTY JTED, 2010

Ultrasound Parameters Frequency: cycles per second (Hz) ◦ 1 MHz – heats tissues from 2 to 5 cm deep ◦ 3MHz – heats superficial tissues Intensity: the amount of energy transferred to the tissues, expressed in W/cm² (ranges from 0.1 to 5.0 W/cm²) Continuous or pulsed sound beam: Continuous output produces thermal effects Pulsed output produces mechanical effects for tissue healing 6/11/2016Property of CTE Joint Venture 10

Ultrasound Parameters Duty cycle: the amount of time the ultrasound is on 20% means it’s on 1 out of every 5 seconds 100% means it’s on continuously Treatment area: should be about twice the size of the sound head Treatment length: usually 5-10 minutes 6/11/2016Property of CTE Joint Venture 11

Ultrasound Guidelines A medium is required to transmit the sound waves into the tissue (either cream, gel or water) The sound head must be moved about 2-4 cm per second to prevent burning Requires constant supervision by AT 6/11/2016Property of CTE Joint Venture 12

Partner Practice PROPERTY OF PIMA COUNTY JTED, Work with a partner to quiz each other on the information

Indications for Ultrasound Acute injuries (tissue healing, non-thermal effects) Chronic injuries Muscle strains Ligament sprains Muscle spasm Tissue tightness Scar tissue 6/11/2016Property of CTE Joint Venture 14

Contraindications for Ultrasound Areas with sensory or circulatory deficits Over fractures or open growth plates Over tumors Over artificial joints Over heart, eyes, brain, spinal cord Over reproductive organs Over abdomen during pregnancy Over herniated discs Acute injuries (in continuous heat setting) 6/11/2016Property of CTE Joint Venture 15

Ultrasound can safely be used: A. To shrink tumors B. Over open growth plates C. Over the brain or spinal cord D. Over scar tissue E. For acute injuries PROPERTY OF PIMA COUNTY JTED,

Ultrasound can be used for all of the following except: A. Ligament sprains B. Acute injuries C. Chronic injuries D. Muscle tightness E. Muscle spasms PROPERTY OF PIMA COUNTY JTED,

Ultrasound is contraindicated in which area? A. Heart B. Brain C. Eyes D. Reproductive organs E. All of the above PROPERTY OF PIMA COUNTY JTED,

Sample Treatments* ConditionFrequencyDuty Cycle Deep muscle adhesion1 MHz100% Deep bursitis1 MHz20-50% Superficial scar3 MHz100% Superficial tendinitis3 MHz20-50% 6/11/2016Property of CTE Joint Venture 19 *Table from France, Robert C. Introduction to Sports Medicine & Athletic Training (Clifton Park, NY: Thomson DelMar Learning, 2004), 220.