Audiences Text for students enrolled in entry-level athletic training and physical therapy programs as well as those in postprofessional education. Reference for athletic trainers, physical therapists or physiotherapists, and sports medicine specialists. He has more than 30 years of experience as an athletic trainer and physical therapist and has extensive clinical practice experience related to persistent orthopedic pain.
Generally, the tissues with the higher protein content will absorb US to a greater extent, thus tissues with high water content and low protein content absorb little of the US energy e. Tissues can be ranked according to their relative tissue absorption and this is critical in terms of clinical decision making .
Relative tissue absorption relates to protein content Although cartilage and bone are at the upper end of this scale, the problems associated with wave reflection mean that the majority of US energy striking the surface of either of these tissues is likely to be reflected.
The application of therapeutic US to tissues with a low energy absorption capacity is less likely to be effective than the application of the energy into a more highly absorbing material. Recent evidence of the ineffectiveness of such an intervention can be found in Wilkin et al.
Pulsed Ultrasound Most machines offer the facility for pulsed US output, and for many clinicians, this is a preferable mode of treatment. Until recently, the pulse duration the time during which the machine is on was almost exclusively 2ms 2 thousandths of a second with a variable off period.
Some machines now offer a variable on time though whether this is of clinical significance has yet to be determined. Typical pulse ratios are 1: The adjacent diagram illustrates the effect of varying the pulse ratio.
Pulsed Ultrasound The effects of pulsed US are well documented and this type of output is preferable especially in the treatment of the more acute lesions.
Some machines offer pulse parameters that do not appear to be supported from the literature e.
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Some manufacturers describe their pulsing in terms of a percentage rather than a ratio 1: The proportion of time that the machine is ON compared with OFF is a relevant factor in dosage calculations and further details are included in the dose calculation support material.
The following information is intended to provide a summary of some of the essential research in this field together with some possible mechanisms through which US treatments may achieve these changes.
It is not intended to be a complete explanation of these phenomena or a comprehensive review of the current literature. It may, none the less, provide some useful basic information for clinical application.
The therapeutic effects of US are generally divided into: Thermal In thermal mode, US will be most effective in heating the dense collagenous tissues and will require a relatively high intensity, preferably in continuous mode to achieve this effect.
Both Nussbaum  and ter Haar  have provided some useful review material with regards the thermal effects of ultrasound. Comparative studies on the thermal effects of ultrasound have been reported by several authors     with some interesting, and potentially useful results.
Further work continues in our research centre with a comparison of contact heating and longwave ultrasound  and comparison of different US regiemes combined with US Aldridge and Watson — in preparation.Ultrasound in contemporary physiotherapy practice Tim Watson* University of Hertfordshire, School of Health and Emergency Professions, College Lane, Hatﬁeld AL10 9AB, United Kingdom.
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Background. The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil.
Therapeutic ultrasound has a long history of use in physiotherapy practice, though the emphasis has changed over the last 15–20 years. Several other professional groups are also using the modality including osteopaths, chiropractors, podiatrists and .
Ultrasound is a sound pressure with a frequency greater than the limit of human hearing. This limit varies from person to person, it is around 20 kilohertz in young adults. 20 kHz is a useful lower limit in describing ultrasound.