A Case Against Ultrasound in the Treatment of Injury

Therapeutic ultrasound is a widely used and generally accepted treatment modality often used in both physical therapy and chiropractic. In fact, therapists are taught in school about the benefits of ultrasound use and how ultrasound it soft tissue healing. They spend a significant amount of time learning how to apply the modality in treatment.

The research, though, does not always support its use.

Often people will learn skills and techniques from their mentors and peers and accept these skills and techniques to be true simply because they are what has always been done. But just because it has always been done one way does not always make that the best way. But because the technique or treatment has been used for years, no one stops to question its effectiveness.

This is what I believe has happened with the use of ultrasound. It’s been used for years despite the fact there is not a solid body of research to back up its use.

The Research

Let’s look at two separate systematic reviews of randomized control trials done in the last ten years. Note: a systematic review is the highest level in the hierarchy of evidence.

The first review looked at 35 studies examining the use of therapeutic ultrasound for musculoskeletal injuries. Of the 35 studies, only ten were found to have adequate methodologies to be part of the review:

Results indicated that only two studies showed an improvement in injury following the application of ultrasound versus placebo.
Eight of the ten studies showed no difference between placebo treatment and ultrasound, and did not recommend the use of ultrasound.
The two studies that did show a positive improvement in injury symptoms were authored by the same researchers who admitted there was a relatively high relapse rate of carpal tunnel (the condition they investigated) following ultrasound treatment.

“Most of the studies reviewed indicated that ultrasound was no better than placebo. Any benefit from using the ultrasound was simply because patients expected an improved result.“

The second systematic review looked at randomized clinical trials investigating the effects of therapeutic ultrasound on pain, disability, or range of motion. 38 studies were included in this review, with thirteen of them including a placebo-controlled trial. In eleven out of the thirteen placebo-controlled trials no evidence of clinically important or statistically significant results were found.

What Does This Mean?

Put simply, the research does not support the use of therapeutic ultrasound for musculoskeletal injuries. Most of the studies reviewed indicated that ultrasound was no better than placebo. Any benefit from using the ultrasound was simply because patients expected an improved result.

Can Ultrasound Cause Harm?

If applied by a trained professional, ultrasound is very unlikely to do you harm. If your therapist uses it on you, he or she is not making your injury worse. The important thing to consider is not whether it is good or bad for you, but whether it is using your time and resources effectively and efficiently.

As a physical therapist, I do not use ultrasound. In fact, I don’t actually own an ultrasound machine. My reasoning is simple: based on this research and on the outcomes I have seen using hands-on, manual, and exercise-based treatments instead of ultrasound, I would much rather spend my clients limited time with me teaching them and doing more active and effective therapies.

If I had a client for an indefinite period of time and our goal was to get him or her back to being 100% as soon as possible, I might use an ultrasound machine – because why wouldn’t I throw absolutely everything at the issue? But unfortunately, I, and every other therapist, do not have indefinite amounts of time with each and every client. And this is why I choose to use the most effective treatments in order for my clientele to get the best value for their time and to not only feel better immediately, but also for the long haul.

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