Ultrasound, Laser and Shock Wave are electrotherapy treatments using technology and are reviewed in this article as additional methods of treatment by physiotherapists.
What is Ultrasound used for in Physiotherapy?
Therapeutic ultrasound is a treatment method that has been used by physiotherapists for approximately 80 years. This should not be confused with diagnostic ultrasound, which is an ultrasound device used to see the inside of the body, such as checking on a foetus during pregnancy or looking at soft tissue integrity.
Ultrasound was, until recently, the treatment of choice for musculoskeletal injuries and pain by physiotherapists globally. Many recent studies have, however, raised questions over the impact which ultrasound has to the overall outcome of physiotherapy and the use of this form of electrotherapy has decreased dramatically in the past 15 years.
How Ultrasound works
Ultrasound works by vibrating a small crystal by applying an electrical charge to it. This creates piezoelectric waves which are emitted from the head as ultrasound waves. The head of the device is then placed in direct contact with your skin over the painful area, or area of tissue damage. This increases blood flow and disruption of cells in the tissue, which is theorised as the benefit of the treatment.
As mentioned above, research has shown that the effect of ultrasound treatment is likely minor and temporary. There is more evidence that “hands on” treatment through soft tissue release (massage), joint mobilisation and rehabilitation result in more permanent changes to damaged tissue and pain.
What alternative electrotherapy treatments are there?
Due to the growing body of evidence which suggests that the use of ultrasound has limited benefits, your physiotherapist may consider alternative electrotherapy treatments which research suggests have higher impact in the treatment of various injuries.
The electrotherapy techniques recommended by Lamberti Physiotherapy are:
- low level laser therapy (LLLT) and
- shock wave therapy (SWT).
Lamberti Physiotherapy currently offers low level laser therapy at all its branches and has a shock wave therapy machine at the Woodmead and Tygervalley Practices.
Low Level Laser Therapy (LLLT)
Laser therapy has increasingly been used by physiotherapists for almost three decades. LLLT is a low intensity light therapy that results in photochemical changes in the tissues (not thermal changes). It has been proven to aid in pain relief, increase blood flow, reduce inflammation, stimulate wound healing and tissue regeneration, as well as reduce scarring.
Research has even proven that LLLT can reduce inflammation equally as well as treatment by non-steroidal anti-inflammatory drugs (NSAIDs).
LLLT is often used to treat:
- Tendonopathies (such as tennis elbow, jumper’s knee and Achilles tendonitis);
- Shoulder pain (frozen shoulder and rotator cuff impingement);
- Arthritis (Rheumatoid- and Osteo-);
- Neck and back pain;
- Jaw soreness (TMJ); and
- Wound and scar healing.
Shock Wave Therapy
Shock Wave therapy uses pressurised air, or electromagnetic pulses, to induce micro-trauma to the tissues. This micro-trauma triggers a healing response as it increases blood flow, which bring more nutrients and oxygen, both of which are important for tissue repair. This, in turn, decreases pain and irritation.
Although Shock Wave is a fantastic non-invasive therapy to treat otherwise challenging problems, it can be quite painful at the time of treatment. Research has shown successful treatment of the following conditions which can be quite resilient to other therapies and are often chronic:
- Hip pain (trochanteric bursitis);
- Frozen shoulder; and
- Tendinopathies (esp. plantar fasciitis, rotator cuff tendonitis, Achilles tendonitis).
Remember that passive treatment techniques such as LLLT and Shock Wave therapy are just one part of an effective treatment regime. One of the most important aspects to a full recovery remains active participation by the patient in their rehabilitation programme. Furthermore, each injury is unique, so come visit us at Lamberti Physiotherapy for a comprehensive clinical diagnosis in order for us to design the most appropriate treatment programme for your condition.
- https://www.painscience.com/articles/ultrasound.php updated Oct 26, 2018 (first published 2009) by Paul Ingraham, Vancouver, Canada
- A Review of Therapeutic Ultrasound: Effectiveness Studies. Valma J Robertson, Kerry G Baker. Physical Therapy, Volume 81, Issue 7, 1 July 2001, Pages 1339-1350, https://doi.org/10.1093/ptj/81.7.1339.
- Effect of therapeutic ultrasound on tendons. Tsai WC1, Tang ST, Liang FC. 2011.
- Usage Patterns and Beliefs about Therapeutic Ultrasound by Canadian Physical Therapists: An Exploratory Population-Based Cross-Sectional Survey. Armijo-Olivo S, Fuentes J, Muir I, Gross DP. Physiother Can. 2013;65(3):289–99. Pubmed.
- The anti-inflammatory mechanism of low level laser therapy and its relevance for clinical use in physiotherapy. Jan Magnus Bjordal,Rodrigo Alvaro Brandão Lopes-Martins,Jon Joensen &Vegard Vereide Iversen. Pages 286-293 | Published online: 19 Jul 2013.
- Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Furia JP, Rompe JD, Maffulli N. Am J Sports Med. 2009 Sep;37(9):1806–13. PubMed #19439756.
- Shockwave Therapy for the Treatment of Chronic Proximal Hamstring Tendinopathy in Professional Athletes. Cacchio A, Rompe JD, Furia JP, et al. Am J Sports Med. 2010 Sep. PubMed #20855554.
- The efficacy of radial extracorporeal shockwave therapy in shoulder adhesive capsulitis: a prospective, randomised, double-blind, placebo-controlled, clinical study. Hussein AZ, Donatelli RA. European Journal of Physiotherapy. 2016 Mar;18(1):63–76.
- The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. Br J Sports Med. 2018 Mar;52(6):387–407. PubMed #28954794.
- Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials. Lou J, Wang S, Liu S, Xing G. Am J Phys Med Rehabil. 2016 Dec. PubMed #27977431.
- The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. Howard B Cotler, Roberta T Chow, Michael R Hamblin, and James Carroll.
- The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue.
- Angela Notarnicola and Biagio Moretti, Muscles Ligaments Tendons J. 2012 Jan-Mar; 2(1): 33–37. Published online 2012 Jun 17.