With therapeutic ultrasound not having a definite mechanism of action on injuries and having no significant evidence behind it – I ask why ultrasound is still used so much as a treatment for musculoskeletal injuries?

Too often when treating in the clinic I am asked either “do you use ultrasound”, “why don’t you use ultrasound” or “normally my past physio just used ultrasound and a heat pack…”

Now I know everything has its place and its uses but when there are so much better alternatives than therapeutic ultrasound that do actually help more that placebo – why not use them?

Now, here is a little background info on ultrasound:

What it is: Therapeutic ultrasound (US) is a popular electrophysical treatment method that generates mechanical energy which propagates through tissues (1). Among physiotherapists, it is used to treat soft tissue injuries, accelerate the wound’s repair, augment fracture healing, on swellings resolution and to solve some bone and circulatory injuries.

Although many lab‐based studies have demonstrated a number of physiological effects of ultrasound upon living tissue, there is remarkably little evidence for real effect and benefit in the treatment of soft tissue injuries(2).

How much is it used?

Therapeutic US is still used almost daily throughout many countries as a go-to treatment for acute injuries and overuse injuries such as runners knee.

In Australia, it is used DAILY by 84% of health professionals

in England, it is used in 54% of all interventions in private clinics(1)

There are some countries which are ahead of the game with such as Sweden, where it is used less than 5% of the time and this needs to be followed by other developed countries(3).

What’s the evidence then?

In most studies, therapeutic ultrasound proved to be no better than Placebo for a wide range of musculoskeletal conditions (4,5), and that there is a lot of variation in parameters used.

I could go into detail but the main point is, therapeutic US has been shown to be no better than placebo or exercises(6), so why would a therapist waste ten minutes of treatment time when they could be doing something else?

Evidence-based practice is becoming increasingly important in physiotherapy as we want to use what works for our patients – So why is US use still so rife in the profession? Is it lack of motivation, education or just plain lazy?

Let me know your thoughts!

Extra reading:

Paul Ingrahams post in a similar vein is a great read