Avenue Clinic Newsletter April 2014
Why We Use Ultrasound Therapy For Soft Tissue Injuries at The Avenue Clinic
When you have visited any of the chiropractors at the Avenue Clinic, you have probably received ultrasound therapy on occasions.
You may have wondered what exactly it does. We use it in conjunction with manipulation, mobilisation and rehabilitation exercises.
Ultrasound can be used in pulsed form or continuous flow.
One study in 2012 by Wouber Herickson de Brito Vieira et al demonstrates the widespread use and the importance of therapeutic ultrasound on clinical practice in Brazil. There is evidence in this study to justify the widespread use of therapeutic ultrasound and one of them is related to its analgesic (pain reducing) potential and also the ability of ultrasound to increase the extensibility of tissues by warming the tissues, which is particularly important in chronic injuries where tissues have gradually contracted and shortened. Their findings showed that therapists noticed improvements in pain after its use and this result was also found by other studies that demonstrated ultrasound as an analgesic for musculoskeletal injuries.
Koybasi, Borman, Kocauglu and Ceceli in a study conducted in 2010 found that “the use of therapeutic ultrasound in the treatment of hip osteoarthritis should be encouraged, and it seems worthy to continue with large clinical trials on ultrasound in order to standardize the treatment modality in this patient group.” Yet another osteoarthritis systematic review of research into the use of ultrasound on the hip and knee was conducted as a Cochrane Database Systematic Review. Their conclusions were that “In contrast to the previous version of this review, our results suggest that therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee.”
A study in 2010 by Goren, Yildiz et al assessed the effectiveness of therapeutic exercise in combination with ultrasound in people with spinal stenosis (see post on our website for more information about spinal stenosis) and found that those who exercised and also received ultrasound therapy used substantially less in the way of pain killers.
In 2010 Draper et al found that use of ultrasound over painful trigger points in the upper trapezius muscles (top of the shoulders) decreased stiffness of the trigger points.
A study published in the British Medical Bulletin by Khanna and colleagues (2009) evaluated the evidence for use of low intenstiy pulsed ultrasound (LIPUS) in soft tissue injuries. This article included studies with both animal and human participants and also in vivo and in vitro conditions. In summary, the review found the following results.
Intervertebral Disc. Ultrasound therapy had the following effects on nucleus pulposus material:
- Increased disc cell proliferation and matrix synthesis
- Increased proteoglycan synthesis; which increased water uptake and may regress herniation
- Induced macrophage migration; which may increase remodeling and healing
- Increased collagen synthesis (16-19%) (Miyamoto et al., 2005)
Ligament. Ultrasound therapy was shown to have:
- Accelerated ligament healing
- Accelerated rat medial collateral ligament injury healing (Takakura et al. 2002; Sparrow et al., 2005).
Cartilage. Ultrasound therapy was shown to have the following effects on cartilage defects:
- Significantly improved full-thickness osteochondral defects with reference to both morphologic features and histologic characteristics of repaired cartilage.
- Enhanced the healing of cartilage defects in vivo.
- Cartilage healing assisted with LIPUS produces fewer degenerative changes in the long term, as compared with controls. (Cook et al., 2001).
Tendon. The 2009 review found that therapeutic ultrasound has been found to have no effect over and above placebo on tendon healing (Khanna et al., 2009). However, this may be contradicted by some brand new research discussed below.
New Research on Tendon Healing and Ultrasound Therapy
Junior et al. (2011) randomised 28 tendons with surgically induced calcaneal tendon injuries into 2 groups, a control and a LIPUS groups. The experimental group underwent 28 consecutive days of low intensity pulsed ultrasound therapy, starting on the first postoperative day. The parameters and dosage where as follows:
- 2 W of irradiation intensity applied to an effective radiation area (ERA) head of 3.8 cm2
- 16-Hz frequency
- Pulsed 20% sonication periods
- Time: 5 minutes
- SATA = 0.1 W/cm2
- SAI = 0.52 W/cm2
- Subaquatic delivery technique
Following the experiment period the results were analysed. To account for differences in tendons the results were normalised to the uninvolved limb, and therefore, each tendon served as their own control. The study examined outcomes variables of cross-sectional area, ultimate load, tensile strength, and energy absorption. The results show that the experimental LIPUS groups consistently performed better on all outcomes, and therefore the LIPUS has improved the biomechanical properties of the tendon.
However, the tendons involved had induced injuries, which are not necessarily the same as acquired injuries. Therefore the effect on tendon problems that have arisen as a result of repetitive strain or sudden overload still remains questionable.
At the Avenue Clinic, we will examine you carefully to try to ascertain the tissue injury that you have. We may refer you to Bournemouth to the Anglo European College of Chiropractic for an Investigative Ultrasound Scan, which is often free of charge for our patients! This will demonstrate soft tissue injuries and will show whether you have calcification, wear or tear of a tendon or ligament or inflammation.
When appropriate we will suggest trying a series of treatments that may include therapeutic ultrasound, used in accordance with the above guidelines.
Cook SD, Salkeld SL, Popich-Patron LS, Ryaby JP, Jones DG, Barrack RL (2001) Improved cartilage repair after treatment with low-intensity pulsed ultrasound. Clin Orthop, 391, 231 – 243
Junior SLJ, Camanho GL, Bassit ACF, Forgas A, Ingham SJM, Abdall RJ. Low-intensity pulsed ultrasound accelerates healing in rat calcaneus tendon injuries. J Orthop Sports Phys Ther 2011;41(7):526-531
Khanna A, Nelmes RT, Gougoulias N, Maffulli N, Gray J. The effects of LIPUS on soft-tissue healing: a review of literature. Br Med Bull. 2009;89:169-182.
Miyamoto K, An HS, Sah RL et al. (2005) Exposure to pulsed low intensity ultrasound stimulates extracellular matrix metabolism of bovine intervertebral disc cells cultured in alginate beads. Spine, 30, 2398–2405.
Sparrow KJ, FinucaneSD, Owen JR, Wayne JS. (2005) The effects of low-intensity ultrasound on medial collateral ligament healing in the rabbit model. Am J Sports Med, 33, 1048–1056.
Takakura Y, Matsui N, Yoshiya S et al. (2002) Low-intensity pulsed ultrasound enhances early healing of medial collateral ligament injuries in rats. J Ultrasound Med, 21, 283–288.