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BY Dr. B. SAMPATH REDDY MPT ortho .

y Ultrasound waves are produced by piezo-electric

effect" principle. When an high frequency alternating current is applied on this crystal, the resonant frequency of the current is at the same natural frequency as that of the crystal, distortions of its molecular structure occur and it mechanically vibrate by the acoustic vibration producing mechanical waves indentical to sound waves. y The frequency of the wave is determined by the size of the crystal and the frequency of the impressed current. y Those produced waves are propogated into the tissue through a transducer treatment head.

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and penetrated into the tissue Peak Intensity : This is defined as the ultrasonic fields. which are roughtly cylindrical in shape of the same diameter as the treatment head.y Mode of Transmission : The treatment head is moved to and fro to form a stream of longitudinal waves that forms the ultrasonic beam. in which is the division the ultrasonic beam is divided into "Near & Far Field" .

Near field is directly proportionate to the frequency and inversly proportionate to wavelength. y To rule out and prevent the irregularity the head is continuously moved to and fro.y Near Field :. .

y This is because the differing path lengths emitted from different points of the head become insignificant at greater distance. the sonic filed spreads out somewhat and becomes much more regular. . As this zone is always noted beyond the near field.y Far Field : where the field is less intense and prominent at the peripheral point of the head.

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but this is a gross measure of the power being emitted by the sound head. Since ultrasound is given in two modes the average is calculated as follows: . The unit of intensity when using ultra sound is watt.y intensity : It is the total output of the intensity given in a unit time. So an average intensity is normally used (W/cm²).

if 2 W power is given with a pulse of 1:4 ratio for 5 minutes then time average will be 2W/cm²/5min . (i.e). total output of power in watts per square centimeter of treatment area . in a total given unit of time(per second) for a specified area of tissue (i.y Space Peak Average / Space Average Intensity : It is the total average intensity given over a specified area of tissue.e).for eg. then space average intensity will be 2W/cm² y Time or Temporal Peak Average / Time or Temporal Average Intensity : It is the total output calculated. If 2 is total output. when using pulsed mode.

if there is an acaustic impendence mismatch there occurs some amount of reflection and simulataneously if there is similar acustic impendence no reflection occurs. Thus the following plays a very important part of the factors affecting transmission.y Factors Affecting Transmission : Since ultrasound behaves similarly to the rays of light it follows all the principle of optical laws. it is always necessary to know the acaustic or sound impedence (Z) of each medium Physical Modalities responsible for reflection. y Reflection : Since ultrasound cannot be transmitted in air. So. .

on insonation. It means the insonated waves touch the tissue at one angle continues to pass at a different angle .y Refraction : As light refraction ultrasound also. deviates.

It can be better understood by knowing the term . It is generally accepted that absorption best occurs at molecular level and generate heat. which varies from tissue to tissue. .alttenuation y Attenuation : It is the progressive loss of insonated energy.y Transmission : It is the insonated energy entering into the tissue from the sound head and gradually reducing in its intensity before it targets the right tissue. They are : y i) Absorption : After the progressive loss the resultant energy retained in the target tissue is stated as absorbtion. This is the end result of insonated power and two major factors contribute to this physical phenominon.

Thus the resultant insonated energy reaching the target tissue shows that there is reduction in internsity the deeper it passes. y This reduction is exactly half of its surface intensity.y Scattering : When the insonated energy strikes the higher viscosity level it reflects from its path due to formed gas bubbles or by any other such disturbances and scatters. . termed as "Half Value Distance" even this also varies from tissue to tissue and frequency .

The best way to propogate y y y y y y y ultrasound energy is through the best coupling medium. applied in between the tissue and the vibrating source. The best medium is selected based on the following factors : It should have a proper tissue matching acustic impendence Increased transmission capacity Low grade of viscosity Low susceptibility in air bubbles. should be non-irritative non corrosive to metal act as a lubricant .y Coupling Medium.

y Degassed water y Paraffin oil y Low viscosity mineral oil y Glycerol y Aqua sonic gel y ECG gel y Lanolin creams .

increases absorption with greatly reduced half value thickness. Frequency. at same ii) pulsed gives non thermal effect .y y y y y y Dosage : Effect and safety of ultrasound treatment depends on the availability and reliability of suitable equipment and its parameters. Time.Mode. intensity Frequency : as increased frequency. Intensity : it is the total output power emitted per second from the circumference diameter of a sound head. Mode : i) continuous gives thermal effect. Intensity. for all treatments generating thermal effect higher frequencies are used and for non thermal effect lower frequencies are used. Progression. . All higher frequencies gives only superficial heating were lower frequencies gives deep heating. such as .

Timing is always based on the mode and stage of the condition.y Time : it is the total maximum duration of insonation and measured in minutes in relation to the area treated. is must y Stage : y Acute : Non thermal . . maximum y Average : minimum.15 min. y Mode : y Continuous : 5 min.10 min.maximum.) y Sub-acute : thermal and micromassage .) .5 min. maximum y Pulsed : 8 min.short time (8 min.minimum time (5 min. . time (10 min.) y Chronic : thermal . 8 min. to maximum.

.y Application Techniques : y a) In Contact or Direct method y b) Acquatic or Water Bath method y c) Sub-Acquatic or Water Bag method.

y y y y y y y y y y y Thermal Effect : This effect is more destructive in nature and requires at least 5 min. to raise the temperature to 40º to 45ºC Increases circulation more locally Increases metabolism Mild raise in temperature 3º to 8ºC Relaxes the muscles Facilitates calcium penetration Helps in release of enzymes like hystamine and such other chemicals Accelerates healing process Increase collagen extensibility of connective tissues Helps in scar tissue mobilisation Increase membran permiability allowing for increased ionic exchange .

During this period. While unstable cavities are more dangerous. This is produced during the period of relaxation.y Non-Thermal Effect : This effect is very soothing. These bubbles can be Stable or Unstable . does not give any sensation changes at the site of interface. Stable cavities are not dangerous. The effects produced are based on the physiological changes taking place in the tissue. free moving molecules catch up air bubbles filled with already dissolved gas. as it increases cell permeability or otherwise called Micro Streaming . can get dislodged in any path of the artery and block the flow or get collapsed and create high concentration of energy (temperature raise) . y Cavitations : it is an important feature of high intensity and care must be taken to avoid producing this. The nature of production is blood naturally contains dissolved gas and when these are insonated with sound waves during relaxation period molecules move more freely followed by immediate compression.

y Proliferation y Remodelling .Micro Massage : It is created due to alternate compression and relaxation of tissue by sounds pressure and mechanical reactions of tissues to sound. y Standing Waves : Isonated energy reflected back to sound head and gets superimposed to incident wave leading to heat concentration. It is best avoided by moving the sound head continuously. y Ultrasound non-thermal effects have an useful effect in all 3 stages of repair y Inflammation.

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y Indications : y Pain and muscle spasm .. etc.localized y Acute and sub acute injuries y Chronic arthritic conditions y Scar and adhesive tissue stretching y Localized low back pain spot due to disc prolapse y Wound healing y All types of immediate and late soft tissue sports injuries y Occupational injuries y Chronic indurated oedema y Plantar fasciitis. y Traumatic neuralgia and neuromas y Calcified tendinitis y Recent healing fractures . retro calcaneal bursitis. calcaneal spur.

y Contraindications : y Brain and spinal cord y Eyes y Reproductive and abdominal organs y Pregnant uterus y Acute infection and sepsis y Malignant tumors y Recent x-ray therapy y Phlebitis and thromboplebitis y Hemophilia y Tuberculosis y Anesthetic areas y Metal in treatment part y Air filled sinuses .

y Advantages : y Easy to carry & apply y A very local treatment with few generalized responses produced y Application time is usually short y Capable of producing significant temperature changes deep within the tissue y Can apply to immediate injuries though it is an heat modality. .

aggravating any tenderness present y Regular damage to crystal occurs y A very costly equipment due to the presence of delicate crystal y . making dosage difficult to monitor y Pressure is exerted on the treatment part.y Disadvantages : y Very little sensation is associated with treatment.

y Dangers : y Burns y Shock y Cavitations y Overdose y Standingwaves .

y Precaution : y Keep the sound head moving y Do not expose the sound head to air y Maintain even contact y Use only suitable and appropriate copulant y Remove air bubbles y Avoid bony prominences y Avoid using high intensities and prevent cavitation y Take care of aneasthetic skin and malignancy .