Journal of Orthopaedic & Sports Physical Therapy

Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association

Effect of Transducer Velocity on

Intramuscular Temperature During a
1-MHz Ultrasound Treatment
Stephanie L. Weaver, LAT, ATC 1
Timothy J. Demchak, PhD, LAT, ATC 2
Marcus B. Stone, PhD, LAT, ATC 3
Jody B. Brucker, PhD, LAT, ATC 4
Phillip O. Burr, PA, MS, ATC 5

M
Study Design: A 3 × 2 repeated-measures design was used. The independent variables were ost textbooks rec-
transducer velocity (2-3 cm/s, 4-5 cm/s, and 7-8 cm/s) and time (pretreatment and posttreatment). ommend the fol-
Objective: To determine if transducer velocity of a 1-MHz ultrasound treatment affects intramus- lowing parameters
cular tissue temperature. to vigorously heat
Background: Most authors advocate ultrasound transducer velocities of 2 to 4 cm/s within an area deep muscle with
of 2 to 3 times the effective radiating area or 2 times the size of the transducer head. However, a
ultrasound: frequency, 1 MHz;
much faster rate of application (approximately 7-8 cm/s) is often observed in clinical settings.
intensity, 1.5 W/cm2; duration,
Methods and Measures: Eleven healthy screened volunteers (9 males, 2 females; mean ± SD age,
22.6 ± 1.7 years; mean ± SD height, 175.7 ± 13.7 cm; mean ± SD body mass, 82.5 ± 19.5 kg)
10 minutes; treatment area, twice
were randomly assigned to a treatment order with all conditions administered during a single the size of the transducer; velo-
testing session. Each transducer velocity condition was administered for 10 minutes, using 1-MHz city of the transducer, 2 to 4
ultrasound with a 100% continuous duty cycle at an intensity of 1.5 W/cm2 over an area twice cm/s.6-8,11,23,29 Although support
the size of the transducer head. After the first treatment, the 2 remaining subsequent velocity for the frequency, intensity, dura-
conditions were administered after the intramuscular temperature returned to within ± 0.3°C of the tion, and treatment area can be
initial pretreatment temperature for 5 minutes. The dependent variable was left triceps surae found,3,5,9,12,16,21,28 information on
muscle temperature measured at 3 cm below one half the measured skinfold thickness. the effect of transducer velocity on
Results: Temperature increase across the 3 velocities was within 0.4°C (F2,20 = 0.07, P = .93). increases in tissue temperature is
Posttreatment values (mean ± SD) ranged from 42.7°C ± 2.3°C for the slowest velocity to 43.1°C absent in the literature. This void
± 1.4°C for the fastest velocity. Temperature increase was significant for time (F1,10 = 155.68,
is apparent when tracing refer-
P ⬍ .00001), increasing from 37.8°C ± 0.8°C pretreatment to 42.9°C ± 1.9°C after treatment.
ences from several textbooks and
Conclusion: Very similar intramuscular temperature increases can be observed among ultrasound
treatments (10-minute duration, 1-MHz frequency, 100% continuous duty cycle, 1.5 W/cm2
published articles, which provide
intensity, within an area twice the size of the transducer head), with transducer velocities of 2 to no data to support the suggested
3, 4 to 5, and 7 to 8 cm/s. J Orthop Sports Phys Ther 2006;36(5):320-325. doi:10.2519/ transducer velocity. 1-5,8,9,10,12,16-
18,20-22,24,26-28
jospt.2006.2157 High beam nonuni-
formity ratio (BNR) is typically
Key Words: calf heating, piezoelectric modality, therapeutic modality
cited as a reason to move the
transducer head in this fashion to
1
Marketing Representative, OrthoIndy, Indianapolis, IN. decrease the risk of causing pain
2
Assistant Professor, Athletic Training Department, Indiana State University, Terre Haute, IN.
3
Director of Orthopedic Trauma Research, OrthoIndy, Indianapolis, IN. to the patient, while maximizing
4
Assistant Professor, Athletic Training Department, Indiana State University, Terre Haute, IN. thermal effects. 6-8,23,29 Today,
5
Student, Athletic Training Department, Indiana State University, Terre Haute, IN. manufacturers are producing
Address correspondence to Timothy J. Demchak, C-10 Arena Building, Athletic Training Department,
Indiana State University, Terre Haute, IN 47809. E-mail: athdemchi@sugw.indstate.edu transducers that contain crystals
This study was funded by the Indiana State University Office of Sponsored Programs. Informed consent with lower BNRs, which may allow
and approval for research using human subjects were obtained from the Health and Human Performance for transducers to be moved at
Institutional Review Committee of Indiana State University. We affirm that we have no financial affiliation
(including research funding) or involvement with any commercial organization that has a direct financial slower rates, while still protecting
interest in any matter included in this manuscript. the patient.

320 Journal of Orthopaedic & Sports Physical Therapy

 Therapeutic modality textbooks6,11,23,25,29 often
state that moving the transducer rapidly at greater
than 4 cm/s will result in decreasing the total
amount of energy absorbed per unit area and lead to
decreased heating benefit. However, as previously
stated, there is no empirical evidence of this claim.
Moreover, we have observed the application of higher
transducer velocities (7-8 cm/s) in several clinical
settings and believe that many clinicians use higher
transducer velocities than recommended.
The purpose of this study was to examine the effect
of 3 transducer velocity conditions (2-3, 4-5, and 7-8
cm/s) on intramuscular tissue temperature during a
standardized ultrasound application. We hypothesized
that there would be no differences in temperature
increases among the velocity conditions. This is based
on the theory that an equal amount of acoustic
energy will be transmitted into the tissue from a
standardized ultrasound treatment regardless of the
transducer velocity. There is evidence to suggest that
ultrasound treatments with equivalent spatial tempo-
ral averages result in equal increases in tempera-
ture.14
METHODS
A 3 × 2, repeated-measures design was used. The
independent variables were transducer velocity (2-3,
4-5, and 7-8 cm/s) and time (pretreatment and
posttreatment). The dependent variable was left tri-
ceps surae intramuscular tissue temperature at a
depth of 3 cm below one half the measured skinfold
thickness. This depth was chosen to compare our
results to other ultrasound studies.
Subjects
Eleven healthy (9 males, 2 females; mean ± SD age,
22.6 ± 1.7 years; mean ± SD height, 175.7 ± 13.7 cm;
mean ± SD body mass, 82.5 ± 19.5 kg) of 12 subjects
who were recruited and volunteered to participate
completed this study. Data from 1 subject were
discarded due to equipment malfunction. Subjects
were excluded if they reported vascular or neurologi-
cal disorders, recent injuries, surgeries in the 6
months prior to testing, or allergies to penicillin,
Keflex, or latex. The study was approved by the
Health and Human Performance Institutional Review
Committee of Indiana State University and each
subject consented to participate prior to data collec-
tion.
Procedures
Each subject reported to the laboratory dressed in
shorts and a T-shirt. Upon arrival the subjects com-
pleted the informed consent and were screened. The
subjects were assigned to a treatment order based on
J Orthop Sports Phys Ther • Volume 36 • Number 5 • May 2006
a Latin square and 2 subjects went through each of
the 6 possible treatment orders. During the entire
testing procedure, all subjects remained prone. A
surgical pen mark was made on the posterior aspect
of the medial triceps surae muscle at the greatest
girth to identify the middle of the treatment area. A
mean of 3 consecutive vertical skinfold measurements
at this site was calculated to estimate superficial tissue
thickness. The desired depth for the thermocouple
below the treatment area was 3 cm plus half the value
of the measured superficial tissue thickness. The
insertion site was located and marked by laying the
carpenter’s square flush against the medial triceps
surae muscle so that the 90° angle was 5.08 cm
(length of the needle) from the middle of the
treatment area and measuring down from the right
angle of the carpenter’s square 3 cm, plus half the
value of the measured superficial tissue thickness
(Figure 1).
The treatment area, insertion site, and the sur-
rounding areas were shaved and cleansed with
Betadine (The Purdue Frederick Company, Norwalk
CT). Prior to insertion, the thermocouple (type
TX-23-21; Columbus Instruments, Columbus, OH)
was threaded into a 5.08-cm 18-gauge reusable hypo-
dermic needle (Popper & Sons, Inc, New Hyde Park,
NY) so that the tip of the thermocouple was within
the beveled tip of the needle. The needle and
thermocouple were both fully inserted (5.08 cm)
parallel to the carpenter square so that the thermo-
couple was in the middle of the treatment area
(Figure 2). The thermocouple was stabilized while
the needle was extracted and then was secured to the
leg with clear adhesive tape to prevent it from
moving.
The thermocouple was connected to a portable
data acquisition device (Datalogger, MSS-3000; Com-
mtest Instruments Ltd, Christchurch, New Zealand),
which measured and recorded the temperature at the
tip of the thermocouple. Intramuscular temperature
was recorded every second starting at the time of
RESEARCH
thermocouple insertion, and continued until the last
treatment was complete. The pretreatment intramus-
cular temperature prior to the first treatment was
recorded after the temperature remained unchanged
(± 0.1°C) for 5 minutes, which took approximately 20
to 30 minutes after thermocouple insertion. This
temperature was used as the pretreatment tempera-
ture for the rest of the study.
REPORT
To make sure the sound head was channeled
overtop an area equal to 2 widths of the transducer
head, a clear (Lucite) rectangular-shaped template
cut to twice the size of the transducer head (Figure
3) was placed on the skin. This ensured that the
center of the transducer traveled directly over the
location of the tip of the thermocouple and that the
transducer did not consistently remain over any area
321

Middle of
treatment 5.08 cm
3 cm +
superficial tissue
thickness
Insertion site
FIGURE 1. Determination of thermocouple insertion site. Middle of
treatment area is 5.08 cm horizontal from insertion site. The
insertion site is 3 cm plus half the measured skinfold thickness.
FIGURE 2. Thermocouple insertion is made parallel to the carpenter
square.
within the treatment site. Room temperature was
controlled by a wall-mounted thermostat.
Each subject received all 3 velocity conditions (2-3,
4-5, and 7-8 cm/s). The transducer velocity was
controlled using a metronome. The distance the
transducer traveled each beat was 2.4 cm (Figure 4).
The metronome was set at 60, 88, and 192 beats per
minute for the 2- to 3-, 3- to 4-, and 7- to 8-cm/s
conditions, respectively. For all conditions, ultrasound
(Omnisound 3000C, Accelerated Care Plus, Topeka,
KS) was delivered with a 5-cm2-area transducer, with
an effective radiating area of 5.0 cm2 and a BNR of
2.1:1 for 10 minutes at a frequency of 1 MHz, with a
100% (continuous) duty cycle and intensity of 1.5
W/cm2. After the initial condition, the subsequent
conditions did not start until the intramuscular tem-
perature returned to within 0.3°C of the pretreat-
ment temperature and remained unchanged
(± 0.1°C) for 5 minutes. Aquasonic Clear ultrasound
gel (Parker Laboratories, Inc, Fairfield, NJ), kept at
room temperature, was applied to the treatment area
to prevent direct contact of the transducer with the
322
skin or air during the treatment. Ultrasound gel was
applied as needed throughout each of the conditions.
Following each condition, the treatment area and
thermocouple insertion site were observed for any
indication of adverse reaction. At the conclusion of
the study, the thermocouple was removed, the sub-
ject’s leg was cleansed with Betadine and a sterile
bandage was applied to the thermocouple insertion
site. The subjects were given instructions on proper
care of the wound and were instructed to seek care at
the Student Health Center if any concerns arose.
Thermocouples were disinfected by soaking them in
CidexPlus 3.4% glutaraldehyde solution (Johnson &
Johnson Company, Irvine, CA) for at least 20 minutes
prior to use, and the reusable hypodermic needles
were sterilized by a regimen of soaking in CidexPlus
and being autoclaved.
Statistical Analysis
Descriptive statistics at the pretreatment and post-
treatment times for each transducer velocity were
calculated. Pretreatment temperatures across the 3
conditions were analyzed using a 1-way repeated-
measures ANOVA to confirm that the tissue tempera-
ture returned to the initial pretreatment temperature
prior to beginning the next condition.
A 2 × 3 repeated-measures ANOVA was used to
detect velocity and time differences, and the Scheffe
multiple-comparison test was used for post hoc test-
ing. The Geisser-Greenhouse method was used to
adjust for the violation of covariance matrix circular-
ity. Significance level was set at P ⬍ .05 prior to
testing. The NCSS 2000 software (Number Cruncher
Statistical Systems, Kaysville, UT) was used for all data
summarization and analyses.
RESULTS
Descriptive statistics for each transducer velocity
pretreatment and posttreatment are presented in
Table 1. The results of the 1-way ANOVA indicated
no statistically significant difference across the 3
pretreatment temperature values (F2,26 = 2.66, P =
.10). Mean intramuscular temperature prior to each
condition varied from 37.7°C to 37.9°C.
Results of the 2-way ANOVA indicated a significant
main effect for time (F1,10 = 155.68, P ⬍ .00001), with
the posttreatment values (42.9°C ± 1.9°C) being
greater than pretreatment values (37.8°C ± 0.8°C).
No significant main effect for velocity (F2,20 = 0.07,
P = .93) and no significant interaction were identified
(F2,20 = 0.33, P = .72).
A clinically relevant temperature change of 2°C
(moderate heating), as the difference needed for
influencing the efficacy of the modality, was se-
lected.15 Using Tukey-Kramer simultaneous confi-
dence intervals (CIs) for multiple comparisons for all
J Orthop Sports Phys Ther • Volume 36 • Number 5 • May 2006

2.4 cm
FIGURE 3. Ultrasound template. Line depicts distance (2.4 cm) that the transducer was moved each beat of the metronome.
pairs, the mean difference and 95% CIs for the
difference in temperatures between the 4- to 5-cm/s
velocity and the other velocities at the end of the
study are reported in Table 2. Because the 95% CIs
on the differences from the 4- to 5-cm/s tempera-
tures did not include the clinically chosen 2°C, the
lack of effect of transducer speed on temperature
increases is not attributed to a lack of statistical power
(type II error).
DISCUSSION
Our data reveal that the heating effect was similar
among conditions regardless of the transducer veloc-
ity. This result supports our hypothesis that there
would be no differences in temperature increases
among the velocity conditions. The increases in tissue
temperature that we reported for transducer rates of
2 to 3 and 3 to 4 cm/s were similar to those reported
in other studies using similar param-
eters;3,9,10,12,13,26,28 therefore, we believe our data to
be accurate with the number of subjects tested and
the absence of a type II error. Gallo et al14 reported
no differences in temperature increase between 2
groups with equivalent energy transfer into the body
for 3-MHz ultrasound treatments.
The amount of temperature increase has been used
to quantify the effect of an ultrasound treatment.10 In
this study, the average temperature increase of 5.1°C
would be considered vigorous heating (defined as a
temperature increase greater than 4°C) and be associ-
ated with accelerating metabolic rate, increasing
blood flow, increasing tissue extensibility, decreasing
pain and muscle spasm, and inhibition of sympathetic
activity.10,29
We recognize that the parameters used in this study
were very well controlled and that there may be other
considerations when applying ultrasound clinically.
First, one common belief for administering
J Orthop Sports Phys Ther • Volume 36 • Number 5 • May 2006
Lucite
form
Treatment
area
Center of
treatment area
Transducer
head
ultrasound at lower velocities (2-4 cm/s) is that
‘‘Rapid movement of the sound head causes the
therapist to slip into treating a larger area, thus the
desired temperatures may not be attained.’’25 In fact,
diminished thermal effects of ultrasound have been
reported using larger treatment areas.15 However, it is
not known if the higher transducer velocity would
increase the treatment area if a template were not in
place. Further research investigating the effect of
transducer velocity on treatment area is warranted.
Another variable affecting the efficacy of thermal
ultrasound is the difference among transducer energy
output. Differences in temperature change have been
reported with different ultrasound transducers, de-
spite the same treatment parameters. Two studies
directly comparing ultrasound manufacturers re-
ported difference in overall temperature increases
and the rate of increase, despite similar BNR, be-
tween the transducers.18,22 Differences in overall tem-
perature increases are also evident when comparing
studies that used different ultrasound transducers,
RESEARCH
REPORT
FIGURE 4. Ultrasound performed using a template twice the size of
the transducer head.
323
 2. Bishop S, Draper DO, Knight KL, Feland JB, Eggett D.
TABLE 1. Summary of temperature (mean ± SD °C) by trans- Human tissue-temperature rise during ultrasound treat-
ducer velocity and time (n = 11). ments with the aquaflex gel pad. J Athl Train.
Time* 2-3 cm/s 4-5 cm/s 7-8 cm/s 2004;39:126-131.
3. Burr PO, Demchak TJ, Cordova ML, Ingersoll CD, Stone
Pretreatment 37.9 ± 1.0 37.8 ± 0.8 37.7 ± 0.8 MB. Effects of altering intensity during a 10 minute 1
Posttreatment 42.7 ± 2.3 43.0 ± 2.0 43.1 ± 1.4 MHz ultrasound treatment on triceps surae temperature
elevation. J Sport Rehabil. 2004;13:275-286.
* Statistical analysis using a 2 × 3 repeated-measures ANOVA
indicate a main effect for time P ⬍ .00001. 4. Byl NN, McKenzie A, Wong T, West J, Hunt TK.
Incisional wound healing: a controlled study of low and
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1993;18:619-628.
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temperature increase between ultrasound transducers increase in human muscle during 1 MHz and 3 MHz
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The results of this study demonstrate that when
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