The waves are generated by a piezoelectric effect caused by the vibration of crystals in the head of the wand / probe. The sound waves that pass through the skin cause a vibration of the tissues. This vibration or cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In cases where a heating effect is not desirable, as a new injury with acute inflammation, the ultrasound can be pulsed continuously instead of transmission.

Ultrasound can produce many effects other than just the potential heating effect. It has shown it can cause increases in tissue relaxation, local blood flow, and scar tissue breakdown. The effect of increased local blood flow can be used to help reduce local swelling and chronic inflammation, and according to some studies, promote bone fracture healing. The intensity or power density of ultrasound can be adjusted depending on the desired effect. A higher power density (measured in watt/cm2 is often used in cases where scar tissue breakdown is the goal.

Ultrasound can be used to achieve phonophoresis. This is not an invasive form of drug delivery to the tissues beneath the skin, perfect for patients who are uncomfortable with injections. With this technique, the ultrasonic energy forces the medication through the skin. Cortisone, used to reduce inflammation, is one of the most commonly used substances delivered in this way.

A typical ultrasound treatment will take 3-5 minutes. In cases where scar tissue breakdown is the goal, this time of treatment may be much longer. During the treatment the head of the ultrasound probe is kept in constant motion. If it is kept in constant motion, the patient should feel no pain at all. If the probe is carried out in one place for more than a few seconds, an accumulation of sound energy that can produce can become uncomfortable. Interestingly, if there is even a very small break in a bone in the area that is near the surface, a sharp pain can be felt. This occurs as the sound waves get trapped between the two sides of the break and build up to become painful. Thus, ultrasound can often be used as a fairly accurate tool for diagnosing minor fractures that may not be evident on the radiograph.

Some conditions treated with ultrasound include tendonitis (or tendinitis if you prefer), no sharp pain, muscle spasms, and even Peyronie’s Disease (to break up scar tissue). Contraindications of ultrasound include local malignancy, metal implants below the area treated, local acute infection, vascular abnormalities, and directly on the abdomen of pregnant women. It is also contraindicated to apply ultrasound directly over active epiphysis regions (growth plates) in children, along the spinal cord in the area of a laminectomy, or over the eyes, skull, or testes.

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