Note: This article was originally published at ProHealth on January 18, 2017. It can be accessed here: http://www.prohealth.com/library/showarticle.cfm?libid=29873.
Chronic pain, muscle stiffness, and impaired circulation are some of the most challenging symptoms to manage in people with chronic conditions that affect the musculoskeletal system. Ask any fibromyalgia or Lyme disease patient for a list of their symptoms, and you are likely to see at least several mentions of musculoskeletal issues such as muscle pain, stiffness, inflammation, and tenderness. While pharmaceutical interventions can provide much-needed relief for musculoskeletal issues, the relief is typically only palliative. Pharmaceutical interventions for pain also come with undesirable side effects and the potential to cause addiction. Body work modalities such as massage and acupuncture are great alternatives to pharmaceutical interventions, but these types of treatments often need to be done on a continuous basis in order to provide symptomatic relief and can therefore become quite expensive. Not long ago in my own battle with musculoskeletal issues resulting from Lyme disease and co-infections, I felt that I had reached a dead-end when it came to my search for effective treatments. I had been using intramuscular analgesics and receiving weekly massage treatment for months, yet I was still struggling to manage my pain. Just as I was about to throw in the towel, I came across an amazing treatment modality that changed the course of my battle with chronic muscle pain, stiffness, and inflammation. This particular modality is called “therapeutic ultrasound.” Therapeutic ultrasound has helped me greatly not only in managing, but reversing, my chronic muscle stiffness and pain associated with chronic illness. I think many other people struggling with chronic illness-induced musculoskeletal issues could also benefit from this simple, quick, and effective treatment modality.
What is Therapeutic Ultrasound?
Therapeutic ultrasound is a technique that has long been used by physical therapists for treating musculoskeletal disorders such as pain and stiffness, as well as for increasing blood flow and promoting tissue healing. It involves the use of an ultrasound probe that is placed in direct contact with the skin, along with transmission coupling gel. The transmission coupling gel is the medium by which the ultrasound waves are transmitted into the body from the ultrasound probe. The gel-covered probe is swept along the skin, over areas of the body that are painful, stiff, or in need of repair. The ultrasound waves emitted from the probe are generated by something called the “piezoelectric effect,” which occurs when the crystals vibrate within the head of the probe.1 The ultrasound waves that pass through the skin from the gel-covered probe cause a vibration of the local soft tissues. The vibration affects the soft tissues through several different mechanisms, which I will discuss next. Therapeutic ultrasound has traditionally been used to treat muscle pain, muscle spasm, joint stiffness, and tissue injury. Due to the mechanisms by which therapeutic ultrasound exerts its effects, it offers unique benefits for people with fibromyalgia, Lyme disease, and other chronic illnesses that affect muscle and connective tissue.
Mechanisms of Therapeutic Ultrasound
There are several mechanisms by which therapeutic ultrasound affects tissues. One mechanism is its ability to increase hemoglobin levels and thereby improve blood oxygenation. In a small clinical trial published in The Journal of the Japanese Physical Therapy Association, 11 healthy men were administered therapeutic ultrasound treatment at a frequency of 3 MHz, intensity of 1.0 W/cm2, and 100% duty cycle for just 10 minutes. After the 10-minute ultrasound treatment, oxygen and total hemoglobin levels were significantly higher in the treated men, than in the men who were allotted to placebo (“fake ultrasound” treatment) or control (no treatment) groups.2 Hemoglobin is the molecule that shuttles oxygen throughout the body, and oxygen is essential for fueling cells and their numerous biochemical l functions. Therefore, by increasing hemoglobin levels, therapeutic ultrasound increases oxygen transport throughout the body, improving oxygenation of cells and tissues. In addition to increasing hemoglobin and oxygen levels, therapeutic ultrasound also has thermal effects in that it increases tissue temperature. The vibration of the crystals in the ultrasound probe, when transmitted through the skin to the tissues, causes a vibration of the tissues that leads to a rise in temperature. The increase in tissue temperature causes vasodilation, a widening of blood vessels, which in turn increases blood circulation through tissues. Increased circulation helps to remove waste products from tissues, and replenishes the tissues with substances they need to function properly. Finally, therapeutic ultrasound also increases the extensibility of collagen fibers and reduces the viscosity of fluid in tissues. This can help reduce pain and stiffness, increase range of motion, and break up adhesions in tissues.
Therapeutic Ultrasound for Fibromyalgia, Lyme disease, and Chronic Illness
The mechanisms by which therapeutic ultrasound exerts its effects can be of great assistance to people struggling with fibromyalgia, Lyme disease, and chronic illness. Chronic illnesses such as these often lead to an accumulation of waste products in tissues, including bacterial metabolites and inflammatory molecules released by the immune system. Muscle pain, stiffness, and inflammation are some of the very common, yet intractable, symptoms that can be caused by the accumulation of these substances in the tissues. Therapeutic ultrasound can help remediate these symptoms by increasing blood flow through tissues, which helps to remove waste products. Increased blood flow also oxygenates the tissues; this mechanism of therapeutic ultrasound is of great benefit to fibromyalgia and chronic fatigue syndrome patients because poor tissue oxygenation has been found to be a key component in the pathogenesis of these conditions. By increasing oxygenation, mitochondria are able to function more effectively, which may improve symptoms of pain and fatigue in Fibromyalgia and CFS patients.3
Increased blood flow induced by therapeutic ultrasound treatment enables cells of the immune system to access tissues that were previously “closed off” due to poor blood flow. This gives the immune system the opportunity to target pathogens that may have been hiding in the previously closed-off areas.
Therapeutic ultrasound also provides pain relief, and has been found to significantly reduce musculoskeletal pain levels in patients with fibromyalgia. A study examining the effect of therapeutic ultrasound on subjective symptoms in 17 fibromyalgia patients found that 12 sessions of ultrasound therapy, combined with another treatment called interferential current, significantly reduced subjective scores of pain as well as objective parameters including “tender point count” and “tenderness threshold,” both of which measure sensitivity to musculoskeletal pain.4
Interestingly, ultrasound therapy has also been examined for its effectiveness in breaking up biofilms. Biofilms are a colonies of microorganisms that bond together and adhere to surfaces within the body; biofilms function intelligently, promoting survival of the pathogenic microorganisms within the colony while negatively affect the health of the host. Biofilms play a major role in Lyme disease and other chronic illnesses with an infectious component, because the biofilm enables pathogens such as Borrelia (the pathogen that causes Lyme disease) to survive even in the presence of antibiotics. Therapeutic ultrasound may be of huge benefit in the case of Lyme disease and chronic infectious diseases because the vibrations it produces have been shown to stress the bacteria in the biofilm, disrupting the integrity of the biofilm. In addition, when ultrasound therapy is combined with simultaneous light therapy, the light has demonstrated the ability to cause the release of Reactive Oxygen Species (ROS) by cells. ROS target pathogens for destruction, helping to fight infections.5
Parameters for Therapeutic Ultrasound
There are several parameters that are used in the application of therapeutic ultrasound. These parameters include frequency, intensity, treatment mode (aka “duty cycle”), length of treatment, and location of treatment. The frequency refers to the number of vibrations per second emitted by the ultrasound machine via the probe. A frequency of 1 MHz means that 1 million vibrations per second are being produced. Frequencies of therapeutic ultrasound range from 1 to 3 MHz, with 1 MHz used for superficial tissues and 3 MHz used for deeper tissues.6 The intensity of the ultrasound treatment refers to the total amount of vibrational energy being applied per unit area; this is typically expressed as Watts per square centimeter. The surface area of a therapeutic ultrasound probe is typically 1, 5, or 10 centimeters squared. The treatment mode, also known as the “duty cycle,” refers to whether the ultrasound vibrations are applied continuously or pulsed on and off over the course of the treatment. Finally, the treatment time is simply the amount of time the ultrasound is applied, and the treatment area refers to the part of the body over which the ultrasound is applied.
Safety of Therapeutic Ultrasound
Therapeutic ultrasound is considered to be very safe. It is important to keep in mind that ultrasound probes do heat up over the course of treatment, but when properly applied, the risk of burns from therapeutic ultrasound is very low. Therapeutic ultrasound is contraindicated where there is a local malignancy, a metal implant (such as metal screws in bone), directly on the abdomen of pregnant women, and over the eyes, skull, or testes. No cumulative dose has been defined for ultrasound therapy, so there are no specific guidelines as to how often one should receive ultrasound therapy. It is best to consult with your doctor to determine the appropriate treatment dose for your needs.
How You Can Try Therapeutic Ultrasound
If you are interested in therapeutic ultrasound, you can try contacting a local physical therapist or physiotherapist to see if they offer this treatment modality. Chiropractors and MDs who specialize in Physical Medicine may also offer this particular treatment in-office. The cost of a therapeutic ultrasound treatment session is typically quite low, because a treatment session typically only lasts around 10 minutes. If you have success after trying therapeutic ultrasound in a physical therapy clinic or doctor’s office, you might want to consider purchasing a therapeutic ultrasound machine for personal use at home. This will be an investment, but in my experience, it was well worth it. I have a small therapeutic ultrasound machine at home that was designed for personal use, and it has been a game-changer for me in terms of reducing my pain levels, breaking up muscle adhesions, and for promoting circulation and tissue healing. I can’t recommend this treatment modality highly enough. If you have been struggling with musculoskeletal issues related to fibromyalgia, Lyme disease, or another chronic illness, give therapeutic ultrasound a try. It just may change your life!
- Miller, J. (2014). What is therapeutic ultrasound? Physio Works. Retrieved from http://physioworks.com.au/FAQRetrieve.aspx?ID=31501.
- Morishita, K., Karasuno, H., Yokoi, Y., Morozumi, K., Ogihara, H., Ito, T., Fujiwara, T., Fujimoto, T., Abe, K. (2014). Effects of therapeutic ultrasound on intramuscular blood circulation and oxygen dynamics. Journal of the Japanese Physical Therapy Association. 17(1): 1-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316550/#!po=42.9825.
- Johnson, C. (2013). Are Oxygen Starved Tissues Causing Pain and Fatigue in Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)? Health Rising [online]. Retrieved from http://www.healthrising.org/blog/2013/04/17/are-oxygen-starved-tissues-causing-pain-and-fatigue-in-fibromyalgia-and-chronic-fatigue-syndrome-mecfs/.
- Almeida, T.F., Roizenblatt, S., Benedito-Silva, A.A., Tufik, S. (2003). The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia. Pain. 104(3): 665-672. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12927639.
- Schafer, M.E. and McNeely, T.B. (2015). Coincident light/ultrasound therapy to treat bacterial biofilms. PhotoSonix Medical [online]. Retrieved from http://ieeexplore.ieee.org/document/7329512/?reload=true.
- Knight, L.K., Draper, O.D. (2013). Therapeutic Modalities. The Art and Science. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins.