Ultrasound Application Techniques

If you have a problem that requires physical therapy, your physical therapist may choose to use various treatments and therapeutic modalities to help decrease pain, improve mobility, and improve function. Ultrasound is one treatment that is used to help provide deep heating to soft tissue structures in the body. If you have tendonitis,bursitis, or tight muscles or joints, ultrasound may be used to help improve the mobility and healing in these body parts.

There are many different methods that your physical therapist can use to help apply ultrasound to your body. Your physical therapist can decide on the best method depending on your specific condition and situation.

Woman getting ultrasound in physical therapy.
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Direct Contact Ultrasound

Direct contact is the most common method that your physical therapist applies ultrasound. In this method, your physical therapist puts a small amount of gel or cream on your body part that is being treated. Then an ultrasound sound head (also known as a transducer) is pressed gently into the gel and against your body. The sound head is moved in a small circular direction over your body. Sometimes, a small amount of anti-inflammatory medication may be used in the ultrasound gel, and is called phonophoresis.

The typical treatment time for ultrasound is five to eight minutes.

Normally when you receive ultrasound, you will not feel anything happening. Occasionally you may feel some gentle warming or tingling under the sound head. If you feel any pain or sharp, burning sensations, let your physical therapist know immediately.

Water Immersion Ultrasound

What if you have arthritis in your hand knuckles and your physical therapist wants to use ultrasound to treat the area that is painful? Your hand and fingers are much too uneven and bumpy to use direct contact ultrasound there. The water immersion technique is used when bony bumps and other irregular surfaces are being treated with ultrasound.

With this technique, your body part to be treated is immersed in a bucket or tray filled with water. The ultrasound sound head is then moved over your body part. It does not contact your body in this technique; rather it is held about 1 cm above your body part. Body parts that are most often treated with water immersion ultrasound are the hands and feet. While you are being treated, you may feel slight warming. Again, be sure to inform your physical therapist if you feel any pain during water immersion ultrasound.

Bladder Technique to Administer Ultrasound

If your physical therapist chooses to treat your injury with ultrasound and you have an open sore or wound, there may be a risk of infection if the ultrasound gel or cream gets into your wound. When this is the case, the bladder technique is used.

The bladder technique of ultrasound application involves using a small balloon (a rubber glove works too) filled with water or gel. The balloon is pressed against your body, and the ultrasound sound head is pressed against the balloon to provide treatment. The ultrasound waves pass through the balloon and into your body part being treated.

This technique may also be used if the water immersion technique cannot be used and you are receiving ultrasound over an irregular or bony surface in your body.

It is very important to remember that scientific studies about ultrasound indicate that while it provides deep heat, it may not produce better results with your condition. Therefore it is important that you discuss the use of ultrasound with your physical therapist. After the application of ultrasound, you should be engaged in passive or active exercise to help improve your condition. Most often ultrasound will not be detrimental to you, and it is a safe method to provide deep heating to injured or tight body parts. While ultrasound may relieve pain because it allows heat to reach deep into your tissues, research is still inconclusive about its overall effectiveness, and therefore it should not be the only treatment you receive.

A Word From Verywell

Therapeutic ultrasound is a treatment that your physical therapist may choose to use to help decrease your pain and improve range of motion in injured body parts. By understanding the different methods that ultrasound can be delivered, you can be better informed about your care and can be sure that your physical therapy experience is a positive one.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Best TM, Wilk KE, Moorman CT, Draper DO. Low intensity ultrasound for promoting soft tissue healing: a systematic review of the literature and medical technology. Intern Med Rev (Wash D C). 2016;2(11):271. doi: 10.18103/imr.v2i11.271

  2. Kim A, Kaminski TW. Assessing the effectiveness of phonophoresis on chronic injuries: an evidence-based approach: a systematic review. Athletic Training & Sports Health Care. 2013;5(2):81-88. doi: 10.3928/19425864-20120914-01

  3. Király M, Varga Z, Szanyó F, Kiss R, Hodosi K, Bender T. Effects of underwater ultrasound therapy on pain, inflammation, hand function and quality of life in patients with rheumatoid arthritis - a randomized controlled trial. Braz J Phys Ther. 2017;21(3):199-205. doi: 10.1016/j.bjpt.2017.04.002

Additional Reading
  • Ter Haar, G. (2007). Therapeutic applications of ultrasound. Progress in biophysics and molecular biology93(1-3), 111-129.

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.