Ultrasound therapy (UST) is one of the most widely used modalities in physical therapy interventions for the treatment of mostly musculoskeletal disorders such as pain, muscle spasm, contractures and tissue injury etc. UST produces both thermal and non-thermal effects (Mechanical effects). Mechanical effects are related to tissue healing while thermal effects modulate pain, increase tissue temperature, increase local blood flow and enhance tissue extensibility.
Clinically, the sequence adopted i.e. UST before stretching or stretching before UST, is largely influenced by several factors such as the physical therapist’s (PT) judgment or call, the physiological effects desired and sometimes the subject’s or patient’s preference etc. some of these determining factors unsurprisingly change on a case-by-case basis.
You can therefore find academic literature to support, for instance UST before stretching here and here, and stretching before UST here. In other words, there is no rigid protocol to be followed and the sequence selected is largely determined by a multitude of clinical factors. For example, a burns patient presents with painful contractures making passive stretching a challenge. The PT may elect to use UST first to reduce pain and stimulate tissue elasticity before stretching. On the other hand, a PT may use UST after stretching on a normal subject to enhance the range of motion achieved by stretching alone or to manage the pain elicited from the passive stretching itself.
The clinical scenarios above are by no means exhaustive and on an individual case basis, you may be required as a PT to make the best decision on the sequence which best fits the clinical scenario presented.
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