Clinically, the decision to use either thermal or non-thermal Ultrasound (US) depends on the treatment goal. In thermal mode, US will be most effective in heating the dense collagenous tissues and will require a relatively high intensity, preferably in continuous mode to achieve this effect. Among the more effectively heated tissues are periosteum, collagenous tissues (ligament, tendon & fascia) & fibrotic muscle. If the temperature of the damaged tissues is raised to about 40‑45°C, then a therapeutic hyperaemia will result. Other therapeutic effects of thermal US include tissue extensibility and the resolution of chronic inflammatory states.
Application of non-thermal US (a combination of cavitation, acoustic streaming and micromassage) to injured tissues will, amongst other things, speed the rate of healing & enhance the quality of the repair. In practice, it is not always the case that a particular treatment application will produce either thermal or non thermal effects. It is almost inevitable that both will occur. However, the dominant effect will be influenced by treatment parameters, especially the mode of application i.e. pulsed or continuous.
Where patient comfort is a consideration, then other forms of thermal therapy may be considered.
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