Shouldn’t Ultrasound Deep Heat therapy feel HOT?
I’m going to a physical therapist for help with plantar fasciitis in both feet. She’s started me with Ultrasound deep heat therapy. I had it twice last week and it was nice, felt pretty hot, but not uncomfortable. This week I had a new therapist with a new machine (the old one apparently broke) and this one didn’t feel warm at all. I inquired about this and she said it was sound waves converted to heat and it’s fine that it doesn’t feel hot. I feel like THAT damn machine was broken and I’m paying for nothing, like she was just rubbing the applicator on my foot with no sound waves. Please advise. Shouldn’t I feel SOME heat?!?!
First, it depends on the desired therapeutic effect. If the desire is to increase permeability of the vascular tissue to promote reduction of edema, this is done at a sub thermal range. In these cases, you definitely should NOT feel the heat.
In most cases of PF, however, the desire is to make the tissue more extensible, so a thermal effect is desired (which increases circulation to the area). Whether you get a thermal effect or not is dependent on several factors…first, depth of the tissue being treated. If you are treating a deep tissue, a lower frequency (usually 1 Mhtz) is desired. If treating a superficial tissue, a higher frequency is desired (3 Mhtz) because higher frequencies have less penetrating power. Ironically, however, the deeper you go into a tissue, the less heat sensing nerve fibers you have. Therefore, it’s entirely possible to get the thermal effects, but you cannot feel it because it doesn’t become thermal until you are too deep to feel it.
The next factor is the intensity. Thermal intensities usually require at least a setting of 1 W/cm2. Settings less than that decrease the thermal effect.
Another factor is frequency. When doing thermal US, it’s usually desired to have it at 100%, whereas, non-thermal settings are done at 20 or 50%.
So, all of these factors increase whether you actually get a thermal effect. What’s ironic here is that you can actually do a DEEP ultrasound that will actually have more thermal effects than a superficial one, however, you are more likely to feel the superficial one as opposed to the deep one due to the location of your sensory nerves. In fact, I usually tell patients that they should feel a little heat or NOTHING at all…and if they do feel anything more than a little warmth, they NEED to tell me so I can turn it down. Perhaps the first therapist was doing a more superficial setting?
The other consideration is that we often use special settings to make it more comfortable for the patient…warmed ultrasound gel and/or a “preheated” sound head can all make the application feel a little warm, whether or not an actual thermal effect is taking place.
If you are REALLY concerned, I would ask what specific settings are being used. However, generally speaking, a DEEP thermal ultrasound should actually feel like no heat at all.
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