A new direction for ultrasound therapy in sports medicine.

Ultrasound therapy is a widely available and frequently used electrophysical agent in sports medicine. However, systematic reviews and meta-analyses have repeatedly concluded that there is insufficient evidence to support a beneficial effect of ultrasound at dosages currently being introduced clinically. Consequently, the role of ultrasound in sports medicine is in question. This does not mean that ultrasound should be discarded as a therapeutic modality. However, it does mean that we may need to look in a new direction to explore potential benefits. A new direction for ultrasound therapy has been revealed by recent research demonstrating a beneficial effect of ultrasound on injured bone. During fresh fracture repair, ultrasound reduced healing times by between 30 and 38%. When applied to non-united fractures, it stimulated union in 86% of cases. These benefits were generated using low-intensity (<0.1 W/cm(2)) pulsed ultrasound (LIPUS), a dose alternative to that traditionally used in sports medicine. Although currently developed for the intervention of bone injuries, LIPUS has the potential to be used on tissues and conditions more commonly encountered in sports medicine. These include injuries to ligament, tendon, muscle and cartilage. This review discusses the effect of LIPUS on bone fractures, the dosages introduced and the postulated mechanisms of action. It concludes by discussing the relevance of these latest findings to sports medicine and how this evidence of a beneficial clinical effect may be implemented to intervene in sporting injuries to bone and other tissues. The aim of the paper is to highlight this latest direction in ultrasound therapy and stimulate new lines of research into the efficacy of ultrasound in sports medicine. In time this may lead to accelerated recovery from injury and subsequent earlier return to activity.