<s>
Therapeutic	B-Algorithm
ultrasound	I-Algorithm
refers	O
generally	O
to	O
any	O
type	O
of	O
ultrasonic	O
procedure	O
that	O
uses	O
ultrasound	B-Application
for	O
therapeutic	O
benefit	O
.	O
</s>
<s>
Physiotherapeutic	O
ultrasound	B-Application
was	O
introduced	O
into	O
clinical	O
practice	O
in	O
the	O
1950s	O
,	O
with	O
lithotripsy	O
introduced	O
in	O
the	O
1980s	O
.	O
</s>
<s>
Others	O
are	O
at	O
various	O
stages	O
in	O
transitioning	O
from	O
research	O
to	O
clinical	O
use	O
:	O
HIFU	B-Architecture
,	O
targeted	O
ultrasound	B-Application
drug	O
delivery	O
,	O
trans-dermal	O
ultrasound	B-Application
drug	O
delivery	O
,	O
ultrasound	B-Application
hemostasis	O
,	O
cancer	O
therapy	O
,	O
and	O
ultrasound	B-Application
assisted	O
thrombolysis	O
It	O
may	O
use	O
focused	B-Architecture
ultrasound	I-Architecture
(	O
FUS	O
)	O
or	O
unfocused	O
ultrasound	B-Application
.	O
</s>
<s>
In	O
the	O
above	O
applications	O
,	O
the	O
ultrasound	B-Application
passes	O
through	O
human	O
tissue	O
where	O
it	O
is	O
the	O
main	O
source	O
of	O
the	O
observed	O
biological	O
effect	O
(	O
the	O
oscillation	O
of	O
abrasive	O
dental	O
tools	O
at	O
ultrasonic	O
frequencies	O
therefore	O
do	O
not	O
belong	O
to	O
this	O
class	O
)	O
.	O
</s>
<s>
The	O
ultrasound	B-Application
within	O
tissue	O
consists	O
of	O
very	O
high	O
frequency	O
sound	O
waves	O
,	O
between	O
800,000	O
Hz	O
and	O
20,000,000	O
Hz	O
,	O
which	O
cannot	O
be	O
heard	O
by	O
humans	O
.	O
</s>
<s>
There	O
is	O
some	O
evidence	O
that	O
ultrasound	B-Application
is	O
more	O
effective	O
than	O
placebo	O
treatment	O
for	O
treating	O
patients	O
with	O
arthritis	O
pain	O
,	O
a	O
range	O
of	O
musculoskeletal	O
injuries	O
and	O
for	O
promoting	O
tissue	O
healing	O
.	O
</s>
<s>
Relatively	O
high	O
power	O
ultrasound	B-Application
can	O
break	O
up	O
stony	O
deposits	O
or	O
tissue	O
,	O
accelerate	O
the	O
effect	O
of	O
drugs	O
in	O
a	O
targeted	O
area	O
,	O
assist	O
in	O
the	O
measurement	O
of	O
the	O
elastic	O
properties	O
of	O
tissue	O
,	O
and	O
can	O
be	O
used	O
to	O
sort	O
cells	O
or	O
small	O
particles	O
for	O
research	O
.	O
</s>
<s>
Focused	O
high-energy	O
ultrasound	B-Application
pulses	O
can	O
be	O
used	O
to	O
break	O
calculi	O
such	O
as	O
kidney	O
stones	O
and	O
gallstones	O
into	O
fragments	O
small	O
enough	O
to	O
be	O
passed	O
from	O
the	O
body	O
without	O
undue	O
difficulty	O
,	O
a	O
process	O
known	O
as	O
lithotripsy	O
.	O
</s>
<s>
Focused	B-Architecture
ultrasound	I-Architecture
sources	O
may	O
be	O
used	O
for	O
cataract	O
treatment	O
by	O
phacoemulsification	O
.	O
</s>
<s>
Ultrasound	B-Application
can	O
ablate	B-Algorithm
tumors	O
or	O
other	O
tissue	O
non-invasively	O
.	O
</s>
<s>
This	O
is	O
accomplished	O
using	O
a	O
technique	O
known	O
as	O
High	B-Architecture
Intensity	I-Architecture
Focused	I-Architecture
Ultrasound	I-Architecture
(	O
HIFU	B-Architecture
)	O
,	O
also	O
called	O
focused	B-Architecture
ultrasound	I-Architecture
surgery	O
(	O
FUS	O
surgery	O
)	O
.	O
</s>
<s>
This	O
procedure	O
uses	O
generally	O
lower	O
frequencies	O
than	O
medical	O
diagnostic	O
ultrasound	B-Application
(	O
250	O
–	O
2000kHz	O
)	O
,	O
but	O
significantly	O
higher	O
time-averaged	O
intensities	O
.	O
</s>
<s>
The	O
treatment	O
is	O
often	O
guided	O
by	O
Magnetic	O
Resonance	O
Imaging	O
(	O
MRI	O
)	O
;	O
the	O
combination	O
is	O
then	O
referred	O
to	O
as	O
Magnetic	O
resonance-guided	O
focused	B-Architecture
ultrasound	I-Architecture
(	O
MRgFUS	B-Architecture
)	O
.	O
</s>
<s>
These	O
procedures	O
generally	O
use	O
high	O
frequency	O
ultrasound	B-Application
(	O
1	O
–	O
10MHz	O
)	O
and	O
a	O
range	O
of	O
intensities	O
(	O
0	O
–	O
20	O
W/cm2	O
)	O
.	O
</s>
<s>
Ultrasound	B-Application
has	O
been	O
used	O
to	O
trigger	O
the	O
release	O
of	O
anti-cancer	O
drugs	O
from	O
delivery	O
vectors	O
including	O
liposomes	O
,	O
polymeric	O
microspheres	O
and	O
self-assembled	O
polymeric	O
.	O
</s>
<s>
Ultrasound	B-Application
is	O
essential	O
to	O
the	O
procedures	O
of	O
ultrasound-guided	O
sclerotherapy	O
and	O
endovenous	O
laser	O
treatment	O
for	O
the	O
non-surgical	O
treatment	O
of	O
varicose	O
veins	O
.	O
</s>
<s>
Ultrasound-assisted	O
lipectomy	O
is	O
Liposuction	O
assisted	O
by	O
ultrasound	B-Application
.	O
</s>
<s>
Phonophoresis	O
is	O
a	O
form	O
of	O
soft	O
tissue	O
treatment	O
that	O
involves	O
the	O
use	O
of	O
ultrasound	B-Application
combined	O
with	O
medication	O
gels	O
and	O
will	O
utilize	O
ultrasound	B-Application
waves	O
to	O
enhance	O
drug	O
delivery	O
to	O
the	O
injured	O
area	O
.	O
</s>
<s>
There	O
are	O
three	O
potential	O
effects	O
of	O
ultrasound	B-Application
.	O
</s>
<s>
These	O
three	O
benefits	O
are	O
achieved	O
by	O
two	O
main	O
effects	O
of	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
.	O
</s>
<s>
The	O
first	O
large	O
scale	O
application	O
of	O
ultrasound	B-Application
was	O
around	O
World	O
War	O
II	O
.	O
</s>
<s>
It	O
was	O
realized	O
that	O
the	O
high	O
intensity	O
ultrasound	B-Application
waves	O
that	O
they	O
were	O
using	O
were	O
heating	O
and	O
killing	O
fish	O
.	O
</s>
<s>
Since	O
the	O
1940s	O
,	O
ultrasound	B-Application
has	O
been	O
used	O
by	O
physical	O
and	O
occupational	O
therapists	O
for	O
therapeutic	O
effects	O
.	O
</s>
<s>
Ultrasound	B-Application
is	O
applied	O
using	O
a	O
transducer	O
or	O
applicator	O
that	O
is	O
in	O
direct	O
contact	O
with	O
the	O
patient	O
's	O
skin	O
.	O
</s>
<s>
Therapeutic	B-Algorithm
ultrasound	I-Algorithm
in	O
physical	O
therapy	O
is	O
alternating	O
compression	O
and	O
rarefaction	O
of	O
sound	O
waves	O
with	O
a	O
frequency	O
of	O
0.7	O
to	O
3.3	O
MHz	O
.	O
</s>
<s>
Conditions	O
for	O
which	O
ultrasound	B-Application
may	O
be	O
used	O
for	O
treatment	O
include	O
the	O
following	O
examples	O
:	O
ligament	O
sprains	O
,	O
muscle	O
strains	O
,	O
tendonitis	O
,	O
joint	O
inflammation	O
,	O
plantar	O
fasciitis	O
,	O
metatarsalgia	O
,	O
facet	O
irritation	O
,	O
impingement	O
syndrome	O
,	O
bursitis	O
,	O
rheumatoid	O
arthritis	O
,	O
osteoarthritis	O
,	O
and	O
scar	O
tissue	O
adhesion	O
.	O
</s>
<s>
There	O
is	O
no	O
evidence	O
to	O
support	O
the	O
use	O
of	O
ultrasound	B-Application
for	O
the	O
treatment	O
of	O
low	O
back	O
pain	O
,	O
and	O
current	O
clinical	O
guidelines	O
recommend	O
that	O
ultrasound	B-Application
is	O
not	O
used	O
for	O
this	O
condition	O
.	O
</s>
<s>
Ultrasound	B-Application
used	O
for	O
calcific	O
tendonitis	O
had	O
a	O
positive	O
short	O
term	O
effect	O
.	O
</s>
<s>
For	O
the	O
long	O
term	O
,	O
there	O
was	O
no	O
significant	O
difference	O
with	O
ultrasound	B-Application
use	O
.	O
</s>
<s>
This	O
shows	O
that	O
for	O
pain	O
relief	O
and	O
short-term	O
treatment	O
ultrasound	B-Application
can	O
be	O
an	O
effective	O
treatment	O
for	O
Calcific	O
Tendonitis	O
A	O
review	O
with	O
five	O
small	O
placebo‐controlled	O
trials	O
from	O
2011	O
,	O
did	O
not	O
support	O
the	O
use	O
of	O
ultrasound	B-Application
in	O
the	O
treatment	O
of	O
acute	O
ankle	O
sprains	O
and	O
the	O
potential	O
treatment	O
effects	O
of	O
ultrasound	B-Application
appear	O
to	O
be	O
generally	O
small	O
and	O
of	O
probably	O
of	O
limited	O
clinical	O
importance	O
,	O
especially	O
in	O
the	O
context	O
of	O
the	O
usually	O
short‐term	O
recovery	O
period	O
for	O
these	O
injuries	O
.	O
</s>
<s>
However	O
,	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
is	O
reported	O
to	O
have	O
beneficial	O
effects	O
in	O
sports	O
injuries	O
pain	O
relief	O
,	O
edema	O
control	O
,	O
and	O
range	O
of	O
joint	O
motion	O
,	O
possibly	O
by	O
increasing	O
pain	O
thresholds	O
,	O
collagen	O
extensibility	O
,	O
reducing	O
edema	O
,	O
and	O
therefore	O
inflammation	O
,	O
muscle	O
spasms	O
,	O
and	O
joint	O
stiffness	O
.	O
</s>
<s>
A	O
meta-analysis	O
found	O
that	O
ultrasound	B-Algorithm
therapy	I-Algorithm
is	O
effective	O
in	O
reducing	O
pain	O
,	O
increasing	O
ROM	O
,	O
and	O
reducing	O
WOMAC	O
functional	O
scores	O
in	O
patients	O
with	O
knee	O
osteoarthritis	O
.	O
</s>
<s>
According	O
to	O
recent	O
research	O
,	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
has	O
not	O
shown	O
any	O
significant	O
improvement	O
for	O
chronic	O
low	O
back	O
pain	O
,	O
chronic	O
neck	O
pain	O
,	O
and	O
hip	O
pain	O
in	O
combination	O
with	O
other	O
physiotherapeutic	O
techniques	O
.	O
</s>
<s>
However	O
,	O
the	O
most	O
conclusive	O
evidence	O
to	O
support	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
use	O
is	O
seen	O
with	O
its	O
use	O
in	O
patients	O
with	O
knee	O
osteoarthritis	O
.	O
</s>
<s>
In	O
a	O
systematic	O
review	O
of	O
15	O
studies	O
,	O
patients	O
who	O
received	O
ultrasound	B-Algorithm
treatments	I-Algorithm
were	O
compared	O
to	O
those	O
who	O
received	O
a	O
placebo	O
treatment	O
.	O
</s>
<s>
The	O
evidence	O
demonstrated	O
that	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
significantly	O
relieved	O
pain	O
,	O
increases	O
range	O
of	O
motion	O
,	O
and	O
reduced	O
WOMAC	O
functional	O
scores	O
in	O
patients	O
with	O
knee	O
osteoarthritis	O
when	O
compared	O
to	O
the	O
placebo	O
group	O
.	O
</s>
<s>
In	O
a	O
separate	O
meta-analysis	O
,	O
it	O
reinforced	O
the	O
use	O
of	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
by	O
deeming	O
it	O
as	O
a	O
safe	O
non-pharmalogical	O
treatment	O
option	O
that	O
may	O
provide	O
additional	O
pain	O
relief	O
as	O
well	O
as	O
functional	O
improvement	O
when	O
used	O
secondarily	O
to	O
therapy	O
in	O
patients	O
with	O
knee	O
osteoarthritis	O
.	O
</s>
<s>
Acoustic	O
tweezers	O
is	O
an	O
emerging	O
tool	O
for	O
contactless	O
separation	O
,	O
concentration	O
and	O
manipulation	O
of	O
microparticles	O
and	O
biological	O
cells	O
,	O
using	O
ultrasound	B-Application
in	O
the	O
low	O
MHz	O
range	O
to	O
form	O
standing	O
waves	O
.	O
</s>
<s>
Application	O
of	O
focused	B-Architecture
ultrasound	I-Architecture
in	O
conjunction	O
with	O
microbubbles	O
has	O
been	O
shown	O
to	O
enable	O
non-invasive	O
delivery	O
of	O
epirubicin	O
across	O
the	O
blood	O
–	O
brain	O
barrier	O
in	O
mouse	O
models	O
and	O
non	O
invasive	O
delivery	O
of	O
GABA	O
in	O
non	O
human	O
primates	O
.	O
</s>
<s>
Using	O
ultrasound	B-Application
to	O
generate	O
cellular	O
effects	O
in	O
soft	O
tissue	O
has	O
fallen	O
out	O
of	O
favor	O
as	O
research	O
has	O
shown	O
a	O
lack	O
of	O
efficacy	O
and	O
a	O
lack	O
of	O
scientific	O
basis	O
for	O
proposed	O
biophysical	O
effects	O
.	O
</s>
<s>
According	O
to	O
a	O
2017	O
meta-analysis	O
and	O
associated	O
practice	O
guideline	O
,	O
Low	B-Algorithm
intensity	I-Algorithm
pulsed	I-Algorithm
ultrasound	I-Algorithm
should	O
no	O
longer	O
been	O
used	O
for	O
bone	O
regeneration	O
because	O
high	O
quality	O
clinical	O
studies	O
failed	O
to	O
demonstrate	O
a	O
clinical	O
benefit	O
.	O
</s>
<s>
An	O
additional	O
effect	O
of	O
low-intensity	O
ultrasound	B-Application
could	O
be	O
its	O
potential	O
to	O
disrupt	O
the	O
blood	O
–	O
brain	O
barrier	O
for	O
drug	O
delivery	O
.	O
</s>
<s>
Transcranial	O
ultrasound	B-Application
is	O
being	O
tested	O
for	O
use	O
in	O
aiding	O
tissue	O
plasminogen	O
activator	O
treatment	O
in	O
stroke	O
patients	O
in	O
the	O
procedure	O
called	O
ultrasound-enhanced	O
systemic	O
thrombolysis	O
.	O
</s>
<s>
Ultrasound	B-Application
has	O
been	O
shown	O
to	O
act	O
synergistically	O
with	O
antibiotics	O
in	O
killing	O
bacteria	O
.	O
</s>
<s>
Ultrasound	B-Application
has	O
been	O
postulated	O
to	O
allow	O
thicker	O
eukaryotic	O
cell	O
tissue	O
cultures	O
by	O
promoting	O
nutrient	O
penetration	O
.	O
</s>
<s>
Long-duration	O
therapeutic	B-Algorithm
ultrasound	I-Algorithm
called	O
sustained	B-Algorithm
acoustic	I-Algorithm
medicine	I-Algorithm
is	O
a	O
daily	O
slow-release	O
therapy	O
that	O
can	O
be	O
applied	O
to	O
increase	O
local	O
circulation	O
and	O
theoretically	O
accelerates	O
healing	O
of	O
musculoskeletal	O
tissues	O
after	O
an	O
injury	O
.	O
</s>
