SPECIALTY TOPICS · GUIDE
Therapeutic Ultrasound
Therapeutic ultrasound in physical therapy is not the ultrasound used for imaging; here is how it is regulated and what reviews show for knee, wrist, fracture and back pain.
Content last updated . This page has not been medically reviewed.
Back to Emerging Wellness ScienceTwo very different uses of sound
Ultrasound used for imaging is a test: an echocardiogram, for example, uses sound waves to create pictures of the heart. [1] Therapeutic ultrasound is a treatment, usually applied with a handheld head moved over the skin in physical therapy, and aimed at pain, tissue healing or stiffness. Focused ultrasound for brain conditions is a separate, specialist technology covered in Focused Ultrasound: Clinical and Investigational Contexts. This page is about physical-therapy ultrasound. We give no machine settings or treatment times.Labels used: established, promising but limited, mixed, no good evidence of benefit. See How We Label Evidence.
What research shows
| Use | What we read | Label |
|---|---|---|
| Knee osteoarthritis | A 2024 meta-analysis of 21 trials (1,315 people) reported better pain and function scores with ultrasound. [5][6] Results varied widely between trials, and the authors said ultrasound "may" be effective. | Promising but limited |
| Carpal tunnel syndrome (wrist nerve) | A Cochrane review of 11 studies (414 people) found one low-quality placebo-controlled trial with short-term benefit, with caution about its design. [7][8] | Insufficient evidence |
| Fresh fractures (low-intensity pulsed ultrasound) | A Cochrane review of 21 studies concluded it probably makes little or no difference to delayed union or non-union. [9][10] | No good evidence of benefit |
| Low back pain | England's NICE guideline says do not offer ultrasound for low back pain with or without sciatica. [11] | Not recommended by NICE |
Frequently asked questions
Is therapeutic ultrasound the same as an ultrasound scan?
No. A scan uses sound waves to create pictures. [1] Therapeutic ultrasound is applied as a treatment.
Does therapeutic ultrasound help knee arthritis?
A 2024 meta-analysis of 21 trials reported better pain scores, but trials differed widely. [6]
Is ultrasound recommended for low back pain?
NICE in England says not to offer it for low back pain. [11]
Does ultrasound speed up healing of broken bones?
A Cochrane review found low-intensity pulsed ultrasound probably makes little or no difference to delayed union or non-union. [10]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
How it is regulated in the United States
Federal regulations describe an ultrasonic diathermy device for therapeutic deep heat as one that applies ultrasonic energy meant to generate deep heat within body tissues for selected conditions such as relief of pain, muscle spasms and joint contractures, and place it in Class II. [2][3] The same regulation puts ultrasonic diathermy for all other uses in a different category (Class III, premarket approval). [4] Read 2026-10-22 from the eCFR. That means a heat-producing physical therapy unit and a device claiming another effect are not treated alike. Laws and rules change; this is not legal advice.
Safety
In the carpal tunnel Cochrane review, no studies reported adverse effects, but this was measured in only three studies, so firm safety conclusions were not possible. [12] The knee meta-analysis likewise relied on trials of varied design. [5] A therapist or doctor should decide whether it suits you. See Talking With a Health Professional.
How to read this
A statistically significant average across many small, varied trials is weaker than consistent results in well-controlled ones. Compare the claim with the exact condition studied. For tools sold for home use, see How to Evaluate a Health Device and Other Physical Modalities. For shockwave, a different technology: Shockwave Therapy.
References
- MedlinePlus Medical Encyclopedia: Echocardiogram - children. Read 2026-10-22.
- Electronic Code of Federal Regulations: 21 CFR 890.5300 Ultrasonic diathermy (deep heat). Read 2026-10-22.
- Electronic Code of Federal Regulations: 21 CFR 890.5300 Ultrasonic diathermy (Class II). Read 2026-10-22.
- Electronic Code of Federal Regulations: 21 CFR 890.5300 Ultrasonic diathermy. Read 2026-10-22.
- Luo Y, et al. Effects of therapeutic ultrasound in patients with knee osteoarthritis: a systematic review and meta-analysis. Heliyon 2024. Read 2026-10-22.
- Luo Y, et al. Effects of therapeutic ultrasound in patients with knee osteoarthritis: a systematic review and meta-analysis. Heliyon 2024 (result). Read 2026-10-22.
- Page MJ, et al. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev 2013. Read 2026-10-22.
- Page MJ, et al. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev 2013 (placebo). Read 2026-10-22.
- Searle HKC, et al. Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database Syst Rev 2023 (size). Read 2026-10-22.
- Searle HKC, et al. Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database Syst Rev 2023. Read 2026-10-22.
- NICE: Low back pain and sciatica in over 16s (NG59), Recommendations. Read 2026-10-22.
- Page MJ, et al. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev 2013 (adverse effects). Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.