BTL – 07p
operating manual & user's guide
page 14
Specific contraindications of ultrasonic therapy
A) Absolute
Epiphysis of growing bones
Ultrasound patients risk irreversible growth zone damage, deformity and/or permanent disablement. Since older
types of ultrasound instruments operate at low intensities (displayed data does not correspond with the actual
amount of the energy applied), their use does not lead, in most cases, to growth zone damage. For this reason,
many physicians disagree with this contraindication. Modern stronger and more effective instruments can, in
contrast with the older ones, cause actual growth zone damage, especially when the emitter is not moved
sufficiently. Prevention of this contraindication is the absolute responsibility of the prescribing physician and the
ultrasound therapist.
Gonads
Small doses result in transient and high doses in permanent spermio- or ovogenesis impairment.
Eyes
The use of opthalmic ultrasound instruments is restricted to specialized centers. Physiotherapy must follow the
above-mentioned contraindication.
St. P. laminectomy
Since the spinal cord is not completely covered by an osseous cover after laminectomy, ultrasound application to
the medulla may result in transient or permanent paraparesis DK (when the axons of the spinal cord paths are
disorganized). This is one of the most serious negative effects of physiotherapy.
New bleeding (anywhere)
Since ultrasound waves spread considerably via humours during ultrasound therapy, various side-effects may
occur in spite of the lowered wave energy. For example, by applying ultrasound to a knee, refractory epistaxis can
re-occur.
B) Relative
Brain, Heart, Parenchymatous Organs
There is no reason to apply ultrasound to these organs. In addition, the brain is covered by the cranium. However,
an article was published about a person who irradiated his sinuses while applying ultrasound to his own knee. This
patient died because of massive bleeding in the forehead lobe, as the calcified atheroma plate was disturbed.
It is
widely believed that this was not an accident. This information is included only as a strong reminder to the
therapist that ultrasound is not to be used in these areas. A patient must never apply ultrasound to himself or
herself, even if the application site can be reached easily.
Peripheral Nerves
(situated just below the surface, on the bone)
This group includes: n. ulnaris in the elbow area, volar areas of the wrist, inguines, the areas under the external
and internal ankles, etc.
As a result of constructive interference (stationary waves), local intensity peaks occur in all of the above-
mentioned areas. Intensity peaks lead to impulse flow speed prolongation and irreversible destruction of nerve
fibres. Muscular fibres and myelin covers of the damaged nerves are usually preserved.
Bone projections just under the skin: - spinous projections of the spondyles, ankles, condyles, and
epicondyles.
This is again a commonly ignored contraindication. Many experts consider ultrasonic therapy to be an
epicondylitis treatment. This is only true insofar as ultrasound application to a corresponding muscular group
(extensoric if lateral, flexoric if there is ulnar epicondylitis) is also taking place. Direct ultrasound application to a
painful attachment often leads to increased pain, but more often leads to the process of chronification (the same
effect as that of numerous massive local corticosteroid applications).
Similarly, the application of ultrasound directly to the spine often results in refractory periosteum pain around
spinal projections.
Emphysema, Bronchiectasis (via ultrasound therapy on the chest)
Menses
This contraindication is considered absolute as far as the hypogastrium area is concerned. Before ultrasound is
applied to a different area, the patient should be told that intensity of menstruation might increase (more often in
menstruation acceleration than in the form of metrorrhagia). If the anamnesis shows that an ultrasound application
may adversely affect menstruation, the therapist should refuse to carry out the procedure and suggest that the
patient consult her physician.