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Continuous Ultrasound Decreases Pain Perception and Increases Pain Threshold in Damaged Skeletal Muscle

Aaron, Stacey E. MS*; Delgado-Diaz, Diana C. PhD; Kostek, Matthew C. PhD

Clinical Journal of Sport Medicine: May 2017 - Volume 27 - Issue 3 - p 271–277
doi: 10.1097/JSM.0000000000000343
Original Research

Objective: Determine whether therapeutic ultrasound (TUS) delivered in a continuous mode reduces pain perception after muscle injury.

Design: Randomized, double-blind trial.

Setting: Institutional laboratory.

Participants: Twenty young healthy participants (11 females; 9 males; mean age ± SD, 24.1 ± 3.7 years).

Intervention: All subjects performed 50 maximal eccentric contractions of the biceps brachii on a Biodex dynamometer. Criterion measures of isometric force production and serum creatine kinase (CK) activity confirmed tissue damage. Both groups received either TUS or sham treatment everyday starting 24 hours after muscle damage. Muscle soreness and pain were assessed at baseline, 48 hours postdamage, and every other day for 8 days.

Main Outcome Measures: Muscle pain was assessed with a battery of tests: visual analog scale (VAS), Short-form McGill Pain Questionnaire-2, joint angle changes, and mechanical pressure threshold.

Results: Confirmation of damage occurred with baseline compared to 48 hours after damage of isometric peak torque (N·m; P < 0.01) and CK activity (IU/I; P = 0.03). Our results showed significant treatment group differences in VAS (P = 0.01) and mechanical pressure threshold (P = 0.02) after the third TUS treatment in the distal bicep brachii region.

Conclusions: Continuous TUS reduced pain perception and increased mechanical pressure threshold in the biceps brachii after muscle damage, specifically near the distal musculotendinous junction.

*Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina;

Escuela de Fisioterapia, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia; and

Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania.

Corresponding Author: Matthew C. Kostek, PhD, Department of Physical Therapy, Duquesne University, 103 Rangos, Pittsburgh, PA 15282 (

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 21, 2015

Accepted April 01, 2016

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