Ultrasound Imaging and Physical Therapy Practice

Ultrasound imaging is being used more frequently in the physical therapy clinical setting. Physical therapists are using ultrasound (US) imaging in varying ways. Some are using it as a training tool for the patient to learn neuromuscular control. Others are using it to guide needle placement while performing dry needling. In a recent article authored by several well-known physiotherapists, the various uses of US imaging were defined, as well as discussions regarding the scope of practice, and training for physiotherapists using ultrasound imaging.

Four uses of US imaging have been reported by physical therapists. The first and most common use of US imaging is the evaluation of muscle structure and function to aid in neuromuscular control. Essentially, the US images are being used as a source of biofeedback. This has been coined Rehabilitative Ultrasound Imaging (RUSI). Additional uses have emerged in recent years including Diagnostic US imaging which is the diagnosis and monitoring of pathology; and interventional US imaging which is using the US images to guide percutaneous procedures involving dry or wet needling. These three categories are performed during clinical care and fall under the umbrella term “point of care ultrasound.” The last category of US imaging use in physical therapy is paired with performing research.

In this article, some thoughts and areas for improvement were brought to light regarding each type of US imaging as well as the scope of practice and training for each type of US use. It was mentioned that RUSI sits almost entirely within the scope of the physical therapy profession, however, it can be difficult for therapists to receive training for this use. Therapists interested in learning diagnostic or interventional US imaging have more options for training because these uses of US have established criteria for training, competence, and regulation outlined by the World Health Organization (WHO), as well as oversight from the World Federation for Ultrasound in Medicine and Biology. These programs often are intended for other healthcare practitioners (radiologists, and sonographers), but physical therapists are able to take the courses. However, it was stated that both diagnostic and interventional US imaging do not fall within the scope of practice for a majority of physical therapists around the world. So, although training may be more available for these types of US use; therapists taking these courses gain increased experience with non-physical therapy applications, and therefore are at risk for operating outside the scope of their practice.

The authors continued with distinct recommendations for needed training for the four different types of US imaging. Several of the listed skills were fundamental knowledge that a therapist should obtain before utilizing any of the four types of US into their practice such as basic physics for US, terminology, safety, among other knowledge. Then there were skills that were specific to the particular type of US being performed. Since point-of-care use of US is generally not included as part of entry level physical therapy education programs, this knowledge needs to be obtained in a postgraduate education format. For therapists who wish to learn diagnostic application of US imaging, there are multiple courses available from schools that train sonographers. However, according to this article, the form of US imaging that sits more within the scope of practice for physical therapists, rehabilitative ultrasound imaging, does not have as many educational opportunities as diagnostic US imaging does.

Herman & Wallace offers a course that provides fundamental skills of US imaging (such as history, and knowledge of the physics needed for US imaging), as well as specific skills for real-time ultrasound imaging. The schedule of the course includes a lot of lab time with multiple US units available so the ratio of participant to US unit low. You will leave the course being able to interpret US images and use it as an assessment tool or biofeedback tool for the patient. Using RUSI will change how you treat patients! The Rehabilitative Ultrasound Imaging course is offered three more times this year. Join me in Columbia, MO this August; Madison, WI in September; or Chicago, IL in December to learn how to use this form of ultrasound imaging in your clinical practice!

Whittaker J, Ellis R, Hodges P, et al. Imaging with ultrasound in physical therapy: what is the PT’s scope of practice a competency-based educational model and training recommendations. Br. J Sports Med. Apr. 2019; 0:1-7.