Indications: Combining ultrasound (US) with electrical stimulation (e-stim) is a treatment option to decrease acute and chronic musculoskeletal pain, decrease muscle tone-spasm, increase local circulation, and increase-maintain joint range of motion (ROM). This approach combines the physiological benefits of electrical stimulation with US and is often applied over motor or acupoints to optimize clinical outcomes. For post traumatic – post-surgical pain, consider using HVPC Sensory with subthermal US. For acute pain, LVPC Sensory or IFC - PREMOD Sensory with subthermal (pulsed) US are therapeutic options. To address chronic pain or limited ROM, consider using LVPC Motor with thermal US or IFC - PREMOD Motor with thermal US. 

Research that supports the use of electrical stimulation combined with US includes:
• Ultrasound and Transcutaneous Electrical Nerve Stimulation (TENS) combination treatment has a more effective analgesic effect and improves the functional efficiency of patients with pain in the lumbar spine than either ultrasound or TENS alone.¹
• The combination of ultrasound therapy and electrotherapy offers a greater immediate increase in the range of motion (ROM) of the muscle than placebo therapy, ultrasound therapy alone, or electrotherapy alone.²
• The combination of TENS and ultrasound therapy proved a more effective treatment modality in active trigger points and provided prompt relief of symptoms (decrease pain and increase ROM) than ischemic compression alone.³

Note:
• Poor US transducer/patient contact will break the e-stim circuit and stop the current flow.
• Use the Ultrasound CPT code (97035) when billing for the treatment.

References:
1. Krukowska J, Dudkiewicz I, Balcerzak E, Linek P, Kulma D, Miller E: Evaluate the efficacy of combination therapy of ultrasound and currents of TENS professionally active in patients with pain of the lumbar spine. Wiad Lek. 2014;67(4):453-9, 2014.
2. Lee JC, Lin DL, and Hong C: The Effectiveness of Simultaneous Thermotherapy with Ultrasound and Electrotherapy with Combined AC and DC Current on the Immediate Pain Relief of Myofascial Trigger Points. Journal of Musculoskeletal Pain 5(1), 1997.
3. Mukkannavar, P. B: Effect of Combination Therapy [TENS & Ultrasound] and Ischemic Compression in the Treatment of Active Myofascial Trigger Points. Journal of Exercise Science and Physiotherapy, 4(2): 95-103, 2008.