Ultrasound: Why Do Manual Therapists Cringe At The Request?

Posted by NAIOMT on Jun 28, 2015 12:56:35 PM

russ Russ Case, PT, OCS, COMT, FAAOMPT, NAIOMT Clinical Fellowship Instructor

Hello from Eugene, Oregon where I've been volunteering at the USATF Outdoor Championships!

Last year I was chosen along with a dozen or so other physical therapist’s to cover the 2014 IAAF World Junior Championships at Hayward Field in Eugene, Oregon. Like many other professionals who volunteer their time, I do it because I love my profession and feel we have much to offer our athletic population. The championship meet brought together the top 1,700 under 19-year-olds from 167 countries to compete at historic Hayward Field, the first IAAF World Junior Championship ever held in the United States. The caliber of young athletes who qualify and train for these events is exceptional. These athletes have a grueling training schedule, five to seven days a week, three to eight hours a day. With the amount of training and competition the strain on their bodies and potential risk of injury is high. I was pretty excited to help out at such an elite level. After receiving my SWAG of matching shirt, shorts and jacket, I was ready to roll.


Right off the bat the first athlete that came to me presented with a groin strain. He was a 19 y/o javelin thrower with complaints of groin pain. After a quick history, I ascertained that he had this strain for over a month, secondary to a strained elbow that he had been nursing for over a period of 2-3 months. Hmm, I wonder what is causing this groin strain. If you have ever seen the mechanics of a right handed javelin thrower you will note in the final stride, the athlete plants their left leg and pushes off with their right. Simultaneously turning hips so they are perpendicular to the target area as they transfer their weight forward while bringing arm up and forward keeping elbow high.

Immediately I wanted to go into manual therapy mode and talk with him about his mechanics and how the elbow being hurt may be causing him to try and compensate with his hip and how this increased torsion can cause stress. I wondered how his thoracolumbar junction mechanics looked. And then he asked me…“Do you have ultrasound”?

What? Did he really just say that? Yes he did, the young athlete and his coach just wanted me to ultrasound the groin area.

Now, any respectful manual therapist knows we despise the referrals that note “ultrasound only”. Ultrasound is not what I want to do after spending thousands of dollars and many hours in the clinic trying to improve my manual therapy skills. I feel I have so much more to offer. Well the truth is at this level, with these kids trying to make the Olympics, the question is not how I can help this athlete in the long run. It is how I can get this athlete enough pain relief to compete today or tomorrow. Sometimes it’s ultrasound. Yes, I said it, ultrasound! That does not mean while I was getting a wrist cramp from ultrasounding every other athlete that walked into the tent, that I was not talking mechanics “to the ones who understood English”. I continued my push to discuss training and mechanics to athletes and their therapists.

Russ Case, PT, OCS, COMT, FAAOMPT and Paul Westgard, PT, DPT, OCS, SCS, CSCS with Eugene, a Kenyan athlete at the USATF Outdoor Championships Russ Case,
PT, OCS, COMT, FAAOMPT and Paul Westgard, PT, DPT, OCS, SCS, CSCS with Eugene, a Kenyan PT at the USATF Outdoor Championships

One of the therapists was Eugene from Kenya, he had the responsibilities for the care and medical treatment for team Kenya. He enjoyed sharing duties and collaborating with us on his athlete’s needs and wants. Most of the time the collaboration came down to Ultrasound, Ice Bath, Iontophoresis and many other things that require no manual or mechanical skill at all.

Even though I did little manual therapy I still found enjoyment working with these elite junior athletes. It was exciting to be a part of such a big international event, this year I am looking forward to working with a great group of medical volunteers and see America’s top track and field athletes compete in the 2015 USATF Outdoor Championships.

So, the next time you get a request for ultrasound, maybe you can come down from that manual therapy pedestal and join me in educating our athletic population while performing this necessary evil.


NAIOMT Clinical Fellowship Instructor

Topics: manual therapy, Manual Therapy, Clinical Fellowship Program, Clinical Reasoning, Hot Topics, sports medicine, track and field PT, ultrasound, USATF

NAIOMT Course Schedule

Get an overview of all upcoming courses. Click the headlines to sort by course title, location, instructor or start date.



NAIOMT Course Locations

Access local course schedules and instructor videos.

NAIOMT Course Registrations

Registration for all NAIOMT's courses, tests and exams are now done through the industry-leading event registration platform Eventbrite. To register, simply go to NAIOMT's Eventbrite page at to view all upcoming courses, tests and exams.


Subscribe to Email Updates

Recent Posts

Posts by Topic

see all