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Ultrasound Stretching Window

Dawn T. Gulick, PT, PhD, ATC, CSCS

September 22, 2015

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Question

Can you explain the term stretching window and how it applies to ultrasound treatment?  

Answer

This term “stretching window” has been coined to apply to ultrasound.  It means how long you have before the ultrasound temperature increase drops back down below a therapeutic level.  Let’s that we render an ultrasound treatment that increases the tissue temperature to 3.5 degrees C over about a 12.5 minute period.  Then we shut the ultrasound unit off, but we continue to measure the tissue temperature.  You will see that in about 10 minutes, from 12.5 to 22.5, we are down 2.5 degrees.  In 10 minutes, we have dropped 2.5 degrees.  This goes down to a mild level of heating.  You have basically 10 minutes to do your stretching technique or do your mobilization technique or to release the trigger point before you have lost the effect of ultrasound.  This is what has been coined as the stretching window.  This is the window of time that you have to render your treatment.  I am sure that all of us have done this scenario that I am going to share with you.  How many times have you put a hot pack on someone, then you do the ultrasound treatment, take the ultrasound off, clean off the head and put it back on the cart, unplug the cart, move it into the next room for one of your colleagues to use, you come back in, clean up the patient, and now about three to four minutes had passed.  You have just lost at least a degree if not a degree and a half.  You have lost a significant portion of the efficacy of the treatment.  That is just common practice.  What about the times when you do an ultrasound treatment and then you have to go check someone’s exercise program?  Or worse yet, you get a call from a physician or insurance company and you take that call?  Ten minutes later when you come back, you might as well have not done the ultrasound


dawn t gulick

Dawn T. Gulick, PT, PhD, ATC, CSCS

Dawn T. Gulick, PhD, PT, AT, CSCS, a Professor of Physical Therapy. Her areas of expertise are orthopedics, sports medicine, modalities, and medical screening.  As a clinician, she has owned a private orthopedic/sports medicine practice.  She also provides athletic training services from the middle school to elite Olympic/Paralympic level.  As a member of the Olympic Sports Medicine Society, Dr. Gulick has provided medical coverage at numerous national and international events.  As a scholar, Dr. Gulick is the author of 4 books (Ortho Notes, Screening Notes, Sport Notes, Mobilization Notes), four book chapters, > 60 peer-reviewed publications, and > 100 professional and civic presentations.  OrthoNotes is in the 5th edition and has been translated into multiple languages.  Dr. Gulick is an entrepreneur.  She is the developer of a mobile app called iOrtho+ (Apple, Android, & desktop versions).  Her app has been downloaded over 160K times around the world. She is the Founder & CEO of Therapeutic Articulations.  She is the inventor of the Mobil-Aider, an orthopedic device designed to quantify joint mobility.  She is the recipient of a phase I and phase II National Science Foundation grant of over $1.2M for the commercialization of the Mobil-Aider.  She owns the utility patent & has achieved FDA clearance.  She has two other medical projects in process.  Dr. Gulick has served and held leadership roles on numerous committees over her 25 years in academia. 

Dr. Gulick earned a Bachelor of Science in Athletic Training from Lock Haven University (Lock Haven, PA), a Master of Physical Therapy from Emory University (Atlanta, GA), and a Doctorate in Exercise Physiology from Temple University (Philadelphia, PA).  She is an AMBUCS scholar and a member of Phi Kappa Phi (past chapter president) and Kappa Delta Pi Honor Societies.


Related Courses

Medical Screening – Part 1 Systemic Pathology
Presented by Dawn T. Gulick, PT, PhD, ATC, CSCS
Recorded Webinar

Presenter

Dawn T. Gulick, PT, PhD, ATC, CSCS
Course: #4473Level: Advanced2 Hours
  'Detailed testing'   Read Reviews
This course focuses on medical screening for the physical therapist and is Part 1 of a four-part series on screening. Part 1 provides an overview of the signs/symptoms of systemic pathology.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of Direct Access CE credit.

Medical Screening – Part 2 Pediatrics & Adolescence
Presented by Dawn T. Gulick, PT, PhD, ATC, CSCS
Recorded Webinar

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Dawn T. Gulick, PT, PhD, ATC, CSCS
Course: #4474Level: Advanced2 Hours
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This course focuses on medical screening for the physical therapist and is Part 2 of a four-part series on screening. Part 2 addresses pathology in the pediatric and adolescent lifespan. Part 1 is recommended prior to part 2.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of Direct Access CE credit.

Medical Screening – Part 3 Adult
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Recorded Webinar

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Course: #4475Level: Advanced2 Hours
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This course focuses on medical screening for the physical therapist and is Part 3 of a four-part series on screening. Part 3 addresses pathology in the adult portion of the lifespan. Part 1 is recommended prior to part 3.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of Direct Access CE credit.

Medical Screening – Part 4 Geriatrics
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Course: #4476Level: Advanced2 Hours
  'can relate to the population that I treat'   Read Reviews
This course focuses on medical screening for the physical therapist and is Part 4 of a four-part series on screening. Part 4 addresses pathology in the geriatric portion of the lifespan. Part 1 is recommended prior to part 4.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of Direct Access CE credit.

Extremity Joint Mobilization Techniques
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This course is designed to provide an objective way to perform joint mobilization techniques utilizing the Mobil-Aider device. Tasks for the shoulder, elbow, wrist, knee, and ankle will be performed. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.