Focused Ultrasound Therapy for Musculoskeletal Pain: What it is, how it works, and who may benefit

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Presented by Dr. Masoud Shamaeizadeh — Soft Touch Chiropractic
TL;DR (quick take)Focused ultrasound (including HIFU and MR-guided FUS) uses concentrated sound energy to create controlled mechanical and thermal effects deep in tissue. It can produce rapid pain relief (especially for bone-related pain), stimulate tissue remodeling, and create short-term analgesia — but the clinical evidence for soft-tissue problems (tendons, fascia) is still evolving and shows mixed results. (PMC)

What is “focused ultrasound” (FUS / HIFU / MRgFUS)?

• Focused ultrasound concentrates many ultrasound beams to a small focal point inside the body — like using many flashlight beams to light one spot. At that focal spot the energy can heat tissue (thermal ablation) or produce mechanical effects (non-thermal), depending on the dose and device. MR-guided FUS (MRgFUS) combines MRI for targeting and temperature monitoring. (PMC)

 

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Simple analogy — speaker vibration Imagine standing close to a big speaker at a concert: the air and your chest vibrate from the sound waves. Focused ultrasound is similar — but instead of vibrating the whole body, it directs many tiny “sound beams” to a single spot (a tendon, ligament or small bone lesion). At that spot the waves can:

• Make tissue vibrate and mechanically disrupt degenerative tissue,
• Heat the targeted tissue (for controlled ablation or stimulating repair),
• Trigger local biochemical responses that reduce pain and promote healing. (PMC)

How FUS may reduce pain and promote healing (mechanisms)

1. Thermal ablation / denervation — heating can destroy pain-generating nerve endings or problematic tissue (used often for bone lesions and osteoid osteoma). (MDPI)
2. Mechanical and cavitation effects — focused pulses can disrupt degenerative fibers and stimulate a local healing response (seen in tendon studies and animal models). (Wiley Online Library)
3. Analgesic/neuromodulatory effects — immediate pain relief is frequently reported after FUS—likely a combination of thermal nerve modulation and local biochemical changes. (PMC)
4. Biologic stimulation — low-intensity focused or pulsed ultrasound can upregulate cellular repair pathways and growth factors that assist regeneration. Evidence here is promising but not yet definitive for all soft-tissue conditions. (Nature)

What the evidence says (short, evidence-focused bullets)

• Clinical trials: Ongoing and completed trials are testing intense or focused ultrasound for chronic plantar fasciitis and other tendinopathies — results show promising.

Practical takeaways for patients and clinicians

• Best current use case: non-invasive treatment of painful bone lesions (e.g., osteoid osteoma, some bone metastasis pain) — reliable pain relief and decreased medication needs are documented. (SpringerLink)
• For tendons/ligaments/fascia: focused ultrasound is promising (can mechanically and biologically influence degenerative tissue), but expect variable results — careful patient selection and device-specific protocols matter. (Wiley Online Library)
• Safety: MR-guided systems allow precise targeting and temperature monitoring which improves safety. Complications are uncommon when performed by experienced teams. (Nature)

Example patient story (how to explain it simply)“Think of a speaker vibrating a small area of your chest. Focused ultrasound is like aiming dozens of tiny sounds beams so only a small spot (your painful tendon or small bone lesion) vibrates or heats.
That focused energy helps dissolve degenerative tissue, calm irritated nerve endings, and trigger the body’s natural repair response — often leading to faster recovery and less downtime 

Short list of key studies & reviews (for deeper reading)

• Bachu V.S. et al., High-Intensity Focused Ultrasound: A Review, overview of development and biomedical applications of HIFU. (PMC)
• Baal J.D. et al., Systematic review: MRgFUS for bone metastasis pain — shows substantial pain reduction and quality-of-life improvement. (SpringerLink)
• Yeo S.Y. et al., HIFU for bone tumors — review of 20 years — effective for pain control and local tumor effects. (MDPI)
• Khandare S. et al., Focused ultrasound vs dry needling (animal models / tendon effects) — demonstrates mechanical and histologic changes and suggests potential for tendon repair. (Wiley Online Library)
• Guan H. et al., Ultrasound therapy for pain reduction in musculoskeletal disease — systematic review & meta-analysis (2024) — summarizes RCTs and observational studies, notes mixed results depending on condition and protocol. (SAGE Journals)

Short disclaimer This blog is educational only and not a substitute for a clinical assessment. Focused ultrasound is a medical procedure; whether it’s appropriate depends on diagnosis, imaging, and individual risks. Always consult a qualified clinician before pursuing treatment.

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Focused ultrasound therapy, HIFU for musculoskeletal pain, MRgFUS, tendon regeneration, plantar fasciitis ultrasound, non-invasive pain relief, Soft Touch Chiropractic, Dr Masoud Shamaeizadee.