Lack of Know-How.

I believe that through the late 80's and 90's when the PT field started to explode, there wasn't as good an understanding of classification, sub-classification, or even treatment-based classification of patients with which to really know which patients benefitted from what treatments.  Clinical prediction rules certainly weren't around, and a lot of research done was just to find out if PT worked for certain diagnoses, or was done within the context of the basic sciences and not clinical trials. 

I believe that as a result of the above ignorance, we (clinicians in general) were using ultrasound (and other modalities) in conjunction with incorrect processes for treating backs, necks, shoulders and what not, and blaming the modalities for our patients not getting better.   Or citing the patient as being a malingerer or crazy.  

Couldn't have been our fault though, right? 

Couldn't have been the fact some were stretching hamstrings and piriformis muscles and having our patients do flexion-based "dead bug" exercises while having a disc derangement, then ultrasound them with the belief that it would do the job.   Huh?  After 4 weeks and the patient's no better, we have to point the finger at something.   Might as well be the ultrasound; after all, you can't feel it when it's on, and it can't defend itself verbally.

Riiiiiight.

Here's the rub: ultrasound is dosage and condition-specific.  Studies show it does what it's supposed to do when used intelligently.

It does increase tissue temperature--even around a lumbar facet---so that it can be prepared for mobilization more appropriately.

It does drive medication through the skin (via ionic streaming)---even when an occlusive dressing is applied between the transducer and the medicated skin.

It does accerate healing in bone and potentially other human tissue.

What else?

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