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BackgroundIntroductionExtracorporeal shock waves are a non-invasive treatment which effectiveness has been broadly corroborated in musculoskeletal pathology. The use of Ultrasound Imaging ensures us dealing with precision in lesional area and follow the evolution.ObjectivesThe main objective of this study is to show how certain physiotherapy techniques increase their effectiveness when combined with ultrasound imaging.Case reportPatient 47-year-old woman. Arrived to our physical therapy department with diagnosis of anserine tendinopathy in right knee, to perform treatment with shock waves.Material and methodsFollowing instruments were usedUltrasound Equipment General Electric Logiq E, linear tranductor 12 L–RS.Extracorporeal Shockwaves BTL–6000 SWT TopLine Plus, maximum power 4 bar.INDIBA HCR 801 Radiofrequency Equipment.Methodology followedFirst perform, ultrasound exploration of lesionalarea. Tendon measurements were warranted.Then, carry out ‘therapeutic tendonopaty’ Extracorporeal Shockwave Protocol in area thanks to ultrasound images (4000 shots with initial 12 Hz, to 6 Hz frequency, initial intensity 1,5 barto 4 bar, variations every 500 shots).Finally radiofrequency INDIBA were applied15–20 min/session capacitative electrode. looking for vascularizing effect on antero-inner thigh and percussived area.ResultsAfter second session changes on tendon thickness were noticed, lowering from 0,35 cm up to 0,30 cm, and after 3rd session further decrease of 0,05 cm, finally reaching normal thickness of 0,25 cm.DiscussionUltrasound imaging allows us to found demonstrable improvement in this case report, althought painful clinic persisted on patient.Now, once recovered normal thickness of tendon, we were allowed to modify treatment,without thinking we have failed and avoiding patient and/or therapist frustration.ConclusionsUltrasound imaging is a very useful tool for physiotherapist because allows us to re-evaluate constantly injury phase, allowing us for better treatment adjustments in every moment.Also prove achieved real-time patient‘s own progress despite pain do not improve on clinical results.

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Background and Aims Previous studies have evaluated electrostimulation of the tibialis anterior muscle via ultrasound. However, to the best of our knowledge, to date, no study has compared percutaneous stimulation compared to transcutaneous stimulation. The aim of this study was to analyze and compare the influence of percutaneous stimulation versus transcutaneous stimulation on the angle and muscle width of the proximal motor point of the tibialis anterior among healthy individuals using ultrasound. Material and Methods A longitudinal prospective study. The study variables were muscle thickness and pennation angle, measured using ultrasound. A sample of 4 healthy individuals with a mean age of 35.25 years ( ± 2.17), mean height of 1.70m ( ±  0.03) and weight of 67.35kg ( ±  6.32), participated in this study. Stimulation was performed on the tibialis anterior of the dominant leg of each individual (n = 4). The subjects were seated in a vertical position. For position 1, the knee of the dominant leg remained completely extended and the ankle was fixed in a neutral position with an orthosis comprised of Velcro straps which immobilized the ankle and forefoot joints. For position 2, the knee remained flexed 90 degrees with the foot fixed in the orthosis and supported on the floor. The proximal motor point of the tibialis anterior muscle was located. A biphasic symmetric pulse current was used with the maximum tolerated intensity. Transcutaneous stimulation was performed via a small circular electrode, and for percutaneous stimulation a filiform acupuncture needle was used. To capture the ultrasound images, the probe was placed on a system with an articulated mechanical arm and a clamp that enabled the possibility of adjusting the height and/or angle and the position marked on the skin. Normality was contrasted using the Shapiro-Wilk test and sphericity was tested using the Mauchly's test. Analysis of variance was performed (ANOVA) for repeated measures. Results The comparison of both techniques in position 1 did not show significant differences between the transcutaneous technique versus the percutaneous technique neither for the angle (F = 2.07; p-valor = 0.18), nor for the width (F =0.28; p-value = 0.60). In the case of position 2, significant differences were not found between the transcutaneous technique versus the percutaneous technique, neither for the angle (F = 0.28; p-value = 0.606) nor for the weight (F =0.11; p-value = 0.75). Conclusions The comparison of transcutaneous stimulation versus percutaneous stimulation in the proximal motor point of the tibialis anterior does not seem to show statistically significant differences for muscle width nor pennation angle.