As a second-year physical therapy (PT) student, I was first introduced to ultrasound for musculoskeletal conditions in 2009.
I was immediately intrigued.
I continued to dabble in musculoskeletal ultrasound (MSKUS) for a couple of years but never really with a focus on becoming good or great at the skill, more on the emphasis of becoming more knowledgeable and comfortable with human anatomy (ie, looking at muscle pennate structure, fibrillar patterns of tendons and ligaments, and identifying what they were).
Then, in 2011, I sought out a mentor for MSK ultrasound whom I had known since PT school, Wayne Smith, who is also a physical therapist with 40 years of experience. Wayne has been doing MSKUS since 2000 and in 2011 was working at Andrews Institute with Josh Hackel in the physical therapy department.
Soon after starting the training, Wayne and I collaborated with my PT clinic owner to help create a physical medicine model combining physiatry with physical therapy; MSKUS was a large piece of this model.
We quickly realized how powerful MSKUS had become and that it had turned into a gatekeeper and point-of-care diagnostic tool. MSK ultrasound is a great adjunct to evaluating a patient at time zero and in the hands of qualified physical therapists with requisite training. MSKUS allowed the clinic to execute and expedite patient plan of care by immediately cutting out unnecessary imaging studies (MRI mainly), streamlining physical therapy plans, aiding the physician with percutaneous-ultrasound-guided needle procedures, and/or immediate referral for surgical consult or advanced imaging if needed.
At this time, the RMSK exam was not on my radar so the training was piecemeal; I made the most out of my time to train with Wayne every 6 weeks while practicing and reading Jon Jacobsen’s Fundamentals of Musculoskeletal Ultrasound book.
In 2014, I took on a part-time trial with an orthopedic surgeon performing MSKUS in his office as well as physical therapy services consisting of evaluation, therapeutic exercise, and home exercise prescription. This business model became very successful and super-charged my learning in MSK ultrasound because I was now able to get feedback not only with other imaging studies, such as MRI, but I was then able to synergize findings in surgery that were based on the MSKUS imaging studies (ie, bursal sided rotator cuff tear vs intrasubstance). This feedback was very valuable and accelerated my learning curve. This orthopedic clinic is now an AIUM-accredited diagnostic center in MSK ultrasound within the state of Arizona.
In the medical model or in a stand-alone outpatient physical therapy practice, incorporating orthopedic physical therapy evaluation, MSK ultrasound evaluation combined with exercise prescription is a very powerful visit for the patient. It cuts out unnecessary imaging, saving the patient money and additional timely medical visits as well as expediting the patient’s plan of care. I’ve since incorporated this business model to many other physician offices in the greater Phoenix area.
Incorporating MSKUS into physical therapy has been a major boon for the profession and for the medical community in general.
My workweek now consists 100% of performing MSKUS scans, teaching at A.T. Still University (Mesa), starting up an online MSKUS training program, and mentoring physical therapists, athletic trainers, general sonographers, and radiology technicians in the field of musculoskeletal ultrasound in their preparation to take the RMSK or RMSKS certification exam.
Interested in reading more about how ultrasound can change physical therapy? Check out Carrie Pagliano’s post, Real-time Ultrasound in Physical Therapy.
Colin Thomas Rigney, PT, DPT, OCS, RMSK, is the Director of MSK Ultrasound for Physicians United as well as a member of both the Residential and Post-Professional Doctor of Physical Therapy Degree Faculty at A.T. Still University in Mesa, Arizona, teaching courses on Radiology and Imaging for Physical Therapy students.
Have you incorporated musculoskeletal ultrasound in your physical therapy practice? What benefits have you experienced? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community to share your experience.