Table 1.

Biomechanical effects of ultrasound

Thermal Effects (increased pulse length, power) Increases local tissue temperature, can lead to liquefactive necrosis [7] Non-thermal effects (increased pressure/amplitude) Microstreaming: increased fluid movements promotes endothelial shear stress [8] Jetting: increases vascular permeability [9] Bubble expansion/compression: increases vascular permeability [10] Molecular effects (may be due to non-thermal effects) Upregulation of angiogenic factors [VEGF and Flt-1] [18] Increased nitric oxide synthase activity [19] Anti-inflammatory properties [20] Increased differentiation of myocytes, endothelial cells, and vascular smooth muscle cells [21, 22]