Hot stone massage with ultrasound waves for muscle pain relief

Hot or Not? Unlocking the Secrets of Heat and Ultrasound Therapy for Muscle Pain

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"Discover the optimal sequence for hot pack and ultrasound treatments to relieve myofascial trigger points and enhance muscle recovery."

Muscle pain is a widespread issue, especially among athletes and active individuals. Often, this pain stems from myofascial pain syndrome (MPS), characterized by sensitive spots known as trigger points within the muscles. These trigger points can cause localized discomfort and referred pain, impacting performance and overall well-being.

To combat muscle pain and trigger points, many therapists and individuals turn to heat and ultrasound therapies. Heat, typically applied via hot packs, helps to relax muscles and increase blood flow. Ultrasound uses sound waves to penetrate deeper tissues, promoting healing and reducing inflammation. But is there a 'right' way to combine these therapies?

A recent study investigated the effects of different sequences of hot pack and ultrasound treatments on latent myofascial trigger points (LMTrP) in the upper trapezius muscle. The goal was to determine if applying heat before ultrasound, or vice versa, yielded better results in terms of pain relief and physiological responses. Let's dive into the findings and explore how you can optimize your muscle recovery routine.

Decoding Hot Pack and Ultrasound: What the Science Says

Hot stone massage with ultrasound waves for muscle pain relief

The study, published in the Asian Journal of Sports Medicine, involved 30 participants with latent trigger points in their upper trapezius muscles. Researchers compared two treatment sequences: hot pack followed by ultrasound (HP + US) and ultrasound followed by hot pack (US + HP). Each participant received both treatments in random order, with a break of 24-48 hours between sessions.

Several measurements were taken to assess the effectiveness of each sequence, including:

Tissue Blood Flow (TBF): Measured using a laser Doppler blood flow meter to assess circulation in the trigger point area.
Pressure Pain Threshold (PPT): Determined using a digital pressure algometer to gauge sensitivity to pressure.
Supra-Thermal Threshold (STT): Assessed using a thermal sensory analyzer to measure pain response to different temperatures.
Visual Analog Scale (VAS): A subjective pain rating scale where participants rated their pain levels.

The results showed that both treatment sequences led to significant improvements in tissue blood flow and pressure pain threshold compared to baseline. This means that both HP + US and US + HP effectively increased circulation and reduced sensitivity in the trigger point area. However, the HP + US sequence showed a trend toward greater improvement in pain (VAS) and supra-thermal threshold (STT) at 45°C.

The Takeaway: Optimizing Your Muscle Pain Relief

While both hot pack and ultrasound, regardless of sequence, can provide benefits for muscle pain and trigger points, the study suggests that applying heat before ultrasound may offer a slight edge. The researchers theorize that heat increases superficial blood flow, making the deeper tissues more receptive to the ultrasound waves. Ultimately, the best approach may depend on individual preferences and the specific nature of your muscle pain. Consulting with a physical therapist or healthcare professional can help you determine the most effective treatment strategy for your needs.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5812/asjsm.23806, Alternate LINK

Title: Effect Of Therapeutic Sequence Of Hot Pack And Ultrasound On Physiological Response Over Trigger Point Of Upper Trapezius

Subject: Orthopedics and Sports Medicine

Journal: Asian Journal of Sports Medicine

Publisher: Briefland

Authors: Dararat Benjaboonyanupap, Aatit Paungmali, Ubon Pirunsan

Published: 2015-09-28

Everything You Need To Know

What exactly is myofascial pain syndrome, and why is it so relevant when discussing muscle pain?

Myofascial pain syndrome (MPS) is a condition characterized by the presence of trigger points within muscles. These trigger points are sensitive spots that can cause localized pain as well as referred pain to other areas of the body. MPS can significantly impact an individual's physical performance and overall sense of well-being due to the discomfort and limitations it imposes.

What is the difference between a hot pack and ultrasound, and how do they each work to relieve muscle pain?

A hot pack is a therapeutic tool used to apply heat to the body, typically to relax muscles and increase blood flow to the treated area. Ultrasound therapy, on the other hand, uses sound waves to penetrate deeper tissues, promoting healing and reducing inflammation. Both modalities are commonly used to manage muscle pain and trigger points, but they work through different mechanisms and target different tissue depths.

What do Tissue Blood Flow, Pressure Pain Threshold, Supra-Thermal Threshold and Visual Analog Scale mean and how are they important in assessing muscle pain?

Tissue Blood Flow (TBF) refers to the circulation of blood within the muscle tissue. It's important because increased blood flow can promote healing, reduce inflammation, and deliver essential nutrients to the affected area. Pressure Pain Threshold (PPT) is the amount of pressure that can be applied to a specific point before it becomes painful, indicating the sensitivity of the trigger point. Supra-Thermal Threshold (STT) is the point at which heat becomes painful. Visual Analog Scale (VAS) is a subjective way to measure pain.

What did the study actually compare when looking at the order of hot pack and ultrasound treatments?

A recent study compared two treatment sequences: hot pack followed by ultrasound (HP + US) and ultrasound followed by hot pack (US + HP). The study measured Tissue Blood Flow (TBF), Pressure Pain Threshold (PPT), Supra-Thermal Threshold (STT), and used Visual Analog Scale (VAS) to measure pain. The results showed that both sequences improved TBF and PPT, but the HP + US sequence showed slightly greater improvement in pain (VAS) and STT.

Is it better to use a hot pack before or after ultrasound for muscle pain, and why might the order matter?

While both sequences, hot pack followed by ultrasound (HP + US) and ultrasound followed by hot pack (US + HP), can provide benefits, the study suggests that applying a hot pack before ultrasound may offer a slight advantage. The researchers theorize that the heat from the hot pack increases superficial blood flow, making the deeper tissues more receptive to the ultrasound waves, potentially enhancing the overall therapeutic effect. However, individual preferences and the specific nature of the muscle pain should also be considered.