Ultrasound elastography: The new frontier in direct measurement of muscle stiffness

Joline E. Brandenburg, Sarah F. Eby, Pengfei Song, Heng Zhao, Jeffrey S. Brault, Shigao Chen, Kai Nan An

Research output: Contribution to journalArticlepeer-review

155 Scopus citations


The use of brightness-mode ultrasound and Doppler ultrasound in physical medicine and rehabilitation has increased dramatically. The continuing evolution of ultrasound technology has also produced ultrasound elastography, a cutting-edge technology that can directly measure the mechanical properties of tissue, including muscle stiffness. Its real-time and direct measurements of muscle stiffness can aid the diagnosis and rehabilitation of acute musculoskeletal injuries and chronic myofascial pain. It can also help monitor outcomes of interventions affecting muscle in neuromuscular and musculoskeletal diseases, and it can better inform the functional prognosis. This technology has implications for even broader use of ultrasound in physical medicine and rehabilitation practice, but more knowledge about its uses and limitations is essential to its appropriate clinical implementation. In this review, we describe different ultrasound elastography techniques for studying muscle stiffness, including strain elastography, acoustic radiation force impulse imaging, and shear-wave elastography. We discuss the basic principles of these techniques, including the strengths and limitations of their measurement capabilities. We review the current muscle research, discuss physiatric clinical applications of these techniques, and note directions for future research.

Original languageEnglish (US)
Pages (from-to)2207-2219
Number of pages13
JournalArchives of Physical Medicine and Rehabilitation
Issue number11
StatePublished - Nov 1 2014


  • Diagnostic imaging
  • Elasticity
  • Hardness
  • Muscles
  • Rehabilitation
  • Ultrasonography

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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