Introduction Extracorporeal 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.

Objectives The main objective of this study is to show how certain physiotherapy techniques increase their effectiveness when combined with ultrasound imaging.

Case report Patient 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 methods Following instruments were used

• Ultrasound 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 followed First 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 applied 15–20 min/session capacitative electrode. looking for vascularizing effect on antero-inner thigh and percussived area.

Results After 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.

Discussion Ultrasound 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.

Conclusions Ultrasound 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.