ELECTROTHERAPY

Ani Elizabeth Jose, MPT(Neuro)

Senior Physiotherapist and Manager
Health Plus Physiotherapy Clinic.


ELECTROMAGNETIC SPECTRUM
Electromagnetic Radiation
Electromagnetic Spectrum
Ionizing Range
Non-Ionizing Range

IONIZING RANGE
Energy readily alters the components of atoms.
Used for X-rays and Treating Cancer.
Not used by Athletic Trainers
NON-IONIZING RANGE
Ultraviolet- Superficial tissue treatment
Infrared-
Near Infrared- 5-10mm deep
Far Infrared- <2mm deep
Diathermy- Conversion

TRANSFER OF ENERGY
Energy moves from an area of HIGH
concentration to an area of LOW
concentration.
Radiation
Conduction
Convection
Conversion
Evaporation

TRANSFER OF ENERGY
Conduction
Heat transferred from higher
temp to lower temp through
contact
Convection
Heat transferred by water/air
moving past the surface of the
body part treating
Radiation
Transfer of heat from a warmer
object to a cooler object via
electromagnetic energy


Conversion
Heat occurs when non-
thermal energy is absorbed
into the tissue via electrical
or mechanical and
transformed into heat
Evaporation
Transfer of heat that occurs
as a liquid absorbs energy
and converts to vapor form

THERAPEUTIC EFFECTS
Decrease mm spasms
Decrease tone
Increase blood flow to
treatment area
Increase capillary
permeability
Increased collagen
extensibility
Increased local
temperature

Increased metabolic
rate
Increased nn
conduction velocity
Increased pain
threshold

INDICATIONS

Abnormal tone
Decreased range of
motion
Muscle guarding
Muscle spasm
Myofascial trigger
points
Subacute pain

Chronic pain
Subacute inflammatory
condition
Chronic inflammatory
condition

SUPERFICIAL HEAT
Hydrocollator Pack (Hot Packs)
Hydrotherapy
Whirlpool
Hubbard tank
Paraffin
Infrared lamps

HOT PACKS
Canvas or nylon filled
with gel substance
Provides moist heat
Size and shape
dependant on the area
being treated
Stored in water: 158
167 F
Remove from water
with tongs

FLUIDOTHERAPY
Container that circulates
warm air and small
cellulose particles
Generates dry heat
through forced
convection
Dry cellulose medium
causes no irritation to
skin = higher treatment
temperatures
Comes in varying sizes
and shapes
most often used to treat
extremities

INFRARED
Superficial heating of
tissue via radiant heat
Main therapeutic effect
= enhancement of soft
tissue healing
Allows constant
supervision of skin
PARAFFIN
Three methods of
application:
Dip-wrap
Dip-reimmersion
Paint application

Common heating source for distal
extremities
DEEP HEATING AGENTS
Short Wave Diathermy
Ultrasound


DIATHERMY
Converts high frequency
electromagnetic energy
to therapeutic heat
Can be continuous or
pulsed
Most common frequency
used is 27.12 MHz
Can utilize capacitance
or inductance

DIATHERMY
Capacitive plates:
High frequency electrical current between plates
Pt becomes part of the electrical circuit
Inductive plates:
Utilizes a coil that generates a magnetic field perpendicular
to the coil
Bundled as cables that wrap around the extremity or as a
drum applicator

ULTRASOUND
Transfers heat to
tissues via conversion
Can elevate tissue
temperature up to 5cm
deep
Can produce both
thermal and
nonthermal effects






PIEZOELECTRIC EFFECT

When an alternating current is passed through a
crystal it will expand and contract

CONTRAINDICATIONS FOR ULTRASOUND
Acute and post-acute
conditions (thermal)
Areas of active
bleeding
Areas dec temperature
sensation
Areas dec circulation
Deep vein thrombosis
Infection
Malignancy

Over breast implants
Over carotid sinus or
cervical ganglia
Over epiphyseal plates
Over eyes; heart; genitalia
Over mehtylmethacrylate
cement of plastic
Pregnancy (pelvis;
abdomen; lumbar)
Over pacemaker
Thrombophlebitis
Vascular insufficiency

CRYOTHERAPY
Types
Cold packs
Ice massage
Contrast bath
Cryo cuff
Cold bath
Controlled cold
compression unit
Vapocoolant spray

CRYOTEHRAPY
General therapeutic
effects
Dec blood flow
Dec edema
Dec local temperature
Dec metabolic rate
Dec nerve conduction
velocity
Dec tone
Increased pain
threshold


ICE MASSAGE

COLD PACK
Typically filled with
silica gel and is
available in many sizes
Stored at 25F
Cooled for at least 30
minutes between use

VAPOCOOLANT SPRAY

Rapid cooling via
evaporation
Temperature changes
are superficial
Used commonly for
trigger points
spray and stretch

SOFT TISSUE MASSAGE
SOFT TISSUE MASSAGE
Physiological Effects:
Increased
venous/lymphatic flow
Stretching/loosening of
scar tissue
Edema reduction
Sedation
Mm relaxation
Pain reduction

SPECIFIC MASSAGE TECHNIQUES
Effleurage (stroking)
Petrissage (kneading)
Friction
Tapotement (tapping)
Vibration

EFFLEURAGE (STROKING)
Hands are gliding over the surface of the skin
Superficial: light touch
Deep: heavy pressure
Used at beginning and ends of treatments
Need good contact between hand and body part
Move distal to proximal
Can be used to transition from one body part to
another (to avoid loss of contact)

PETRISSAGE (KNEADING)
Grasping and lifting the tissue
Milking
aids in loosening adhesions and increasing venous return
Lift and wring the tissue
Done distal to proximal

FRICTION
Compression of tissue
Use long strokes or circular movements
Done with palm of hand or fingertips
Initially pressure is light, then progresses to
heavy, deep
Helps to stretch scars or loosen adhesions

TAPOTEMENT (TAPPING)
Rapid striking
Clapping/percussion: palmar surface of hands
(cupped hands/fingers)
Hacking: Ulnar edge of hand/fingers
Both done in alternating manner
Tapping used for stimulation
Cupping implemented to mobilize chest
secretions
VIBRATION
Shaking of the tissue
Uses short, rapid movements with both
hands
Often used with cupping to move secretions
during postural drainage

MASSAGE APPLICATION
Position pt appropriately
Body part being treated is
exposed and supported
Start with light effleurage,
progressing to deep
effleurage (to warm tissues)
Then progress to kneading or
friction (depending on
patients goals)
Begin massage proximal
All stroke movements are
initiated distal to proximal
Complete treatment with
effleurage (deep to light)
Treatment time varies with
condition, tissue response,
and patient tolerance

INDICATIONS FOR SOFT TISSUE MASSAGE
Subacute/chronic pain
Muscle spasm
Superficial scar
formation
Burns or trauma
Edema
Postural drainage

CONTRAINDICATIONS FOR SOFT TISSUE
MASSAGE
Acute inflammation
Acute febrile condition
Severe atherosclerosis
Severe varicose veins
Phlebitis
Areas of recent surgery
Thrombophlebitis
Cardiac arrhythmia

E-STIM
INDICATIONS FOR E-STIM
Bells palsy
muscle atrophy
muscle spasm
muscle weakness
open wound/ulcer pain
stress incontinence
shoulder subluxation
THERAPEUTIC EFFECTS OF E-STIM
Decrease Edema
Decrease Pain
Eliminate disuse
atrophy
Facilitate bone repair
Facilitate wound
healing

Improve ROM
Increase circulation to
area
Muscle re-education
Muscle strengthening

CONTRAINDICATIONS FOR E-STIM
Cardiac arrythmias
Cardiac pacemaker
Malignancy
Osteomyelitis
Over pregnant uterus
Over carotid sinus

Patient with bladder
stimulator
Phlebitis
Seizure disorders

THERAPEUTIC CURRENTS
Flows between two points
DC- Direct-current
Continuous one directional flow
Used for pain modulation or muscular contraction
also produce ion movement
AC- Alternating-current
Continuous two directional flow of ions
Used for pain modulation or muscular contraction

ELECTROTHERAPY
TENS (transcutaneous
Electrical Nerve
Stimulation)
Neuromuscular
Electrical Stimulation
Interferential
stimulation



Russian current
Iontophoresis

TENS
Conventional
Low Rate
TENS
electrical signal
v
nerve sensation stops
v
natural pain relieving substances
(endorphins)
v
no pain massages to brain
v
no pain.
CONVENTIONAL TENS
Indications:
Any painful condition
Chronic typically
If Muscle contraction:
increases pain
contraindicated
Post-op management
of pain
Contraindications:
Known myocardial
problems, pacemakers
Stimulation over
anterior neck
Thrombophlebitis
Superficial skin lesions
LOW RATE TENS

More vigorous than high-rate
Used to treat sub-acute, chronic pain
and trigger points
Pain modulation:
neurochemical inhibitory mechanisms
motor level pain modulation
Beta-endorphins!

LOW RATE TENS
Indications:
pain, now tolerates muscle contraction
trigger points
muscle guarding

THERAPEUTIC ELECTRICALLY INDUCED
MUSCLE CONTRACTION
Therapeutic gains:
muscle reeducation
muscle pump contractions
muscle strengthening

MUSCLE REEDUCATION
Primary indication: inhibition after injury or
surgery
Theory for inhibition related to sensorimotor
dysfunction
ES induces involuntary muscle contraction
which increases sensory input from that
muscle

INDICATIONS FOR RUSSIAN CURRENT
Post knee lig surgery (Curwin et al, Can Ath J, 1980)
Post arthroscopic knee surgery (Williams et al, JOSPT,
1986)
ACL sprain (increase quad force during
immobilization) (Nitz, PT, 1987)
PRIME indication: strengthen the muscular
apparatus of HEALTHY population

MUSCLE PUMP CONTRACTIONS
EDEMA REDUCTION
ES to induce muscle contractions
(pumping action)
Duplicates normal muscle pumping
contractions
Stimulates circulation thru venous and
lymphatic channels
Induce circulatory changes while
protecting limb
EDEMA REDUCTION
Sensory level stimulation may be
used for edema control
increase ionic movement

INTERFERENTIAL CURRENT
Methods of delivery (cont)
quadripolar
Target
sweep: enlarge field
ELECTRICAL STIMULATION FOR
DENERVATED MUSCLE
Utilized in PT for decades
Purpose: minimize atrophy during
regeneration
Parameters depend on generator:
Can be DC or AC
IONTOPHORESIS
The use of an electrical current for the
transcutaneous delivery of ions into the body
TRACTION
Modality that applies
force to the body to
separate a joint surface
and decrease pressure

THERAPEUTIC EFFECTS OF TRACTION
Decrease disk
protrusion
Decrease pain
Increase joint mobility
Increase mm relaxation
Increase soft tissue
elasticity
Promote arterial,
venous, and lymphatic
flow

INDICATIONS FOR TRACTION
Disk herniation
Joint hypomobility
Muscle guarding
Muscle spasm
Narrowing of IV foramen
Nerve root impingement
Spinal ligament
contractures
Subacute joint
inflammation
Subacute pain

CONTRAINDICATIONS FOR TRACTION
Acute inflammation
Acute sprains/strains
Aortic aneurysm
Bone disease
Cardiac/pulmonary
problems
Conditions were movement
is contraindicated
Dislocation
Fracture
Hiatal hernia
Increased pain or radicular
symptoms with traction
Infections in bone or joint
Meningitis
Osteoporosis
Peripheralization of
symptoms

Positive alar ligament test
Positive vertebral artery test
Pregnancy
Rheumatoid arthritis
(advanced)
Subluxation
TMJ
Trauma
Tumors
Vertebral joint instability

MECHANICAL TRACTION
Static Traction
Steady force
maintained
Continuous
Sustained
Intermittent
Applied and released in
rhythmic pattern