What is Electrotherapy?
Electrotherapy is a physical therapeutic treatment whereby electrical stimulation is applied to nerves and muscle-motor fibres via electro-pads placed on the skin. There are different types of electrotherapeutic devices in rehabilitation clinics today, with T.E.N.S. being one of the most popular options. Electrotherapeutic programs, utilizing prescribed variations in electrical frequencies and intensities, serve to interrupt, alter or induce specific electrical impulses in order to affect the perception of pain and/or facilitate wound healing and muscle rehabilitation.
These effects are achieved by:
reducing localized inflammation
increasing blood flow
stimulating muscles
triggering the release of endorphins, hormones that act as the body's natural analgesic
About Electrotherapy...
At its simplest level electrotherapy can be defined as the treatment of patients by electrical means. By application this means that electrical forces are applied to the body bringing about physiological changes for therapeutic purposes. Physical agents like heat, light, sound, and mechanical modalities used in management of pain and regaining power and mobility.The modalities include various method of heating or cooling the tissues ultrasound, electromagnetic radiations, medium and low frequency currents, iontophoresis and phonophoresis.
Low frequency currents: This type of currents alternate at 1 – 1000 Hz. At this frequency currents can stimulates both motor and sensory nerves. Faradic type and galvanic type current used as low frequency current for therapeutic purposes.
Faradic Currents produce a tetnic contraction and that electrical muscle stimulation is usually achieved by 0.1 – 1 ms pulses at frequencies between 30 and 100 Hz. Faradism can be used to facilitate a muscle response and regain normal muscular strength and action. Reduction of oedema, prevention and loosening of joints adhesion by the application of faradic stimulation is common.
Ultrasound: This is the production of longitudinal mechanical waves above the audibla range(20kHz). The frequency used in physiotherapy vary from 0.75 MHz to 3 MHz.These are produced by distortion of a quartz crystal by a high frequency alternating current. Physiological effects of ultrasound accelerate the healing process and results in pain relief. Ultrasound may be used in resent soft tissue injuries, back pain, recent and chronic scar tissues, skin grafts and venous ulcer or pressure sore.
T.E.N.S. (Transcutaneous Electrical Nerve Stimulation)
T.E.N.S. is a highly effective treatment for pain whereby electrodes are placed on or near the area of pain and soothing pulses are sent via the electrodes through the skin and along the nerve fibers. The pulses (controlled by the user at all times) suppress pain signals to the brain. T.E.N.S. also encourages the body to produce higher levels of its own natural pain killing chemicals called Endorphins and Encephalin.
Recognition of T.E.N.S. by healthcare professionals has increased dramatically over the years as results from an enormous amount of research continue to illustrate its effectiveness. Studies on T.E.N.S. have been going on since 1965 when a landmark paper entitled “Pain Mechanism:A New Theory” was written by Melzack and Wall. T.E.N.S. is used worldwide by physical therapists, pain clinics, doctors and other medical practitioners. In recent years, health professionals have been recommending T.E.N.S. for home use on a more frequent basis. By easing pin, T.E.N.S. often results in a decrease of drug intake. For many, the relief is dramatic.
Not only does T.E.N.S. help relieve pain, but the sensation felt is very pleasant and soothing and is totally controlled by the user. It is extremely easy to operate and we ensure that you will understand all instructions provided. T.E.N.S. on its own, is highly effective in MANAGING pain. However, in combination with the right exercises and proper posture, application of T.E.N.S. can actually ELIMINATE your pain within days!
Conditions and Types of Pain that T.E.N.S. Helps...
Electrotherapy’s pain and injury management applications include treatment for:
Acute and chronic ankle pain and ankle joint arthritis
Acute and chronic low back pain associated with spinal nerve and disc pain or spinal osteoarthritis/degenerative disc disease (DDD)
Acute and chronic neck pain associated with soft tissue injury to the muscles, ligaments or spinal discs, joint inflammation and spinal arthritis
Acute, chronic and post surgical knee pain associated with muscle, tendon, ligament or joint arthritis problems
Acute and chronic shoulder pain associated with muscle, tendon, ligament or shoulder joint arthritis
Carpal tunnel syndrome – pain associated with compression of the nerves in the carpal tunnel
Foot pain including Plantar Fasciitis, Achilles Tendinopathy, Morton’s Neuroma and Peripheral Neuropathy
Post lumbar laminectomy – a type of surgery to the spine
Use in labour and delivery
Dental pain including TMJ pain (jaw joint)
Facial paralysis
Trigeminal Neuralgia
Hip pain
Post-operative pain
Sciatica
Bicipital tendonitis
Tennis elbow
Wrist pain
Shin splints
Diabetes neuropathy
Fibromyalgia
Degenerative Joint Disease (DJD)
Reflex Sympathetic Dystrophy (RSD)
Acute Herpes Zoster/Post Herpetic Neuralgia
Rheumatoid Arthritis (RA)
DO NOT use T.E.N.S. in the following circumstances:
If you are in your first trimester of pregnancy (it is okay to use during labor – please consult your doctor)
If you have numbness or less feeling over a painful area
If you have pre-existing lymphoedema. T.E.N.S. may affect lymphatic circulation, causing further fluid retention. Issues of skin integrity should also be considered
How Safe is Electrotherapy?
Contra-Indications - Circumstances in which you should NOT use T.E.N.S. Remember that the current emitted from a T.E.N.S. unit travels through the skin between pairs of electrodes and only penetrates to a depth of 1-2 inches (to the level of the underlying nerve fibres). Such a small electrical current does not pose any danger.
CONSULT YOUR DOCTOR before using T.E.N.S. for the following circumstances:
If you have a pacemaker
If you have a cardiac condition
If you currently have Cancer or if you have previously had cancer
If you have recently experienced unexplained noticeable weight loss
If you have undiagnosed pain
If you have epilepsy
If you have had a stroke (Cerebrovascular Accident – CVA) or mini-stroke (Transient Ischemic Attack – TIA)
DO NOT use T.E.N.S. in the following ways:
While driving or operating potentially dangerous machinery
While in the shower
Do not use internally (inside your body)
Do not place pads in a way that directs the current through the chest wall (i.e. by placing one electrode on the back and the other opposite this on the front of the chest)
Do not place pads on the front of your neck. This risks stimulating the carotid sinus, which could cause cardiac problems (usually hypotension)
Do not apply pads over the eyes
Do not place pads across the temples on the head
Do not place pads over incisions or broken skin, sores and areas of eczema and psoriasis
Do not use with very high intensity if you find that your skin feels like it burns (dermal reaction due to electrical irritation)
Do not use if an allergy develops to the pads, adhesive or tape that is used. Find alternative materials
About Ideal Treatment Periods
Studies have shown that in most cases at least 20 minutes is needed for a T.E.N.S. treatment to begin to be effective.
However, in the case of using low-frequency or "burst" mode for acupuncture-like effects, 20 minutes would be considered the maximal treatment time, though it could be repeated later in the day.
On the other hand, for high-frequency or "conventional" T.E.N.S., there are no rules governing total treatment times. Most people find that anywhere between 20-60 minutes can provide them with several hours of relief.
It is normally not recommended that you use your T.E.N.S. when sleeping, but rather for a couple of hours before bed-time. Rolling over on your electrodes may cause them to come off or may put excess pressure on them which could result in skin irritation.
Although we can provide very helpful information specific to your needs, we still advise you to seek medical advice from your doctor to receive an accurate diagnosis and additional treatment recommendations.
How Does Electrotherapy Reduce Pain?
1. GATE CONTROL
The ‘Gate Control’ theory was first proposed in 1965. The main concept of this theory is that the brain can only pay attention to one stimulus (or message) at a time. When a painful stimulus causes a pain receptor (specialized cell that detects painful stimuli) to send a message to the brain via a ‘pain nerve’, the brain perceives that message as ‘pain’. Similarly, if a touch receptor is stimulated, a message is sent to the brain by a ‘touch nerve’ so that the brain perceives that message as ‘touch’ rather than pain.
Experience tells us that even if we feel pain after hitting our elbow, the natural response is to rub the elbow and suddenly the pain is not as intense. This is because the ‘touch nerve’ is larger and sends its information to the brain faster so that the pain message never really gets recognized by the brain. This is the same mechanism by which mom’s kisses seem to help most of the pain that children experience! T.E.N.S. also works by this method. The appropriate electrical signal stimulates the touch receptors, and via a bit of fancy signaling in the spinal cord, the pain message is not acknowledged by the brain. It is important to recognize though, that this phenomenon doesn’t take away what is causing the pain and the pain relief doesn’t last forever. It simply provides a “rest from pain” (as in the following quote by John Dryde, (1631–1700) English poet and dramatist: "For all the happiness mankind can gain is not in pleasure, but in rest from pain") to permit you to move better and thus assist the body in getting the nutrition and activity that it needs to complete the healing of the painful area both at rest and during appropriate exercises. Pain relief usually does not continue beyond 6 hours. This time frame is similar to that of many common pain medications yet without the unwanted side-effects.
2. RELEASE OF NATURAL PAIN-RELIEVING SUBSTANCES
The other way that T.E.N.S. works to relieve pain is by stimulating the release of natural chemicals in the body which the body usually releases when there is injury or stress.
The chemical substances released are known as endorphins and enkephalins. Endorphins are also naturally released by the body during prolonged exercise to produce the feeling of euphoria known as the “runner’s high”. Enkephalins are normally released with more intense but shorter duration exercise.
The T.E.N.S. unit can be adjusted to selectively stimulate the release of either enkephalins or endorphins. A physical therapist can help you to select which settings of the T.E.N.S. would be most appropriate for your pain.
The small electrical signal which is developed by the T.E.N.S. device is delivered to the body by specialized pads called electrodes. These electrodes are placed around the area of pain or on other areas of your body which are known to affect perception of pain. They are designed to ensure safe and effective treatment. It is important though that you ask your physical therapist to address with you the best ways to keep the electrodes working properly and optimally. Cleaning your electrodes and washing your skin (only where you are going to place the electrodes) with warm water before each treatment can prevent your skin from becoming irritated by the treatment. A physical therapist can also help you identify exactly where the electrodes should be placed on your body to optimize your pain relief.
Acute or Chronic Pain
T.E.N.S. can be used for either acute (recent or short-term) or chronic (long-term) pain. The settings on the T.E.N.S. unit can be adjusted to more effectively treat either type of pain. Again, a physical therapist can assess your pain and advise you on the settings that would be best for your type of pain.
The two electrodes that attach to the TENS machine are called the anode and the cathode. The anode is positively charged, and sometimes represented by a + (plus) sign (sometimes coloured black). The cathode is negatively charged, and sometimes represented by a - (minus) sign (sometimes coloured red). The electrical current travels from the anode to the cathode, so the sensation is often stronger under the anode.
THREE basic modes of relieving pain with T.E.N.S. :-->
CONTINUOUS (Constant or Normal)-
The standard T.E.N.S. treatment (also known as "conventional" or "high-frequency") is performed when the Pulse Rate is set to 60-100 pulses per second or more (in this method, rate, width (usually 200mcsec - and intensity settings are fully adjustable). It is thought that in this mode, pain relief is achieved through the gate control theory. The sensation produced with this setting can be described as a steady "buzzing" or "tingling" feeling between the electrodes. At this frequency the unit produces an electrical signal that is stronger than the pain signal that the body produces. Because the signal is perceived as stronger, it effectively blocks the pain signal from traveling along nerves to the brain. Most patients find that high-frequency treatments produce the quickest relief from pain, as well as providing hours of relief after the treatment if it is long enough .
BURST -
A "low-frequency" or "burst" type treatment is produced when the Pulse Rate setting on the T.E.N.S. unit is below 10 pulses per second ie. 2Hz (set manually) or at "burst" mode (automatic) (in this mode, width (often set at 200mcsec) and intensity settings are fully adjustable, however, the rate setting is not adjustable). Low-frequency treatments are done at an intensity that produces visible muscle twitching. The sensation at these settings is described as a "tapping" or "pulsating" feeling. The body reacts to this type of stimulation by releasing "endorphins" (pain-killing chemicals produced naturally in the body). These endorphins act as a chemical nerve block, effectively reducing pain by interrupting the flow of pain signals along the nerves. Patients find that this type of treatment sometimes takes longer to be effective (30 to 45 minutes), but once pain relief is experienced, it lasts for a longer period of time .
MODULATED -
Pulse width is automatically varied in a cyclic pattern at intervals of 6 seconds. The modulation range of pulse width varies from the control setting value to 40% less than that value. Rate, width and intensity are fully adjustable. Modulation of the T.E.N.S. output parameters (width, rate and amplitude) may prevent the nervous system from accommodating to the continuous mode of T.E.N.S., thus improving duration of pain relief.
Therapeutic Ultrasound
Ultrasound therapy is just about the most popular of the Electrophysical agents (EPA's), though strictly speaking, it is not 'electrotherapy' even though it is widely referred to as an electrotherapy modality.
There are several sections of the site that relate to ultrasound and I have divided them up to make navigation a bit easier
Ultrasound therapy : ** THE DOWNLOAD VERSION OF THIS DOCUMENT IS CURRENTLY MORE UP TO DATE THAN THE WEB PAGES. I WILL BE RENEWING THE WEB PAGES JUST AS SOON AS I GET SOME WRITING TIME, BUT I SUGGEST THAT YOU USE THE DOWNLOAD VERSION (
HERE) IN THE MEANTIME **
the basics of the modality, what it does and how it works
Ultrasound Dose Calculations :what it says on the label really - a review of how to work out an effective dose without needing a 'recipe' based approach
Ultrasound for Fracture healing :Lots of new material around on the use of low intensity pulsed ultrasound (LIPUS) as an adjunct the fracture management (fresh fractures, delayed and non unions)
Ultrasound Gels and Coupling Agents :A summary of some of the recent work produced by our research unit and some of the ongoing work
Ultrasound in the Treatment of Apomorphine Nodules A summary of the current position with regards the use of therapeutic ultrasound in the treatment of Apomorphine nodules in patients with Parkinsons Disease - plus research update
Current use
Electrotherapy includes a variety of stimulation types, protocols and uses. Most common are:
NMES (for Neuro-Muscular Electro-Stimulation) aka EMS (for Electro-Muscular Stimulation) for rehabilitation
TENS (Transcutaneous Electrical Nerve Stimulation) for pain therapy
Interferential currents; Russian currents (aka Kotz)
Microcurrents (aka MENS)
Galvanic currents for
Iontophoresis.
Electrotherapy is used for relaxation of muscle spasms, prevention and retardation of disuse atrophy, increase of local blood circulation, muscle rehabilitation and re-education, maintaining and increasing range of motion, management of chronic and intractable pain, post-traumatic acute pain, post surgical acute pain, immediate post-surgical stimulation of muscles to prevent venous thrombosis, wound healing and drug delivery.
Reputable medical and therapy Journals have published peer-reviewed research articles that attest to the medical properties of the various electro therapies. Yet some of the treatment effectiveness mechanisms are little understood. Therefore effectiveness and best practices for their use in some instances are still anecdotal.
Electrotherapy devices have been studied in the treatment of chronic wounds and
pressure ulcers. A 1999
meta-analysis of published trials found some evidence that electrotherapy could speed the healing of such wounds, though it was unclear which devices were most effective and which types of wounds were most likely to benefit.
[4] However, a more detailed review by the
Cochrane Library found no evidence that
electromagnetic therapy, a subset of electrotherapy, was effective in healing pressure ulcers
[5] or
venous stasis ulcers.
[6] See also
Neuromuscular diagnosticsGalvanic bathFrequency Specific Microcurrent
History
In 1855
Guillaume Duchenne, the father of electrotherapy, announced that alternating was superior to direct current for electrotherapeutic triggering of muscle contractions.
[2] What he called the 'warming affect' of direct currents irritated the skin, since, at voltage strengths needed for muscle contractions, they cause the skin to blister {at the anode} and pit (at the cathode). Furthermore, with DC each contraction requiring the current to be stopped and restarted. Moreover alternating current could produce strong muscle contractions regardless of the condition of the muscle, whereas DC-induced contractions were strong if the muscle was strong, and weak if the muscle was weak.
Since that time almost all rehabilitation involving muscle contraction has been done with a symmetrical twin-phase wave. In the 1940s, however, the US War Department, investigating the application of electrical stimulation not just to retard and prevent atrophy but to restore muscle mass and strength, employed what was termed galvanic exercise on the atrophied hands of patients who had an ulnar nerve lesion from surgery upon a wound.
[3] These Galvanic exercises employed a monophasic wave form, direct current - electrochemistry. The clinical findings were favorable, which made electrochemical therapy (ECT or EChT) an important subset of electrotherapy.
Electrotherapy is the use of
electrical energy in the treatment of
impairments of health and a
conditions of abnormal functioning.
[1] In
medicine, the term electrotherapy can apply to a variety of treatments, including the use of
direct current in
cardioversion and the use of electrical devices such as
deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electrical current to speed wound healing. Additionally, the term "electrotherapy" has also been applied to a range of
alternative medical devices and treatments.
