Interferential Therapy (Notes)

INTERFERENTIAL THERAPYSagar Naik, PT

1

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Interferential therapy is a form of electrical treatment in which two
medium-frequency currents are used to produce a low-frequency effect.Inte rferential
current can be defined as the transcutaneous application of alternating medium- frequency
electrical currents, which are slightly out of phase through the tissues, amplitude modulated
at low frequency for therapeutic purposes such as relief of pain, improve circulation and
enhances healing process. Frequency used for
interferential therapy is 3500 Hz to 5000 Hz.
Z=1/2Π fC
Where, Z = skin impedance or capacitive resistance or skin interface or reactance
resistance or skin resistance
f = frequency in Hertz (Hz)
C = capacitance of skin in microfarads
From above formula, skin impedance is inversely proportional to
frequency and capacitance of the skin. Capacitance of the skin cannot be changed;
hence by increasing the frequency the skin impedance can be lowered.
Skin impedance is of two types namely, ohmic resistance andcapacitiv e
resistance.
Ohmic resistance is developed due to skin and depends on following
factors:

 O h m i c r e s i s t a n c e i s i n v e r s e l y p r o p o r t i o n a l

t o t h e s i z e o f t h e e l e c t r o d e s u s e d .

 O h m i c r e s i s t a n c e i s d i r e c t l y p r o p o r t i o n a l t o

t h e d r y n e s s o f t h e s k i n .
 O h m i c r e s i s t a n c e i s d i r e c t l y p r o p o r t i o n a l t o

t h e h a i r y a n d o i l y s k i n .
Capacitive resistance is developed deep in the tissues due to electrolytic
potential difference generated in the cell membrane.
Interferential currents have advantage of reducing the skin impedance
or resistance, and thus the discomfort normally incurred by traditional low-frequency
currents, but still producing low-frequency effects within the tissues. They are used to
produce effects in deeper tissues of the body.
 Production of Interferential Current:
 I n t e r f e r e n t i a l c u r r e n t i s e s s e n t i a l l y a
m e d i u m - f r e q u e n c y c u r r e n t t h a t r h y t h m i c a l l y
increases and decreases in amplitude at low frequency.
INTERFERENTIAL THERAPYSagar Naik, PT
2
 T h e p r i n c i p l e u p o n w h i c h i n t e r f e r e n t i a l
t h e r a p y i s b a s e d i s t h a t w h i c h p r o d u c e s
the interference effect where two medium frequency currents cross in the
patient’s tissues.
 T w o m e d i u m f r e q u e n c y c u r r e n t s a r e
u s e d t o p r o d u c e t h e i n t e r f e r e n t i a l
c u r r e n t .
They are known as carrier waves as they do not produce muscle nerve stimulation and are
just used to get the greater depth of penetration and to produce the interferential current.
channel 2
channel 1
channel 1
channel 2
interferential
current
 I n t e r f e r e n t i a l c u r r e n t i s p r o d u c e d
b y m i x i n g t w o m e d i u m - f r e q u e n c y
c u r r e n t s
that are slightly out of phase, either by applying them so that theyinterfere within the tissues,
or alternatively by mixing them within the stimulator prior to application (premodulated
current).
 S t i m u l u s a s y n c h r o n o u s i s a p p l i e d
f o r p r o d u c t i o n o f i n t e r f e r e n t i a l
c u r r e n t s o
Wedensky inhibition doesn’t takes place and thereby there is no accommodation
phenomenon. Stimulus asynchronous produces Gilde-Meister effect.
[In low-frequency currents, stimulus synchronous is used which causes Wedensky
inhibition and thus nerve or muscle gets accommodated to that current.
Inability of tissue to respond during the refractory period due to stimulus
synchronous current is known as Wedensky inhibition.]
 O n e c u r r e n t i s n o r m a l l y o f f i x e d
f r e q u e n c y , f o r e x a m p l e a t 4 0 0 0 H z , a n d
o t h e r
current is adjustable, for example between 4000 Hz and 4250 Hz.
 T h e o r e t i c a l l y , t h e t w o
c u r r e n t s s u m m a t e o r c a n c e l
e a c h o t h e r o u t i n a
predictable manner, producing the resultant amplitude-modulated
interferential current.

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 T h e f r e q u e n c y o f t h e r e s u l t a n t
c u r r e n t w i l l b e e q u a l t o t h e m e a n o f
t h e t w o
original currents, and will vary in amplitude at a frequency equal to the difference between
these two currents. This later frequency is known as the amplitude-modulated frequency
(AMF)or beat frequency.
 Amplitude-Modulated Frequency (AMF):
 It is also known as the beat frequency.
 A M F i s d e f i n e d a s t h e d i f f e r e n c e
b e t w e e n t h e f r e q u e n c i e s o f t h e t w o
m e d i u m -
frequency currents, which is produced in the tissues at the point where the two
currents cross.
 A m p l i t u d e o f A M F i s a l w a y s h i g h e r
t h a n t h e a m p l i t u d e o f t h e t w o
m e d i u m -
frequency currents.
 N e r v e o r c e l l m e m b r a n e d o e s n o t
c o i n c i d e w i t h t h e i n t e n s i t y o f A M F
o f t h e
current, which we give to the tissues.
 AMF is a low-frequency current, which is
produced deep inside the tissues.
 For example, Circuit A
4000 Hz
medium
Circuit B
3900 Hz
frequency
Beat Frequency 100 Hz – low frequency
 AMF are of two types, which are as follows :
1) Static AMF:
By varying the frequency of the second circuit relative to the constant frequency of the
first, it is possible to produce a range of beat frequencies deep in the patient’s tissues. It can
be constant or variable. It is used for the treatment of localized or smaller areas. Constant
beat frequency is also
known as selective beat frequency. Variable beat frequency is also known as
automatic beat frequency.

 0 t o 5 H z s t i m u l a t e s s y m p a t h e t i c n e r v e s

 5 t o 1 0 H z s t i m u l a t e s p a r a s y m p a t h e t i c n e r v e s

 1 0 t o 5 0 H z s t i m u l a t e s m o t o r n e r v e s

 5 0 t o 9 0 H z p r o d u c e s s e d a t i v e a n d

s p a s m o l y t i c e f f e c t

 9 0 t o 1 0 0 H z p r o d u c e a n a l g e s i c o r p a i n

r e l i e f e f f e c t
2) Dynamic or vector or scanning AMF:
By varying the intensity of the second circuit relative to the constant intensity of the
first, it is possible to produce the dynamic AMF. It is also known as vector AMF or scanning
AMF. This vector can be of 45° or 90°. It is used for the treatment of larger areas.
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 Advantages of Interferential Currents:
 T h e r e i s n o a c c o m m o d a t i o n o f n e r v e
o r m u s c l e d u e t o s t i m u l u s
a s y n c h r o n o u s
current, which produces Gilde-Meister effect in the tissues.
 S k i n r e s i s t a n c e i s v e r y m u c h l o w e r e d ,
h e n c e t h e r e i s n o i r r i t a t i o n o f s k i n , a n d
thus interferential currents can be given for longer period of time.
 I n t e r f e r e n t i a l c u r r e n t s a r e u s e d t o
t r e a t d e e p e r t i s s u e s a s a m p l i t u d e -
m o d u l a t e d
frequency is produced deep in the tissue.
 It relieves pain by the pain gate theory.
 It can give sensory stimulation and motor
stimulation.
 T h e r e a r e m i n i m u m c h a n c e s o f e l e c t r o l y t i c
b u r n s w i t h t h e i n t e r f e r e n t i a l c u r r e n t s
as the amplitude of the current keeps on varying continuously.
 Interferential currents are used to treat
larger area.
 Area of Interference:
It is the area where interferential current is set-up. The pattern of the
interferential area may be static or dynamic.
channel 1
channel 2
channel 2
clove leaf
channel 1
appearance
 S t a t i c I n t e r f e r e n c e :
The area in which interferential current is set-up remains stationary is
known as static interference. This are of static interference gives an appearance
of clove leaf as a result of the vector addition of two currents and it lies to 45°
angles to the perpendicular lines from each electrode.
 D y n a m i c I n t e r f e r e n c e :

It is possible to move the area in which interference current is developed in a to and

fro manner through 45°. It is obtained by varying the current intensity in suitable manner.
Current is varied from 50 to 100%. This dynamic
are of interference is also called as vector sweep, vector scan, rotating vector, etc.
It can also be rotated through 90°.

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 Methods of Application:
 Quadripolar / Bipolar Application:
 I n t e r f e r e n t i a l c u r r e n t s m a y b e p r o d u c e d
e i t h e r b y a p p l y i n g t h e t w o m e d i u m
frequency currents via four electrodes (quadripolar method) so that they intersect in the
tissues, or alternatively by mixing the two currents in the stimulator prior to application via
two electrodes (premodulated or bipolar method).
 A q u a d r i p o l a r a p p l i c a t i o n o f
i n t e r f e r e n t i a l c u r r e n t p r o d u c e s
m o d u l a t e d
current in a clove leaf pattern, with leaves set up at right angles to the two
medium frequency currents.
 Q u a d r i p o l a r i n t e r f e r e n t i a l c u r r e n t i s
p r o d u c e d d e e p i n s i d e t h e t i s s u e s ( A M F
is produced endogenously); hence there is lowered skin impedance. Thus it
is used to treat larger areas.
 B i p o l a r i n t e r f e r e n t i a l c u r r e n t w i l l
b e d i s t r i b u t e d s i m i l a r l y t o
c o n v e n t i o n a l
electrical stimulation, with maximal current intensities underneath the
electrodes, progressively decreasing with distance.
 B i p o l a r i n t e r f e r e n t i a l c u r r e n t
i s p r o d u c e d i n s i d e t h e m a c h i n e
( A M F i s
produced exogenously); hence there is increased skin impedance. Thus it is
used to treat localized area or smaller areas.
 V a c c u m ( S u c t i o n ) / R u b b e r ( P l a t e ) e l e c t r o d e s :
 I n t e r f e r e n t i a l current is often applied via
electrodes that are held in place using
an intermittent suction unit. Alternatively, flat carbon rubber electrodes may
be used.
 S u ct i o n el ec t r o d e s h av e a d v a n t a g e o f
a l l o wi n g ap p l i c at i o n t o l ar g e f l at ar ea s
or to patients who are relatively immobile.
 T h e s u c t i o n a l s o s t i m u l a t e s c u t a n e o u s
n e r v e s a n d c a u s e v a s o d i l a t a t i o n a n d
thus increases blood circulation to that area.
 F l a t ca r b o n r u b b e r el ec t r o d e s m ay b e ea s i er
t o a p p l y t o p er i p h er al l i m b s , wh en
they may be held in position by bandages or elasticated Velcro straps. On other hand there
may be anatomical areas that are less accessible and in these cases the suction option may be
advantageous.
 Constant / Dynamic AMF:
 I f c o n s t a n t A M F t y p e o f c u r r e n t i s
g i v e n , t h e n t h e r e a r e s o m e c h a n c e s o f
getting nerve or muscle accommodation.
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INTERFERENTIAL THERAPYSagar Naik, PT
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 I f d y n a m i c A M F t y p e o f c u r r e n t i s
g i v e n , t h e n t h e r e a r e n o c h a n c e s o f
getting nerve or muscle accommodation.
 S c a n n i n g / S t a t i c I n t e r f e r e n c e :
 I f v e c t o r 4 5 ° o r 9 0 ° ( d y n a m i c ) i s u s e d ,
t h e n l a r g e r a r e a o f t h e b o d y c a n b e
treated.
 I f s t a t i c t y p e o f i n t e r f e r e n c e i s u s e d
t h a n o n l y s m a l l e r a r e a o f t h e b o d y c a n
be treated.
 2 K H z / 4 K H z :
 M o s t l y , 2 K H z f r e q u e n c y i s u s e d
f o r t h e m u s c l e s t i m u l a t i o n a n d 4
K H z
frequency is used for pain relief.
 Selection of Pulse:
 T r i a n g u l a r – A c u t e c a s e s

 R e c t a n g u l a r – C h r o n i c c a s e s

 T r a p e z o i d a l – S u b a c u t e c a s e s
 Intensity:
 L e s s t h a n 8 m A – S e n s o r y s t i m u l a t i o n ( 4 t o
8 m A )
 M o r e t h a n 8 m A – M o t o r s t i m u l a t i o n ( 8 t o
1 6 m A )
 Physiological Effects of Interferential
Current:
 Pain Relief:
 I n t e r f e r e n t i a l c u r r e n t i s
c o m m o n l y u s e d f o r e l e c t r o -
a n a l g e s i a i n v a r i o u s
musculoskeletal conditions.
 Pain relief may occur as a result of removal
of irritant or pain substances.
 I n t e r f e r e n t i a l c u r r e n t c a n
s t i m u l a t e a u t o n o m i c n e r v e s ,
w h i c h r e s u l t s i n
vasodilatation and improved circulation. Improved circulation can remove
the waste products or pain substances from the site of application.
 P a i n r e l i e f m a y b e d u e t o r e l e a s e o f
e n d o r p h i n s o r d u e t o a c t i v a t i o n o f p a i n
gate mechanism.
 Pain relief may also occur due to placebo
effect.
[Placebo Effect: A positive or negative response to a therapy resulting
from person’s expectations rather than from any real effects.]
 Pain may be relieved if a constant beat in the
range of 0 – 100 Hz is used. This
causes a tingling sensation, which after fifteen minutes treatment can produce
relief of pain for upto one hour.
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 Mo t o r S t i m u l a t i o n :
 N o r m a l i n n e r v a t e d m u s c l e s w i l l b e
m a d e t o c o n t r a c t i f a c o n s t a n t f r e q u e n c y
between 1 to 10 Hz is used.
 Muscle contraction can be achieved at higher
current amplitude.
 S t r o n g m u s c l e
c o n t r a c t i o n s c a n b e
a c h i e v e d w i t h o u t a y
s i g n i f i c a n t l y
uncomfortable skin sensation.
 I n t e r f e r e n t i a l c u r r e n t c a n s t i m u l a t e
d e e p l y s i t u a t e d m u s c l e s , a s i t i s l i k e
a
low frequency current.
 T h e c o n t r a c t i o n i s p r o d u c e d w i t h
m i n i m a l s e n s o r y s t i m u l a t i o n a n d c a n b e
deeply placed muscles, e.g., those of the pelvic floor.
 E f f e c t o n v e n o u s & L y m p h a t i c R e t u r n s :
 T h i s i s a c c e l e r a t e d b y f r e q u e n c y
o f 1 – 1 0 H z ( r h y t h m i c ) , a s
r h y t h m i c a l
pumping action produced in muscle helps in improving the drainage of
blood and lymph.
 Thus, this effect of interferential current is
used in the treatment of oedema.
 R e l i e f o f Mu s c l e S p as m :
 Interferential therapy can bring about relief
of muscle spasm.
 Indications of Interferential Current:
 I n t e r f e r e n t i a l c u r r e n t i s c o m m o n l y u s e d f o r
p a i n r e l i e f , r e l i e f o f m u s c l e s p a s m ,
promote tissue healing, relief from oedema and re-education of deeply situated
muscles.
 I t s u s e i n t h e a r e a o f s p o r t s m e d i c i n e
i s c l a i m e d t o b e p a r t i c u l a r l y b e n e f i c i a l
i n
reducing pain and oedema.
 I n t e r f e r e n t i a l t h e r a p y
h a s b e e n u s e d e x t e n s i v e l y
i n t r e a t m e n t o f s t r e s s
incontinence, as it is possible by placing electrodes on lower abdomen and
inner thigh to produce good strong contractions of pelvic floor muscles.
 Co n d i t i o n s t r e a t e d b y I n t e r f e r e n t i a l C u r r e n t :
 Peripheral vascular disease (PVD)
i. Vasoconstrictive disease (Raynaud’s Disease)
A disorder wherein exposure to cold causes sudden contraction of small arteries supplying
the fingers and toes is known as Raynaud’s disease.
ii. Venous insufficiency
Inability of veins to pump the blood towards the heart is known as
venous insufficiency.
iii. Buerger’s disease

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INTERFERENTIAL THERAPYSagar Naik, PT

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 It is a combination of thrombosis, inflammation and obliteration of small and medium
sized arteries. The disease begins in distal small arteries and spreads upwards.
 Facial nerve neuritis
Inflammation of facial nerve, which leads to oedema of the face and
results in further compression of the facial nerve.
 Orthopedic conditions
i)
Osteotendinitis Eg:- Lateral epicondylitis
ii)
Joint sprains
iii) Fracture complications like delayed union, non-union & retarded
callous formation
iv) Pseudus atrophy (dystrophy)
 Gynecological Problems
i)
Stress incontinence
ii)
Urinary frequency
iii) Pelvic floor dysfunction
 Pain (All types of musculoskeletal pains)
i)
Low back pain
ii)
Brachial neuralgia
Severe pain in the course or distribution of a brachial nerve due to
irritation or damage to the brachial nerve is called brachial neuralgia.
iii) Sciatica
Pain in the distribution of sciatic nerve due to lateral disc protrusion on L4
and/or L5 spinal nerve roots is called sciatica.
iv) Phantom limb pain
Pain felt as though arising in an amputated limb is called phantom limb
pain.
v)
Myalgia
Pain in the muscles is known as myalgia.
 Muscle re-education and muscle strengthen
 O s t e o a r t h r i t i s

Degenerative joint disease characterized by both degeneration of articular cartilage and

simultaneous proliferation of new bone, cartilage, and connective tissue.
 Ankylosing spondylitis
A chronic inflammatory arthritis with a predilection for the sacroiliac joints and spine is
known as ankylosing spondylitis. It manifests by progressive stiffening and fusion of the
axial skeleton.
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INTERFERENTIAL THERAPYSagar Naik, PT
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 Spondylosis
A defect in the interarticular part of the vertebra is called spondylosis.
 Frozen shoulder
A painful stiff shoulder secondary to periarthritis of the shoulder joint is
known as frozen shoulder.
 Chondromalacia
Softening of the cartilage is called chondromalacia.
 Nocturnal incontinence
Inability to control the passage of natural discharges or evacuations as
urine or faeces during night or sleep is known as nocturnal incontinence.
 Myositis
Inflammation of the muscles is known as myositis.
 Following immobilization
 Bronchial asthma
Bronchial asthma is a complex and heterogeneous syndrome characterized by episodic
intrathoracic airways obstruction, airways inflammation resulting in occurrence of dyspnoea
and wheezing which varies widely over time either spontaneously or in response to
treatment.
 Bursitis
Inflammation of a bursa is called bursitis.
 Tendinitis
Painful inflammation of a tendon caused by injury, overuse or prolonged
pressure is called tendinitis.
 Hazards (Dangers) of Interferential Current:
 Adverse Effects:
A number of adverse effects have been reported with interferential current
treatment; these includes

 Burns
 Increased pain
 General malaise
 Nausea
 Vomiting
 Dizziness / Faintness
 Migraine / Headache
 Neurological effects
 Contraindications:
 Cardiac pacemakers

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 Advanced cardiac disease

 Hypertension
 Hypotension
 Patients where disturbance of thrombus, spread of infection or cancerous
cells, hemorrhage might result
 Pregnant women (Interferential therapy is contraindicated in abdominal,
lumbosacral, and pelvic area as it may lead to uterine contractions.)
 Increased cellular metabolism
i)
Neoplasm
A tumour; an abnormal growth serving no function is called neoplasm.
ii)
Tuberculosis
An infectious disease caused by Mycobacterium tuberculosis. Lungs form
the common site of the disease.
iii) Infection
The invasion of the body by microorganisms that reproduce and multiply
causing disease is called infection.
 Asthenic individuals (Children with small body mass should not be given
interferential current to rib cage.)
 Trauma
 Hyperpyrexia
Extremely high fever with a temperature above 41°C is known as
hyperpyrexia.
 Senile or confused patients (Mentally retarded, Mentally confused or Elderly
patients)

 Loss of skin sensations

 Open wounds, cuts or skin lesions
 Nearby short wave diathermy (SWD) i.e., 15 feet.
The leads of interferential therapy may act as antenna and may collect radio frequency
energy from SWD and produce undesirable surging of stimulus that patient receives.
 Precautions or Preparation before the Treatment:
 Aims:

 To avoid dangers
 To increase positive outcome of the treatment
 To optimize patients complains
 Precautions:
 Evaluate the sensations like touch, pain, and temperature.

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INTERFERENTIAL THERAPYSagar Naik, PT

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 Prepare the skin to avoid ohmic resistance
i)
Wash the skin
ii)
Warm the skin
iii) Clip the hairs
 Don’t place the electrodes on cuts, abrasions, open wounds, scratches, or
denuded skin.

 Use equal size electrodes.

 Apply even pressure during trapping.
 Evenly moist the sponges.
 Apply enough and comfortable vaccum during vaccum electrodes to prevent
haematoma or ecchymosis.
[Haematoma: A collection of blood inside the body, caused by bleeding from
an injured vessel is called haematoma.
Ecchymosis: A purplish discolouration from extravasated blood into the skin
or mucous membrane. It follows bleeding from a large vessel.]

 Optimal positioning of electrodes (Diagonal pattern).

 Educate the patient about the interferential current.
 Instruct the patient not to touch leads and apparatus during the treatment.
 Important Points of Interferential Current:
 2 KHz – Muscle Stimulation
4 KHz – Pain Modulation
 High AMF (70 to 130 Hz) – Acute problems and pain
Low AMF (less than 50 Hz) – Chronic and Subacute problems where muscle
contraction is needed.
 Metal implants are not the contraindications of interferential therapy.

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Interferential Therapy
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Notes
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clinical
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nerve
healing
inter ferential
ferential therapy
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Notes
Summary
clinical
khz
disease
dangers
nerve
healing
inter ferential
ferential therapy
methods
farential therapy
inter farential
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