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Alternating vs. Direct Current

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Alternating vs. Direct Current

• Nerve doesn’t know
the difference
between AC and DC
• With continuous DC,
a muscle contraction
occurs only when the
current intensity
reaches threshold for
the motor unit DC current influence on a motor unit

Alternating vs. Direct Current

• Once the membrane

of the motor unit
repolarizes, another
change in the current
intensity would be
needed to force
another depolarization
to elicit a muscle DC current influence on a motor unit
contraction

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Alternating vs. Direct Current

• Biggest difference between the effects of
AC and DC is the ability of DC to cause
chemical changes
• Chemical effects usually occur only when
continuous DC is applied over a period of
time

Galvanic current

 Itis an interrupted direct current also called long duration

current having more than 1 ms up to 300 ms or 600 ms.

 the commonly used duration is 100 ms duration requires

a frequency of 30 pulses/ min.

If the duration increases the frequency must be reduced.

 The interval between the impulses should never be of

shorter duration than the impulses themselves.

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different types of direct current impulses

A rectangular impulse
B trapezoidal
C triangular
D saw tooth impulse.

Current Density

• Current density refers to the volume of

current in the tissues
• Current density is highest at the surface and
diminishes in deeper tissue

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Altering Current Density

• Change the spacing of electrodes

• Moving electrodes further apart increases
current density in deeper tissues

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Contra – indications
Cardiac pacemakers and Arrhythmias
Hemorrhagic condition
Thrombosis and thrombophlebitis (inflammation of wall of vein)
Early tendon transfer and repair
Pregnancy: On pelvic, low back and abdomen
Unconscious patient
Recent radiotherapy
Carotid sinus
Child with mental disturbance
Malignancy
Infected wound and skin lesion

Altering Current Density

• Changing the size of the electrode

• Active electrode is the smaller electrode
– Current density is greater
• Dispersive electrode is the larger electrode
– Current density is less

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Frequency

• Effects the type of muscle contraction

• Effects the mechanism of pain modulation

Intensity
• Increasing the
intensity of the
electrical stimulus
causes the current
to reach deeper into
the tissue

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Duration
• More nerve fibers will
be stimulated at a
given intensity by
increasing the duration
(length of time) that an
adequate stimulus is
available to depolarize
the membranes
• Duration is typically
adjustable on low-
voltage stimulators

Electrode Placement

• On or around the painful area

• Over specific dermatomes correspond
to the painful area
• Close to spinal cord segment that
innervates an area that is painful
• Over sites where peripheral nerves that
innervate the painful area becomes
superficial and can be easily stimulated

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Electrode Placement

• Over superficial vascular structures

• Over trigger point locations
• Over acupuncture points
• In a criss-cross pattern surrounding the
treatment area

• If treatment is not working, change

electrode placement

interrupted direct
current

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Stimulation of Denervated Muscle

• Denervated muscle has lost its peripheral

nerve supply
– Results in a decrease in size, diameter, and weight
of muscle fibers
– Decrease in amount of tension which can be
generated
– Increase the time required for contraction
• Electrical currents may be used to produce a
muscle contraction in denervated muscle to
minimize atrophy

Stimulation of Denervated Muscle

• Degenerative changes progress until

muscle is re-innervated by axons
extending across site of nerve lesion
• If re-innervation does not occur within 2
years, fibrous connective tissue replaces
contractile elements
– Recovery of muscle function is not possible

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Denervated Muscle Protocol

• Intensity: should be enough to produce
moderately strong contraction
• Pulse Duration: must be equal to or
greater than chronaxie of denervated
muscle
• Current: asymmetric, biphasic (faradic)
waveform
– After 2 weeks, other waveforms may be
used
• Interrupted DC square, Progressive DC
exponential, or Sine AC

Denervated Muscle Protocol

• Frequency: as low as possible but
enough to produce a muscle contraction
• On/Off Cycles:
– On-time should be 1 - 2 seconds
– Off-time may be 1:4 or 1:5 contraction to
recovery ratio
– Fatigue must be considered

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Denervated Muscle Protocol

• Electrode Placement: either a

monopolar or bipolar electrode setup can
be used
– Small diameter active electrode placed over
most electrically active point on muscle
• Treatment Time: should begin
immediately after injury or surgery
– 3 sets of 5 -20 repetitions 3 x per day

Low-Voltage Continuous DC:

Medical Galvanism

• Intensity: should be to tolerance

• Intensity in the milliamp range
• Current: low-voltage, continuous DC
• Frequency: 0 pps
• Electrode Placement: equal-sized electrodes
are used over saline-soaked gauze
– Skin should be unbroken
– Precaution = skin burns
• Treatment Time: should be 15 - 50 min

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Low-Intensity Stimulators
• LIS is a sub-sensory current
• Intensity of LIS is limited to <1000
microamps (1 milliamp)
• Exact mechanism of action has not yet
been established
• More research is needed

Low-Intensity Stimulators:
Analgesic Effects
• LIS is sub-sensory, therefore it does not fit
existing theories of pain modulation
• May create or change current flow of the neural
tissues
– May have some way of biasing transmission of painful
stimulus
• May make nerve cell membrane more receptive
to neurotransmitters
– May block transmission

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Low-Intensity Stimulators:
Wound Healing

• Intensity:
– 200 - 400 µamp for normal skin
– 400 - 800 µamp for denervated skin
• Pulse Duration: long, continuous,
uninterrupted
• Current: monophasic DC is best
– May use biphasic DC
• Frequency: maximum

Low-Intensity Stimulators:
Wound Healing

• Treatment Time: 2 hours

– Followed by a 4 hour rest time
– May administer 2 - 3 treatment per day
• Electrode Placement:
– First 3 days…
• Negative electrode positioned in the wound
area
• Positive electrode positioned 25 cm proximal

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Low-Intensity Stimulators:
Wound Healing

• Electrode Placement continued:

– After 3 days…
• Polarity reversed and positive electrode is
positioned in the wound area
– In the case of infection…
• Negative electrode should be left in wound area
until signs of infection disappear for at least 3
days
• Continue with negative electrode for 3 more
days after infection clears

Low-Intensity Stimulators:
Fracture Healing
• Intensity: just perceptible to patient
• Pulse Duration: should be the longest
duration allowed on unit
– 100 to 200 msec
• Current: monophasic or biphasic current
– TENS units
• Frequency: should be set at lowest
frequency allowed on unit
– 5 to 10 pps

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Low-Intensity Stimulators:
Fracture Healing

• Treatment Time: 30 minutes to 1 hour

– May repeat 3 - 4 times per day
• Electrode Placement:
– Negative electrode placed close to, but
distal to fracture site
– Positive electrode placed proximal to
immobilizing device

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DIADYNAMIC CURRENT


Diadynamic is one of the most common devices
of electro-therapy, which uses a low current for
its analgesic and spasmolytic effect.
 are mixed currents, which use effects of the
concurrent application of galvanic and faraday, or
other impulse-like currents.
 This results in combined effects of both types of
currents, especially induction of hyperaemia and
analgesia.

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 Sinusoid-like impulse currents have inhibitory or

facilitation effect, which depends on the
frequency, intensity and other parameters.
 The current with predominantly inhibitory effect
has the frequency 100 Hz, current with frequency
50 Hz acts rather dynamogenically, i.e. causing
excitation, facilitation and supporting muscle
tone, it eliminates oedema around the nerve
envelope, reducing pain and supporting muscle
tone.

Two main types which are characterized by

the different types of waveforms produced by
the device
 Half-wave rectification (single phase or
monophasé fixe (MF)) Eliminates the second
half of each AC cycle to produce a monophasic
pulsed current with a pulse duration equal to
the interpulse interval and a frequency equal
to that of the original AC

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Full-wave rectification (double phase or

diphasé fixe (DF) Produces a monophasic
pulsed current with no interpulse internal at
twice the original AC frequency

Types of diadynamic current

It has five classic current types:
1- DF (diphase Fixe)
2- MF (monophase Fixe)
3-CP (Courtes Periodes),
4- LP (Longues Periodes)
5-RS( Syncopal Ryhthm)

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1- DF (diphase Fixe):
- Full wave rectified alternating current
- Frequency 100 Hz
- The patient feels tickling sensation and muscle
contraction occurs only at high intensities
- Used for initial treatment and has analgesic
effect and for interrupted circulation.

2- MF (monophase Fixe)
- Half wave rectified alternating current
- Frequency 50 Hz
- The patient feels strong vibration sensation
- It is used in treatment of pain without muscle spasm
- MF current can cause muscle stimulation at lower
intensity then with DF and used after (D.F.).

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3-CP (Courtes Periodes, short periods)

Rapid alternation between one second of
MF current and one second of DF
without interval pauses
used for facial palsy and sciatica..

4- LP (Longues Periodes, long periods)

Slow alternation between six seconds of
DF current and six seconds MF phase in
which a peak intensity is varied.
sedative for rheumatoid arthritis and
for neck rigidity.

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5. RS (Syncopal Rhythm):

• It comprises 1-sec phase of MF, followed by

a 1-sec rest phase. .) used after removing
cast for rehabilitation of fractures.

Indications

Didynamic stimulation causes relief of pain and edema in the

following conditions:

- Soft tissue injury (sprains, strain, contusion and epicondylitis).

- Joint disorders (post-immobilization and arthritis).
- Circulatory disorders (Raynaud's disease and migraine).
- Peripheral nerve disorders (neuralgia and sciatic neuritis).

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Contraindications

* Open skin: The current tends to concentrate at this point;

small broken areas can be insulated by Vaseline.
* Bony areas: It may produce burn.
* Loss of sensation: It can produce burn.
* Skin lesions: Eczema fungi can be irritated and made
worse.
* Infections: It may cause spreading of infection.
* Thrombosis.
* Cardiac pace makers.
* Superficial metal.

Dosage

Intensity: It should be increased gradually until

definite vibration or prickling sensation occurs.
Duration: Not more than 12 minutes; each type for
3 minutes.
Frequency: Daily or every other day for 12 sessions.

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 Interferential Current (IFC)
• A unique use of kilohertz AC waveform
• “endogenous production of the IFC”
• Emphasis on use for pain control & some
limited NMES applications
• Anecdotal support - tissue healing & increase
circulation via autonomic stimulation

IFC Waveform Precursors

• 2 electrical circuits (channels) of AC
– Medium Frequency AC (1,000 - 10,000 Hz)
– One Carrier (fixed) frequency AC
– One Variable frequency AC
– Example: 5000 Hz / 5100 Hz.
 IFC production - in uniform medium
• Clover-leaf Pattern of IFC
• Each circuit equal amplitude at a 90 degree
angle to each other.

Indications

- Pain relief / anaesthetic effect by stimulating the release

of endorphins and blocking the transmission of pain
impulses (pain gate mechanism).

- Increase in blood flow to promote tissue healing and

reduce swelling/ inflammation.

- Muscle stimulation to activate weak muscles and

overcome muscle inhibition caused by the injury
Contraindications
- Patients with pacemakers

- Near the low back or abdomen of

pregnant women

- Local malignancy

Treatment Parameters

 Stimulation can be applied using pad electrodes and

sponge covers (which when wet provide a reasonable
conductive part)
 though electroconductive get is an effective alternative.
The sponges should be thoroughly wet to ensure even
current distribution.
 Self adhesive pad electrodes are also available (similar to
the newer TENS electrodes) and make the IFT application
easier in the view of many practitioners
 electrode positioning should ensure adequate coverage of
the area for stimulation.
 Using larger electrodes will minimise patient discomfort
whilst small, closely spaced electrodes increase the risk of
superficial tissue irritation and possible damage / skin burn.
 Application & Rx Guidelines
• Treatment of an area of pain (joint OR soft tissue) with IFC.
Quadpolar setup, X marks the spot.
– Acute Pain: High Freq (>50), Sensory to Low Motor Amp
– Chronic Pain: Low Freq (<10), Motor to Noxious Amp

Premodulated IFC (Bipolar)

IFC produced in the unit & delivered thru 1 channel,

not as comfortable but can put on & over; convenient
Types of Electrodes

1) Plate Electrodes

plates made of conducting rubber which are comfortable

and long lasting
-larger plates give more comfortable treatment and deeper
effect
-smaller plates are used for a localized effect, but this
effect is more superficial
-plates are attached to the patient by means of straps or
bandages
-be sure to have good contact of the plate with the patient
allows for more pleasant
treatment and greater tolerance of current

Covering:

-the electrodes must be fully covered with absorbent

material
-coverings should be soaked in water or a solution of
bicarbonate of soda to conduction and allow a more
comfortable contact with skin

-the coverings must be kept clean and washed

thoroughly and dried after use
2) Vacuum Electrodes

-the IFC unit is plugged into a vacuum unit a rubber

suction cup connected to a machine capable of producing
a vacuum
-they’re really plate electrodes kept in position by a
vacuum instead of bandaging
-around the neck of the cup is a rubber collar covering a
small hole
-by lifting the collar, air is let into the cup, thus allowing the
electrode to be moved while the vacuum is in operation
-do not try and tug off the electrode from the patient
without releasing the vacuum discomfort and bruising may
result!

-place wet sponges in the cups and moisten the edges of

the cups for better adherence
-the suction should not be constant è uncomfortable and
causes bruising
-it may be pulsed and adjusted to increase and decrease at
a desired speed
-vacuum electrodes are excellent for treating flat smooth
areas e.g. back knee.
-not ideal for hairy areas can’t get an airtight seal
3) Combined Electrodes

-all four contacts are embedded in some insulating material

and can be applied as one pad
-there are different sizes (small, medium and large) for
different surfaces to be treated
-limited by the low intensity of current that can be tolerated \
general effect is small
-if possible, use larger separate plate electrodes!!

Intensity of Treatment
-use an intensity of current which produces a strong but
comfortable prickling without a muscular contraction
-steps to follow:

1) increase current until the patient feels a definite

prickling, and leave for one minute for it to decrease

2) Increase current again until the patient reports a slight

muscular contraction, then decrease until contraction stops
-may teach the patient to increase intensity periodically in
order to obtain longer lasting pain relief
Duration of Treatment
-IFC usually applied for 10-15 minutes
-treatment at a normal intensity should not be given to one
area for longer than 20 minutes
-if more than one area is to be treated è total time should
not exceed 30 min.
**too long a Rx makes pt. unacceptably tired later in the
day!**

Frequency of Treatment
-in most cases, treatment every other day (i.e. 3x/wk.) is
ideal
-treatment less than twice/week is usually a waste of
time
-a course of 12 treatments is given

Electrode Placement:

-painful area (86.4%)

-spinal nerve root (53%)
-peripheral nerve (26%)
-trigger point (10%)
-acupuncture point (5%)
IFC – sample applications

Ant knee: IFC (left) vs Tens (right)

Gastroc: IFC (right) vs Tens (left)
 Hamstring: IFC (right) vs Tens (left)

Lateral Elbow: IFC (left) vs Tens (right)

Strength duration curve (SDC)
It shows the interdependence between stimulus strength and
the time required in activating the muscles. It indicates the
strength of impulses of various durations required to produce
muscle contraction by joining the points that graphically
represent the threshold value along the ordinate for various
durations.
Advantages of SDC:
This is a simple, reliable and shows a proportion of
denervation.
Disadvantages of SDC:
In large muscles it can not shows the full pictures but only a
proportion of muscle fibers can be stimulated.
It can not show the site of lesion.

Strength Duration
(V) (ms)
0.64 1.0
0.8 0.42
1.0 0.25
1.2 0.18
1.42 0.134
1.62 0.105
2.0 0.082
2.4 0.063
2.82 0.05
3.45 0.038
 Optimum timing of SDC:

 SDC test can be done 10 – 14 days after the lesion has

occurred. The degeneration of nerve from the proximal to distal
is called Wallerian degeneration.
 When the motor end plate is no longer functioning, it is
done weekly under the same condition until there is recovery
and decision has been reached on the eventual final state of
the muscle.
 SDC is used to identify denervation, partial innervation, and
compression.

Methods of SDC:

 Take a neuromuscular stimulator (TENS, stimulator) having

rectangular duration i.e. 0.3, 0.1, 1, 3, 10, 30, 100, 300 ms and
constant current.
 Put the passive electrode over the midline of the body or
near the origin of the muscle.
 Put the active electrode over the fleshy belly of the muscle.
Alternately both the electrodes are placed on both ends of the
muscle.
 First apply current having longest duration and look for
minimum perceptible contraction, gradually shorten the
impulse duration and note the corresponding increase in
current strength.
 The electrode placement should not be changed through out
the test. Plot a SD graph from the results of the test.
 Characteristics of SDC:
i. Innervated muscles:
 When all the nerve fibers supplying the muscles are intact,
the strength duration curve has a shape characteristic of
normally innervated muscles. Less than 1.0 ms
 The same strength of stimulus is required to produce a
response with all the impulses of longer duration, while those
of shorter duration require an increase in strengths of the
stimulus each time the duration is reduced.

ii. Denervated muscles:

 When all the nerve fibers supplying a muscle have
degenerated, the strength duration produced is characteristic of
complete denervation .
 For all impulses with duration of 100 ms or less the strength of
the stimulus must be increased each time the duration is reduced
and no response is obtained to impulses of very short duration.
 The curve rises steeply and is shifted to the right than that of
normally innervated muscle. more than 10.0 ms complete
denervated
 iii. Partial denervated muscles:

 For the stimulation of denervated fibers impulses of longer

duration are required while for the stimulation of innervated fibers
impulses of shorter duration are required.
 The kink produce show the partial denervation which
disappear after 10 -20 days or month. 1.0-10.0 ms partial
denervated

Practical application of SDC

 two type of application A) direct method B) shortcut

 find the motor point
 fix pulls duration 700
 fix on rectangular shape
 duration 10 min
 increase intensity to reach muscle contraction
 Russian Stimulation

 It is also called as Tone Burst current. It was first

investigated by Dr. Y M Kots in the Russian literature.

 It provoked much interest because the successful Olympic

team was using it in addition to their usual training program.

It was suggested that its use lead to significant gain in

muscle strength (about 30 – 40 %).

In 1970 claims were published that this 2500 Hz medium

frequency interrupted current (Russian current) could produce
to generate greater muscle force (contraction) than a maximal
voluntary contraction.

Introduction

 basically a medium-frequency current

 it is an intermittent alternating sinusoidal current with
a carrier frequency of 2500 HZ
 is sinusoidal waveform, delivered in bursts or series
of pulses
Hence, it is known as medium frequency ,burst
alternating current
Base Frequency : 2500Hz (2.5kHz)
Burst @ 50Hz
10ms ON : 10 ms OFF (50% duty cycle)
Stimulation delivered thus for 10 seconds
Rest period of 50 seconds
Repeated 10 cycles
Daily
Maximum tolerable intensity
 Indication
Reduce spasticity
muscle re-education
Strengthening muscular system
Post-knee ligaments surgery
Post-arthroscopic knee surgery
Following ligament sprain

Contra indications:
Cardiac pacemakers and Arrhythmias
Hemorrhagic condition
Thrombosis and thrombophlebitis (inflammation of wall of vein)
Early tendon transfer and repair
Pregnancy: On pelvic, low back and abdomen
Unconscious patient
Recent radiotherapy
Carotid sinus
Child with mental disturbance
Malignancy
Infected wound and skin lesion
Protocols for Russian current:
Protocol for muscle strengthening/
hypertrophy:
Amplitude/ Intensity:
Tetanic contraction
Pulse rate:
50 – 70 Hz
Pulse duration:
150 – 200 µs
Apply current during volitional activities (voluntary
activities)Isometric exercises at several points through range
of motion.
Slow isokinetic (movements in same direction) exercises 5 -
10° per second.
Short arc joint movement when ROM is restricted.

Protocol for muscle spasm reduction

Amplitude:
Small visible muscle contraction
Pulse rate:
50 – 70 Hz
Pulse duration:
50 – 175 µs
Muscle contraction isometric
 To reduce Edema
Amplitude:
Tetanic contraction depending upon patient tolerance
Pulse rate:
50 – 70 Hz
Pulse duration:
50 – 175 µs
Muscle contraction isometric

Duration and application

Stimulation periods (9 or 19 days) and stimulation daily
or alternate days were also considered.
 concluding that daily stimulation was more effective.
 The RStim was shown to be more effective than
voluntary contraction alone (i.e. with no supportive
stimulation).
 time (15-20 min)
 duty cycle -muscle reeducation: 10/10 or 5/5
 start stimulate till feeling tingling then increase dosage
to contract muscle and ask pat to contract muscle then
relax muscle
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Transcutaneous electrical nerve

stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) is a

simple, non-invasive analgesic technique that is used
extensively in health-care settings by physiotherapists,
nurses, and mid-wife’s.
TENS is mainly used for the symptomatic management
of acute and non-malignant chronic pain. However,
TENS is also used in palliative care to manage pain
caused by metastatic bone disease and neoplasm. It is
also claimed that TENS has antiemetic and tissue
healing effects although it is used less often for these
actions

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types of TENS apparatus are manufactured on

the basis of following parameters:
  Pulse Shape – Usually rectangular.
  Pulse Width – Measured in microseconds (μs) and is often fixed at
100 μs or 200 μs. Other units can vary the pulse width from 50 μs
through to 300 μs.

Frequency – Can be as low as 2 Hz or as high as 600 Hz. A frequency of

150 Hz is commonly used.

Intensity – Can be varied from 0 to 60 milliamperes (mA).

The wide range of variation in pulse width, frequency, and intensity
gives great flexibility in terms of the treatments applied to patients with
chronic pain syndromes

Traditional TENS (Hi TENS, Normal TENS)

Frequency – 50 Hz to 100 Hz
  Pulse Width – 20 μs to 60 μs
  Intensity – Till patient receives strong paraesthesia without
muscle contraction (0 mA to 30 mA)

Duration – 30 to 60 minutes
once or twice daily.
  Notes –
1) Very comfortable for the
patient.
2) Produces shorter level of pain
relief.
3) More accommodation.
  Uses – High frequency TENS
is mainly used for acute pain.

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Acupuncture TENS (Lo TENS, AcuTENS)

  Frequency – 1 Hz to 4 Hz
  Pulse Width – 150 μs to 250 μs
  Intensity – Till patient receives muscle contraction of
related myotome (30 mA to 60 mA)
Duration – 20 to 30 minutes once a day.
  Notes – 1) Increase in the endorphins
level in the cerebrospinal fluid CSF.
2) Long lasting pain relief.
3) Longer time is taken for pain relief.
  Uses – Low frequency TENS is mainly
used for chronic pain

Modulation mode TENS

In modulated TENS the pulse length, frequency, and
amplitudes can be constantly and automatically varied.

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Electrode Placement in TENS

The most usual is to site electrodes close to where the
pain is perceived to be; often one electrode is sited
over the place where the most intense pain is felt or
the greatest tenderness elicited
The electrodes may be placed within the same
dermatome, myotome, or sclerotome.
  Placement within the involved dermatome
  Placement on a specific site in the dermatome (for
example, a trigger, motor, or acupuncture point)
  Placement on both anterior and posterior aspects of a
particular dermatome (for example, the thoracic region)

Cont’d
Trigger or acupuncture points may be the preferred
sites of current application
Stimulation of peripheral nerves is used. Electrodes
are placed in the line of the nerve and where it is
particularly superficial
 Remote stimulation of deeper nerves is possible
before the nerve branches to innervate deeper fields.
 It may be used in sensitive dermatologic conditions.
 It requires less amplitude of output to stimulate
directly over a nerve trunk.
It may be an effective means of locating acupuncture
points.

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Cont’d
 Another area of electrode placement location is
paravertebral

Cont’d
 Cathode is the active electrode, in stimulation of a
nerve fiber it should be applied nearest to the desired
destination of the action potential. Thus for stimulation
of sensory nerves it is proximal to the anode, i.e.,
nearer the spinal cord.
 Dermatome: The area of the skin, supplied by one
dorsal root is called a dermatome. Dermatome -area of
skin supplied by a single nerve- may place electrodes in
the same dermatome of the offending structure.
 Myotome: From anterior horn motor nerve emerges
and supplies the skeletal muscle, which is known as
myotome . Myotome - The muscles innervated by a
single spinal nerve.

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Cont’d

 Sclerotome: A group of mesenchymal cells migrating

from mesodermal somite towards notochord are called
sclerotome. Sclerotome - The bone and joint structures
innervated by a single nerve.
 Trigger Point: Local regions of increased tenderness
are known as trigger points.
 Motor Point: It is a point which when stimulated leads
to maximum contraction with minimal current. So, it is a
point where
1) main nerve enters the muscle
2) muscle becomes superficial
3) junc on of upper ⅓ and lower ⅔ of muscle

Cont’d
 Acupuncture Point: Acupuncture points seem to be
where bundles of Aδ nerves pierce the deep fascia.
They apparently have lower electrical impedance than
the surrounding area.

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Indication of TENS
Arthritis
Pelvic pain caused by endometriosis
Knee pain
Sports injuries
Post-traumatic and post-surgical pain (acute and chronic)
Phantom pain
Causalgia (nerve pain)
Low back pain
Neck pain
Post-herpetic pain

Contraindications
•DVT or thrombophlebitis
•Hemorrhagic conditions
•Pregnancy
•Eyes, anterior neck, carotid sinus, head, reproductive
organs
•Impaired cognition or communication
•Regenerating nerves
•Cardiac failure (local)
•Damaged or at-risk skin (local)
•Infection or tuberculosis (local)
•Malignancy (local)
•Recently radiated tissue (local)
•Electronic device (local)
•Impaired sensation (local)

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Protocol for the safe application of TENS

  Check contraindications with patient.

  Test skin for normal sensation using blunt/sharp test.
  TENS device should be switched off and electrode
leads disconnected.
  Set electrical characteristics of TENS while device is
switched off.
  Connect electrodes to pins on lead wire and position
electrodes on patients skin.
  Ensure TENS device is still switched off and connect
the electrode wire the TENS device.

Cont’d

  Gradually (slowly) increase the intensity until the

patient experiences the first tingling sensation from the
stimulator.
  Gradually (slowly) increase the intensity further until
the patient experiences a strong but comfortable tingling
sensation.
  This intensity should not be painful or cause muscle
contraction

8
 2/8/2022

Poor Response of TENS

  Psychogenic Pain
  Pain of central nervous system (CNS) origin
  Diabetic and alcoholic neuropathy physio4