Electromagnetic Biology and Medicine

ISSN: 1536-8378 (Print) 1536-8386 (Online) Journal homepage: http://www.tandfonline.com/loi/iebm20

XXIst century magnetotherapy

M. Markov

To cite this article: M. Markov (2015) XXIst century magnetotherapy, Electromagnetic Biology
and Medicine, 34:3, 190-196, DOI: 10.3109/15368378.2015.1077338

To link to this article: http://dx.doi.org/10.3109/15368378.2015.1077338

Published online: 07 Oct 2015.

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ISSN: 1536-8378 (print), 1536-8386 (electronic)

Electromagn Biol Med, 2015; 34(3): 190–196

! 2015 Taylor & Francis. DOI: 10.3109/15368378.2015.1077338

ORIGINAL ARTICLE

XXIst century magnetotherapy

M. Markov

Research International, Williamsville, USA

Abstract Keywords
This paper discusses the state of the art therapeutic application of magnetic and electromag- Clinical application, electromagnetic fields,
netic fields (EMF) in treatment of various medical problems – from pain relief to musculoskel- magnetotherapy
etal trauma, to vascular and endocrine disorders. The paper describes problems related to
physical parameters of used fields, biophysical dosimetry, clinical protocols, and safety of the History
Downloaded by [University of Waterloo] at 11:39 14 October 2015

device operators. Clinical benefits and mechanisms of action are also discussed.
Received 24 July 2015
Accepted 24 July 2015
Published online 7 October 2015

Introduction There is a large body of basic science and clinical

evidence that time-varying magnetic fields can modulate
There are numerous reports and evidences that in different
molecular, cellular and tissue functions in a physiologically
parts of the world people knew that some natural materials
and clinically significant manner (Markov, 2002; Rosch and
possess magnetic properties that might be used for the healing
Markov, 2004).
of specific health problems. It is difficult to identify the exact
During the 1970’s, the team headed by C.A.L. Bassett
time when physicians from ancient Greece, China, Japan and
introduced a new approach for the treatment of delayed
Europe discovered these possibilities. Historically, one may
fractures, employing a very specific biphasic low-frequency
turn to the ‘‘Yellow book of Chinese emperor’’ where some
signal (Bassett et al., 1974, 1977). This signal was approved
knowledge about magnetic materials could be found.
by the Food and Drug Administration (FDA) for application
One of the earliest scientific accounts is found in the book
in the USA only for non union/delayed fractures and this label
De Magnete, written in 1600 by William Gilbert, the personal
is still in action. A decade later, the FDA allowed the use of
physician of the English Queen (Gilbert, 1600). This brilliant
pulsed radiofrequency electromagnetic field (PRF) with
natural philosopher used ‘‘load stones’’ to treat a variety of
27.12 MHz frequency for treatment of pain and edema in
health problems of ordinary British citizens and even the
superficial soft tissues.
Queen of England.
It is now commonly accepted that selected weak EMFs are
Contemporary magnetotherapy began in Japan immedi-
capable of initiating various healing processes from delayed
ately after World War II by introducing both magnetic and
fractures, to pain relief, multiple sclerosis, and Parkinson’s
electromagnetic fields (EMFs) in clinical practice. In Japan
disease (Rosch and Markov, 2004). This proven benefit could
magnetotherapeutic devices are registered under the Drug
be obtained by using both static and time-varying magnetic
Regulation Act of 1961 as #81 and quickly became popular in
fields. (Bassett, 1989, 1994; Detlavs, 1987; Markov, 1987,
Japan mainly through the efforts of Kyochi Nakagawa. The
1994, 2004c, 2015; Shupak, 2003; Todorov, 1982).
use of magnetic material for medical purposes has long
During nearly seven decades of development of contem-
history in Europe, but the real use of magnetotherapeutic
porary magnetotherapy more than a million patients have
devices followed the Japanese experience first in Romania
been treated worldwide for pain, many musculoskeletal
and the former Soviet Union. Later on, during the period
injuries, postsurgical and traumatic wounds. Magnetic/
of 1960–1985, nearly all European countries designed
electromagnetic stimulation was proven to enhance such
and manufactured their own magnetotherapeutic systems
fundamental properties as nerve repair and regeneration, as
which utilize various magnetic systems and magnetic/
well as immune and endocrine functions.
electromagnetic waveshapes.
It should be noted, that thus far, the medical community’s
Therapeutic magnetic fields
approach to magnetotherapy is as to adjuvant therapy, espe-
cially for treatment of a variety of musculoskeletal injuries. Let start with the question: What magnetotherapy should be?
As a part of bioelectromagnetic technology, magnetotherapy
Address correspondence to M. Markov, Research International, requires interdisciplinary efforts. Magnetotherapy could
Williamsville, NY 14221, USA. E-mail: msmarkov@aol.com not be developed without integrated efforts of physicists,
 DOI: 10.3109/15368378.2015.1077338
engineers, biologists and medical practitioners. An important
role is reserved for medical practitioners, including physical
and occupational therapists who routinely use physical
modalities in their practice and to scientists who need to
create methodology and dosimetry for magnetotherapy.
There are three general types of magnetotherapeutic
devices: (a) solenoid, (b) two coils and (c) flat mattress. In
the solenoid approach the limb or even part of the torso might
be inserted into EMF generating system. The two coil
approach is based of placing two coils on both sides of the
limb. This provides conditions for creation of homogenous
EMF secured by both coils. The flat mattress is mostly used in
home settings and for wellness purposes. Each of these
systems has advantages and disadvantages related to con-
venience of use, standardization of parameters, and control of
conditions of use.
Magnetotherapy includes at least seven groups of EMFs,
developed and utilized in different countries of the world
during the last 50 years (Markov, 2015):
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 Static/permanent magnetic fields created by various
permanent magnets as well as by passing direct current
(DC) through a coil.
 Low-frequency sine wave EMFs mostly utilize 60 Hz (in
the USA and Canada) and 50 Hz (in Europe and Asia)
frequency in distribution lines.
 PEMF are usually low-frequency fields with various
specific shapes and amplitudes.
 PRF utilizes the selected frequencies in the radio-
frequency range: 13.56, 27.12, and 40.68 MHz.
 Transcranial magnetic/electric stimulation is a method of
treatment of selected areas of the brain with short but
intensive magnetic pulses.
 Millimeter waves have a very high-frequency range of
30–100 GHz. In the last 10 years this modality has been
used for treatment of a number of diseases,
 Ultrashort pulses were developed and investigated in the
recent decade.
The fundamental question in magnetotherapy is related to
the biophysical interactions that allow EMF signals to be
recognized by cells. The biophysical mechanisms of these
interactions and the possibility of the signals to modulate cell
and tissue functioning remain to be elucidated. The scientific
and medical communities still lack the understanding why the
same magnetic fields applied to different tissues can cause
different effects.
The medical part of the equation requires proper diagnos-
tics and identification of the exact target as well as the
‘‘dose’’ of EMF that the target needs to receive. Then,
physicists and engineers should offer the appropriate protocol
and exposure system which will ensure that the target tissue
received the required magnetic flux density. The question of
‘‘dosage’’ in magnetotherapy is much more complex than
the dosage in case of prescribing pharmaceutics. Because of
the large variety of electromagnetic signals available at the
moment, the correct design of the protocol and selection of
proper signal is really a question of art.
The EMF signals in clinical use have variety of designs,
which in most cases is selected without any motivation for the
choice of the particular waveform, field amplitude or other
physical parameters. An excellent review of the physics and
XXIst century magnetotherapy 191
engineering of low frequency signals was published by Liboff
(2004).
I have introduced the vision that two types of dosimetry
should be used in the evaluation of the device properties and
the protocol development: physical and biophysical dosim-
etry. The physical dosimetry should characterize engineering
and physical parameters of the device, while biophysical
dosimetry must take care about the biophysical interactions of
the applied signal with the target tissue. Unfortunately, even
today state-of the-art provides medical staff with little
information about both types of dosimetry. There are several
reasons for this. The manufacturers and distributors of
magnetotherapeutic devices, as a rule, do not provide
sufficient information about the device characteristics. In
most cases, it is not done on purpose, but because of lack of
knowledge as to what information is necessary for clinicians
to make proper selection of the device and protocol for
treatment. Here is the list of parameters needed for charac-
terization of device and study/clinical trial:
 Type of the field
 Frequency
 Pulse shape
 Intensity or induction
 Gradient (dB/dt)
 Vector (dB/dx)
 Component (electric or magnetic)
 Depth of penetration
 Localization
 Time of exposure (duration of session)
The bioelectromagnetics community has developed several
methods of biophysical dosimetry, including myosin phos-
phorylation assay (Markov, 2004a,b) which are able to predict
which EMF signals could be bioeffective and monitors this
efficiency. Therefore, theoretical models and biophysical
dosimetry could be instrumental in selection of the appropri-
ate signals and in engineering and clinical application of new
EMF therapeutic devices. Once again, the same signal may
have different efficiency depending on the particular target
and medical problem to be treated.
It seems reasonable that the first and widely used
waveshape is the sine wave with frequency of 60 Hz in
North America and 50 Hz in the rest of the world. From the
symmetrical sinewaves engineers moved to an asymmetrical
waveform by means of rectification. These types of signals
basically flip-flop the negative part of the sinewave into
positive, thereby creating a pulsating sinewave.
In addition to sinewave type signals, a set of devices which
utilize unipolar or bipolar rectangular signals is available at
the market. Probably for those signals the most important is to
know that due to the electrical characteristics (mostly the
impedance) of the unit, these signals could never be
rectangular. It should be a short delay both in raising the
signal up and in its decay to zero. The rise-time of such signal
could be of extreme importance because the large value of
dB/dt could induce significant electric current into the target
tissue.
The first clinical signal approved by FDA for treatment of
nonunion or delayed fractures (Bassett et al., 1974, 1977)
exploited the pulse burst approach. Having repetition rate of
15 burst per second, this asymmetrical signal (with a long
 192 M. Markov
positive and very short negative component) has more than 30
years of very successful clinical use for healing nonunion
bones. It was supposed that the cell would ignore the short
opposite polarity pulse and respond only to the envelope of
the burst which had duration of 5 ms, enough to induce
sufficient amplitude in the kHz frequency range.
A series of modalities utilizes signals that consist of single
narrow pulses separated by long ‘‘signal-off’’ intervals. This
approach allows modification not only of the amplitude of the
signal, but duty cycle (time on/time off) as well.
The pulsed radiofrequency signal, originally proposed by
Ginsburg (1934) and later allowed by FDA for treatment of
pain and edema in superficial soft tissues (Diapulse) utilizes
the 27.12 MHz in pulsed mode. Thus, having short 65 ms burst
and 1600 ms pause between pulse bursts, the signal does not
generate heat during 30 min use.
Cost and benefit of EMF therapy
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The estimation of the benefit of EMF therapy should be
started with discussion pharmaceutics vs. electroceutics. Let
us to first define the terms. Pharmaceutics is a common term
for all pharmaceuticals prescribed in solid or liquid forms.
Electroceutics was introduced 15 years ago to demonstrate the
possibility of electric current or EMFs to be applied for
therapeutical purposes. What is the difference?
On one hand, pharmaceuticals are chemical substance,
while the electroceutics are physical modalities which we
discuss in this paper. On the other hand, pharmaceutics are
invasive substances with inaccurate dosage, while electro-
ceutics are non-invasive and easy to control the parameters of
the dosage. The way a physician estimates the dosage is based
on body weight and because of that for delivering the dose
necessary to treat a problem in a given organ, the patient’
body receives hundred or thousand time larger dose.
Therefore, the benefit for one organ could be a hazard for
another. Just the opposite is the situation with electroceutics:
they are non-invasive with the possibility to focus the factor
on the target organ/tissue without affecting other parts of
the body.
The use of electroceutics would be of great benefit: less
suffering, reduced expenses, decreased duration of treatment
and should be considered in parallel with individual and
social welfare. Thus, the clinical effects of EMF on muscu-
loskeletal system repair are physiologically significant and
often determine the method of choice when the conventional
standard of care has failed to produce adequate clinical
results.
EMF modalities are usually applied directly on the targeted
area of the body. Compared to regular pharmaceuticals, EMF
offers an alternative with fewer, if any, side effects. One
should not forget that in order to deliver the medication dose
needed to treat the target tissue/organ, patients routinely
receive medication dose hundred times larger than the dose
needed by the target.
However, regulatory and reimbursement issues have pre-
vented more widespread use of EMF modalities, especially in
the USA. The FDA policy towards magnetotherapy is
unnecessarily restrictive. In concert with this policy, the
Center for Medicare Services (CMS) for a period of time
Electromagn Biol Med, 2015; 34(3): 190–196
refused to allow reimbursement even for modalities cleared
by FDA. It took several years of court fighting until CMS
reversed its position. This was a result of the pressure from
general public and physical therapy communities. In fact, the
CMS has now recognized that EMF is a plausible therapeutic
modality which produces sufficient clinical outcome to
permit, and reimburse for, use in the off-label application of
healing chronic wounds, such as pressure sores and diabetic
leg and foot ulcers (Pilla, 2007).
Clinical benefit
A plethora of scientific and clinical studies have been
reporting that EMF help in wound healing, bone unification,
in reducing pain, edema and inflammation, in increasing
blood circulation; in stimulation of immune and endocrine
systems. Since cells involved in tissue repair are electrically
charged, some endogenous EMF signals may facilitate
cellular migration to the injured area, thereby restoring
normal electrostatic and metabolic conditions. An important
concept was proposed, that at any injury site of the
musculoskeletal system an injury current occur (Canaday
and Lee, 1991). Because the main goal of any therapy is to
restore normal function to the organism, electric, magnetic or
electromagnetic modalities appear suitable to compensate the
injury currents. Of course, the optimal parameters to achieve
this goal would depend on the type and extent of the injury
that cause the specific injury current to originate.
Numerous cellular studies have addressed effects of EMF
on signal transduction pathways. It is well accepted now that
the cellular membrane is a primary target for magnetic field
action (Adey, 2004). Evidence is collected that selected
magnetic fields are capable of affecting the signal transaction
pathways via alteration of ion binding and transport. The
calcium ion is recognized as a key player in such alterations.
In a series of studies of calcium-calmodulin dependent
myosin phosphorylation was demonstrated that specific
static magnetic fields and PEMF as well as 27.12 MHz PRF
could modulate Ca2+ binding to CAM to a twofold enhance-
ment in Ca2+ binding kinetics in a cell-free enzyme prepar-
ation. (Markov et al., 1992, 1993, 1994; Markov and Pilla,
1993, 1994; Markov 2004a,b,d; Pilla, 2015)
Which signals and at which conditions could be most
effective? It should be pointed out that many EMF signals
used in research and as therapeutic modalities have been
chosen in some arbitrary manner. Very few studies assessed
the biological and clinical effectiveness of different signals
by comparing the physical/biophysical dosimetry and
biological/clinical outcomes. With the exponential develop-
ment of Internet it is easy to find tens, if not hundred of
devices, which promised to cure each and any medical
problem. A careful look at the Internet sites would show that
no engineering, biophysical and clinical evidence is given to
substantiate the claims.
Practically there is no single publication in which the word
‘‘contradiction’’ is missing. What is the reason for statement
that EMF interactions with living tissues are contradictional?
The reason should be searched in statements that one specific
magnetic/electromagnetic signal could be used for treatment
of every type of clinical problem. ‘‘Today there is abundance
 DOI: 10.3109/15368378.2015.1077338
of in vitro and in vivo data obtained in the laboratory research
as well as clinical evidence that time-varying magnetic fields
of various configurations can generate beneficial effects for
various conditions, such as chronic and acute pain, chronic
wounds and recalcitrant bone fractures. This has been
achieved with low intensity, non-thermal, non-invasive time-
varying EMFs, having various configurations within a broad
frequency range’’ (Pilla, 2007). What is wrong with this
statement? Only one word is missing ‘‘some’’. By not saying
that some or selected PEMF could initiate plausible thera-
peutic effects, we simply say that all magnetic fields could
achieve the goals.
This brings the problem of ‘‘dosage’’. To say that a patient
is ‘‘magnetically stimulated’’ has the same meaning as to
say ‘‘the patient receives a drug’’ without specifying what
exactly is the drug. We will come to this issue a little bit later
in this paper.
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Mechanisms of action
Analyzing the successful treatment of diseases and healing of
injuries could elucidate the cellular and tissue components that
may be plausible targets for MF action. Since an important
clinical principle of health management is to provide a natural
physiological environment for optimum healing, the proper
choice of the MF parameters may significantly enhance the
healing process. It is possible, then, that exogenous MF could
recreate normal physiological conditions, and return the tissue
or body to a disease/injury free status.
Basic scientific studies suggest that nearly all participants
in the healing process (such as fibrinogen, leukocytes, fibrin,
platelets, cytokines, growth factors, fibroblasts, collagen,
elastin, keratinocytes, osteoblasts, free radicals) exhibit
alterations in their performance when exposed to the action
of MF (Bourguignon and Bourguignon, 1989; Detlavs, 1987;
Katz et al., 2005; Leszczynski et al., 2003; Markov, 1995,
2004a,b, 2015; Polk, 1994; Rosch and Markov, 2004; Shupak,
2003; Markov, 2015; Pawluk, 2015). Magnetic fields affect
vasoconstriction and vasodilation, phagocytosis, cell prolif-
eration, formation of cellular network, epithelization, and scar
formation (Bassett, 1989, 1994; Markov and Pilla, 1994;
Markov and Colbert, 2000; Rosch and Markov, 2004).
It is well accepted that biochemical and physiological
processes are based on the flow of electrical charges (ions,
electrons) or charge redistribution. Therefore, when an injury
disturbs tissue integrity, an ionic current occurs. Further, ionic
currents between normal and injured tissue play an important
role in the repair processes. Due to its ability to penetrate
deep into the body, exogenous magnetic fields can effectively
influence normal and injury currents, thus contributing to the
healing process.
Since the energy applied is below the thermal threshold
level, it is more likely that applied therapeutic magnetic fields
trigger some important biophysical/biochemical cascades, and
affects signal/transduction pathways.
Healing occurs via a series of integrated stages, each of
which is essential to the repair processes. Therefore it is
important to evaluate the contribution of basic cellular
activities occurring at a stage in tissue repair. This extremely
complex phenomenon involves a number of processes such as
XXIst century magnetotherapy 193
vascular responses, cellular activity, and release of chemical
mediators within the injured tissues. The list should also
include regeneration of parenchymal cells, migration and
proliferation of both parenchymal and connective tissue cells,
synthesis of extracellular matrix proteins, remodeling of
connective tissue, collagenization, and acquisition of tissue
strength. One area of specific interest is the effect of EMF and
MF on cell proliferation. Most cells normally differentiate to a
specific morphology and function. In pathological conditions,
cell proliferation is usually suppressed (in conditions of
chronic wounds) or enhanced (in the case of neoplastic
growth). Magnetic field stimulation of the skin fibroblast
resulting in significant increase in collagen secretion and
protein concentration has been reported, and these results
suggest a favorable alteration in the proliferative and migra-
tory capacity of epithelial and connective tissue cells involved
in tissue regeneration and repair (Bourguignon and
Bourguignon, 1989; Rodeman et al., 1989).
The clinical outcome of magnetotherapy therapy includes
analysis of hemodynamics, microcirculation, transcapillary
phenomena, morphological, and cytochemical characteristics
of blood components, including lymphocytes, erythrocytes,
leukocytes, and thrombocytes. Low-intensity EMF stimulates
the microcirculation, and initiates compensatory/adaptational
changes in elderly patients with arteriosclerosis. The thera-
peutic efficiency was dependent on the status of the patient
(age, general health, gender) as well as on the disease stage.
There is also a distinct relationship between specific diseases
and the MF parameters which initiate optimal response
(Todorov, 1982).
Assuming that the exogenous signal can be detected at the
cell or tissue level, the biophysical mechanism(s) of inter-
action of weak magnetic fields with biological tissues as well
as the biological transductive mechanism(s) remain to be
elucidated. At present, the following areas appear to be of
scientific and medical interest:
 Search for possible targets for magnetic fields
 examining biophysical mechanisms of MF action on
living systems
 evaluation of ‘‘window’’ or resonance effects
 adaptation of living system to applied MF
 long-lasting effects.
It is not surprising that not only clinicians, but also patients
are interested in the search of the mechanisms of action. Both
experimental and theoretical data have been collected world-
wide in search of potential mechanisms of interactions.
The biophysical dogma prevailing until the late 1980’s and
lingering to this day is that, unless the amplitude and
frequencies of an applied electric field were sufficient to
trigger membrane alterations, to produce tissue heating or to
move an ion along a field gradient, there could be no effect.
This was a serious obstacle in the search for biological
mechanisms and therapeutic applications of weak EMF
signals.
The underlying problem for any model of biophysical
mechanism of weak EMF bioeffects relates to the signal
detection at the molecular/cellular/tissue target in the pres-
ence of thermal noise, i.e. signal to thermal noise ratio (SNR).
As of today, a number of mechanisms have been proposed,
such as window hypothesis, ion cyclotron resonance (ICR),
 194 M. Markov
ion parametric resonance (IPR), free radical concept, heat
shock proteins, etc. One of the first proposed models uses a
linear physicochemical approach (Pilla, 1972, 1974), in which
an electrochemical model of the cell membrane was employed
in order to assess the EMF parameters for which bioeffects
might be expected. It was assumed that non-thermal EMF
may directly affect ion binding and/or transport and possibly
alter the cascade of biological processes related to tissue
growth and repair.
ICR proposed during the mid-1980’s by Liboff (1985),
Liboff et al. (1987), described specific combinations of DC
and AC magnetic fields which can increase the mobility of
specific ions near receptor sites and/or through ion channels.
To resolve the thermal noise problems in the ICR model,
Lednev (1991) formulated an IPR model which was further
developed during the 1990’s (Blanchard and Blackman, 1994;
Blackman et al., 1995). In this quantum approach, an ion in
the binding site of a macromolecule (e.g. Calmodulin) is
considered to be a charged harmonic oscillator.
Downloaded by [University of Waterloo] at 11:39 14 October 2015
The most important contribution of Lednev is the experi-
ment he designed to estimate the validity of his ICR model:
myosin phosphorylation in a cell-free mode (Shouvalova
et al., 1991). The calmodulin molecule provides ideal model
for investigating ion binding without and with the presence of
exogenous magnetic field. The experiment proposed by
Lednev, and further elaborated by my group (Markov,
2004a,b), allows the Pilla to propose a model that overcomes
the problem of thermal noise. (Pilla, 2007).
Clinical experience, as well as numerous animal and
in vitro studies, suggest that the initial conditions of the EMF-
sensitive target pathway determine whether a physiologically
meaningful bioeffect could be achieved. For example, when
broken bone received treatment with EMF, the surrounding
soft tissues receive the same dose as the fracture site, but
physiologically important response occurs only in the injured
bone tissue, while changes in the soft tissue have not been
observed.
This is crucially important behavior, indicating that
magnetic fields are more effective when the tissue is out of
equilibrium. Therefore, the experiments with healthy volun-
teers are not always indicative of the potential response of
patients who are victims of injury or disease. The healthy
organism has much larger compensational ability than the
diseased organism, which in turn would reduce the manifest-
ation of the response.
Support for this notion comes from a study of Jurkat cells
in which the state of the cell was found to be important in
regard to the response of tissues to magnet fields: normal
T-lymphocytes neglect the applied PEMF, while being
stimulated by other factors. Furthermore, the response of
lymphocytes to magnetic fields clearly shows a dependence
on the stimulation with other factors. In other words, it might
be approximated with pendulum effect – the larger is the
deviation from equilibrium, the stronger is the response
(Markov et al., 2006; Nindl et al., 2002). For example, Nindl
has demonstrated, in an in vitro study, that the initial
conditions of lymphocytes are important in terms of the
biological effects of those cells to magnetic fields.
It has been nearly four decades, since the concept of
‘‘biological windows’’ was introduced. In fact, three groups,
Electromagn Biol Med, 2015; 34(3): 190–196
unknown to one another, published, almost simultaneously
that during evolution Mother Nature created preferable levels
of recognition of the signals from exogenous magnetic fields.
The ‘‘biological windows’’ could be identified by amplitude,
frequency and their combinations. The research in this
direction requires assessment of the response in a range of
amplitudes and frequencies. It has been shown that at least
three amplitude windows exist: at 50–100 mT (5–10 Gauss),
15–20 mT (150–200 Gauss) and 45–50 mT (450–500 Gauss)
(Markov, 1990). Using cell-free myosin phosphorylation to
study a variety of signals, was shown that the biological
response depends strongly on the parameters of applied
signal, confirming the validity of the last two ‘‘windows’’
(Markov, 2004a,b).
Advantages of MF stimulation compared with
current stimulation
Electric current stimulation has a long history of application
as a therapeutic modality in Western medicine. However,
there are significant differences between electric current and
MF modalities. Electric current stimulation requires skin
contact electrodes placed either on both sides of the wound/
injury or with one electrode on top of the wound, and the
other over normal adjacent tissue. Electrode size, spacing, and
polarity are the most critical factors for delivering an adequate
stimulating current. Closely spaced small electrodes generally
make the effective area of stimulation rather superficial due to
the lower impedance of the current path through proximal
tissue. The conduction of electrical current through biological
tissues occurs as a result of movement of charges along
specific pathways. This charge transfer might result in
electrothermal, electrochemical, or electrophysical effects
depending on the type of the electrical current, and can
occur at membrane, cellular, or tissue level immediately after
applying the voltage. The direct responses usually result in
many indirect cellular reactions, which may subsequently
alter biochemical and physiological pathways.
MF represents a significantly more effective approach to
the healing process – it is easier to apply, less expensive and
comfortable therapy. MF modalities do not exhibit the
complications of contact electrodes because the contact is
not necessary to achieve the desired dose at tissue level. Thus,
MF can be applied in the presence of a cast or wound
dressing. The risk of infection is significantly reduced, and
dressings may remain as long as the therapy requires. With
this modality is possible to know the value of the magnetic
field in any section of the tissue. The magnetic flux density
remains unchanged while tissue dielectrics change as a
function of healing, resulting in consistent dosimetry through-
out the healing process.
The choice of a therapeutic device should be based on its
biological and clinical effectiveness. The field amplitude,
spatial distribution, and duration of exposure must be
adequate to meet the requirement of therapy. MF treatment
requires placement of the patient and applicator in close
proximity, therefore a permanent magnet may be fixed to the
site of pathology during therapy. Modalities which utilize
electric current or EMFs may require the patient to be
available at specified time periods at treatment facilities.
 DOI: 10.3109/15368378.2015.1077338
The use of the equipment and the treatment protocol requires
simple and easy manipulation with stimulation devices by
clinicians and, in some countries, by patients.
Safety
Three general problems need to be discussed in
magnetotherapy:
(1) Electrical safety
(2) Patient safety
(3) Operator safety
Electrical safety is a duty of the design engineer and
manufacturer. In all countries that allow manufacturing and
sale of magnetotherapeutic devices strong rules in electrical
engineering exist and in addition – there are controlling
institutions which are authorized to prevent potential damage
because of malfunctioning of the device. However, we would
suggest the medical institution, especially large hospitals
where electrical safety department exists, to examine func-
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tioning of device prior to first use.
The patient safety is very well designed and controlled at
each clinical trial. The monitoring is achieved in several
different ways: by the design and execution of protocol,
by monitoring the activity of technicians and nurses over
the accuracy of treatment of patients, by ethical committees,
by national controlling institutions. Even in the case of
occurrence of some unfortunate problems during the treat-
ment session, medical practitioner is available to help the
patient.
The third problem is generally neglected. While the patient
is exposed to action of therapeutic factor for 30–60 min during
10–15 sessions, the operators of the magnetotherapeutic
device are on duty 6–8 h a day, 5–6 days per week. During
these working time operators are exposed to various by
nature, frequency and intensity signals. If in case of ionizing
radiation, therapists are carrying dosimeters, in non-ionizing
environment dosimeters are not available.
We would like to emphasize that potential hazard for
operators health exists and needs to be evaluated. In a recent
paper, based on multi-year, multi-centers study of the health
and morbidity status of operators was shown to face various
health problems (Vesselinova, 2015).
We strongly believe that in the physical therapy wards
actions should be taken to minimize the exposure to specific
EMFs as well as the total exposure to EMF.
Limited medical acceptance of the use of magnetic
fields
Why despite the documented success in the basic science and
clinical application worldwide, magnetotherapy still has
limited acceptance in the Western medicine?
Some of the essential elements of the rapidly growing and
expanding database on reproducible biological and clinical
effects of selected magnetic fields are not well known or
interpreted too narrowly by physics, medicine, and the
regulatory and public sectors of society. As a result:
 Medical practitioners are unprepared to utilize this
technology.
 Regulatory activity is unnecessarily restrictive to the
detriment of patient care and cost containment.
XXIst century magnetotherapy 195
 Public concern about the safety of magnetic and EMFs is
sensationalized in news media.
Medical students studied anatomy, physiology, and disease
through chemistry and biochemistry with little attention to
physics and biophysics. In general, their analysis of biological
responses and clinical outcomes rarely would include physics
and biophysics. Despite knowledge of biochemistry and
pharmacology, to move forward with magnetotherapy, phys-
icians would benefit from a stronger knowledge of the
principles of thermodynamics and electrodynamics, biomech-
anics, electricity and magnetism.
Many medical practitioners learned about the EMF
interactions via news media when the media report the
hazard of EMFs. Therefore, they immediately reject any idea
to apply magnetotherapy in their practice.
Summary
The correct evaluation of the efficacy of magnetic stimulation
for the acceleration of healing requires measurements and
computations of a variety of parameters, such as amplitude,
field gradients, duration of exposure, and others.
Not only should the precise characteristics of the applied
MF be taken into account, but also the exact diagnosis and all
relevant clinical data. Further research into magnetic stimu-
lation needs to identify which magnetic fields are detectable
by cells or subcellular structures, and what are the cellular and
tissue responses to the applied signals. These evaluations are
important since there are a growing number of magnetic and
electromagnetic technologies and devices being used in
clinical practice. Cooperation between experts from physical
sciences, engineering, biological sciences, and clinical medi-
cine would significantly improve EMF-based therapy.
Declaration of interest
The author declares that there is no conflict of interest with
this paper. The author alone is responsible for the content and
writing of the article.
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