Assist. Prof.

Baha NACI
2022-2023 Spring Semester
27.02.2023
 The feedback mechanism in the human organism
includes the process of perceiving, interpreting and
responding to changes in the system.

 Pain, muscle atrophy and paralysis occur as a clinical

result of the malfunction in this feedback system.

 This system can be rearranged with electrical currents

created using electronic devices.
 In this context, electrotherapy is an approach that
provides control of pathological events by creating
non-physiological feedback systems.

 Electrotherapy has two basic elements:

electrical current used for treatment
tissues to which this treatment is applied.

 In order to understand the effects of electrotherapy,

the characteristics of the electrical current and the
tissues to which it is applied electrophysiologically
should be well known.
 There are two opposite electric charges in nature. Positive
and negative charges.

 The amount of positive or negative charge an atom or a

substance carries is called electrical charge. It is
expressed in Coulombs.
 If there is a difference in electric charge between any two
points on a conductive object, electrons are forced to move
from the point where the negative electric charge is greater
to the positive.

 This force that enables the movement of electrons is called

electromotor force or electrical potential difference or
voltage. Its unit is volt.
 The number of electrons passing through any point of a
conductor in one second is defined as the current intensity
and its unit is ampere.

 This electric current passes easily through some materials

and passes hardly through others.

 The force that determines the conductivity of the object and

makes the flow of electrons difficult despite the electrical
potential is called resistance. Its unit is ohm.
Electrical Current
 Since the fluids in the human body contain acids, bases
and salts, they easily transmit electric current.
Types of Currents
1. According to the current direction
 Direct current
 Alternating current

2. According to its clinical and electro-physiological effects

 Low frequency currents
 Medium frequency currents
 High frequency currents
Classification according to the
direction of the current
 The direction of the electric current is from the negative
pole to the positive pole.

 The direction of the electric current may remain constant

or change periodically.

 In this framework, two types of waves can be mentioned.

Direct current
 The direction of the electric current is constant. For this
reason, it is also called monophasic (unidirectional,
unipolar) or galvanic current.

 Physiologically, the current that does not change direction

for more than 1 second is accepted as direct current.

 Direct current is a unidirectional flow of electrons toward

the positive pole.
Alternating current
 The direction of the electric current changes constantly.
This type of current is also called biphasic (bidirectional,
bipolar) or faradic current.

 In alternating current, the current intensity rises from the

zero point to the highest positive value, then decreases to
the zero point, and then returns to the zero point by
reaching the lowest negative value. The time elapsed
during this time is called the period.
 The number of periods per second is called frequency. Its
unit is Hertz (Hz).

 In the devices used in electrotherapy, alternating current

is converted into direct current with the help of a special
electronic arrangement.
 Each of the periods when the current rises from the zero
point to the peak value and then returns to the zero point is
called a phase.

 Alternating current consists of two opposite phases in

duration of one period. So it's biphasic.

 The shape of these phases can be sinus wave, triangular

or square.
 If the opposite phases have the same shape, it is said to be
a symmetrical alternating current.
 Electrons flowing in alternating current always move from
the negative to positive pole, reversing direction when the
polarities are reversed.
What is the frequency of the AC signal below?
Classification according to clinical and
electrophysiological effects of currents

 The clinical and electrophysiological effects of currents

vary depending on their frequency. Accordingly, there are
3 types of current.
1. Low frequency currents

▪ Current frequency between 1-1000 Hz.

▪ Usually 1-200 Hz. frequencies are used.

▪ Faradic, diadynamic flow and TENS are in this group.

2. Medium frequency currents

 Its frequency is between 1000 and 1.000.000 Hz and is

generally used at a frequency of 4000-20.000 Hz.

 The most important example of this group is interferential

currents.
3. High frequency currents

 Its frequency is more than 1.000.000 Hz.

 Sense of this type of the current is not perceived, as with

medium and low frequency currents,

 Vibration and heat effects are primary.

Modulation of the currents
➢ Modulation is important to increase the physiological effect.

➢ The weakest current that can stimulate the tissue in the shortest time
is used.

➢ In the meantime, both the accommodation, which reduces efficiency,

and the development of polarization, which causes side effects, can
also be prevented.

➢ In this way, in direct, low or high frequency currents, the transit time
of the current through the tissue, and shape, frequency and direction
of the current can be changed.
➢ There are 3 different modulations in direct current.

1. Reversed direct current

 The direction of the current changes constantly, as in

alternating current.

 Unlike alternating current, the time of each phase takes

longer than 1 second.
2. Interrupted direct current

 The direction of the current is constant.

 However, the current is interrupted periodically.

 Periods when the current is cut off last 1 second or

longer. Between these interruptions, the current flows
for not less than 1 second.

 The most common endication of interrupted galvanic

current is denervated muscle stimulation.
3. Surged (ramped) direct current

 It is similar to interrupted galvanic current, but the current

intensity does not rise suddenly from 0 to its peak value.

 This rise lasts between 0-5 seconds.

 The flow decreases suddenly or slowly from its peak value

to 0.
➢ In the modulation of alternating current, the time or amplitude
of the current is changed.

1. Time

a. Burst Type modulation

▪ The passage of alternating current cuts for a few ms.

▪ The periods in which the current passes last also a few ms.

▪ Russian current is an alternating current modulation created

in this way. Polyphasic.
b. Interrupted alternating current

 The interruption lasts longer than 1 second and the current

passes for a few seconds.

 The main difference of interrupted alternating current

modulation from the burst type is that after muscle
contraction it provides sufficient resting time for the
muscle to relax.
2. Amplitude Modulation

 Two alternating currents with different frequencies are

applied to the same tissue at the same time.

 Since these two currents spread in the same tissue, they

combine with each other resulting in a single current
effect.

 In clinical practice, this modulation is known as the

interference current.
➢ Currently, there is no
known physiological or
clinical advantage of
alternating currents
modulated by time or
amplitude.
Pulsed current
 Pulsed current is the
unidirectional or
bidirectional flow of charged
particles that periodically
stop for a limited period of
time before the next event.
 More specifically, a pulse is
an isolated electrical event
separated by a finite period of
time from the next event.
Pulsed currents
 Pulsed current is defined as electrical current transmitted
in the form of short-duration signals.

➢ The parameters that determine the characteristics of these

currents are as follows:
1. Current rise time

 It is the time the pulse amplitude rises

from 0 to the maximum value.

2. Pulse duration

 To stimulate the nerve with minimum

electrical energy, the pulse duration is
kept equal to the chronaxie of the
nerve to be stimulated.

 It can range from a few milliseconds

to a few microseconds.

3. Time between pulses (Interpulse

interval)

 Generally ranges from 10 to 999

milliseconds.
4. Current frequency

 Muscle contraction occurs when the current amplitude

increases or decreases.
 Therefore, it is preferred that the current rise time is short.
 In currents with an impulse duration of 1 millisecond or
less, the motor effect is primary.
 If this time is shorter than 10 ms, there is no difference
between triangular and quadrangular currents in terms of
motor effect.
 The current rise time should be shorter than 60
microseconds to prevent the development of
accommodation.

 Accommodation develops faster in nerve fibers than

muscle fibers.

 The pulse duration is adjusted according to the chronaxis

of the nerve to be stimulated.

 Chronaxis is 30 microseconds in A alpha fibers, 200

microseconds in A beta fibers, 450 microseconds in A
delta fibers and 1500 microseconds in C fibers.
 During the pulse period, when the amplitude is constant,
sensory stimuli such as tingling, burning, stinging occur.

 These effects are most pronounced when the amplitude remains

constant for 20 milliseconds or more.

 To eliminate or reduce these unpleasant sensory effects, the

ideal phase duration should be less than 200 microseconds.

 Because, at currents with a pulse duration longer than 200

microseconds, very small fluctuations in current intensity cause
motoric or sensory stimulation to become painful.
 The number of pulses per second is defined as the pulse
frequency. Its unit is pps (pulse per second).

 The pulse frequency in the stimulators used at the present

time ranges from 1 to several hundred pps.

 In practice, low-frequency stimulation is used.

 Pulsed currents can be monophasic or
biphasic.

 The shape of the pulse phases can be

square, triangular or sinusoidal.

 In this respect, biphasic pulsed currents

can be symmetrical or asymmetrical.

 Biphasic symmetric pulsed currents are

important because they do not create
polarization in the tissue under the
electrode.
 In pulsed currents, since the total amount of current
passing to the tissue in one second is low, it provides a
safe and comfortable stimulation.

 In general, this amount does not exceed 20 milliamperes,

and most are 2-5 milliamperes.

 However, it is 80 milliamperes in Russian current, and 100

milliamperes in interferential current.
Modulation in pulsed currents
 The current rise time is kept
very short to prevent
accommodation.

 Rectangular currents are

generally used to achieve
optimal effect with the smallest
electric current intensity.

 In these rectangular currents, the

ideal flow duration is equal to
the chronaxie of the nerve to be
stimulated.
 However, if this current form is given monophase, the
polarization effect occurs.

 To prevent this, biphasic current can be given to the tissue

with a total current of 0 (symmetrical or asymmetrical).

 Since one of the phases is positive and the other negative

in biphasic currents, the net current passing to the tissue is
the difference of the currents given in these 2 phases.
 Symmetrical biphasic currents are more effective in motor
nerve stimulation than asymmetrical biphasic ones.

 Pulse or current modulations can be made.

Pulse Modulation
 In this modulation, the duration, amplitude or frequency
of the pulsed current automatically increases and then
decreases.

 Physiological or clinical superiority of these different

modulations to each other has not been demonstrated.

 The purpose of pulse modulation is to delay

accommodation.
Current modulation
 There are 3 forms.
a. Interrupted type

 The current passes for a few seconds, followed by a rest

period of few seconds.

b. Burst or packet type

 In fact, it is a type of interrupted pulsed current.

 The difference is that the current flow and subsequent rest

periods are a few milliseconds.

 Within a few milliseconds of the current, a few pulses pass

into the tissue in forms of packets.
c. Ramp type

 It is similar to interrupted type modulation.

 In interrupted current, the intensity of the current increases

suddenly, and decreases suddenly after a few seconds of
current flow.

 In the ramp current, the current amplitude gradually

increases, and the current is cut off by gradually decreasing.

 Then a rest period of a few seconds occurs, as in the

interrupted current.
General Physiological Effects of Electrotherapy
➢ Electrothermal effect

•Electrical charges cause heat generation in the

conductive environment with the effect of
microvibration and friction force.
•In thermal effect, the effect of current on vasomotor
nerves is more important.
•With the application of galvanic current for 20 minutes,
the skin circulation increases by 90% and there is a 0.4
degree heat increase in the subcutaneous and muscle
tissue.
General Physiological Effects of Electrotherapy
➢ Electrochemical effects

Electric currents cause the formation of new chemical

compounds in the conductive setting they pass through.
Acid is formed under the positive electrode, and base is
formed under the negative electrode.
Chemical burns can occur if the electrolytic reaction is
not buffered by tissue.
These reactions can be prevented by applying pulsed
current instead of direct current.
General Physiological Effects of Electrotherapy
➢ Electrophysical effects

The electrical current causes the ions to move.

As a result of these effects; muscle contraction,

activation of endogenous analgesic mechanisms, and
vascular response may occur.

The physiological effects of electrical current occur

directly or indirectly at four different biological levels:
cell, tissue, segmental and systemic.
General Physiological Effects of Electrotherapy

➢ Effects at the cellular level

Peripheral nerve stimulation

Changes in membrane permeability

Fibroblast and osteoblast formation

Increase in ATPase activity
Increase in protein synthesis
General Physiological Effects of Electrotherapy

➢ Effects at the tissue level

Skeletal and smooth muscle contraction and relaxation

Tissue regeneration

Joint effusion, and interstitial fluid resorption

Changes in thermal and chemical balances
General Physiological Effects of Electrotherapy

➢ Segmental effects

Contraction of muscle groups

Pumping effect on artery, vein and lymph flow

Increased arterial and lymphatic drainage independent

of skeletal muscle contraction
General Physiological Effects of Electrotherapy
➢ Systemic effects

Analgesic effect through increased endogenous peptide

secretion
Analgesic effect through serotonin release

Effects on circulation via vasoactive intestinal

polypeptide
Regulation of the functions of internal organs such as
kidney and heart
General Physiological Effects of Electrotherapy
➢ Muscle Stimulation through Electrical Current

Instead of direct stimulation of the healthy muscle

fiber with electrical current, it is stimulated indirectly
via the motor nerve being innervating by.
Stronger stimuli are required for stimulating the
muscle fiber than for the nerve fiber.
This is because the membrane resting potential and
excitation threshold are lower.
General Endications of Electrotherapy

▪ Muscle strengthening
▪ Prevention of muscle atrophy and degeneration

▪ Maintaining or increasing joint range of motion

▪ Spasticity

▪ Motor facilitation and reeducation

▪ Reduction of joint fluid and interstitial edema
▪ Eliminating pain
▪ Resolving muscle spasm

▪ Treatment of skin ulcers and wounds

▪ Prevention of the development of deep vein

thrombosis
▪ Fracture healing
Thank you…
Assist. Prof. Baha NACI
2022-2023 Spring Semester
07.03.2023
GALVANIC CURRENT
 Direct current is a form of current that has two
different poles and provides a direct, constant,
continuous current from one pole to the other.
Effects of Direct Current
➢ Chemical Effects
 Iontophoresis
 Medical galvanism
 Surgical galvanism

➢ Physiological Effects
 Interpolar
 Polar

❑ Heat effect: Galvanic currents are not used for heat in

physical therapy. Because the current intensities are very low.
 IONTOPHORESIS
➢ Moving of the (+) charged ions towards the (-) pole and the
(-) charged ions towards the (+) pole is called
iontophoresis (Ion transfer).

➢ By using the ionic power through the skin, the process of

introducing some chemicals or drugs that can be ionized
into the body for treatment purposes is IONTOPHORESIS.
EXPERIMENTS
 LEDUC EXPERIMENT

 SCHATSKI EXPERIMENT
LEDUC EXPERIMENT
 In an experiment conducted by Leduc, one of two rabbits with
shaved bellies was given strychnine sulfate from + polar, and the
other one was given potassium cyanide - polar . At the end of the
experiment, it was observed that two rabbits died because
strychnine is a poison and is + charged. In addition, cyanide is a
poison and - loaded. Since the like polars would repel each other,
the poisons entered the body and it was seen that the rabbits
died.
 As a result of this experiment, it was stated that iontophoresis
occurs under that electrode when the electrode and the active
substance are charged with the same charge.
 Negatively charged ions should be located under the cathode,
and positively charged ions should be located under the anode.
LEDUC EXPERIMENT
SCHATSKI EXPERIMENT
 A hole was cut in the middle of the potato. This hole was filled with a
KI (potassium iodine) solution. Electrodes connected to the right and
left terminals cause Potassium(+) to collect at the cathode (-) and
Iodine (-) at the anode (+). The starch in the potato, which turns blue
with iodine, proves that the ions are displaced by the effect of
electricity.
AIMS OF IONTOPHORESIS
 To localize the desired
chemical substance to the
desired location.

 Through the skin, transmitting

substances which are not
desired to be transmitted
systemically to the body.

 To increase the effect of the

substances, which are absorbed
very slowly into the skin if
taken systemically, by storing
them in the skin.
 Iontophoresis Technique
 A well-functioning tool should be present

 The poles should be well known.

 Electrodes should be selected according to the treatment area.

 Electrodes should be covered with a 16-20 layer cloth (pad) or sponge

cover.

 Whichever ion will be given to the patient, its solution should be

prepared (1-2%).

 Before treatment, the treatment area should be cleaned.

Iontophoresis Technique
 If there is a wound or scratch in the area to be applied,
cellophane paper should be placed on it or it should be
covered with vaseline.

 The treatment should be explained to the patient.

 A sensory test should be performed on the treatment

area (sharp-blunt test with needle test).

 To reduce pain, the passive electrode should be larger

than the active electrode.
Iontophoresis Technique
 Electrodes and pads should be bandaged so that they are
firmly in contact with the area to be treated.

 It should be wrapped with nylon.

 The current intensity should be gradually increased or

decreased.

 The patient should be in a comfortable position.

 After treatment, the electrode pads should be cleaned.


 The duration of treatment is 15-30 minutes.
Pathologies
• Pain: Hydrocortisone, salicylate, magnesium, lidocaine
• Inflammation: Hydrocortisone, salicylate
• Spasm: Magnesium, calcium
• Ischemia: Magnesium, mecolyl, salicylate, hyaluronidase
• Calcific tendinitis: acetic acid
• Fungus: copper
• Gout tophi: lithium
• Open wounds: copper
• Scar-Adhesion: Chlorine, iodine, salicylate
• Hyperhidrosis: tap water
• Hypo/hyper irritability: calcium
 IONS APPLIED FROM (-) POLE
➢ IODINE (KI)

 In case of inflammatory conditions following the wound,

relieving stiff joints
 Releasing scar tissues
➢ CLORINE (NaCl, CaCl2)

 Releasing tissue stiffness

➢ SALICYLATE

 Rheumatic diseases

 It has an analgesic effect on sensory nerves.

➢ CITRATE

 Rheumatic diseases, especially rheumatoid arthritis

IONS APPLIED FROM (+) POLE
➢ ZINC (ZnCl2, ZnSO4)

 It is especially used for superficial wounds, sinusitis,

ear infections.
 It is an antiseptic substance.

➢ COPPER (CuSO4)

 It is used for fungal infection, superficial wounds.

➢ HISTAMINE

 It is used for chronic inflammatory conditions,

circulatory disorders.
 It results in capillary dilatation, arterial dilatation,
increased capillary permiability

➢ MAGNESIUM

 It is used for bursitis, periarthritis.

➢ PROCAINE

 It is used for sprains, low back pain, muscle spasm.

 Relaxing function

➢ MECOLYL

 It is used for chronic RA, and peripheral vascular

diseases caused by vasospasm.
 It is used for Raynaud's disease, varicose ulcers.
IONS APPLIED FROM BOTH POLES

1. Tap water: used for hiperhydrosis

2. Ringer solution: used for open wounds

Iontophoresis for hiperhydrosis
Complications
• Burns:
- Chemical Burns: It happens due to
accumulation of excessive NaOH under
cathode. Compared to anode, larger cathode
is recommended.
- Thermal Burns: Excessive heat leads to
burns in high resistance areas.
➢Electrode pads with sufficient moist
➢Ensuring full contact
➢Absence of air gap between the skin and the
electrode is important
Complications
• Sensitivity and allergic reactions
➢ Iodine is not used in allergies for sea products
➢ Hydrocortisone may cause reaction in presence of
active ulcer, and gastritis
➢ Salicylate is not used in allergies for aspirin
➢ Metals such as copper, zinc, magnesium are not used
in presence of sensitivities for metals including watch
strap, bracelet
MEDICAL GALVANISM

 Anodal Galvanism

 Cathodal Galvanism

 Anode-Cathode bilaterally application

 Water applications
Anodal Galvanism
 The active electrode is the (+) electrode.

 It is used to benefit from the features of the (+) pole.

 It reduces muscle spasm and pain as the anode reduces the

excitability of the nerves.

 It is used especially in reducing pain in subacute conditions.

 It is used for joint sprains, joint stiffness, nonarticular rheumatic

diseases.

 Application Time: 45-60 Minutes

Cathodal Galvanism
 It is used to benefit from the features of (-) pole

 The active electrode is (-).

 It is used for chronic painful conditions, nonarticular rheumatic diseases, sprains.

 The active electrode is placed on the painful area and the passive electrode is placed
on any part of the body.

 It is used to soften scar tissue

 Application Time: 20-30 Minutes

Anode-Cathode bilaterally application

 It is especially preferred for joints.

 (+) and (-) electrodes are placed to the medial and lateral
parts of the joint.

 It is used for the same endications as for cathodal

galvanism

 Application Time: 20-30 minutes

Water applications
➢ ADVANTAGES

 Water is a good conductor.

 Since the skin is in water, its resistance decreases.

 Large areas can be stimulated.

 If the electrodes do not contact with the patient and if

the patient does not have metal objects, a burn does
not occur.
➢ DISADVANTAGES

 The current is not localized in a particular area

 Current accumulates especially on the surface

Application types
1. Bipolar

2. Monopolar

3. Schnee 4 basin application

Surgical Galvanizm
 It is the destruction of undesired tissues with direct
current.

 Destruction of skin blisters

 Removal of hair (epilation)

PHYSIOLOGICAL EFFECTS
➢ Effects of the current on living tissues such as nerve,
muscle, blood circulation, and skin

 Inter-polar Effects

 Polar Effects
Interpolar Effects
➢ The effects occuring in the path which the current
passes through.

 Vasodilation occurs. Reasons for vasodilation:

The release of histamine substances,

Mechanical effect of ion bombardment,

Reflex vasodilation occurs with stimulation of sensory

nerve endings as a result of ion movements.
Polar effects
➢ Changes occuring under the electrodes

 + electrode →anelectrotonus → Nerve Conduction Velocity

 - electrode →catelectrotonus→ Nerve Conduction Velocity 

Effects of galvanic current on body tissues
Effects on Central Nervous System
 In an experiment on human, a man was placed in a
bathtub. A negative electrode was placed on the
head, while a positive electrode was placed on the
foot. When the current was applied, the patient
developed tension. When the current was cut off,
the patella reflex was increased.

 When the positive electrode was placed on the head

and the negative electrode on the foot, numbness
occurred with the application of current. When the
current was cut off, the patella reflex decreased.
 Effects on sensory nerves

 Anesthesia is produced by stimulating the sensory

nerves.

 This anesthesia is evident under the positive pole.

 Pricking under the negative pole.

 However, its anesthetic effect is less than other

currents.
 Effects on sensory organs

 Various tastes can be perceived by stimulating the

nerves in the sense of taste.

 With the optic nerve stimulation, a flash of light is

observed in the eye.

 Whistling, ringing or musical sounds are heard

when a negative electrode is placed on the ear.
 Effects on muscles and peripheral nerves

 It provides easier excitability.

 Especially at the negative pole, the excitability is higher.

 It never causes muscle contraction.

 Excitability increases when negative poles are applied to

peripheral nerves.

 The positive pole reduces subacute pain.

Effects on vessels

 A sudden, short-term, temporary vasoconstriction

occurs when first applied.

 Following this, a prolonged vasodilation is produced.

 Redness and hyperemia of the skin are observed

under the negative electrode. This is because the
capillary vessel is chemically affected.
MODIFIED GALVANIC CURRENT
1. INTERRUPTED GALVANIC CURRENT

 Rectangular Galvanic Current

 Triangular Galvanic Current

2. SURGED GALVANIC CURRENT

Interrupted Galvanic Current
 The current transition and resting times are in the ratio of
1 to 2.

 250ms to 500ms, 300ms to 600ms..

Surged Galvanic Current
 The current transition and resting times
1sn 1sn

➢ It is surged to get 25 contractions per minute.

➢ There is a constant contraction of the muscle over 60

contractions per minute. This is called tetanic
contraction.
Effects of Modified Galvanic Current on Body Tissues

 Stimulating the sensory nerves

 Reflex Vasodilation and Erythema

 Stimulating motor nerves

 Stimulating denervated muscles

 Creating contraction of the muscle

 Used in circulatory disorders

 Used in diagnosis by electricity

Monopolar Technique
 Pencil electrode and plaque electrode are used.

 The plaque electrode is passive and is placed on the muscle origo.

 The pencil electrode is placed on the motor point of the muscle.

 90 contractions should be taken from one muscle in one session.

 In order not to cause muscle fatigue, it is applied in a way that takes

30-30-30 or 45-45 contractions.

 Used to treat isolated muscles.

Bipolar technique
 Two plaque electrodes are used, one is placed on the origo
and the other on the insertion.

 300 contractions should be taken in one session.

 ( 7,3,10=20 min) rule is applied.

Bipolar technique
Two Pencil Electrodes

 Having a contraction between the beginning and the

end points of a muscle by bringing two pencil
electrodes closer and then moving them away.

 Mostly used for deep muscles.

Water Application

 It is a rarely used method.

 Used for diseases such as poliomyelitis, Guillain-

Barre.
Thank you..
Assist. Prof. Baha NACI
2022-2023 Spring Semester
14.03.2023
FARADIC CURRENT
 Definition: It is a short-duration interrupted current, with a
pulse duration ranging from 0.1 and 1 ms and a frequency of 30 to
100 Hz.

Wave forms:

1. Induced asymmetrical alternating current.

2. Biphasic, Asymmetrical, Unbalanced, Spiked.
3. Positive portion- short duration, high amplitude and spiked.
4. Negative portion- long duration, low amplitude and curved
 Modifications
➢ Faradic currents are always surged for treatment purposes
to produce a near normal tetanic-like contraction and
relaxation of muscle.
 Forms of faradic current
Each represents one impulse:
* In surged currents, the intensity of the impulses increases
gradually, each impulse reaching a peak value greater than
the preceding one then falls suddenly or gradually.
* Rest period should be at least 2 to 3 times as long as that of
the pulse to give the muscle the sufficient time to recover.
 Forms of faradic current
 The most comfortable pulse is 0.1-msec pulse, with a
frequency of 70 Hz or 1-msec pulse with a frequency of 50
Hz.
 For practically all skeletal muscles, tetanic contraction
requires a minimum frequency of 7 Hz.
 The most comfortable tetanic contractions are obtained
with 40 to 80 Hz frequencies.
 Effects of faradic currents
1. Stimulation of sensory nerves:

 It is not very noticeable because of the short duration.

 It causes reflex vasodilation of the superficial blood vessels
resulting in slight erythema.
 Effects of faradic currents
2. Stimulation of the motor nerves:

 It occurs if the current has sufficient intensity, resulting in

contraction of the muscles innervated by the nerve distal
to the point of stimulus.
 A suitable faradic current applied to the muscle produces a
contraction of the muscle itself and may also spread to the
neighboring muscles.
 Effects of faradic currents
2. Stimulation of the motor nerves:

 The contraction is tetanic because the stimulus is repeated

50 times or more per second.
 If this contraction type continues for more than a short
time, muscle fatigue occurs.
 So, the current is commonly surged to allow for muscle
relaxation
 Effects of faradic currents
3. Creating a change in the semi-permeability of the
cell membrane stimulates the nerve

 This is achieved by altering the resting membrane

potential.
 When it reaches a critical excitatory level, the muscle
supplied by this nerve is activated to contract.
 Effects of faradic currents
6. Chemical changes:
 The ions move one way during one phase of the current;
and in the reverse direction during the other phase of the
current if it is alternating.
 If the two phases are equal, the chemicals formed during
one phase are neutralized during the next phase.
Application of faradic current

 Muscle stimulation with faradic current; the muscle must

have a good general innervation.
 The current may be applied for diagnostic and therapeutic
objectives.
Diagnostic objectives

 Investigation of myasthenic reaction;

 Investigation of myotonic reaction;
 Localization of a neurapraxia(nerve compression) block.
Indications:

1. Facilitation of muscle contraction inhibited by pain:

 Stimulation must be stopped when good voluntary contraction is obtained.

2. Muscle re-education:

 Muscle contraction is needed to restore the sense of movement in cases of

prolonged disuse or incorrect use; and in muscle transplantation.

3. Training a new muscle action:

4. Nerve damage:

 When a nerve is severed, degeneration of the axons occur

several days later.
 So, for a few days after the injury, the muscle contraction
may be obtained with faradic current.
 It should be used to exercise the muscle as long as a good
response is present but must be replaced by modified
direct current as soon as the response starts to weaken.
5. Improvement of venous and lymphatic drainage:

 In oedema and gravitational ulcers, the venous and

lymphatic return should be improved by the pumping
action of the alternate muscle contraction and relaxation.
6. Prevention and loosening of adhesions:

 After effusion, adhesions are prone to form. This can be

prevented by keeping structures moving with respect to each
other.
 Adhesions may be stretched and loosened by muscle
contraction.

7. Painful knee syndromes:

 After trauma, muscle contraction is inhibited, resulting in

muscle atrophy.
Contraindications:

 Skin lesions
 Loss of sensation
 Certain dermatological conditions: psoriasis, eczema
 Thrombosis
 Acute infections and inflammations
 Cancer
 Cardiac pacemakers
 Superficial metals
Methods of Application

 Unipolar
 Bipolar

Technique of Application

1. Group muscle stimulation

2. Motor Point stimulation.
3. Labile technique
4. Baths
5. Stimulating through the nerves
6. Faradism Under Pressure
7. Faradism Under Tension
1. Group Muscle Stimulation
It is used to stimulate muscle groups with same origin. There
are two plaque electrodes. One of the electrodes is placed on
the muscle belly and the other one on the place where the
nerve becomes superficial.
The active electrode is the electrode on the nerve. The
passive electrode is larger. Sometimes electrodes are placed
on the origin and insertion of the muscles.
2. Motor Point stimulation.

After finding the motor point of the paralyzed muscle,

muscle contraction is obtained with a surged faradic current
using a pen electrode. It is used in isolated muscles. This
method is preferred if a single muscle is performing a
movement.
Motor Points of Axiallary Nerve
Motor Points of Musculocutaneous Nerve
3. Labile Technique

In this technique, the active electrode is not fixed. It is

moved closer and further away from the motor point. The
pencil electrode cannot be used for surged currents.
4. Baths

Application of faradic current to the body parts in a tub,

tray or tank containing water is termed as bath method of
application
● Depending on the placement of electrodes bath can be:
1. Bipolar : both electrodes are in the water
2. Unipolar : one electrode is in the water while the
other one is kept at any convenient part of the body
Advantage of bath method are:
 Skin resistance is lowered considerably by prolonged
soaking in water
 Water makes perfect contact with the tissues
 Wash of electrolytes formed under the electrodes
Disadvantages are:
 Current can not be localized
 Superficial muscles contract more than deep muscles due
to the presence of water
 Electric shock risk is higher
Faradic Foot Bath

 ES by faradic current may be applied in baths.

 Can be used to stimulate
- Lumbricals
- Plantar interrossei
- Abductor hallucis
Lumbicals
Plantar Interrossei
Abductor hallucis
Faradic Foot Bath

 Position the patient in high sitting with back supported

 Position the feet on a stool covered with a plastic sheet
 Place the foot in a bath containing enough warm water to
cover the toes
Faradic Foot Bath

 To stimulate the
lumbricals place two
electrodes transversely,
 one under the heel
and the other under the
metatarsal heads
Faradic Foot Bath

 To stimulate the plantar

interossei place one
electrode on each side of
the foot at the level of
metatarsal shafts
Faradic Foot Bath

For Abductor hallucis

place
 one electrode under the
heel and
 stimulate the muscle
through the motor point
using a pen electrode
Faradic Foot Bath

 A surged faradic current is used for this

 Surge duration 1 sec.
 Surge interval 3 sec.
 Intensity : enough to produce a visible contraction of the
muscles.
 Treatment time: 15 – 30 minutes
Faradic Foot Bath

 Rectangular metal or carbon rubber electrodes of 3 X 7 cm

can be used
 No lint pad or coupling medium required
 Encourage the patient to contract the muscle voluntarily
with the current
5. Stimulating through the nerves

 If the muscle to be stimulated is in plaster, nerve

stimulation can be done by opening a plaster window.

6. Faradism Under Pressure

 ES of muscle combined with compression and elevation of

the limb can be used to increase venolymphatic drainage
and thus to improve edema.
 This technique is known as Faradism Under Pressure
Faradism Under Pressure

 Patient in supine position

 The limb is elevated above the heart level using pillows
 The pressure bandage is applied over the electrode, with
maximum pressure distal to proximal
 The skin must be cleaned before treatment
Faradism Under Pressure

 Placement of electrode for lower limb:

• Active electrode is over the belly of the calf muscle
• Passive electrode is over the sole of the foot

 Placement of electrode for upper limb:

• Active electrode over the volar aspect of forearm at the
junction of proximal 1/3 and distal 2/3 of the muscle belly
• The passive electrode over the palm or cubital fossa
Faradism Under Pressure

 A surged faradic current is used for this

 Surge duration 3 sec.
 Surge interval 9 sec.
 Intensity : enough to produce a visible contraction of the
muscles i.e. clenching of toes or fingers.
 Treatment time: 15 – 30 minutes
Faradism Under Pressure

 Rectangular metal or carbon rubber electrodes of 3 X 5 cm.

can be used

 Encourage the patient to do active movement along with

the current and relax during surge interval
7. Faradism Under Tension

 Shortening of contractile soft tissues (muscles) can be

treated with Faradism.
 Such contractures develop in major muscle groups like
quadriceps or elbow flexor group
 This is mostly after prolonged immobilization
 Passive mobilizations can be very painful.
 Titanic contraction by the surged current gradually pulls
apart the shortened myofibrils with less pain.
Faradism Under Pressure

 A surged faradic current is used for this

 Surge duration 3 sec.
 Surge interval 9 sec.
 Intensity : enough to produce a visible contraction of the
muscles.
 Treatment time: 15 – 30 minutes
Faradism Under Pressure

 Rectangular metal or carbon rubber electrodes of 5 X 10 cm

can be used.
 Encourage the patient to do actively contract the muscle
along with the current and relax during surge interval
Faradism Under Pressure

 For quadriceps contracture:

 Patient is positioned on a plinth.
 A roll of towel or pillow is placed below the knee to give a
stretch
 Passive electrode is placed over proximal 1/3 of the
quadriceps
 Active electrode is placed on the junction of proximal 2/3
and distal 1/3 of the belly of the muscle
Faradism Under Pressure

 For quadriceps contracture:

 Patient is positioned on a plinth.
 A roll of towel or pillow is placed
below the knee to give a stretch
 Passive electrode is placed over
proximal 1/3 of the quadriceps
 Active electrode is placed on the
junction of proximal 2/3 and
distal 1/3 of the belly of the
muscle
Faradism Under Pressure

 For elbow flexor contracture:

 Patient is positioned on a plinth.
 A roll is placed under the elbow just proximal to the
joint.
 Passive electrode is placed over proximal 1/3 of the elbow
flexor
 Active electrode is placed on distal 1/3 of the belly of the
muscle
Precaution & Dangers
 If the skin sensation is not normal, position the electrodes
at an alternative site ensuring effective circulation.
 Avoid active epiphyseal regions in children.
 Select stimulation parameters appropriate to the effect
desired.
 Inappropriate stimulation may result in muscle damage,
reduction in blood flow through the muscle and muscle
fatigue.
 Appropriate care should be taken to ensure that the level
of muscle contraction initiated does not compromise the
muscle and the joint(s) over which it acts.
Dangers

 Burns
 Electric shock
 Hypovolemic shock
References

1. Low J & Reed A. Electrotherapy Explained: Principles and

Practice. 2nd ed. Butterworth-Heinemann. 2006
2. Foster A, Palastanga N. Clayton’s Electroptherapy Theory
and Practice. 9th edition. W B Saunders. 2006;pp 70 – 79
3. Mitra PK. Handbook of Practical Electrotherapy. Jaypee.
2006; pp 44–49
4. Khatri S. Basics of Electrotherapy. Jaypee. 2003. pp 28 –
30
Thank you..
 DIADYNAMIC CURRENTS

Assist. Prof. Baha Naci

2022-2023 Spring Semester
21.03.2023
SINUSOIDAL CURRENTS

◼ Low frequency currents alternating equally.

◼ Symmetrical bipolar alternating current.
◼ Its frequency is 50-100 Hz, current duration is 10ms.
◼ They do not have chemical effects as they constantly
change direction.
◼ Not used for heat purposes due to low intensity
SINUSOIDAL CURRENTS

Physiological effects:
◼ Sensory nerves: Prickling sensation, reflex vasodilation
and erythema (more than faradic current)
◼ Motor nerves: Muscle contraction through stimulation of
its motor nerve. Tetanic contractions are obtained with at
least 20 Hz
◼ Denervated muscles: Results in contraction of
denervated muscle but the patient can not tolerate
because of pain.
DIADYNAMIC CURRENTS

◼ Diadynamic current was discovered by Pierre Bernard

60 years ago
◼ Diadynamic currents are basically a variation of
sinusoidal current.
◼ They are monophasic sinusoidal currents (rectified
alternating current) with duration of 10 ms
◼ They are half or full wave rectified sinusoidal currents.
DIADYNAMIC CURRENTS

◼ Basic principle of diadynamic current is an electronic

modulation of symmetrical biphasic sinusoidal waveform,
with frequency of (50-60Hz).
◼ Pulse duration is extremely long, (6-10 ms) so it is more
painful
Half and Full Wave Rectification
◼ Half wave Rectification - When a sinusoidal current is
half wave rectified, half of the sinusoidal oscillation is
removed and the result is no longer AC but a series of
pulses.
◼ Full wave Rectification – includes reversing the polarity
of one phase of sinusoidal AC current so that current
flows in the same direction with each pulse
DIADYNAMIC CURRENTS
◼ Diadynamic currents are alternating sinusoidal
monophasic pulsed, galvano-faradic currents.
◼ There are two basic forms of diadynamic currents:
◼ Diphase Fixe (DF) or double phase, which is full-wave
rectified sinusoidal current.
◼ Monophase-Fixe or single phase current, known as half-
wave rectified sinusoidal current.
◼ Short Period (CP), Long Period (LP) and Rhythm
Syncope (RS) current types are obtained by
combinations of DF and MF.
Diadynamic Current Types

◼ Diphase fixe (DF)

◼ Monophase Fixe (MF)

◼ Courtes Period (CP)

◼ Long Period (LP)

◼ Rhythm Syncope (RS)

Diphase fixe (DF):
◼ Generally used for initial treatment and has analgesic effect
◼ Indication: Pain with muscle spasm
◼ DF is frequently used in cases of increased sympathetic tone
and peripheral circulatory disorders.
◼ Tickling and prickling sensations occur during the application.
◼ Muscle contraction occurs only at high intensities

◼ Frequency: 100Hz
◼ Impulse duration: 10 ms
◼ No rest between the impulses
Monophase Fixe (MF)
◼ MF is generally used for connective tissue
stimulation, and for pain without muscle
spasm
◼ The patient feels strong vibration sensation.
◼ MF current can result in muscle stimulation at
lower intensity than DF
◼ Fr: 50 Hz.
◼ Impulse duration: 10 ms
◼ Rest time: 10 ms
Courtes Period (KP)

◼ Consists of equal phases of consecutive DF and MF.

◼ The duration of each component is 1 second.
◼ No interval pause
◼ Rapid alternating feeling between DF and MF
◼ Fine tremors in MF phase (strong and constant vibration)
◼ It is used for trophic disorders, traumatic conditions and
non-spasm-related painful conditions.
◼ 1 s DF, 1 s MF passes sequentially.
Long Period (LP):

◼ 10 sec MF followed by 5 sec DF in which

intensity and frequency gradually rise then fall
◼ This type of current produces a long-lasting
analgesic effect.
◼ It is used for chronic painful conditions such as
neuralgia and myalgesia.
◼ Feeling: Strong vibration to pricking
Rhythm Syncope (RS):

◼ MF currents following each other intervally

◼ 1 second phase of MF, followed by a 1 second
rest phase
◼ Can be used for stimulation of muscles with
preserved innervation (faradic stimulation) and
as a test for motor nerve excitability.
◼ RS and MF are the same. Only passing
durations are different.
Parameters to consider
◼ Treatment can be started with direct current application.

◼ After direct current, DF is applied.

◼ Then MF, CP, LP or RS can be applied for 2-5 min.

◼ Intensity should be increased gradually until definite vibration or

prickling sensation occurs - within the pain threshold limit

◼ Frequency – 6-7 treatments given daily or every other day

Parameters to consider
◼ Total application time should not exceed 10-12 minutes
– electrochemical reactions – maximum 4-5 min.

◼ In acute painful cases, it is appropriate to apply the

treatment everyday and, if possible, 2 times in 24 hours.

◼ The interval between two treatment sessions should not

exceed 24 hours.
Electrodes:
◼ Metal plate or carbon rubber electrode / cup electrode /
Yoke electrode may be used.
◼ The electrodes should be separated from the skin by
moist sponge pads which are at least 1 cm-thick and
which absorb plenty of water.
Electrodes:

◼ Electrode may be of equal size or small electrode is

applied on the trigger site with a large electrode
proximal to it.
◼ Intensity will be gradually increased to produce muscle
contraction.
◼ To avoid tissue damage, current reversal during
treatment is followed
 CLINICAL APPLICATION OF DD CURRENT

◼ Pain spot: The two electrodes are applied as a bipolar

technique with the anode applied over pain spot and the
cathode adjacent to it. Cathode may be applied
proximally on the limb or over the nerve supplying the
painful area (monopolar technique)

◼ Nerve trunk: The two electrodes are placed along the

course of the peripheral nerve where the nerve is
superficial. A tingling sensation will be felt in the area
stimulated
 CLINICAL APPLICATION OF DD CURRENT

◼ Paravertebral or segmental application: The

electrodes may be applied on both sides of the spine at
the level of the nerve root supplying the painful area. If
several nerve roots are compromised, the electrodes
may be applied alongside the spine at the highest and
lowest nerve root levels.

◼ Vasotropic application: The electrodes are applied

along the vascular paths affected in the circulatory
disorders.
 CLINICAL APPLICATION OF DD CURRENT

◼ Myoenergetic application:
• The two electrodes at each end of the muscle belly to
produce stimulation
• Alternatively, monopolar technique with one electrode on
the motor point of the muscle belly and the other
proximal to it

◼ Transregional application (at painful spots on the

affected nerve) : to treat a joint, electrodes positioned
on opposite side of the joint.
Effects of DD current

◼ Similar to galvanic and faradic currents but DD is

superior in terms of producing hyperaemia and analgesia

◼ These strong effects are caused by the constant change

of the combined direct and alternating currents, and the
current shape.
Physiological Effects

◼ Sensory stimulation -prickling sensation

◼ Motor stimulation – Muscle contraction – intramuscular
blood flow
◼ Effects on blood flow – vasodilation & hyperaemia
◼ Altering the ionic distribution around the cell
◼ Tropic changes
Therapeutic Effects

1. Pain relief due to

• Direct mechanism - stimulation of sensory nerves

causing pain relief through stimulation of pain gate
mechanism
• Indirect mechanism - improving circulation through
pumping action of muscle contraction with subsequent
removal of irritant wastes.
Therapeutic Effects

2. Decrease inflammation and swelling – due to

increased local circulation and change of cell
membrane permeability

3. Muscle reeducation and strengthening – due to

stimulation of motor nerves
Therapeutic Effects

4. Increase of local circulation due to

• Release of H-like substance due to polar effect
• Changing autonomic activity – reduced sympathetic tone
causes vasodilation

5. Facilitation of tissue healing – due to local circulatory

changes and the polar effects resulting in increased cell
activity
Electrochemical Effects

◼ Skin damage due to electrochemical changes and

changes in the pH value of the skin.

◼ To minimize the risk of skin damage, treatment time

should be limited to 10 minutes.
Indications
1. Muscle and Joint Problems

◼ Sprain: 3-4 min CP (if there is pain, 1 min DF initially)

◼ Contusion: CP for painful spots
◼ Muscle injuries: 3-4 min CP
◼ Epicondylitis: 2-3 min LP
◼ Joint stiffness due to immobilization: 5 min CP
◼ Osteoarhritis: DF, CP, LP applications
◼ Humeroscapular periarthritis: 3-4 min CP, (LP is also applied if there
is muscle spasm.)
◼ Sudeck's atrophy
◼ Myositis
◼ Torticollis
Indications

2. Circulatory disorders

➢ Raynaud disease
➢ Buerger (thromboangiitis obliterans)
➢ Arteriosclerosis obliterans
➢ Migraine
➢ Varicosis
Indications

3. Neuralgia

➢ Trigeminal neuralgia
➢ Occipital neuralgia
➢ Sciatalgia
◼ Joint sprains: plaque or Yoke electrodes on
both sides of the joint

◼ DF 1 min
◼ CP 3-4 min
◼ RS 2 min
◼ Osteoarthritis: transarticular application

◼ DF 1 min
◼ LP 5 min
◼ (2-3 min MF)
◼ Migraine:
◼ DF is used
◼ one of the small cup electrodes is placed on
gg. cervicale sup, while the other one 2-3 cm
proximally - 3 min
◼ Then a. temporalis superficialis - 2-3 min
◼ Sciatalgia: starting from low back
- application through sciatic nerve

◼ DF 1 min
◼ CP 2-3 min
◼ LP 2-3 min
◼ Sudeck's Atrophy:

◼ (-) cup electrode is placed on stellar ganglion

◼ (+) electrode is placed behind SCM muscle
◼ DF application
◼ Torticollis:

◼ Paravertebral application
◼ DF 1 min
◼ LP 3 min
◼ Can be applied on painful spots of SCM
muscle
◼ Raynoud disease:

◼ Initially DF on stellar gg. with small cup

electrodes.
◼ Then CP (2 min) on dorsal and volar parts of
the hand with large plaque electrodes
Contradictions

◼ Acute inflammation
◼ Active bone, joint, and other organ tuberculosis
◼ Malignant tumor
◼ Transthoracic and transcranial regions
◼ Diseases that cause cachexia
◼ Decompensated heart condition
◼ Hemorrhage
◼ Metals in the tissue (after the injury, endoprosthetics,
osteosynthesisetc.)
◼ Dysesthesia
◼ Pregnancy
Summary

◼ DD current is particularly suitable for treating PAIN in small

joints. (e.g. finger joints & wrist joints).
◼ Segmental application of diadynamic current gives
outstanding results in REFLEX DYSTROPHY & in
SUPERFICIAL HYPERALGESIA
◼ MF – Good analgesic effect –treating painful conditions.
◼ DF –Strong analgesic effect –Connective tissue toning
◼ CP –Effective in oedema & hematoma & decreasing pain.
◼ LP –Strong & long lasting analgesic effect (Electroanalgesia)
–Painful syndromes & extra-articular rheumatism
Thank you..
TRANSCUTANEOUS ELECTRICAL
NERVE STIMULATION

(TENS)

Assist. Prof. Baha Naci

2022-2023 Spring Semester
28.03.2023
HISTORY

 The first stimulators that pioneered today's

TENS devices were used in the US in the early
1900s under the name Electreat.
 Canadian physiologist Ronald Melzack and
British neuroanatomist Patrick Wall played a key
role in the discovery of TENS.
 Melzack and Wall published a very important
work on Gate Control Theory in 1965.
DEFINITION

 TENS is a method used to create analgesia

in chronic or acute painful diseases.

 Pain transmission is blocked by stimulation

of sensory nerves via a direct, low-intensity
current.
BIOPHYSICAL CHARACTERISTICS

 Waveform: Symmetrical, asymmetrical or

balanced biphasic.
BIOPHYSICAL CHARACTERISTICS

Waveform

1. + monophasic rectangular
2. + - biphasic asymmetrical

3. + + biphasic symmetrical
-
4. + modified spike
-
BIOPHYSICAL CHARACTERISTICS
 Pulse duration (width): 50-400 microseconds
 Short pulse duration < 150µs > Long pulse duration

 Pulse frequency: 1-200 Hz

 Low frequency < 10 Hz 80 Hz < High frequency

 Current intensity: 0,1-120mA

 Comfortable / Tolerable
PERIPHERAL FIBRES

Can be grouped into three:

1-Thick, high conduction velocity, myelinated fibres:

 alpha

 beta

 gamma fibres

❑ They transmit the senses of touch and proprioception.

PERIPHERAL FIBRES

2- Diameters 2-5 micron, conduction velocity 3-15m/sec,

 myelinated A delta fibres.

❑ Some of them originate from pain receptors, while some of

them from proprioceptive receptors.

3- Diameters - 0,4-1,2 micron, conduction velocity 0,5-2

m/sec

 Unmyelinated C fibres .
GATE CONTROL THEORY

 Pain is modulated at the spinal column level by the open or

closed gate control system, which is under central and
peripheral influences

❑ Modulation: Adjustments made to decrease or increase pain.

GATE CONTROL THEORY

 Afferents conducting the sense of pain (C fibers) are

carried to the upper centers by passing through the Target
(T) cells located in the dorsal horn of the spinal cord.

 Large-diameter fibers (A-beta, etc.) are carried to the

upper centers by passing through the Substantia
Gelatinosa located in the dorsal horn of the spinal cord.
 GATE CONTROL THEORY

 Substantia Gelatinosa
(SG) cells are
inhibitory to T cells.

 Thus, it acts as a gate in

the transmission of
pain impulses.

Gate Control System Opioid System

GATE CONTROL THEORY

With the effectiveness of thick afferents, the inhibitory mechanism acting

on T cells from the SG is facilitated.
(presynaptic inhibition)

The transmission of stimuli (carried by pain fibers) to T cells is reduced.

Gate is closed.
GATE CONTROL THEORY
 The dominance of thin fibers creates an opposite condition.

 Based on this principle, by stimulating the thick fibers selectively, it is

possible to prevent the transmission of pain sensation from the
medulla spinalis to the upper centers and thus its perception.
CENTRAL CONTROL SYSTEM

 Some of the A fibers proceed from the dorsal column to the

brain without undergoing the SG.

 In these pathways, the transmission is very fast. Before the

action system takes action, the cortex learns about the
location and type of pain.

 It sets this system by sending orders to the gate control

system at the same speed.

 After setting, the action system is activated.

CENTRAL CONTROL SYSTEM

❑ The importance of this system:

 Conditions such as the person's psychological state, anxiety

and excitement always open and close the gates of the gate
control system.

 Example: Soldiers wounded in the battle.

ACTION SYSTEM

 Once the pain out-put in T cells exceeds the

threshold level, the action system is fired.
PAIN MODULATION AFTER TENS

1-Gate Control System:

 Closing the transition at the spinal cord level by

selective stimulation of thick afferent fibers
(presynaptic inhibition)
2-Opioid System:

 It is the activation of higher-level inhibitory

mechanisms by giving painful stimuli and thus
breaking the pain memories.

 It explains more chronic pain. (Post synaptic

inhibition) Reason for success is thought to be an
increase in the release of endorphins.
PHYSIOLOGICAL CHARACTERISTICS

 Selection of depolarized nerve fibers: sensory, motor

and nociceptive
 One or more of the peripheral nerve fiber types can be
depolarized by adjusting the pulse duration, frequency
and current height.

 Mechanism selected in pain modulation:

 Gate control / Opioid system
 Onset of analgesia: variable

A few minutes– a few hours

 Duration of analgesia : Unpredictable

 Less than an hour – More than a few hours

TREATMENT MODES OF TENS
1. Conventional TENS

 Electric current is of short duration and high frequency.

 Current passing time: 50-100 µs
 Frequency: 60-120 Hz

 It can be tolerated very easily.

 It is generally the most easily tolerated
application by the patients at the beginning
of the treatment.

 There is no muscle contraction.

 It is facilitated by thick peripheral afferents.

TREATMENT MODES OF TENS
2. Acupuncture-like TENS

 The electric current is of long duration and low frequency.

 Current passing time: 150-200 µs
 Frequency: 1-5 Hz

 It can be tolerated easily, there is a very mild feeling of

discomfort.

 Current intensity is increased until muscle contraction is

achieved.

 It is similar to acupuncture treatment due to its low frequency

feature.
TREATMENT MODES OF TENS

3. Brief Intense TENS

 The electric current is of long duration and high frequency.

 Current passing time: 200 µs
 Frequency: 60-120 Hz

 It can be tolerated easily.

 Trigerring effect during treatment
 There is tetanic muscle contraction.
 It is described as hyper stimulation analgesia.
 Predominantly, it creates input in small fibers.
TREATMENT MODES OF TENS

4. Burst TENS

 Low-frequency pulses are interrupted and delivered at

tolerable intensity.

5. Modulation TENS

 Pulse duration, pulse frequency and current height

are randomly adjusted electronically.
 Conventional TENS

 Acapuncture-like TENS

 Brief Intense TENS

 Burst TENS
 Classification of Five Classical TENS Modes According to their Biophysical and
Physiological Features

Conventional Acupuncture-like Brief Intense Burst Modulation

Pulse Duration Short Long Long N/A-not suitable Variable

(<150µs) (>150µs) (>150µs)
Frequency High Low High Low Variable
(>80Hz) (<10Hz) (>80Hz) (<10Hz)
Current Comfortable Comfortable / Comfortable / Comfortable Variable
Intensity Tolerable Tolerable

Depolarized Sensory Sensory and motor Sensory, motor Sensory and Variable
Nerve Fibers and nociceptive motor

Modulation Gate control Opioid system Opioid system Opioid system Variable
Mechanism

Onset of Fast Short Fast Short Variable

Analgesia -in minutes -in hours -in minutes -in hours
Duration of Short Long Long Long Variable
Analgesia (<a few hours) (> hours) (> a few hours) (> a few hours)
PHYSIOLOGIC AND THERAPEUTIC EFFECTS

 The basic physiological effect is selective depolarization

of sensory, motor, sensory-motor-nociceptive fibers.

 Stimulation of sensory fibres:

 Low current intensity + Short pulse duration

 Stimulation of sensory-motor and sensory-motor-

nociceptive fibres:

 High current intensity + Long pulse duration

PHYSIOLOGIC AND THERAPEUTIC EFFECTS

 Therapeutic effect:

 Reducing pain by affecting neuro-hormonal, neuro-

physiological, cognitive systems, and the central system as
well as the peripheral system.
SELECTIVE STIMULATION OF SENSORY NERVES
 Sensory Nerve Fibres
 No muscle contraction during application
must occur
 Easily tolerated electrical stimulation
 Sensory-Motor Nerve Fibres
 Muscle contraction detectable by observation or palpation
must occur
 A well-tolerated current level

 Sensory-Motor-Nociceptive Nerve Fibres

Clearly pronounced muscle contraction must occur
Detection of current painless but at the upper limit of tolerance
TENS DEVICES
 Clinical type TENS devices

 Portable TENS devices

 Battery operated

 Two channel output

ELECTRODE TYPES

 It should be of a type and size that can adapt to the application

area.

General Electrodes:

 Non-sterile, reusable electrodes.

 Carbon saturated rubber electrodes.
 Electrodes coated with sticky substance

Special Electrodes:

 Disposable, sterile electrodes developed for usage after surgery.

Electrode Intermediate (Electroconductive intermediate)

 Transition materials that allow current to flow from the

electrode to the skin

1. Water-based or wet-type transition material

2. Gel type transition material in hydrogel structure

CLEANSING THE SKIN

 The surface layer of the skin, like the electrode surface,

resists current, which is called impedance.

 In order to reduce the resistance of the skin, cleaning with

soap and alcohol should be performed before the application.
LOCALIZATION OF ELECTRODES
1-Painful Area:

 The placement of electrodes on or near the painful area.

 The most frequently recommended electrode placement

method.
LOCALIZATION OF ELECTRODES
2- Dermatome:

 Placement according to dermatome areas associated with painful

areas.

 The skin over a particular area is innervated by the same nerve as

the underlying structures.

 However, in some cases, the dermatomes of the skin, muscle and

bone may differ.
LOCALIZATION OF ELECTRODES

3-Special Points:

 Electrode placement on acupuncture or trigger points.

 The distribution of these points in the human body can be

controlled from different sources.
LOCALIZATION OF ELECTRODES

4-Spinal Cord Segment:

 Placement of electrodes next to the vertebrae or between the

spinous processes.

 Successful in relieving localized vertebral column pain.

LOCALIZATION OF ELECTRODES
5-Periphreal nerve:

 Placement of electrodes on one or more points where the

peripheral nerve becomes superficial along its path.

 In the treatment of a sore muscle; placement of the

proximal electrode to the peripheral nerve and the distal
one to the motor (acupuncture) point.

 Example: Sciatalgia
LOCALIZATION OF ELECTRODES

6-Nerve plexus:

 Placement of the electrodes on the nerve plexus.

 The only plexus where stimulation with superficial

electrodes can be effective is the “BRACHIAL PLEXUS”.

 Others are stimulated by implanted electrodes.

APPLICATION METHODS
a. Dual channel placement:

 Four electrodes are used for this method.

 Especially useful in the treatment of pain spreading over

large areas.

 Forexample, in patients with back pain and low back

pain, the proximal electrodes can be placed on the
cervicothoracic region and the distal ones on the
lumbosacral region.
APPLICATION METHODS

b. Bilateral placement:

 Applied to increase the effect provided by TENS.

 Placement of electrodes on both extremities and at the same

points, although the patient complains of unilateral pain.
APPLICATION METHODS

c. Contralateral placement:

 Used in cases of destruction of sensory nerves such as in

causalgia, herpes zoster.

 Successful results can be obtained by stimulating the

peripheral nerve or dermatome from the opposite side.
APPLICATION METHODS
d. Using multiple electrodes:

 Some TENS devices allow the use of more than four

electrodes.

 These are multi-output devices.

 In the stimulation of peripheral nerve, it is possible to apply

along the nerve path or to place on all painful points or
paravertebral regions for large surfaces such as the back.
APPLICATION METHODS
e. Circling:

 The painful area can be circled so that the electrodes form a

triangle or square.

 Generally, the use of cross electrodes is preferred.

 Thus, the effect of the current increases.

APPLICATION METHODS

f. Electrode placement on indifferent area:

 It is used when all electrode placement techniques are

ineffective.

 Picasa, a researcher, reported that especially the stimulation

of the ulnar nerve is effective in relieving many painful
conditions except headaches.
ADJUSTING THE DOSAGE
 The dosage varies depending on 3 parameters:

1. Selected TENS mode:

 Conventional TENS is generally preferred initially.

 If there is no pain relief, acupuncture-like TENS is applied.

 Brief-intensity TENS is the alternative.

2. Duration of the application:

 Normally 20-30 min.

 However, it can be applied continuously for 48 hours following

the surgery. Or it can be used continuously in some cancer cases.
ENDİKASYONLAR
Basic Indications

 Low back pain

 Chronic painful conditions

 Postoperative pain
INDICATIONS
 Low back pain
 Chronic pain
 Postoperative pain
 Pain during childbirth or
postpartum pain
 Rheumatic pains (RA, OA,
AS)
 Migraine
 Craniofacial pain
 Brachial plexus pain
 Temporomandibular pain
 Angina pectoris
 Central pain
 Neuropathic pain
 Phantom pain
 Causalgia
 Trigeminal neuralgia
 Reflex sympathetic dystrophy
 Soft tissue injuries
 Dysmenorrhea
 Myofascial pain syndrome
CONTRAINDICATIONS

 Lower abdominal region and pelvic region during pregnancy

 May affect uterine contraction and fetal development.

 Transcervikal area
 May stimulate n. Vagus, n. Phrenicus and sinus caroticus

 Thoracic area near the heart

 May cause arrhythmia and fibrillation, respiratory
distress.

 Pacemaker and cardioverter defibrillator

 May affect the operation of the devices
CONDITIONS TO BE CAREFUL OF

 Sports injuries in which pain is protective

 Allergic skin reactions under the electrode

 All other electronic implants

 Patients with mental problems

CONDITIONS TO BE CAREFUL OF

 Sensory loss on the surface of application

 Cerebrovascular events

 In acute phases of quadriplegic patients

 Suppressing pain in conditions such as rheumatoid

arthritis
DECISION STAGES REGARDING TREATMENT

1. Begin treatment with a physical examination and

diagnosis.

2. Question the presence of contraindications.

3. Set your treatment goals.

4. Decide on the area to be treated.

5. Clean the treatment area.

DECISION STAGES REGARDING TREATMENT

6. Position and inform the patient.

7. Select the appropriate electrode type.

8. Decide on the appropriate electrode placement.

9. Begin dosing procedures (TENS mode, duration of

treatment, current intensity).

10. Apply the treatment.

REFERENCE

Transkutanöz Elektriksel Sinir Stimülasyonu. Prof. Dr. Arzu

Razak Özdinçler (Ed.). içinde Fiziksel Modaliteler ve
Elektroterapi (ss. 127-137). 2. Baskı 2016. İstanbul Tıp
Kitabevi. ISBN - 978-605-4499-80-9.

THANK YOU…
RUSSIAN CURRENT

Assist. Prof. Baha Naci

2022-2023 Spring Semester
04.04.2023
 INTRODUCTION

 It was first investigated in 1977 by Dr. Yakov Kots.

 It was suggested that its use results in significant increase
in muscle strength (about 30–40%).
 It was suggested that this 2500 Hz medium frequency
interrupted current could produce greater muscle
contraction than a maximal voluntary contraction.
It is basically:
• Medium-frequency current (carrier frequency of 2500Hz)

• Intermittant alternating sinusoidal waveform current

• Waveform delivered in bursts or series of pulses.

Thus, it is known as Burst Modulated Alternating Current

(BMAC)
Russian current is most often used to strengthen muscles. It is
also commonly used to re-educate muscle groups after a nerve
pathway has been damaged, such as in the case of someone
who has had a stroke.
 Although it is a medium frequency current, the nerves
are stimulated because it is interrupted to give a low
frequency stimulation of 50 Hz (in fact like low
frequency faradic type of current).

 Provides maximal electrical stimulation of nearly all

motor units in a muscle to produce contraction that can
not be achieved by the voluntary contraction.

 This produces greater muscle contraction and hence

produces hypertrophy.
 CHARACTERISTICS
 carrier frequency - 2500 HZ(2.5 KHz)
 wave form - poliphasic alternating sinusoidal waveform
 current amplitude - the maximum current amplitude is 100 mA.
Clinical used at 70 mA.
 bursts frequency - 50 Hz (50 bursts/sec)
 bursts duration - 10 ms (25 cycles or 50 pulses per 10 ms)
 Each sinusoidal wave (period) is 0.4 ms
 Pulse/phase duration 0.2 ms)
 CHARACTERISTICS

 on/off ratio: the on/off ratio is defined as the ratio of the time
during which there is stimulation (contraction) to the time during
which there is no stimulation set as 10ms:10ms.

 duty cycle: duty cycle is the proportion of on time to the

summation of both the on and off time expressed as percentage :
50%

• ramp-up and down : setting the ramp time is crucial to evoked

contraction similar to muscle contraction. as the ramp provides
gradual increase of intensity with associated gradually increase of
muscle contraction. set for 1-2 seconds
As a result, 2500 Hz alternating current with a burst frequency of 50
Hz is called Russian current
 CHARACTERISTICS

 Similar to the pulse widths generated by conventional TENS.

 The difference is that with conventional TENS, the pulses are
seperated by a large interpulse interval while with Russian currents
there is no interpulse interval : positive pulses are immediately
followed by negative pulses.
 The short pulse duration of Russian current produces efficient, pain
free motor stimulation
PHYSIOLOGICAL EFFECTS

 Training protocol with Russian current: (10/50/10) – this protocol leads

to maximum gain with no significant muscular fatigue.
10 = Each muscle contraction lasting for 10 sec
50= off time (no contraction) for 50 sec
10= cycle repeated for 10 times (10 electrical contractions)
 Amplitude/Intensity: (70mA) strong but comfortable muscle cotraction
 Pulse rate (frequency): 50-70 Hz (tetanic muscle contraction)
 Duration of treatment: 10 min
 Frequency of treatment: once daily for 3-6 months
 Electrode placement: Arranged parallel to the direction of muscle fibers
 Apply current during voluntary activities
 Supportive to isometric/izotonic/isokinetic exercise programs
 The on-time may be adjustable from 1 to 20 s (0f
10ms, 50 Hz bursts) and the off-time from 1 to
50s.

 The treatment time can also be varied.

THERAPEUTIC EFFECTS / PROTOCOL

1. To improve muscle strength/hypertrophia

 Amplitude: Tetanic muscle contraction

 Pulse rate (Burst frequency):50–70 Hz
 Pulse duration: 150-200µs
 Apply current during the following volitional activities-
Isometric exercise at several points through ROM.
Slow speed isokinetic exercise, e.g. 5-10˚/sec.
Short arc joint movement when ROM restricted.
 10/50/10 – Rule applied. 10-15 mins/session/daily for 3-6
months
THERAPEUTIC EFFECTS / PROTOCOL

2. To reduce spasm

 Amplitude: Tetanic muscle contraction up to patient

tolerance.
 Pulse rate(Burst frequency)- 50-70Hz
 Pulse duration: 50-175µs
 Muscle contraction: stimulation is applied to provide brief
isometric contraction
 On-time 5-12seconds and off time 8-15 seconds
THERAPEUTIC EFFECTS / PROTOCOL

3. To reduce oedema (due to lack of muscle

contraction)

 Amplitude: small visible muscle contraction

 Pulse rate (Burst frequency): 35-50 Hz.
 Pulse duration: around 400µs.
 On: off time: An on-time of 1-2 secs and an off time of 1-
2secs - promote pumping of muscle
 Treatment time: 10-15 mins/session( can be used more
than once a day)
INDICATIONS

• The prime indication for using Russian currents is to

strengthen the muscular system of healthy and athletic
population.
• Post-knee ligament surgery
• Post arthroscopic knee surgery
• Following ligament sprain (ex. for ACL sprain to increase
quadriceps force during immobilisation)
• Post casting
• Muscle spasm
CONTRAINDICATIONS

 Cardiac pacemakers and Arrhythmias

 Hemorrhagic area
 Thrombosis and thrombophlebitis (inflammation of the wall of a vein)
 Early tendon transfer and repair
 Pregnancy: On pelvic, lumbar, and abdomen
 Unconscious patient
 Recent radiotherapy
 Carotid sinus, anterior cervical area
 A child with mental disturbance
 Malignancy
 Metallic and electronic implant
 Impaired skin sensation
 Infected wound and skin lesion
 DIFFERENCE BETWEEN INTERFERENCIAL CURRENT
AND RUSSIAN CURRENT

 IFT and Russian Current both are medium frequency

current. These current have frequencies between 1000 Hz
and 10000 kHz.
 Interferential Current are Amplitude modulated and
Russian Current are Time modulated.
THANK YOU…
Assist. Prof. Baha NACI
2022-2023 Spring Semester
11.04.2023
 Superimposition of one alternating current on another is referred to as
interference.

 Currents obtained by the interference of two or more alternating currents

of slightly differing medium frequency.

 Amplitude modulated at low frequency for therapeutic purposes.

 The ITF depends upon the interferencial
effect of two medium frequency currents
crossing in the patient tissue.
 Beat frequency: The interference produced
by the two current in the tissue is called beat
frequency.
 Modulation: process of varying one or more
properties of a periodic waveform

 Frequency of one of the alternating currents

may be fixed at 4000 Hz and the other can
be set between 4000 and 4250 Hz.
 The two medium-frequency currents
“interfere” within the tissues and produce an
amplitude-modulated low “beat” frequency
(0–250 Hz), which is the difference between
the values of the two currents applied

 The frequency of the resulting current is

equal to the difference of the frequencies of
two medium frequency sinusoidal
alternating currents applied simultaneously
at the point of intersection in a given
medium.
 The frequency varies between 0-100 or 0-250 Hz depending on the
interference current device used.

 One of the most important features of the IC is that the skin resistance is
very low against the current.

 ICs generate a low frequency current in the body without the problem of
overcoming skin resistance.
 When two or more sinusoidal
currents alternate at the same
frequency, rising and falling at
exactly the same time, they are said
to be in phase.
 Waves become out of phase when
they are a half wavelength out of
step and the rising segment of one
coincides with the falling segment
of the other.
 Waves in phase interfere
constructively to produce a
resultant wave with an amplitude
greater than that of either of the
originals.
 Waves out of phase interact in a
similar way but interfere
destructively to cancel each other
out.
https://quizlet.com/549730696/interferential-
current-ifc-flash-cards/
 Direct current and low-frequency alternating currents encounter a high
electrical resistance in the outer layers of the skin.
 This makes the treatment of deep structures painful because a large
transcutaneous current must flow so that adequate current passes deeply.
 Alternating currents of medium or high frequency meet little resistance
and penetrate the tissues easily, although such currents generally oscillate
too rapidly to stimulate the tissues directly.
Physiological Effects
➢ EC leads to increased ionic exchanges in the intracellular and intercellular
spaces.
➢ It increases cell permeability and stimulates the lymphatic system. Major effects:
1. Pain relief with gate control theory (90-150 Hz)
2. Increased blood flow
3. Reduction of edema.
4. Muscle stimulation 0-10 cycle/sec most effective. Recommended for new
training of muscle (very effective method in the treatment of urinary
incontinence)
5. Increased production of chemical substances that are important for tissue
healing
6. Placebo effect; no thermal effect
Physiological Effects
➢ Stimulation of the motor
nerves can be achieved with
a wide range of frequencies.
➢ Low frequency (ex 1-5 Hz) –
twitches
➢ (5-20 Hz) Partial tetany
➢ 30-100 Hz Tetanic
contraction
https://www.slideshare.net/riaz6849/interferential-current
Electrode types
 Application is performed with different
sized plaque or vacuum electrodes.

 Especially ease of application is considered

for the selection of electrodes.

 Vacuum electrodes are preferred for the

treatment of large or irregular areas.
Application Techniques
1. Skin must be clean and clear before the start of the treatment
2. The electrodes should be placed in such a way that the crossing point of
two currents lie above or around the affected part.
3. The convenient frequency current should be applied for different
conditions.
4. Increase the power gently and cautiously until the patient starts feeling
the current. It can be increased until the patient tolerance.
Application Techniques
1. Bipolar application

 The current is created using one circuit.

 Amplitude modulation occurs within the stimulator.

 In the bipolar application, the maximum effect occurs in the superficial

tissues close to the electrodes.
2. Tetrapolar (Quadripolar) application

 The current is applied using two different circuits.

 Interference occurs within the tissues.

 The region of maximum interference develops at 45 degrees diagonally between the

two sets of electrodes, representing the region of therapeutic effect

 The resultant current, which is formed by the crossing of the two circuits in the
tissue, is stated to
 be tolerated better by the patient than bipolar application,
 reveal more effects in deep tissues.
■ Vacuum application:

■ Bell-shaped rubber electrodes connected to a vacuum pump are

used.

■ A massage-like effect may occur as the pressure inside the bell

increases and decreases rhythmically.

■ It can be used if there is significant edema in the treatment area.

Treatment frequencies
 Current intensity: As low as possible-generally 1-100 mA

 The frequencies used in the treatment can be constant or rhythmic.

 When rhythmic application is preferred, the frequency continuously changes

from low frequency to high frequency and then returns to the beginning (ex. 90-
100 Hz)

 For muscle stimulation applications, the current is increased until a good visible
contraction of the muscle is achieved.

 The application time is usually 20-30 minutes.

 Fr. 0-10 Hz → muscle stimulation – muscle rehabilitation

 Fr. 0-100 Hz→ increase in skin, blood and lymph circulation –

treatment of edema

 Fr. 90-100 Hz→ sedative effect –pain relief

 Fr. constant 100 Hz→ analgesic effect – pain relief

 INDICATIONS CONTRAINDICATIONS

 Stress incontinence  Pregnancy

 Osteoarthritis knee  Cervical transition zone
 Periarthritis shoulder  Thoracic transition zone
 Cranial transition zone
 Low back pain
 Hemorrhage
 Fracture healing  Electronic implant
 Musculoskeletal problems  Arterial-venous thrombus, fever
 Fibromyalgia  Malignant tumors
 Muscle atrophy  Conditions where active movement is
contraindicated
 Psoriasis
 Severe renal and cardiac failure
 Absorption of exudates  Epileptic patients
 Loss of sensation
 ADVANTAGES DISADVANTAGES
 Low skin resistance, no burns.
 Not used for denervated muscles.
 High tolerance and comfort

 The current occurs within the body.

 Effective for deep tissues.

Thank you..
 HIGH VOLTAGE PULSED GALVANIC
STİMULATION

(HIGH VOLTAGE PULSED CURRENT=HVPC)

Assist. Prof. Baha NACI

2022-2023 Spring Semester
18.04.2023
 Originally developed by Haslip in 1940, and known as Dyne-wave
neuromuscular stimulation;

 Known as HVPC in 1970s

 High-voltage pulsed galvanic stimulation

 Pulsed= pulse indicates that the current is not direct galvanic.

 Twin-pulsed monopolar waveform includes a spike and
a slow descent.

 Twin pulse duration; 0.1-0.2ms

 Each peak lasts a few microseconds

 Current shape and duration are normally constant

 Twin pulse frequency ranges from 2-100Hz

Characteristics of the current shape;

 The HVPC stimulator is a device with a constant-

duration bi-peak monophasic waveform.

 Duration is set to 200µsec.

 The treatment voltage is above 100 volts (0-500V)

 Devices have constant voltage

 Frequency adjustable
Characteristics of HVPC

HVPC produces a
high-voltage current
with a high-peak
intensity of a
maximum of 300 to
400 mA but with a
low-frequency current
and a very short
duration.
Waveform characteristics of HVPC
Potential Advantages of HVPC (due to very short pulse
duration + long interpulse interval)

 Selectively stimulate motor rather than sensory nerves,

 No chemical effects – stimulation is safe and more comfortable
than faradic current – maintained for longer periods of time
(60 min)
 Due to less tissue resistance, HVPC penetrates deeper than
that of low voltage currents
 Direct stimulation of deep nerves and muscles can be effective.
 No stimulation of denervated muscles
 Partially or totally innervated muscle will respond well to HVPC
 In the presence of such short-duration peaks, very
high voltage is needed to stimulate nerve fibers.

 This kind of current;

a. Passes easily through tissues.
b. Used easily because they distinguish between
the nerves that carry the motor-sensory and pain
sensation.
Electrodes;

 In different sizes
 In the form of a flexible or rigid plaque
 Probe electrodes

 Can be applied with a large passive electrode; 1, 2 or

4 active electrodes; 1 pen electrode; or 1 anal
electrode. Gel, as a transition material, is used.
Clinical Application;

1. The physiotherapist should determine which

of the patient's problems is indicated for
neuromuscular electrical stimulation.
2. The physiotherapist should have the
necessary knowledge to use the HVPC
3. The physiotherapist should identify the
tissues through which the current passes.
4. The physiotherapist should observe the
current flow from the active electrode to
the passive electrode.
5. Appropriate documentation methods are
necessary to measure the effectiveness of
treatment
 Indications;

1. Wound healing – pressure ulcer, decupitus ulcer,

diabetic foot ulcer, burn wound
2. Pain elimination – chronic low back pain,
osteoarthritis
3. Muscle stimulation – innervated muscle stimulation
4. Edema reduction – posttraumatic edema
5. Muscle spasms
6. Increase of joint mobility
 Skin wound healing

 Pulse frequency: 30-200 pulse per second (pps)

 Continuous mode

 Voltage intensity: 1-500 V (with no discomfort)

 Treatment duration: 10-60 min.

 Pain therapy

 Pulse frequency: 1-200 pps

 Continuous mode
 Voltage intensity: 1-500 V (with no discomfort)
 Treatment duration: 10-20 min.

 Pain reduction is accomplished through decreasing pain by using

two small electrodes closely-spaced in a narrow area or through
decreasing pain fiber stimulation by using two widely-spaced
large electrodes.
 Edema, spasm, muscle weakness

 Pulse frequency: 30-60 pps

 Pulsed current form with an on:off ratio of 15:45 sec. This
ratio can be applied for 20 times.
 Voltage intensity: 1-500 V (with no discomfort)
 Treatment duration: 5-30 min.
Contraindications;

1. Circulatory Disorders
2. Anterior cervical region-Carotid sinus
3. Transthoracic region-Heart
4. Pregnancy-lumbar and abdominal regions
5. Transcranial region
6. Frequent epilepsy attacks
7. Neoplasmic lesions
8. Hemorrhagic area
9. Electronic implants (cardiac and other devices)
THANK YOU…