Diathermy

Shortwave Diathermy
Microwave Diathermy
 Introduction
• Diathermy is a Greek word meaning “through heating”

• This heating modalities can do this heating in superficial and deeper areas of the
body

• Examples of each are given in the next slide

 Introduction
• Superficial
• Infrared lamps
• Moist heat packs
• Paraffin baths
• Warm whirlpool or immersion
• Deep
• Microwave diathermy
• Shortwave diathermy
• Ultrasound
 Introduction
• Wavelength: The distance between the peak of 1 wave and the peak of either
the preceding or succeeding wave.
• Frequency: The number of wave oscillations or vibrations occurring in 1 second
and is expressed in units Hz.
• Velocity (v) = Wavelength X Frequency
Velocity is a constant of 3x10.8 m/s
 Diathermy Physiology

Thermal Effects - High frequency vibration of molecules

Blood flow
Inflammation Vasodilatation
Joint stiffness Membrane permeability
Muscle tension
Metabolic rate
Pain
Enzymatic reactions

Extensibility of soft tissues

Nerve growth and repair

 Frequency and Wavelength of SWD and MWD

Diathermy Frequency Wavelength Commonly Commonly

used frequency used
wavelength

SWD to 100 MHz 10 to 30 m 3 MHz 27.12 m 11

MWD MHz to 300 300 mm to 1m 1 MHz 2450 cm 12

GHz
 Shortwave Diathermy

• High-frequency electrical current produce an Electrical field and a

Magnetic field.

• The ratio of the two fields depends on the type of unit and the electrodes
(applicators)
• Unit types:
• 13.56 MHz produces stronger magnetic field
• 27.12 MHz produces stronger electrical field
 Physiological Effects

• The principal effect of shortwave diathermy on the body is the production of

heat in the tissues due to the rise of temperature.

• Because of this following changes happens in the body

 Physiological Effects

• 1. Increased metabolism

• 2. Increased blood supply

• 3. General rise of temperature

• 4. Fall in blood pressure

• 5. Increased activity of sweet glands

Increased metabolism .1

• Heating tissues accelerates chemical changes such as metabolism, so oxygen and

food stuffs are used up.

• With increased metabolism, there will be increased out put of waste products.
:Increased blood supply .2

• As a result of increased output of waste products such as metabolites, which act

on the walls of the capillaries and arterioles, these tissues dilate.
• In addition, heat has direct effect on blood vessels, causing vasodilatation.
:Increased blood supply .2

• Heat also produces stimulation of superficial nerve

endings, causing reflex dilatation of the arterioles.
• Vasodilatation increases blood flow through the area, so
that the necessary oxygen and nutritive materials are
supplied and waste products are removed.
General rise of temperature .3

• As blood passes through the heated tissues, it also becomes heated and carries
the heat to other body parts.
• As a result, heat reduces the excitability of nerves, provided that heat is not
excessive.
• Further more, rise of temperature induces muscle relaxation and increases the
efficiency of muscle action.
Fall in blood pressure .4

• The generalized vasodilatation reduces the peripheral resistance to blood flow.

Heat also reduces blood viscosity, which helps in the reduction of blood pressure.
5. Increased activity of sweat glands

• If a general rise of temperature occurs, there will be increased activation of the

sweat glands.
 Indications

• 1. For chronic and mild conditions:

• -Myositis and arthritis.
• -Pelvic inflammation.
• -Otitis media.
• -Bronchitis.
• -Sinusitis.
• 2. As an adjunctive modality:
• Short wave is also used with other procedures such as iontophoresis to enhance local
absorption
• Stretching, Mobilization etc..
 Contraindications

• 1. Acute inflammatory conditions or hemorrhage

• 2. Venous thrombosis or phlebitis
• 3. Arterial diseases
• 4. Pregnancy
• 5. Metals in the tissues
• 6. Loss of skin sensation
• 7. Tumors
• 8. X-ray therapy
 Electrodes types
• Induction Electrodes (cable or drum)-strong
magnetic field

• Capacitor Electrodes (pad or plate)-strong

electrical field
 Induction field diathermy

• Strong magnetic forces are produced by the patient circuit which then induces a
electrical current within the body part.
• A single induction field coil is made of metal shaped into a coil, which is highly
conductive.
• It can be given by drum or cable electrodes
• Deepest form of Diathermy
Drum or cable inductive method
 Capacitive field

• Separate pads or air-spaced drums are used as the electrode. The patient is
placed between them
• The intensity and depths of penetration are determined by the shape and
distance between the electrodes.
• Much is absorbed by fat.
• Most effective when there is little fat.
• Field is placed perpendicular to the area to be heated.
• This will be given by plate or pad electrodes
Disc or pad capacitive method
 Advantage of SWD

• 1- Operation of machine is simple .

• 2- Comfortable for the patient .
• 3- Heat can be applied to deep &
superficial structures.
• 4- Undue skin heat can be avoided .
• 5- Easily adapted to suit body
curvature.
• 6- Can heat through a joint.
• 7- Many different variety of
applications are available
 Disadvantage of SWD

Accurate measurement of the -1 •

amount of heat received by the
.patient is not possible

.Deep tissue burns can occur -2 •

 Pulsed SWD (PSWD)

Referred To By Different Names •

Pulsed Electromagnetic Energy (PEME) •

Pulsed Electromagnetic Field (PEMF) •
Pulsed Electromagnetic Energy Treatment (PEMET) •
 Pulsed SWD

Is a SWD at the frequency of 27.12 MHZ which is pulsed at a rate selected by the •
. therapist

.The pulse duration is constant at 0.4ms •

: The value of PSWD •

A very high intensity of power (1000w) can be administered with no or minimal •

.thermal effects
 Pulsed SWD

The thermal effect produced by one pulse is of very short duration …… it can be •
.dissipated by the circulation before the next pulse occur

.The other biological effects are the same as continuous SWD •

. With the exception of increase in temperature in tissues •

Therapeutic Effects of PSWD

. Increase metabolism by 2-4 times -1 •

. Relief of pain -2 •
Stimulate the healing process of -3 •
.wounds
.Relaxes the muscle spasm-4 •
Decrease the rate of hematoma-5 •
.formation
.Stimulate the peripheral circulation-6 •
Increase the defense mechanisms-7 •
.in the periphery
Lab – Practical's for SWD
Types of Electrodes
 Diathermy Techniques

Induction type for area of high adipose content and/or muscular structures •
Capacitor type for joints, ligaments, tendons •
One layer of towel should be used for drum and plates, approx 1” space •
Thicker layering for pads and cables •
 Electrode placement

a) Capacitive method (condenser•

: electrode)
Electrodes are placed on each side of the treated part, separated from the skin •
.by an insulating material
 -In capacitive electrodes, high frequency alternating electric current flows from •
.one plate to the other through the patient tissue producing electrostatic field
As current flows through the tissue, it causes oscillation of charged- •
particles and thus an increase in tissue temperature •
 Electrode placement

: b) Inductive electrode (Cable method) •

The cable is coiled in relation to the patient’s skin but separated from it by a •
.layer of insulating material
As high-frequency currents oscillate in the cable, an electric field is set up •
.between its ends and a magnetic field around its center
.These fields affect the tissues that lie within them •
 :Electrode arrangement

:Contra planar technique .1 •

It is the most satisfactory technique, especially for the •
.treatment of deeply-placed structures
The electrodes are then placed over the opposite •
aspects of the trunk or limb, so that the electric field is
.directed through the deep tissues
 :Electrode arrangement

:Coplanar technique .2 •
In this technique, electrodes are placed side by •
side on the same aspect of the part, provided
.there is an adequate distance between them
The distance between the two electrodes should •
.be more than the total width of spacing
The heat is more superficial and suits certain •
areas such as the spine
 :Electrode arrangement

:Cross fire technique .3 •

Half of the treatment period is given with the •
electrodes in one position and then they are
moved to be at right angle to that obtained during
.the first part of the treatment
 :Electrode arrangement

For example •
For the knee joint, during the first half of the session, the electrodes are placed •
on the medial and lateral aspects of the knee. On the opposite, during the
second half of the session, the electrodes are transferred to the anterior and
.posterior aspects of the knee
 :Electrode arrangement

:Monopolar technique .4 •
The active electrode is placed over the site of the lesion, while the indifferent •
.one is applied to some distant part of the body
.This method is used for very superficial lesions (sinusitis) •
 Preparation of the patient

Treatment should be on a couch, chair or a table, which must be wooden and •

.free from metals
Do not allow the target area to be hidden by clothes to avoid unwanted irritation •
.or burn
.The skin must be dry •
 Preparation of the patient

Metal objects such as earrings and necklaces, tight straps or elastic supports •
.should be removed
The patient must be comfortable and the part to be treated should be fully •
.supported
.Skin sensation must be tested before treatment starts •
 Precautions during SWD treatment

Avoid direct contact of the lead cables •

.Use special care to avoid contact between skin and cables from main unit •
Avoid crossover of the lead cables •
During treatment, do not allow patient to touch metallic objects •
 Precautions during SWD treatment

Keep away other medical electrical devices •

Be especially vigilant with patients where loss of normal sensation may result •
such as DM, Arteriosclerosis
Keep away watches and jewelry •
Do not use metal treatment chair or table •
 Monitoring the treatment

Before starting treatment, all meters of the apparatus should be on zero position •
.(the starting position)
.Select the power level according to the patient’s condition •
.Increase the intensity gradually till the desired heating level is reached •
 Dosage of intensity

Patient Sensation Provides Basis For Recommendations Of Continuous SWD •

Dose I (Lowest) (<38 W) - No Sensation of Heat •

Dose II (Low) (~80 W) - Mild Heating Sensation •
Dose III (Medium) (80-300 W) - Moderate or Pleasant Heating Sensation •
Dose IV (Heavy) (>300 W) - Vigorous Heating Within Pain Threshold •
 Monitoring the treatment

.A mild sensation of warmth is felt which continues throughout the session •

.Immediately check for any complaint of hot sensation •
The physical therapist should remain within call of the patient during the whole •
.treatment period
At the end of treatment, the control knobs are returned to zero position, current •
.switched off and the electrodes removed
 Duration and Frequency

Treatment time may vary between 10 and 30 minutes, depending on the •

.patient’s condition
Frequency of treatment is usually 2-3 times weekly, while daily treatment is not •
.contraindicated when needed
When treatment is within a limited space such as the sinuses or the face, •
.excessive treatment should be avoided
Micro Wave Diathermy
 Introduction

. MWD is a high frequency electrical current •

. They are a form of electromagnetic radiation •
. Its wave length between infra-red & SWD •
It is a means of applying heat to the tissues but did not penetrate as deeply as •
. SWD
They penetrate more deeply than IRR •
 Frequency and Wavelength of SWD and MWD

Diathermy Frequency Wavelength Commonly Commonly

used frequency used
wavelength

SWD to 100 MHz 10 to 30 m 3 MHz 27.12 m 11

MWD MHz to 300 300 mm to 1m 1 MHz 2450 cm 12

GHz
 Biophysical& Biochemical effects of MWD

Electromagnetic energy is transformed into heat energy as it interact with the •

. molecules of different tissues
Muscle & other tissues of high fluid content will absorb more electromagnetic •
. energy than tissues as fat &bone
Tissues of low fluid content are penetrated to a greater depth than tissues of •
. high water content
 Therapeutic effects of MWD

• Are similar to SWD but the penetration of MWD is superficial only

which is effective in treating a superficial structures & localized area
because only one aspect can be treated at a time .
 Therapeutic effects of MWD

.Relief of pain •
.Reduce muscle spasm •
.Inflammation & infection •
.Promote healing of skin wounds •
.Increase extensibility of fibrous tissues ( scars-tendons) •
.Increase ROM & easy ADL •
 Indication of MWD

• Musculoskeletal disorders: sprain, strain, muscle , tendon tear or

capsule lesions.

• Infection & inflammation : synovitis, bursitis, or tenosynovities.

 Contra-indications of MWD

• Over malignant tissues.

• Over ischemic tissues.
• Metal implants.
• Pacemaker.
• Over growing bone.
• Male gonads.
• Hemorrhage.
• Impaired thermal sensation.
.Moderate & excessive edema •
.Unreliable patients •
 Contra-indications of MWD

• Tuberculosis in joints.
• Over eyes.
• Recent RADIOTHERAPY.
• Pregnancy.& menstruation
• Obesity.
• Sever cardiac conditions.
• Blood pressure abnormality
• Venous thrombosis or phlebitis.
• Acute dermatological conditions.
 : ADVANTAGE OF MWD

• 1- Simple application .
• 2- Heat can be localized accurately .
• 3- The machine is comfortable for
patient .
• 4- Using low frequencies of it - give
selective heating to the muscle is
possible .
• 5- Operation of machine is simple .
 : DISADVANTAGE OF MWD

• 1- It can not used for heating deep

structures .
• 2- It can only treat one aspect of a
joint at time .
• 3- Skin burn may occur rapidly .
• 4- Accurate measurement of the
amount of heat received by the
patient is not possible .
 Directors used in MWD applications
(Electrodes)
Small circular filed director: the heating pattern is more intense around the
outer portion than in the center.

Large circular field director: the heating pattern is more intense around the
outer portion than the center.

Longitudinal director: the heating pattern tends to be more concentrated in the

center of this area.
Directors continue

• For large circular…….The effective diameter is 200 mm……..The power output is

up to 250 watts.

• For small circular……..The effective diameter is 100mm………..The power output is

up to 25 watts.

• For longitudinal director……The effective treatment area is 500mm…….The power

output is up to 250 watts.
 Pulsed MWD

• The effect of PMWD are the same as those of NON PMWD with the exception of
the production of rise in temperature in tissues .

• Many conditions which contraindicated with MWD can be treated effectively

with PMWD .

• It is also treated one aspect of the body at a time & the depth of penetration is
superficial .
 The penetration depends on
• A- wave length.
• B- The part which is penetrated .
• C- Property of this part .
• D-Thickness of skin & subcutaneous
tissues .

• Depth of Penetration - 3cm

• Heat conducted from high temperature to lower one .

 DOSAGE OF MWD
• Duration of treatment : 20 min. is the optimum.

• Intensity: the patient should feel mild & comfortable warmth.

• Frequency: daily or on alternative day.