Physical Agents &

Electrotherapy II
DR.MUHAMMAD SHAHID SHABBIR
DPT,MS.NMPT
DPT LECTURER AND HEAD OF CLINICAL
PRACTICE ZIHS
 Semester 6
 3(2-1)
 2 lectures +1 lab per week
 30% mid
 50% final
 20% internal assessment
Electrotherapy
• Definition: the use of electric currents passed
through the body to stimulate nerves and
muscles, chiefly in the treatment of various
forms.
• Electrotherapy or Electro Physical Agents
(EPA)  is one component
of physiotherapy treatment techniques or
modalities. Some examples of EPA are:
Therapeutic ultra sound
TENS
EMS OR NMES
• Modern electrotherapy practice needs to be evidence
based and used appropriately. Used at the right place,
at the right time for the right reason, it has a
phenomenal capacity to be effective. Used unwisely, it
will either do no good at all or possibly make matters
worse – as would be true for any other therapy. 
• The evidence base to support the use of
electrotherapy modalities as a component of practice
is extensive, despite popular claims that these
'agents' lack evidence. There are very few occasions
where an electrotherapy modality employed in
isolation is the most effective intervention. Used as a
part of a package of care, the evidence is strong and
supportive.
ASSIFICATION:
PY ENERGY SPECTRUM AGENT
MOTHERAPY Hot pack and paraffin bath th
Fluidotherapy
Cryotherapy
Hydrotherapy
Shortwave Short wave diathermy therap
(SWD)
THERAPY Visible and infrared Low – level laser therapy

Ultraviolet Ultraviolet therapy

ROTHERAPY Electric Iontophoresis therapy
TENS therapy
Microcurrent therapy
HVPC therapy

Contd..
THERAPY ENERGY SPECTRUM AGENT

Russian current therapy

Intraferential current therapy

Diadynamic current therapy

ULTRASONOTHERAPY Mechanical Ulrasound therapy

MECANOTHERAPY Mechanical Spinal traction therapy

Continuous passive
movement therapy

Intermittent pneumatic
compression therapy
TYPES OF CURRENTS
 The currents are arranged according to three
categories :

 The low frequency which covers the spectrum from 0 to

1 000 Hz 

 The medium frequency of 1 000 to 10 000 Hz

 The high frequency for the frequencies higher than 10

000 Hz
SAFETY RULES AND GUIDELINES FOR THE
APPLICATION OF ELECTROTHERAPY
• Before applying any modality of electrotherapy to a
patient the following questions should be considered:
 Effect required???
 Treatment would be effective???
 unsure???
 Safe???
 Risks???
 Best method???
• PT’s should confine themselves to the use of
electrophysical modalities in which they are
competent. Usually electrotherapy is part of an
overall treatment plan which is selected and
modified on the basis of repeated examination and
assessment.
BASIC GUIDELINES:
• 1. PREPARATION OF THE PATIENT:
a. EXPLAINATION: An explanation of the treatment
is an essential precursor of application. This not only
reassures the patient but ensures informed consent.
The type of sensation to be experienced is explained,
and the patient is warned of any effects that should be
reported.
b. EXAMINATION AND TESTING: This refers to the
specific examination of the part to be treated for
possible dangers and contraindications plus any
relevant tests. Example for normal thermal sensitivity.
The results should be recorded.
• 2. ASSEMBLY OF APPARATUS:
• All the apparatus and equipment needed should be
assembled and suitably positioned. Visual checks are made
of electrodes, leades, cables, plugs, power outlets,
switches, controls, dials and indicator lights.
• 3. PREPARATION AND TESTING OF
APPARATUS:
• This includes setting up the apparatus and any necessary
testing of it prior to application. When this has been done
satisfactorily treatment can begin. The operator should
minimize their own exposure to the effects of the modality
being used.
• 4. PREPARATION OF THE PART TO BE
TREATED:
 This involves any preparatory procedure, example.
Washing the area and positioning the patient, and in
particular the part to be treated, comfortably and
appropriately, so that he or she is relaxed and
unnecessary movement is avoided.
• 5. SETTING UP:
 The apparatus is set up to ensure optimum therapeutic
effect and safety.
• 6. INSTRUCTIONS AND WARNINGS:
• Before the treatment commences it is mandatory to
instruct the patient that what he or she must and must not
do, example, keep still and not touch the apparatus, and
to give essential warnings, example, ‘if it become more
then a comfortable warmth/or any abnormal pinching or
burning sensation felt report it immediately.
• 7. APPLICATION:
• The patient must be observed throughout to ensure that
treatment is progressing satisfactorily and without
adverse effects. Accurate timing is essential.
• 8. TERMINATION OF TREATMENT:
• At the termination of the part treated should be examined
to ensure that the desired effects have occurred if visible,
example, superficial vasodilatation, and that there are no
unwanted effects. If electrotherapy is a precursor to
another form of treatment, the patient is prepared for
that. If it forms the whole treatment, example, UVR, an
explanation of what to expect is given as well as
instructions of when to come again and what must be
done between treatments.
• RECORDING:
• An accurate record of the treatment and its effects must
be made for assessment purposes, and for legal
requirements.
ELECTRICAL CHARGES
GENERATED BY THE BODY
 The resting membrane potential of nerves

 The nerve impulse

 Electrical charges generated by muscle cells

 Electrical charges generated by the c.T cells

 Signalling between cells

THE HEALING PROCESS
 INITIAL INJURY
 INFLAMMATION
 VASCULAR CHANGES
 ACTIVATION AND CONTROL
 PAIN
 CELLULAR RESPONSE
 INFLUENCE OF THE NERVOUS SYSTEM
 PROLIFERATION
 REMODELLING
 TIMMING OF THE PROCESSES
TIME SCALE OF THE HEALING PROCESS:

CONTRACTION AND REMODELING

HEALING AND REPAIR

PROLIFERATION

INFLAMMATIION
2 3 4 5 6 7 8 9 10 11 12 13 12 13 14 21 28

DAYS
se of the Wound Healing

ammatory Phase : at the moment of injury – 3 (2-5) days

liferative Phase : 3 (2-5) day to 20 days
modeling Phase : 9 days to 18 (24) months

matory Phase Remodeling Phase

Proliferative Phase
THE APPLICATION OF ENERGY TO THE
BODY FOR THERAPY:
1. PRESSURE AND VIBRATION – most obvious in mechanical
energy, like hand, being pressed against the body surface. If this
pressure varies at a suitable rate it is called vibration therapy.

2. ULTRASOUND – if the frequency of vibration occurs between

about 30 and 20,000 cycles per second, i.e. Hertz, it is detected as
sound when it strikes the tympanic membrane of the ear. At higher
frequencies the sensory nerves cannot detect the vibration so we
are unaware of it, it is then called ultrasound. This energy can be
passed through the body tissues generating heat and causing other
effects where it is absorbed.
3. CONDUCTION HEATING - if the atoms and
molecules of the object placed against the skin are given
more motion – that is, the object is made hotter – this
heat energy can be transferred to the skin and tissues.
4. COLD THERAPY – if the molecules of the object in
contact have less motion than those of the tissues then
heat is conducted from the tissues to the object, thus
cooling the tissues.
5. DIRECT CURRENT – where particles on or near the
skin are given an electric charge this can cause ions in
the tissues to move. The movement of charges is an
electric current in the tissues
6. MUSCLE – STIMULATING CURRENTS & TENS -
If these currents are varied, either in the intensity or
the direction, at a suitable frequency, example, at
50Hz, it can disturb the ionic balance across nerve or
muscle membranes, causing a nerve impulse or
muscle contraction to occur. Increasing the frequency
of current change to, say, 4000Hz will allow the ions
to pass easily through the tissues without stimulating
nerve or muscle.
7. INTERFERENTIAL THERAPY (IFC) – if two such
currents are passed through the tissues slightly out of
phase they interfere to produce amplitude – modulated
current of low frequency which will stimulate nerve
and muscle.
8. SHORTWAVE DIATHERMY – still higher frequencies,
in the megahertz range, will allow large currents to pass
through the tissues, producing significant heating spread
throughout the tissue.
9. MICROWAVE – when the movement of electron is made
to occur at very high frequencies energy is given off in
the form of electromagnetic radiations. These radiations
can enter the tissues and cause effects when they are
absorbed. Thus where the electron movement is at
frequencies of thousands of millions of cycles per second
(GHz) it produces radiations called Microwaves (radar)
which lead to heat when absorbed in the tissue.
10. INFRARED – at higher frequencies they are called
infrared and are absorbed at the skin surface but still
causing heating.
11. LASER - Still higher frequencies given radiations
which stimulate the retina of the eye, i.e. They are
visible.
12. ULTRAVIOLET – those beyond the visible – ultraviolet,
cause marked biological changes when absorbed at the
skin surface i.e. sunburn.
RISKS, PREVENTIONS AND KNOWLEDGE OF INDICATIONS
AND CONTRAINDICATIONS

• This will be discussed with respect to the Current

from.
COURSE OUTLINE
• Medium Frequency Current:
• Interferential Current
• Introduction, physical principles, electro-
physiological effect
• Clinical applications, methods of
application
• Treatment consideration &
contraindications.
• Physics of head and Radiation
• Definition of heat and temperature
• Physical effects
• Transmission of heat .
• Radiant energy electromagnetic spectrum
its production & properties
• Laws governing radiation
• Infra-Red Rays
• Definition
• Production, luminous & non-luminous
generators
• Physiological effects
• Therapeutic effects
• Uses
• Techniques of application
• Dangers and contraindications
• Ultra Violet Rays
• Production, U.V. rays
• Mercury Vapour Lamp: Air cooled
mercury vapour lamp &Kromayer lamp
• Fluorescent Tubes
• Penetration of rays into the skin
• Physiological effects (local & general)
• Therapeutic effects
• Heliotherapy
• Introduction
• Effects
• Uses
• Dangers and contraindications
• Cryotherapy
• Definition
• Methods
• Physiological & therapeutic effects
• Dangers, indications and precautions.
• Hydrotherapy
• Physiological principles of hydrotherapy
• Application of heat & cold
• Outline of methods of applying moist heat
• Medium used, contrast bath, paraffin baths, whirlpool baths,
techniques, effects, uses, dangers, contraindications of each
• The use of water as medium of each, the use of water as a
medium of movement pool therapy
• Immersion baths, full, plain and medicated, partial baths,
packs, general local methods of application
• Hot air, vapors, the car of patients in hydrological department
• Detailed description of indication of hydrotherapy
• Traction
• Effects of spinal traction
• Clinical indications for the use of spinal
traction
• Contraindications and precautions for spinal
traction
• Adverse effects of spinal traction
• Application technique.
• Adverse effects of spinal traction
• Application technique
• Compression
• Effects of External Compressions
• Clinical indications for the Use of External
Compression
• Contraindications and Precautions of External
Compression
• Contraindications for the Use of Intermittent or
Sequential Compression Pumps
• Precautions for the Use of Intermittent or Sequential
Compression Pumps
• Adverse Effects of External Compression
• Application Techniques.
• Laser therapy:
• Definition
• Properties of laser
• Production of Lasers
• Types of Lasers
• Techniques of application
• Dosage parameters
• Interaction of laser with body tissues
• Physiological and therapeutic effects of lasers
• Dangers and contraindications
• Methods of Treatment
RECOMMENDED TEXT BOOKS:

1. Clayton’s Electrotherapy and Actinotherapy, 10th

edition by PM Scott.
2. Electrotherapy: Evidence based Practice, 11th
edition by Shelia Kitchen.
3. Michelle H Cameron’s Physical Agent in
Rehabilitation: From research to Practice.
4. Electrotherapy and Electrodiagnosis by S. Lient.
5. Applications of Shortwave Diathermy by P.M. Scott.
6. Practical Electrotherapy by Savage.
Class Room Code Of Conduct
 Be on time, be on task, be prepared.

 Demonstrate respect for yourself, other students and

property.
 Behave appropriately at all times.
 Be quiet while working .
 Mobile phones are not allowed during the class session.
 Students having attendance less than 80% will not be
allowed to sit in sessional or terminal examinations .
BEST WISHES & PRAYERS