INTRODUCTION AND

GENERAL
CONSIDERATION OF
ELECTROTHERAPY
DR. TANVEER SIKANDER PT
DPT (DOW) MSPT (LNH)
LEARNING OBJECTIVES
  Electrotherapy.
 Types of currents and its parameters.
 Identification of the safety rules for using electrical currents.
 Background with respect to RMP, nerve impulse, electrical
charges of nerve and tissues.
 Healing process.
 Application of the energy to the body for therapy.
 List of the risks, preventions and knowledge of indications and
contraindications
What is Electrotherapy.

Treatment or rehabilitation through electro-

physical agents

Physical agents consist of energy and

materials applied to patients to
assist in their rehabilitation.
The terms physical modality,
biophysical agent, physical agent
modality, electro-physical agent,
and modality are frequently used
interchangeably
CATEGORIES OF PHYSICAL AGENTS

 Thermal agents
– deep-heating agents, superficial heating agents, and
superficial cooling agents.
 Mechanical agents
– traction, compression, water, and sound.
 Electromagnetic agents
– electromagnetic fields and electrical currents
THERMAL AGENTS

 ■ Thermal agents transfer energy to a patient to produce an increase or decrease in

tissue temperature. Examples of thermal agents include hot packs, ice packs,
ultrasound, whirlpool, and diathermy.
■ Cryotherapy is the therapeutic application of cold
■ Thermotherapy is the therapeutic application of heat
Categories of Physical Agents
ELECTROMAGNETIC AGENTS

Electromagnetic agents apply energy in the form of

electromagnetic radiation or an electrical
current.
■ Examples
– UV radiation
– infra- red (IR) radiation
– Laser
– Diathermy
– electrical current (Electrical Stimulation)
■ Variation of the frequency and intensity of
electromagnetic radiation changes its effects and
depth of penetration
Types of currents and its parameters.

Current is the rate at which electrons flow past a point in a complete electrical circuit.
Low frequency currents (100-1000hz)
Medium frequency currents (1000-10,000hz)
High frequency currents (more than 10,000hz)
Electrical stimulation

 Use of electrical current to induce muscle contraction (motor

level ES) and changes in sensation (sensory level ES), reduce
edema, or accelerate tissue healing.
■ The effects and clinical applications of electrical currents vary
according to the
– Waveform
– Intensity
– Duration
– direction of the current flow
– and according to the type of tissue to which the current is
applied.
Continue …

 Electrical currents of sufficient intensity and duration can depolarize nerves,

causing sensory or motor responses that may be used to control pain or increase
muscle strength and control.
 Other than stimulation Electrical current can be used
– to control the formation of edema
– promote tissue healing,
– facilitate transdermal drug penetration (Iontophoresis).
Identification of the safety rules for using
electrical currents.
 Physical agents have direct effects primarily at the level of impairment.
 These effects can improve activity and participation. For example, for a patient with
pain that impairs motion, electrical currents can be used to stimulate sensory nerves to
control pain and allow the patient to increase motion and thus increase activity, such
as lifting objects, and participation, such as returning to work.
 Physical agents can also increase the effectiveness of other interventions and should
generally be used to facilitate an active treatment program
Background with respect to RMP, nerve impulse,
electrical charges of nerve and tissues
 An AP is the basic unit of nerve communication. When
a nerve is at
rest, without physiological or electrical stimulation, the
inside is more negatively charged than the outside by 60
to 90 mV.
 This charge difference at rest is known as the resting
membrane potential (Fig. 11.15).
 The resting membrane potential is maintained by having
more sodium ions outside the cell and fewer potassium
ions inside the cell, making the inside negative relative
to the outside.
 When a sufficient stimulus is applied, sodium channels in the cell membrane open
rapidly, whereas potassium channels open slowly. Because of the high
extracellular concentration of sodium, sodium ions rush into the cell through the
open sodium channels.

 This makes the inside of the cell more positively charged, reversing the membrane
potential. When the membrane potential reaches +30 mV, the permeability to
sodium decreases, and potassium channels rapidly open, increasing the
permeability to potassium
 Because the intracellular concentration of
potassium ions is high, potassium ions then
flow out of the cell, returning the membrane
polarization to its resting state of -60 to -90
mV.
 This sequential depolarization and
repolarization of the nerve cell
membrane caused by the changing flow of
ions across the cell membrane is the AP (Fig.
11.16).
EFFECTS OF PHYSICAL AGENTS

 The application of physical agents primarily results in modification

of
– tissue inflammation
– healing,
– relief of pain
– alteration of collagen extensibility
– Modification of muscle tone
Three Phase of the Healing

1. Inflammatory Phase : at the moment of injury – 3 (2-5) days

2. Proliferative Phase : 3 (2-5) day to 20 days
3. Remodeling Phase : 9 days to 18 (24) months
INFLAMMATION AND HEALING

 When tissue is damaged

 Inflammation is the first phase of recovery, followed by the
proliferation and maturation phases.
 Modifying this healing process can accelerate rehabilitation and
reduce adverse effects, such as prolonged inflammation, pain, and
disuse.
 This in turn leads to improved patient function and more rapid
achievement of therapeutic goals.
 Thermal agents modify inflammation and healing by changing the
rates of circulation and chemical reactions.
 Mechanical agents control motion and alter fluid flow,
 Electromagnetic agents alter cell function, particularly membrane
permeability and transport
Role of Physical Agents during
Inflammation
 Physical agents generally assist during the inflammation
phase by:
 Reducing circulation
 Reducing pain
 Reducing the enzyme activity rate
 Controlling motion
 Promoting progression to the proliferation phase of healing.
Physical agents generally assist during the
proliferation phase
of healing by
 Increasing circulation
 Increasing enzyme activity rate
 Promoting collagen deposition
 Progression to the remodeling phase of healing.
 Altering the balance of collagen deposition and resorption
 Improving the alignment of new collagen fibers.
Physical Agents for Promoting Tissue
Healing
LIST OF THE RISKS, PREVENTIONS AND
KNOWLEDGE OF INDICATIONS AND
CONTRAINDICATIONS
 Indications: 1.Physical Agents for the Treatment of Pain
2.Physical Agents for the Treatment of
Motion Restrictions
3.Physical Agents for the Treatment of
Tone Abnormalities
HOT VS COLD
Measures Used to Assess Effectiveness of Therapeutic
Modalities
CONTRAINDICATIONS FOR
APPLICATION OF ELECTROTHERAPY
 Pregnancy
 Malignancy
 Pacemaker or other implanted electronic
device
 Impaired sensation
 Impaired mentation
Risk and preventions

 Use of cold pack/icing directly over skin(without layers of towel)

can cause froze bite on the skin
 Do NOT use ice on patients with ice allergy or Renaud's phenomena
 Prolong use of hot pack or thermotherapy will results in blisters over
the skin.
 Special precautions should be taken in patient with diabetic
neuropathy, before using electrotherapy and thermotherapy. It may
cause burns.
 Do NOT apply thermo or electro physical agent over skin disease or
rashes.

Precaution

 Do not touch the bare electrode

 Never pull the electrode while detaching from patients skin
 Always ask the patient before increasing intensity of current
 In case if there is a relative contraindication of thermotherapy and electrotherapy
in patients with diabetic neuropathy, keep vigilance for that complete duration of
treatment.
Clinical case
 60 years old male patient came to OPD with chronic back pain (for last months),
going down to thighs. He is known case of Hodgkin's lymphoma. Has last dose of
chemotherapy next week. Unable to continue his job, prolong sitting aggravates
his pain. Relief temporarily with pain killer.
 On objective examination, Physiotherapist noted spasm on paraspinal muscles.
 What would be the likely modality to decrease pain?
Reference

 Physical agent evidence based

 By Camron