INTERFERENTIAL

CURRENT
HISTORY
 IFT was developed in 1950s by Dr, Hans
Nemec in Vienna and became increasingly
popular in UK during 1970s.
INTRODUCTION
 It is application of two medium frequency currents
which produces a low frequency current effect at
the point of intersection of the two currents.

 IFT current has advantage of reducing the skin

resistance.

 Discomfort is less as compare to low frequency

current so tolerance is better
 Z = 1 / 2πFC ;
where Z – Impedance in ohms,
F – Frequency in Hertz,
C – Capacitance of the skin in
microfarads.

 This shows that as the frequency increases, the

impedance offered by the skin decreases.
PRINCIPLE
 When two medium frequency Alternating currents of
slightly different frequencies are passed through
tissues.

 They interfere with one another to produce a low

frequency current effect at the point of intersection

 The resultant amplitude of this new current is the sum

of individual current amplitude at any given point.
 When 2 peaks of amplitude in same direction
coincide, the resultant amplitude is at maximum.

 When 2 peaks are in opposite direction, there

will be no current.

 This summation and cancellation of current

values produces the amplitude modulated beats
that are characteristic of interferential current.
 INTERFERENCE OF WAVES
 Types of interference:
◦ Constructive
◦ Destructive
 Constructive Interference -
Maximum interference will be the if two wave
are exactly in phase

 Destructive Interference –
It will be there if two wave are out of phase
 This resultant current varies in amplitude i.e. it
is amplitude modulated.

 The frequency with which the amplitude

varies is called amplitude modulated
frequency or beat frequency. It is the
difference in frequencies between the 2
interfering currents.
 If 2 medium frequency remain constant, the beat
frequency will also be constant. This may lead to
gradually diminishing response due to habituation of
tissues so a varying beat frequency is used. This is
called frequency swing or frequency sweep.

 Therefore, IFT machines have one medium

frequency current at constant frequency for e.g. 4000
Hz while frequency of 2nd is variable between 4000
Hz to 4100 Hz. So a variable beat frequency is
between 0 – 100Hz.
 In sweep mode, the beat frequency changes
automatically and regularly between some preset pair
of frequencies over a specified time period.

 For e.g. between 20 and 80 Hz over a period of 6 sec.

and back over the next 6 sec.

 The pattern and timing of this modulation is usually

adjustable and is also called as spectrum.

 This arrangement reduces nerve adaptation.

METHODS OF APPLICATION
 2 pole method (Bipolar)
 4 pole method (Quadripolar)
 4 pole with vector scanning
2 pole method
 2 electrodes are used.
 2 medium frequency alternating currents are
superimposed inside the machine (Premodulated)
with the result that interference occurs throughout
the region between the 2 electrodes.
 Electrodes are placed opposite to one another so
that the part to be treated lies between them
 Sensory stimulation will be more than Quadripolar
method but less than low frequency current.
 In this method, interferential current is
generated inside the equipment and
interferential current is delivered to the patient
through two electrodes only.

 Maximum current intensities are just under the

electrodes.
4 pole method
 4 electrodes are used in 2 pairs.

 They are placed diagonally opposite one another in

such a way that the interference effect i.e. beat
frequency is produced in desired tissues, which may
be very deep.

 When 2 equal forces intersect at 90°, the maximum

resultant force is half way between these 2 forces (45°
diagonally).
 Quadripolar application of interferential current
produces modulated current in a ‘clover leaf pattern’

 There is 100% depth of modulation at 45° diagonally –

Clover leaf model

 Sensation will be comfortable in comparison to bipolar

electrode. The effect is deep within the tissues.

 There is static interference pattern.

Static interferential field
4 Pole Method using Automatic vector scan

 It is possible to move the clover leaf pattern of maximum

modulation to and fro through 45° in the region of
intersection. Such mechanism is called vector sweep.

 There is dynamic interference pattern.

 It serves to increase area of effective treatment.

 Whenever it is difficult to identify the exact site of tissue

involvement scanning mode is preferable than the static
mode.
Dynamic interferential field
 Application of IFT
 Interferential currents are applied by means of
electrodes, which may be malleable metal or carbon
rubber electrodes with a water-soaked pad to pass
current to the skin.
 Carbon rubber electrodes are secured by rubber straps or
alternately by suction.
 Suction units can be connected to the IFT machine.
 Flexible rubber cups of different sizes are connected by
tubes to a pump that can provide negative pressure. This
suction may be continuous or variable, the variable
suction diminishes the risk of skin damage.
 Metal electrodes mounted inside the cups are
connected by wires carried within the tubes to the
IFT source.
 Contact is made by moistened sponges placed
inside the cups between the metal electrode and
skin.
 The leads and the suction tubes are colour coded to
ensure correct arrangement of the circuit.
 The 5 basic methods are as follows:
 Plate electrodes and pads
 Suction cup electrodes and pads
 Quadripolar pad electrodes
 Quadripolar suction cup electrodes
 Combination of plate and suction cup electrodes
 Other methods:
 The glove electrode
 The disc and point electrodes
Plate electrodes and pads
 These electrodes represent the standard method of
application for interferential currents.
 Moderate plate electrodes of various sizes are used.
 It is important to ensure a firm even pressure over
each electrode and a variety of elasticated straps are
available for this purpose.
Suction cup electrodes and pads
 These electrodes provide a useful means of
attaching electrodes to certain body parts e.g.,
shoulder.
 However, their use is contraindicated in case of
acute oedema.
Quadripolar plate electrodes
 A collection of specialized electrodes is embedded
in a single pad.
 The entire pad is then moved on the patients skin
until the stimulation is localized to the required
areas.
Quadripolar suction cup electrodes
 This method has a single suction cup containing 4
small electrodes.
Combination of plate and suction cup electrodes

 On most IFT units, which have a vaccum unit, it is

possible to combine plate and suction cup
electrodes, i.e., 2 cups and 2 electrodes to be used
at the same time.
 The ability to combine plate and suction cup
electrodes allows a measure of flexibility in the
application of electrodes to the patient.
 It also allows the unit to be used if a single
electrode becomes defective.
The glove electrode
 The use of this electrode is effective in certain
cases because it is easily shifted in the course of
treatment.
The disc and point electrodes
 These electrodes are most suitable for point
stimulation.
 The indifferent electrode is best placed opposite to
stimulating electrode in order to obtain a greater
depth effect.
Procedure
 The electrodes may be placed with co-planar
arrangement or contra-planar arrangement using
quadripolar or bipolar technique.
 The nature and effect of the treatment should be
explained to the patient and re-assurance given that
it is a harmless treatment producing no unpleasant
sensations.
 IFT should be applied to the tissues with following
steps:
 The patient should be suitably positioned ensuring
maximum comfort and suitable exposure of the part
for the application of interferential current.
 Prepare the area to be treated. The skin should be
inspected and then cleaned to reduce the skin
impedance and to achieve the best conduction.
 The points where electrodes are to be placed should
be marked.
 The size of the electrodes is selected depending on
the affected area.
 The electrodes should be applied on the marked points
and held in position firmly with the help of straps or
suction force.
 The parameters on the machine should be selected and
set.
 The patient should be explained about the subjective
sensory motor feeling, which he will experience. The
patient should experience a sensation of deep,
sufficiently strong but pleasant vibrations by
rhythmical frequencies and a pleasant tingling
sensation at a constant frequency of 100 Hz.
 The intensity is gradually and uniformly increased
to low, moderate and high levels depending upon
the stage and nature of disorder.
 Patient should be explained to immediately inform
the therapist, of any unpleasant sensation or any
other discomfort.
 The therapist should promptly but gradually reduce
the intensity to zero as and when patient reports of
any discomfort.
 After removing the electrodes, the part should be
inspected and the transitory erythema effect may be
explained to the patient specially when
suction/vaccum electrodes have been used.
Effects of IF currents
 Different beat frequencies lead to different effects.
 In general, the higher beat frequencies, around 100
Hz, are used for their analgesic effect whereas the
lower beat frequencies, around 10 Hz, produce
contraction of innervated muscle.
Pain relief
 This the most important effect and can be achieved by
several mechanisms:

1. Activation of the ‘pain gate control’ mechanism

2. Activation of nociceptive fibres
3. Physiological block
4. Increased blood flow
5. The placebo effect
6. Absorption of exudates
7. Muscle contraction
8. Vasodilatation
 Activation of the pain gate control mechanism

 Stimulation of large diameter afferent nerve fibers , Aß

fibers closes the ‘gate’ to nociceptive impulses in the
substantia gelatinosa of the posterior horn of the spinal
cord.

 Impulses of very short duration at a frequency of 100

Hz should selectively stimulate these large diameter
nerve fibres, that inhibit transmission of small diameter
nociceptive traffic(C and A§ fibers),which effectively
close gate for painful impulses.
Activation of nociceptive fibres
 Activation of the nociceptive fibres themselves can
diminish pain by means of the descending pain-
suppressor system.
 In this system, nociceptive impulses passing up to
regions in mid brain provoke impulses in neurons
travelling back down the spinal cord to inhibit
nociceptor neurons at the original level.
Physiological block
 It is possible, though not proven, that high
frequency electrical stimuli could cause a
temporary physiological block in both finely
myelinated and unmyelinated nociceptor nerve
fibres (A-delta and C fibres).
Increased blood flow
 Pain suppression can also be due to an increased
local blood flow and tissue fluid exchange. This
may hasten the removal of chemical irritants acting
on pain nerve endings and reduce pressure due to
local exudates.
 Vasodilatation may occur as a result of stimulation
of the ANS and the regular mild muscle
contraction has a pumping effect on the vessels.
The placebo effect
 The machines are technically impressive and
produce an unfamiliar and not the least an
unpleasant feeling.
Absorption of exudates
 This is accelerated by a frequency of 1-10 Hz
rhythmic as a rhythmical pumping action is
produced by muscle contraction, and there is an
effect on the autonomic nerves, which can affect
the diameter of blood vessels and therefore
circulation.
 Both of these factors help absorb exudates and thus
reduce swelling.
Muscle contraction
 The lower beat frequencies stimulate motor nerves
leading to contraction of voluntary muscle (mainly at 10-
50 Hz) and smooth muscle.
 Muscle contraction can be quite strong without any
discomfort because there is little skin effect.
 When the beat frequency is varied, rhythmic muscle
contraction will occur, helping to reduce oedema or
congestion by the pumping action of soft-walled vessels.
 It may also aid muscle control as in the treatment of
incontinence.
Vasodilatation
 Stimulation of the sympathetic ganglia with 100 Hz
produces reflex vasodilatation and is valuable in
the treatment of causalgia.
INDICATIONS
 Pain and muscle spasm
 Delayed union and sudek’s atrophy- constant 100 Hz
with a moderately strong dosage for 15-20 mins
for 2-3 weeks daily.
 Haematoma- during the 1st 24 hrs, 100 Hz constant.
 Chronic oedema
 Gynaecological conditions- rhythmic modes of 0-
100 Hz and 90-100 Hz. Anterior and posterior
placement of electrodes so that current crosses in
the pelvis.
 Stress incontinence- rhythmic
modes of 0-10 Hz or 0-100
Hz. Electrodes are to be positioned anteriorly on the
lower abdomen and posteriorly on the upper medial
aspect of the thighs with the patient in the half lying
position.
 Contractures
 Sports injuries
 Muscle weakness
 Neuritis
 Disuse atrophy
 Lymphoedema
 Spondylosis
CONTRA-INDICATIONS
 Arterial disease- because the stimulatory effect of the
current could produce emboli.
 DVT- in acute stages should not be treated as it
could dislodge the thrombi or increase the
inflammation.
 Acute infections- it may exacerbate and provoke the
spread of infection.
 Pregnant uterus- direct stimulation of the pregnant
uterus should be avoided, but in cases of sacroilliac
strain during pregnancy, IFT may be used if
superficially placed over the sacroilliac ligaments.
 Danger of haemorrhage- the stimulating effects of
IFT can cause further bleeding.
 Malignant tumours- it may stimulate growth of
neoplastic tissue or encourage metastasis if used
directly.
 Artificial pacemakers- it could be affected if the
current were passed close to the heart or the
implanted pacemaker itself.
 During menstruation- it is contraindicated over the
abdomen only.
 Febrile conditions- it may be exacerbated by IFT
 Large open wounds- these will cause concentration
of the current and distortion of the interferential
field.
 Unreliable patients- patients who are unable to
understand the warning and instructions, very
young or very old patients.
 Dermatological conditions- interferential may
exacerbate any dermatological conditions in the
area being treated.
DANGERS

 Burns- burns may occur.

 Bare metal electrode against the skin
 If the electrodes, that lie close together, are of the
opposite polarity.
 Increased intensity with skin currents.
 Insufficient moisture in the pads.
 Haematoma- the vacuum pads may
produce a haematoma if the pressure is high and
the speed is too fast. Poor results may be due to:
 Faulty positioning of electrodes
 Poor balancing of the circuits if the calibration
dials are not properly positioned.
 Incorrect choice of frequencies.
General malaise
Nausea
Dizziness
Migrain/headache
Neurological effects.
ELECTRODES PLACEMENT
 Russian current
 Also known as tone burst current.

 developed by Dr Yakov kots for increasing muscle force

that increase the maximum voluntary contraction.

 Russian Olympic team were using it in addition to their

usual training methods.

 Its use led to significant(30% to 40%) gains in muscle

strength.
 Russian Stimulation was probably the earliest name
for this stimulation type. Several multi-modal
stimulation devices include it as one of their
options.

 Burst Mode Alternating Current (BMAC) is a more

generic and more recently employed term, which is
probably preferable.
 In 1970, claims were published that this 2500 Hz
medium frequency interrupted current could be
used to generate greater muscle force than a
maximal voluntary muscle contraction.

 Although it is a medium frequency current, the

nerve are stimulated because it is interrupted to
give a low frequency stimulation of 50 Hz.
 Essentially, this type of electrical stimulation
employs what is referred to as a medium frequency
alternating current (in the low kHz range -
thousands of cycles a second), which is delivered in
a pulsed (or burst or interrupted) output.

 The pulsing or bursting is at a 'low' frequency, and

as a result, nerves will respond.
 The current consist of 2500 Hz evenly alternating
medium frequency current applied as a series of
separate burst, having a burst duration of 10
milliseconds with a pulse duration of 0.2ms, which
is interspersed with 10ms periods when no current
flows, producing 50 bursts per second, which is in
fact like the low frequency faradic type pulse at 50
Hz.
 The stimulation was applied at a range of 'medium'
frequencies (100-500-1000-2500-3000-5000Hz)
and it was found that as the stimulating frequency
increased, there was a greater comfort for the
recipient, and it was therefore (predictably)
identified that a greater current could be delivered
to the muscle with increased (higher) frequencies.
 The researchers concluded that 2500Hz (2.5kHz)
was the most effective frequency at which to
stimulate muscle tissue (1000Hz or 1kHz was more
effective for nerve trunk stimulation), stimulating
for a 10 second duration.

 Using a 2500Hz stimulation at 10milliseconds

means that the effective muscle stimulation is at
50Hz.
 The theoretical basis for the use of this current is
that, maximal electrical stimulation can cause
nearly all the motor units in a muscle to contract
synchronously; something that can not be achieved
in voluntary contraction.

 This produce stronger muscle contraction and

greater muscular hypertrophy.
 Electrode placement : over muscle belly.
 The continuous vs burst protocols were evaluated
(i.e. continuous 2500Hz or 2500Hz burst at 10ms
intervals). There was no significant difference in
the maximal force generated, but the burst mode
generated the same result with less current having
been applied (50% less). The recommendation is
therefore that the stimulation should be applied
with a 2500Hz carrier medium frequency
sinusoidal alternating current, burst at 50 Hz (10ms
ON : 10ms OFF) at a maximum tolerable level.
 The 1971 Russian experimentation set out to establish
the fundamental principle of this stimulation method.
The timing (stimulation/rest/repetitions) protocols
were considered as was the issue of treatment
frequency. What has become known as the 10/50/10
protocol was identified as being effective (this
essentially means stimulating for 10 seconds, leaving
a 50 second rest period and repeating this sequence
for 10 minutes (i.e. 10 stim/rest cycles) was indeed
effective.
 The 1971 Russian experimentation set out to establish
the fundamental principle of this stimulation method.
The timing (stimulation/rest/repetitions) protocols
were considered as was the issue of treatment
frequency. What has become known as the 10/50/10
protocol was identified as being effective (this
essentially means stimulating for 10 seconds, leaving
a 50 second rest period and repeating this sequence
for 10 minutes (i.e. 10 stim/rest cycles) was indeed
effective.
The resulting stimulation pattern from this work

Base Frequency : 2500Hz (2.5kHz)

Burst @ 50Hz

10ms ON : 10 ms OFF (50% duty cycle)

Stimulation delivered thus for 10 seconds

Rest period of 50 seconds

Repeated 10 cycles

Daily

Maximum tolerable intensity

 Rebox currents
 Rebox type currents are derived from a device
called rebox.
 It was developed in Czechoslovakia in the 1970s.
 There is a point electrode and a hand held device.
 The point electrode is made the negative pole.
 The current produced consists of unipolar
rectangular pulses of between 50 and 250 µs at
3000 hz.
 Rebox electrotherapeutic method is based on
non-invasive transcutaneous application of specific
electric currents to a living tissue.

 Main indications for using the Rebox include

treatment of acute and chronic pain, immobility,
musculoskeletal and neurological disorders
and oedema.
Effects
 Within several seconds, local acidosis in the treated
tissue will be corrected, lymphatic fluid and blood
circulation will be increased, and effective
myorelaxation will take place at the same time.
 It restores the microcirculation in living tissue,
reduces inflammation, improves blood and lymph
circulation, decreases pain, and provides tissue
relaxation.
 This speeds up recovery time.
 Treatment modes
1. GENTLE
- Recommended for a new patient
(first few sessions).
2. STANDARD
- The most frequent mode when patient is used to the
treatment.
3. STRONG
- For patients who do not respond to normal stimulation
amplitude.
Procedure
 The small, pencil-probe is placed over the treated area
lightly touching the skin.
 The other probe is held by the hand of the person
receiving treatment.
 The therapist monitors the treatment reading the meter.
 Treatment should be repeated for stable results.

 Rebox therapy is more effective in acute cases, than in

chroniccases.
Duration
 A typical session length is between 5-10 minutes
and a sufficient number of sessions of 4-5 during a
week for acute injuries.