MICROCURRENT

ELECTRICAL
NERVE
MENS
STIMULATION
Basic 217
Lecture 7
Definition:
1. Microcurrent Electrical Nerve Stimulation (MENS)
is the therapeutic use of continuous or pulsed
current in the microampere range (µA).
2. MENS uses very low intensity current that is
biologically more compatible with the resting
membrane potentials of human tissue than other
electrical currents,
 Biphasic symmetric
square waves or pulsed
monphasic square wave

Polarity
depend
50-250
on ttt
goals Parameters .μsec

μA 0-1000 .Hz 5-120

Physiological effect of
MENS:

Tissue
Pain relief
healing
Indications:
1. Pain relief.
2. TMJ dysfunction.
3. Wound healing.
4. Sports injury.
5. Fracture healing.
Contraindications:
1. Unreliable patients.
2. Patient receiving deep X-ray therapy.
3. Neoplasm.
Practical Application of Microcurrent

Standard electrodes, with appropriate conductive

gel, are placed astride the target tissue.
The area under the electrodes should be cleaned
with alcohol to decrease skin resistance.
In cases of painful conditions probes are used.
Probes with moistened cotton swabs are held by the
clinician on both sides of the target area, so the
current flows through or along the painful region.
 Recommended Techniques for Specific Conditions:
 Non-united fracture: It is a fracture of 6 months with no healing.
A cathode is placed at the site of the bone defect with an anode in the soft tissue nearby. Between 2 and 4 electrodes are situated on
the skin on either side of the fracture site. An external power source is then attached to the electrodes, which induces an electric
field at the fracture site. If the plaster cast is not removed, the current will pass onto the skin surface through holes (windows) in a
plaster cast. Treatment time is from 30 minutes to 1 hour, three to four times daily (Fig. 1).
 Wound Healing: MES is used to accelerate the healing of wounds. The polarity of the
electrode is selected according to the wound stage. The anode is used first in the early
period of wound inflammation and infection. The cathode is used during the proliferation
phase. The anode is then used for debridement (e.g., phagocytosis and autolysis) and for
promotion of epithelialization during the later proliferation stage of healing. Alternate
polarity (+/-) at least every week, based on the stage of healing.

 For chronic skin ulcers.

 The negative electrode is placed in the wound area for the first 3 days. The positive
electrode should be positioned proximal to the wound.
 After 3 days, the polarity is reversed and the positive electrode is positioned in the wound.
 When the wound size plateaus, re-put the negative electrode in the wound area again.
 Treatment duration: 2 hours followed by 4 hours rest, then repeated 2 to 3 times per day.
 Probe Technique: It is used in painful conditions
 Step 1: First treat in a large X manner over a wide area
holding the probes so that the current is directed through the
problem area. An example of this strategy for knee pain
would be to first make the large X by treating from the
inside top thigh to the outside foot and from outside top
thigh to inside foot (Fig. 2a).
 Step 2: Treat with smaller Xs, closer and directly around
the involved knee e.g. one probe on either side of the knee,
one probe above and below the knee, then one probe back
and front of the knee (Fig. 2b).
 Step 3: Treat the opposite knee for at least 20 seconds (one
X), even if there is no pain in this knee (Fig. 3a).
 Step 4: Connect the two knees by placing a probe on each
knee, e.g. on the outside of each knee, then on the inside of
each knee (Fig. 3b), (a most important step).
 These first 4 steps should take at least 2 minutes (12 x 10-
second placements) (Fig. 4).
 Wound Healing:
Application same as HVPS
(Fig. 5).
IONTOPHORESIS
 the introduction of charged
ions into the body tissues by
using low voltage direct
electrical current.

is

Iontophoresis
Advantages of iontophoresis
1. Produces local high concentration of the
drug.
2. Does not cause gastrointestinal tract (GIT)
irritation.
3. Produces sustained drug release for 12-24
hours.
 Basic mechanisms of ion
transfer
Iontophoresis forces charged molecules into the skin through;
◦ Overcoming the electric impedance of the stratum corneum.
◦ Forcing charged molecules into skin.

It is a relatively superficial treatment, with maximum medication's

penetration of 1.5 cm.
 Parameters
Type of Current mode: Intensity: 1-5
current: direct CC mA

Polarity:
depend on
medication

:Duration
recommended drug dose (mA.min) = current
.amplitude (mA)  treatment time (minutes)
 Physiological effect of
iontophoresis

The cathode (-) produces The anode (+)

an alkaline reaction (a produces an acid
strong sodium reaction (a weak HCL
hydroxide), it is then acid), it is considered
considered sclerolytic, sclerotic, which tends
which is a softening to harden tissues,
agent due to the serving as an analgesic
hydrogen release, serving agent due to local
in the management of release of oxygen
scars and burns.
 Iontophoresis Phonophoresis
Derive drug Derive drug
molecules through molecules through
the skin. the skin.
Using direct Using acoustic
electric current. energy
(ultrasound).
Charged Whole uncharged
molecules or ions. molecules.
 Complications
It is caused by accumulation of (NaOH) under the
negative electrode.
Initially, the burn lesion is pink and edematous but
within hours becomes grey, oozing wound.
To avoid chemical burn;
Increase the size of the negative electrode relative to
the positive electrode.
Increase the space between the electrodes to decrease
current intensity.
Indications of iontophoresis
1. Inflammation.
2. Pain relief.
3. Muscle spasm.
4. Calcium deposits.
5. Scar tissue.
6. Open wounds and burns.
Contraindications of iontophoresis
1. Skin sensitivity.
2. Allergy to the drug.
Precautions
1.Excessive hair and bear
2.Skin abrasion
3.Skin dirt, oils, or creams
4.Skin disease
5.Acute inflammation
6.Allergic patient for the drug
Optimal Treatment Parameters
During the 20- minute treatment session, the current intensity is
maintained at 2 mA for the first 5 minutes.
Then it is increased to 3 mA for the next 5 minutes and remained at 4
mA during the last 10 minutes.
In total, this protocol produced a current dosage of about 80
mA/minute. Although the gradual increase of DC might minimize the
possibility of skin irritation, the efficiency of ion transfer would be
diminished due to the lower current dosage.
 Guidelines for Use of Iontophoresis:
1. Shave the excess hair
2. Clean the area of the skin underneath the active and dispersive electrodes with alcohol prep. Let it dry.
3. Remove jewelry before iontophoresis treatments.
4. If there is a little area of skin inflammation or tiny abrasion, scratches, tender cuticles cover it with cream or petroleum jelly
like Vaseline.
5. Select an ion appropriate for the pathology or condition.
6. Identify the correct polarity of the ion to be used.
7. Determine if the patient is allergic to the ion or drug.
8. Select an iontophoresis device providing DC current.
9. Select electrodes with appropriate size to maintain current density in the recommended range.
10. Inspect and prepare the area to be treated before application.
11. Place active electrode over target tissue(s) and inactive electrode away at a distance not less than twice the diameter of the
cathode.
12. Choose an effective dosage by selecting an appropriate duration and amplitude.
13. Slowly increase the amplitude to the peak. After treatment, inspect the skin integrity for signs of adverse effects to current.
14. Know that the electric current used during iontophoresis is not strong enough to cause a harmful shock but it could startle you,
so don’t remove your hands or feet from the water during treatment.
15. Treat any post-treatment, mild skin irritation, or redness with 1% hydrocortisone cream.
16. If excessive dryness occurs, use a moisturizer after treatment sessions.
 Some Clinical Applications of Iontophoresis

The use of iontophoresis in inflammatory musculoskeletal conditions has received more

attention. A combination of dexamethasone (10%) and lidocaine with epinephrine (2%)
iontophoresis is used for various inflammatory conditions.
Thank You