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What We Actually Do?

ELECTROPHYSIOLOGY

Electrotherapy
 
Electrotherapy uses electrical signals to interfere with the transmission of neural pain signals into the brain. It effectively slows down or distracts the message from the nerve to the brain. From a physiotherapy point of view, affecting one’s ‘Pain Gate’, whether in an acute or chronic pain episode, is crucial area of treatment and electrotherapy is a very useful resource where conventional medicines are not as affective. Electrotherapy can also involve the use of this electric current to speed tissue healing where tissue damage has also occurred. 
 
Two commonly used forms of electrotherapy at GoPhysio are:
TENS (transcutaneous electrical nerve stimulation) and Interferential therapy.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is widely used around the world for a variety of painful conditions such as:
 
• Arthritis
• Low back pain
• Labour pain
• Nerve related pain such as phantom pain
 
How Does It Work?
 
The electrical device delivers electrical impulses across the skin.  
 
TENS Can Work In Two Ways:
1: On a high frequency, by selectively stimulating certain ‘non-pain’ nerve fibres to send signals to the brain that block other nerve signals carrying pain messages. High frequency stimulation, is tolerable for hours, but the resultant pain relief lasts for a shorter period of time.
2: Lower frequencies stimulate the production of endorphins, natural pain-relieving hormones – your own built-in pain management system.  Low-frequency stimulation, is more uncomfortable and tolerable for around 20-30 minutes, but the resultant pain relief lasts longer.
 
Unlike many pain-relieving drugs, TENS isn’t addictive and has few side-effects. Most people can use a TENS machine but it is unsuitable for:
 
-Epileptics.
-Patients with pacemakers and certain other types of heart disease.
-Unknown causes of pain.
-Certain body sites in pregnancy(other than in labour)
-Certain skin conditions
 
TENS can be used with various electrode placements. Electrodes can be placed over the painful area, surrounding the painful area, over the nerve supplying the painful area, or even on the opposite side of the body
 
Interferential Therapy
 
Here at GoPhysio we also use an electrotherapy modality called interferential therapy (IFT). It is essentially a deeper form of TENS.  It utilises two high frequency currents which are slightly out of phase, and are passed through the skin at the same time where they are set up so that their paths cross and simply interfere with each other. This interference gives way to a beat frequency which has the characteristics of low frequency stimulation deep under the skin.
 
It is administered by a physiotherapist and  involves the placement of damp sponges on the body which deliver a mild current similar to the sensation of pins and needles. Manipulation of the current allows the physiotherapist to target the correct structure and to treat.
 
There are 4 main clinical applications for which IFT has been found to be effective:
 
• Pain relief (in a similar fashion to TENS)
• Muscle stimulation – prevent muscle wastage, re-education, maintain range of motion
• Increased local blood flow 
• Reduction of oedema  
 
How Does Electrical Stimulation Therapy Work?
 
The American Physical Therapy Association has supported the use of electrotherapy because it has shown to provide the following:
• Relaxation of muscle spasms
• Prevention and cessation of muscular atrophy due to disuse
• Improved local blood circulation and flow
• Re-education of muscles using targeted stimulation
• Preserve and improve range of motion
• Management and reduction of pain (chronic, post-traumatic, and post-surgical acute)
• Prevention of deep vein thrombosis post-surgery
• Facilitation of wound healing
• Improvement in the effectiveness in delivering prescription drugs-electromotive drug administration (EMDA)
 
 
Electrotherapeutic devices can offer different therapeutic waveforms. An electrical stimulation device includes electrodes that are attached to the treatment area and when activated, the electrical energy of the device causes the muscles to contract. This contraction imitates the body’s natural movement during activity and can prevent muscular atrophy.
 
The most common waveforms found in electrical stimulation are: TENS, Russian, Interferential, Premodulated, Biphasic, High Voltage and Microcurrent. Each waveform has its own therapeutic benefits, so many devices may offer the practitioner multiple waveforms in order to offer them the most use across diverse patient
 
Different Waveforms Used in Stimulation Therapy
 
The various waveforms used in e-stim are designed to target specific areas of the body and to provide customized forms of energy transfer. This variance in energy transfer helps address diverse therapy needs.
 
Transcutaneous Electrical Neural Stimulator (TENS)
 
TENS works to decrease pain by blocking pain signals from reaching the brain. The stimulation of TENS also encourages the production of endorphins, making it a popular waveform for treating neck and back pain.
 
Russian Current
 
The Russian Current waveform delivers medium frequency in alternating pulses of energy. This makes it a popular waveform to use when there is a need to increase muscle strength and re-educate specific areas. The Russian current can also stimulate the relief of pain-relieving endorphins, increasing its versatility and applications.
 
Interferential Current (IFC)
 
Interferential Current (also referred to as IFC) is the waveform to use when treating chronic, post-surgical and post-trauma acute pain. IFC e-stim is non-invasive with minimal side effects. IFC delivers higher frequency energy so it crosses the skin barrier easier for deeper access into areas of pain, but also has improved tolerance.
 
Premodulated Current (Premod)
 
Premodulated Current, also referred to as “premod”, is similar to interferential current. The main difference is that with premod current, a single channel is used to mix the frequencies prior to before current reaches the patient. This makes it a good choice when treating smaller areas of the body like: elbows, ankles, feet, or hands.
 
Biphasic Current
 
"Biphasic" has two pulses of 2 different intensities. These alternate during treatment which makes it very versatile. Biphasic can be used for both acute and chronic problems for different goals including:
 
• Strengthening & re-educating muscles
• Improving blood circulation
• Decreasing edema & swelling
 
High Voltage
 
High Voltage electrical stimulation is a monophasic waveform which uses polarity (positive or negative) to stimulate the tissue. This is a popular modality to aid in decreasing pain and swelling, reducing muscle spasms and facilitating wound healing.
 
Microcurrent
 
Microcurrent is also used for wound healing, utilizing micro-size, pulsing current. Because of its low intensity, 
How Electrotherapy Can Be Used in Physical Therapy
 
Used alone or in conjunction with other modalities, such as therapeutic ultrasound, electrotherapy can be used in physical therapy to treat many diverse patient issues including:
 
• Sciatica
• Fibromyalgia
• Arthritis
• Bursitis
• Post-Surgical Pain & Swelling
• TMD
• Complications associated with Diabetes
• Tennis Elbow
• Carpal Tunnel Syndrome
 

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