PHYSIOTHERAPY METHODS

Dr.Sarthy.V. DNB (Ortho)

Asst Professor

Department of Orthopaedics

SSSMCRI

Will be introduced to:

Short Wave Diathermy :

SWD

Ultra Sound Therapy.

Inter Ferential Therapy :

IFT

Short Wave Diathermy : SWD

Principle• High frequency Electromagnetic energy.

SWD

Radio frequency vibration

Penetrates deep tissue

Molecular vibration

Thermal & Non thermal effects

Thermal Effects• Deep Heat• Increase Metabolism• Increase Extensibility• Muscle Relaxation• Modify Enzyme Reactions

Non Thermal Effects• Edema Reduction• Superficial wound healing• Heal venous stasis ulcers

types

Induction field

Capacitive field

Induction field

• Uses Coil & Drum.

• Places the patient in the electromagnetic field.

• Produces Eddy Current.

• Heat generated from friction.

Capacitive field

• Patients tissue is part of the circuit.

• tissue’s electrical resistance produces heat.

• Selectively heats Skin. . • Muscle heats up through conduction from Skin &

Adipose tissue.

precautions

• Heat produced directly related to the

tissue’s resistance.

• Adipose tissue / fat - provides

maximum resistance.

Mode of application

Continuous• Unsafe.

Pulsed• Allows prolonged use.• Allows more intensity to be used.

Therapeutic use

• Pain relief: Traumatic & Rheumatic.

• Relieves Spasm.

• Resolution of inflammation.

• Accelerate wound healing.

• Infection: • Increases circulation.• Brings in more WBCs.

• Increases Extensibility of Fibrous tissue.

contraindications

• Metal implants or metal jewelry

•Cardiac pacemakers

• •Ischemic areas

• •Peripheral vascular disease

• •Perspiration and moist dressings: The water collects and concentrates the heat.

• •Tendency to hemorrhage, including menstruation.

• •Pregnancy

• •Fever

contraindications

• Sensory loss

• •Cancer

• •Areas of particular sensitivity: • –Epiphyseal plates in children • –The genitals • –Sites of acute infection • –The abdomen with an implanted

intrauterine device (IUD) • –The eyes and face • –Application through the skull

Electrodes

Microwave diathermy

• Electromagnetic wave frequency range:

• Between:

• ShortWave & Infra Red.

Therapeutic ultrasound

• Mechanical waves in the form of sound energy.

• Normal sound range:• 16Hz – 20,000Hz

• Ultrasound frequency: > 20,000Hz.

• Therapeutic range:• 1.0 MHz – 3.0 MHz

(1MHz – 1 Million cycle / Second )

Mechanism of action

Ultra Sound Waves

Oscillation of Particles

Molecular Vibration

Thermal Reaction

Production of us waves

Crystals are exposed to alternating electrical current.

contract/expand/oscillate

Produce pressure waves

Ultra Sound Waves

indications

• To decrease pain & spasm.

• Increase collagen elasticity.

• Increase blood flow.

• Increase metabolic rate.

• Enhance tissue healing.

• Early organization of healing tissue.

precautions

• Anesthetic areas.

• Myositis Ossificans.

• Fibrotic myopathy.

• Implants: Plastic & Metallic.

• Carotid Sinus.

• Pregnant uterus.

contraindications

• Over heart.

• Over spinal cord.

• Epiphysis/Growth plate.

• Acute infection.

• Bleeding areas.

• Neoplasm.

• Thrombophlebitis.

Us - Frequency

• 1 MHz – Penetrate deeper tissue : 2-3 cm.

• 3 MHz – Heats superficial tissue : 0-3 cm.

Mode of application

Continuous• Thermal effect

Pulsed• Non Thermal effect.

Pulsed mode

• Pulse ratio determines the

concentration of energy.

• Acute conditions : Increased Pulse ratio.

• More Pause than Pass (1:3,1:4)

• Chronic Conditions : Decreased Pulse

Ratio.

• More Pass than Pause (1:1)

Interface reflection

• Temperature increase at tissue interfaces, due

to reflection.

• Always use low intensity over bony areas.

• Heating of the overlying periosteum very

painful.

• Maximum heat produced at a depth of 1cm.

mechanism

US waves

Unidirectional movement of fluid in the field.

Micro massage.

Increased Cell Diffusion & Permeability & Increase Calcium ion transport.

More rapid recruitment of endothelial cells & fibroblasts – help in healing.

INTERFERENTIAL THERAPY (IFT)

introduction

• Widely used electrotherapy modality

• Developed by Dr. Hans Nemec of Vienna in Australia 1950s

• Utilizes the therapeutic aspects of low frequency currents without the discomfort.

principle

Transcutaneous uses of two or three alternating medium frequency (2000 to 5000Hz) sinusoidal current

Introduce low frequency (1 to 250Hz) current

Stimulate sensory and motor nerves

principle

Depolarizes Sensory & Motor

Nerve Fibers

Why ift ?

• Low skin resistance.

• More comfortable.

• More tolerable.

• Deep penetration.

• Larger area.

Mode of application

2 Poles(Bipolar) 4 Poles

Stereodynamic

3D

Static Static Dynamic

Ovalfield

Clover leaffield

Circularfield

Smaller areas:AnkleElbow

Acute Conditions:Milder effect.

Larger areas:Diffuse pain..

ShoulderBackThigh

Duration of application

• 10 to 30 minutes.

• 12 to 24 sittings.

• NEVER FOR MORE THAN 30 minutes.

disadvantages

• Eliminates pain but not its cause.

• Not easily portable.

• Expensive.

Clinical effect

• Pain relief.

• Muscle Stimulation.

• Increased local blood flow.

• Decreases edema.

Pain alleviation

• Stimulation of Reticular formation in the

brain via the sensory nerve endings.

• Block “C “ fiber transmission (Gate

Control).

Edema reduction

• Ion vibration.

• Ion diffusion.

• Increased Permeability.

• Increased venous & lymphatic drainage.

Marked use

• Complex Regional Pain Syndrome.

• Stump Pain.

• Herpes Zoster.

• Vascular Insufficiency.

• Myofascial pain syndromes.

• Muscle re-education for patients with urinary incontinence.

Not of use

•In acute post traumatic pain.

contraindications

• Arterial/venous Thrombi.

• Infected areas.

• Cranium.

• Pregnant Uterus.

• Hemorrhagic areas.

• Malignancy.

• Implants : plastic & metallic.

• Unreliable Patients.

dangers

BURNS• Metal electrode over skin.• Increased intensity.• Insufficient Moisture pads.

ECCHYMOSES/HEMATOMA• Suction from the negative pressure

created.

Poor results

• Improper electrode placement.

• Incorrect choice of frequency.

• Incorrect balancing of the frequencies.

Thank you