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We having been providing physiotherapy for the people of Gachibowli / Kondapur / Indra Nagar / Telecom Nagar / Anjiah Nagar / Ramky / L&T / NCC / APHB Colony since 2011.


 

Electrical stimulation for pain control was used in ancient Rome, 63 A.D. It was reported by ScriboniusLargus that pain was relieved by standing on an electrical fish at the seashore. From the 16th to 18th centuries various electrostatic devices were used for headaches and other pains, even Benjamin Franklin was a supporter of this method for pain relief.


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.  I’m going to discuss two different forms of it today, TENS (transcutaneous electrical nerve stimulation) and Interferential therapy.

Gachibowli Physiotherapy
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?
TENS can work in two ways:
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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, sometimes called “conventional”, 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, sometimes called “acupuncture-like”, 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 users should experiment 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. TENS users need to try the unit for several days with several electrode placements prior to deciding if it will be useful. A home trial for several days to weeks is preferable.


Interferential Therapy
Here at Gachibowli Physiotherapy Clinic, 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

 

Stimulating Soft Tissue Healing & Repair
In acute conditions, shorter treatment times of 5-10 minutes may be sufficient to achieve the effect. In other circumstances, it may be necessary to stimulate the tissues for 20-30 minutes. It is suggested that short treatment times are initially adopted especially with the acute case.


Electrotherapy is used as an adjunct to traditional physiotherapy treatments.  Many of our physiotherapists will recommend the use ofElectrotherapy in the provision of their treatments.

 

ULTRASOUND THERAPY

Ultrasound therapy is just about the most popular of the Electrophysical agents (EPA's), though strictly speaking, it is not 'electrotherapy' even though it is widely referred to as an electrotherapy modality. 

 

Tissue Repair Phases and Timescal

 

INFLAMMATION:
During the inflammatory phase, US has a stimulating effect on the mast cells, platelets, white cells with phagocytic roles and the macrophages (Nussbaum 1997, terHaar 1999, Fyfe &Cahal 1982, Maxwell 1992, Watson 2008; Li et al 2003). For example, the application of ultrasound induces the degranulation of mast cells, causing the release of arachidonic acid which itself is a precursor for the synthesis of prostaglandins and leukotreine – which act as inflammatory mediators (Mortimer & Dyson 1988, Nussbaum 1997, Leung et al 2004). By increasing the activity of these cells, the overall influence of therapeutic US is certainly pro-inflammatory rather than anti-inflammatory.

 

The benefit of this mode of action is not to ‘increase’ the inflammatory response as such (though if applied with too greater intensity at this stage, it is a possible outcome (Ciccone et al 1991), but rather to act as an ‘inflammatory optimiser’ (Watson 2007, 2008). The inflammatory response is essential to the effective repair of tissue, and the more efficiently the process can complete, the more effectively the tissue can progress to the next phase (proliferation).

 

ultrasound in proliferation

 

LIPUS (Low Intensity Pulsed Ultrasound) for Fracture Repair – there is a wealth of research information in this area (summarised on a separate page  if you want the detail). The NICE guidelines (Jan 2013) are supportive of this clinical application. Essentially, the application of very low dose ultrasound over a fracture (whether healing normally or delayed or non union) can be of significant benefit.