Mark Kroeger Burnaby Physiotherapy Clinic uses the following modalities to stimulate tissue healing, reduce swelling and pain, and restore normal muscle function.
Ultrasound treatments are used in the management of soft tissue injuries. Sound energy causes molecular vibration; this mechanical energy turns into heat energy. Ultrasound is generally painless and is applied to the skin through a metal sound head containing a quartz crystal. A coupling gel is applied to the skin to allow an efficient transfer of the ultrasound into your soft tissues. There is usually no medicine in this coupling agent however on occasion anti-inflammatory or analgesics may be used and the ultrasound is used to help deliver the medicine into your underlying tissues.
Ultrasound therapy uses high-frequency sound waves usually 1 or 3 megahertz (frequencies well above our hearing range of 20 to 20,000 hertz.) The lower frequencies provide deeper penetration of the ultrasound waves. The sound waves cause molecules in the tissues to vibrate, producing heat and mechanical energy. If you observe the action of the sound waves in water you will see the vibration or wave action created in the water. This same wave action or cellular massage is what is transferred into your tissues during an ultrasound treatment. Ultrasound is used to treat tissues such as muscles, tendons, ligaments, joint capsules and bone.
Effects of Ultrasound may include:
- Increased circulation and metabolism
- Breaking up and softening scar tissue, preventing development of adhesions
- Reducing inflammation or swelling
- Diminishing and relaxing muscle spasm
- Relieving acute and chronic pain
- Enhancement of the natural healing processes
Ultrasound is a safe therapy when applied properly however caution is necessary for conditions such as:
- Cancerous tumors
- Paget’s disease
- Near pacemakers
- Near metal implants such as joint replacements
- Patients with impaired sensation
- Near bone growth plates
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation is one of the most commonly used forms of electroanalgesia.
Transcutaneous electrical nerve stimulation, more commonly referred to as the acronym TENS, is the application of electrical current through the skin for pain control. The TENS unit is a pocket size, portable, battery-operated device that sends electrical impulses to the skin via two or more electrodes. The electrodes are attached to the surface of the skin over or near the area where you are experiencing pain. Other locations such as over cutaneous nerves, trigger points, or acupuncture sites may also be used.
The goal of these tingling electrical impulses is to block pain signals and to stimulate the release of naturally produced pain killers such as endorphins. TENS is usually applied at high frequency (>50 Hz) primarily stimulating cutaneous (skin) nerves or and less frequently used at lower frequencies (<10 Hz) with an intensity that produces motor contraction.
Some patients will experience pain relief from a TENS treatment that may last for several hours. The pain relief provided from a TENS unit may help reduce the amount of pain medications required.
The cost of a TENS unit can range from about $100 to several hundred dollars. TENS units can be purchased for home use and some patients will hook the unit onto a belt and turn it on and off as needed throughout the day.
TENS is a non-invasive, very safe method to reduce both acute and chronic pain.
The use of TENS is contraindicated in patients with pacemakers.
Interferential Current (IFC)
The interferential current machine is commonly used amongst Physiotherapists. It is similar to the TENS machine in that it transmits electrical currents but does so at a higher concentration or higher frequency (4000 Hz) waveform. This technique enables the electrical current to penetrate deep in tissues, comfortably. It acts on the same principle as the TENS machine and can stimulate muscular contractions and cutaneous nerves.
The electrical current is applied to the affected area using four electrodes. In some situations, the Therapist may choose to include a massaging suction effect to the electrodes. The four electrodes deliver two currents into the tissues. Where the two currents meet, they actually ‘interfere’ with each other hence the name ‘interferential.’ These interfering currents allow the delivery of a relatively high stimulus to the underlying tissues in a comfortable manner.
During treatment the patient will feel a tingling or ‘pins and needles’ sensation and often also muscular contractions. This sensation may continue for a brief period following treatment as well.
The electrical stimulation of the patient’s tissues results in a number of physiological effects that have therapeutic value such as reducing pain by blocking the transmission of the pain signals (pain gate mechanism) or by stimulating the release of pain reducing endorphins, reducing swelling, improving circulation, and muscle relaxation.
Electrical Muscle Stimulation (EMS)
Electrical Muscle Stimulation (EMS) is the elicitation of muscle contraction using electric impulses. The impulses are generated by a pocket size device and delivered through electrodes on the skin in direct proximity to the muscles to be stimulated. EMS is both a form of electrotherapy and of muscle training. It is used primarily to aid in:
- Diminishing of muscle spasms
- Help minimize muscular atrophy
- Muscle re-education
- Increasing local blood circulation
- Maintaining or increasing muscle flexibility and joint range of motion
Shortwave Diathermy (SWD)
Shortwave Diathermy is a form of Electrotherapy used primarily to heat and improve circulation deep within patients’ tissues. The prefix ‘Dia” means through and “therm” refers to heat. Diathermy means “through heating”, or producing heat deep within the patient’s tissues. The heat is produced deep within the tissues and not transferred through the skin. This allows an efficient warming of deeper tissues without overheating the surface of the skin. It produces heat deep within the tissues as well as superficially.
Electrical fields produced by the Shortwave Diathermy machine oscillate at a frequency of 27.12 KHz and have a wavelength of 11.06 metres. This oscillating radio frequency electromagnetic energy produces distortion of molecules, rotation of dipoles and vibration of ions which in turn causes heating of the tissues.
Local tissue effects occur due to the elevated local temperature. Some of these include:
Increased blood flow, capillary dilation and capillary permeability
Increased metabolism and transfer of nutritional ingredients
Promoting enhanced enzymatic activity and healing
Increased elasticity of connective tissue
Reduced muscle spasm
Sedation of the nerve endings to reduce pain
Improved range of motion (ROM)
- Pace Makers
- Metal implants
- Malignant cancer
- Open wounds or skin lesions
- Acute infections/fever
Shortwave Diathermy Benefits
Shorwave Diathermy is used in our clinic primarily for treating painful osteoarthritic hips and knees. However it may also be used to treat a variety of other subacute or chronic musculoskeletal conditions.