Making Progress

Shortwave Diathermy

In health care, there’s no substitute for clinical skill, judgment and decision making. These essentials help you diagnose, manage and treat a host of patients. But sometimes, you need help to achieve treatment goals. In those cases, you can turn to modalities to jumpstart the healing process. The following is a brief primer on shortwave diathermy.

Shortwave diathermy uses high-frequency electric current to produce heat using either a condenser field or an induction field. The condenser field uses the patient’s tissues as the dielectric between two electrodes. With the induction field, the patient is in the electromagnetic field so that current flows between the patient’s conductive tissues.

Shortwave diathermy heats the tissue by causing oscillations of electromagnetic energy of high frequencies. With the changes in the new diathermy units, therapists can now provide treatment over pins and screws, prostheses and other noncircular metals. These areas were previously contraindicated.

Shortwave diathermy can reach deep tissue, a primary advantage of this modality. The diathermy head is approximately 25 times the size of an ultrasound head, thus allowing therapists to treat a large muscle group in less time.

Producing a variety of physiological changes, diathermy increases local metabolism and white blood cell concentration to the injured area. It also removes bacteria and toxins with increased cell membrane permeability, reduces muscle spasm and sedates nerve endings. In addition, it increases connective tissue elasticity, body temperature, respiratory and pulse rates and decreases blood pressure.

Diathermy is indicated for subacute and chronic inflammatory conditions of superficial joints, subacute and chronic traumatic muscle inflammation, indirect heating for peripheral vascular disease, contusions and post-surgery sites, sprains, strains, bursitis and tendinitis. It also can enhance epithelialization.

Very young and very old patients aren’t candidates for diathermy. Nor are those who are pregnant, have cardiac disease, a known cancer, an infection, an existing fever or a tendency to hemorrhage. Diathermy can’t be used over any metal that forms a circular pattern or has the same circumference as the diathermy coil. It also shouldn’t be used over the epiphyses of growing bones.

Therapists must remove electronic or magnetic equipment from the condenser field or induction field. Be careful with patients who are poor judges of heat, are obese and have sensory impairment. Avoid ischemic areas, open wounds or moist dressings, uneven spacing of the electrodes and uneven pressure of the electrodes.

Advance for Physical Therapists & PT Assistants

Making Progress: Modalities can jumpstart the healing process

By Danielle Montbriand, MPT, and Jessica F. Broussard, OTR/L

Ultrasound

In health care, there’s no substitute for clinical skill, judgment and decision making. These essentials help you diagnose, manage and treat a host of patients. But sometimes, you need help to achieve treatment goals. In those cases, you can turn to modalities to jumpstart the healing process. The following is a brief primer on ultrasound.

Ultrasound is a form of deep heat generated through a piezo-electric crystal soundhead. Sound waves cause vibration of the cells in the soft tissue, therefore increasing temperature and inducing vasodilatation. Ultrasound can separate collagen fibers, thereby increasing tissue extensibility, or it can increase membrane permeability, increasing ion exchange. Ultrasound waves can cause thermal and nonthermal effects.

As a thermal agent, this modality can increase the tissue temperature to depths of 5 cm or more. By increasing collagen tissue extensibility, it promotes circulation, relaxes tight muscles, changes nerve conduction velocity, reduces pain and decreases inflammation.

In rehabilitation, ultrasound serves many uses. For the patient with joint contracture, ultrasound can help raise tissue temperature. The combined effect of heat and stretch will promote greater tissue extensibility, thus increasing range of motion.

Ultrasound is indicated to treat soft tissue shortening (joint contractures, scarring); subacute and chronic inflammation; painful conditions, including muscle guarding; neuroma; trigger points and warts.

Ultrasound is contraindicated in people with poor arterial circulation. It can’t be used over an area with bleeding or infection, on someone who is pregnant or doesn’t know she’s pregnant, on someone who has known cancer, over the spinal cord after a laminectomy and over the carotid sinus or cervical ganglia.

Advance for Physical Therapists & PT Assistants

Making Progress: Modalities can jumpstart the healing process

By Danielle Montbriand, MPT, and Jessica F. Broussard, OTR/L

Electrical Stimulation

In health care, there’s no substitute for clinical skill, judgment and decision making. These essentials help you diagnose, manage and treat a host of patients. But sometimes, you need help to achieve treatment goals. In those cases, you can turn to modalities to jumpstart the healing process. The following is a brief primer on electrical stimulation.

Various types of electrical stimulation exist: microcurrents, interferential, Russian current, functional electrical stimulation, high-voltage pulsed stimulation and variable muscle stimulation.

Electrical stimulation uses electrical current to provide active exercise to muscles that are incapable of voluntary contraction. E-stim promotes blood flow to the muscle to maintain nutrition, slow the atrophy process, decrease fibrotic muscle changes and decrease muscle spasm.

In addition, it can strengthen healthy muscle, increase range of motion, promote circulation and provide proprioceptive input. For someone with upper trapezius tightness, e-stim can decrease muscle trigger points and increase circulation.

E-stim offers numerous advantages. The electrodes can be used multiple times, the intensity and type of current can be individualized, and treatment can be done in the clinic or at home with a home unit. Most insurance companies will pay for home units. On the flip side, an e-stim machine for the clinic can be expensive, and uninnervated muscles will atrophy over time.

Although many different modalities exist for treatment, familiarize yourself with studies of the latest findings to best serve your patients. This article merely touches on the indications, contraindications and precautions. To learn more, familiarize yourself with the literature on these modalities. This will help you choose the most effective method for your patients.

Advance for Physical Therapists & PT Assistants

Making Progress: Modalities can jumpstart the healing process

By Danielle Montbriand, MPT, and Jessica F. Broussard, OTR/L