THERAUPEUTIC TECHNOLOGY

PHYSIOTHERAPY
TRAINING

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Contents
Introduction
Principle
Application
Operation
Maintenance & Cleaning
Safety Precautions
Troubleshooting

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Introduction
Diathermy is a therapeutic treatment commonly prescribed
for muscular and joint associated pains.
The term ‘diathermy’ means ‘through heating’ or producing
deep heating directly in the tissues of the body.

‘ Dia’ through (also means two)

‘thermy’ heat or temperature

It simulates the circulation, relieve pain, enhances rate of

recovery of healing the tissue

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PRINCIPLE OF DIATHERMY
 Before injury, the dipole molecules of the body tissue are
arranged on the basis of polarity .
 When the tissue is damaged the dipoles distribution
become irregular and deviates from polarity based
arrangement .
 Under the influence of an electric field , they rotate
according to the polarity of their charge in the direction
of the field lines and get rearranged and tends to acquire
its previous stage of polarity.

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HEAT AND TISSUE INTERACTION

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DIATHERMY
Diathermy uses an electric current to produce heat
deep inside a targeted tissue. It can reach areas as
deep as two inches from the skin’s surface.
The diathermy machine does not apply heat directly
to the body. Instead, the current from the machine
allows the body to generate heat from within the
targeted tissue.
As the heat increases, it promotes blood flow. It can
also help improve flexibility in stiff joints and
connective tissue.

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BENEFITS OF DIATHERMY
 Intense heat delivered
provides pain

 relief and better flexibility

 Reduces inflammation

 Improves circulation

 Accelerate healing

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ELECTRICAL STIMULATION

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Application of suitably modified electric current to
stimulate excitable tissues like nerves and muscles
to produce therapeutic benefits

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ELECTRIC CURRENT
Flow of electric charge
Two types: direct current and alternating current

Direct current (DC) : the unidirectional flow of

electric charge.
Alternating current(AC) : flow of electric charge
periodically in reverses direction

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FARADIC CURRENT

Interrupted direct current

Pulse duration- (0.1 – 1 ms )
Frequency (50 – 100 Hz)
Surged form of current is used

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PHYSIOLOGICAL EFFECTS OF FADADIC
CURRENT
Sensory nerve stimulation
Motor nerve stimulation; stimulation with 50 Hz
frequency and 0.1 – 1ms with surged current
Effect on muscle contraction:
Effect on denervated muscles

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Produces chemical changes in electrodes
Current flow in one direction for short periods
No serious danger of burns

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STIMULATION OF MOTOR POINTS
Superficial location of
motor nerve
Usually located at upper
and middle one-third of
belly of muscles
Suitable frequency and
duration is used

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INDICATIONS OF FARADIC CURRENT
Facilitation of muscle contraction
Re – education of muscle action
Training of new muscle action
Neuropraxia of a motor nerve
Severed motor nerve
Improved venous and lymphatic drainage
Prevention and loosening of adhesions

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INTERRUPTED DIRECT
CURRENT

Frequency of 30 Hz
Duration 100 ms
Applied through a potentiometer

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Stimulation of denervated muscles
Stimulation of sensory nerves
Stimulation of motor nerves

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INDICATIONS
To produce contractions of denervated muscles
Re –education of muscles in early phase of re-
innervation

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As electricity moves through the body's conductive
medium, changes in the physiologic functioning can
occur at various levels
Cellular
Tissue
Segmental
Systematic

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Excitation of nerve cells
Changes in cell membrane permeability
Stimulation of fibroblast, osteoblast
Modification of microcirculation

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Skeletal muscle contraction
Smooth muscle contraction
Tissue regeneration

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EFFECTS AT SEGMENTAL LEVEL
Modification of joint mobility
Muscle pumping action to change circulation and
lymphatic activity
Alteration of the microvascular system not associated
with muscle pumping
Increased movement of charged proteins into the
lymphatic channels

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Analgesic effects as endogenous pain suppressors are
released and act at different levels to control pain
Analgesic effects from the stimulation of certain
neurotransmitters to control neural activity in the
presence of pain stimuli

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Purpose
– Completes the circuit
– Interface between
electron and ion flow
– resistance to current

 Materials
– Metallic
– Carbon rubber
– Self-adhesive
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ELECTRODE PLACEMENT
Electrodes spaced far apart penetrate more deeply
with less current density
Larger the electrode the less density
A multitude of placement techniques may be used to
create desire able clinical and physiological effects

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Neuromuscular electrical stimulation(NMES)
Functional electrical stimulation(FES)
Transcutaneous electrical nerve
stimulation(TENS)
Interferential therapy unit

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NMES applies electrical impulses to the nervous
system to
stimulate sensory and/or motor neurons
Common Uses
Relaxation of muscle spasms
Prevention or retardation of disuse atrophy
Improvement of local blood circulation
Re-education of the muscle

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Technique that used electric currents to activate nerves
innervating extremities affected by paralysis and
neurological disabilities to restore normal functions

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Functional electrical stimulation (FES) is a
technique that uses low energy electrical pulses to
artificially generate body movements in individuals
who have been paralyzed due to injury to the
central nervous system

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Stimulate muscles in a
programmed synergystic sequence
that allow patient to accomplish a
specific functional movement
pattern

Multichannel microprocessors are

pre-programmed to execute
variety of specific movement

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USES
Prevent or correct diffuse atrophy
Improve ROM in stiff joints and spasticity
Re- education of new muscle action in muscle and
tendon transfers
Supplementation or substitution of orthosis

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Frequency-(12-100Hz)
Intensity of current-(90-200)mA
Pulse duration(20-300)msec

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STRENGTH- DURATION CURVE

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Electrical stimulation which primarily aims to provide a
degree of symptomatic pain relief by exciting sensory
nerves

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General Concepts:
An Approach to pain control
Trancutaneous Electrical Nerve Stimulation:
Any stimulation in which a current is applied across the
skin to stimulate nerves
1965 Gate Control Theory created a great popularity of
TENS
TENS has 50-80% efficacy rate
TENS stimulates afferent sensory fibers to elicit
production of neurohumneral substances such as
endorphins, enkephalins and serotonin (i.e. gate theory)
MECHANISM OF TENS
Gate Control Theory(Malzack and Wall)

Activation of peripheral sensory Aβ fibers stimulates

the inhibitory interneuron in substansia gelatinosa in
dorsal horns of the spinal cord

Activated interneurons produces inhibition of pain

carrying A-delta and C fibres and closes spinal pain gate
to prevent painful impulse to reach at sensory cortex

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DESCENDING PAIN CONTROL
Stimulation of smaller peripheral Aδ and C fibers
through the CNS causes a release of enkephalins
blocking pain at the spinal cord

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ENDOGENOUS OPIATE PAIN CONTROL

Noxious stimulus causes release of β–endorphins and

dynorphin resulting in analgesia

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TYPES OF TENS
High TENS (Sensory Level)
o Duration (100-500 μsec)
o Frequency (100-150Hz)
o Sensory-level output
o Activates spinal gate

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LOW TENS
Duration (100 to 150 μsec)
Low pulse frequency (1 to 5 Hz)
Motor-level output
Modulation through release of β-endorphin

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Acute and chronic pain,
Back and cervical muscular and disc syndromes,
Arthritis
Shoulder syndromes
Neuropathies
Many other painful conditions

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ELECTRODE PLACEMENT

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Two medium frequency currents pass through the
tissues simultaneously
Their paths cross; and interfere with each other
Gives an interference or beat frequency which has
low frequency stimulation

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Low frequency stimulation of muscle and nerve tissues
at sufficient depth without painful and side effects
Medium frequency currents penetrate the tissues with
little resistance, but the resulting interference current
allows effective stimulation of the biological tissues

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CONTRAINDICATIONS
Undiagnosed pain
Pacemakers
Heart disease
Epilepsy
Pregnancy: first trimester-over the uterus
Over the carotid sinus
On broken skin
On dysaesthetic skin
Over the eyes, larynx, pharynx, over mucosal
membranes
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Questions!!!

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The concept of producing heat deep within the tissues,
beyond the reach of infrared and other forms of
superficial heat is appreciated by physical therapists.
Currents with oscillations greater than 1000 Hz
(cycles / second) are termed high-frequency currents.
Generally, this type of currents used to generate heat,
is in the megacycle range. Most commonly utilized
high-frequency currents are found with:
*Short wave diathermy.
* Microwave diathermy

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Diathermy
Application of High-Frequency Electromagnetic
Energy
Used To Generate Heat In Body Tissues
Heat Produced By Resistance of Tissues
Also Used For Non-Thermal Effects

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Physiologic Responses To
Diathermy
Not Capable of Producing Depolarization and
Contraction of Muscles
Wavelengths Too Short

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Physiologic Responses To
Diathermy
Physiologic Effects Are Those of Heat In General
Tissue Temperature Increase
Increased Blood Flow (Vasodilation)
Increased Venous and Lymphatic Flow
Increased Metabolism
Changes In Physical Properties of Tissues
Muscle Relaxation
Analgesia

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Diathermy Heating
Doses Are Not Precisely Controlled Thus The
Amount of Heating Cannot Be Accurately Measured
Heating= Current2 X Resistance

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Non-Thermal Effects
Pulsed SWD Used To Treat Soft Tissue Injuries and
Wounds
Related To Depolarization of Damaged Cells
Loss of Cell Division
Loss of Proliferation
Loss of Regenerative capabilities
Repolarization Corrects Cell Dysfunction

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Shortwave Diathermy
Radio Transmitter With FCC Assigned Frequencies
27.12 MHz at 11 M
13.56 MHz at 22 M
40.68 MHz at 7.5 M

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Shortwave Diathermy Unit
Power Supply Powers Radio Frequency Oscillator
(RFO)
RFO Provides Stable Drift-Free Oscillations at Given
Frequency
Power Amplifier Generate Power To Drive Electrodes
Output Resonant Tank Tunes In The Patient for
Maximum Power Transfer

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PRINCIPLES
It is not possible to produce high frequency currents
by some mechanical device which produces sufficient
rapid movements.
This type of current can only be produced by
discharging a condenser through an inductance of
low ohmic resistance.
If a current of very high frequency is required, the
capacitance and inductance should be small.
If a current of low frequency is required the
capacitance and inductance should be large.

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CONSTRUCTION
The system consists of two circuits:

 The machine circuits

 The patient circuit

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THE MACHINE CIRCUIT
It consist of two transformers, whose primary coil are
connected to source of AC.
One is step-down transformer and its secondary coil
supplies current to the filament heating circuit of triode
valve.
The other is set-up transformer and connected to anode
circuit. Anode circuit carries the current produced by valve.
Here it consists of triode valve and oscillator circuit.
Oscillator circuit consists of condenser and inductor or
oscillator coil.

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Current of different frequencies are obtained by
selecting suitable condensers and inductances.
To produce a current of high frequency the
capacitances and inductance used must be small and
is made to charge and discharge repeatedly and for
obtaining this an Oscillator is incorporated in to
machine circuit along with valve circuit.
Another coil AB lie close to oscillator coil and had
one end connected to the grid of the valve and other
through grid leak resistance to the filament.

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THE PATIENT CIRCUIT
Also known as resonator circuit.
It‘s a coupled to machine circuit by a inductor coil lying
close to oscillator coil and also consist variable condenser
which is usually in parallel to patient terminal.
A matching high frequency current is produced in the
resonator circuit by electro magnetic induction.
For this to happen the oscillator and resonator circuit
must be in resonance with each other, Which requires
that the product of inductance and capacitance must be
the same for both circuits.

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WORKING

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The electrons flows to filament through anode valve,
through oscillator coil in direction C and D and to
transformer back to filament.
The electron form in CD will induce EMF in coil AB in
direction that electrons will move to grid of valve making it
negative thus blocking the flow of electrons from filament.
This will lead to dying of current in anode circuit.
This reduction in current will lead to self-induced EMF.
According to Lenz law, this EMF will try to prevent fall in
current by offering resistance to flow of current

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This will charge condenser X(positive) and Y(negative)
polarity opposite to earlier one.
Now when self-induced EMF totally dies away, condensers
again discharges through oscillator coil, but in opposite
direction(D to C).
Flow of current from D to C induce an EMF in AB such
that electrons move from A to B and grid loses its negative
charge and anode current flows again.
This sequence continues and each time condenser charges
and discharges through oscillator circuit leading to
production of high frequency current(SWD).

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Shortwave Diathermy Unit

A=Power Switch
B=Timer
C=Power Meter(monitors current from power supply not current entering patient-
volume control)
D=Output Intensity(%max power to patient)
E=Tuning Control(tunes output from RFO)

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Shortwave Diathermy Unit
Power Output Should Provide Energy To Raise
Tissue Temp To Therapeutic Range (40-45 deg C)
(80-120 watts)
Should Exceed SAR-Specific Absorption Rate (rate of
energy absorbed /unit area of tissue mass)

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Adjusting SWD Unit
Manual vs Automatic Tuning
Manual Tuning (adjusts patient circuit)
Set Output Intensity at 30-40%
Adjust Tuning Control Until Power Output Meter
Reaches Max
Then Adjust Down to Patient Tolerance Which Is
About 50%
If More Than 50% Patient Is Out of Resonance

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Shortwave Diathermy Unit
Generates Both an Electrical and a Magnetic Field
Ratio Depends on Characteristics of Both The
Generator and the Electrodes
SWD Units at 13.56 MHz= Stronger Magnetic Field
SWD Units at27.12 MHz = Stronger Electrical Field

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SWD Electrodes
Capacitor Electrodes
Inductor Electrodes
Selection of Appropriate Electrodes Can Influence
The Treatment

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Capacitor Electrodes
Create Stronger Electrical Field Than Magnetic
Field
Ions Will Be Attracted Or Repelled Depending
on the Charge of the Pole

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Capacitor Electrodes
Electrical Field Is The
Lines of Force Exerted on
Charged Ions That Cause
Movement From One Pole
To Another
Center Has Higher
Current Density Than
Periphery

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Capacitor Electrodes
 Patient Is Between
Electrodes and Becomes
Part of Circuit
 Tissue Is Between
Electrodes in a Series
Circuit Arrangement

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Electrical Field
The Tissue That Offers The Greatest Resistance To
Current Flow Develops The Most Heat
Fat Tissue Resists Current Flow
Thus Fat Is Heated In An Electrical Field
Typical With Capacitor Electrodes

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Capacitor Electrodes
(Air Space Plates)
Two Metal Plates
Surrounded By Plastic Guard
Can Be Moved 3cm Within
Guard
Produce High-Frequency
Oscillating Current
When Overheated
Discharges To Plate Of
Lower Potential
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Air Space Plate Electrodes
Area To Be Treated
Is Placed Between
Electrodes Becoming
Part of Circuit

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Air Space Place Electrodes

Sensation Of Heat In Direct Proportion To Distance

Of Electrode From Skin
Closer Plate Generates More Surface Heat
Parts Of Body Low In Subcutaneous Fat Best Treated

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Capacitor Electrodes
(Pad Electrodes)
Greater Electrical Field
Patient Part of Circuit
Must Have Uniform
Contact (toweling)
Spacing Equal To Cross-
sectional Diameter of
Pads
Part To Be Treated
Should Be Centered
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Pad Electrodes
Increasing The
Spacing Will Increase
The Depth Of
Penetration But Will
Decrease The
Current Density

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Induction Electrodes
Creates A Stronger Magnetic Field Than Electrical
Field
A Cable Or Coil Is Wrapped Circumferentially
Around An Extremity Or Coiled Within n Electrode

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Induction Electrodes

Passing Current Through A Coiled Cable

Creates A Magnetic Field By Inducing Eddy
Currents (small circular electrical fields) That
Generate Heat

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Induction Electrodes
Patient In A Magnetic Field Not Part Of A Circuit
Tissues In A Parallel Arrangement
Greatest Current Flow Through Tissue With Least
Resistance
Tissue High In Electrolytic Content Respond Best To
A Magnetic Field

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Induction Electrodes
(Cable Electrode)
Two Arrangements:
Pancake Coils
Wraparound Coils
Toweling Is Essential
Pancake Coil Must
Have 6” in Center
Then 5-10cm Spacing
Between Turns

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Induction Electrodes
(Drum Electrode)
One Or More
Monopolar Coils
Rigidly Fixed In A
Housing Unit
May Use More Than
One Drum
Depending On Area
Treated
Toweling Important

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Heating With Continuous SWD
Patient Sensation Provides Basis For
Recommendations Of Continuous SWD
Dose I
(Lowest) - No Sensation of Heat Dose II(Low) -
Mild Heating Sensation Dose III(Medium)-
Moderate or Pleasant
Heating Sensation Dose IV(Heavy)-Vigorous
Heating Within Pain Threshold

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Pulsed SWD
Referred To By Different Names
Pulsed Electromagnetic Energy (PEME)
Pulsed Electromagnetic Field (PEMF)
Pulsed Electromagnetic Energy Treatment (PEMET)

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Pulsed SWD

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Pulsed SWD
Interrupted Output Delivered In Series Of High-
Frequency Bursts (20-400usec)
Pulse Rate Selected With Pulse Frequency Control
Off-Time Longer Than On-Time
Low Mean Power Output
Uses Drum Electrode

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Shortwave Diathermy
vs.Ultrasound

 Pulsed SWD Produces The Same Magnitude And Depth Of

Muscle Heating as 1MHz Ultrasound (Draper, JAT 1997)
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Treatment Time
Most Typically SWD Treatments Last For 20-30
Minutes
Remember As Skin Temperature Rises Resistance
Falls

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Questions!!!

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Microwave Diathermy
Two Assigned Frequencies-2456 MHz and 915 MHz
MWD Has Higher Frequency and Shorter
Wavelength Than SWD
Generates Strong Electrical Field and Relatively Little
Magnetic Field
Depth Of Penetration Is Minimal In Areas With
Subcutaneous Fat > 1 cm

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Frequency and wavelength
Microwave has a much higher frequency and a
shorter wavelength than shortwave diathermy.
The general frequency of microwave is between 300
MHz to 300 GHz with wave length of 10 mm to 1
meter.
The therapeutic microwave generators used
frequency of 2450MHz with wave length of 122.5mm.

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Properties of Microwaves
Microwave diathermy (MWD), is a form of
electromagnetic radiations lying between shortwave
and infrared waves.
Microwave diathermy does not penetrate as deep as
shortwave diathermy.
The energy is first absorbed at the surface of the body
(skin) and a part of it penetrate and absorbed in deep
tissues.
It generates Strong Electrical Field and relatively
Little Magnetic Field

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Microwave Production and Device
The generator used to produce microwaves has three
main components:
1- A multi-cavity magnetron valve
2- A coaxial cable
3- A director.

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Mechanism of MW production
The magnetron produces a high frequency alternating
current which is carried by coaxial cable to the
transducer (director).
The coaxial cable transmits the energy to the director
whereas a radiating system comprising an antenna
within a reflector that is used to direct the microwave
to the patient

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The alternating current in the antenna produces an
electromagnetic field that is directed toward the tissue
by a curved reflecting director surrounding the
antenna.
The presence of a director and the short wavelength
of microwave radiation allow this type of diathermy to
be focused and applied to small, defined areas.
Therefore these devices can be useful during
rehabilitation when only small areas of tissue are
involved.
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Directors Used in Microwave
Applications
Circular directors
- The heating pattern is more
intense around the outer
portion than the centre.
There are small and large

Rectangular directors
The heating pattern tends to
be more concentrated in the
center of the treated area.

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Biophysics of MWD
MWD tend to be reflected and scattered at different
interfaces as air-skin, skin-fat, and the fat-muscle
which limit its penetration into the tissues.
Because of the spreading of MW, the superficial
tissues tend to be heated more than deeper tissues.
Depth of penetration depends on the frequency of the
wave and the medium. The effective penetration of
2450MHz is approximately 3 cm.
Mechanism of heat production by MWD is the same
as SWD

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Microwave Diathermy Unit

A= Power Switch

B=Timer
C=Output Meter (indicates relative output in watts
D= Power Output Level Knob
E= Amber Light-Warming up / Red Light- Ready

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MWD Applicators
(Electrodes)

Circular Shaped Applicators

4” or 6”
Maximum Temperature At Periphery
Rectangular Shaped Applicators
4.5 x 5” or 5 x 21”
Maximum Temperature At Center

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Microwave Applicator Set-Up
Microwave Applicator Beams Energy To Patient
Must Pay Attention To Cosine Law
In 915 MHz Units Applicators Placed 1 cm From Skin
2456 MHz Units Have Manufacturer Recommended
Distances and Power Outputs (Uses Antenna)

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Therapeutic Effects of Microwave
Diathermy
 Pain: MWD is useful in the treatment of traumatic
and rheumatic conditions affecting superficial
muscles, ligaments and small superficial joints.
Muscle spasm: which may be reduced directly by
MWD or may be reduced by relieving of pain.
Inflammation: MWD reduces inflammation by
increase blood supply that will increase venous return
from the inflamed area and aids the reabsorption of
edema exudates.

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ULTRASOUND DIATHERMY
Ultrasound diathermy uses sound waves to treat
deep tissues.

Heat is generated by the vibration of the tissue.

This promotes blood flow into the area.

It is used for many types of musculoskeletal

sprains, strains, and fractures.

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INFRARED Therapy
Infrared radiations are part of an electromagnetic spectrum,
with wavelength of 750nm-1mm, and frequency of 4x1014 and
7.4x 1011, and located between microwave and visible light.
Infrared is superficial Heating modality (penetration depth 1-
10mm).

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Source of Infrared

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IR- Generator
Non-Luminous and Luminous
Non-Luminous:
A coil of wire wound on a cylinder of some insulating
material. Electric current passes through wire and
produces Heat.
IRR emitted by hot wire.
It produces IRR and Some visible rays.
This kind of lamps required sometime to warmup,
the lamp may take up to 15 mins to reach maximum
emission

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Luminous(Visible) generator
Luminous generator are produced by INCANDESCENT
LAMPS.
This lamps consists of a TUNGSTEN FILAMENT
which contain INERT GAS AT LOW PRESSURE.
Inside of glass is silvered to provide reflection. When
you pun on lamp it produces visible light, IR and
few UVR.
The radiation extends from FAR IR to UVR.
Out side of glass is reddened, to absorb green and
blue rays. Human skin absorbs 95% of energy if it is
perpendicular to surface.
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Physiological Effects of IRR
INCREASE
Local temperature superficially
Local metabolism
Capillary permeability and bloodflow
Lymphatic and venous drainage
Vasodilatation of arterioles andcapillaries
Leukocytes& phagocytes activity
Axon reflex activity
Stimulation of sensory nerve

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Therapeutic Effects and Uses
1. Relief of pain & muscle spasm.

 Mild heating has a 'sedatory' effect on sensory nerves

used for the relief of acute pain.
 Strong heating has a ‘counter irritant' effect on sensory
nerves endings and used for the relief of chronic pain.

2. Joint stiffness: viscosity decrease, increase collagen

extensibility
3. Skin lesion: psoriasis

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Prior to other Treatments: (e.g. stretching,
mobilization, traction, massage, exercise therapy,
electrical stimulation, and biofeedback).

5. Increased blood flow and circulation (e.g. reduce

chronic edema)
6. Muscles relaxation
7. Increase healing of tissue (no more recommended)

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When Should Diathermy
Be Used?

 If

If The
The Skin
Skin Or
Or Some
Some Underlying
Underlying Soft
Soft
Tissue
Tissue Is
Is Tender
Tender And
And Will
Will Not
Not Tolerate
Tolerate
Pressure
Pressure
 In

In Areas
Areas Where
Where Subcutaneous
Subcutaneous FatFat Is
Is Thick
Thick
And
And Deep
Deep Heating
Heating Is
Is Required
Required

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When Should Diathermy
Be Used?

 When

When The
The Treatment
Treatment Goal
Goal Is
Is To
To Increase
Increase
Tissue
Tissue Temperatures
Temperatures In
In A
A Large
Large Area
Area

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Questions!!!

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THANK YOU

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