Definition and subdivisions of physical therapy, theoretical background of electrotherapy , low frequency treatments, galvanic current therapy, special Galvanic treatments and iontophoresis

Low frequency electrotherapy (<1000Hz)

 Galvanic currents
 Stimulatory currents
 Iontophoresis
 Diadynamic currents
 Hydrogalvanic bath
 TENS

Middle Frequency Electrotherapy (1000-100.000Hz)

Interferential current therapy

High Frequency Electrotherapy (>100.000Hz)

 Microwaves-therapy
 Decimeter-waves
 Short-waves

Biological effects of electrotherapy

1. Pain management
2. Treatment of neuromuscular dysfunction
3. Improves range of joint mobility
4. Tissue repair
5. Acute and chronic edema
6. Peripheral blood flow
7. Urine and fecal incontinence

Dose depends on

Intensity of the energy
Treatment time
Distance between the device and the patient (in therapies using radiation).

Arndt–Schulz rule

For every substance, small doses stimulate, moderate doses inhibit, large doses kill.

Effects of electric current

A. Heating (always occurs)
B. Chemical (electrolysis)
C. Magnetic (always occurs)
D. Light (semiconductors and gases)
E. Physiological ( complex)

When electrotherapy goes wrong

1. Electrolysis
2. Burns
3. Muscle cramps
4. Respiratory arrest
5. Cardiac arrest
6. Ventricular fibrillation

Electrolysis

The movement of ions of opposite polarities in opposite directions through a medium

DC current through body tissues or fluids → ulceration →necrosis

Prevention: using wet pad around the electrode, maximum treatment time

Warnings

No Electrotherapy can be applied to a patient with PACEMAKER, or METAL IMPLANT!

Galvanic or Constant direct current

These are unidirectional flow of electrons towards the positive pole. (0 Hz) Does not provide muscle contraction

1. Galvanic current
2. special galvanic current
3. Hydro Galvan
4. iontophoresis

Interrupted direct current (impulse current):

If the continuous unidirectional current is interrupted, it gives rise to series of pulses or phases of unidirectional current. Muscle contraction

1. Diadynamic
2. selective current
3. TENS
4. URS

Alternating current

the electrons are constantly changing the direction.

Electrons in the alternating current always move from negative pole to positive pole. This is used for:
• reducing oedema
• pain killing.

Galvanic Current

A constant direct current is called a galvanic current. The term constant refers to the current and voltage as they do not change during treatment

Due to the direction of current:
1/ Longitudinal descending (analgetic effect) – The positive electrode (anode) is placed on the proximal and the negative pole (cathode) is placed on the distal part. Effects: Analgetic, Spasmolytic, Relaxation

2/ Longitudinal ascending (stimulating) -The negative pole (cathode) is placed on the proximal and the positive pole is placed on the distal part Effects: convulsive, increases muscle spasm

3/Transversal (front and back/ medial and lateral)

4/Transregional (around joints)

Biological Effects of Galvanic Current

1. Painkiller
2. Vasodilatory effect
3. Anti-inflammatory effect
4. General tissue regenerative effects
5. Effects of the central nervous system
6. Local effects on tissues
7. Effect on autonomic nerve system

Pflüger’s Law

Due to galvanic current a given segment of a nerve is irritated at the cathode (negative pole) by the development of catelectrotonus. The intensity decreases after a period of time.

A segment of a nerve is less irritated at the anode (positive pole) anelectrotonus, pain killer effect.

Indications of galvanic current therapy

– Osteoarthrosis, chronic arthritis
–neruralgia
- myalgia
- tendinitis, tendosynovitis
- epicondylitis
- bursitis
- spondylarthrosis
- Sudeck syndrome, Raynaud’s disease
- artherosclerosis
– local ostheoporosis

Contra indications of galvanic current therapy

– Fever, infectious diseases
– Acute arthritis
– Thrombophlebitis
– Presence of pacemaker
– Carcinoma
– Endoprosthesis, metal implant, metal allergy
– Heart attack, angina pectoris
– Thromboembolism
– Gravidity
– Wounds, skin diseases
– Bleeding disorders (hemophilia and anticoagulation treatment) - Osteomyelitis
- Psychiatric disorders
- Hypertension
-Anesthesia

Kowarschik galvanic treatment

It is a special galvanic treatment to decrease femoral and brachial neuralgic pain
Two long electrodes are placed on the leg: the positive pole is placed on the flexor side, the negative pole is placed on the extensor side of the leg

• Average intensity: 20-30mA
• Time of treatment: 15 -20min.
• Indications :
– Ischialgia
– lumboischialgia
– Femoralis neuralgia
– Brachialgia
– cervico-brachialgia

Bergonier galvanic treatment

It is galvanic current for treating trigeminal neuralgia

Special positive electrode is placed on the face and the negative electrode is placed on the neck
• Average intensity: 10mA
• Time of treatment: 3-5 min.
• Indication: neuralgia of the trigeminal nerve

Bourgignon therapy

-Unipolar and pericerebral galvanic therapy
-Analgetic effect
-Supraorbital neuralgia
-Migrane

With 2 round electrode(anode) pads on eyes 100cm2 cathode back at the neck
-Intensity:2-3 mA
-Time:3-5 minutes

Ries calcium electrostasis therapy

Bipolar, transversal therapy 2 pieces of 5x8 cm electrode pads Cathode should be on calcium deficiency spot (local bone dystrophy, fracture,local osteoporosis)

Calcium ion is positive charged, so moves towards cathode Patient receives 10 ml intravenous calcium injection
Time: 20-30 minutes

Hydrogalvanic current therapy

Combination of electric and water effect. Electrical treatment is used to decrease pain and inflammation of the hands and the feet

This treatment follows as the patient sits in a chair with his hands and feet placed in 4 small tubs (30-40 l) filled with water through which pulsed currents running.
• Treatment types:
1. Cranio-caudal and caudo-cranial currents
2. Transverse current direction
3. Combined current direction
4. Crossed current direction
Treatment time: 20 minutes
Intensity: 5-20 mA

Indications of Hydrogalvanic current therapy

– RA (rheumatoid arthritis)
– Progressive Systemic Sclerosis
– Psoriatic arthritis
– Reiter’s syndrome
– Osteoarthritis
– Polyneuropathy
– Chronic arthrosis