PHYSMOD _ DEEP HEATING MODALITY

• Uses this spectrum like the IR

• Emits energy based on different frequencies and wavelengths

Electromagnetic spectrum

Electromagnetic Spectrum

________ may damage soft tissue by changing the polarity 

Ionizing Property ( > 10 ev)

Both SWD & MWD are nonionizing

FATES OF ELECTROMAGNETIC SPECTRUM

________ - Use of head perpendiculary

Lambert's Cosine Law/Right Angle Law

FATES OF ELECTROMAGNETIC SPECTRUM

________ - Intensity of radiation is inversely proportional to the distance squared

(Appropriate distance of the machine for treatment )

Inverse Square Law 

FATES OF ELECTROMAGNETIC SPECTRUM

_________ - Ensure proper absorption of radiation

Law of Grotthus Draper/ Principle of Chemical Activation

FATES OF ELECTROMAGNETIC SPECTRUM

________ - There is an optimal amount of energy absorption per unit time for beneficial results to be expected

Dosage determination (intensity = warmth)

Arndt-Schultz Principle 

FATES OF ELECTROMAGNETIC SPECTRUM

________ - Intensity and duration of the dose of radiant energy is inversely proportional

Adjustment of parameters in treatment

Bunsen Roscoe Law of Reciprocity

PRINCIPLES OF DIATHERMY

Greek δια + θερμία (dia & thermia) = “_______” or “________”

First used in 1892 by _________

Application of ______ or _________ to produce heat and other physiological changes within tissues

to heat through” or “through heating”

Jacques Arsene d’Arsonval

shortwave (radio) / microwave electromagnetic energy

microwave radiation has a ______ wavelength and _____ frequency than shortwave radiation

shorter & higher freq

TYPES OF DIATHERMY

Longwave Diathermy

• Wavelength

• Frequency

• Frequency Bands

• Penetration Depth

• Therapeutic Use

• 300 - 30m

• -

• -

• Deep

• No longer used

TYPES OF DIATHERMY

SHORTWAVE DIATHERMY (SWD)

• Wavelength

• Frequency

• Frequency Bands

• Penetration Depth

• Therapeutic Use

• 30 - 3m ,200 - 3m

• 10 - 100 MHz , 1.8 - 30 MHz

• 13.56 MHz (22 m) , 27.12 MHz (11 m) ,40.68 MHz (7.5 m)

• Deeper

• For rehabilitation (thermal effects)

TYPES OF DIATHERMY

Microwave Diathermy

• Wavelength

• Frequency

• Frequency Bands

• Penetration Depth

• Therapeutic Use

• 2 - 0.03 m ,1m - 1mm

• 300 MHz - 300 GHz

• 433.9 MHz (69 cm) , 915 MHz (33 cm) , 2,450 MHz (12 cm)

• Deepest

• For rehabilitation (thermal effects)

PHYSICAL PROPERTIES OF DIATHERMY : TISSUE ABSORPTION

Factors: _________ & _________

Amount of Energy

Tissue Type

PHYSICAL PROPERTIES OF DIATHERMY : FOR SWD vs Other Agents

• Heats _______ tissues vs Superficial Heating agents

• Heats ______ areas vs US

• Not reflected by _____ and do not concentrate on ____

Deeper tissues

Larger Areas

bones → periosteum (no periosteal burning or pain) vs US

PHYSICAL PROPERTIES OF DIATHERMY : FOR MWD

Danger of Overheating Fats

• Some energy is being absorbed directly by the _______

• Some energy is being _____ to the fatty tissue at __________

Has _____ absorption for fatty issue

• Does not go through completely to the _____

• _______ to the fat

• fatty tissues

• reflected → fat-muscle interface

• Absorption

• muscle

• Bounces back

MWD is reflected at tissue interfaces = hotspots in other areas

PHYSIOLOGICAL EFFECTS OF DIATHERMY : Thermal Effects

• __ Pain control

• ___ Accelerated tissue healing

• __blood flow (vasodilation)

• __ metabolism

• ___ joint stiffness

• __collagen extensibility

• Muscle _______

• In conjunction with _____ to ↑ ROM

  • INC tissue tempertature by up to ____ in ____ mins

Achieved when using ______ mode

• Used in adjunct to ____ for full physiological effect such as plastic mode of muscles after _____ 

• Can bring both _____ & ____ effects 

• INC Pain control

• INC Accelerated tissue healing

• INC blood flow (vasodilation)

• INC metabolism

• DEC joint stiffness

• INC collagen extensibility

• Muscle relaxation

• In conjunction with stretching to ↑ ROM

  • 3.5°C in 20 mins

Continuous

Exercises → stretching

thermal and non-thermal

PHYSIOLOGICAL EFFECTS OF DIATHERMY : NON- Thermal Effects

• ↑ microvascular ______ 

  • __ minutes around ulcer sites in patients with diabetic ulcers

• Modulates_______ & ____

• Accelerate ____ & _____ healing

• Accelerates ________ binding to ______

• ↑rate of _______ (SWD) 

• ↑_____ activity 

• ____ soft tissue healing

  • incisional wounds, pressure ulcers, burn & tendon injuries

• Controls _____ & _____

Achieved when using ___ modes: ______

• Can activate both both _____ & ____

• ____ can be used to isolate non thermal effects

• ↑ microvascular ______ 

  • 40-45 minutes

• Modulates cell growth and division 

  • Accelerates process, if slow , Inhibits process, if fast 

  • Controls 

• bone and nerve healing acceleration

• Accelerates Ca²⁺ binding to calmodulin 

• ↑rate of phagocytosis (SWD) 

• ↑ATP activity 

• INC

• pain and edema

both modes → Continuous & Pulse

• thermal and non-thermal effects

• Pulse

APPLICATION TECHNIQUES FOR DIATHERMY

2 kinds of Diathermy : _____&______

Shortwave Diathermy & Microwave Diathermy

APPLICATION TECHNIQUES FOR DIATHERMY

2 types of Shortwave Diathermy : _____&______

Type of Microwave Diathermy : _____&______

Capacitive Plates or Electric Field Method & Inductive coils / Magnetic Field Method

Magnetron (Condenser)

APPLICATION TECHNIQUES FOR DIATHERMY

________ is made of metal encased in plasting housing or transmissive carbon rubber electrodes

Heating by electric field method

The current will not effectively penetrate to deeper tissues but will concentrate more in superficial tissues such as ________

Capacity Plates

Fat or collagen

CAPACITY PLATES TECHNIQUE

____________

• Plates in series on each side of body part

• Pt is part of the _______ circuit

• “sandwich the tissue”

• Absorption is _______

• Plates in series on each side of body part

• Pt is part of the electromagnetic circuit

• “sandwich the tissue”

• Absorption is THROUGH

Contra Planar / Transverse Positioning

CAPACITY PLATES TECHNIQUE

____________

• Plates in parallel on same body surface 

• Applied on the _______ surface 

• Electromagnetic circuit will jump from one plate to another 

• Absorption by ______

• Plates in parallel on same body surface 

• Applied on the same body surface 

• Electromagnetic circuit will jump from one plate to another 

• Absorption by PASSING

Co Planar Positioning

Types of Electrodes or Condensers: Capacity Plates

___________

• Capacitor or Condenser Electrodes

__________

• Flexible or Condenser Pads

Distance: ____ inches (____ cm) (Between skin and condenser)

Plates

Pads

Distance: 1-3 inches (2-10 cm) (Between skin and condenser)

Tissue Heating of Capacity Plates

• Most heating occurs on tissues with _______

• Produces more heat on ______

  • ________ on superficial tissues

• Do not penetrate as effectively to_______ if less conductive tissues, such as ___, are present superficially

• Conductivity depends on _______ of soft tissues

• Most heating occurs on tissues with highest conductivity

• Produces more heat on superficial tissues

  • Greater conduction on superficial tissues

• Do not penetrate as effectively to deeper tissues if less conductive tissues, such as fats, are present superficially

• Conductivity depends on water content of soft tissues

Fatter = less effective (because fat will block the heat)

TISSUES	CONDUCTIVITY (siemens/meter)
MUSCLE	______
Kidney	____
Liver	_____
Brain	____
FAT	_____
Bone	___

Tissue Heating for SWD & MWD

0.7 - 0.9

0.83

0.48-0.54

0.46

0.04-0.06

0.01

Made up of coil where Alternating Current (AC) flows (inside the applicator head)

AC produces magnetic fields → induces electrical ______ in tissues → oscillation of charged particles → friction → generates heat

The strength of magnetic field _____ in proportion to the distance between tissue and applicator which does not vary with tissue type.

Can heat both deep & superficial tissues but produce most heat in ________

INDUCTIVE COILS or MAGNETIC FIELD METHOD

Eddy Currents

EDDY CURRENT - INDUCTIVE COIL - SWD 

Dec

muscle/synovial fluid

INDUCTIVE COILS : Types of Electrodes or Condenser

• _____

• _____

  • Able to heat up larger surfaces

    • Has 2 heat applicators

• _____

  • 1 applicator only

  • Same with lab diathermy

• ___________

  • Circumferential effects on limbs

Drum

Diplode

Monode

Sleeves with Cables

NDUCTIVE COILS : Tissue Heating

• Most heating occurs on tissues with_____

• Heats tissues____ to the applicator 

• Distance: _______

  • Between___ & ____ technique (only)

• Most heating occurs on tissues with highest conductivity 

• Heats tissues closest to the applicator 

• Distance: Slight air gap

• Between skin and drum technique (only)

SHORTWAVE DIATHERMY : Factors Affecting Field Distribution 

SPACING

• _______ distance to tissue → more ______

• Might be because of the ________ capacity

ELECTRODE SIZE

• ______ → more superficial

SPACING

• Closer distance to tissue → more superficial

• Might be because of the absorption/condution capacity

ELECTRODE SIZE

• Smaller → more superficia

SHORTWAVE DIATHERMY : THERMAL (continuous) vs NON- THERMAL (pulsed)

For Non- Thermal

• Pulsed SWD (PSWD) or Pulsed Electromagnetic Fields (PEMF) or Pulsed Electromagentic Energy (PEME) 

• With “on” and “off” cycles 

• Can be isolated since pulse cant activate thermal effects

Microwave Diathermy

• Produces high-frequency Alternating Current in an antenna → electromagnetic field

• Used for smaller, defined areas

• Medicallly treat malignant tumors by hyperthermia

• Penetrates less deeply than SWD but can generate most heat in tissues with high electrical conductivity

MAGNETRON (Condenser)

MAGNETRON (Condenser) : Tissue Heating

• Most heating occurs on tissues with highest conductivity( _______ ); however, it penetrates less deeply than SWD

• Distance:_______

Muscles

Few inches

MAGNETRON (Condenser) : Tissue Heating

• → ______ of penetration

• → _____ absorption by fatty tissues

• → _____ at tissue interfaces

= Risk for Burn on Superficial Skin or Fat

• → Shallow depth of penetration

• → Direct absorption by fatty tissues

• → Reflection at tissue interfaces

= Risk for Burn on Superficial Skin or Fat

COMPARISON OF HEAT DISTRIBUTION

MODALITY	FAT	MUSCLE	BONE
Inductive Coil	____	__________	None
Capacitive Plate	_____	_____	_____
Magnetron	_____	______	None
Ultrasound	Slight	Maximum	None

MODALITY	FAT	MUSCLE	BONE
Inductive Coil	Minimum	Maximum m	None
Capacitive Plate	Maximum	Moderate	Low
Magnetron	Maximum	Maximum	None
Ultrasound	Slight	Maximum	None

DOSIMETRY AND INDICATIONS OF DIATHERMY

DOSAGE	Patient’s Perceived Tissue Heating	Suggested Clinical use (INDICATIONS)
DOSE I	Non-thermal (pulse)	________ (sprains, strains, etc.)
DOSE II	Mild heat sensation  (continuous)	_________
DOSE III	Moderate heat sensation (comfortable) (continuous)	_____________
DOSE IV	Vigorous heating  (continuous)	_________________

COMMONLY USED INTENSITY: _________

DOSAGE	Patient’s Perceived Tissue Heating	Suggested Clinical use (INDICATIONS)
DOSE I	Non-thermal (pulse)	Acute injuries (sprains, strains, etc.)
DOSE II	Mild heat sensation  (continuous)	Subacute injuries
DOSE III	Moderate heat sensation (comfortable) (continuous)	Pain, muscle spasm, chronic inflammation
DOSE IV	Vigorous heating  (continuous)	Increase blood flow, heating of collagen fibers for stretching of soft tissues (or tissue extensibility)

Mild, comfortable, dry warmth

INDICATIONS FOR DIATHERMY

THERMAL LEVEL

• ______ control

• Accelerates _______

• Decreases_______

• ______ soft tissue extensibility

• Use ________ mode

NON-THERMAL LEVEL

• ____ & ____ control

• _____tissue healing

• Nerve and bone healing on animal studies (so not yet applicable)

• Use_________ mode; can isolate by using pulse only

THERMAL LEVEL

• Pain control

• Acccelerates tissue healing

• Decreases joint stiffness

• Increase soft tissue extensibility

  • Use continuous mode

NON-THERMAL LEVEL

• Pain and edema control

• Soft tissue healing

• Nerve and bone healing on animal studies (so not yet applicable)

  • Use continuous and pulse mode; can isolate by using pulse only

CONTRAINDICATIONS FOR DIATHERMY

THERMAL LEVEL

• Pacemakers or electronic-implants

• Metal implants

• Malignancies

• Thromboplebitis

• Over abdomen, low back or pelvis of pregnant women

• Over the eyes or testes

• Over growing epiphyses of children

• Hemorrhage

• Contact lenses

NON-THERMAL LEVEL

• Pacemakers or electronic-implants

• Metal implants

• Malignancies

• Thromboplebitis

• Over abdomen, low back or pelvis of pregnant women

• Deep tissues (internal organs)

PRECAUTIONS FOR DIATHERMY

• External __________ (EKG, EEG, TENS, & computer-controlled devices) = ___ m (__ ft) away from active diathermy devices 

• Copper-bearing intrauterine contraceptive devices 

• _____ (Capacitive SWD and MWD) 

• Impaired ____ or ____ 

• Decreased ______ 

• Over _____ clothes or accumulated _____ 

• _____, ____ or _____ skin 

• Over growing epiphyses of ______ (PSWD) 

  • Only if PSWD, otherwise it is CI 

• Excessive exposure of PT to ______

  • _____ (Continuous SWD); _____ (PSWD)

• External electronic medical devices nearby (EKG, EEG, TENS, & computer-controlled devices) = 3-5 m (10-16 ft) away from active diathermy devices 

• Copper-bearing intrauterine contraceptive devices 

• Obesity (Capacitive SWD and MWD) 

• Impaired sensation or circulation 

• Decreased consciousness 

• Over moist clothes or accumulated sweats 

• Atrophic, infected or damaged skin 

• Over growing epiphyses of children (PSWD) 

  • Only if PSWD, otherwise it is CI 

• Excessive exposure of PT to radiation 

  • 1-2 m (Continuous SWD); 0.5-1m (PSWD)

ADVERSE EFFECTS OF DIATHERMY

_________

• because of focused heat

• Fat layers are at greatest risk of burning when ______ applicators are used because they are more effectively heated

• Imperative to monitor and check pt

  • Check for blanching

  • Inspect area

  • Ask pt input

Burns and Blisterings

Capacitive plate applicators

DOCUMENTATION LEC

Continuous SWD or MWD x <distance> x 20 min on <treatment area> in <position> to <rationale>

Pulsed SWD x <distance> x 30-60 min x <od/bid> on <treatment area> in <position> to <rationale>

DOCUMENTATION LAB

MWD using <MW-7S machine> x <distance> x <duration> x <pt position> over <body area> to <rationale>

Inductive SWD using <Curapuls 670 machine> x <duration> x <pt position> over <body area> to <rational>

“Confine yourself to the present”

Marcus Aurelius 💫