Electrotherapy In Sport

Electrotherapy is the use of electricity as a form of treatment for soft tissue injuries. Here we explain the various forms it used for the treatment of sports injuries.

Interferential

interferential therapy

Interferential is a form of electrotherapy which uses two alternating medium frequency currents. The two currents are applied simultaneously and where they cross, form an area of wave interference which results in a modulated frequency equal to the difference in frequency of the two waves.

It stimulates the muscle in a simlar way to a normal muscle contraction. It helps to reduce pain in the same way as TENS, using the pain-gate theory. it and also affects circulation. At low frequencies of 0-10 Hz muscle stimulation occurs which helps the removal of any build-up of swelling. At higher frequencies, of 90-100 Hz, vasodilation occurs and increases the blood flow to the area to help healing.

What can Interferential be used for?

Interferential can be used to treat a large range of musculoskeletal injuries including those where swelling and muscle spasm are present. Joint pain can also be treated effectively by interferential stimulation. Specific injuries include back pain; frozen shoulder; patellofemoral knee pain; meniscus injuries; sacroiliac joint pain….the list goes on!

What are the Contraindications?

Interferential should not be used in the following situations:

  • When there are sensory disturbances
  • Local infection
  • Malignant tumors
  • Deep vein thrombosis
  • Circulatory conditions
  • Over or near a pacemaker
  • Pregnancy

Laser Therapy

Laser stands for Light Amplification by Stimulated Emission of Radiation. Laser is pure light which is produced by a series of reactions.

What is Laser Therapy?

laser therapy

There are two types of laser, high powered lasers which are used in industry and engineering settings, with an ouput of up to 100 mW. Low and mid-powered lasers produce up to 50 mW and are the type of laser used in therapeutic treatments. There is no heat associated with laser treatment and so they are sometimes also known as cold lasers.

There are two types of laser used in the treatment of musculoskeletal injuries, Gallium Arsenide (GaAs) which is not visible and Helium-Neon (HeNe) which has a lower wavelength and is visible. The settings and dosage used depend on the depth of the injury being treated, the amount of fatty tissue overlying the injured structure and age of the client. Laser appears to be of most benefit in tendinopathy type injuries.

What can Laser be used for?

Laser is used for the treatment of all kinds of musculoskeletal injuries to help reduce pain, muscle spasm, inflammation and encourage cell reproduction. Research has however shown that Laser may not be as effective as other forms of electrotherapy.

What are the Contraindications?

Laser should not be used in the following situations:

  • Pregnancy
  • Malignant tumours
  • Treating infants
  • Patients receiving photosensitive medication

Magnetic Field Therapy

magnetic field therapy

This type of electrotherapy treatment is used regularly in people with chronic pain conditions. Treatment can either be pulsed electromagnetic fields (PEMF) or static magnetic fields (SMF).

What is Magnetic Field Therapy?

PEMF uses an alternating current through a coil applicator, whereas SMF uses simple, static magnets. The most common example is the magnetic bracelets and other jewellery which can be purchased from high street pharmacies. Both forms of magnetic field therapy are said to have the effect of decreasing swelling and inflammation.

Practitioners of magnetic field therapy believe that to maintain health and for healing, the bodies electromagnetic field must be in balance and the use of magnetic field therapy helps to restore this balance.

What can Magnetic Field Therapy be used for?

Magnetic field therapy has been shown to be successful in producing analgesia (pain relief) in a number of different conditions including lower back pain and osteoarthritis. However, most studies demonstrating a positive effect on pain are of poor quality and so there is no solid evidence promoting the use of magnetic fields in treating injuries or chronic pain.

What are the Contraindications?

Magnetic field therapy should not be used in the following situations:

  • Pregnancy
  • Tuberculosis
  • People with pacemakers

Short Wave Diathermy

short wave diatheramy

Pulsed short wave diathermy is a form of electrotherapy, similar to Ultrasound. It is sometimes also called pulsed electromagnetic energy.

What is Pulsed Short Wave Diathermy?

Pulsed short wave diathermy uses electromagnetic energy to heat the underlying tissues. High frequency, short wave, alternating electrical currents are passed into the muscles, tendons, ligaments, etc.

As the current alternates between positive and negative, this causes structures within the muscle to rotate in reaction. This friction from repeated movement causes an increase in temperature.

This works in a similar way to ultrasound, however, diathermy can be used to heat a larger area and also heats the deep muscles more effectively. On the downside, diathermy units are expensive and can only be used by one person at a time.

What can Short Wave Diathermy be used for?

  • Muscle strains.
  • Ligament sprains.
  • Tendinopathies (e.g. Achilles)
  • Back or joint pain.

What are the Contraindications?

Short Wave Diathermy should not be used in the following circumstances:

  • Over metal implants such as pins and plates.
  • On the chest of patients with pacemakers.
  • Over the abdomen or back of a pregnant woman.
  • When infection is present.
  • Over open wounds.
  • Over cancerous tissue.

TENS

tens machine therapy

Transcutaneous electrical nerve stimulation (TENS) is a method of providing pain relief. As the name suggests, it involves the application of electrical current to the affected area. This is achieved via a number of electrodes that can be fixed to the skin.

TENS relieves pain mainly by stimulating the pain gate mechanism. Electrical signals from the machine block the bodies natural pain signals.

Read more on Transcutaneous electrical nerve stimulation.


Ultrasound Therapy

ultrasound therapy

Ultrasound has been used as an electrotherapy treatment modality by therapists over the last 50 years. It transmits high frequency sound waves into tissues. It has a number of benefits and effects including heat and micro massage effects.

The effects of therapeutic ultrasound are still being disputed. To date, there is still very little evidence to explain how ultrasound causes a therapeutic effect in injured tissue. Nevertheless, practitioners worldwide continue to use this treatment modality relying on personal experience rather than scientific evidence.

Read more on Ultrasound therapy.


Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy is a form of Electrotherapy which has shown to be beneficial in the treatment of tendon injuries such as Achilles Tendinopathy and Tennis Elbow, as well as Plantar Fasciitis.

What is Extracorporeal Shock Wave Therapy (ESWT)?

shock wave therapy

Extracorporeal Shock Wave Therapy is a method of therapeutic treatment for soft tissue injuries. It works by passing shock waves (short but intense energy waves) which travel faster than the speed of sound, into the tissues.

The form of treatment was originally developed to break down kidney stones and has been used in this way for the last 20 years. It was noticed that patients receiving this treatment also noticed a decrease in pain from other soft tissue injuries. The technology was then adapted to be suitable for use specifically on these areas.

What Injuries is it used for?

ESWT is most effective in treating conditions where major tendons connect to bones:

ESWT also encourage bone healing and so can be used for stress fractures.

When should it NOT be used?

In some cases, shock wave therapy is not suitable. Here are the most common examples:

  • Application over open growth plates (where there may still be growth)
  • Over metal pins or plates etc
  • Malignant tumours
  • Pregnancy
  • Nerve and circulation disorders
  • Infections.

How does ESWT Work?

Whilst the exact process is still up for debate, it is thought that ESWT works by causing microtrauma to the tissues which creates neovascularisation – an increase in new blood vessels. These bring an increase in blood flow to the area and therefore aid tissue healing. Beneficial effects may also be down to the stimulation of an acute inflammatory response in a chronic injury. This can effectively re-stimulate the healing process.

Extracorporeal Shock Wave Therapy can be either High-level or Low-level energy.

High-Level ESWT

  • Applied in a single dose.
  • Energy levels above 0.6 mJ/m.
  • Can be painful.
  • Used in conjunction with local aneasthetic.

Low-Level ESWT

  • Requires multiple treatments.
  • Energy levels below 0.08 mJ/m.
  • Less painful – may be uncomfortable.
  • Local anaesthetic not normally used.

Exogen – Ultrasound Bone Healing System

Exogen is a bone healing system which is used in treating fractures, especially those which are not healing naturally. It uses ultrasound waves to stimulate bone healing.

How Does Exogen Work?

Exogen uses a low-intensity pulsed ultrasound (LIPUS) signal to stimulate the natural bone healing process.

It is a portable device with a small transducer which is placed on the skin over the broken bone. Ultrasound waves pass through the overlying soft tissues to penetrate the bone.

Exogen is simple to use and has a short treatment time of 20 minutes a day. It can be used with casts and is effective even where metal fixations are present

It can be used on recent fractures to accelerate the healing time, as well as on non-union fractures (where the bone is not healing).

Facts and Figures

  • Accelerates the healing of broken bones by 38% 1,2
  • High heal rate for non-union fractures (no sign of healing observed) – 86%3
  • 10 percent of fractures (c. 85,000 fractures per annum) are estimated to be classed as delayed or non-union – where slow or no signs of normal healing are observed4

Indications and Contraindications

The Exogen bone healing system can be used for:

  • Treatment of delayed union and non-unions
  • Accelerating the time to heal of fresh fractures
  • Treatment of stress fractures
  • Accelerating repair following osteotomy
  • Accelerating repair in bone transport procedures
  • Accelerating repair in distraction osteogenesis procedures
  • Treatment of joint fusion

There are currently no known contraindications (when the system cannot be used). Although safety and effectiveness have not been established for children, pregnant women or patients with pacemakers, fractures from bone cancer, poor circulation or blood clotting disorders.

Reference Articles

1. Heckman JD, Ryaby JP, McCabe J, Frey JJ, Kilcoyne RF. Acceleration of tibial fracture-healing by noninvasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am 1994;76:2634.

2. Kristiansen TK, Ryaby JP, McCabe J, Frey JJ, Roe LA. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound.J Bone Joint Surg Am 1997;79:96173.

3. Nolte PA, van der Krans A, Patka P, Janssen JMC, Ryaby JP, Albers GHR. Low-intensity ultrasound in the treatment of nonunions. J Trauma 2001;51:693 703.

4. Rubin C, Bolander M, Ryaby JP, et al. The use of low-intensity ultrasound to accelerate the healing of fractures. J Bone Joint Surg 2001;83A(2):259 70

You can read more about the Exogen ultrasound bone healing device by visiting www.exogen.com

This article has been written with reference to the bibliography.