Electrotherapy is an increasingly popular modality in sports medicine. Electrotherapy is the application of low-level electrical current to the peripheral nervous and musculoskeletal systems. It has widespread applicability for the treatment of orthopedic conditions and varied indications, although its application in sports medicine is typically for pain control and muscle reeducation. This class of modalities has many advantages, including portability, ease of use, and noninvasive special applications for cutaneous wound and fracture healing
Electrotherapy is the use of electrical energy as a medical treatment.[1] In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. Additionally, the term “electrotherapy” or “electromagnetic therapy” has also been applied to a range of alternative medical devices and treatments.
Types of Electrotherapy
- Balneotherapy – medical use of spa pools and mineral baths particularly for arthritis therapy.
- Cervical traction – a means of separating the cervical vertebrae 1 to 2 mm to help relieve painful neck conditions or cervical radiculopathies; may be intermittent or continuous.
- Contrast baths – alternately exposing affected limb to warm and cool water for specified periods. This is a means of reducing swelling, diminishing pain, and improving joint ROM.
- Cryotherapy – use of low temperatures to decrease inflammation, decrease pain and spasm, promote vasoconstriction.
- Diathermy – electromagnetic waves with a specific wavelength (shortwave diathermy, microwave diathermy) used as a means of producing heat deep inside tissues.
Electrical Stimulation
- Alternating current – sinusoidal or faradic; stimulates normally innervated muscles to relieve pain and relax muscle spasm.
- The galvanic – direct current used to stimulate denervated muscles and for ion transfer (iontophoresis).
- High-voltage pulsed galvanic – to relieve pain and relax muscle spasm. Stimulates normally innervated muscles.
- Iontophoresis – the use of direct current to drive water-soluble ions through the skin. Dexamethasone and lidocaine (Xylocaine) are commonly used to treat acute and subacute localized inflammation and pain.
- Microampere electrical nerve stimulation (MENS) – micro amperage current that is below the patient’s threshold; to relieve pain.
- Transcutaneous electrical nerve stimulation (TENS) – self-contained, modulated galvanic current (low voltage) that seems to block painful afferent nerve impulses. Helps to control pain so the patient may exercise.
- Fluid therapy – the use of forced warm air through a container holding fine cellulose particles to provide dry heat and exercise to upper and lower extremities. Both the temperature and the particle agitation can be controlled for edema and desensitization of hypersensitive area.
- Hot packs – silicone gel, clay, or other material in bags that can be heated to provide superficial heat for tissues.
- Hubbard tank – a large full-body water tank used to assist in ROM and endurance exercise.
- Hydrostatic bed – essentially a waterbed that supports the patient for specific therapies.
- Hydrotherapy treatments – as commonly used today, immersion of affected limbs (sometimes including the trunk) in a tank of water at a specified temperature. The water may be moving (whirlpool), which is one means of debriding tissue. There are also tanks in which patients may sit (Lo-Boy) and in which they may be almost totally immersed (Hubbard tank). In a pool, the buoyancy of water can assist patients with partially paralyzed legs to walk. Some therapists refer to the
- Archimedes principle – because the buoyancy in the water supports the weight, eliminates shock, and decreases the concern for the need for balance.
- Interferential current – application of two medium-frequency alternating currents that interfere with each other. Used for pain control and muscle stimulation.
- Intermittent compression – a boot or sleeve that encloses the leg or arm and is alternately pressurized with air and then deflated. The inflate-deflate action provides a pumping effect that reduces disabling edema. It is often prescribed for breast cancer patients after a mastectomy and for lymphedema that may result.
- Paraffin bath – a combination of wax and mineral oil at 126° F used as a means of heating the hands or feet.
- Phonophoresis – the use of ultrasound to drive molecules of medications through the skin to the underlying tissues.
- Rest, ice, compression, and elevation (RICE) – for the initial treatment of an injury; the treatment of choice for acute musculoskeletal injuries that include sprains, strains, and hematomas.
- Traction – for low back pain; application of pelvic belt with caudad pull, which may be continuous or use greater force intermittently.
- Ultrasound – ultra-high-frequency sound waves that mechanically vibrate soft tissue. Secondary deep heat may develop according to the method of application.
- Whirlpool – a form of hydrotherapy using fast moving water that is usually heated.
Uses/ Indications of Electrotherapy
The use of electrotherapy is accepted practice in the field of physical therapy[rx] the American Physical Therapy Association acknowledges the use of electrotherapy for [rx]
Pain management
- Improves range of joint movement
Treatment of neuromuscular dysfunction
- Improvement of strength
- Improvement of motor control
- Retards muscle atrophy
- Improvement of local blood flow
Improves the range of joint mobility
- Induces repeated stretching of contracted, shortened soft tissues
Tissue repair
- Enhances microcirculation and protein synthesis to heal wounds
- Increased blood flow to the injured tissues increases macrophages to clean up debris
- Restores the integrity of connective and dermal tissues
Acute and chronic edema
- Accelerates absorption rate
- Affects blood vessel permeability
- Increases mobility of proteins, blood cells, and lymphatic flow
Peripheral blood flow
- Induces arterial, venous and lymphatic flow
Iontophoresis
- Delivery of pharmacological agents
- DC (direct current) transports ions through the skin
- Common drugs used:
- Dexamethasone
- Acetic acid
- Lidocaine
Urine and fecal incontinence
- Affects pelvic floor musculature to reduce pelvic pain and strengthen the musculature
- Treatment may lead to complete continence
Lymphatic Drainage
- Stimulate the lymphatic system to reduce edema
- Electrotherapy is primarily used in physical therapy for relaxation of muscle spasms, prevention and retardation of disuse atrophy, increase of local blood circulation, muscle rehabilitation and re-education electrical muscle stimulation, maintaining and increasing range of motion, management of chronic and intractable pain, post-traumatic acute pain, post-surgical acute pain, immediate post-surgical stimulation of muscles to prevent venous thrombosis, wound healing and drug delivery.
- Musculoskeletal conditions – In general, there is little evidence that electrotherapy is effective in the management of musculoskeletal conditions.[rx] In particular, there is no evidence that electrotherapy is effective in the relief of pain arising from osteoarthritis,[rx] and little to no evidence available to support electrotherapy for the management of fibromyalgia.[rx]
- Neck and back pain – A 2016 review found that in evidence of no effectiveness, clinicians should not offer electrotherapy for the treatment of neck pain or associated disorders.[rx] Earlier reviews found that no conclusions could be drawn about the effectiveness of electrotherapy for neck pain,[rx] and that electrotherapy has limited effect on neck pain as measured by clinical results.[rx] A 2015 review found that the evidence for electrotherapy in pregnancy-related lower back pain is “very limited”.[rx]
- Shoulder disorders – A 2014 Cochrane review found insufficient evidence to determine whether electrotherapy was better than exercise at treating adhesive capsulitis.[rx] As of 2004, there is insufficient evidence to draw conclusions about any intervention for rotator cuff pathology, including electrotherapy;[rx] Furthermore, methodological problems precluded drawing conclusions about the efficacy of any rehabilitation method for impingement syndrome.[rx]
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