Involves the application of Ultrasound waves above the range of human hearing in order to treat various types of injuries. The application of Ultrasound Therapy helps increase the blood flow of a localized area to reduce the swelling and inflammation in that area. It is also used to enhance the healing of a tissue particularly soft tissue, skin and bone.

TYPES

Thermal Ultrasound Therapy This therapy involves the continuous transfer of sound waves resulting in small vibrations in the deep tissue molecules. These vibrations increase heat and friction in the molecules. This heating effect results in the increases in the metabolism of the tissue cells resulting in the healing of the soft tissues.

Mechanical Ultrasound therapy This therapy uses single the vibration of sound waves to penetrate tissue. It actually causes the expansion and contraction in the tiny gas bubbles of the soft tissues which then helps to reduce the inflammation, reducing tissue swelling and thus decreasing pain in the tissue.

TREATMENT PARAMETERS

• Intensity The unit of intensity when using ultrasound is the watt.
• Space averaged intensity where the average intensity over a specified area is given, e.g. watts per square centimeter (Wcm-2).
• Time-averaged/space averaged intensity can be used when the ultrasound is being applied in a pulsed mode and gives the average intensity over the whole treatment time (per second) for a specified area Wcm-2).
• Pulsed mark :space ratio When ultrasound is applied in its pulsed mode, the ratio of the time on to time off should be expressed. This is the mark: space ratio, the mark being the time ultrasound is on space being the silence, both being measured in milliseconds eg. 2: 8, 1: 7.
• Reflection of ultrasound Air does not transmit ultrasonic waves, so in ultrasonic treatment great care is taken to avoid leaving air between the treatment head and the patient, to minimize reflection. Though there will always be some reflection at each interface that the ultrasound beam encounters. This gives rise to acoustic impedance. When the acoustic impedance is low, the transmission is high, and vice versa.
• Transmission of ultrasound If the ultrasound beam encounters an interface between two media and is transmitted, it may be refracted. As refraction does not occur when the incident waves travel along the normal, treatment should be given with the majority of waves traveling along with the normal, whenever possible.
• Attenuation of ultrasound Attenuation is the term used for the gradual reduction in the intensity of the ultrasonic beam once it has left the treatment head. Two major factors contribute to attenuation.
• Absorption Ultrasound is absorbed by the tissues and converted to heat at that point. This constitutes the thermal effect of ultrasound.
• Scatter This occurs when the normally cylindrical ultrasonic beam is deflected from its path by reflection at interfaces, bubbles or particles in its path.The overall effect of these two is such that the ultrasonic beam is reduced in intensity the deeper it passes. Therefore, when treating deep structures consideration needs to be given to the frequency and intensity of ultrasound chosen.
• Ultrasonic fields Depth of penetration and intensity of the ultrasonic beam is the division of the beam into a near and a far-field. The near and far-fields arise because the wave fronts from different parts of the source have to travel different distances and consequently there is interference between adjacent fronts. At some points, the interference is constructive at other points the interference is destructive. The extent of the near field is of significance in that it is more intense than the far-field and may have a more profound effect in the treatment of certain conditions. The frequency of the ultrasound and radius of the transducer may need to be considered when treating tissues at a depth greater than 6.5cm.
• Coupling media Ultrasonic waves are not transmitted by air, thus some coupling agent that does transmit them must be imposed between the treatment head (transducer) and the patient’s skin. No couplant affords perfect transmission; only a percentage of the original intensity is transmitted to the patient. Air reflects the ultrasonic beam back into the treatment head and thus produces standing waves that might damage the crystal. The treatment head is never left switched on when not in contact with a transmission medium.

PHYSIOLOGICAL EFFECTS

• Ultrasound Therapy has got numerous benefits as it can be used for a vast range of issues. However its most commonly used for:
• Heating and relaxing of the muscles in order to alleviate the pain.
• Increasing the blood flow i.e. lymph (lymph: a fluid that carries white blood cells throughout the body) to enhance the healing process not only of muscles but also joints and ligaments.
• Softening of any existing scar tissue.
• A low-intensity Pulsed Ultrasound (LIPUS) is used for fracture repair.
• Management of the Knee Osteoarthritis (OA)

INDICATIONS

• Tendonitis/Tendonitis
• Golfer’s Elbow
• Tennis Elbow
• Tendinitis (Achilles, Wrist, supraspinatus, bicipital)
• Jumper’s Knee
• Swimmer’s Shoulder
• Trigger Finger or Thumb
• Ganglion
• Joint Swelling
• Muscle spasm
• Pain
• Fractures
• Muscle or ligament injury(ACL, PCL, MCL, LCL)
• Sprains and Strains ( ankle, knee, lower back)
• Knee Bursitis
• Osteoarthritis
• Rheumatoid arthritis
• Myofascial pain
• Carpal Tunnel Syndrome
• Low back pain
• Phantom Limb Pain
• Varicose ulcers
• Herpes zoster
• Pressure sores
• Frozen shoulder
• Temporomandibular joint disorder
• Prolapsed intervertebral disc
• Dupuytren’s contracture
• Meniscal injury

CONTRAINDICATIONS

• It is not applied to people who have cardiovascular issues.
• It is not applied over the abdomen, pelvic regions, or lower back in pregnant or menstruating women.
• It is not applied over broken skin or healing fractures.
• It is not applied around the eyes, breasts, or sexual organs.
• It is not applied over the areas with plastic implants, or cardiac pacemakers.
• It is not applied over or near the areas with malignant tumors.
• It is not applied and cannot be used in acute sepsis.
• It is not applied over spina bifida or after laminectomy.
• It is not applied to the radiated area for at least six months after irradiation.

Is a form of superficial heat therapy one of the most effective ways of applying heat to improve mobility by warming the connective tissues.  Wax Therapy, involves the application of molten paraffin wax, to the connecting tissues causing muscle relaxation and improving joint mobility. It is mainly used to treat mainly post-traumatic stiffness (PTS) of limbs. It is basically used in combination with common mobilizing techniques and customized exercise programs to achieve better results.

EFFECTS

It is an ideal therapy that helps in: Relieving pain, decrease joint stiffness, helps in increasing blood flow, decrease muscle spasms and decrease inflammation. The material required is a paraffin wax bath, a pair of lint cloths, and about 1 kg (2lb) of paraffin wax. If we look after the paraffin wax, we can reuse it and it may last almost 2 months or more. You we need a paraffin wax bath that has a thermostat so that we can be able to control the heat and avoid overheating. It is strongly recommend to test a small area on the inside of wrist prior to a full immersion of hands or feet. In Wax Therapy, Molten Paraffin wax is applied to the skin in the form of layers so that it gets built up. Then the wax starts getting hard upon coming in contact with air away from the wax bath. The wax is then peeled off with no pain and the area is now ready for Massage, Exercise, Stretching or any additional therapeutic measures.

INDICATIONS

Wax Therapy is a painless, relaxing, and pleasurable treatment. It soothes chronic joint pain and relaxes stiff muscles. It is used to treat the conditions like:

• Osteoarthritis
• Rheumatoid Arthritis
• Fibromyalgia
• Joint Mobility issues
• Scleroderma
• Raynaud’s or any rheumatic pains

CONTRAINDICATIONS

• Open wounds
• Skin rashes.
• Allergic conditions.
• Impaired skin sensations.
• Defective arterial supply, etc.

TECHNIQUES OF WAX APPLICATION

The part that is to be treated should be cleaned with soap and water. Moisture is to be soaked with towel. Position the patient in such a way that the part to be treated comes in close proximity with the wax bath. Warm wax is applied over to the body part by various techniques such as

• Direct Pouring – Molten Wax is poured directly by a mug or utensil over to the affected site and wrapped with a towel.
• Brushing method – Several coats of wax is applied over to the affected part using Brushes of various sizes and wrapped with cloth.
• Direct immersion / Dipping method – The affected body part is directly immersed into the container of paraffin wax and then taken out. Once wax solidifies the part is immersed again to make another layer, and finally wrapped with cloth.
• Towelling / Bandaging method – A towel or a roll of bandage is immersed in molten paraffin wax and then wrapped around body parts.

TIME FOR WAX THERAPY

About 10 to 20 minutes.

Electromagnetic Therapy provides a non-invasive, safe and easy method to treat pain with respect to musculoskeletal diseases. It is a therapeutic technique that consists of applying artificial magnetic fields on an affected part of the human body, controlling intensity and frequency.

Magnetic field therapy was applied to promote bone healing, treat osteoarthritis and inflammatory diseases of the musculoskeletal system. It also help to alleviate pain, enhance healing of ulcers and reduce spasticity. This kind of therapy is delivered to the patients in two different forms. They are

1. Non-Stationary, pulsed electromagnetic field (PEMF): it works only when connected to an electric source. In this setup, a pulsed generator is connected to a coil which produces a magnetic field allowing current flow through the tissues. Its can be of 6 to 10 sessions with duration of 20 to 30 minutes.
2. Stationary (Permanent magnets): are fully charged with electric current and remain permanently magnetized. Such as earrings, bracelets, necklace or even pellets.

INDICATIONS

1. Spondylosis, Muscle spasm
2. Osteoporosis, Osteomylitis
3. Dysmenorrhae
4. Depression &Migrane
5. Epicondylitis, Sciatica
6. Gouty artritis, Rheumatoid arthritis and osteo arthritis.

CONTRAINDICATIONS

1. Acute infections
2. Haemorrhagic focus
3. Cardiac pacemaker
4. Pregnancy
5. Tumor
6. Diabetes etc.

There are many thermal agents out of which the SWD is the only deep heating agent.  Shortwave diathermy is a therapeutic modality that uses high-frequency alternating currents to generate heat in the body’s tissues. It is commonly used to produce deep heating in joints and soft tissues. Treatment that uses electromagnetic energy to produce deep heating in joints and soft tissues. This form of heat can be applied to deeper structures than other forms of heat treatment. Thus SWD can effectively relieve joint pain, improve soft tissue healing and decrease the symptoms of osteoarthritis. Best Health Physiotherapists are knowledgeable and experienced in the appropriate application of SWD.

TYPES

• Condenser shortwave diathermy (high-frequency electrical field)
• Induction shortwave diathermy (high-frequency magnetic field)

PHYSIOLOGICAL EFFECTS

1. Increased heat production
2. Temperature: – local temperature increases as there is an increase in heat. If given for a prolonged time, there will be a generalized increase in body temperature by a few degrees.

iii. Metabolism: – When SWD is applied to bodily tissues, it produces heat, which in turn increases the metabolic rate of the body tissues. 

1. Blood Supply: – SWD application increases local blood supply. Increase in blood supply may occur due to the direct effect of the heat on the vessels in terms of vasodilation. Due to increased vasodilation, there is an increase in the lumen of the vessels, which leads to increased blood supply.
2. Effect on nerves: – reduce the excitability of the nerves, especially sensory nerves.
3. Muscle relaxation: – rise in temperature induces relaxation of muscles and increases their efficacy of action

vii. Blood Pressure: -reduces blood pressure. This happens due to reduction in peripheral resistance to the flow of blood, which is due to generalized vasodilation and reduction in viscosity of the blood.

TREATMENT PARAMETERS

Frequency:

Shortwave diathermy uses a frequency ranging from 3 to 30MHz Usually a frequency of 27.12 MHz and a wavelength of 11 meters is used. Currents of such high frequencies do not stimulate sensory or motor nerves nor do they produce any muscle contraction. Shortwave diathermy can either be

Continuous shortwave diathermy (CSWD).

Pulsed shortwave diathermy (PSWD).

Continuous short-wave diathermy has a thermal effect more than pulsed, so it is generally used for its thermal effects whereas pulsed short-wave diathermy has athermal effects. Shortwave diathermy uses high-frequency electromagnetic energy to generate heat, in pulsed or continuous energy waves.

Electrodes:

The current is applied to the patient by a heavy, flexible, insulated cable which is used as the electrode and is coiled about or around the patient’s part to be treated.

Methods of application of electrode pads

• Contra planar.
•  

Contra planar electrode placement:

The two electrodes are placed in two different planes, therefore it is called contra planar. The two pads sandwich the treating body part between them.

Coplanar electrode placement:

In contra planar arrangement, the pads are placed side by side on the same plane. This is used to treat large body parts such as the upper back. Lower back. The electrodes should not be placed too close as the wave path does not go deeper.

INDICATIONS

• Sprain and Strain
• Frozen shoulder
• Degenerative joint disease (OA)
• Joint stiffness.
• Tenosynovitis
• Arthritis
• Tendinitis
• Bursitis
• Myofascial pain.
• Lumbar pain.
• Tennis elbow

CONTRAINDICATIONS

• Pregnancy
• Patients who are taking blood-thinning medications
• Cancer
• Severe/excessive edema
• Metallic implant
• Cardiac pacemaker
• Over wet dressing
• Acute inflammation
• Infected open wound
• Impaired thermal sensation
• Recent radiotherapy
• Pregnancy
• Severe cardiac abnormality
• Blood pressure abnormality
• Anesthetic area
• Tuberculosis
• Reproductive organ.

PRECAUTIONS

• Ensure the earthing of the machine.
• The machine and the electrodes should be properly connected.
• Patients should not be allowed to touch the unit.
• Check contraindications.
• The patient should be properly positioned.
• Do not place it over the wet area.
• Check the thermal sensitivity.
• Remove metal if wearing.
• Skin surfaces should be separated by a towel.
• Wait for 2-3 minutes after setting

DURATIONS

In Acute conditions: – 5 to 10 minutes (once or twice daily)

In Chronic conditions: – 20 to 30 minutes

Phototherapy is one among the physiotherapic modalities in which different sources of light are used for therapeutic purpose. These sources of light can be either laser, or infrared or even ultraviolet rays. Infrared rays are electromagnetic waves with a wavelength of 750 to 4,00,000 nm. It is also called as thermiogenic rays since these rays produce heat when they are absorbed by the body tissue. Based on wavelength, the infrared rays are divided into 2 namely shortwave infrared (750 – 1,500 nm) and long wave infrared (above 1,500nm).

In physiotherapy several artificial generators are used for the production of infrared lights and they can be classified into 2 – namely luminous and on luminous generators.

1. Luminous Generators – they are also called as high temperature generators and are in the form of incandescent bulbs. All luminous generators emit electromagnetic waves with a wavelength between 350 – 4000 nm, but the maximum emission of the rays is around 1,000 nm.
2. Nonluminous Generators – also called as low temperature generators. They produce only infrared rays and are not visible. These generators are heated by the passage of electric current through them. All non-luminous generators emit infrared rays in between 750 to 1,500 nm. The maximum emission of the rays is around 4,000 nm.

DEPTH OF PENETRATION

Maximum effective penetration of infrared rays is three centimetres; however it may vary from 0.1mm to a few centimetre.

INDICATIONS

1. Various subacute and chronic inflammatory conditions
2. Various arthritis such as osteoarthritis and rheumatoid arthritis
3. Skin conditions (furunculosis, folliculitis, etc)
4. Bell’s palsy (mainly for pain relief)
5. Various muscle spasm

CONTRAINDICATIONS

1. Fever
2. Pregnancy
3. Malignant conditions
4. Impaired sensations, anaesthetic areas.
5. Cardiac disorders
6. Eczema, dermatitis,
7. Impaired circulation, oedema
8. Varicose veins, etc.