About Electrotherapy

Electrotherapy is the use of electrophysical agents for both evaluation and treatment in a broader context today. The terms “Electrotherapy” and “Electrophysical Agents” are interchangeable terms in the use of any of the electrophysical agents applied externally to the human body for evaluation and treatment. The electrotherapy has been used for many years in physiotherapy and rehabilitation science. The recent growth in the use of electrotherapy is probably related to recent manufacturing and technologic improvements in electrotherapy devices that make the use of these devices more easier and make the use of enhanced treatment options possible.

Characteristics of the Currents
Electric currents create electrothermal, electrochemical, and electrophysical effects in the body in order to achieve therapeutic purposes by revealing direct and indirect physiological responses in the tissues. It is important that practitioners have a good understanding in the basics of electrotherapy and have the ability to apply these basics in order to achieve the desired outcomes.
The desired effects and outcomes of electrotherapy can be influenced specifically by the current type, intensity, voltage, duration, and density of the electrical current. The characteristics and type of the involved or targeted tissue will also affect the outcome of electrotherapy.
Current type: The commonly used electrical currents are direct (DC), alternating (AC), and pulsatile (PC). The current type differentiates depending on:
•    Waveform: sinusoidal, rectangular, twin spike
•    Amplitude: current intensity
•    Pulse duration: width or one pulse length time, a shorter duration is more comfortable
•    Frequency: rate or number of pulses or cycles delivered in per unit time; pulse per second (pps) for PC, or cycles per seconds (cps) for AC. Low-frequency currents used to provide analgesia and to stimulate motion. Medium-frequency currents employed chiefly for pain control. High-frequency currents used to cause a thermal, analgesic and anti-inflammatory effect.
•    Polarity: Polar or apolar stimulation


Action Mechanism of Electrotherapy
Changes occur at various levels of body systems with electrical currents. These changes occur at 4 levels: cellular, tissue, segmental, and systemic. Many structures at any level are affected by means of increased or suppressed physiological activities directly, indirectly, or both.

               Table 1. The Physiological Effects of Electrotherapy
Cellular level
    Excitation of peripheral nerves D
Change in fibroblastic activity D-ID
Change in osteoblastic and osteoclastic activity D-ID
Change in artery, venous, and lymphatic capillary flow D-ID
Change in “Succinate Dehydrogenase” and ATPas activity D-ID
Change in mitochondria size and concentration D-ID
Tissue Level     Regeneration of bone, ligament, connective tissue, and dermal tissue ID
Thermal and chemical changes in tissue D
Muscle contraction, increase in strength ID
    Muscle activation, increased joint mobility ID
Increase in arterial, venous, and lymphatic flow with the pumping action of the muscle ID
Systemic Level     Analgesic effect by releasing betaendorphin, enkephalin, dopamine and dynorphin ID
     D: Direct effects, ID: Indirect Effects  

Therapeutic Goals of Electrotherapy
•    Muscle re-education: Retrain firing patterns or overcome neuromuscular inhibition in intact muscles following injury or pathology. The mechanism is thought in order to increase the quantity of recruited motor units or in order to decrease the inhibition of the motor nerves that limits normal function.
•    Retard atrophy: Cause the muscle to contract during an effort in order to reduce the effects of immobilization or paralysis on atrophy.
•    Retard edema formation: Limits the formation of edema during acute inflammation by inhibiting the increase in vascular permeability with sensory-level stimulation.
•    Remove edema: Removing existing edema through a muscle pump mechanism with motor-level stimulation.
•    Reduce pain: Interfere with the transmission or perception of pain through a variety of different electrotherapy approaches.
•    Reduce spasm: Reduce acute spasms by either decreasing the muscle's contraction frequency or by fatiguing the muscle up to failure (very uncomfortable). Electrotherapy can also be used in order to manage the spasticity associated with neuromuscular diseases or spinal cord trauma.
•    •    Increase strength: Increase muscle force output in non-pathologic tissue by causing hypertrophy of the muscle. The muscular strength can be improved with motor-level stimulation. Although the required protocols are uncomfortable, they are as effective as resistance exercise in increasing strength.  
•    Increase range of motion: A commonly cited but misleading goal. Electrotherapy can be effective in reducing muscle spasticity or edema, which can be encountered with the associated loss of ROM.  Improving ROM by itself could also be gained by increasing muscle strength or elasticity.
•    Transport medications: Iontophoresis deliver medications by driving electrically charged ions through the skin.
•    Tissue healing: There are some evidences that microcurrent may augment tissue repair in individuals with fractures or slow-healing skin ulcerations. The mechanism has yet to be described.

Electrotherapy Modalities
•    Iontophoresis
•    Modified Galvanic Current
•    Faradic Current
•    Diadynamic Currents
•    High Voltage Pulsed Current
•    Transcutaneous Electrical Nerve Stimulation (TENS)
•    Microcurrent Therapy
•    Interferential Therapy
•    Russian Stimulation
•    Functional Electrical Stimulation
•    Biofeedback
•    Shortwave Therapy
•    Microwave Therapy
•    Therapeutic Ultrasound
•    Magnetic Therapy
Shockwave Therapy