Stanbridge - T4 - Modalities - W6 - Other Modalities

PTA 1009 - Modalities Week 6: Additional Physical Agents

• This week's focus is on extracorporeal shockwave therapy (ESWT) and pulsed electromagnetic fields (PEMF).

Extracorporeal Shockwave Therapy (ESWT)

• ESWT uses high-energy shockwaves.
• Originally used for lithotripsy (breaking up kidney stones).
• Gradually integrating into physical therapy.
• Different energies include reverse piezoelectric, electromagnetic, and electrohydraulic.
• Treatment area must be targeted using ultrasound or fluoroscopy.
• Treatment success depends on shockwave concentration.

ESWT Objectives

• Students should be able to describe types of ESWT.
• Understanding physical principles of ESWT and physiological responses.
• Knowing indications, contraindications, and side effects of ESWT.
• Recognizing the advantages and disadvantages.
• Learning about dosage and frequency for ESWT.

ESWT Physiological Effects

• Disintegrates calcium deposits.
• Produces hyperstimulation analgesia.
• Promotes neovascularization.
• Affects cell permeability.

ESWT Clinical Applications

• Number of shockwave pulses and energy density determine treatment energy.
• Low intensity: less than 0.1 mJ/mm².
• Moderate intensity: 0.1-0.2 mJ/mm².
• High intensity: greater than 0.2 mJ/mm².
• Treatment duration can be up to 30 minutes.
• Possible side effects include hematoma, redness, petechiae, local soft tissue swelling, and transient pain.

ESWT Contraindications

• Bleeding conditions.
• Pacemakers.
• Medications preventing blood clotting.
• Children.
• Pregnancy.
• Acute injuries.

ESWT Evidence

• Successful in treating conditions like plantar fasciopathy, noncalcific supraspinatus tendinopathy, calcifying shoulder tendonitis, Achilles tendonopathy, and lateral epicondylitis.

Pulsed Electromagnetic Fields (PEMF)

• Non-thermal treatment introduced in the mid-1970s.
• Primarily used for fracture healing (non-unions or delayed unions, 16 weeks or later).
• Other uses include soft tissue trauma, acute inflammation, osteoarthritis, and depression.

PEMF Therapy Mechanisms

• Every living cell produces an electromagnetic field, which helps cells communicate.
• Disruption in electromagnetic communication can impair cell metabolism.
• PEMFs deliver precisely targeted electromagnetic fields.
• These fields stimulate chemical and electrical processes.
• Cells improve cellular energy.

PEMF Intended Effects

• Reduce pain and inflammation.
• Improve energy, circulation, and tissue oxygenation.
• Enhance sleep quality, blood pressure, cholesterol levels, cell regeneration, and nutrient absorption/cellular detoxification.
• Balance the immune system.
• Stimulate RNA and DNA synthesis and repair.
• Accelerate bone and soft tissue repair.
• Relax muscles.

PEMF Contraindications

• Pacemakers.
• Insulin pumps.

PEMF Treatment Time and Frequency

• Fractures (non-unions): 8 hours/day.
• Soft tissue/osteoarthritis: 2 x 15 minutes/day.
• Frequency: usually 1-50 Hz (extremely low frequency).
• Speed: 50 T/sec (T=Tesla).

PEMF Evidence

• Studies including We et al. (2013) and Dingemanse et al. (2014) show PEMF improving knee function after treatment.
• Additional studies suggested PEMF might help with pain relief.

Electromagnetic Therapy Documentation

• Documentation should include modality used, method of application, duration, body area treated, patient position, special precautions/concerns, and patient response (especially adverse responses).

Electromagnetic Therapy Assessment

• Outcome measures to assess effectiveness include pain scales (VAS), range of motion (goniometry), and muscle guarding/flexibility (related to joint ROM).