Textbook Of Electrotherapy

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Textbook ofElectrotherapynasstth/: /pp.iv pisre/r.i

nasstth/: /pp.iv pisre/r.i

Textbook ofElectrotherapySecond Edition/ri.ssnis arep.iv p/: /tt phJagmohan Singh PhDProfessor and PrincipalGian Sagar College of PhysiotherapyRam Nagar, RajpuraPatiala, Punjab, India JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTDNew Delhi Panama City London Dhaka Kathmandu

Jaypee Brothers Medical Publishers (P) LtdHeadquartersJaypee Brothers Medical Publishers (P) Ltd4838/24, Ansari Road, DaryaganjNew Delhi 110 002, IndiaPhone: 91-11-43574357Fax: 91-11-43574314Email: [email protected] Medical Publishers Inc.City of Knowledge, Bld. 237, ClaytonPanama City, PanamaPhone: 507-301-0496Fax: 507-301-0499Email: [email protected] Medical Ltd83 Victoria Street, LondonSW1H 0HW (UK)Phone: 44-2031708910Fax: 02-03-0086180Email: [email protected] pJaypee Brothers Medical Publishers (P) Ltd17/1-B Babar Road, Block-B, ShaymaliMohammadpur, Dhaka-1207BangladeshMobile: 08801912003485Email: [email protected]/: /pWebsite: www.jaypeebrothers.comWebsite: www.jaypeedigital.comtthssnaOverseas Offices/r.iisreJaypee Brothers Medical Publishers (P) LtdShorakhute, KathmanduNepalPhone: 00977-9841528578Email: [email protected] 2012, Jaypee Brothers Medical PublishersAll rights reserved. No part of this book may be reproduced in any form or by any means without the prior permissionof the publisher.Inquiries for bulk sales may be solicited at: [email protected] book has been published in good faith that the contents provided by the author contained herein are original, and isintended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher andthe author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or applicationof any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Whereappropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.Textbook of ElectrotherapyFirst Edition: 2005Second Edition: 2012ISBN 978-93-5025-959-7Printed at

Dedicated tossMy Parents, Teachers, Friends, Students, WifeandMy Daughters Jinia & Jinishanatth/: /pp.iv pisre/r.i

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Preface to the Second Edition/r.iTextbook of Electrotherapy Second Edition has been designed to cater to the long-pendingneeds of students of Bachelor of Physiotherapy (BPT) especially 1st and 2nd year and alsoof 3rd and 4th year. The book is also useful for professionals of physiotherapy, teachers,doctors, rehabilitation professionals, other paramedics and public in general.The book has been compiled and prepared as per the curriculum of Electrotherapy forBPT degree courses devised by the following Universities: Baba Farid University of HealthSciences, Faridkot, Tamil Nadu; Dr MGR Medical University, Chennai, Tamil Nadu; RajivGandhi University of Health Sciences (RGUHS), Bengaluru; Manipal Academy of HigherEducation (MAHE), Manipal; NTR University of Health Sciences, Vijayawada, AndhraPradesh; Guru Nanak Dev University, Amritsar, Punjab; Punjab University, Chandigarh;Punjabi University, Patiala; Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh; Choudhary Charan Singh (CCS) University, Meerut, Uttar Pradesh;HNB University, Srinagar, Garhwal, Uttaranchal; University of Allahabad; Dr Bhim RaoAmbedkar University, Agra; Guru Jambheshwar University, Hisar, Haryana; KurukshetraUniversity, Kurukshetra, Haryana; Nagpur University, Nagpur; University of Pune, Pune;Devi Ahilya University, Indore, Madhya Pradesh; University of Delhi; GGS IndraprasthaUniversity, New Delhi; Jamia Hamdard, New Delhi; Utkal University, Bhubaneshwar,Odisha; University of Calcutta, Kolkata, West Bengal; Sri Ramachandra Medical Centre(SRMC), Chennai, Tamil Nadu; Alagappa University, Karaikudi, Tamil Nadu, etc.Not many books on Electrotherapy are available, especially the books which is writtenfor the students studying physiotherapy. This subject is essential and is a basic subjectof physiotherapy for the undergraduate and as well as for the postgraduate courses.A limited number of textbooks are available in the markets, which are suitable for thestudents. To avoid confusion in understanding each topic of the entire subject, Textbook ofElectrotherapy has been written in a systematic manner in a very simple approach for thestudents, professionals of physiotherapy, teachers, doctors, rehabilitation professionals,other paramedics and public in general. Recently, lots of advances have taken place in thefield of electrotherapy. Utmost efforts have been made to cover all the necessary aspects ofelectrotherapy. All chapters have been written in a very simple and lucid manner.In ancient times, two modes of treatments—physical therapy and chemotherapywere available to mankind, i.e. treatment by physical means and treatment by chemicalmeans. Physical means included the use of sun, earth, air, water, electricity, etc. Chemicalmeans included chemical agents which were therapeutically useful for clinical purposes.Electrotherapy is an ever-advancing field. Recent advances have made electrotherapy veryinteresting, lots of new modalities have been found effective for the treatment of variousailments. Utmost efforts have been made to make the textbook up-to-date. Starting fromthe history of electrotherapy to the recent advances, all the aspects have been covered indetails.nasstth/: /pp.iv pisre

Textbook of ElectrotherapyviiiI have tried to give a fairly complete coverage of the subject describing the mostcommon modalities known to be employed by physiotherapists. The intention is toexplain how these modalities work and their effects upon the patient. In the initial chapter,I have tried to lay the foundations of the principles of electrotherapy because a thoroughunderstanding of these principles will ultimately lead to safer and more effective clinicalpractice. The nature, production, effects and uses on the body tissues of each modality areexplained and illustrated.Chapter One covers the Basics of Electricity, Light and Sound. Starting from the origin ofElectricity, to the use in various experiments in sciences, to the conduction of electricityin nerves and contraction of muscles, all basic aspects have been covered in details.Fundamental principles of electricity have been explained in details, i.e. Ohm’s Law,Coulomb’s Law, Law of conservation of energy, quantization of electricity, etc. Staticelectricity and current electricity has also been explained. Thermal and chemical effectsof currents, magnetic effects of currents and electromagnetic waves have also been added.Physical principles of Light and Sound has been added.Chapter Two covers the Low Frequency Currents. Starting from faradic type current,modified faradic current, iontophoresis, commonly used ions and their indications for use,methods of treatment, safety and precautions have also been included. TENS, types ofTENS, methods of treatment, indications for use, dangers and contraindications, MENSare also added. Indications for the use of low frequency currents and physiological effectsof low frequency currents have been explained in detail.Methods of treatment are the special features of the book. Comprehensive proformafor the assessment of the patient’s condition has been formulated for the convenienceof the students. Methods of median nerve stimulation, ulnar nerve stimulation, radialnerve stimulation, Erb’s paralysis, facial nerve stimulation, deltoid inhibition, quadricepsinhibition, lateral popliteal nerve stimulation, faradism under pressure and faradic footbath have been explained in detail. Common motor points have also been demonstrated.Chapter Three covers the Middle Frequency Currents. Interferential therapy, methodsof treatment, advantages of interferential currents, physiological effects of interferentialtherapy have been explained in detail. Russian currents and Rebox-type currents are alsoexplained.Chapter Four covers the High Frequency Currents. Short wave diathermy, methods ofapplications, indications for use, physiological effects, therapeutic effects, dangers andcontraindications are explained in detail.Microwave diathermy, methods of applications, indications for use, physiologicaleffects, therapeutic effects, dangers and contraindications are also explained in this chapter.Long Wave Diathermy has been added.Chapter Five covers the Radiation Therapy. Infrared therapy, ultraviolet radiation, typesof generators, methods of applications, indications for use, physiological effects, therapeutic effects, dangers and contraindications have been explained in detail.Chapter Six covers the Laser Therapy. Production of lasers, types of lasers, methodsof application, indications for use, physiological effects, therapeutic effects, dangers andcontraindications have been explained in detail.Chapter Seven covers the Superficial Heating Modalities. Its composition, methodsof applications, indications for use, physiological effects, therapeutic effects, dangersnasstth/: /pp.iv pisre/r.i

Preface to the Second Editionixand contraindications have been explained in detail. Hot packs, electric heating packs,whirlpool bath, contrast bath, heliotherapy and sauna bath have also been explained.Chapter Eight covers the Ultrasonic Therapy. The production of ultrasound, thermal andmechanical effects of ultrasound, methods of applications, indications for use, physiologicaleffects, therapeutic effects, dangers and contraindications have been explained in detail.Shockwave Therapy is also added.Chapter Nine covers the Cryotherapy. Methods of applications, indications for use,physiological effects, therapeutic effects, dangers and contraindications have been explainedin detail.Chapter Ten covers the Biofeedback. Its instrumentation, types of biofeedback, effectsand uses, indications for use.Chapter Eleven covers the Electromyography. Its instrumentation, uses, study ofelectromyograph, spontaneous potential, insertional activity, motor unit action potentialand recruitment pattern, abnormal potentials, spontaneous activity, positive sharp waves,fasciculation potential, and repetitive discharges have been explained in details.Nerve conduction velocity, its instrumentation, sensory nerve conduction velocity,motor nerve conduction velocity, methods of stimulation and recording have also beenincluded. The H reflex, F wave, and their clinical significance have also been explained.Kinesiological Electromyography, surface and fine wire recording, placement of electrodesand its clinical importance have been explained.Glossary of terms, Suggested Reading and Index are also given at the end of this book.Any suggestions from the teachers and students will be highly appreciated so thatfurther improvements in the title can be made in the subsequent edition in the light of thesame.ssnatth/: /pp.iv pisre/r.iJagmohan Singh

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Preface to the First Edition/r.iThe book titled Textbook of Electrotherapy has been designed to cater the long-pendingneeds of students of bachelor of physiotherapy especially 1st and 2nd year and also of 3rdand 4th year. The book is also useful for professionals of physiotherapy, teachers, doctors,rehabilitation professionals, other paramedics and public in general.This book has been compiled and prepared as per the curriculum of Electrotherapy forBPT degree courses devised by the following Universities: Baba Farid University of HealthSciences, Faridkot; Tamil Nadu Dr MGR Medical University, Chennai; Rajiv GandhiUniversity of Health Sciences, Bangalore; Manipal Academy of Higher Education, Manipal;NTR University of Health Sciences, Vijayavada; Guru Nanak Dev University, Amritsar;Punjab University, Chandigarh; Punjabi University, Patiala; PGIMER, Chandigarh; CCSUniversity, Meerut; HNB Garhwal University, Srinagar, Garhwal (UA); University ofAllahabad; Dr Bhim Rao Ambedkar University, Agra; Guru Jambheshwar University,Hisar (Haryana); Kurukshetra University, Kurukshetra (Haryana); Nagpur University,Nagpur; University of Pune, Pune; Devi Ahilya University, Indore (MP); University ofDelhi; GGS Indraprastha University, New Delhi; Jamia Hamdard, New Delhi; UtkalUniversity, Bhubaneshwar, Odisha; University of Calcutta; SRMC, Chennai; AlagappaUniversity, Karaikudi; etc.Not many books on Electrotherapy are available in India, especially the book which iswritten for the students studying physiotherapy in India. This subject is essential and is abasic subject of physiotherapy for the undergraduate and as well as for the postgraduatecourses. Very few books by the Indian authors are available. A limited number of textbooksare available in the market, which are suitable for the students. To avoid confusion inunderstanding each topic of the entire subject; this Textbook of Electrotherapy has beenwritten in a systematic manner in a very simple approach for the students, professionalsof physiotherapy, teachers, doctors, rehabilitation professionals, other paramedics andpublic in general. Recently, lots of advances have taken place in the field of electrotherapy.Utmost efforts have been made to cover all the necessary aspects of electrotherapy. Allchapters have been written in a very simple and lucid manner.In ancient times, two modes of treatments—physical therapy and chemotherapywere available to mankind, i.e. treatment by physical means and treatment by chemicalmeans. Physical means includes the use of sun, earth, air, water, electricity, etc. Chemicalmeans includes chemical agents which were therapeutically useful for clinical purposes.Electrotherapy is an ever-advancing field. Recent advances have made electrotherapy veryinteresting, lots of new modalities have been found effective for the treatment of variousailments. Utmost efforts have been made to make this textbook up-to-date. Starting fromthe history of electrotherapy to the recent advances, all the aspects have been covered indetails.nasstth/: /pp.iv pisre

Textbook of ElectrotherapyxiiI have tried to give a fairly complete coverage of the subject describing the mostcommon modalities known to be employed by physiotherapists. The intention is toexplain how these modalities work and their effects upon the patient. In the initial chapter,I have tried to lay the foundations of the principles of electrotherapy because a thoroughunderstanding of these principles will ultimately lead to safer and more effective clinicalpractice. The nature, production, effects and uses on the body tissues of each modality areexplained and illustrated.Chapter One covers the Introduction of Electrotherapy. Starting from the origin ofelectricity, to the use in various experiments in sciences, to the conduction of electricityin nerves and contraction of muscles, all basic aspects have been covered in details.Fundamental principles of electricity have been explained in details, i.e. Ohm’s Law,Coulomb’s Law, Law of conservation of energy, quantization of electricity, etc. Staticelectricity and current electricity has also been explained. Thermal and chemical effectsof currents, magnetic effects of currents and electromagnetic waves have also been added.Chapter Two covers the Low frequency currents. Starting form faradic type current,modified faradic current, electrotherapeutic currents including alternating, direct andpulsed currents, interrupted direct current, evenly alternating currents including sinusoidalcurrents and didynamic currents, interrupted ialvanic current to the electrical nervestimulation, accommodation, effects of frequency of stimulation, strength of contraction,pathological changes in peripheral nerve, seddon’s classification of nerve injuries, processof denervation and regeneration of nerve. Different waveforms, waveform shape, pulse vsphases and direction of current flow, pulse amplitude, pulse charge, pulse rate of rise anddecay time, asymmetric waveforms, exponential current, pulse duration, pulse frequencyand current modulations have also been added in this Chapter. Indications for the useof low frequency currents and physiological effects of low frequency currents have beenexplained in details.Methods of treatment are the special features of this book. Comprehensive proformafor the assessment of the patient’s condition has been formulated for the convenienceof the students. Methods of median nerve stimulation, ulnar nerve stimulation, radialnerve stimulation, Erb’s paralysis, facial nerve stimulation, deltoid inhibition, quadricepsinhibition, lateral popliteal nerve stimulation, faradism under pressure and faradic footbath have been explained in details. Common motor points have also been demonstrated.Iontophoresis, commonly used ions and their indications for use, methods of treatment,safety and precautions have also been included. TENS, type of TENS, methods of treatment,indications for use, dangers and contraindications are also added.Chapter Three covers the Middle Frequency Currents. Interferential therapy, methodsof treatment, advantages of interferential currents, physiological effects of interferentialtherapy have been explained in details. Russian currents and Rebox-type currents are alsoexplained.Chapter Four covers the High Frequency Currents. Short wave diathermy, methodsof application, indications for use, physiological effects, therapeutic effects, dangers andcontraindications are explained in details.Microwave diathermy, methods of application, Indications for use, physiological effects,therapeutic effects, dangers and contraindications are also explained in this Chapter.nasstth/: /pp.iv pisre/r.i

Preface to the First EditionxiiiChapter Five covers the Radiation Therapy. Infrared therapy, ultraviolet radiation,types of generators, methods of applications, indications for use, physiological effects,therapeutic effects, dangers and contraindications have been explained in details.Chapter Six covers the Laser Therapy. Production of lasers, types of lasers, methodsof applications, indications for use, physiological effects, therapeutic effects, dangers andcontraindications have been explained in details.Chapter Seven covers the Paraffin-wax Bath Therapy and Other Healing Modalities. Itscomposition, methods of applications, indications for use, physiological effects, therapeuticeffects, dangers and contraindications have been explained in details. Hot packs, electricheating peaks, whirlpool bath, contrast bath, heliotherapy and sauna bath have also beenexplained.Chapter Eight covers the Ultrasonic Therapy. The production of ultrasound, thermaland mechanical effects of ultrasound, methods of applications, indications for use,physiological effects, therapeutic effects, dangers and contraindications have beenexplained in details.Chapter Nine covers the Cryotherapy. Methods of applications, indications for use,physiological effects, therapeutic effects, dangers and contraindications have beenexplained in details.Chapter Ten covers the Biofeedback. Its instrumentation, types of biofeedback, effectsand uses, indications for use.Chapter Eleven covers the EMG, NCV and Evoked Potentials. Its instrumentation, uses,study of electromyograph, spontaneous potential, insertional activity, motor unit actionpotential and recruitment pattern, abnormal potentials, spontaneous activity, positivesharp waves, fasciculation potential, and repetitive discharges have been explained indetails.Nerve conduction velocity, its instrumentation, sensory nerve conduction velocity,motor nerve conduction velocity, methods of stimulation and recording has also beenincluded. The H reflex, F wave, and their clinical significance have also been explained.Kinesiological Electromyography, surface and fine wire recording, placement of electrodesand its clinical importance have been explained.Glossary of terms

Electrotherapy Second Edition Jagmohan Singh PhD Professor and Principal Gian Sagar College of Physiotherapy Ram Nagar, Rajpura Patiala, Punjab, India JAYPEE BROTHERS MEDICAL PUBLISHERS (P) L