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The Effects of Home Interferential Therapy on Post-Operative Pain, Edema, and Range of Motion of the Knee
Abstract
We studied the effects of home interferential current therapy (IFC) on postoperative pain, range of motion, and edema in subjects undergoing anterior cruciate ligament (ACL) reconstruction, menisectomy, or knee chondroplasty.
Randomized, double-blind, placebo-controlled prospective study.
A tertiary care outpatient orthopaedic clinic/ambulatory surgery center. SUBJECTS OR PARTICIPANTS: Eighty-seven subjects were separated into three groups based on their type of knee surgery and within each group randomized into a treatment or placebo group.
All subjects received home IFC units. Subjects randomized to treatment group received a working IFC unit. Placebo subjects received units that were previously set to deliver no current.
Post-operative edema at 24, 48, and 72 hours, and weeks 1-8; range of motion at 1, 3, 6, and 9 weeks; pain immediately after surgery, at 24, 48, and 72 hours, and weeks 1-7; and amount of pain medication taken at days 1-10 were compared between treatment and placebo groups.
All IFC subjects reported significantly less pain and had significantly greater range of motion at all post-operative time points. ACL and menisectomy IFC subjects experienced significantly less edema at all time points, while chondroplasty subjects experienced significantly less edema until 4 weeks postoperatively.
These findings indicate that home IFC may help reduce pain, pain medication taken, and swelling while increasing range of motion in patients undergoing knee surgery. This could result in quicker return to activities of daily living and athletic activities.
... [3,14] The uses of IFT include enhancing muscle strength and endurance by continuing contraction through the muscles, controlling and reducing pain by pain gate theory and pain mechanism, [15,16] as well as enhancing tissue healing, managing spasticity, reducing joint swelling, improving the range of motion of joints, and assisting in the use of orthoses. [16][17][18][19][20][21] IFT has many advantages including being completely noninvasive, easy to use, cost-effective, and suitable for wide use as it can be self-administered at home. [22] Notable that the main cons of therapeutic interferential are to be considered the placebo effect in many studies in terms of pain which may give false and inaccurate indications. ...
... [9,30] IFT is commonly used clinically in terms of reducing pain in the form of an analgesic effect. [18,[31][32][33][34][35] The sedative effect of therapeutic IFT involves increasing local vasodilatory on the tissues and the pain gait theory [15] which can be explained as the following. When action potential traveling through large diameter myelinated afferent nerves to the central ascending sensory tracts in the dorsal horn of the spinal cord with small diameter unmyelinated sensory fibers carrying pain information. ...
... [7] Studies have shown that using a suction electrode may be beneficial in reducing edema, but the evidence remains limited. [9,34] Jarit et al. [18] illustrated a change in edema following knee surgery among 87 patients who had different forms of knee surgery such as anterior cruciate ligament repair, meniscectomy, or chondroplasty. The subjects were allocated into three groups and given IFT for 9 weeks. ...
... IFC is delivered superficially using electrodes placed on the skin (Johnson andTabasam, 2003a, 2003b). The use of this current has been proved effective for individuals in: musculoskeletal affections (Fuentes, Armijo-Olivo, Magee, and Gross, 2010b); postoperative pain (Jarit, Mohr, Waller, and Glousman, 2003); chronic low back pain (Albornoz-Cabello et al., 2017;Correa et al., 2013;Rajfur et al., 2017); osteoarthritis (Burch, Tarro, Greenberg, and Carroll, 2008;Gundog et al., 2012); total knee arthroplasty surgery (Kadı et al., 2019); carpal tunnel syndrome (Koca et al., 2014); and hemiplegic shoulder pain (Eslamian et al., 2020;Suriya-Amarit, Gaogasigam, Siriphorn, and Boonyong, 2014). ...
... IFC's hypoalgesic response has been effective with lower medium frequencies (Venancio et al., 2013) regardless of AMF (Fuentes, Armijo-Olivo, Magee, and Gross, 2010a;Jarit, Mohr, Waller, and Glousman, 2003;Johnson and Tabasam, 2002;Palmer, Martin, Steedman, and Ravey, 1999). In addition, previous studies suggest that medium frequency and intensity level of IFC are the relevant stimulation parameters to produce hypoalgesia (Johnson and Tabasam, 2003a;Kinnunen and Alasaarela, 2004;Palmer, Martin, Steedman, and Ravey, 1999). ...
... Evidence on IFC is still reported empirically and studies showed the hypoalgesic efficacy of IFC is independent from AMF (Fuentes, Armijo-Olivo, Magee, and Gross, 2010a;Jarit, Mohr, Waller, and Glousman, 2003;Johnson and Tabasam, 2003a;Palmer, Martin, Steedman, and Ravey, 1999). Lower medium frequencies (1 and 2 kHz) produced a greater analgesic effect (Venancio et al., 2013). ...
Background:
Interferential current (IFC) is a non-pharmacological therapy often used to reduce pain intensity. However, there is no scientific evidence of the biological effects of the adjustment of IFC intensity of stimulation.
Objective:
To investigate whether the adjustment of IFC intensity influences pain on cutaneous sensory threshold (CST), pressure pain threshold (PPT) and pain intensity in healthy subjects under mechanically induced pain.
Methods:
This is a placebo-controlled randomized trial. One hundred and two healthy university students blinded to intervention were randomized using opaque sealed envelopes to the following groups: 1) sensory IFC (n = 24); 2) fixed motor IFC (n = 26); 3) adjusted motor IFC (n = 27); and 4) placebo IFC (n = 25). After 40 minutes of stimulation or placebo, subjects were evaluated by an investigator blinded to group allocation. CST (von Frey filaments), PPT (algometry), and pain intensity (11-point numerical scale) were measured.
Results:
Adjusted motor IFC promoted a significant reduction of CST (hand: mean difference (MD) = 2.39, confidence intervals (CI) = 1.39-3.38; and forearm: MD = 3.01, CI = 2.87-3.14) compared to placebo. Adjusted motor IFC increased PPT significantly (hand: MD = 27.59, CI = 26.80-28.37; and forearm: MD = 34, CI = 25.74-42.25) when compared to placebo. Adjusted motor IFC reduced pain intensity by 4.01 points (CI = 3.64-4.55) when compared to placebo. No adverse events were observed.
Conclusions:
Adjusted motor IFC intensity increased PPT and CST and also reduced pain intensity in healthy subjects under mechanically induced pain.
... The upper limb functionality was evaluated using the Constant-Murley score, which consists of a 100-point scale, with final values representing different functional levels: excellent (>80), good (65-79), medium (50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64), and bad (<50) [44]. The minimal detectable change for the Constant-Murley score has been set at 17 points for individuals with subacromial impingement syndrome [45]. ...
... Third, the clinical context and the social connection between patient and therapist seem to modulate the effect of IFT [62,63], although these aspects have been scarcely controlled in the existing literature. Finally, only one previous trial has evaluated the effects of IFT, compared to sham IFT, on post-operative pain, and range of motion in patients undergoing knee surgery [64]. Even though IFT showed positive findings on increasing range of motion, and reducing pain, medication intake, and swelling [64], more definite conclusions need to be built upon more high-quality evidence [27]. ...
... Finally, only one previous trial has evaluated the effects of IFT, compared to sham IFT, on post-operative pain, and range of motion in patients undergoing knee surgery [64]. Even though IFT showed positive findings on increasing range of motion, and reducing pain, medication intake, and swelling [64], more definite conclusions need to be built upon more high-quality evidence [27]. Some potential study limitations should be mentioned. ...
Subacromial pain syndrome (SAPS) is a prevalent condition that results in loss of function. Surgery is indicated when pain and functional limitations persist after conservative measures, with scarce evidence about the most-appropriate post-operative approach. Interferential therapy (IFT), as a supplement to other interventions, has shown to relieve musculoskeletal pain. The study aim was to investigate the effects of adding IFT electro-massage to usual care after surgery in adults with SAPS. A randomized, single-blinded, controlled trial was carried out. Fifty-six adults with SAPS, who underwent acromioplasty in the previous 12 weeks, were equally distributed into an IFT electro-massage group or a control group. All participants underwent a two-week intervention (three times per week). The control group received usual care (thermotherapy, therapeutic exercise, manual therapy, and ultrasound). For participants in the IFT electro-massage group, a 15-min IFT electro-massage was added to usual care in every session. Shoulder pain intensity was assessed with a 100-mm visual analogue scale. Secondary measures included upper limb functionality (Constant-Murley score), and pain-free passive range of movement. A blinded evaluator collected outcomes at baseline and after the last treatment session. The ANOVA revealed a significant group effect, for those who received IFT electro-massage, for improvements in pain intensity, upper limb function, and shoulder flexion, abduction, internal and external rotation (all, p < 0.01). There were no between-group differences for shoulder extension (p = 0.531) and adduction (p = 0.340). Adding IFT electro-massage to usual care, including manual therapy and exercises, revealed greater positive effects on pain, upper limb function, and mobility in adults with SAPS after acromioplasty.
... Interferential current (IFC) therapy is a simple, non-invasive and non-pharmacological treatment commonly used in clinical practice to alleviate pain, mainly of musculoskeletal origin, for muscle strength production, edema reduction, autonomic effects (control of incontinence, heart rate variability, blood flow velocity and vessel size), tissue repair and spasticity treatment after a cerebrovascular accident [1][2][3][4][5][6], mostly in the United Kingdom, other European countries and Australia [7]. It is a medium-frequency alternating current, and although commercial units allow several parameter adjustments, the rationale behind each parameter effect has been based on textbooks and the clinical experience of physical therapists rather than well-controlled studies [8]. ...
... No positive IFC therapy results have been found for shoulder disorders [36,37]. Nevertheless, IFC therapy has shown analgesic effects for neck pain [38,39], low back pain [21,22,[40][41][42], knee osteoarthritis [26,27,[43][44][45] or postoperative knee pain [4,46]. Most of these studies have used the following parameters: carrier frequency of 4 kHz, AMF between 30-180 Hz, for 20-40 min with a strong but comfortable intensity. ...
Background and Objectives: Transcutaneous electrical stimulation of low- and medium-frequency currents is commonly used in pain management. Interferential current (IFC) therapy, a medium frequency alternating current therapy that reportedly reduces skin impedance, can reach deeper tissues. IFC therapy can provide several different treatment possibilities by adjusting its parameters (carrier frequency, amplitudemodulated frequency, sweep frequency, sweep mode or swing pattern, type of application (bipolar or quadripolar), time of application and intensity). The objective of this review article is to discuss the literature findings on the analgesic efficacy of IFC therapy. Conclusions: According to the literature, IFC therapy shows significant analgesic effects in patients with neck pain, low back pain, knee osteoarthritis and post-operative knee pain. Most of the IFC parameters seem not to influence its analgesic effects. We encourage further studies to investigate the mechanism of action of IFC therapy.
... The theory behind the use of IFT is based on the intersection of two medium frequency currents, between 2 and 10 KHz, considered as carrier frequencies and generating what is called beating lowfrequency current between 0 and 150 Hz in the deep tissues [9]. These created beat frequencies, depending on the frequency chosen, are accused to modulate pain in the applied region and foster the reduction of edema and improvement of joint range of motion (ROM) [10]. The choice of amplitude modulated frequency (AMF) is dependent to the desired physiological and therapeutic response whether the target is the nerve or other tissues. ...
... When comparing the effect of IC in comparison with other types of electrical stimulation particularly Transcutaneous Electrical Nerve Stimulation [TENS], it was found that IC application significantly reduced pain [22], they also explained the reported results by the fact that IC have the potential to enter deeply into the targeted tissues, due to the low tissue impedance resulting from the carrier frequency. In other context, IC has been also proven effective in managing many reported dysfunctions particularly pain, edema, and limited range of motion [10]. A systematic review discussing the effectiveness of IC in various musculoskeletal conditions concluded that such noninvasive intervention appears to have an additional analgesic effect for reducing pain than control treatment and more effective than placebo treatment at the 3month followup [23]. ...
Background. Interstitial cystitis is a range of urological manifestations that are characterized by bladder, pelvic and urethral pain, just as irritative voiding side effects. It is characterized by the International Continence Society as the protest of suprapubic pain, identi ied with bladder illing combined by different manifestations, for example, expanded day time and evening time recurrence, without demonstrated urinary contamination or different evident pathology of the lower urinary tract. Objective. To investigate the effect of interferential electrical stimulation on pain perception and disability level on interstitial cystitis. Participants and methods. A total of 40 volunteering women diagnosed with interstitial cystitis. Their ages were ranged between 25 to 40 years old and their body mass index was > 30 kg/m2. Participants were randomly assigned to two equally numbered groups; group (A) receiving interferential current at the lower abdomen, in addition to a routine medical intervention, or group (B) receiving solely routine medical intervention for 8 successive weeks. Participants were assessed for pain using visual analog scale (VAS), related disability index using levels using O'Leary-Sant Symptom Index or Interstitial Cystitis Index (ICSI), and blood cortisol concentration. Measurements were taken before and after eight weeks of intervention. Results. The analysis of the results revealed a signi icant reduction in VAS score (P < 0.0001), ICSI scores (P < 0.0001), and the plasma cortisol concentration (P < 0.0001) in the participants of group (A) at the end of the treatment, compared to group (B). Conclusion. These results concluded that adding IC therapy to routine medical intervention had an excellent effect on the management of interstitial cystitis associated signs and symptoms particularly pain, plasma cortisol levels, related disabilities.
... The use of IFC has been commonly reported for the promotion of symptomatic pain relief [4,5]. Studies have shown that this current is effective in reducing pain in individuals with arthritis [5], gonartrosis [6,7], psoriasis [8], fibromyalgia [9], primary dysmenorrhea [10], low back pain [11][12][13], and postoperative pain [14,15]. ...
... Despite this, many studies use the inactive placebo to test the effectiveness of IFC [7, 14,23,34,35]. Fuentes et al. [23] demonstrated the efficacy of active IFC compared to a placebo condition (inactive placebo) and control, in which no treatment is applied and the research subject knows that there is no intervention. In this study, the placebo and control methods used were not effective in reducing pain, and the effects did not differ among them. ...
Objective. The present study aimed to investigate if a new placebo device for interferential current (IFC) that delivers current during only the first 40 seconds of stimulation is effective at promoting adequate subject blinding.
Methods. Seventy-five subjects were recruited and enrolled into three groups: active IFC, inactive placebo, and new placebo. Pressure pain threshold (PPT), cutaneous sensory threshold (CST), and pain intensity were measured before and after the intervention. After the final assessment, the subjects and the investigator who applied the current were asked about the type of stimulation administered.
Results. None of the placebo forms studied resulted in significant changes to PPT, CST, or pain intensity. The subjects stimulated with active IFC at high intensities (> 17 mA) of stimulation showed higher PPT and CST and lower pain intensity than subjects stimulated at low intensities ( p < 0.03). The new placebo method blinded the investigator in 100% of cases of IFC and 60% of subjects stimulated, whereas for inactive placebo, the investigator was blinded at a rate of 0% and 34% of subjects.
Conclusion. The new method of placebo IFC was effective for blinding of research investigators and most of the active IFC-treated subjects, promoting an appropriate placebo method.
... It is characterized by the interference of two mediumfrequency currents, which combine to produce a new medium-frequency current whose amplitude is modulated at low frequency [DeDomenico, 1982;Noble et al. 2000], which produces lower impedance to the skin and allows deeper penetration into tissue [Noble et al. 2000]. Some studies have shown that IFT is effective in the management of various pain conditions [Bircan et al. 2002;Jarit et al. 2003;Johnson and Tabasam, 2003]. ...
... IFT is an electrotherapy modality that is thought to decrease pain, increase range of motion, and decrease oedema [Jarit et al. 2003;Jorge et al. 2006;Werners et al. 1999]. Similar to our findings, other studies has shown significant improvement in VAS, and WOMAC subscales including pain, stiffness and physical function in knee related pathologies [Burch et al. 2008;Cheing and Hui-Chan, 2003;Gundog et al. 2012]. ...
... It is characterized by the interference of two mediumfrequency currents, which combine to produce a new medium-frequency current whose amplitude is modulated at low frequency [DeDomenico, 1982;Noble et al. 2000], which produces lower impedance to the skin and allows deeper penetration into tissue [Noble et al. 2000]. Some studies have shown that IFT is effective in the management of various pain conditions [Bircan et al. 2002;Jarit et al. 2003;Johnson and Tabasam, 2003]. ...
... IFT is an electrotherapy modality that is thought to decrease pain, increase range of motion, and decrease oedema [Jarit et al. 2003;Jorge et al. 2006;Werners et al. 1999]. Similar to our findings, other studies has shown significant improvement in VAS, and WOMAC subscales including pain, stiffness and physical function in knee related pathologies [Burch et al. 2008;Cheing and Hui-Chan, 2003;Gundog et al. 2012]. ...
Knee osteoarthritis (OA) is the main cause of pain, physical impairment and chronic disability in older people. Electrotherapeutic modalities such as interferential therapy (IFT) and action potential simulation (APS) are used for the treatment of knee OA. In this study, we aim to evaluate the therapeutic effects of APS and IFT on knee OA.
In this randomized clinical trial, 67 patients (94% female and 6% male with mean age of 52.80 ± 8.16 years) with mild and moderate knee OA were randomly assigned to be treated with APS (n = 34) or IFT (n = 33) for 10 sessions in 4 weeks. Baseline and post-treatment Western Ontario and McMaster Universities Osteoarthritis (WOMAC) subscales, visual analogue scale (VAS) and timed up and go (TUG) test were measured in all patients.
VAS and WOMAC subscales were significantly improved after treatment in APS and IFT groups (p < 0.001 for all). TUG was also significantly improved after treatment in APS group (p < 0.001), but TUG changes in IFT was not significant (p = 0.09). There was no significant difference in VAS, TUG and WOMAC subscales values before and after treatment as well as the mean improvement in VAS, TUG and WOMAC subscales during study between groups.
Short-term treatment with both APS and IFT could significantly reduce pain and improve physical function in patients with knee OA.
... Interferential Current (IFC) or Therapy (IFT) IFC, sometimes called IFT, uses differing medium-frequency electrical currents to reduce tissue impedance, theoretically allowing higher penetration into target tissues to inhibit the nervous system, supposedly resulting in muscle relaxation, pain suppression, and accelerated healing [50]. However, IFC has provided no additional clinical benefits for first-line conservative treatment of patients with low back or lower extremity pain, or for subacromial impingement syndrome [51][52][53]. While two older systematic reviews suggested marginal benefit, non-standardized protocols, heterogeneity, and other methodological limitations have significantly undermined the quality of IFC evidence in musculoskeletal pain and knee osteoarthritis [54,55]. ...
Multiple forms of electrical stimulation (ES) potentially offer widely varying clinical benefits. Diminished function commonly associated with acute and chronic pain lessens productivity and increases medical costs. This review aims to compare the relative effects of various forms of ES on functional and pain outcomes.
A comprehensive literature search focused on studies of commonly marketed forms of ES used for treatment of pain and improvement of function. Peer-reviewed manuscripts were categorized as “Important” (systematic review or meta-analysis, randomized controlled trial, observational cohort study) and “Minor” (retrospective case series, case report, opinion review) for each identified form of ES.
Varying forms of ES have markedly different technical parameters, applications, and indications, based on clinically meaningful impact on pain perception, function improvement, and medication reduction. Despite being around for decades, there is limited quality evidence for most forms of ES, although there are several notable exceptions for treatment of specific indications. Neuromuscular electrical stimulation (NMES) has well-demonstrated beneficial effects for rehabilitation of selective spinal cord injured (SCI), post-stroke, and debilitated inpatients. Functional electrical stimulation (FES) has similarly shown effectiveness in rehabilitation of some stroke, SCI, and foot drop outpatients. H-Wave® device stimulation (HWDS) has moderate supportive evidence for treatment of acute and refractory chronic pain, consistently demonstrating improvements in function and pain measures across diverse populations. Interestingly, transcutaneous electrical nerve stimulation (TENS), the most widely used form of ES, demonstrated insignificant or very low levels of pain and functional improvement.
Ten of 13 reviewed forms of ES have only limited quality evidence for clinically significant reduction of pain or improvement of function across different patient populations. NMES and FES have reasonably demonstrated effectiveness, albeit for specific clinical rehabilitation indications. HWDS was associated with the most clinically significant outcomes, in terms of functional improvement combined with reduction of pain and medication use. More rigorous long-term clinical trials are needed to further validate appropriate use and specific indications for most forms of ES.
II.
... Interferential Therapy (IFT) involves the application of two medium-frequency currents to the skin in such a way that they "interfere" with each other to produce a "beat" frequency (9). Interferential current (IFC) is a simple and noninvasive treatment often used to induce analgesia [10], elicit muscle contractions [11], and reduce oedema [12,13]. Lung function tests (also called pulmonary function tests, or PFTs) asses the efficiency of the lungs. ...
Background: Interferential Therapy (IFT) is the administration of two medium-frequency currents to the skin, stimulating varying systems in the body using specific frequencies and frequency ranges. IFT in the thoracic region aims to reduce muscle soreness in the chest and upper back, reduce muscular fatigue and induce mucus expectoration. This study is designed to test the efficacy of IFT on bronchial asthma patients exposed to the SARS-CoV-2 virus.
Methods: IFT will be administered as an intervention to 28 asthma patients with and without a history of COVID-19 exposure for 20 minutes. Six continuous outcome variables at different points will be utilized as an outcome measure; the selected Baseline Pulmonary Function Test (PFT) and Cardiopulmonary Variables (CVS) will be assessed upon entry into the study and after every intervention, while asthma quality of life and asthma control test will be measured fortnightly. In addition, participants will be required to visit the study location 3 times per week for 12 weeks.
Results: The means ± SD will be compared, while the participant's outcome variables will be evaluated for study homogeneity at baseline. Repeated measures of MANOVA will be used to evaluate the study outcome within group participants. In contrast, a one-tail independent t-test will be used to evaluate the efficacy of IFT on bronchial asthma patients with Post COVID-19 exposure across groups. The level of significance will be set at P<0.05.
Discussion and Conclusion: Asthma control in the SARS-CoV-2 virus is still unclear; this study aims to evaluate the effect of airway smooth muscle relaxation induced by IFT on the possible long-term manifestations of SARS-CoV-2 virus on asthma control, quality of life, and selected cardiopulmonary variables of asthma patients. This study will add to the knowledge of managing severe acute respiratory syndrome.
... ES is used to treat patients who do not respond to conservative therapy. It has been widely employed to treat neurological and musculoskeletal conditions, and urinary incontinence [6,7]. ES is gradually becoming employed to treat NBD. ...
Neurogenic bowel dysfunction (NBD) is common in patients with cauda equina syndrome (CES). Previous studies have reported that electrical stimulation (ES) improves NBD but more neurophysiologic evidence is required. This case report describes a patient who experienced difficulty with defecation as a result of cauda equina syndrome (CES) that developed after a cesarean section performed 12 years ago under spinal anesthesia. The neurophysiological effects were assessed using the bulbocavernosus reflex (BCR) and electromyography (EMG). Two ES treatments, interferential current therapy and transcutaneous electrical stimulation, were used to stimulate the intestine and the external anal sphincter, respectively. The BCR results showed right-side delayed latency and no response on the left side. Needle EMG revealed abnormal spontaneous activities of the bilateral bulbocavernosus (BC) muscles. Electrodiagnostic testing revealed chronic bilateral sacral polyradiculopathy, compatible with CES. After treatment, the patient reported an improved perianal sensation, less strain and time for defecation than before, and satisfaction with her bowel condition. At the follow-up electrodiagnosis, the BCR latency was normal on the right side—needle EMG revealed reductions in the abnormal spontaneous activities of both BC muscles and re-innervation of the right BC muscle. Electrodiagnostic testing can offer insight into the neurophysiological effects of ES, which can help in understanding the mechanism of action and optimizing the therapy for patients with NBD.
... Both groups were treated with IFT with the frequency of 4000 Hz. For the duration of 10 minutes for 4 weeks [9]. The exercise program included static quadriceps, static hamstrings exercises, and circuit training includes warm up for 5 minutes, repetition of walking, straight lunges, one leg balance, balance training using wobble board, for 20 minutes/session, for 4 weeks, 3 times/weeks, 3 sets. ...
Objectives: The objective of the study is to find the effect of circuit training on quality of life. To find the effect of conventional therapy (interferential therapy [IFT] and isometric exercise) and to find the effect of conventional therapy with or without circuit training in OA knee.Methods: A total of 30 participants of 50-60 years of age, having osteoarthritis (OA) knee were recruited and allocated into two groups and treated with IFT, exercises, and circuit training for 4 weeks. Pre- and post-intervention outcome were measured using Western Ontario and McMaster University OA Index (WOMAC) and visual analog scale (VAS).Result: Both groups showed improvement, but there was an extremely significant improvement on VAS and WOMAC scales in the group treated with circuit training along with conventional treatment (IFT and isometric exercises).Conclusion: From this study, we conclude that circuit training along with IFT and isometric exercises shows an extremely significant effect over IFT and isometric exercises alone in OA knee patients.
... Note -*(p < 0.05), **(p < 0.01), ***(p < 0.001). Advanced rehabilitation (muscle strengthening and improve ROM) -Inferential therapy (Fig. 5) is indicated for pain relief in musculoskeletal injuries and researches have proved that it does stimulation of muscles, reduces swelling and boosts up the healing process [23,26]. Incorporating muscle strengthening exercises (Tables 2 and 3) in the earlier phase helps in improving muscular strength, dynamic postural stability and endurance of sports person [27]. ...
Background
Sports injuries are the second most common type of accident after domestic (3.7%) and occupational accidents (3.1%). There is an average annual estimate of 8.6 million sports and recreational related injury incidents with an age-adjusted rate of 34.1 per 1000 populations. Common sports injuries are musculoskeletal injuries i.e. Sprains, Strains, Joint injuries, soft tissue injury (STI). The sports injury in Ayurveda can be co-related within dissimilar facets of trauma related ailments.
Objective
To evaluate the efficacy of a protocol-based management of common sports injuries using an integrated approach.
Materials and methods
Integration of Ayurveda and Physiotherapy procedures was done and phase wise treatment was framed. Total 30 patients of age between 10 and 60 years ful-filling the inclusion criteria were selected for the present study. The patients were treated with Phase wise protocol consisting of three phase’s i.e. Inflammatory (1–5 days), Stabilization and recovery (6–10 days), Muscle strengthening (11–17 days). Assessments were done through various variables like pain, tenderness, swelling, local temperature, manual muscle testing (MMT) and range of motion (ROM) at different time points.
Statistical analysis
Wilcoxon matched pair test was used to assess within group results for subjective parameters and paired t-test (Dependent t-test) was used to assess for objective parameters.
Result
The study showed that integrated treatment approach has given significant results in the parameters like pain, loss of function, tenderness, local temperature, MMT and ROM.
Conclusion
Phase wise management through integrated protocol is effective in the management of common sports injuries.
... These time courses were similar to those observed in human patients after ACLR. 28 After 12 weeks post-surgery, we also measured passive ROM after myotomy to check the contribution of arthrogenic factors to ACLR-induced joint contracture. We found that passive ROM was increased by myotomy and that ROM restriction remained even after myotomy, indicating that both myogenic and arthrogenic factors contribute to ACLR-induced joint contracture. ...
Purpose: Complications including arthrofibrosis have been reported after anterior cruciate ligament reconstruction (ACLR) even under accelerated rehabilitation. To overcome this, we developed an animal model of ACLR-induced arthrofibrosis without immobilization.
Materials and Methods: Thirteen male Wistar rats were divided into ACL transection (ACLT) and ACLR groups. Surgery was performed in the right knees and untreated left knees were used as controls. After surgery, rats could move freely without joint immobilization.
Results: One week after surgery, flexion contracture represented by passive ROM reduction was 49 ± 5° and 21 ± 6° in ACLR and ACLT groups, respectively. Thereafter, flexion contractures were gradually reduced to 21 ± 8° and 12 ± 6° after 12 weeks, respectively. Fibrosis, which is characterized by significant upregulation of fibrosis-related genes, thickening, and adhesion in the posterior joint capsule, was observed in the ACLR group after 12 weeks of surgery. Nociceptive behavior and joint swelling were more apparent in the ACLR group than in the ACLT group, especially after 1 week of surgery.
Discussions: We developed a rat model of ACLR-induced joint contracture due to arthrofibrosis without rigid immobilization. Joint contracture was also observed in the ACLT group, but to a considerably milder degree than in the ACLR group. Thus, signs of inflammation as a result of reconstruction surgery, rather than ACL transection, play an important role in the formation of joint contracture after ACLR. Our animal model is suited to examine the mechanisms and efficacy of therapeutic strategies for arthrofibrosis following ACLR treated without rigid joint immobilization.
... Studies have reported IFC therapy's e®ectiveness in the treatment of painful musculoskeletal problems such as sports injuries; bruising and swelling, low back pain, osteoarthritis, rheumatoid arthritis, and muscular pain. [13][14][15] Therapeutic US is one of the most frequently applied electrotherapeutic modalities in orthopedics physiotherapy. 16 It produces thermal e®ects which increase tissue metabolism, collagen elasticity, and capillary blood°ow and reduce skeletal muscle spasm. ...
Background: Knee osteoarthritis (KOA) is a common degenerative articular disease that causes disability and poor quality of life (QoL) of the individuals. Electrotherapeutic agents such as therapeutic ultrasound (US), interferential current (IFC), and infrared radiation are used in the treatment. It is not clear which of these agents is the best in improving these variables.
Objectives: The study aimed to compare the effects of the combined application of US and IFC therapies and infrared radiation on pain, functional activities, and QoL in people with KOA.
Method: In a randomized controlled study, 60 participants were randomized into two groups, the combination therapy group (CTG) and the infrared radiation group (IRG). Each group received 15-min treatment three times per week for 12 weeks. The visual analog scale (VAS) was used to assess the pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for functional activities and the Short Form Health Survey questionnaire for QoL.
Results: Participants in the CTG had a significant ([Formula: see text]) reduction in pain and significant ([Formula: see text]) improvement in functional activities and QoL compared to the IRG.
Conclusion: The results of this study support the use of the combination of IFC and US therapies to reduce pain and improve function and QoL for KOA patients.
... Above 250 Hz, electrical stimulation is without associated painful or unpleasant side effects. There are four main clinical applications of interferential therapy: pain relief (Johnson and Tabasam 2003;Hurley et al. 2004;Jorge et al. 2006;McManus et al. 2006;Walker et al. 2006;Atamaz et al. 2012;Gundog et al. 2012;Rocha 2012), muscle stimulation (Bircan et al. 2002;Bellew et al. 2012), increased local blood flow (Noble et al. 2000), and reduction of edema (Christie and Willoughby 1990;Jarit et al. 2003). ...
Treatment of pain is one of the most important aims of medicine. Over the past several decades, invasive, semi-invasive and non-invasive brain stimulation methods have been tested and implemented for modulation of the pain. In this review we bring the overview of those methods including stimulation of both the deep brain structures utilizing invasive and semi-invasive techniques and brain cortex stimulated by non-invasive transcranial magnetic and electrical techniques. The potentially beneficial method which could modulate the pain by stimulating the deep brain with the interferential transcranial alternating current are discussed as well.
... This current is an electrical stimulus that causes analgesia in musculoskeletal affections 13 . This therapy is used in different syndromes and diseases, such as urinary stress incontinence 14 , enuresis in children 15 , chronic nonspecific low back pain 16 , osteoarthritis 17,18 , psoriasis 19 , primary dysmenorrhea 20 and during the postoperative period 21 . ...
High-intensity and widespread muscle pain is the main complaint of patients with fibromyalgia. Interferential current is a treatment often used in pain relief; however, its effects on these patients are unclear. The objective of this review was to analyze the effects of interferential current therapy on the treatment of patients with fibromyalgia in previously published scientific articles. We searched the following databases: Central, CINAHL, Lilacs, PEDro, Medline (PubMed), SciELO, Science Direct, Scopus and Web of Science on November 2016. We included only controlled clinical trials and had no restrictions for language and date of publication. We used the Cochrane Collaboration’s tool to assess the risk of bias of the articles. We found a total of 415 articles, however, only four of them were selected for analysis. Three of these studies were excluded because they were not controlled clinical trials. Thus, only one study was analyzed for this review. According to the study the combination of ultrasound and interferential current improved pain relief and the sleep quality of patients with fibromyalgia. However, the study presented a high risk of bias, being impossible to verify the isolated effect of the interferential current in those patients. Randomized controlled studies on the use of interferential current in patients with fibromyalgia are lacking on literature. The results of this review evidence the importance of developing future studies with adequate methodological design and using only interferential current therapy to improve the use of this therapy for these patients in this clinical setting.
... The RS Medical RS-4i Plus Sequential Stimulator V R is an electrical stimulation device that delivers current through gel electrodes placed transcutaneously around the site of pain. This device has proven successful in treating a number of pain conditions including knee and back pain (25)(26)(27)(28)(29). The device applies conventional TENS and a technology known as interferential current therapy (ICT), which occurs when the two electrodes are set at slightly differing frequencies, for example, 5000 and 5100 Hz. ...
Introduction
“Dry eye” or “keratoconjunctivitis sicca” is a multifactorial disease estimated to have a worldwide prevalence of 5–33%. Conventional therapies targeting the ocular surface with artificial tears, anti‐inflammatories, punctal closure, eyelid hygiene, and antibiotics do not provide relief in all patients, especially those with neuropathic‐like ocular complaints (wind hyperalgesia and photophobia). We anticipated that ocular transcutaneous electrical nerve stimulation (TENS) would alleviate symptoms of ocular pain, photophobia, and dryness in these latter individuals.
Methods
All individuals who received electrical stimulation between May 10, 2016 and April 6, 2017 for the treatment of chronic ocular pain at the oculofacial pain clinic of the Miami Veterans Administration Hospital were included in this retrospective review. All patients had symptoms of dryness along with other neuropathic‐like symptoms (e.g., photophobia) and minimal signs of tear dysfunction. Ocular pain intensity, symptoms of dryness, and light sensitivity were compared pre‐treatment and five min post‐treatment via a two‐tailed paired Student's t‐test.
Results
The use of TENS significantly reduced the mean pain intensity in both the right and left eyes five min after treatment compared to prior to treatment (p < 0.05, paired t‐test). The use of TENS significantly decreased light sensitivity in both eyes (p < 0.05). The findings for symptoms of dryness, however, were equivocal with a significant decrease in the left eye but not the right (p < 0.05, paired t‐test).
Discussion
Our data indicate that TENS may similarly provide analgesia in patients with dry eye symptoms as it does for many other chronic pain conditions. Furthermore, the noted effect on symptoms of photophobia and dryness suggest that all may be linked by similar trigeminal–thalamic–cortical pathways. Prospective studies with electrical stimulation of dry eye are needed to further elucidate its benefit and mechanism of action.
... Transcutaneous electrical stimulation equipment have been used in clinical practice mainly for analgesia, acting at the sensory level by closing the spinal cord gates, releasing endorphins, [8][9][10] and helping in tissue repair. 11 Although these effects are already well established in the literature for low-frequency current, there are no studies showing the direct effect of medium frequency current in the induction of large or polyarticular muscle relaxation. ...
Purpose: To evaluate the muscular relaxation of the upper trapezius induced by interferential current (IFC) application during rest and functional activities using surface electromyography registration (EMG). Method: We evaluated the "root mean square" value (RMS) of the upper trapezius during rest and functional activities in subjects with neck discomfort before and after IFC applications. Thirty female participated in the study, mean age of 23.0 (±4.0) years and a body mass of 22.1 (±2.5) kg/m2. The subjects received three IFC applications over a 5-day period, with a frequency of 4.000 Hz, an amplitude modulated frequency (AMF) of 75 Hz, a frequency variation (δF) of 35 Hz, a slope of 1/1, a sensorial level intensity, and an application time of 30 minutes per session in the upper trapezius. Results: Repeated measures analysis of variance demonstrated significant bilateral decrease (p<0.001) of mean RMS value of the upper trapezius in the final evaluation in relation to initial evaluations. This suggests that IFC can promote a muscle-relaxing effect after a few applications such as during rest as well as during functional activities. However, we did not find relaxing effect immediately after an IFC application (p>0.05). Conclusion: IFC seems to induce a relaxation of the upper trapezius muscle in both medium-term analyses at rest and during functional activities. Therefore, there was not an immediate effect in the experimental model used.
... In a randomized study of the effects of IFS on what the authors describe as "softtissue shoulder disorders", Van Der Heijden et al. demonstrated no improvement in pain with the use of IFS [16]. Jarit et al. performed a randomized, controlled, double-blinded study on the use of IFS following Anterior Cruciate Ligament (ACL) reconstruction [17]. In this well designed and executed study, they demonstrated decreased pain, improved motion and decreased edema with the use of IFS. ...
Purpose: The purpose of this study is to determine the effects of interferential stimulation on pain and motion after shoulder surgery. Study Design: Randomized Controlled Trial. Methods: 102 patients undergoing arthroscopic rotator cuff repair or labral repair were prospectively randomized to receive either an interferential stimulation unit immediately after surgery (STIM) or not to receive the unit (NO-STIM). Each patient was measured for the range of motion (ROM) in forward flexion (FF), abduction (ABD), internal rotation (IR) and external rotation (ER). These measurements were taken prior to surgery and at the 6 weeks post-operative time point. Visual Analogue Scale (VAS) scores (0 - 10) and the amount of narcotic taken (standardized to 10 mg equivalents of hydrocodone) were measured and compared between the two groups at 2 days and 4 weeks post-operatively. 51 patients were excluded due to failure to document VAS scores and medication usage, lack of follow-up at the 6 weeks post-operative time point or hospitalization after surgery. This left 27 patients in the STIM group and 24 patients in the NO-STIM group. Results: No difference was found in the amount of narcotic taken after 2 days (STIM 14.37 ± 1.02, NO-STIM 15.88 ± 1.22, p = 0.34) or after 4 weeks (STIM 45.32 ± 4.36, NO-STIM 48.96 ± 5.50, p = 0.60). No difference in mean VAS scores were found at 2 days (STIM 5.56 ± 0.53, NO-STIM 4.63 ± 0.57, p = 0.24) or 4 weeks (STIM 1.68 ± 0.39, NO-STIM 1.38 ± 0.34, p = 0.57). At 6 weeks post-operatively, a difference was found in ER (STIM 62.5 ± 4.09, NO-STIM 50.4 ± 4.09, p = 0.04), and no differences found in FF (STIM 134.2 ± 5.29, NO-STIM 133.3 ± 4.85, p = 0.60), ABD (STIM 124.8 ± 6.22, NO-STIM 119.6 ± 5.42, p = 0.53) or IR (STIM 60.0 ± 3.69, NO-STIM 55.9 ± 3.03, p = 0.39). A post-hoc power analysis performed using an a = 0.05 revealed the study to be 90% powered to identify a difference of one narcotic equivalent between groups and 90% powered to identify a 0.3 difference in VAS scores. Conclusions: The use of an interferential stimulator in the immediate post-operative period had no effect on pain or narcotic usage following arthroscopic rotator cuff repair or labral repair. External rotation was significantly greater in the interferential stimulator group while no differences were found in other motion parameters.
... Ayrıca kas kontaksiyonunu sağlayarak ödemin azalmasını sağlar. 68 Diz osteartriti, kronik bel ağrısı, omuz ağrısı, fibromyalji yumuşak doku ağrılarında, myofasial ağrı sendomu gibi birçok KA'lı durumlarda kullanılmaktadır. 69,70 YÜKSEK FREKANSLI AKIMLAR Ultrason Mekanik bir enerji şekli olup derin dokularda termal ve nontermal etkiye sahiptir. ...
70 ğrı doku hasarı riski veya varlığında reseptör ve periferik sinirlerden me-dulla spinalise ulaşan sinyallerin beyine iletilmesiyle oluşan duyusal ve du-yumsal hoşa gitmeyen deneyimler olarak tanımlanır. İnternal veya eksternal uyaranlar etkisiyle oluşan savunma veya alarm durumudur. Uyaranların oluşturduğu sinyal oluşumu devam ederse ağrı devam eder. 1,2 Kronik Ağrı (KA) en az 3-6 ay devam eden ve devamlı veya ara sıra tekrarlayan rahatsız edici bir durum olarak tanımlanabilir. KA, akut ağrı gibi koruyucu değildir. Doku iyileşmesinin üç aydan daha fazla devam ettiği ve tamamlanamadığı durumlarda kronik süreç baş-lar. 1-3 Kronik Muskuloskeletal Ağrının Fizyoterapi-Rehabilitasyon ile Yönetimi Ö ÖZ ZE ET T Pek çok insan altı aydan fazla süren ağrı olarak tanımlanan kronik ağrıdan (KA) yakınır. KA hafif şiddette olabildiği gibi ızdırap verici, devamlı veya ara sıra olabilir. Bireyi sadece rahatsız ede-bilir veya tamamen çaresiz duruma getirebilir. KA Muskuloskeletal Ağrı (KMSA) dünya genelinde oldukça sık karşılan bir sağlık problemidir. KMSA ile sinir sitemi aylar hatta yıllar bounca aktive edilir. Bu durum bireyin fiziksel ve emosyonel yapılarını olumsuz etkiler. KMSA sıklıkla fiziksel fonksiyon bozukluğuna, dizabiliteye ve azalmış yaşam kalitesine yol açar. Fizyoterapi ve Rehabili-tasyon (F&R) KMSA'lı bireylerin yaşam kalitelerini artırmada hayati önem taşır. Fizyoterapistler elekrofiziksel ajanlar, maual teknikler ve davranış terapi odaklı egzersiz yaklaşımlarını kullanarak holistic bir bakış açısıyla (biyo-psiko-sosyal model) KMSA'lı hastalarıyla çalışırlar. F&R hastalara KMSA ile başa çıkma yöntemlerini öğretir ve yardımcı olur. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Kronik ağrı; rehabilitasyon; kas-iskelet ağrısı A AB BS S T TR RA AC CT T Many people suffer from chronic pain (CP), defined as pain that lasts longer than six months. CP can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. Chronic musculoskeletal pain is (CMSP) is a common health problem worldwide. With CMSP, signals of pain remain active in the nervous system for months or even years. This can take both a physical and emotional toll on a person. It often leads physical dysfunction, disability, and a decreased quality of life. In that condition, physiotherapy and rehabilitation is vital so as to improve quality of life of the individuals with CMSP. Physiotherapists work with patients with CMSP in a holistic away (bio-psycho-social model) using by electro-physical agents, manual techniques , and behavioural oriented therapeutic exercises. Physiotherapy and rehabilitation also helps and teaches the patients with CMSP how they can cope with this chronic problem. K Ke ey y W Wo or rd ds s: : Chronic pain; rehabilitation; musculoskeletal pain
... Ayrıca kas kontaksiyonunu sağlayarak ödemin azalmasını sağlar. 68 Diz osteartriti, kronik bel ağrısı, omuz ağrısı, fibromyalji yumuşak doku ağrılarında, myofasial ağrı sendomu gibi birçok KA'lı durumlarda kullanılmaktadır. 69,70 YÜKSEK FREKANSLI AKIMLAR Ultrason Mekanik bir enerji şekli olup derin dokularda termal ve nontermal etkiye sahiptir. ...
70 ğrı doku hasarı riski veya varlığında reseptör ve periferik sinirlerden me-dulla spinalise ulaşan sinyallerin beyine iletilmesiyle oluşan duyusal ve du-yumsal hoşa gitmeyen deneyimler olarak tanımlanır. İnternal veya eksternal uyaranlar etkisiyle oluşan savunma veya alarm durumudur. Uyaranların oluşturduğu sinyal oluşumu devam ederse ağrı devam eder. 1,2 Kronik Ağrı (KA) en az 3-6 ay devam eden ve devamlı veya ara sıra tekrarlayan rahatsız edici bir durum olarak tanımlanabilir. KA, akut ağrı gibi koruyucu değildir. Doku iyileşmesinin üç aydan daha fazla devam ettiği ve tamamlanamadığı durumlarda kronik süreç baş-lar. 1-3 Kronik Muskuloskeletal Ağrının Fizyoterapi-Rehabilitasyon ile Yönetimi Ö ÖZ ZE ET T Pek çok insan altı aydan fazla süren ağrı olarak tanımlanan kronik ağrıdan (KA) yakınır. KA hafif şiddette olabildiği gibi ızdırap verici, devamlı veya ara sıra olabilir. Bireyi sadece rahatsız ede-bilir veya tamamen çaresiz duruma getirebilir. KA Muskuloskeletal Ağrı (KMSA) dünya genelinde oldukça sık karşılan bir sağlık problemidir. KMSA ile sinir sitemi aylar hatta yıllar bounca aktive edilir. Bu durum bireyin fiziksel ve emosyonel yapılarını olumsuz etkiler. KMSA sıklıkla fiziksel fonksiyon bozukluğuna, dizabiliteye ve azalmış yaşam kalitesine yol açar. Fizyoterapi ve Rehabili-tasyon (F&R) KMSA'lı bireylerin yaşam kalitelerini artırmada hayati önem taşır. Fizyoterapistler elekrofiziksel ajanlar, maual teknikler ve davranış terapi odaklı egzersiz yaklaşımlarını kullanarak holistic bir bakış açısıyla (biyo-psiko-sosyal model) KMSA'lı hastalarıyla çalışırlar. F&R hastalara KMSA ile başa çıkma yöntemlerini öğretir ve yardımcı olur. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Kronik ağrı; rehabilitasyon; kas-iskelet ağrısı A AB BS S T TR RA AC CT T Many people suffer from chronic pain (CP), defined as pain that lasts longer than six months. CP can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. Chronic musculoskeletal pain is (CMSP) is a common health problem worldwide. With CMSP, signals of pain remain active in the nervous system for months or even years. This can take both a physical and emotional toll on a person. It often leads physical dysfunction, disability, and a decreased quality of life. In that condition, physiotherapy and rehabilitation is vital so as to improve quality of life of the individuals with CMSP. Physiotherapists work with patients with CMSP in a holistic away (bio-psycho-social model) using by electro-physical agents, manual techniques , and behavioural oriented therapeutic exercises. Physiotherapy and rehabilitation also helps and teaches the patients with CMSP how they can cope with this chronic problem. K Ke ey y W Wo or rd ds s: : Chronic pain; rehabilitation; musculoskeletal pain
... In general, all patients who had received IF currents showed substantial reduction of pain and edema and increased range of motion. [25] Basically, IF currents can reduce local edema, reducing pain as well as improving the muscle tonicity. [26] In a study conducted on the effects of IF currents on two experimental models of pain, McManus et al. showed that these currents are effective on mild pain(before patient reaches pain threshold) particularly when the origin of the pain is cold or mechanical. ...
Pressure ulcers' treatment imposes a considerable cost on health system and patients. Electrical stimulation has already been introduced as an effective method for promoting wound healing. This study was conducted to determine the impact of interferential current (IF) on healing of pressure ulcers (grade1 and 2).
In this clinical trial, 23 patients (12 as cases and 11 as controls) were recruited. The study group was treated with IF daily for 10 days. IF current was applied via isoplanar current with a sweep frequency of 30-99 Hz and with tolerable intensity for 15-20 min. Before intervention, condition of the wounds was assessed and recorded. Routine characteristics of the ulcers in both groups were recorded before intervention (first day) and on the fifth and tenth days after intervention. SPSS (ver. 13) with paired t-test and Fisher's exact test was also used to analyze the data. A P-value of 0.05 was considered significant.
According to one-sample Kolmogorov-Smirnov test, demographic characteristics, features of ulcer, as well as the intensity of pain were not significantly different between the study and control groups. All patients in the control and study groups were complaining of pain (7.25 ± 1.21 in the intervention group vs. 6.35 ± 1.28 in the control group). Ulcer size decreased significantly in the study group (P = 0.012) with a significant reduction in pain intensity (P = 0.000), amount of discharge (P = 0.008), and level of edema (P = 0.000), compared to controls.
As a first study in this field, the results showed that the use of IF current can accelerate pressure ulcer healing and reduce its size. As IF current can be considered as a deeper form of Transcutaneous Electrical Nerve Stimulation (TENS), it seems to be a safe method with no side effects.
... In general, all patients who had received IF currents showed substantial reduction of pain and edema and increased range of motion. [25] Basically, IF currents can reduce local edema, reducing pain as well as improving the muscle tonicity. [26] In a study conducted on the effects of IF currents on two experimental models of pain, McManus et al. showed that these currents are effective on mild pain(before patient reaches pain threshold) particularly when the origin of the pain is cold or mechanical. ...
Impact of Interferential Current on Recovery
of Pressure Ulcers Grade 1 & 2
AkramShahrokhi, Azam Ghorbani, Atefeh Aminian Far
Objective: The aim of this study was to determine the impact of Interferential current (IF) on healing of pressure ulcers (grade1&2).
Setting Patients: In clinical trial study 23 patients (12 as case and 11 as control) were recruited.
Interventions: The study group was treated with interferential current daily for 10 days. IF current was applied via isoplanar current with sweep frequency of 30-99 Hz and tolerable intensity for 15- 20 minutes.Before intervention condition of the wound were assessed and recorded. Routine characteristics of the ulcers in both groups were recorded before the intervention(first), fifth and tenth day. SPSS (ver.13) with Paired T-test and Fisher exact test were also used to analyze data. P-value significant level was considered as 0.05.
Main results::According to One Sample Kolmogorov-Smirnov test demographic characteristics, features of ulcer as well as the intensity of pain were not significantly different between study and control groups.
All patients in control and study groups were complaining from pain ( intervention group7.25 ± 1.21 vs. 6.35 ± 1.28in control group.Ulcer size decreased significantly in the study group (P = 0.012) with significant reduction in pain intensity(P=0.000),amount of discharge(P=0.008), and level of edema(P=0.000) compare to controls.
Conclusion:This study is the first study conducted on utilizing interferential currents to control and improve pressure ulcers healing process. The results(besides its limitations) showed that the use of IF current can accelerates pressure ulcer healing and reduces its size.As IF current is considered as a deeper form of TENS that is safe with no side effects.
Keyword: Pressure Ulcers, Interferential Current, Wound care
We examined the time-dependent differences in the effects of treadmill exercise on joint contracture after anterior cruciate ligament (ACL) reconstruction. Rats received ACL reconstructive surgery. After surgery, rats were reared with or without treadmill exercise (60 min/day) starting at 3 days (when inflammatory reactions are active) or 14 days (when inflammatory reactions have subsided) post-surgery. Untreated rats were used as controls. Data were collected at two or four weeks post-surgery. The range of motion (ROM) decreased following surgery at both time points and treadmill exercise during the first two weeks post-surgery further decreased the ROM. Moreover, treadmill exercise during first two weeks post-surgery upregulated the pro-inflammatory cytokine interleukin-1β gene in the joint capsule and aggravated joint capsule fibrosis. For exercise started at 14 days post-surgery, the ROM recovered to control levels at four weeks post-surgery. In addition, delayed exercise contributed to resolving inflammatory and fibrotic reactions. Treadmill exercise initiated soon after surgery aggravates joint contracture via enhanced inflammatory and fibrotic reactions in the joint capsule. Conversely, exercise initiated after active inflammation has subsided facilitates joint capsule reorganization and increases joint ROM. Therefore, aggressive exercise should be started only after active inflammation is resolved to improve joint contracture following ACL reconstruction.
Background: Functional activity is an important aspect of normal human function. Limited functionalactivities due to in sciatica have been shown to predispose a person to several restrictions in functionand significantly affect the normal daily life.Objective: To determine and compare the effectiveness of Neurodynamic Slider Technique (NST) withconventional therapy (CT) and conventional therapy alone in sciatica for improving functional abilityand pain.Method: 40 subjects with sciatica were allocated into two groups (20 subjects in each group). Theoutcome measure used was Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS).Subjects of group A were treated with Conventional therapy only, whereas the subjects of group B weretreated with Neurodynamic slider technique. For both the groups, the technique was performed threetimes a week for a total treatment period of four weeks.Results: The results demonstrated significant improvement in functional ability for subjects of group Bwhen compared with those of group A (P<0.05) at the end of four weeks.Conclusion: The study shows that CT along with NST are efficient in the rehabilitation of sciaticapatients reflecting the improvement of functional ability by reducing pain and considerably increase thephysical performance of patients in their own aspects. Thus, Neurodynamic Slider technique along withConventional therapy can be used in clinical practices for the treatment of sciatica.
Background
Although anterior cruciate ligament reconstruction surgery is known to cause joint contracture, the mechanisms of this process are unknown. We aimed to assess the effects of transection of this ligament and each phase of reconstruction surgery on contracture formation.
Materials and methods
Rats were divided into groups according to treatment received: sham (arthrotomy), ligament transection, ligament transection plus bone drilling, and ligament reconstruction. Surgery was performed on the right knee. Untreated left knees in the sham group were used as controls.
Results
At 7 and 28 d post-surgery, range of motion before myotomy, mainly representing myogenic contracture, was restricted in the sham and ligament transection groups, and more so in the bone drilling and reconstruction groups. Restricted range of motion after myotomy, representing arthrogenic contracture, was detected at both timepoints in the bone drilling and reconstruction groups, but not in the sham or ligament transection groups. At 3 d post-surgery, although a large blood clot was observed in all three treatment groups, only the bone drilling and reconstruction groups showed significant joint swelling. At 7 d post-surgery, inflammatory-cell infiltration into the joint capsule was most apparent in the bone drilling and reconstruction groups, and joint capsule fibrosis was also most apparent in these groups at 7 and 28 d post-surgery.
Conclusions
Our results suggest that (1) myogenic contracture after anterior cruciate ligament reconstruction is caused by arthrotomy and aggravated by bone drilling, and (2) arthrogenic contracture is mostly due to bone drilling, which triggers an inflammation–fibrosis cascade.
The use of physical agent modalities dates back to the early days in the development of the field of physical and rehabilitation medicine. The term physiatrist is derived from the Greek words physis, pertaining to physical phenomena, and iatreia, referring to healer or physician. Thus a physiatrist is a physician who uses physical agents to relieve a patient's discomfort. Modalities are physical agents used to produce desired therapeutic effect. They include cold, heat, sound, electromagnetic waves, electricity, and mechanical forces. In this chapter, their physiologic effects, indications, techniques, and precautions are reviewed and discussed. Acupuncture and moxibustion, which use needling and heat to produce therapeutic effect, are also included. Physical agent modalities, although generally considered adjunctive rather than curative treatments, are widely used and important in the daily practices of most physiatrists.
Introduction: Low back pain is a highly prevalent condition worldwide. Physiotherapists commonly use a system of diagnosis and exercise prescription called the McKenzie Method to manage patients with low back pain. Objective: The main aim of this study was to evaluate the effectiveness of the Mckenzie method treatment, in sub-acute and chronic low back pain. Meterial and methods: Our study was conducted between years 2009-2010 , in General Hospital "Rezonanca", in physical therapy care. We did a short-term, prospective study in duration of 15 days. The total number of patients enrolled in the study was 100, age above 23 years, of both sexes. Patients were treated with McKenzie Method, the assessment was done before and after the treatment .We used the Numeric Rating Scale to assess the pain, and Modified Schober's test for mobility. Results: McKenzie method increases the mobility and reduces the pain in the lumbar region more on sub-acute stage. Short-term treatment of patients, (on sub-acute and chronic stage) with the McKenzie method is more effective in reducing pain. McKenzie method is most effective in patients in sub-acute stage. Conclusions: Chronic low back pain patients need to be treated for longer periods, with the McKenzie Method. Our recommendation is to further research the efficacy of Mckenzie method for longer periods, larger sample size, with randomized, crossed-over, double-blind, placebo-controlled treatment groups, in order to avoid bias.
Objective:
To investigate the effectiveness of interferential current implementation following total knee arthroplasty surgery.
Design:
Double-blind randomized controlled study.
Setting:
Orthopedics and traumatology in-patient clinic.
Participants:
From an initial enrollment of 132 patients, 113 who met the study inclusion criteria were randomly separated into two groups: the interferential current group ( n = 57) and the sham current group ( n = 56). A total of 98 patients completed the study: 49 in the interferential current group and 49 in the sham group.
Intervention:
Patients in the interferential current group received interferential current treatment for 30 minutes, twice a day for five days postoperatively. For the patients in the sham interferential current treatment group, the same pads were applied to the patients for the same time periods but no electrical stimulation was applied.
Main outcome measures:
Patients were assessed in respect of pain, range of motion (ROM), edema, and the amount of paracetamol used at baseline and on the 5th and 30th days after surgery.
Results:
No significant difference was determined between the groups in respect of pain, ROM, and edema at days 0, 5, and 30. At the end of the 5th day, the amount of paracetamol used was significantly lower in the interferential current group ( P < 0.05).
Conclusion:
In this study, both groups showed significant improvements in pain, ROM, and edema with no significant difference between the groups. Although there was a significant difference in paracetamol intake of the two groups, this cannot be argued as showing the effectiveness of interferential current.
The following proposed project is about modified type of Interference Therapy which we are going to introduce now. Since now days in Health and Research sector, various type of instrument is being used. Interferential Therapy (IFT) is one of the physical therapy and the mid-frequency electrical signal to treat muscular strains and spasms. The current produces a massaging effect in the affected area at periodic intervals, and it stimulates the secretion of endorphins, the natural pain relievers, thus relaxing strained muscles and promoting soft-tissue healing. Its use is contraindicated if the affected area has wounds, cuts or infections. The principle of IFT is to use physiological effects of low frequency at <250 pps electrical stimulation of nerves without the associated pain and side effects associated with low-frequency stimulation.
SUMMARY
BACKGROUND AND OBJECTIVES: Since its widespread
clinical use, but the differences with respect to the parameters of
use, notes the importance in find the best way to adjust the IC
in each condition. The objective of this review was to analyze the
applications and the most described parameters, correlating them
with the findings regarding this current.
CONTENTS: were consulted databases of Pubmed, Capes journals, SciElo and Google Scholar, with the following keywords:
interferential current; interferential treatment; interferential
therapy; electrostimulation. We reviewed 50 references, the use
of 100 Hz was described for analgesia, 20 Hz for urinary incontinence, 80-160 Hz in constipations cases and it may also be
applied to skin problems, vascular and others. Decreased sensation of the current seems not to interfere in its effect, the base
frequency (4000 Hz) is the biggest reason for the benefits and the
application time is less than in other equipment.
CONCLUSION: the IC can be applied in several diseases; it is
most often adjusted by the physiotherapist experience than evidence based. However, the base frequency may be responsible for
its effects. Despite good results, it is necessary high-quality studies to further address this issue.
Keywords: Electric stimulation therapy, Electrotherapy, Physiotherapy, Rehabilitation, Treatment.
Background: Interferential therapy (IFT) is applied to intersect in the painful area but no confirmed effect with this method. Experimentally, the highest voltage of IFT is induced outside the intersection of the two currents. Placing the painful area outside the intersection point (external application) would reveal a better effect.
Objectives: To examine the effect of external application in pain compared to traditional method.
Design: A double-blind placebo-controlled clinical investigation.
Setting: A public hospital.
Participants: 168 LBP subjects.
Interventions: Assignment: (1) external IFT, (2) placebo external IFT, (3) traditional IFT and (4) placebo traditional IFT. Groups 1 and 3 received 20 min of IFT at 100 Hz and groups 2 and 4 received sham IFT.
Main outcome measures: Before and after IFT session, pain severity (VAS), pressure threshold (PPT), pain distribution and ROM were assessed.
Results: IFT changed all outcomes similarly. VAS and ROM improved statistically, P < 0.03. A trend of better VAS reduced with active IFTs.
Conclusions: No therapeutic difference between the two methods.
Rehabilitation professionals often use therapeutic modalities as a component of the surgical and nonsurgical management of orthopaedic injuries. Myriad therapeutic modalities, including cryotherapy, thermotherapy, ultrasonography, electrical stimulation, iontophoresis, and laser therapy, are available. Knowledge of the scientific basis of each modality and the principles of implementation for specific injuries enables musculoskeletal treatment providers to prescribe these modalities effectively. The selection of specific therapeutic modalities is based on their efficacy during a particular phase of rehabilitation. Therapeutic modalities are an adjunct to standard exercise and manual therapy techniques and should not be used in isolation.
Anterior cruciate ligament reconstruction (ACLR) remains one of the most common sports medicine procedures performed in the young, athletic patient population. Over the past 2 decades, advances in surgical technique as well as improvements in perioperative pain control modalities have enabled the vast majority of patients undergoing ACLR to have the procedure performed in the outpatient setting. Multimodal pain control is paramount to the success of outpatient ACLR and incorporates various combinations of general-epidural-regional anesthetics, perioperative peri-incisional local anesthetics, oral analgesics, electrostimulation, compressive cryotherapy, and early physical therapy. This article provides a concise summary of evidence-based guidelines for perioperative pain and swelling management following ACLR, with an emphasis on oral agents and postoperative modalities.
The consequences of cartilaginous acute or chronic disorders of the knee
are a growing health problem not only among those who practice sport activity. Cartilaginous
injuries represent a critical event because of limited potential for intrinsic cartilage
repair and for the long and variable time period required for functional recovery,
which precludes the athlete to practice competitive sports. Cartilaginous injuries do not
heal spontaneously but tend to degenerate over time in arthritis. Exercise and an adequate
rehabilitative treatment can delay this process. There are many conservative and
surgical therapeutic proposals which in many cases may respond to the different needs
of thosewhowant to go back to practice sports at a competitive level. The crucial rehabilitation
treatment following surgery is defined according to a path for clinical and
functional objectives and is based on the recovery ofmovement, sport specific skills and
strength avoiding pain, swelling or joint suffusion.Monitoring of these three basic clinical
signs is an expression of the delicate balance required to promote healing of cartilage
and to achieve predetermined functional goals of each phase. The time required to
reach a specific functional goal is the consequence of injury type, surgical technique, rehabilitation
protocol, healing capacity and intrinsic recovery of each patient.
NWBNo weight allowed to be placed on affected limb
The objective of this survey was to collect information about physiotherapists' self-report of their use of interferential therapy (IFT) to manage pain. Physiotherapists working in four city hospitals in the North of England completed a questionnaire designed by the authors to establish the use of IFT. Fifty two of the 57 respondents reported that they had previously used IFT in clinical practice. Thirty six respondents reported that they used IFT on a regular (weekly) basis and 35 of these used it for pain relief. However, 25 of the 35 respondents who regularly used IFT for pain relief reported that they used it on less than 25% of all of the pain patients that they managed in the clinic. The 35 respondents who regularly used IFT for pain relief reported that they administered one to five IFT treatments (n=26) to each patient with individual IFT treatments usually lasting 11–20 minutes (n=27). The respondents reported that they most commonly used amplitude modulated frequencies of 100Hz, together with 6^6 (delivery of a 6-second decrease between two predetermined amplitude modulated frequencies of IFT) swing patterns. Their knowledge about IFT practice was reported to be gathered from departmental colleagues (n=26).
The survey concludes that there was similarity in the IFT parameters and regimens used for pain relief between respondents. Most respondents used a trial and error approach to establishing IFT parameters using feedback from the patient about the comfort of IFT. In addition, IFT devices are large and expensive and remain in physiotherapy clinics and this may be the reason why respondents tend to administer IFT for less than 30 minutes while the patient attends the clinic. Perhaps physiotherapists should consider recommending cheap portable transcutaneous electrical nerve stimulation (TENS) devices instead of IFT, as patients can self-administer TENS whenever they need
Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. Preoperative assessment includes management of patient expectations, recognition of conditions and early counseling for high-risk patients (ie, opioid dependence, psychiatric comorbidities), and use of preemptive analgesia techniques (ie, preoperative IV medications, peripheral nerve blocks, incisional field blocks). Intraoperative strategies include meticulous surgical technique, limiting the use of tourniquets (ie, duration and pressure), and using preventive analgesia methods (ie, postoperative field block, continuous nerve catheters, intra-articular injection). Postoperative analgesia may be facilitated by cryotherapy, early mobilization, bracing, and rehabilitation. Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.
We assessed the effectiveness of interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) therapies in the management of carpal tunnel syndrome (CTS) compared with splint therapy, a standard treatment modality for CTS. This was a prospective, single-blinded, single-center, randomized, three-group parallel intervention study of 3 weeks duration. Efficacy was examined in the third week after the end of treatments. Subjects were assigned randomly to one of three groups: group I patients received splint therapy, group II patients received TENS applied on the palmar surface of the hand and the carpal tunnel, and group III patients underwent IFC therapy applied on the palmar surface of the hand and the volar surface of the forearm. TENS and ICF treatments were applied five times weekly for a total of 15 sessions. Group 1 patients were stabilized with volar wrist splints for 3 weeks. The efficacy of the therapies was assessed before initiation of therapy and at 3 weeks after completion of therapy using a visual analog scale (VAS), a symptom severity scale, the functional capacity scale of the BCTQ, and measurement of median nerve motor distal latency (mMDL) and median sensory nerve conduction velocity (mSNCV). Groups were compared pairwise using the Mann-Whitney U test to identify the source of differences between groups. The Wilcoxon test was used to analyze changes in variables over time within a group. In the VAS, BCTQ, MDL, and mSNCV, no significant difference was observed between the groups (p > 0.05). In the VAS, BCTQ, and mSNCV, statistically significant improvements were detected in all groups (p < 0.05). There was no statistically significant difference between TENS and splint therapy with respect to improvement in clinical scores, whereas IFC therapy provided a significantly greater improvement in VAS, mMDL, and mSNCV values than splint therapy (VAS: 4.80 ± 1.18 and 6.37 ± 1.18; p = 0.001, mMDL: 3.89 ± 0.88 and 4.06 ± 0.61; p = 0.001, mSNCV: 41.80 ± 1.76 and 40.75 ± 1.48; p = 0.010). IFC therapy provided a significantly greater improvement in VAS, symptom severity, functional capacity, and mMDL and mSNCV values than TENS therapy (VAS: 4.80 ± 1.18 and 6.68 ± 1.42; p < 0.001, symptom severity: 2.70 ± 1.03 and 3.37 ± 1.21; p = 0.015, functional capacity: 1.90 ± 1.21 and 2.50 ± 0.78; p = 0.039, mMDL: 3.89 ± 0.88 and 4.06 ± 0.88; p = 0.003, and mSNCV: 41.80 ± 1.76 and 41.38 ± 1.78; p = 0.021). IFC may be considered a new and safe therapeutic option for the treatment of CTS.
Fragestellung: Der Einfluss einer transkutanen Elektrostimulationsbehandlung auf die Schmerzen und Ödementwicklung nach Implantation einer Knie-Totalendoprothese sollte durch eine placebokontrollierte Studie untersucht werden.
Material und Methoden: 60 Patienten wurden nach Implantation einer Knie-TEP randomisiert drei Gruppen zugeteilt: Jeweils 20 Patienten erhielten ein funktionstüchtiges Elektrostimulationsgerät, ein Placebo-Gerät oder kein Gerät. Postoperativ wurden die Patienten mit Verum- und Placebo-Gerät eine Woche lang 2–3 mal täglich jeweils einer 45-minütigen Behandlung unterzogen. In den ersten 30 min erfolgte eine Ödemtherapie mit Hochvoltstrom negativer Polarität und einer Impulsfrequenz von 100 Hz. Unmittelbar anschließend folgte eine 15-minütige sinusförmige Impulsform mit einer Impulsfrequenz von 1 000 Hz zur Schmerztherapie. Alle Teilnehmer führten ein Schmerztagebuch mit visueller Analogskala (VAS). Präoperativ, 2–3 Tage und 5–8 Tage postoperativ wurden alle Patienten zusätzlich befragt, klinisch untersucht und Daten aus der Krankenakte aufgenommen.
Ergebnisse: Ab dem 3. postoperativen Tag lagen die Werte für die stärksten Schmerzen in der Verum Gruppe immer unter denen der Placebo Gruppe und denen der Patienten ohne Gerät. Am 7. Tag war der gemessene Unterschied statistisch signifikant (p=0,02). Bezüglich der Umfangsabnahme auf Höhe des Kniespaltes zeigten Patienten mit Verum-Behandlung eine statistisch signifikante (p=0,012) Umfangsabnahme von 0,925 cm während des Behandlungszeitraumes. Die Flexionswerte verbesserten sich signifikant in der Verum (29°; p=0,027) und Placebo Gruppe (30°; p=0,007). Die Verumgruppe hatte nach Behandlungsende einen statistisch signifikant höheren HSS Score gegenüber der Gruppe ohne Gerät (p=0,003) und der Placebogruppe (p=0,04).
Schlussfolgerung: Die Behandlung mit dem Elektrostimulationsgerät zeigte sich im Vergleich zu den beiden anderen Gruppen statistisch signifikant überlegen bezüglich der Reduktion der Kniegelenkschwellung und Schmerzen, Steigerung der Beugefähigkeit und des HSS Scores.
To assess the efficacy of bipolar interferential electrotherapy (ET) and pulsed ultrasound (US) as adjuvants to exercise therapy for soft tissue shoulder disorders (SD).
Randomised placebo controlled trial with a two by two factorial design plus an additional control group in 17 primary care physiotherapy practices in the south of the Netherlands. Patients with shoulder pain and/or restricted shoulder mobility, because of a soft tissue impairment without underlying specific or generalised condition, were enrolled if they had not recovered after six sessions of exercise therapy in two weeks. They were randomised to receive (1) active ET plus active US; (2) active ET plus dummy US; (3) dummy ET plus active US; (4) dummy ET plus dummy US; or (5) no adjuvants. Additionally, they received a maximum of 12 sessions of exercise therapy in six weeks. Measurements at baseline, 6 weeks and 3, 6, 9, and 12 months later were blinded for treatment. Outcome measures: recovery, functional status, chief complaint, pain, clinical status, and range of motion.
After written informed consent 180 patients were randomised: both the active treatments were given to 73 patients, both the dummy treatments to 72 patients, and 35 patients received no adjuvants. Prognosis of groups appeared similar at baseline. Blinding was successfully maintained. At six weeks seven patients (20%) without adjuvants reported very large improvement (including complete recovery), 17 (23%) and 16 (22%) with active and dummy ET, and 19 (26%) and 14 (19%) with active and dummy US. These proportions increased to about 40% at three months, but remained virtually stable thereafter. Up to 12 months follow up the 95% CI for differences between groups for all outcomes include zero.
Neither ET nor US prove to be effective as adjuvants to exercise therapy for soft tissue SD.
This paper considers some of the developments in knowledge and understanding of the phenomenon of pain. The 'pain-gate' theory and the descending pain suppression mechanisms are mentioned briefly. A number of mechanisms are suggested whereby interferential therapy may relieve pain. A brief description of the interferential stimulus and its potential for utilising the mechanisms described in earlier sections is given. Suggestions are made concerning the frequencies used for gaining this pain relieving effect.
The stimulation of motor nerves to produce muscle contraction in normally innervated muscles is a long established part of orthodox physiotherapy. Recently however, a revival of interest in the area has occurred, particularly in the U.S.A. Recent research has indicated that such stimulation can improve muscle strength, reduce muscle spasm and modulate spasticity, in addition to the more usual re-educative role of electrical stimulation. The concept of functional electrical stimulation (F.E.S.) seems destined to become an integral part of many programmes for the neurologically handicapped patient. This paper describes the technique of motor stimulation using interferential currents. The stimulating parameters and electrode placement are considered, along with a detailed explanation of the pre-modulated system of electrode arrangement.
A gate control system modulates sensory input from the skin before it evokes pain perception and response.
A randomized trial designed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting.
To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage.
Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany. No reports of previous randomized trials for the outcome from interferential therapy were found.
Consenting patients were randomly assigned into one of two groups. A pretreatment interview was performed by the patient using a computer-based questionnaire. It also incorporated the Oswestry Disability Index and a pain visual analog scale. Management consisted of six sessions over a 2- to 3-week period. Oswestry Disability Indexes and pain visual analog scale scores also were obtained immediately after and at 3 months after treatment.
A total of 152 patients were recruited. The two treatment groups had similar demographic and clinical baseline characteristics. The mean Oswestry Disability Index before treatment was 30 for both groups (n = 147). After treatment, this had dropped to 25, and, at 3 months, were 21 (interferential therapy) and 22 (motorized lumbar traction and massage). The mean pain visual analog scale score before treatment was 50 (interferential therapy) and 51 (motorized lumbar traction and massage). This had dropped, respectively, to 46 and 44 after treatment and to 42 and 39 at 3 months.
This study shows a progressive fall in Oswestry Disability Index and pain visual analog scale scores in patients with low back pain treated with either-interferential therapy or motorized lumbar traction and massage. There was no difference in the improvement between the two groups at the end of treatment. Although there is evidence from several trials that traction alone is ineffective in the management of low back pain, this study could not exclude some effect from the concomitant massage.