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TECAR® THERAPY IN THE TREATMENT OF ACUTE AND CHRONIC PATHOLOGIES IN SPORTS

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Abstract

This study utilized Tecar® therapy, a capacitive and/or resistive energy transfer system that operates within the long wave radio frequency range in the treatment of acute and chronic musculo-articular pathology in athletes. Tecar® therapy is characterized by the transfer of energy within tissues by using a capacitive electrode covered by an insulator and a resistive electrode conductor, following the mechanism of a condenser. The device used is composed of a generator that distributes signals at a frequency of 0.5 MHz at a maximum power of 300 watts. The study observed 327 subjects (120 females, 207 males) between 18 and 60 years of age with acute and chronic sports pathologies. They were divided into two groups, one comprised of 68 cases of acute pathologies which had not been previously treated, and another comprised of 259 cases of chronic pathologies treated by various methods. The sessions were started with resistive treatment with an electrode positioned on the area to be treated for 10 minutes (5 minutes for muscular pathology), followed by another 10 minutes (15 minutes for muscular pathology) with a capacitive electrode applied.
TECAR® THERAPY
IN THE TREATMENT OF ACUTE AND CHRONIC PATHOLOGIES IN SPORTS
G.P. Ganzit, L. Stefanini, G. Stesina
FMSI (Italian Sports Medicine Federation)-CONI Institute of Sports Medicine, Torino
ABSTRACT
This study utilized Tecar® therapy, a capacitive and/or resistive energy transfer system that
operates within the long wave radio frequency range in the treatment of acute and chronic
musculo-articular pathology in athletes. Tecar® therapy is characterized by the transfer of
energy within tissues by using a capacitive electrode covered by an insulator and a resistive
electrode conductor, following the mechanism of a condenser. The device used is composed of a
generator that distributes signals at a frequency of 0.5 MHz at a maximum power of 300 watts.
The study observed 327 subjects (120 females, 207 males) between 18 and 60 years of age
with acute and chronic sports pathologies. They were divided into two groups, one comprised of 68
cases of acute pathologies which had not been previously treated, and another comprised of 259
cases of chronic pathologies treated by various methods. The sessions were started with
resistive treatment with an electrode positioned on the area to be treated for 10 minutes (5
minutes for muscular pathology), followed by another 10 minutes (15 minutes for muscular
pathology) with a capacitive electrode applied.
The progression of symptoms was clinically monitored and evaluated by an independent
observer using the Steinbroker index modified for athletic activity and with the visual analogue
scale (VAS) from 0 to 10 where 0 corresponds to no pain and 10 corresponds to intolerable pain.
The pathologies treated were articular, muscular, and tendinous, and among these, those that
displayed a more marked change in functional class were the muscular pathologies.
The results obtained indicate that Tecar® therapy is a useful tool in the treatment of sports
pathologies of the bone, joints, and muscles. It compares with other therapies in terms of the
presence or absence of certain positive effects but it also has distinct characteristics that are
effective even where other treatments have failed.
KEYWORDS
Hyperthermia, musculo-articular pathology, vasodilatation
Although a relatively broad range of physiotherapeutic equipment is currently in use, including
various devices for generating electric currents induced or transmitted directly to the human body,
there are various articular, tendinous, and myoenthesic pathological processes that are
particularly resistant to treatment and significantly limit the possibility of athletic activity both at
competitive and amateur level.
The possibility that a new method of energy transfer at a deep level could also be useful in certain
cases to shorten and resolve pathologies limiting athletic performance as well as daily activity
seems to be, at the very least, worthy of consideration.
Hyperthermia was developed to treat, in conjunction with other chemical and physical means,
tumorous masses in order to destroy the most central cells, which are less metabolically active and
have little contact with circulating blood. One of the methods used is hyperthermia induced by
radio frequency
1
. In addition to central necrosis, some observations indicated a reduction in
peripheral oedema around the carcinomatous mass
2
and have suggested that this method could
also be used in tissues subject to inflammatory reactions with the required proportions of
intensity and time. In this case, the blood flow, accentuated by increase in temperature, could,
with an increase in caloric exchange, avoid reaching temperatures that could cause cellular
necrosis, observed in the therapy of tumours.
In 1953, Lehmann
3
had already demonstrated how temperatures from 40 to 45ºC could have
therapeutic effects in various pathological conditions, but temperatures of 44-45ºC should be
maintained for only brief periods of time.
Recently, a system for capacitive and resistive energy transfer known as Tecar® therapy has been
developed, operating within the long wave radio frequency range at 0.5 MHz, hence lower than the
frequencies used in short wave diathermy (27.1 MHz), and higher than the frequencies that can
cause muscle contractions. Tecar® therapy has its own distinguishing characteristic in the field of
diathermy equipment, by stimulating energy transfer within tissues by using a capacitive or
resistive electrode.
The first electrode (Capacitive) is covered by an insulator, and the second (Resistive) is a
conducting electrode. In the first case, let us imagine a condenser with two frameworks, where one
is a metal conductor plate (the dielectric is opposite its surface), and the other is a type-2
conductor, formed from the biological tissue and from another metal conductor plate (Return
Plate) that closes the circuit.
A type-2 conductor is characterized by displacement currents rather than conduction, and the
charged particles tend to have a higher density in the vicinity of the dielectric and their energy
tends to increase progressively from the counter electrode to the insulated electrode with resulting
increase in temperature. Hence, there is a greater increase in energy in muscles positioned closely
to the insulated electrode.
If the insulated electrode is held still, the sensation of heat on the skin on contact quickly becomes
intolerable, thus the treatment involves the slow and continuous movement of the electrode in a
circular fashion and subsequent displacements equal to the electrode beam.
In the case of a resistive electrode, the circuit is formed in which the framework is comprised of an
electrode which is a type-1 conductor and underlying biological tissues with characteristics of
type-2 conductors, a dielectric formed from bone tissue, a second framework formed from the
biological tissue conductor and a (Return Plate) that closes the circuit.
In this case, the higher energy density is close to the bone surfaces, hence at the level of insertion
of the tendons, ligaments, and joints. In fact, in this case, the active electrode can be kept still
and the sensation of increase of energy will be felt, above all, in cases of insertion-point or
articular pathology at this level. All of the conducting structures subjected to electromagnetic
waves will have an increase in energy as an increase in ionic movement and where the waves
accumulate, in each case there will be an increase in temperature.
The increasing power of the generator is perceived by the patient as excessive, and this is also the
case with a resistive electrode. In fact, it can be observed that the skin temperature with the use of
a resistive electrode progressively diminishes towards the counter electrode. For example, in the
treatment of the Achilles tendon, the maximum skin temperature is shown at the heel (table 1).
TABLE I
SKIN TEMPERATURE IN ºC DURING TREATMENT WITH RESISTIVE ELECTRODE
FOR ACHILLES TENDINOPATHY
INITIAL 10' 20' 30'
HEEL 27.7 38.7 39.8 40.1
At 5 cm 28.4 38.8 39.7 38.7
At 10 cm 30.0 36.9 39.6 38.2
At 20 cm 31.2 34.5 36.7 37.2
CONTROLLED 27.6 27.7 27.7 27.7
The temperature rises rapidly in the first 10 minutes and more slowly in the subsequent minutes.
After 20 minutes, the increments are very slight and in some areas the temperature tends to rise
depending on the circulatory flow.
The appropriate positioning of electrode (smaller with higher current density) and counter electrode
allows for the treatment of various areas of the body. In particular, for treatment of muscles, a
capacitive electrode is positioned with counter electrode (Return Plate) that closes the circuit on
the opposite side of the limb, while for treatment of joints, the electrode is positioned on one side of
the joint and a counter electrode on the opposite side.
The physiological effects of this increase in energy are represented by:
Increase in extensibility of the collagenous tissue due to reduction in viscosity.
Reduction of pain due to ant-irritant action or release of endorphins.
Reduction of muscular spasms and contractions due to reduced activity of secondary
efferents.
More rapid and complete dissociation of oxygen from haemoglobin with more availability,
accompanied by a reduction in activation energy of important chemical and metabolic
reactions.
Vasodilatation with increase of local blood flow contributing to the re-supply of oxygen and
nutritional substances as well as the removal of catabolytes.
Quickening of re-absorption of haemorrhagic masses.
Other possible effects related to the specific action of the electromagnetic field may be envisaged
but have not been demonstrated.
MATERIALS AND METHODS
The apparatus used is comprised of a generator that supplies a signal at the frequency of 0.5 MHz
and a maximum power of 300 watts (HCR900).The power can be regulated by controlling the
quantity of transferred energy and the relative biological action. The active electrodes are formed
of metallic elements of various dimensions (from a few centimetres to a few millimetres), some of
which are completely covered by a special ceramic material that functions as a dielectric.
The counter electrode (Return Plate) that closes the circuit consists of a metal plate that is applied
in opposition or a cylinder that is clasped. The area to be treated is covered by a light layer of a
special gel that has the sole function of smoothing physical contact between the electrode and the
skin.
The session begins with resistive treatment with an electrode that is positioned on the area to be
treated, kept fixed for 10 minutes (5 minutes in cases of muscular pathology) with power regulated
in order to obtain the maximum skin temperature acceptable to the patient without creating any
pain (repeated adjustments may be necessary to achieve this).
This is followed by application with capacitive electrode for 10 minutes (15 minutes in cases of
muscular pathologies). In this case, the electrode must be continually moved by the operator
in circular motions to avoid disturbing skin sensations from the excessive local heat.
A total of 10 sessions per day were carried out on successive days with a pause of two days at the
end of the week.
The 327 subjects (120 females and 207 males) were between 18 and 60 years of age and had
acute and chronic pathologies from sports activity.
They were subdivided into two groups; one comprised of 68 subjects with acute pathologies
that were not previously treated and the other comprised of 259 subjects with chronic
pathologies that were already treated a number of times with various treatments (FANS,
steroid injections, US, ionophoresis, etc.).
No other physical or pharmacological treatment was used during the phase of Tecar® therapy. In
cases of acute pathologies, bandages or orthopaedic devices were used when necessary, and
treatment was only initiated 72 hours after the trauma.
The progression of symptoms was clinically monitored and evaluated by an independent
observer using the Steinbroker index modified for athletic activity as follows:
athletic activity possible without limitations;
more intensive phases of athletic activity are subject to certain conditions and are limited;
athletic activity is only possible at a moderate level;
the patient is not capable of performing any athletic activity.
In addition, the patients were given a visual analogue scale (VAS) from 0 to 10 where 0
corresponded to no pain upon movement and 10 corresponded to intolerable pain that made the
required movements impossible.The evaluation was repeated at the beginning and at the end of
the treatment. At the end of the treatment, the patients were also asked for their opinions on the
efficacy and tolerability of the therapy.
RESULTS AND DISCUSSION
The patients treated were athletes involved in various disciplines: swimming, skiing, football,
basketball, volleyball, cycling, and, in particular, running and tennis. The various pathologies
treated were subdivided into three groups:
Articular involving sprains, effusion, arthrosynovitis, synovitis from overload and from impact,
meniscal synovitis, chondropathy, lumbago;
Muscular involving 1-3 degree lesions with loss of continuity, myoenthesitis, fibrous scarring;
Tendinous involving acute and chronic tendonitis, paratendonitis and entesopathy.
The articular pathologies were represented by 145 cases (44.3%), muscular pathologies by
46 cases (14.1%), and tendinous pathologies by 136 cases (41.5%).
In choosing the pathologies, we considered the indications for diathermy at the short wavelength
4.5 including those for muscular and ligamentary fibrosis, tendinous and articular lesions, bursitis,
recurrent inflammation such as traumatic arthritis, and epicondylitis. In regard to contraindications,
we referred to general contraindications for application of heat such as infections and sensitivity
deficits whereby the patient is unable to perceive or communicate the sensation of possible pain,
as well as to contraindications more specific to electromagnetic diathermy such as coagulopathy
and thrombophlebitis.
Other examples of contraindications for treatment with short wavelengths such as oedema,
articular effusion, and the presence of metallic objects could, instead, be treated with the capacitive
energy transfer system in accordance with the builders of the system and some experimental
observations
2
.In this experiment, we treated 12 cases of hydrarthrosis of the knee. In each case, it
is necessary to have a correct application of electrodes, respect for time periods, and transmitted
energy that must be regulated according to the sensations indicated by the subject in order to
avoid causing lesions at the end of the treatment from excessive increases in temperature.
The majority of the patients expressed a reduction in pain and improvement in function at
the end of treatment and the categories of the modified Steinbroker index and VAS (Table 2
and Graph 1) were statistically significant.
The changes were statistically significant in acute and chronic cases and in the 3 pathology
groups observed (Tables 3 and 4 and Graphs 2-6).
In order to verify the results more thoroughly, we considered the pre-treatment and post-treatment
Steinbroker index differences for the various types of pathologies.
In doing so, we were able to observe that in chronic cases (Table 5), 45.2% of the patients did not
display changes in functional class and in acute cases, and this figure was 33.8%.
Considering the distribution in all of the classes, however, this difference is not statistically
significant, and we must, therefore, state that, statistically, we have not found significant
differences between acute and chronic pathologies in terms of reported improvements.
If we consider, instead, the 3 groups of pathologies (Table 6), we are able to observe that the
muscular pathologies show a more marked modification in functional class but the patients that
remained in the same class before and after treatment represented 30% of the muscular pathology
cases and 38-39% of the articular and tendinous cases.
If, instead, we observe the final judgments (Table 7), we see that only 14.4% of the patients report
an ineffective treatment without any result. Medical opinion is slightly more severe (17.4%)
probably because in some cases the improvement on the basis of the clinical experience was not
verified.
CONCLUSIONS
The results obtained are interesting and indicate that Tecar® therapy is a useful tool in the
treatment of pathologies of the locomotor system in sports. It overlaps with other therapies in terms
of the presence or absence of certain positive effects, but it also has distinct characteristics that
are effective even where other treatments have failed.
REFERENCES
1. LEVEEN H.H., WAPRICK S., PICONE W.E AL: Tumor eradication by radiofrequency therapy.
Response in 21 patients. JAMA 1976; 235:2198-2200.
2. LEY A., CLADELLAS J.M., DE LAS HERAS P. E AL: Trasferencia electrica capacitiva (TEC).
Tecnica no invasiva de hipertermia profunda en el tratamiento de los gliomas cerebrales.
Resultatos preliminaries, Neurochirurgia 1992; 3: 118-123.
3. LEHMANN J.F., DE LATEUR B.J.: Therapeutic Heat and Cold, Hydrotherapy. In: Leek J.C.,
Gershwin M.E., Fowler W.M. Eds. Principles of Physical Medicine and Rehabilitation in the
Musculoskeletal Disease. Orlando F1: Grune & Stratton Inc., 1986; 61-101.
4. COLE A.J., EAGLESTONE M.A.: The benefits of Deep Heat. Ultrasound and Electromagnetic
Diathermy. Physic. Sportsmedicine 1994; 22: 77-88.
5. MCMEEKEN J.: Electrotherapy in Zuluaga e al. Eds. Sportphysiotherapy. Applied science &
practice. Melbourne: Churcill Livingstone 1995, 233-244.
TABLE 2
MODIFIED STEINBROKER INDEX IN ALL
SUBJECTS BEFORE AND AFTER
TREATMENT (X
2
=143.1)
BEFORE
AFTER
S. I. N. % N. %
1 6 1.8 93 28.4
2 146 44.3 177 54.1
3 145 44.3 54.0 16.5
4 30 9.2 3.0 0.9
TABLE 3
MODIFIED STEINBROKER INDEX IN ACUTE
(X
2
=53.6) AND CHRONIC (X
2
=53.6) CASES
BEFORE AND AFTER TREATMENT
BEFORE
AFTER
ACUTE
S.I. N. % N. %
1 0 0.0 27 39.7
2 28 41.2 35 51.5
3 31 45.6 6 8.8
4 9 13.2 0.0 0.0
BEFORE
AFTER
CHRONIC
S.I. N. % N. %
1 6 2.3 66 25.5
2 118 45.6 142 54.8
3 114 44.0 48 18.5
4 21 8.1 3 1.2
Graph 1. Values of the visual analogue scale of all of the athletes before and after treatment.
median
BEFORE
Graph 2. Values of the visual analogue scale before and after treatment in cases of acute
pathology.
Graph 3. Values of the visual analogue scale before and after treatment in cases of chronic
pathology.
Graph 4. Values of the visual analogue scale before and after treatment in cases of articular
pathology.
median
BEFORE
median
BEFORE
median
BEFORE
Graph 5. Values of the visual analogue scale before and after treatment in cases of muscular
pathology.
Graph 6. Values of the visual analogue scale before and after treatment in cases of tendinous
pathology.
median
BEFORE
BEFORE
median
TABLE 4
MODIFIED STEINBROKER INDEX IN 3 GROUPS
OF PATHOLOGIES BEFORE AND
AFTER TREATMENT
BEFORE
AFTER
ARTICULAR X
2
=49.9
S.I. N. % N. %
1 2 1.4 34 23.4
2 63 43.4 77 53.1
3 68 46.9 32 22.1
4 12 8.3 2 1.4
BEFORE
AFTER
MUSCULAR
S.I. N. % N. %
1 2 4.3 21 45.7
2 28 60.9 25 54.3
3 13 28.3 0 0.0
4 3 6.5 0 0.0
BEFORE
AFTER
TENDINOUS
S.I. N. % N. %
1 2 1.5 38 27.9
2 54 39.7 75 55.1
3 65 47.8 22 16.2
4 15 11.0 1 0.7
TABLE 5
DIFFERENCE BETWEEN THE MODIFIED INDEX OF STEINBROKER BEFORE AND
AFTER
TREATMENT (x
2
=5.81) IN ACUTE AND CHRONIC CASES
ACUTE CHRONIC
DIFFERENCE S.
Index N. % N. %
0
23
33.8
117
45.2
1
32
47.1
113
43.6
2
12
17.6
23
8.9
3
1
1.5
6
2.3
TABLE 6
DIFFERENCE BETWEEN THE MODIFIED INDEX OF STEINBROKER BEFORE AND
AFTER
TREATMENT (X
2
=58.7) IN 3 GROUPS OF PATHOLOGIES
PATHOLOGIES ARTICULAR MUSCULAR
TENDINOUS
DIFFERENCE S.
Index N. % N. % N. %
0 55 37.9 14 30.4 53 39.0
1 78 53.8 22 47.8 60 44.1
2 11 7.6 8 17.4 17 12.5
3 1 0.7 2 4.3 6 4.4
TABLE 7
OPINION ON THE THERAPY AT THE END OF TREATMENT
BY THE ATHLETE AND THE PHYSICIAN
OPINION ATHLETE PHYSICIAN TOLERABILITY
N. % N. % N. %
SUBSTANDARD
47 14.4 57 17.4 13 4.0
MODEST 68 20.8 73 22.3 44 13.5
GOOD 178 54.4 173 52.9 230 70.3
OPTIMAL 34 10.4 24 7.3 40 12.2
.
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A new, non-invasive technique for treating intracranial tumours by producing local hyperthermia is described. The procedure is called «Transferencia eléctrica capacitiva» (T.E.C.). Two cases of glioblastoma multiforme treated by TEC are reported with a description of the pathological findings and the clinical course. The literature on the effects of hyperthermia on intracranial neoplasms is reviewed.
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Tumor blood flow, measured by an isotope dilution technique, is only 2% to 15% that of the surrounding tissue. This sluggish circulation difdifferententiatesm normal tissue and forms the basis for a new therapy that entails the transfer of radiofrequency (RF) energy for heating tissueng oissues cally.eated tissue is cooled by the circulation of blood, which carries away the heat. Impaired perfusion, as in cancers, impedes cooling. Heating by RF elevated the temperatures of animal and human cancers by 5to 9.5 C above that of healthy tissue. The heat eradicated the animal cancers without destruction of normal tissue. Radiofrequency therapy produced y produced crosisbstantial regression of cancer in 21 patients.(JAMA 235:2198-2200, 1976)
Therapeutic Heat and Cold, Hydrotherapy Principles of Physical Medicine and Rehabilitation in the Musculoskeletal Disease
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The benefits of Deep Heat
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Principles of Physical Medicine and Rehabilitation in the Musculoskeletal Disease
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LEHMANN J.F., DE LATEUR B.J.: Therapeutic Heat and Cold, Hydrotherapy. In: Leek J.C., Gershwin M.E., Fowler W.M. Eds. Principles of Physical Medicine and Rehabilitation in the Musculoskeletal Disease. Orlando F1: Grune & Stratton Inc., 1986; 61-101.
Applied science & practice
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