Electrical Stimulation

All Kinds of Choices

Stimulating Units
Fall into one of two categories:

Low Volt (Less than 100V)
TENS (9V battery)

High Volt (Greater than 100V)
Pretty much everything else
Carrier Frequencies
Low-frequency currents
1000 pps or less (Monophasic, Biphasic)
Medium-frequency currents
1000 pps 100,000 pps (IFC, Russian)
High-frequency currents
100,000 pps and higher (Diathermies)
Waveforms
Monophasic
Biphasic
Interferential
Pre-modulated Interferential
Russian
TENS
Microcurrent
Monophasic
Unidirectional flow of electrons
Negative / Positive polarity
Twin Peaked Monophasic
Peak Current
Pulse Duration
75 s
Biphasic
Positive and Negative Phases
Symmetrical / Asymmetrical




Interferential Current
Two channels at separate frequencies
Less skin resistance
Quadripolar Electrode Configuration
5,000 Hz
5,100 Hz
Interferential
Channel 1
Channel 2
Beat Frequency: 100 Hz
Interference Current
Ch 1
Ch 2
Ch 2
Ch 1
Pre-modulated IFC
Bipolar electrode configuration
Mixing of currents occurs inside the machine
Less penetration than IFC
Russian
Classical Russian Stim involves 2500 Hz carrier
frequency w/ beat frequency from 1 100 Hz
Thought to allow more current to reach motor
nerve at lower intensities
Results have never been duplicated
TENS
Transcutaneous Electrical Nerve Stimulation
Primarily used for pain reduction
Gate Control
Endogenous-opiate release
Microcurrent
Subsensory or very low sensory level
Very small current amperage / Very high pulse duration
Very theoretical / not much supporting research
Attempts to re-establish bodys natural electrical balance by
allowing ATP supply to increase metabolic energy for
healing to occur
Levels of Electrical Stimulation
Subsensory
Sensory
Pain Relief
Edema Control
Motor
Pain Relief
Edema Control
Muscle Re-education
Noxious
Subsensory
Microcurrent
Unable to stimulate nerve or muscle
Variety of recommended parameters
Generally consists of 2 10 minute Txs
Parameters
1
st
Treatment
Frequency: 30 Hz
Intensity: 600 A

2
nd
Treatment
Frequency: .3 Hz
Intensity : 60 A
Lynn Wallace

Pain Mode
Frequency: 30 Hz
Intensity: 80-100 A
Healing Mode
Frequency: .3 Hz
Intensity: 20-40 A
Sensory Level Pain Relief
Stimulation at or above sensory threshold
but below motor level
Stimulation of A fibers
Gate Control Theory
Frequency: 50 150 Hz
Phase Duration: Less than 100 s
Intensity: Comfortably strong
Sensory Level Edema Control
Done immediately following injury to limit
formation of edema
Not widely researched but a few theories
Decreased capillary pressure and permeability
which keeps plasma and proteins from entering
extracellular tissues
Vascular spasm preventing leaking from
vessels
Waveform: Monophasic
Frequency: 120 pps
Phase Duration: As high as possible
Intensity: Comfortably strong
Monopolar electrode configuration
Negative electrodes over injured area

Motor Level Pain Control
Best used with subacute / chronic pain
Endogenous opiate release
Longer duration of pain relief

Also good for trigger points
Frequency: Low; 2-4 pps
Phase Duration: Wide; 200-300 s
Intensity: Strong, twitch contractions

Motor Level Edema Control
Muscular contractions encourage venous
and lymphatic milking fluids from the
area
Electrodes arranged to follow primary vein
exiting swollen area
May be continuous or on / off time
Continuous

Frequency: 1 2pps
(or as low as possible)
Phase Duration:
200 400 s
Intensity:
Strong, twitch contractions
On / Off time

Frequency: 25 50pps
Phase Duration:
200 400 s
Intensity:
Strong, tonic contractinons
Duty Cycle: 50%
5 on / 5 off
10 on / 10 off
Muscle Re-education
Neuromuscular Electrical Stimulation (NMES)
Muscle re-education, reduction of spasticity, delay
of atrophy, muscle strengthening
Stronger type of current, not as comfortable as
other forms of ES
Not as effective as voluntary contractions
Frequency: 25 50 pps
Phase Duration: 200 400 s
Intensity: Strong tonic contractions

NMES Principles
Duty Cycle
1:5 (10 on / 50 off) Strength
1:2 (10 on / 20 off) Endurance
1:1 (10 on / 10 off) Fatigue
Ramp Times
Fast ramp on: .5 1 sec Power
Long ramp on: 1 2 sec Strength
Long ramp off: 3 5 sec Eccentrics
Noxious Stimuli
Causing pain to relieve pain
Stimulation of A and C fibers
Electrode placement is variable
Generally used as a last resort
Longer lasting pain relief
Frequency: 1-5 pps or 80-100 pps
Phase Duration: 1 ms or higher
Intensity: Noxious (painful)
Conclusion


Lots of machines, lots of choices.
Everybody is different, so dont be afraid to
try different things if things arent going as
planned.