MEDIUM

FREQUENCY
CURRENTS
MEDIUM FREQUENCY
CURRENTS
Medium frequency: range of 100 to
4000HZ
TYPES:
Interferential
current
Rebox type current
Russian current
REBOX TYPE CURRENTS
 Rebox–type currents are derived from a device called Rebox. It was
developed in the 1970s. There is a point electrode and a hand held
device. The point electrode is made the negative pole. The device
consists of a micro ammeter and earphone.
 This system can be linked to a computer for display of graph of
current. The current produced consists of unipolar rectangular pulses
of between 50 and 250 μs at 3000 Hz.
 Russian Currents
 Russian currents are evenly alternating currents with a frequency of
2500 Hz (between2000–10000 Hz).
 These are applied with a series of separate bursts, i.e. polyphasic
AC waveforms . There are thus 50 periods of 20 ms duration
consisting of 10 ms burst and 10 ms interval. Each 10 ms burst
contains 25 cycles of alternating current, i.e. 50 phases of 0.2 ms
duration.
 These bursts reduces the total amount of current given to the patient
thus increases patients tolerance
 The other factor affecting patients tolerance is the effect of frequency on the patients
tissue.
 Higher frequency current reduces the resistance to the current flow again making
this type of waveform comfortable enough that the patient may tolerate with higher
intensities.
 There are two basic waveforms which are used:
A sine wave and a square waveform with a fixed intrapulse interval.
interferential therapy
 The principles of interferential therapy were first
introduced by Ho Nemec (an Austrian scientist).
Interferential currents are also known as Nemec’s currents.
In this two medium frequency currents are used to produce
a low frequency effect. Since direct application of faradic
current results in pain due to high impedance of tissues, so
to have a low frequency effect two medium frequency
currents are used.
 Basic principles of Interferential Therapy
 The Interferential therapy depends upon the principles of
Interferential effect of two medium frequency currents
crossing in the patient’s tissues. The interference produced
by two currents in the tissues is called the beat frequency.
For example, let us take two medium frequency currents,
 current in circuit A = 4000 Hz and
 circuit B = 3900 Hz.
Where these two currents are applied to
the tissues, at the point where the
currents cross over, a new beat
frequency current is set up whose
amplitude is modulated and the
frequency of new current is called beat
frequency (interferential current) and
that is 100 Hz
 Definition and Terms Applied with Interferential Therapy
 Interferential current is the resultant current produced when two or more
alternating currents are applied simultaneously at the point of intersection in a
given medium
 Impedance: Resistance, capacitance and inductance all these collectively form
the impedance of the circuit. This impedance is a type of resistance produced
by the tissues against any electrical stimulation of low frequency.
 Impedance is denoted by “Z”.
 Where, f = Frequency of current
 C = Capacitance
 Phase: The current traveling from 0 to 180º is called to be in the same phase
and the current traveling from 180 to 360º is called to be in opposite phase,
i.e. if current A is traveling to B andC, then A to B it is called to be in same
phase and from B to C it is called to be in opposite phase
 Wherever two waves of same frequency travel in same phase, then the peak of their
crest and trough coincide and the resultant wave has amplitude more than the original
amplitudes. But frequency will not change.
 If two currents are traveling with little difference in their frequency then the amplitude
of the resultant wave will increase or decrease in regular cycle. This is called amplitude
modulation.
 This amplitude modulation is denoted by the difference of two original frequencies and
is termed as beat frequency.
 Modulation depth: Apart from frequency of modulation, the amplitude modulation is
also characterized by depth of modulation. The modulation will be between 0 and 100%.
 Sweep frequency: Sweep frequency is the frequency which can be directly fed to the
beat frequency by the machine.
 Electrodes: In interferential therapy, the flexible electrodes are used
which are taped or bound to skin. Usually four electrodes are used in
interferential therapy, but two electrodes may be used in the
treatment.
 Balance: Electric current applied through the skin depends on the
condition of electrode, sponge and the skin. Hence when two
currents are applied there may be unequal current passing through
each circuit. This occurs due to the unequal resistance encountered.
In order to compensate this situation the current in both the channels
can be equalized.
 Spectrum: Interferential therapy (IFT) makes use of varying the
frequency to prevent accommodation
 Methods of Treatment
 1. Skin must be clean and clear before the start of the treatment.
 2. The part of the body to be treated should be washed and if there is any skin lesion it
should be covered by applying petroleum jelly on it.
 3. The electrodes should be placed in such a way that the crossing point of two
currents lie above or around the affected part.
 4. The suitable frequency current should be given for different conditions.
 5. Select the spectrum mode rectangular, triangular or trapezoidal as needed.
 6. Select the base frequency and upper frequency, the difference between upper
frequency and base frequency would give the spectrum.
 7. Increase the power gently and slowly until the patient starts feeling the current. It
can be increased till the patient can tolerate
 8. The current in channel-I and channel-II are independently
measured.
 9. If there is difference in current in both the channels, this
can be equalized by the balance control provided for this
purpose. Usually, this difference is caused due to difference
in resistance in the body where the two currents are passing.
 10. Afterthe treatment, adjust the intensity control to
minimum.
 11. Switch ‘OFF’ the mains and disconnect the electrodes.
 Advantages of Interferential Currents
 1.The interferential currents do not produce any sensory nerve irritation, irrespective of
amplitude. Their application is free of any burning sensation on the skin surface as is
sometimes experienced with other low frequency currents which are disturbing to current
sensitive patients.
 2. A medium frequency alternative current, it is medium frequency and absence of direct
current properties, are the most suitable for treating deeper layers of tissues. It is therefore
most useful in treating tissues at a greater depth. For example, in muscles, tendons, nerves,
bursae and periosteum. Unlike galvanic which has more reaction in the skin and
subcutaneous tissues, IFT is harmless.
 3. Resistance of skin is minimum while using frequencies in the range of 4,000 Hz, and
therefore higher doses can be given to the body without any discomfort to the skin.
 4. The current can be localized more effectively in specific area. Extensive area can also be
covered.
Physiological Effects of Interferential Therapy
 The physiological effects of interferential therapy depend upon:
 1. Magnitude of the current
 2. Type of mode used—Rhythmic or constant
 3. The frequency range used
 4. Accuracy of electrode positioning.
 The effects are:
 1. Relief of pain:
 Relief of pain is an important physiological effect obtained by the use of interferential
therapy. The increase in local blood circulation due to the local pumping effect of the
stimulated muscles or the effect on autonomic nerves and thus the blood vessels help
removing the chemicals from the local area.
 Short duration pulses at a frequency of 100 Hz may stimulate large
diameter nerve fibers which will have an effect on the pain gate in the
posterior horn, and inhibit transmission of small diameter nociceptive
traffic. A frequency of 80–100 Hz rhythmic is usually chosen for this
effect, as the problem of accommodation is reduced
2.Motor stimulation:
 Normal innervated muscles will be made to contract if interferential
frequencies between 1 and 100 Hz are used. The type of contraction
depends on the frequency of stimulation, At low frequencies a twitch is
produced, between 5 and 20 Hz a partial tetany, and from 30 to 100 Hz a
tetanic contraction.
 A complete range of all these types of muscle contraction can be seen
when a rhythmical frequency of 1–100 Hz is used. Muscle contraction is
produced with little sensory stimulation, and can be of deeply placed
muscles, e.g. pelvic floor. Unfortunately, the patient is unable to
voluntarily contract with the current (unlike faradism), but this does not
seem to adversely affect the results
3.Absorption of exudates:
 This is accelerated by a frequency of 1–10 Hz rhythmic, as a rhythmical
pumping action is produced by muscle contraction, and there is possible
an effect on the autonomic nerves which can affect the diameter of
blood vessels, and therefore the circulation. Both of these factors will
help absorb exudates and thus reduce swelling.
 Treatment of patient’s condition
1. Relief of chronic pain
i. Low back pain
ii. Periarthritis shoulder
iii. Osteoarthritis knee
2. Absorption of exudates
3. Stress incontinence.

LOW BACK PAIN

 Low back pain is characterized by pain which is present in the lower part
of the back region. As much as 80% of the industrial population and 60%
of the general population
 experience acute low back pain at some point of time in their life. Hence,
low back pain is a cause of great economic and clinical significance.
 Etiology
 In the majority of the patients, the common causes of low back pain are:
1. Idiopathic
2. Discogenic.
 However, LBA could result from various other causes. It is therefore
necessary to identify and rule out the other causes of LBA before
initiating physiotherapy.
1. Receiving the patient:
 Good morning, I am a Physiotherapist and going to treat you. Please,
cooperate with me during the treatment and wait until I go through your
case sheet.
2. History taking or going through the case sheet:
– Name
– Father’s and Mother’s name
– Age
– Sex
– Occupation
– Address: Correspondence and permanent.
– History of present illness
– History of past illness
– Social and occupational history
– Treatment history
– Prognosis of the treatment
– Investigations:
 i. Hematological tests
 ii. Radiological tests—
 X-rays, MRI scan, etc.
3.Checking for general contraindications:
– Hyperpyrexia/Fever
– Hypertension
– Epileptic patients
– Non cooperative patients
– Mentally retarded patients.

4.Checking for local contraindications:

– Open wounds
– Hairy surface
– Metal implant
– Malignant growth
– Hypersensitive skin
– Loss of sensation
5. Preparation of trays:
– Treatment tray: Mackintosh, lint pads, pad or plate electrodes, leads, straps,
cotton,powder, gel, etc.
– Skin resistance lowering tray: Saline water, soap, cotton, Vaseline, towels,
etc.
6. Preparation of apparatus:
– Check whether all the knobs are at zero
– Checking the pins of the plug and check whether the switch is turned off
– Check the insulation of the wire
– Check whether the switch in the stimulator is working
– Check whether fuse is present in the apparatus; see that it is not blown out
– Check whether hand switch for patients use is intact and is working
7. Correct positioning of the patient:
– Patient must be comfortably placed preferably in lying (prone) position.
– Part to be treated must be exposed and should be at adequate distance
from the modality.
8.Correct positioning of Physiotherapist:
Position of Physiotherapist should be in closed vicinity of the patient and at
appropriate reachable distance from the modality.
9. Correct placing of pads and electrodes:
Four electrodes are placed in two pairs (sets) to be placed diagonal to each
other
10.Regulating the current:
– Gradually increase the current
For relief of pain, a frequency of 80–100 Hz rhythmic is
used
– Keep talking with the patient about the feel of the
current
– Tell him to inform you immediately about any
inconvenience, discomfort or burning.
 Treatment
1. Rest and analgesics
2. Spinal extension exercises
3. Postural correction.
OSTEOARTHRITIS
OF KNEE
Osteoarthritis is a chronic
degenerative disease of
joints with exacerbations of
acute inflammation