CURRENTS

Di-dynamic current
 Diadynamic currents are also
called Bernard's currents based on a sine
wave with a frequency of 50Hz.

 Didynamic currents have two basic forms:

 Half wave rectified sinusoidal current
known as monophasic fixe (MF)
 Full wave rectified sinusoidal current
known as diphasic fixe (DF)
Diadynamic current is a low frequency current. It can be semi-wave
and full-wave sinusoidal current, 50-100 Hz frequency.
Parameters to consider

1 Duration of Treatment –limited to 10

min –electro chemical reactions –Maximum 4 -5 min

2. Amplitude – within the pain threshold limit.

Types of diadynamic current

It has five classic current types:

1- DF (diphase Fixe)
2- MF (monophase Fixe)
3-CP (Courtes Periodes),
4- LP (Longues Periodes)
5-RS( Syncopal Ryhthm)
 Monophasic is a half sinusoidal alternating
current.
 This consist of a series of 10ms half sign
wave shaped pulses with 10 ms pulse
interval.
 Diphase type of current is created by
alternating current of 50 Hz by means of a
two way DC converter so that a current of
100 Hz is achieved
 This is continuous series of 10 ms
sinousidal pulses resulting in a frequency of
100 Hz.
Short period current/CP module
 If two currents form MF and DF are applied
alternatively for 1 sec each the resulting current
is called CP module (module in courtes periods
 The patient senses the abrupt change between
tensing MF current and relaxing DF current
Long period current/LP current
 If two MF currents are applied so that one series of
pulses occupies the pulse interval of the other and one
is of constant intensity while the other is surged the
result is called LP current.
 The gradual raising and lowering of the amplitude is
experienced by the patient as a more pleasant
sensation than that is produced by SP current.
Syncopated rhythm RS:
 The current is interrupted by the pause of 0.9
sec after a current flow 1.1 sec.
 This type of current is used for the electrical
stimulation of the muscle.
 This consists of a 1s phase of MF followed
by a 1s rest phase
Physiological effects:
1- Relief of pain due to
Direct mechanism
 Stimulation of sensory nerves leading to pain relief
through stimulation of pain gate mechanism
Indirect mechanism
 Improving circulation through pumping action of muscle
contraction with subsequent removal of irritant wastes
2- Increase local circulation due to
 Reduced sympathetic tone leading to vasodilatation and the
release of histamine like substances because of
unidirectional effect
Cont.
3- Decrease inflammation and swelling
Due to increased local circulation and change of cell
membrane permeability
4- Muscle re-education due to
stimulation of motor nerves but it is not the current of
choice for muscle strengthening
Indications
 Soft tissue injury as sprains, contusions and
epicondylitis

 Treating pain especially in small joints.

 Peripheral nerve disorders as radiculopathy .

Contraindications
 Open skin as the current tend to concentrate
 Bony areas
 Loss of sensation
 Infection
 Unreliable patients
 Superficial metals
 Thrombosis.
 Cardiac pace makers.
 acute inflammation active bone, joint, and other organ tuberculosis
 malignancy illnesses
Transcutaneous elctrical nerve stimulation(TENS)

 TENS is the application of a pulsed rectangular wave

current via surface electrodes on the patient,s skin
 Pulse shape: rectangular
 Pulse width: 100 microsec or 200 microsec
 Frequency :as low as 2Hz or as high as 600Hz.A
frequency of 15oHz is commonly used.
 Intensity :can be varied from 0 to 60 mA.
Pain modulation
 The effect and use of TENS depends upon gait
control theory and pain modulation:
 Nociceptive stimulus is carried to the cord along
either a
 Slow conducting ,non myelinated C fiber
 Fast myelinated A delta fibers
 Both enter a cord via posterior route
 Both of these fibers have maximum frequency at which
they conduct(C_15 pulses per sec,A delta_40 pulses
per sec)
Pain gate:
 Small fibers- nociceptors (slow conducting non myelinated C
fibers or fast myelinated A delta fibers)
 Large fibers- mechanoreceptors, thermo receptors .
 If nociceptors are activated and thermo and mechano receptors are
also activated then gate close.
 If nociceptors are activated and thermo and mechano receptors are
not activated then gate open.
 Pain full stimulus nociceptors activation lateral spino
thalamic tract mid brain(PAG, raphae nucleus) thalamus
cerebral cortex
 Mid brain (PAG,raphae nucleus)form the part of the descending
pain suppression endogenous opiate(endorphins,enkephalins)
inhibition of the nociceptive circuit
Pain gate
Types of TENS
 High TENS:
 In this high frequency and low intensity electrical
stimulation is applied.
 Frequency: between 100 and 150Hz
 Pulse width: between 100 and 500 micro sec.
 Intensity :between 12 and 30mA.
 When TENS is applied in this way the stimulation will
cause impulses to be carried along large diameter afferent
nerves, and this can produce the presynaptic inhibition of
transmission of nociceptive A delta and C fibers at the
substantia gelatinosa of the pain gate.
 Thus the patient is aware of strong tingling sensation but
pain traffic is reduced.
Low TENS
 Frquency:1_5Hz
 Pulse width:100_150Hz
 Intensity :higher than 30mA
 In this low frequency and high intensity electrical
pulses are applied ,it gives a sharp stimulus an and
like a muscle twitch.
 As the nociceptive stimulus is carried towards
cerebrum,its passage through the mid brain will
cause the PAG and RAPHE nucleus to interact to
cause the opiate like substances at cord level.
 The encephalins and endorphins released have the
effect of blocking forward transmission in the pain
circuit.
Application
 The device is consist of two parts,one is battery
and other are conductive rubber
electrodes.Conductive rubber electrodes are
covered by the gel and placed on the skin in order
to gain good skin contact.
 Electrodes can be placed over :
 Acupunture points,motor points,trigger points.
 Area of the greatest intensity of pain.
 Appropriate dermatome,spinal segment.
 Appropriate peripheral nerve.
Treatment
 TENS can be used for a single daily treatment of
40 min duration.
 Portable TENS can be used continuously for 24
hours.

 Indications for use:

 Chronic pain syndromes
 Phantom limb pain
 Post operative pain
Dangers and contraindications
 Continuous application of high TENS may result in some
electrolytic reaction below the skin surface.
 Contraindicated in patients having cardiac pacemakers.
 TENS should be avoided in first three months of
pregnancy .
 TENS should be avoided in hemorrhagic conditions.
 Should be avoided over open wounds, over the mouth, near
eyes etc.