Table 4: Commonly used Electrotherapy Modalities Modality Description Indications
Contraindications
Adverse Effects
Ultrasound therapy (UST) [26]
• Uses therapeutic ultrasound waves. • A gel-like coupling medium is used to transmit the waves effectively to the body. • 2 modes: • Pulse UST. • Continuous UST.
• Adhesions. • Pain. • Muscle spasm. • Neurological pain. • Delayed union and nonunion fractures. • Damaged articular cartilage. • Pressure sores. • Acute, surgical incisions or chronic wounds. • Soft tissue injuries. • Calcified tendinitis. • Hematoma. • Edema. • Muscle pain. • Muscle spasm. • Neurological pain. • Labor pain. • Pain following amputation.
• Malignant or
• Brain, spinal cord, eyes, and Stellate ganglion. • Uncontrolled hemophilia. • Over epiphysial plates. • Subcutaneous major nerves. • Anesthetic areas. • Over tuberculosis of lungs or bones. • Over metal
• Burning sensation.
benign tumors. • Tissues previously treated by deep x-ray or other radiation. • Vascular abnormalities (e.g., Deep Vein Thrombosis, emboli, severe atherosclerosis). • Cardiac area in advanced heart disease.
implants, pace makers, acrylic bone glues.
Transcutaneous electrical nerve stimulation (TENS) [27]
• Uses low voltage electric impulses. • Single/dual channel.
• Pacemakers. • Pregnancy. • Over the anterior neck/sides of neck.
• Impaired skin sensation. • Pain with no evident cause. • Epileptic patients.
• Increased pain. • Burning sensation.
MANIPULATION
Medically, manipulation is defined as “the act, process, or an instance of manipulating especially a body part by manual examination and treatment; especially, adjustment of faulty
structural relationships by manual means (as in the reduction of fractures or dislocations or the breaking down of adhesions) [28] .” Classification of manipulative techniques is shown in Figure 7.
Figure 7: Manipulation Techniques
Massage Massage stimulates the touch sensory receptors, blocking the pain signal at the pain gate. Massage consists of methods such as stroking, kneading, and friction. Stroking Stroking can be performed either with one hand or both hands. It starts with a firm contact and ends with a smooth liftoff of the hands. Usually, it is applied proximal to distal. It gives a sedating effect to tight muscles, so the muscles relax. Slow strokes are more sedative, while fast strokes are more stimulating. Kneading Kneading moves the skin and the underlying soft tissues in a circular motion. It can be performed using the palmar side of the whole hand, heel of the hand, palm, all fingers, one/two fingers, thumb, and elbow. If the force given by one hand is not sufficient, it can be reinforced by the other hand (called
superimposed kneading ). Adhesions formed in the subcutaneous soft tissues are broken down by kneading, leading to pain relief. Friction In friction, deep manipulation is applied over a specific structure by thumbs or fingers. The adhesions formed in the deeper soft tissues are deformed by this technique. There are two types of friction: circular and transverse. Circular friction is used for adhesions in the ligaments and myofascial junctions, whereas transverse friction is used for adhesions in the muscles, myofascial junctions, tendons, and ligaments. When performing transverse friction, the tendons must be stretched and the muscles must be relaxed.
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