Sekar.L
 Application ‫التطبيق‬of High-Frequency
Electromagnetic Energy ‫عالية التردد الطاقة‬
‫الكهرومغناطيسية‬
 A deep-heating ‫في أعماق التدفئة‬modality ‫شكل‬
 Does Not stimulate ‫ال حفز‬MOTOR ‫&المحركات‬
SENSORY NERVES. .‫األعصاب الحسية‬
 No Danger ‫ال يوجد خطر‬of CHEMICAL BURNS
‫الحروق الكيميائية‬
2
 No Contraction of Muscles is produced ‫ال تقلص العضالت وينتج‬
 Frequency ‫( تردد‬27.12 MHz at wavelength of 11 M)
 Dia ‫ضياء‬means through ‫من خالل‬and
 Thermo ‫الحرارية‬means temperature ‫درجة الحرارة‬heat.
 Short wave diathermy (SWD), or radio frequency (RF), is
used to penetrate deep ‫اختراق عميق‬into the body tissues
‫أنسجة الجسم‬to stimulate blood flow ‫تدفق الدم‬.
3
A=Power Switch
B=Timer
C=Milliameter (monitors current
from power supply not current
entering patient-volume control)
D= Intensity(%max power to patient)
E=Tuning Control(tunes output from
RFO)
4
•Generates Both an Electrical ‫الكهربائية‬and
a Magnetic Field ‫المجال المغنطيسي‬
SWD Units at 13.56 MHz= Stronger
Magnetic Field
SWD Units at 27.12
MHz =
Stronger Electrical Field
5
SWD have two main ‫الرئيسيتين‬
circuits ‫;الدوائر‬
1. The machine circuit ‫الجهاز الدوائر‬
which produce high frequency
current coupled with
2. The patient circuit ‫الدائرة المريض‬
through inductors to transfer the
electrical energy to the patient.
6
•This type of high frequency
current is obtained by
DISCHARGING ‫التفريغ‬a
CONDENSER ‫المكثف‬through an
INDUCTANCE ‫ملف محاثة‬of LOW
OHMIC RESISTANCE.
‫انخفاض المقاومة األومية‬
7
Effects of an electrostatic field
‫الحقل الكهربائي‬:
1- Free ions in the tissues give
minimal movement (Vibration
of Ions ‫ )اهتزاز األيونات‬due to high
frequency leading to friction
‫احتكاك‬between ions and
produce heat.‫إنتاج الحرارة‬
+
-
-
-
+
+
-
+
8
2- The dipolar ‫وثنائي القطب‬
molecules ‫(جزيئات‬as water –
will rotate to & fro Swinging) charge change
rapidly, friction between
molecules leads to heat in
the tissues.
9
3- The non-polar ‫وغير القطبية‬
molecules (as fat ‫ –الدهون‬Insulator
‫عازل‬, undergo distortion ‫تشويه‬of
their electron cloud ‫اإللكترون سحابة‬
leading to back & forth ‫ويعود عليها‬
movement) cause minimal
friction and molecular
movement producing little heat.
10
 Tissue Temperature Increase
 Increased Blood Flow (Vasodilatation)
 Increased Venous and Lymphatic Flow
‫تدفق الدم الوريدي‬
‫واللمفاوي‬
 Increased Metabolism
 Changes In Physical Properties
 Muscle Relaxation - ‫االسترخاء‬
 Analgesia - ‫تسكين‬
‫الخواص الفيزيائية‬of Tissues
‫عضلة‬
11
 Flexible pads ‫منصات مرنة‬: consist of metal
electrode encased ‫المغطى‬in rubber and
produce an electrostatic field.
12
 Space plates ‫لوحات الفضاء‬: consist of a
rigid metal electrode ‫قطب المعادن الصلبة‬
encased in a Perspex cover 
electrostatic field.
13
Coil:‫ ملف‬or cable electrode
‫كابل كهربائي‬consists of a wire
with plugs at either end
electromagnetic field.
14
The monode: flat, rigid coil
encased in Perspex cover
electromagnetic field.
15
 The diplode: or drum electrode
‫طبل الكهربائي‬, consists of a flat coil
electrode encased in a Perspex cover
with two wings electromagnetic field
16
1. Capacitor field Method
‫مكثف مجال األسلوب‬
2. Inductive field / Cable Method
‫ كبل األسلوب‬/ ‫حثي حقل‬
Selection of Appropriate methods
Can Influence The Treatment
17
 The electrodes acts as
CAPACITOR
 The patient tissues & Insulating material acts as
DIELECTRIC MEDIUM. ‫المتوسط‬
‫عازل‬
 Heat production by conversion of
ELECTROMAGNETIC ENERGY ‫الطاقة الكهرومغناطيسية‬
MECHANICAL ENERGY(HEAT)
)‫الميكانيكية (الحرارة‬
‫الطاقة‬
18
If the goal of treatment is to
increase tissue extensibility
‫ &زيادة األنسجة التمدد‬the limitation
is primarily to capsular
tightness, ‫المحفظة ضيق‬then
capacitor field method of
SWD is the more appropriate
choice.
19
 Create Stronger Electrical Field Than
Magnetic Field
 Ions Will Be Attracted Or Repelled
Depending on the Charge of the Pole
20
 Center Has
Higher
Current
Density Than
Periphery
21
Patient
Is
Between
Electrodes and
Becomes Part
of Circuit
22
 Fat Tissue Resists
‫يقاوم‬Current Flow
 Thus Fat Is Heated In An Electrical
Field
 Precaution: electrical field may
overheat area with large fat content
23
 Two Metal Plates
Surrounded By
Plastic Guard
 Can Be Moved 3cm
Within Guard
 Produce High-
Frequency
Oscillating Current
24
Area To Be
Treated Is
Placed Between
Electrodes
Becoming Part
of Circuit
25
 Sensation Of
Heat In Direct
Proportion To
Distance Of
Electrode From
Skin
 Closer Plate
Generates More
Surface /
superficial Heat
26
 Greater Electrical Field
 Patient Part of Circuit
 Must Have Uniform Contact
(toweling)
 Spacing Equal To Cross-
sectional Diameter of Pads
 Part To Be Treated Should
Be Centered
27
1. COPLANAR
METHOD
‫طريقة متحد المستوى‬
In this electrodes
can be placed side by
side ‫جنبا الى جنب‬on the
same aspect of the
part, provided that
there is adequate
distance between
them. ‫كافية المسافة بينهما‬
28
 Increasing The
Spacing Will
Increase The Depth
Of Penetration. But
Will Decrease The
Current Density
 Capacitive Method
Good for Treating
Superficial Soft
Tissues
29
1. CONTRAPLANAR
METHOD
‫كونترا طريقة مستو‬
In this electrodes are
placed on opposite
sides ‫األضالع المتقابلة‬of
the treatment part.
Most satisfactory
method for deeply
placed structures.
‫وضع هياكل عميق‬E.g. Joints
30
1. CROSSFIRE
‫ تبادل الطالق النار‬METHOD
‫طريقة‬


In this first half of the
treatment is given with the
electrodes in one contra
planar position & for the
second half the electrodes
are repositioned at right
angles.
31
1. MONOPOLAR
METHOD ‫القطب‬
‫أحادي‬
‫طريقة‬
The active electrode
‫أحدث الكهربائي‬is placed over
the site of the lesion ‫اكثر من‬
‫ &موقع من اآلفة‬the
indifferent electrode is
applied to some distant part
of the body.
32
 Creates A Stronger Magnetic Field
Than Electrical Field
‫المجال المغنطيسي‬
 Using a long tubular flexible conductor
‫موصل أنبوبي طويل مرنة‬covered in thick rubber called
a Cable Or Coil, is Wrapped Circumferentially ‫بشكل‬
‫محيطي‬Around An Extremity Or Coiled Within
Electrode
 If the goal is to increase blood flow to aid healing of
a muscle injury then Inductothermy can be chosen.
33
Passing Current Through A Coiled
Cable Creates A Magnetic Field By
Inducing Eddy Currents
‫(دوامة التيارات‬small circular electrical
fields) That Generate Heat
34
Two Arrangements:
Pancake Coils
‫فطيرة لفائف‬
Wraparound Coils
‫ملفوف لفات‬
•Toweling Is
Essential.
•Pancake Coil Must
Have 6” in Center.
Then 5-10cm Spacing
Between Turns
35
‫تباعد‬
Spacing provided by:
1- Wrapping
‫غالف‬flexible pads in towel.
2-Flat felt spacing pads between pad
electrode and skin.
3-Air when using space plates.
36
a- Normal spacing ‫تباعد طبيعية‬ even field ‫الميدان حتى‬
distribution.
b- Increased spacing ‫زيادة التباعد‬ deep field
‫ عمق الميدان‬concentration.
c- Decreased spacing ‫إنقاص تباعد‬ superficial ‫سطحي‬
concentration.
a)
c)
b)
37
•About 4 cm distance will give
heating of the deep tissues.
•Conversely the minimum skin
electrode distance is about
2 cm, will give superficial
heating.
38
‫ حجم القطب‬If the electrodes are
too small than the diameter of treated part line of
force will be concentrated superficially.
-If the electrodes are markedly larger the line of
force will be lost in the air.
-Ideally, the electrodes should be slight larger
‫أكبر قليال‬than the area treated.
39
‫ المعادن‬metal causes the lines of
force to concentrate on the metal
40
Patient Sensation Provides Basis For
Recommendations Of Continuous SWD
Dose I (Lowest) - No Sensation ‫هناك إحساس‬of
Heat
Dose II (Low) - Mild Heating Sensation
‫معتدل تدفئة اإلحساس‬
Dose III (Medium) - Moderate or Pleasant
Heating Sensation ‫معتدلة أو بليزانت تدفئة اإلحساس‬
Dose IV (Heavy) -Vigorous Heating Within
Pain Threshold ‫تدفئة قوية ضمن عتبة األلم‬
41
Uses
Thermal Effects
‫التأثيرات الحرارية‬
 Deep heat
 Increased blood flow
Non-thermal Effects
‫اآلثار غير الحرارية‬
•Edema reduction
•Lymphedema
reduction
 Increased cell metabolism
•Superficial
wound
 Increased tissue extensibility
healing
 Muscular relaxation
 Possible changes in enzyme
reactions
•Treatment of
venous stasis ulcers
42
Disorders of Musculoskeletal System;
( Sprain, Strain, Muscle & Tendon tear,
Capsule lesion, Joint stiffness, Hematomas)
Sub acute & Chronic Inflammatory
Conditions;
(Tenosynovitis, Bursitis, Synovitis, Sinusitis,
Dysmenorrhoea, Fibrositis, Myositis)
43

‫يزرع معدنية‬
(be
aware of body piercings) – Concentration of the
field.
‫ – الناظمات القلبية‬Interference
with function
‫ – المناطق الدماغية‬The inability of the
circulation to disperse heat could result in high
temperature – Burns.
44

‫عرق‬
‫ رطبة الضمادات‬The water collects and
concentrates the heat.
‫نزف‬
‫ – حيض‬Increase
vasodilatation, prolong hemorrhage.
‫ – الحمل‬Miscarriage
‫فرط السخونة‬
45
 Sensory loss / Impaired thermal sensation
‫ضعف اإلحساس الحراري‬
 Cancer ‫السرطان‬/ Malignant tissues
‫ –األنسجة الخبيثة‬Accelerate the rate of growth &
Metastasis
 Active ‫أحدث‬TUBERCULOSIS ‫ –السل‬Increase
the rate of development of the infection.
 Recent ‫األخيرة‬Radiotherapy ‫–العالج اإلشعاعي‬
Skin sensation & Circulation may be
decreased.
46
Dermatological ‫األمراض الجلدية‬
Conditions – Will exacerbate
Severe Cardiac conditions
‫ – ظروف قاسية القلب‬Greater demand
of Cardiac output.
‫أمراض األوعية الدموية المحيطية‬- DVT
47
Areas of particular sensitivity:
 Epiphysis plates
‫مشاشي لوحات‬in
children
 The genitals ‫األعضاء التناسلية‬
 Sites of infection ‫مواقع اإلصابة‬
 The abdomen with an implanted
intrauterine device ‫جهاز مزروع داخل‬
‫(الرحم‬IUD)
 The eyes and face
 Application through the skull ‫جمجمة‬
48
‫تخفيف اآلالم‬
Stimulation of Sensory heat receptors – Pain Gate
Mechanism.
‫تشنج العضالت‬
Heating Secondary Afferent muscle spindle –
Inhibitory influence to motor pool.
‫ التهاب‬Assists in removal of cellular
debris and toxins.
Nonthermal: Alters diffusion rate across the cell membrane
Thermal: Increases intramuscular metabolism
49
‫تسريع‬
‫التئام الجروح‬
by
increase cutaneous circulation ‫جلدي تداول‬,
Vasodilatation increases:
Blood flow
Capillary filtration
Capillary pressure
Oxygen perfusion
‫ عدوى‬increase circulation and increase
white blood cells and antibodies – Reinforcing body’s
normal defense mechanism.
‫ تليف‬increase extensibility ‫ التمدد‬of fibrous
tissues such as tendons, joint capsule and scars.
Alters collagen properties, allowing it to elongate.
50
1- Burn - can be avoided by:
 -Checking all contra-indications and area to be treated.
 -Test of thermal skin sensation.
 -Taking care during application over a bony prominence.
 -Never apply SHORT WAVE DIATHERMY over clothing.
 -Making sure that the skin is dry.
 -If you apply over two skin surfaces in contact, they must be separated by
absorbent material towel.
 -Making sure that the leads from the machine are not touching or within 25
mm electromagnetic field around the lead.
 -Making sure that there is adequate spacing between the electrodes and the
skin.
 -Allowing 2 or 3 minutes on each intensity setting maximum heat.
51
2- shock -
can be avoided by:
 -Not increasing intensity unless the leads and electrodes are
connected to machine.
 -Making sure that the machine is earthed. ‫اختبأ‬
‫اآللة‬
 -Not touching the machine.
 -Making sure that there is no metal within the range of
300mm.
 -If the patient is wearing a hearing aid
switch it off.
‫جلسة المعونة‬
52
3.Synthetic Material ‫المواد االصطناعية‬
 These do not absorb moisture as readily as
normal materials
 They ignite more easily
 The material may absorb energy or
concentrating the field.
53
4. Obese Patients ‫المرضى‬
‫السمنة‬
Fat layers more readily heated
Absorbing 8 times that
absorbed in muscle.
54
Continuous ‫ المستمر‬short wave
diathermy
 Increases tissue temperature
 Increased risk of burns
Pulsed ‫نابض‬short wave diathermy
 May or may not increase temperature
 Pulses allow for increased treatment intensity and duration
 Not the same as “non-thermal”
55
 It is also known as
 Pulsed electromagnetic energy
(PEME)
 Pulsed electromagnetic field (PEMF)
 The production of HFC for PSWD is
exactly same as for CSWD.
56
 By incorporating ‫إدماج‬a timing circuit ‫توقيت الدوائر‬,
the output can be turned on & off allowing bursts of
Oscillations.
 Off-Time Longer Than On-Time
 Low Mean Power Output
 Uses Drum Electrode
 Some machines give fixed – length pulses (65 or
400µsec)
57
 -Is short wave at the frequency of 27.12 MHz, which
is pulsed at a rate, selected by the therapist.
 -The pulse frequency range is from 15 to 200 Hz.
 -The maximum intensity is 1000 watts.
 -The pulse duration is constant at 0.4 ms in square
pulse.
 -The advantage of pulsed S.W.D. is that a very high
‫عالية جدا‬intensity ‫كثافة‬of power ‫السلطة‬can be
administered with minimal effect.
58
59
1-Increases the number & activity of cells in the
injured region
2-Reabsorption ‫استيعاب‬of hematoma ‫دموي‬
‫ورم‬.
3-Reduces swelling & Inflammation
4-Increases rate of fibrin deposition
orientation
‫&الليفين ترسب‬
5-Increases collagen deposition & organization
6-Increase nerve growth
‫ &نمو األعصاب‬repair.
60
1- Acute Sprains.
2- Contusions. ‫كدمات‬
3- Acute Haematoma.
4- Bursitis. ‫التهاب كيسي‬
5- Sinusitis. ‫إلتهاب الجيب‬
6-Synovitis ‫الزليل‬
7-Sports Injuries
8-Superficial Ulcers ‫قرحة سطحية‬
9- Neurogenic Pain (Phantom Pain ‫األلم‬
‫فانتوم‬, Causalgia ‫) حراق‬
61
1- Cardiac Pacemakers.
2- High fever.
3- Tumour.
4- Metal in the area , including implants.
5-Pregnant Women
6-Impaired sensation
7-Uncooperative ‫متعاون‬
‫الوعي المرضى‬
‫غير‬/ Unconscious patients ‫فاقد‬
62
1- Synthetic materials
2- Obese patients
63
1-Decrease of pain & Swelling – Tissue trauma.
2-Acceleration of Inflammatory & Healing Process
3-Relaxation of Muscle Spasm
4-Decreases the rate of hematoma formation
5-Superficial ulcers are treated successfully – Bed
sores
6-Acceleration of bone growth
64
1-Effective in treatment of post
traumatic & Infective conditions
2-Often used in conditions where
continuous SWD is
contraindicated.
65
1- Shortwave machine with chosen
electrodes and its test tube ‫ أنبوب إختبار‬to
ensure the machine is working.
2- Test tubes for skin test.
3- Cotton towels or felt pads for spacing.
4- Ensure that there are no
contraindications for SW application.
5- Put the patient in a comfortable position
and well support, allow the area to be
treated to be completely uncovered.
66
6- Inspect the area to be treated.
7- Ensure there is no metal (jewellery or
hairpin) within 300mm of treatment area.
8- Explain the procedure and feeling to the
patient.
9- If using flexible pad electrodes, wrap them in
several layers of towelling or place them
between felt pads to ensure the required
amount of spacing.
67
10- If using space electrodes adjust the
distance according to the concentration
needed.
11-Instruct the patient not to move during
treatment and warn her/him from
uncomfortable heat feeling.
12- If the machine has a patient safety switch
instruct the patient to switch the machine
off if he feel more heat.
68
13- Check the machine controls at the zero position, then
switch the power on.
14- Switch the intensity on and wait 2-3 minutes on the
minimum intensity and ask the patient about her/his
feeling, then adjust the timer to the required treatment
time.
15- After treatment time has finished, turn the intensity
switch to zero and remove the electrodes.
16-Inspect the area after treatment and ask the patient to
stay few minutes for rest and to regain to normal
temperature.
69
1-Application using two flexible pads or
space plates:
A- The electrodes should be slightly larger than the area
treated and spaced from the skin by approximately 25
mm.
B- To concentrate heat on one aspect of the part the
electrode should be unequal in size (smaller one placed
over the area where concentration of heat is required).
70
C- Coplanar application to treat structures on one
aspect of the body.
The distance between adjacent ends (x) must be greater
than the sum of skin electrode distance (A+B) otherwise
the line of force will pass directly between electrodes
rather than tissues.
71
D- Application using a coil electrode:
1- The coil wound evenly firmly heat superficial
tissue.
2- Pancake application heat superficial tissues.
72
 E- Application using diplode:
 Adjust wings of diplode parallel to the skin of the
treated area, electromagnetic field will produce.
73
F- Applications to two limbs:
Two flexible pads, two space plates or flexible pad
with a space plate are used. It is essential to put a
cotton towel between the two limbs to absorb any
perspiration.
74
 G- Cross-fire application:
 For the treatment of sinuses, space plates
positioned diagonally, after half of treatment time
the positions are alternate. This ensures that all
aspects of the sinus membrane are heated. Care
must be taken to avoid direct placement over the
eye.
75
 Most Typically SWD Treatments Last For 20-30
Minutes
 Remember As Skin Temperature Rises Resistance
Falls
76
When Should Diathermy
Be Used?
If The Skin Or Some Underlying Soft Tissue Is Tender
And Will Not Tolerate Pressure
 In Areas Where Subcutaneous Fat Is Thick And Deep
Heating Is Required

 Induction

method
When The Treatment Goal Is To Increase Tissue
Temperatures Over A Large Area
77