Banarsidas Chandiwala Institute of Physiotherapy

AFFILIATED TO G.G.S. INDRAPRASTHA UNIVERSITY

Chandiwala Estate, Maa Anandmai Marg, Kalkaji, New Delhi-110019.
Phone: 01149020292 Fax: 011- 49020292
E-mail: director@[Link] Website: [Link]

Date: -------------------
Short wave diathermy- II
Practical- Application of Short-wave diathermy

Aim of practical

 To understand SWD application prerequisites

 To be able to perform different methods of application of SWD
 To understand positioning of patient with respect to each method of application of SWD
 To be able to understand positioning of electrodes ( pad electrodes/ disc electrodes) and role of
spacing of electrodes
 To be able to analyze and decide dosage comprising intensity, duration, tuning and timing in
SWD
 To able to give instructions to patient before and after treatment
 To be able to understand contraindications and comprehend accordingly with patients

1. Enumerate steps for preparation of patient and paste a picture of it while practicing.

ANS.

1. Explain the procedure

 Tell the patient about the purpose of SWD and the sensations expected (gentle warmth).
 Obtain consent and reassure the patient.
2. Check indications and contraindications
 Ensure SWD is indicated for the condition.
 Rule out contraindications such as pacemaker, metal implants, pregnancy, malignancy, or
impaired sensation.
3. Remove metallic objects
 Ask the patient to remove jewellery, watches, belts, coins, hairpins, or any metal near the
treatment area.
4. Inspect the treatment area
 Examine
[Link] theskin for wounds,
patient comfortablyinfection, rashes, or loss of sensation.
 Place
Checkthe
circulation
patient inand sensation.
a relaxed and well-supported position.
5. Expose the treatment
Use pillows or towels if needed to maintain proper alignment.
 Adequately
[Link] expose
the skin the and
is clean bodydry
part to be treated.
 Remove
Removesweat,
tight clothing if present.
oils, or lotions to prevent uneven heating.
 Place towels or spacing material (if required)
 A dry towel may be placed between electrodes and skin to absorb moisture and maintain
distance.
[Link] the electrodes/applicators
 Arrange condenser plates or drum electrodes properly around the treatment area with equal
spacing.
2. Explain different methods of application of SWD

ANS. SWD can be applied by two main methods:

1. Condenser Field Method (Capacitive Method)

 Principle:
 The body part acts as a dielectric medium between two capacitor plates, and heat is produced due to
the oscillation of ions in the tissues.

 Procedure / Features:
 Two metal condenser plates are placed on opposite sides of the body part.
 A small air gap or towel layer is maintained between the plates and the skin.
 Electric field passes through the tissues between the plates.

 Types of placement
a) Contraplanar method – Plates placed on opposite sides of the body part (e.g., medial and lateral
side of knee).
b) Coplanar method – Plates placed on the same side of the body (used for superficial structures).
c) Cross-fire technique – Treatment given in two directions alternately to heat the area uniformly.

 Heating pattern
 Produces more heating in superficial tissues such as skin and subcutaneous fat.

2. Inductive Field Method (Inductive Method)

 Principle:
 Heat is produced due to eddy currents induced in the tissues by a magnetic field.

 Types of applicators
 Cable method (Inductive cable / coil)
 Drum electrode (Monode electrode)

 Procedure / Features
 A coil or drum applicator is placed over the treatment area.
 An alternating magnetic field induces currents in tissues.

 Heating pattern
 Produces greater heating in deeper tissues, especially muscle and blood-rich tissues.
3. Steps for coplanar method of SWD application and paste pictures for the same.

ANS. Steps for Coplanar Method of Shortwave Diathermy (SWD) Application

a) Explain the procedure to the patient

 Inform the patient about the purpose of SWD and that a mild comfortable warmth will be felt.
b) Check contraindications
 Ensure the patient has no pacemaker, metal implants, pregnancy, or loss of sensation in the
treatment area.
c) Remove metallic objects
 Ask the patient to remove jewellery, watches, coins, belts, or any metallic items.
d) Expose and inspect the treatment area
 Examine the skin for wounds, infection, or impaired sensation.
e) Position the patient comfortably
 Place the patient in a relaxed position with proper support to the body part being treated.
f) Place the condenser plates on the same side of the body part
 In the coplanar method, both plates are placed parallel to each other on the same surface of the
body.
g) Maintain equal spacing
 Keep an equal air gap or towel spacing between the plates and the skin to ensure uniform
heating.
h) Adjust machine parameters
 Set the intensity gradually until the patient feels mild comfortable warmth.
i) Observe the patient during treatment
 Ensure the patient does not feel burning or excessive heat.
j) Stop treatment and remove electrodes
 After the required treatment time, switch off the machine and remove the plates.
k) Check the skin
 Inspect the treated area for any redness or discomfort.
4. Contra planar method of SWD application and paste pictures for the same.

ANS. The contra-planar method is one of the most common ways to apply Shortwave Diathermy (SWD)
using the condenser (capacitive) technique. In this setup, the body part is placed between two electrodes,
allowing the electromagnetic field to pass through the tissues from one side to the other.

This arrangement is ideal for deep, uniform heating of joints like the knee, ankle, or wrist.

Pre-Treatment Preparation

1. Screen for Contraindications: Ensure the patient does not have a pacemaker, metal implants in the area,
or loss of thermal sensation.
2. Remove Metal: The patient must remove all jewelry, watches, and clothing with metal (zippers, bras
with underwires, etc.) as these will concentrate the heat and cause burns.
3. Inspect and Dry the Skin: Check the skin for any cuts or rashes. The area must be completely dry; any
sweat will lead to a localized burn.
4. Positioning: Place the patient in a comfortable, supported position. Ensure the limb is resting on a non-
conductive surface (like a wooden plinth or a towel-covered table).

Step-by-Step Application

1. Electrode Selection and Spacing

 Select Pads: Choose two capacitor pads of equal size that are slightly larger than the area being treated.
 Insert Spacing: Place several layers of dry toweling or felt spacing between the skin and the electrode.
 The "Air Gap" Rule: Ensure there is an even distance (usually 2–3 cm) between the electrode and the
skin. If the gap is too small, the superficial fat will overheat; if it is too large, the treatment will be
ineffective.

2. Positioning the Electrodes

 Place the electrodes on opposite sides of the limb (e.g., one on the medial side of the knee and one on
the lateral side).
 Ensure the electrodes are parallel to each other. If they are angled (tilted), the electric field will
concentrate at the point where they are closest, causing an uneven "hot spot."

3. Connection and Tuning

 Connect the electrode leads to the SWD machine. Ensure the cables do not touch each other or the
patient's skin to prevent "short-circuiting" or burns.
 Turn on the machine and slowly increase the intensity.
 Tune the Circuit: Adjust the tuning dial until the resonance indicator (often a needle or a light) reaches
its maximum point. This ensures the machine's frequency matches the patient's circuit for maximum
energy transfer.

4. Monitoring the Treatment

 Patient Feedback: The patient should feel a mild, comfortable warmth. It should never feel hot, stinging,
or painful.
 Duration: A typical session lasts between 15 to 20 minutes.
5. Cross fire method of SWD application and paste pictures for the same.

ANS. The "crossfire" method is a specific electrode placement technique used in Shortwave Diathermy
(SWD) to ensure more uniform distribution of the electromagnetic field, particularly when treating
irregular or deep-seated structures like joints or sinuses.

Because it relies on redirecting the field, this technique involves a two-stage application.

The Crossfire Procedure

The core principle of the crossfire method is to treat the target area from two different angles within a
single session.

1. Preparation: Ensure all standard safety protocols are met, including the removal of metal objects
(jewelry, belts, implants) from the patient and the treatment area. Position the patient comfortably.
2. Initial Setup (First Half):
 Arrange the electrodes in a contraplanar configuration (on opposite sides of the joint or body part).
 Set the machine parameters as prescribed for the specific condition.
 Administer the treatment for exactly half of the total planned duration.
3. Repositioning:
 Turn the machine output to zero or pause the treatment safely.
 Adjust the electrodes so they are at right angles (90 degrees) to their original position. For
example, if you began with an anterior-posterior placement, move the electrodes to a lateral-medial
position.
[Link] Phase (Second Half):
 Verify that the spacing between the electrodes and the skin remains consistent and correct.
 Resume the treatment for the remaining half of the time.
6. Paste picture for SWD application for low back, cervical, shoulder, and knee joint

Low Back pain Cervical

Shoulder Knee joint

7. Enumerate contraindications of SWD

ANS. Shortwave Diathermy (SWD) is a therapeutic modality that uses electromagnetic energy to generate deep
heat within body tissues. Because it involves high-frequency currents and significant thermal effects, the
contraindications are strict to prevent tissue damage or device interference.

Absolute Contraindications

1. Metal Implants and Objects:

Metal is a highly efficient conductor. SWD can cause rapid overheating of metallic objects, leading to internal
burns or tissue necrosis.

 Internal: Joint replacements, plates, screws, or shrapnel.

 External: Jewelry, piercings, watches, or bras with underwires (must be removed).
 Electronic: Pacemakers, implantable cardioverter-defibrillators (ICDs), and neurostimulators. The
electromagnetic field can disrupt or permanently damage these devices.

2. Impaired Sensation or Circulation

 Sensory Loss: If a patient cannot feel heat, they cannot provide the feedback necessary to prevent burning.
 Ischemia: Tissues with poor blood supply cannot dissipate heat effectively through convection, leading to
localized overheating.

3. Pregnancy

 SWD should not be applied over the pelvic, abdominal, or lumbar regions of a pregnant woman, as deep
heating and electromagnetic fields may adversely affect fetal development.

4. Active Malignancy

 Increasing the temperature of a tumor site can accelerate cell metabolism and potentially promote the
spread (metastasis) of cancer cells.

5. Hemorrhage or Bleeding Disorders

 Heat causes vasodilation, which increases blood flow. This can exacerbate active bleeding or trigger a
hemorrhage in patients with conditions like hemophilia.

Relative & Site-Specific Contraindications

 Acute Inflammation: Adding heat to an area already experiencing acute edema and inflammation can
worsen the condition.
 Epiphyseal Plates: SWD should be avoided over the growth plates of children and adolescents, as it may
disturb bone growth.
 The Eyes and Testes: These areas are highly sensitive to heat and lack efficient cooling mechanisms;
exposure can lead to cataracts or damage to spermatogenesis.
 Ischemic Heart Disease: Large-area applications can cause systemic circulatory changes that may stress a
compromised heart.
 Menstruation: Application over the lower back or abdomen may significantly increase menstrual flow.
8. Enumerate precautions taken during SWD application

ANS. To ensure patient safety and the effectiveness of Shortwave Diathermy (SWD), strict precautions must
be followed. These go beyond the absolute contraindications and focus on the physical setup and the
patient’s environment.

1. Patient Preparation

 Skin Sensation Testing: Before every session, you must verify that the patient can distinguish
between hot and cold. If thermal sensation is impaired, the risk of a severe burn is significantly
higher.
 Removal of Metal: All external metal must be removed from the treatment area. This includes:
 Jewelry, watches, and piercings.
 Clothing with zippers, metal buttons, or underwires.
 Coins or keys in pockets.
 Skin Condition: The skin must be clean and completely dry. Moisture (like sweat) will cause the
electromagnetic field to concentrate, leading to a localized "scald" or burn.

2. Positioning and Spacing

 Use of Toweling: Always place at least one layer of dry Turkish toweling between the electrode (or
drum) and the skin. This absorbs any perspiration that might form during the session.
 Spacing of Cables: The cables connecting the machine to the electrodes must not touch the patient,
each other, or any grounded metal objects. Touching cables can cause a short circuit or "hot spots"
that melt the insulation or burn the patient.
 Fixed Position: Instruct the patient to remain completely still. Even a small movement can change the
distance between the electrode and the skin, causing a sudden spike in heat intensity.

3. Equipment & Environment

 Wooden Furniture: The patient should ideally be treated on a wooden plinth or chair. Metal treatment
tables or chairs with metal frames can conduct and distort the electromagnetic field, leading to
unpredictable heating.
 Electronic Interference: Keep the SWD unit at least 3 meters away from other electronic medical
equipment (like TENS units or interferential therapy machines) to prevent electromagnetic
interference.
 Hearing Aids and Tablets: Patients and nearby staff should remove hearing aids, and mobile phones
should be kept away from the immediate vicinity of the active field.

4. Therapist Safety

 Safe Distance: The therapist should stand at least 1–2 meters away from the electrodes and cables
while the machine is on to minimize long-term exposure to radiofrequency (RF) radiation.
 No "Test-Touching": Never attempt to adjust the electrodes or cables while the machine is delivering
power.
 Questions
[Link] or placement of electrode should be based on.

ANS. The size and depth of the target tissue, ensuring the electrode is parallel to the skin and
appropriately spaced to maintain a uniform electromagnetic field.

2. Spacing of electrode in SWD depends upon?

ANS. required depth of tissue heating and the thickness of subcutaneous fat.

3. Name three different positioning of electrode.

ANS. Contra-planar (Transverse) Positioning: Electrodes are placed on opposite sides of the body part
(e.g., front and back of the knee) to provide deep, "through-and-through" heating of joints.

Co-planar Positioning: Electrodes are placed side-by-side on the same surface of the body (e.g., along the
spine or a long muscle) to treat superficial or longitudinal structures.

Cross-fire Positioning: Half of the treatment time is spent in one contra-planar position, and the other half
is spent with the electrodes rotated 90° (e.g., treating a sinus or pelvic organ from the front/back, then the
sides).

4. What is Inductothermy.

ANS. Inductothermy is a method of Shortwave Diathermy that uses a high-frequency alternating current
passed through a coil or cable to produce an oscillating magnetic field, which generates heat in deep,
conductive tissues (like muscle) via induced eddy currents

5. Name advantages of cable method

ANS. The primary advantages of the cable method in Shortwave Diathermy (Inductothermy) are:

 Versatility in Contouring: The flexible cable can be easily wrapped around irregular body parts,
such as the knee, shoulder, or ankle, ensuring uniform heating.
 Large Treatment Area: It can cover a much larger surface area than a static drum or plate, making
it ideal for treating an entire limb (e.g., the whole quadriceps or calf).
 Selective Deep Heating: It preferentially heats deep, vascular tissues (muscles) through eddy
currents while minimizing the overheating of superficial fat.
 Adjustable Field Concentration: By varying the number of turns or the spacing between loops, the
therapist can concentrate heat on a specific segment of a limb

6. Minimum duration of SWD treatment.

ANS. The minimum duration for a Shortwave Diathermy (SWD) treatment is typically 15 to 20 minutes.
7. Name four physiological effects of SWD .

ANS. The four primary physiological effects of Shortwave Diathermy (SWD) are:

a) Deep Vasodilation: Increasing blood flow to enhance nutrient delivery and waste
removal.
b) Increased Metabolic Rate: Accelerating the chemical reactions necessary for tissue
repair.
c) Enhanced Tissue Extensibility: Reducing the viscosity of collagen to improve joint
range of motion.
d) Pain Relief: Sedating sensory nerve endings and reducing muscle spindle excitability to
relieve spasms.
8. SWD can be used in continuous and pulsed mode TRUE/FALSE.
ANS. TRUE
9. Heat retention of SWD is?
ANS. The heat retention of SWD is approximately 20 to 30 minutes after the treatment session
ends.
10. SWD uses high frequency electromagnetic energy to produce heat within the tissues
TRUE/FALSE?
ANS. TRUE

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