Therapeutic Modalities

Comparison of Shortwave Diathermy

and Microwave Diathermy
David O. Draper, EdD, ATC, FNATA • Brigham Young University

A ny therapeutic modalities textbook includes

information about a myriad of therapeutic
modalities used for the treatment and
rehabilitation of injuries. Two frequently
Microwave diathermy, seldom used in the United
States, uses high-frequency electromagnetic waves
(2450 MHz; wavelength of 11 m) to heat tissues. Short-
wave diathermy uses high-frequency electromagnetic
used modalities are ice and ultrasound; probably the waves that are similar to radio waves (10–100 MHz) to
modality used least often is diathermy. The purpose of heat deep tissues. Table 1 presents key characteristics
this report is to contrast shortwave diathermy (SWD) that differentiate microwave diathermy and shortwave
and microwave diathermy (MWD), and to present two diathermy.
cases that involved administration of pulsed shortwave
diathermy (PSWD) over surgically implanted metal.
Physiological Effects
The word diathermy means “through heat” (dia
and therm). Therapeutic diathermy is defined as high- Both thermal and nonthermal physiological effects are
frequency electromagnetic waves that heat tissues up created by SWD, which are similar to those of ultra-
to 5 cm deep.1 Heat is produced by the resistance of sound. Nonthermal effects include acceleration of cell
tissue to the passage of energy.1,2 growth,3 repolarization of damaged cells (enabling them
There are two classifications of diathermy: medical to perform normal functions),4,5 and wound healing.6
and surgical. Medical diathermy is used for a therapeu- The main reason diathermy is used relates to its
tic purpose, such as heating of deep tissues. Surgical thermal effects. Thermal SWD has been shown to
diathermy is used for cauterizing or burning tissue. increase tissue temperature, 7-11 increase blood flow,10
Two main types of medical or therapeutic diathermy decrease joint stiffness,11,12 increase metabolism,5
are microwave and shortwave. relax muscles,11,13 relieve pain,5,14 facilitates resolution

Table 1. Microwave Diathermy Versus Shortwave Diathermy

Microwave Shortwave
2456 and 915 MHz frequency 10–100 MHz frequency
Heating mainly due to electrical fields Heating mainly due to magnetic fields
Penetration of fat is only one third of SWD Penetrates fat layer easily
Can create hot spots Unlikely to create hot spots
Spacing required between skin and applicator Can apply directly to skin
No metal can be within 4 ft of applicator Does not heat metal as much as MWD
Becoming obsolete Most commonly used in orthopedics

© 2013 Human Kinetics - IJATT 18(6), pp. 13-17

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of hematomas,5 and increase extensibility of collagen Many athletic trainers and therapists believe that
fibers. 11,13 Table 2 presents recommended PSWD ultrasound can heat deep tissues as well as diathermy.
parameters for attainment of specific treatment goals. Although the magnitudes of tissue temperature eleva-
tion are similar, diathermy heats a much larger area
than ultrasound.20 Ultrasound will heat up an area
Why Diathermy Is Seldom Used
about as large as a catsup packet, whereas diathermy
Diathermy has fallen out of favor among athletic train- can heat up an area as large as a salad plate.
ers and therapists in many parts of the world, with the Much of the widely-accepted misinformation
exceptions of the United Kingdom and Japan. Surveys about diathermy has failed to differentiate SWD from
of physical therapists in Canada15 and Australia16 have MWD. The contraindications of MWD have often been
documented that diathermy was used on a daily basis attributed to both types of treatment. This misinfor-
by 0.6% and 8% respectively, whereas ultrasound was mation led to the widespread beliefs that no type of
used daily by 93.5%.15,16 Diathermy is seldom used in diathermy should be administered in the same room
the United States, which is probably due to its expense, with a pregnant therapist,26 and that it should not be
outdated research, and misinformation. used over surgically implanted metal.2 These are both
The price of a diathermy device can range from contraindications for MWD, but they are only precau-
USD $6,000 to $25,000. Because many insurance com- tions for SWD.5 In the text Therapeutic Modalities: The
panies do not provide reimbursement for diathermy Art and Science,5 the Megapulse II PSWD device is
treatments, insufficient revenue is likely to be gener- described as safe for use over metal implants, based
ated to cover the cost of acquiring the equipment. on years of using this device on patients with surgically
Prior to the last 15 years,7-11,17-25 little research evi- implanted metal rods, plates, and screws.5 However, no
dence of therapeutic benefit from diathermy existed. form of diathermy treatment should be administered
Many improvements in the function of the devices over looped wires, which can act as an antenna and
started taking place in the 1990s. One improvement overheat surrounding tissues. Also, SWD should be
was proper shielding from electromagnetic waves, pulsed (PSWD), not continuous.5
which improved safety for both the patient and the
clinician.
Case Report 1
There also can be a significant difference in heating
effect between various SWD devices. A recent study24 A 38-year-old construction worker fell two stories
compared the heating effect of the ReBound SWD onto a concrete floor. The impact collapsed a lung and
device (ReGear Life Sciences, Inc., Pittsburg, PA) and caused a humerus fracture. The fractured humerus was
the Megapulse II SWD device (Accelerated Care Plus, surgically repaired with a metal rod. At approximately
Reno, NV). Temperature probes were inserted 3 cm 6 months postinjury, two thermocouples were inserted
into the triceps surae of 12 human subjects. Treatments into his upper arm to measure the tissue heating effect
were administered for 30 minutes. The Megapulse II of PSWD. One thermocouple was inserted until it came
SWD device increased the muscle temperature 4.32°C, into contact with the metal at a depth of 2.6 cm. The
whereas the ReBound SWD device increased the tem- other thermocouple was inserted into muscle tissue
perature only 2.3°C.24 at the same depth (Figure 1). The Megapulse II drum

Table 2. Shortwave Diathermy Parameters

for Specific Treatment Goals
Dose Indications Pulse width Pulse rate Average watts
n/a Acute trauma, edema reduction, 65 μs 100–200 pps n/a
cell repolarization, and repair
1°C Subacute inflammation 100–200 μs 400–800 pps 12
2°C Pain reduction, muscle spasm, 200–400 μs 400–800 pps 24
chronic inflammation
4°C Stretch collagen-rich tissues 400 μs 800 pps 48

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(Accelerated Care Plus, Reno, NV) was applied to the pronation and supination. Four months earlier, she had
skin over the thermocouples. A 20-minute diathermy dislocated the elbow and fractured her distal humerus
treatment was administered at 27.12 MHz, 800 μsec, when she fell during a gymnastics event (Figure 3). The
400 Hz, and 100 Watts average power (Figure 2). Previ- humerus fracture was surgically repaired with titanium
ous research has documented that this technique will pins and screws. After several weeks of immobilization,
raise the temperature in the deep tissues over 4°C.1 she received extensive physical therapy treatments
The temperature was recorded every 10 minutes. At (ultrasound and passive stretching). Her full range of
the end of the 20-minute treatment, the temperature elbow flexion was restored, but elbow extension, fore-
had increased 4.5°C on the metal rod and the sur- arm pronation, and forearm supination were restricted.
rounding muscle. The treatment regimen consisted of 20 minutes
of PSWD at an average of 48 Watts (Figure 4), which
was followed by 8–10 minutes of joint mobilization
Case Report 2
A female collegiate gymnast presented an elbow that
she could not extend beyond the last 30° of the normal
arc of motion. She also lacked full range of motion in

Figure 1  Patient 1 with a metal rod in his humerus. Note the two
temperature probes in his tissue. Figure 3  Radiograph of patient 2.

Figure 2  Patient 1 receiving PSWD treatment. Figure 4  Beginning ROM for patient 2.

international journal of Athletic Therapy & training november 2013  15

(traction, anterior glides of the distal humerus on the implant should be viewed as a treatment precaution.
ulna, and radial head glides). After seven treatments, However, any type of diathermy treatment is always
she had attained full range of motion in extension, contraindicated over metal implants that have circular
pronation, and supination (Figure 5). wire components or elements that form loops, which
may result in excessive heating of the metal.2,5,26 

References
1. Draper DO, Knight KL, Fujiwara T, Castel JC. Temperature change in
human muscle during and after pulsed shortwave diathermy. J Orthop
Sports Phys Ther. 1999;29(1):13-18.
2. Cameron MH. Physical Agents in Rehabilitation; From Research to
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Figure 5  Full ROM was reached with a regimen of PSWD and joint
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Discussion restricts swelling and bruising of liposuction patients. Am J Cosmet
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stretch regimen using PSWD can increase the flexibility stretching regimen, with or without PSWD on ankle dorsiflexion and
of subjects with tight muscles,17 and improve the joint 3 weeks. J Athl Train. 2005;40(4):189-193.
mobility of patients with limited ankle dorsiflexion.22 12. Kaltenborn FM. Manual Mobilization of the Joints. Minneapolis, MN:
OTPT, 2002.
These effects likely result from reduction of muscle 13. Draper DO. Induction cable diathermy and joint mobilization restore
guarding and pain, decreased tissue stiffness,22 and range of motion in a post-operative ACL patient. Athl Ther Today.
increased extensibility of collagen fibers.5-7,11-13 2010;15(1):36-38.
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PSWD over surgically implanted metal screws, rods, osteoarthritis. Scand J Rheumatol. 1987;67:83-85.
or pins is contraindicated.2,5,18,19,22 The close proximity 15. Lindsay DM, Dearness J, McGinley CC. Electrotherapy usage
trends in private physiotherapy practice in Alberta. Physiother Can.
of a radio frequency field to a metal implant is widely 1995;47(1):30-34.
believed to cause a greater temperature increase in 16. Lindsay DM, Dearness J, Richardson C, Chapman A, Cuskelly G. A
the adjacent tissue than in tissue that does not con- survey of electromodality usage in private physiotherapy practices.
Aust J Physiother. 1990;36(4):249-256.
tain a metal implant.2,5,18,19,22 This concern should be
17. Draper DO, Castro J, Feland JB, Schulthies SS, Eggett D. Shortwave
viewed as more of a precaution than a contraindication, diathermy and prolonged stretching increase flexibility more than
because therapeutic benefits have been documented stretching alone. J Orthop Sports Phys Ther. 2003;34(1):13-20.
when the power level was 100 Watts or less.5 18. Draper DO, Castel JC, Castel D. Low-watt pulsed shortwave diathermy
and metal plate fixation of the elbow. Athl Ther Today. 2004;9(5):27-31.
19. Draper DO. Shortwave diathermy in the athletic training room. Paper

Conclusion presented at: Annual Symposium of the NATA; Los Angeles , CA, June
2001.
20. Garrett CL, Draper DO, Knight KL. Heat distribution in the lower leg
Pulsed shortwave diathermy (< 100 Watts) is a safe from pulsed shortwave diathermy and ultrasound treatments. J Athl
therapeutic procedure, and the presence of a metal Train. 2000;35(1):13-22.

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 21. Peres S, Draper DO, Knight KL, Ricard MD, Durrant E. Pulsed short- 25. Hawkes A, Draper DO, Johnson AW, Diede M, Rigby J. Heating capacity
wave diathermy used prior to stretch increases flexibility more than of ReBound shortwave diathermy and moist hot packs at superficial
stretch alone. J Athl Train. 2000;37(1):43-50. depths. J Athl Train. 2013;48(4):471-476.
22. Seiger C, Draper DO. Use of pulsed shortwave diathermy and 26. Hellstrom RO, Stewart WF. Miscarriages among female physical
joint mobilization to increase range of motion in the presence of therapists who report using radio- and microwave-frequency electro-
surgical implanted metal: A case series. J Orthop Sports Phys Ther. magnetic fields. Am J Epidemial. 1993;138(10):775-785.
2006;36(9):669-677.
23. Draper DO. Shortwave diathermy and joint mobilizations for postsurgi-
David O. Draper is a professor in the Exercise Sciences division at
cal restoration of knee motion. Athl Ther Today. 2010;15(1):38-40.
Brigham Young University in Provo, UT.
24. Draper DO, Hawkes A, Johnson AW, Diede M, Rigby J. Muscle heating
with the Megapulse II shortwave diathermy and ReBound diathermy. Lindsey Eberman, PhD, ATC, LAT, Indiana State University, is the
J Athl Train. 2013;48(4):477-482. report editor for this article.

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