SHORT WAVE DIATERMY

Lecturer [Link] KARAAĞAÇ

• Short wave diathermy (SWD) is a high frequency current that allows
high frequency electromagnetic energy to be transmitted to tissue
and used in musculoskeletal and neurological problems.
• Shortwave generators use non-ionizing radiation
in the electromagnetic spectrum.
• The frequency range is 10-100 MHz and includes
short, medium and long radio waves.
• The most frequently used frequency in clinic is
27.12 MHz.
• In SWD devices, energy transfer to tissue can be done continuously
and intermittently.
• In continuous SWD, energy transfer occurs during the entire
application period and thermal effect occurs.
• In intermittent SWD (ISWD); it allows the energy to be transferred to
the tissue in variable time and repeat counts, in the form of pulses.
• Thermal or nontermal effects occur depending on frequency and
transition time.
• The pulse repetition (Hz), pulse duration (microsecond), pulse peak
power (Watts) and average power (Watts) can be changed according
to the characteristics of the used instrument.
• Average power is obtained by multiplying all parameters.
Physical Characteristics
• The two main areas of short-wave electromagnetic energy are the
electric and magnetic fields created within the tissue.
• These areas are responsible for physiological changes that occur in
the tissue with thermal or nonthermal effects.
 Heat Production with Short Wave Diathermy
• During SWD application, the increase in tissue temperature occur due to
the energy ratio that absorbed by the known mass of the tissue.
• Electrical field energy is more concentrated in high conductivity tissues.
• The tissues with high conductivity such as muscle and blood absorb
more energy and use the formed heat more effectively.
• Fat tissue has low conductivity and causes heat to rise with different
reasons.
• In SWD, heat formation occurs by the kinetic energy of the molecules
due to the energy absorbed by the tissue.
• Thermal effects continue to occur at the cellular level, although no
heat change is felt on the skin.
• These effects are seen more in the electric field than in the magnetic
field.
• The treatment effect differs according to the amount of heat increase
in the tissue.
• 1 degree rise in temperature reduces mild inflammation and
increases metabolism.
• 2-3 degree rise in temperature is necessary to reduce pain and
muscle spasm, and 3 to 4 degree rise in temperature is necessary to
increase tissue flexibility.
Physiological Effects
• 1. Increase in Metabolism:
• Between the applied energy and the membrane of biological tissues
an interaction occur.
• The opening rates of the ion channels in the cell membrane and the
ion intensities of the intra and extracellular spaces change.
• With this change mitochondria is affected, cell metabolism is
accelerated and ATPaz activity is increased.
Physiological Effects
• 2. Increased Blood Circulation:
• Vasodilatation, which occurs after SWD, reduces blood viscosity and
facilitates blood flow.
• In this way, drop in blood pressure occurs.
Physiological Effects
• 3. With increase in blood flow and accompanied temperature
changes, increase in the tissue flexibility and healing rate of open
wounds; decrease in edema, hematoma, inflammation, joint stiffness
and pain occur.
Application Principles of Short Wave Treatment
to Tissue
• There are two methods for energy transfer in SWD treatment:
• The capacitor field method (capacitive technique)
• The inductive method.
• Each application affects different target tissues and the heat
generation mechanism of each application within tissue is different.
1. Capacitor Field Method (Capacitive
Technique)
• The capacitor electrodes produce more electric field (E) and they are
stronger in the center of the treated area.
• The power of the field varies depending on;
• The location of the electrode according to the tissue (more power is
produced in electrodes that positioned close to the skin),
• The size of the electrodes (small size electrodes have less penetration
than medium and large electrodes) and
• T he distance (a more regular electric field is obtained with electrodes
that slightly larger than the treatment area).
• As the force of the electric field and the conductivity of the tissue
increase, the generated heat is also increases.
• For this reason, the superficial tissues are more heated in electrical
field application.
• The strength of the electrical field is reduced in deep tissues because
the fat layers in the muscle break the force lines.
Characteristics of Electrical Force Lines
• a. Electrical force lines pass from one electrode to another in the
shortest path. (from negative to positive)
• b. Electrical force lines push each other as they move from one
electrode to another. Since this pushing force is too much in the
center, the middle force line is almost straight.
• c. The electromotor force carried by the electrical force lines depends
on the distance between the electrodes. As the electrodes move
away from each other, it is difficult that the electrical force lines to
pass from one to another.
Characteristics of Electrical Force Lines
• d. The electrical force lines try to pass through places with high
dielectric constant. The dielectric constant of air is 1. The dielectric
constant of each layer of the human body is different. The
permeability of tissues which are rich for veins is greater than poor
ones. Therefore much warming will occur.
• Two types of electrodes are used in the capacitor field method.
• These are;
• Disk electrodes
• Pad electrodes
1. Disc Electrodes:
• They are formed by two metal plates parallel to each
other with diameters of 7.5-17.5 cm, which are
surrounded by a plastic or glass protector.
• Two electrodes are required to complete the cycle.
• The distance between the skin and the electrodes can
be adjusted by moving the electrodes closer to the skin
or away from it, or moving the metal plates in the
electrode.
1. Disc Electrodes:
• Although there is no clear data about the distance of the electrodes,
it is stated in the old sources that it should be 1.5-5 cm distance
between the electrodes and the skin, and the new sources state that
the distance should be 2.5 cm.
2. Pad (Carbon-Plaque) Electrodes:
• They consist of a metal layer surrounded by rubber.
• They adapt to the area to be treated and create a more smooth
electrical field.
• The distance between the skin and the electrodes is provided by
putting towels or felt between.
2. Pad (Carbon-Plaque) Electrodes:
• The amount of generated heat in the tissue depends on the distance
between the skin and the electrodes and the distance between the
electrodes with each other.
• As the distance between the pads increases, the depth of penetration
also increases.
• In some cases, an air spaced disc electrode and a rubber electrode
may be used together.
Electrode Placement
• a) Opposed Application:
• The electrodes are positioned as opposite to each other.
• During application, if an equal amount of electrical field is wanted to be
created on the treatment area, the distance between both electrodes to
the skin is adjusted equally.
• If more electrical field is wanted to be created at a certain point and more
density is desired at that point, the distance of electrodes may be different.
• The electrodes are placed on both sides of the part to be treated, and the
treatment site is put in between.
• It is preferred in the treatment of deep structures such as joints.
b) Coplanar Application:
• The electrodes are placed on the same side of the area to be treated.
• The distance between the electrodes must be greater than the sum of the
distance of each electrode to the skin for optimal electrical field
distribution and safety. (A> a + b).
• Otherwise, the electrical force lines pass through the air and lose their
energy.
• Although this placement is suitable for the production of superficial heat,
the penetration depth can be increased by increasing the distance between
the electrodes.
• It is preferred for the treatment of superficial structures like spinal muscle
group.
c) Monopolar Application:
• It is used in more superficial applications.
• One of the electrodes is placed to the treated area, the other is
placed away from it or may not be used.
• It is used in superficial heat desired situations, such as eye treatment.
d) Cross Application:
• The electrodes are placed diagonally (cross) to the treated region.
• In the half of the application period, the electrodes are placed in the
other cross region.
• Thus, it is intended to distribute the electric field effect equally.
• Cross placement is used to treat cavitation spaces that has air in it.
(such as sinuses and uterus)
• It is also used in the treatment of deeply located tissues, especially in
areas which there are veins commonly. (such as pelvic organs, hip
joint)
• The dielectric constant of the vascular tissues is very high and the
cross application area is larger than the electrodes.
• Thus, the electrical force lines are spread in the deep tissues, and as a
result, the deep tissues become less heated than the superficial
tissues.
Electrode Size
• One of the most important factors that determine the force of the
electrical field within the tissue is the size of the electrodes.
• Similar size two electrodes that slightly larger than the treatment area
provide a smooth distribution of the electrical field.
• The use of different size electrodes allow the field to concentrate on
the small electrode side.
• In this way, while the excess heat is accumulated in the superficial
tissues, the depth of penetration decreases.
• If the electrodes are smaller than the treatment area, the superficial
tissues become more heated.
• Furthermore, unless the electrodes are slightly larger than the
treatment area, effective electromagnetic field can not be created,
energy loss occurs.
2. Inductive Method
• With the inductive method, magnetic field (M) is obtained
predominantly in the tissues.
• The electrodes used in the inductive method are monod (drum
electrode) and cable electrode.
• Unlike other techniques, the patient is not a part of the circuit and
the electrodes are placed perpendicular (monod) to the surface or
wrapped around the surface (cable electrode).
• Generated magnetic field forms a secondary current in the tissue
which is called Eddy Current.
2. Inductive Method
• The Eddy current occurs from small circular electric fields.
• Heat is produced by the friction of intermolecular vibrations in the
tissue as a result of "eddy currents".
• The magnetic field generated by the inductive method acts as a
carrier for Eddy currents and the physiological effects are more likely
occur due to the Eddy current.
2. Inductive Method
• This warming does not cause strong sensory stimulation and does not
cause strong heating as in capacitive application.
• In inductive applications, selective energy absorption and warming
happen.
• Structures with higher electrode content and lower impedance such
as muscle and blood are more affected.
• Because of that a 4°C increase in the intramuscular temperature can
be achieved.
 A) The Drum Shaped Electrode
• They are electrodes that is formed by placing one or more coils in a
plastic protector.
• The biggest advantage of the electrode is its ease of positioning, even
though it is not compatible with the skin.
 A) The Drum Shaped Electrode

• There are Minod, Monod, Diplod, Circuplode and Megaplode

electrode types produced by the companies.
• Similar to the radar electrodes.
• Deep tissue is heated.
• The distance between the skin and the electrode should be at least 1
cm.
• Penetration depth is about 3 cm.
• If the thickness of the subcutaneous fat tissue is more than 2 cm, the
penetration depth decreases and excessive heat increase occur in the
fat tissue.
b) Cable Electrode
• The cable is a thick, insulator and flexible electrode with plugs on
both ends.
• It can be wrapped flat and placed on the treatment area or wrapped
around the extremity.
• Unlike air-spaced or drum electrodes, it is an advantage to adapt to
body surface.
b) Cable Electrode
• To prevent overheating, a space of at least 1 cm between the
electrode and the skin and minimum 5 cm space between the folds of
the cable is required.
• The tips are strong for the electric field, while the middle part is
strong for magnetic field.
Physiological Effects of Short Wave Diathermy
• The main effect of the shortwave diathermy current on the body is to
create heat in the tissues.
• Physiological effects are the result of increased heat.
• These effects are:
• 1. Increases metabolism:
• Increase in the metabolism increases consumed oxygen and the need
for nutrients, which results with increase in metabolites.
• 2. Increases blood circulation:
• Since the shortwave diathermy current has not got a stimulating
feature, the effect of vasodilatation by reflex way is very small.
• On the contrary, formed metabolites as a result of increased
metabolism cause dilatation effect on the veins and it results an
increase in the blood circulation.
• 3. Analgesic effect:
• In SWD, analgesia occurs by several mechanisms.
• Gate control theory
• The resulting heat effect allows stimulation of A delta fibers and blocking
of pain transmission with presynaptic inhibition.
• Another mechanism is the removal of painful stimulus of inflammation
with increased vasodilatation and circulation.
• Pain that occurs due to spasms is reduced by removal of lactic acid and
metabolic waste resulting of vasodilation.
• 4. Tissue damage:
• Excess temperature of the shortwave diathermy current burns the
tissues and causes coagulation. (Surgical diathermy)
• 5. Increase General Heat:
• The blood heats up because of the blood vessels in the heated tissue.
• The warmed blood causes heat to increase where it goes with the
circulatory system.
• The warmed blood goes to the vasomotor center in the central
nervous system and stimulates it to cause a general vasodilation in
the body.
• So body heat increases.
• 6. Reduces blood pressure:
• As the temperature decreases blood viscosity and enlarges the vessel
wall, blood flows more freely and blood pressure decreases.
• 7. Increased secretion of sweat glands:
• It happens with the rise of general body temperature. There is more
sweating especially under electrodes.
Safety in SWD Applications
• SWD devices are devices that create occupational risk.
• The biggest reason for this is the free spread of electromagnetic
waves from the device.
• In small treatment cabins this risk is higher.
• In addition to the factors related to the device and the electrodes, the
presence of a metal furniture in the application room or another SWD
device within 2 meters also affects field force.
• The safety rules that physiotherapists should pay attention in this
application are:
• 1. Standing on the opposite side of the electrodes, close to the back
of the device,
• 2. Standing at least 1 meter away when the device is running.
 Application Technique
• The patient needs to be informed about the intended effect mechanism
of the treatment, contraindications, how he will feel during application.
• It is important that the treatment area is open and that there is no
clothing, because the dielectric constant varies with the dress, etc.,
prevents the patient to feel the warmth.
• In addition to these, a hot-cold sensation test should also be performed.
Application Technique
• You need to connect the device and the electrodes and make sure
that the device works.
• The patient should be in safe and comfortable position.
• The treatment area should remain as stable as possible.
• All metals and synthetic materials at a distance of 30 cm from the
area to be treated should be removed.
• If the skin is moist, it should be dried.
• Absorbent materials such as a cotton towel should be placed
between the skin surfaces that is in contact with each other.
 Application Technique
• The patient must be checked frequently during treatment, because a
warming above the patient's comfort level may cause burns.
• It should be questioned whether there are local areas where the increase
in temperature occurs.
• In addition, the patient should not move during the application or touch
any part of the device.
Application Technique
• The physiotherapist starts the instrument and boosts the heat at a
slow rate until the appropriate level.
• If any pain or discomfort is felt, the device should be closed and
treatment is terminated.
• A normal periode of treatment should be 15-20 min.
• The duration can be increased up to 30 min in cases where it is
desired that the vascular effects continue for longer periods.
Dosage
• To determine the dosage, the patient may be asked about the
temperature level that he feels warm.
• It should be remembered that a possible tissue damage may have
begun if the patient mentions the feeling of warming during the
application.
• Because deep tissue heat receptors are far fewer than the skin.
Dosage
• Another thing to keep in mind is that the maximum dosage will only
cause a slight warming sensation.
• In today's devices, dosages and durations are defined according to
specific pathologies.
• However, in situations where manual adjustment is required, it is
necessary to adjust the dosage according to the patient's feedback.
• At the end of the session, the electrodes and device are removed
from the patient and the treated area is carefully examined for any
color change or erythema.
 Used Conditions
• 1. Inflammatory Conditions:
• Shortwave diathermy is used in inflammatory conditions (except the
acute phase), taking advantage of the vasodilatation feature.
• It can be easily applied in subacute and chronic conditions, but it should
be used in the subacute phase with less dosage and treatment duration.
 Used Conditions
• 2. Traumatic Conditions:
• Shortwave diathermy can be used in traumas (except in acute phase)
especially in chronic stage by using the features as increasing the
circulation, solving spasm by loosening the muscles and decreasing the
pain transmission.
• SWD is often used in musculoskeletal system problems due to some
physiological effects.
• It accelerates fibroblast activity, ATP stimulation and protein synthesis,
thereby increases collagen accumulation.
• As it affects collagen-containing tissues, it affects tendon flexibility and
muscle performance, especially with stretching exercises.
Used Conditions
• 3. Bacterial Infections:
• Shortwave diathermy is used in boils, acnes and abscess, taking
advantage of the ability to create antibodies in the body and increase
leukocytes.
• However, to be able to use SWD in these cases, the inflammation
must not have occurred yet.
Used Conditions
• 4. Circulatory Disorders:
• Shortwave diathermy is never applied on vessel with occlusion or to the
distal part of occlusion.
• This is because more metabolites are exposed in the ischemic tissue due to
the increase in circulation in the upper parts.
• They cause pain in the tissues because they cannot be thrown out, results
with gangrene.
• For this reason, the shortwave diathermy is applied to the proximal part
above the obstruction.
• For example, if there is a blockage in the popliteal artery, the application is
made to the lumbal region, the origin of this artery.
• Thus, dilatation of the collateral vessels is achieved by reflex vasodilatation.
Used Conditions
• 5. Pain Relief Effect:
• The pain relief effect of short wave diathermy is achieved by the
following effects:
• a) Reduce the excitability of sensory nerves.
• b) Allows the acceleration of metabolite excretion from the body.
• c) If the pain is associated with inflammation, the reduction of
inflammation is reduces the pain.
• d) If the pain is due to spasm, the muscle will relax and dissolve the
spasm and relieve the pain.
Potential Hazards

• 1. Burns
• 2. Can disrupt the working patterns of the pacemakers and
permanent stimulators.
Potential Hazards

• 3. Synthetic products do not absorb the moisture and leave the skin
moist. Keeping the skin moist can cause scalding burns. They can also
easily ignite.
• 4. Overweight or obese patients: With the capacitor field method,
excessive heat increases in fat tissue. In such patients, the self-
oscillating electrode, which has a strong magnetic field direction, is
more suitable.
Contraindications and Precautions

• 1. Implanted device use: SWD should not be used in patients

who use pacemakers or other active implant devices. Also patients
should be taken to safe distances that they will not be affected from
interference. The safe distance must be at least 3 meters.
• 2. Pregnancy: Pregnants should never be treated with SWD and
should be at least 1 meter away from the device. A physiotherapist
who is pregnant should also not use SWD for treatment and should
stay at least 3 meters away from the device.
Contraindications and Precautions

• 3. Metal implant in the tissue: SWD can cause deep burns

due to the high heating capacity of the metals. For this reason,
intermittent SWD application which using total power below 5 Watts
may be preferred.
• 4. Malignant conditions: SWD application is contraindicated in
malignant conditions due to the effect of increasing cell metabolism.
• 5. Special tissues: It is dangerous to keep areas such as eyes and
testicles in the electromagnetic field.
Contraindications and Precautions
• 6. Local circulatory disorders: It is not used in local circulatory
disorders due to the risk of thrombus and gangrene.
• 7. Bleeding: It is not used in areas with risk of bleeding and systemic
problems.
• 8. Active tuberculosis: In this case the application should not be done.
• 9. High fever: SWD has an effect that increases body temperature and
should not be applied when fever is high.
Special Application Methods
1. Bauwen Method
• It is used to heat the pelvic
organs.
• The patient is supported in half
sitting position.
Special Application Methods
2. Cable-Rubber Electrode
Technique
• It is preferred for heating the hip
joint.
• The patient is positioned as in the
Bauwen method.
• Rubber electrodes are placed in
the lumbar region, cable
electrodes are wrapped around
the thigh.
 Special Application Methods
3. Shunt Technique
• It is used to treat two extremities at the
same time.
• It is an ideal technique for the treatment
of both feet simultaneously.
• Two air-spaced electrodes are placed at
lateral side of the ankles.
• Two rubber electrodes are placed on the
medial side of the ankles by placing a
felt between them.
• Rubber electrodes reduce the resistance
between the extremities and maintain
the effectiveness of the electric field.
Special Application Methods
4. Two Separate Active Electrode
Technique
• It is an effective method that can
be used in cases where heat
effect is desired in forearm.
• The application is similar to the
coplanar method.
• The biggest difference is to place
a rubber electrode under the
extremity to make easier the
passage of force lines.
THANKS 