Environmentalist

DOI 10.1007/s10669-007-9128-2

Pulsed electromagnetic field therapy history, state of the art

and future
Marko S. Markov

Ó Springer Science+Business Media, LLC 2007

Abstract Magnetic and electromagnetic fields are now magnetic materials in their daily practice. The contempo-
recognized by the 21st century medicine as real physical rary magnetotherapy has begun immediately after the
entities that promise the healing of various health prob- World War II by introducing both magnetic and electro-
lems, even when conventional medicine has failed. Today magnetic fields, generated by various waveshapes of the
magnetotherapy provides a non-invasive, safe, and easy supplying currents. Starting in Japan, this modality quickly
method to directly treat the site of injury, the source of pain moved to Europe, first in Romania and the former Soviet
and inflammation, and other types of diseases and pathol- Union. During the period 1960–1985 nearly all European
ogies. Millions of people worldwide have received help in countries designed and manufactured own magnetothera-
treatment of musculoskeletal system, as well as pain relief. peutic systems. Indeed, the first book on magnetotherapy,
Pulsed electromagnetic fields are one important modality in written by N. Todorov, was published in Bulgaria in 1982
magnetotherapy and recent technological innovations, such and summarizes the experience of utilizing magnetic fields
as Curatron pulsed electromagnetic field devices, offer for treatment of 2700 patients, having 33 different
excellent, state of the art computer controlled therapy pathologies.
system. In this article the development, state of the art and During the 1970s, the team of Andrew Bassett intro-
future of pulsed electromagnetic field therapy are duced a new approach for treatment of delayed fractures,
discussed. that employed a very specific biphasic low frequency sig-
nal (Bassett et al. 1974, 1977). This signal was allowed by
FDA for application in the USA only for non-union/
delayed fractures. A decade later, FDA allowed the use of
1 Introduction pulsed radiofrequency electromagnetic field (PRF) for
treatment of pain and edema in superficial soft tissues.
This article was triggered by information found on Internet It is now commonly accepted that weak electromagnetic
that a new, computerized system for pulsed electromag- fields (EMF) are capable of initiating various healing
netic field (PEMF) therapy has been introduced on the processes including delayed fractures, pain relief, multiple
market. It appears that the Curatron system marks a sclerosis, and Parkinson’s disease. (Rosch and Markov
new era in the biomagnetic technology: use of computer 2004). This proven benefit could be obtained by using both
during the planning and executing of the therapy static and time-varying magnetic fields.
(http://www.curatronic.com). This article discusses only the modalities that utilize
It is recognized that the use of magnetic fields for time varying low frequency EMF, known as PEMFs.
therapy has a long history. Physicians from ancient Greece, Therefore, a large body of research, including many clin-
China, Japan, and Europe successfully applied natural ical studies that report the successful application of static
magnetic fields and high frequency EMF as well as elec-
troporation and electrical stimulation will remain outside
M. S. Markov (&)
Research International, Williamsville, NY 14221, USA
this article. Several excellent reviews concerning these
e-mail: [email protected] stimulation modalities (Gardner et al. 1999; Rushton 2002;

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Sluka and Walsh 2003; Ojingwa and Isseroff 2003; 600,000–2.5 million more have chronic leg and foot
Rosch and Markov 2004). wounds (Wysocki 1996).
It should be noted, that, thus far, the medical community Diabetic foot ulcers are probably the most common
approach to magnetotherapy is as to an adjuvant therapy, chronic wounds in western industrialized countries. Of the
especially for treatment of a variety of musculoskeletal millions who have diabetes mellitus, 15% will suffer foot
injuries. There is a large body of basic science and clinical ulceration which often leads to amputation (100,000 per
evidence that time-varying magnetic fields can modulate annum in the US alone) (Pilla 2006).
molecular, cellular, and tissue function in a physiologically The National Institutes of Health estimate that more
and clinically significant manner. (Markov 2002; Rosch than 48 million Americans suffer chronic pain that results
and Markov 2004). in a 65 billion loss of productivity and over $100 billion
The fundamental questions related to the biophysical spent on pain care (Markov 2004c). Better part of this
conditions under which EMF signals could be recognized money is spent for pain-relief medications.
by cells in order to modulate cell and tissue functioning Recent advances in magnetotherapy suggest that care-
remains to be elucidated. The scientific and medical com- fully selected magnetic fields might be helpful in treatment
munities still lack the understanding that different magnetic of diseases as Parkinson’s, Alzheimer, as well as Reflex
fields applied to different tissues could cause different Sympathetic Disorders which have relatively small number
effects. of potential users.
The medical part of the equation should identify the
exact target and the ‘‘dose’’ of EMF that the target needs to
receive. Then, physicists and engineers should design the 3 Cost and benefit of EMF therapy
exposure system in such a way that the target tissue
receives the required magnetic flux density. One should not Improvement in only a small percentage of above-men-
expect, for example, that the magnetic field which is ben- tioned cases would be of great benefit: less suffering,
eficial for superficial wounds, might be as good for fracture reduced expenses, and decreased duration of treatment
healing. Particular attention must be paid to the biophysical should be considered in parallel with individual and social
dosimetry, which should predict which EMF signals could welfare. Thus, the clinical effects of PEMF on musculo-
be bioeffective and monitor this efficiency. This raises the skeletal system repair are physiologically significant and
question of using theoretical models and biophysical often constitute the method of choice when the conven-
dosimetry in selection of the appropriate signals and in tional standard of care has failed to produce adequate
engineering and clinical application of new PEMF thera- clinical results.
peutic devices. PEMF modalities are usually applied directly on the
targeted area of the body. Compared to regular pharma-
ceuticals, PEMF offers an alternative with fewer, if any,
2 Some examples for target populations side effects. This is a tremendous advantage versus phar-
maceutical treatment at which the administered medication
The largest populations of patients that have received, or spreads over the entire body, thereby causing adverse
could benefit from magnetic field therapy are victims of effects in different organs, which sometimes might be
musculoskeletal disorders, wounds and pain. Following is a significant. One should not forget that in order to deliver
summary of information for the number of people in the the medication dose needed to treat the target tissue/organ,
USA who need help in above-mentioned areas. patients routinely receive medication dose hundreds of
Five million bone fractures occur annually in the United times larger than the dose needed by the target.
States alone. About 5% of these became delayed or non- However, regulatory and reimbursement issues have
union fractures (Ryaby 1998). According to National prevented more widespread use of PEMF modalities,
Osteoporosis Foundation about 10 million Americans have especially in the USA. The FDA policy toward magneto-
osteoporosis and 34 millions of US citizens have low bone therapy is unnecessarily restrictive. In concert with this
density, which put them at risk for further musculoskeletal policy, the Center for Medicare Services (CMS) for a
disorders. period of time refused to allow reimbursement even for
Chronic wounds and their treatment are an enormous modalities cleared by FDA. It took several years of court
burden on the healthcare system, both in terms of their cost fighting until CMS reversed its position. This was a result
($5 billion to $9 billion annually) and the intensity of care of the pressure from general public and physical therapy
required. There is even more cost to society from human communities. In fact, the CMS has been now recognized
suffering and reduced productivity. More than 2 million that PEMF is a plausible therapeutic modality which pro-
people suffer from pressure ulcers and as many as duces sufficient clinical outcome to permit, and reimburse

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for, use in the off-label application of healing chronic

wounds, such as pressure sores, diabetic leg, and foot
ulcers (Pilla 2006).

3.1 PEMF signals

Today, magnetic-field-dependent modalities could be cat-

egorized in six groups, but this article is discussing only the
PEMF signals (for details see Markov 2004c). An excellent
review of the physics and engineering of low frequency
signals was published by Liboff (2004).
The PEMF signals in clinical use have variety of
designs, which in most cases are selected without any
motivation for the choice of the particular waveform, field
amplitude or other physical parameters.

3.2 Sinewave type signals

It seems reasonable that the first and widely used wave-

shape is the sine wave with frequency of 60 Hz in North
America and 50 Hz in the rest of the world (Fig. 1).
Though not a subject of this article, it should be noted that
the 27.12 MHz continuous sinewave have been used for
deep tissue heating in fighting various form of cancer.
From the symmetrical sinewaves engineers moved to an
asymmetrical waveform by means of rectification. These
types of signals basically flip–flop the negative part of the
sinewave into positive, thereby creating a pulsating sine-
wave. The textbooks usually show the rectified signal as a Fig. 1 Three types of sinewave signals with the same amplitude, but
set of ideal semi-sinewaves. However, due to the imped- different frequencies
ance of the particular design such ideal waveshape is
impossible to be achieved. As a result, the ideal form is
distorted and in many cases a short DC-type component
appears between two consecutive semi sinewaves (Fig. 2).
This form of the signals has been tested for treatment of
low back pain and Reflex sympathetic disorder (Ericsson
et al. 2004). However, the most successful implementation
of this signal is shown in animal experiments as causing
anti-angiogenic effects (Williams et al. 2001; Markov
et al. 2004d). Investigating a range of amplitudes for 120
pulses per second signal, the authors demonstrated that the
15 mT prevents formation of the blood vessels in growing
tumors, thereby depriving the tumor from expanding the Fig. 2 Example of real bridge rectified signal: a small DC component
blood vessel network and causing tumor starvation and occurs between two semi sine waves and a slight distortion of the
death. front part of semi sine wave might be observed
In the middle of 1980s the Ion Cyclotron Theory was
proposed by Liboff (1985), Liboff et al. (1987) and shortly Ca2+ and Mg2+ resonance frequencies). This signal, shown
after that a clinical device was created based on the ICR in Fig. 3 has oscillating character, but due to the DC
model (Orthologics, Temple, AZ). This device is in current magnetic field it oscillates only as a positive signal.
use for recalcitrant bone fractures. The alternating 40 lT The other type of sinewave-like signals might be seen
sinusoidal magnetic field is at 76.6 Hz (a combination of when a sinewave signal is modulated by another signal.

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Fig. 3 Adding a DC signal to sinusoidal signal might cause the

positive only signal to originate Fig. 5 Trapezoid signal minimizes the problems with the rising time
in case of rectangular signals

response, but the raising time dB/dt rate is the factor

responsible for observed beneficial effects. There are recent
suggestions that the rectangular signals should be replaced
by more realistic trapezoid signals (Kotnik and Miklavcic
2006) (Fig. 5).

3.4 Pulsed signals

The first clinical signal approved by FDA for treatment of

nonunion or delayed fractures (Bassett et al. 1974, 1977)
exploited the pulse burst approach. Having repetition rate
Fig. 4 Example of amplitude modulation of a high frequency of 15 burst per second, this asymmetrical signal (with a
sinusoidal signal
long positive and very short negative component) has more
than 30 years of very successful clinical use for healing
This exploits the principle of amplitude modulation, used nonunion bones (Fig. 6) It was assumed that the cell would
in radio-broadcasting (Fig. 4). Usually, the sinewave signal ignore the short opposite polarity pulse and respond only to
is at high frequency (in kHz and MHz range), while the the envelope of the burst which had a duration of 5 ms,
modulating signal is a-low frequency signal. There are also enough to induce sufficient amplitude in the kHz frequency
devices that apply two high frequency signals and the range.
interference of both signal results in an interference mag- A series of modalities utilizes signals that consist of
netic field (Todorov 1982). single narrow pulses separated by a long ‘‘signal-off’’
intervals. This approach allows modification not only of the
amplitude of the signal, but also of duty cycle (time on/
3.3 Rectangular type of signals time off) as well.
The pulsed radiofrequency signal, originally proposed
In addition to sinewave type signals, a set of devices which by Ginsburg in 1934 and later allowed by FDA for treat-
utilize unipolar or bipolar rectangular signals is available at ment of pain and edema in superficial soft tissues
the market. Probably for those signals the most important is (Diapulse) utilizes the 27.12 MHz in pulsed mode. Thus,
to know that due to the electrical characteristics (mostly the having short 65 ls burst and 1,600 ls pause between pulse
impedance) of the unit, these signals could never be rect- bursts, the signal does not generate heat during 30 min use.
angular. It should be a short delay both in raising the signal
up and in its decay to zero. The rise-time of such signal
could be of extreme importance because the large value of 4 Clinical benefit
dB/dt could induce significant electric current into the
target tissue. Some authors consider that neither frequency, A large number of scientific and clinical studies have been
nor the amplitude are so important for the biological reporting that PEMF help in bone unification; reduce pain,

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magnetic field action. (Adey 2004) Evidence is collected

that selected magnetic fields are capable of affecting the
signal transaction pathways via alteration of ion binding
and transport. The calcium ion is recognized as a key
player in such alterations. In a series of studies of calcium-
calmodulin dependent myosin phosphorylation my group
demonstrated that specific static magnetic fields, PEMF
and 27.12 MHz PRF could modulate Ca2+ binding to CaM
to a twofold enhancement in Ca2+ binding kinetics in a
cell-free enzyme preparation. (Markov et al. 1992, 1993,
1994; Markov and Pilla 1993, 1994a,b; Markov 2004a,b)
The ion binding target pathway has been confirmed in other
studies using static magnetic fields (Engstrom et al. 2002;
Liboff et al. 2003).
A meta-analysis performed on randomized clinical trials
using PEMF on soft tissues and joints showed that both
PEMF and PRF were effective in accelerating healing of
skin wounds (Ieran et al. 1990; Itoh et al. 1991; Stiller
et al. 1992; Comorosan et al. 1993; Seaborne et al. 1996;
Canedo-Dorantes et al. 2002), soft tissue injury (Bental
1986; Foley-Nolan et al. 1990; Vodovnik and Karba 1992;
Pennington et al. 1993; Pilla et al. 1996), as well as pro-
viding symptomatic relief in patients with osteoarthritis
and other joint conditions (Fitzsimmons et al. 1994; Zizic
Fig. 6 The original signal for treatment of non-union fractures et al. 1995; Ryaby 1998).
proposed by Bassett et al
We, as scientists, are guilty of making statements like
this: ‘‘Today there is abundance of in vitro and in vivo data
edema and inflammation; increase blood circulation; obtained in the laboratory research as well as clinical
stimulate immune, and endocrine systems. Most wounds evidence that time-varying magnetic fields of various
studies involve arterial or venous skin ulcers, diabetic configurations can generate beneficial effects for various
ulcers, pressure ulcers as well as surgical and burn wounds. conditions, such as chronic and acute pain, chronic wounds
Since cells involved in wound repair are electrically and recalcitrant bone fractures. This has been achieved
charged, some endogenous EMF signals may facilitate with low intensity, non-thermal, non-invasive time-varying
cellular migration to the wound area (Lee et al. 1993), EMF, having various configurations within a broad fre-
thereby restoring normal electrostatic and metabolic con- quency range.’’ (Pilla 2006). What is wrong with this
ditions. An important concept was proposed, that at any statement? One only word is missing ‘‘some’’. By not
injury site of the musculoskeletal system an injury current saying that some or selected PEMF could initiate plausible
occur (Canaday and Lee 1991). Since the main goal of any therapeutic effects, we simply say that all magnetic fields
therapy is to restore normal function to the organism, could achieve the goals.
electric, magnetic or electromagnetic modalities appear Which signals and at which conditions could be effec-
suitable to compensate the injury currents. Of course, the tive? Are any signal parameters better than others? It
optimal parameters to achieve this goal would depend on should be pointed out that many EMF signals used in
the type and extent of the injury that cause the specific research and as therapeutic modalities have been chosen in
injury current to originate. some arbitrary manner. Few studies assessed the biological
PEMF have also been beneficial in treatment of chronic and clinical effectiveness of different signals by comparing
pain associated with connective tissue (cartilage, tendon, the physical/biophysical dosimetry and biological/clinical
ligaments and bone) injury and joint-associated soft tissue outcomes. With the exponential development of Internet it
injury (Rosch and Markov 2004; Hazlewood and Markov is easy to find tens, if not hundreds of devices, which
2006). promise to cure each and any medical problem. A careful
Numerous cellular studies have addressed the effects of look at these sites would show that no engineering, bio-
EMF on signal transduction pathways. It is now well physical and clinical evidence is given to substantiate the
accepted that the cellular membrane is a primary target for claims.

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It has been three decades since the concept of ‘‘bio- It should be noted the significant contribution of late
logical windows’’ was introduced. In fact, three groups, Ross Adey in studying biophysical mechanisms of inter-
unknown to one another, published, almost simultaneously actions of EMF with biological membranes which has both
that during evolution Mother Nature created preferable fundamental and clinical importance (Adey 1986, 2004).
levels of recognition of the signals from exogenous mag- ICR proposed during the mid-1980’s by Liboff (1985,
netic fields. The ‘‘biological windows’’ could be identified 1987), described specific combinations of DC and AC
by amplitude, frequency and their combinations. The magnetic fields which can increase the mobility of specific
research in this direction requires assessment of the ions near receptor sites and/or through ion channels.
response in a range of amplitudes and frequencies. It has Any discussion of the possibility for EMF to cause
been shown that at least three amplitude windows exist: at biological/clinical effects must involve a discussion of the
50–100 lT (5–10 Gauss), 15–20 mT (150–200 Gauss) and problem of thermal noise (‘‘kT’’). Physicists and physical
45–50 mT (450–500 Gauss) (Markov 2005). Using cell- chemists, for example, have rejected the possibility that
free myosin phosphorylation to study a variety of signals, static and low frequency magnetic fields may cause bio-
my group has shown that the biological response depends logical effects because of the ‘‘thermal noise.’’ Indeed,
strongly on the parameters of applied signal, confirming the thermal noise has been cited as the main objection to the
validity of the last two ‘‘windows’’ (Markov 2004a,b). ICR model (Muesham and Pilla 1996; Pilla et al. 1999;
Interestingly, a new PEMF system, developed by Cura- Zhadin 1998). Bianco and Chiabrera (1992) have provided
tronic Ltd. generates electromagnetic signals within the an elegant explanation of the inclusion of thermal noise in
range of these amplitude windows and exploit amplitude the Lorentz-Langevin model which clearly shows the force
signals already proven to be biologically and clinically applied by a magnetic field on a charge moving outside the
effective (http://www.curatron.com) binding site is negligible compared to background
Brownian motion and, therefore, has no significant effect
on binding or transport at a cell membrane.
In order to resolve the thermal noise problems in the
5 Mechanisms of action ICR model, Lednev (1991) formulated an IPR model which
was further developed during the 1990’s (Blanchard and
The biophysical mechanism(s) of interaction of weak Blackman 1994; Blackman and Blanchard 1995; Engstrom
electric and magnetic fields with biological systems, as 1996). In this quantum approach, an ion in the binding site
well as the biological transductive mechanism(s), have of a macromolecule is considered to be a charged harmonic
been vigorously studied by the bioelectromagnetics com- oscillator. It was proposed that the presence of a static
munity. Both experimental and theoretical data have been magnetic field could split the energy level of the bound ion
collected worldwide in search of potential mechanisms of into two sublevels with amplitudes corresponding to elec-
interactions. As of today, a number of mechanisms have tromagnetic frequencies in the infrared band. The
been proposed, such as ion cyclotron resonance (ICR), ion difference between these two energy levels is the Larmor
parametric resonance (IPR), free radical concept, heat frequency.
shock proteins, etc. One of the first proposed models uses a For me, the most important contribution of Lednev is the
linear physicochemical approach (Pilla 1972, 1974), in experiment he designed to estimate the validity of his ICR
which an electrochemical model of the cell membrane was model: myosin phosphorylation in a cell-free mode
employed in order to assess the EMF parameters for which (Shouvalova et al. 1991). The calmodulin molecule pro-
bioeffects might be expected. It was assumed that non- vides ideal model for investigating ion binding without and
thermal EMF may directly affect ion binding and/or with the presence of exogenous magnetic field. This mol-
transport and possibly alter the cascade of biological pro- ecule has 4 molecular clefts ready to bind Calcium ion.
cesses related to tissue growth and repair. Moreover, calmodulin undergoes conformational changes
This electrochemical information transfer hypothesis at each filling of the binding sites. The experiment pro-
postulated that one plausible way for interactions between posed by Lednev, and further elaborated by my group
the cell membrane and the EMF could modulate the rate of (Markov 2004a,b), allows the Pilla’s group to propose a
ion binding to receptor sites. Several distinct types of model that overcomes the problem of thermal noise. In
electrochemical interactions can occur at cell surfaces, but addition, evidence showing both low frequency sinusoidal
two deserve special attention: non-specific electrostatic magnetic fields, which induce electric fields well below the
interactions involving water dipoles and hydrated (or par- thermal noise threshold, and weak static magnetic fields,
tially hydrated) ions at the lipid bilayer/aqueous interface for which there is no induced electric field, can have bio-
of a cell membrane as well as voltage dependent ion/ligand logically and clinically significant effects (Shouvalova
binding (Pilla et al. 1997). et al. 1991; Markov et al. 1992, 1993, 1994; Markov and

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Pilla 1993, 1994a,b; Liburdy and Yost 1993; Engstrom biological mechanisms and therapeutic applications of
et al. 2002; Liboff et al. 2003) have been collected. weak EMF signals.
Larmor precession, which describes the effects of The underlying problem for any model of biophysical
exogenous magnetic fields on the dynamics of ion binding, mechanism of weak EMF bioeffects relates to the signal
when the ion is already bound, has been suggested, as a detection at the molecular/cellular/tissue target in the
possible mechanism for observed bioeffects due to weak presence of thermal noise, i.e., signal to thermal noise ratio
static and alternating magnetic field exposures (Zhadin and (SNR).
Fesenko 1990; Edmonds 1993; Muehsam and Pilla Clinical experience, as well as numerous animal and
1994a,b, 1996; Pilla et al. 1997a,b). in vitro studies, suggest the initial conditions of the EMF-
A bound ionic oscillator in a static magnetic field will sensitive target pathway determine whether a physiologi-
precess at the Larmor frequency in the plane perpendicular cally meaningful bioeffect could be achieved. For example,
to the applied field. This motion will persist in superposi- when broken bone received treatment with PEMF, the
tion with thermal forces, until thermal forces eventually surrounding soft tissues receive the same dose as the
eject the oscillator from a binding site. The threshold for fracture site, but physiologically important response occurs
Larmor precession model is determined only by the bound only in the injured bone tissue, while changes in the soft
lifetime of the charged oscillator, allowing extremely weak tissue have not been observed.
magnetic fields to affect its dynamics. It should be taken This is crucially important behavior, indicating that
into account, that when an ion is approaching the binding magnetic fields are more effective when the tissue is out of
site, the molecular cleft is already occupied with water equilibrium. Therefore, the experiments with healthy vol-
molecules. Therefore, the ion must compete with the water unteers are not always indicative for the potential response
molecules. The geometry of the binding site can create a of patients who are victims of injury or disease. The
locally hydrophobic region, from which water molecules healthy organism has much larger compensational ability
could be repelled. Weak static magnetic fields have been than the diseased organism, which in turn would reduce the
reported to accelerate Ca/CaM dependent myosin light manifestation of the response.
chain kinase (MLCK) and protein kinase C (PKC) depen- Support for that notion comes from a study of Jurkat
dent processes up to twofold (Markov and Pilla 1994a). cells in which the state of the cell was found to be
The further development of this approach leads to the important in regard to the response of tissues to magnetic
dynamical systems model which assumes the ion binding fields: normal T-lymphocytes neglect the applied PEMF,
as a dynamical process wherein the particle has two ener- while being stimulated by other factors. Furthermore, the
getically stable points separated by a few kT (double response of lymphocytes to magnetic fields clearly shows
potential well), either bound in the molecular cleft, or a dependence on the stimulation with other factors. In
unbound in the plane of closest approach to the hydrated other words, it might be approximated with pendulum
surface (Helmholtz plane) at the electrified interface effect—the larger is the deviation from equilibrium, the
between the molecular cleft and its aqueous environment. stronger is the response (Nindl et al. 2002; Markov et al.
Ion binding/dissociation is treated as the process of hop- 2006). For example, Nindl has demonstrated, in an
ping between these two states driven by thermal noise and in vitro study, that the initial conditions of lymphocytes
EMF effects are measured by modulation of the ratio of are important in terms of the biological effects of those
time bound (in the molecular cleft) to time unbound (in the cells to magnetic fields.
Helmholtz plane) (Pilla et al. 1997).
This dynamical system uses the thermal noise as the
driving force for ion binding and dissociation. The external 6 The future
force could modulate the relative depth of the wells thereby
affecting the ratio of time bound to time unbound and thus Even with the large variety of devices and signals in use for
the kinetics of the binding process. A weak magnetic field PEMF therapy, some general categories have been identi-
can indirectly affect the double well, which, in turn, fied as more promising for the future development of the
modulates the ratio of time bound to time unbound and magnetic field therapy. It appears that semi sinewaves are
therefore reaction rate (Pilla et al. 1997). more effective compared to continuous sine waves.
The biophysical dogma prevailing until the late 1980s This approach is based on rectification of the continuous
and lingering to this day is that, unless the amplitude and sinusoidal signal, described earlier. It is too preliminary to
frequencies of an applied electric field were sufficient to generalize, but the future research should clarify the
trigger membrane alterations, to produce tissue heating or importance of the short DC component between the con-
to move an ion along a field gradient, there could be no secutive semi sinewaves (Fig. 2). In an unpublished study,
effect. This was a serious obstacle in the search for we have found that the duration of this DC component is

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One of the most promising PEMF units available now

worldwide is the Curatron system, designed and distributed
by Curatronic Ltd. (Israel). The Curatron system generates
a sinusoidal dual rectified waveform, subjected to Fast
Fourier Transformation. This way the signal contains at a
given time only one frequency component, resulting in a
single peak at the frequency of the wave. Gating of the
above waveform with a precise time window creates the
pulsing frequency. The process of creating the pulse
waveform, pulsing frequency, zero crossing, timing and
impulse intensity is completely software controlled by the
built-in computer (http://www.curatron.com).
By utilizing the precise computer-controlled timing for
gating of the time window, responsible for the actual pulse
Fig. 7 Some therapeutic modalities use monophasic pulsed (both frequency, the maximum utilization of the energy contents
with low and high frequency components) with different duty cycles of the modulated sinusoidal signal is obtained. Very fast
pulse rise time guarantees maximum electromagnetic
energy transfer deep inside the tissue and cells, explaining
associated with different biological response in several the high efficacy for the Curatron. The strength of the
outcomes Fig. 7, 8. PEMF generated by the coil applicators is monitored and
There are at least two different approaches for utiliza- controlled by a laser-calibrated Hall-effect sensor.
tion of these signals. One relies on constructing an By connecting the unit to a standard Personal Computer
elliptical or spherical coil which could be moved around (PC) a large database with readily pre-programmed ther-
the patient body (Williams et al. 2001) and the other, apy, protocols becomes available. Thus, the specially
applies the magnetic field on the upper or lower limbs, designed software package takes full control of the Cura-
assuming that the results appear following systemic effects tron unit and all therapy parameters are under direct
when the benefit is obtained at site distant from the site of command and control of the PC program.
application (Erickson et al. 2004). Therapy setting can be selected from a database, which
Living in the era of computers, we should expect that the contains an extensive list of preprogrammed treatment
advantages of powerful computer technologies should be protocols, applicable for various diseases. Besides the pre-
implemented in designing new magnetotherapeutical programmed protocols the therapist can easily compile his
devices. At first, it should be the computerized control of own therapy protocols and save it in the database for future
the signal and maintenance of the parameters of the signal use. The complete program runs fully automatic in
during the whole treatment session. Next, inclusion of user- sequence, according to the corresponding frequencies and
friendly software packages with prerecorded programs, as intensities for each stage, during the total treatment time of
well as with the ability to modify programs depending the each session. The inventors of Curatron assume that the
patient needs. With appropriate sensors, the feedback automatic parameters change is important to avoid adap-
information could be recorded and used during the course tation of the body to repeated stimulus. As an example, the
of therapy. Last, but not least, is the possibility to store the therapy program developed for osteoporosis monitors the
data for the treatment of individuals in a large database and bone density and the bone densitometry values and scores
further analyze the cohort of data for particular study or are used for calculating automatically the optimal therapy
disease. parameters for each individual patient.

Fig. 8 Curatron therapeutic

system

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7 Conclusions chronic arterial and venous leg ulcers with systemic electro-
magnetic fields. Archives of Medical Research, 33, 281–289.
Comorosan, S., Vasilco, R., Arghiropol, M., Paslaru, L., Jieanu, V., &
The author strongly believes that a lot of work remains to Stelea, S. (1993). The effect of Diapulse therapy on the healing
be done in designing both technology and methodology of of decubitus ulcer. Romanian Journal of Physiology, 30, 41–45.
application of magnetotherapeutic devices. One of the very Edmonds, D. T. (1993). Larmor precession as a mechanism for the
important issues that engineers and biophysicists neglect, is detection of static and alternating magnetic fields. Bioelectro-
chemistry and Bioenergetics, 30, 3–12.
the frequency spectrum of the signal. At any PEMF, a large Engstrom, S. (1996). Dynamic properties of Lednev’s parametric
spectrum of harmonics, up to 3 kHz exists with the first resonance mechanism. Bioelectromagnetics, 17, 58–70.
harmonic usually having the amplitude close to 20% of the Engstrom, S., Markov, M. S., McLean, M. J., Holcomb, R. R., &
amplitude of basic signal. In that aspect, the computerized Markov, J. M. (2002). Effects of non-uniform static magnetic
fields on the rate of myosin phosphorylation. Bioelectromagnet-
system, offered and already in use, by Curatron is of great ics, 23, 475–479.
importance. The computer technology allows a collection Ericsson, A. D., Hazlewood, C. F., Markov, M. S., & Crawford, F.
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