ELECTROTHERAPY - II (Syllabus Based)

HIGH FREQUENCY AND ACTINOTHERAPY

### CHAPTER A: SHORT WAVE DIATHERMY (SWD)

#### 1. Definition:

Short Wave Diathermy (SWD) is a therapeutic modality that uses high-frequency

electromagnetic waves to generate heat in deep tissues, aiding in pain relief, muscle relaxation,
and increased circulation.

#### 2. Principle of Working:

SWD operates on the principle of converting electromagnetic energy into heat as it penetrates
body tissues. The electromagnetic waves cause molecular vibration in tissues, producing
thermal effects for therapeutic purposes.

#### 3. Indications & Contraindications of SWD:

- **Indications**: Arthritis, muscle spasms, sprains, strains, chronic inflammatory conditions,

joint stiffness, and muscle pain.

- **Contraindications**: Pregnancy, pacemakers, metal implants, active infections, malignancies,

and sensory impairment.

#### 4. Bio-Physics of Deep Heating Using SWD:

SWD heats tissues by using two primary methods:

1. **Capacitor or Condenser Field Method**: In this method, the patient's body part is placed
between two capacitor plates, creating an electric field that oscillates, producing heat.

2. **Inductance or Magnetic Field Method**: This method uses an inductive applicator, where
electromagnetic fields create currents in tissues, generating heat.

### 1. Production:
#### 1. Construction:

A. **Machine Circuit (Oscillator Circuit)**: Generates high-frequency oscillations using vacuum

tubes or transistors.

B. **Patient Circuit (Resonator Circuit)**: Delivers energy to the patient, converting

electromagnetic energy into heat within tissues.

#### 2. Mechanism of Production of SWD:

The oscillator circuit generates high-frequency electromagnetic waves, which are delivered to
the patient circuit. The energy is converted into heat in the tissues through molecular
oscillations and resistance to current flow.

#### 3. Indications for Circuits to be in Tune:

The oscillator and patient circuits must be in resonance or "tuned" to ensure efficient energy
transfer and minimize energy loss.

#### 4. Transmission of Shortwave into Tissues:

Shortwave energy penetrates the tissues by oscillating electromagnetic fields, which generate
heat deep within the body, affecting muscles, bones, and joints.

### 2. Technique or Method of Application of SWD:

#### 1. Preparation of Equipment:

- **Warming, Tuning, and Testing**: Ensure the SWD machine is properly warmed up, tuned for
resonance between circuits, and tested for safety before use.

#### 2. Application of Treatment:

A. **Condenser Field Method/Capacitor Field Method**: Electrodes are placed on either side of
the body part to create an electric field for deep heating.

B. **Cable Method/Inductothermy**: Coils or cables are used to generate a magnetic field

around the body part.

#### 3. Condenser Field Method:

A. **Type of Electrode**: Metal or rubber electrodes.

B. **Size of Electrode**: Chosen based on the area to be treated.

C. **Electrode Spacing**:

- **Wide Spacing**: For deep heating.

- **Narrow Spacing**: For superficial heating.

D. **Electrode Positioning**:

1. **Co-planar**: Electrodes on the same plane.

2. **Contra-planar**: Electrodes on opposite sides of the body part.

3. **Mono-planar**: One electrode.

4. **Cross-fire Method**: Electrodes positioned at right angles for focused heating.

#### 4. Cable Field Method:

A. **Electrode**: Consists of cables or coils.

B. **Electrostatic & Magnetic Field**: Generates a magnetic field that induces heat.

C. **Advantages**: Effective for treating larger or deeper tissues.

D. **Dosage**: Based on time, intensity, and frequency.

### 3. Dangers of SWD:

- Burns from excessive heat.

- Risk of tissue damage due to improper dosage.

- Potential interference with implanted electronic devices.

### 4. Precautions and Contraindications of SWD:

- Avoid use near metallic implants or pacemakers.

- Do not use on patients with poor thermal sensation or over malignant tumors.

- Monitor closely to prevent burns or overheating.

### 5. Pulsed Short Wave Diathermy (PSWD):

#### A. Definition, Frequency, Wavelength:

- **Definition**: A variation of SWD that uses pulsed electromagnetic waves to minimize heating
while providing therapeutic benefits.

- **Frequency**: Typically around 27 MHz.

- **Wavelength**: Varies based on pulse duration and frequency.

#### B. Production:

Pulsed electromagnetic waves are generated by modulating the frequency and intensity of the
electromagnetic field in a series of pulses.

#### C. Parameters:

1. **Pulse Repetition Rate (PRR)**: The number of pulses per second.

2. **Pulse Duration (PD)**: The time duration of each pulse.

3. **Peak Pulse Power (PPP)**: The maximum power during each pulse.

#### D. Physiological Effect:

- Increases local circulation.

- Reduces pain and muscle spasms.

- Promotes tissue healing with minimal heating.

#### E. Indications & Contraindications:

- **Indications**: Soft tissue injuries, post-operative pain, chronic pain conditions.

- **Contraindications**: Similar to continuous SWD, including metallic implants and pacemakers.

#### F. Dosage:

- Dosage is determined by adjusting pulse rate, intensity, and duration to ensure therapeutic
effects without overheating tissues.

### CHAPTER B: MICROWAVE DIATHERMY (MWD)

#### 1. Definition:

Microwave Diathermy (MWD) is a form of deep heat therapy that uses microwaves
(electromagnetic waves of short wavelength and high frequency) to generate heat in body
tissues for therapeutic purposes. The frequency used typically ranges from 300 MHz to 300
GHz, with a common therapeutic frequency of 2450 MHz.

#### 2. Bio-Physics of Microwave Diathermy:

Microwaves penetrate the skin and cause water molecules in tissues to oscillate, generating
heat through dielectric heating. This process results in the absorption of electromagnetic
energy and conversion into heat, particularly in tissues with high water content (muscles, joints).
The depth of penetration is less than SWD but still sufficient for effective therapeutic heating.

#### 3. Indications & Contraindications of MWD:

- **Indications**:

- Muscle spasms
 - Joint stiffness

- Chronic inflammatory conditions (e.g., arthritis)

- Soft tissue injuries

- Scar tissue or adhesions

- **Contraindications**:

- Presence of metal implants (due to risk of overheating)

- Pacemakers

- Pregnancy

- Malignant tumors

- Sensory deficits or impaired thermal regulation

#### 4. Production of MWD (Magnetron):

MWD is produced using a device called a **magnetron**, which generates microwaves by

accelerating electrons in a vacuum tube. These microwaves are then directed through a
waveguide to the applicator, which focuses the waves onto the target area. The magnetron
operates at high frequencies, converting electrical energy into microwave energy, which is then
used for therapeutic heating.

#### 5. Technique of Application of MWD:

A. **Patient Preparation**:

- Ensure the patient is comfortable and positioned properly to expose the treatment area.

- Remove any metal objects (jewelry, implants) from the treatment area to avoid burns.

B. **Selection of Treatment Applicator**:

- Choose the appropriate microwave applicator size based on the area being treated (small
applicators for localized areas, larger applicators for broader areas).
C. **Selection of Appropriate Power Level and Application of Treatment**:

- Set the power level based on the desired therapeutic effect (lower for mild heating, higher for
deep heating).

- Apply the microwave energy to the targeted area using the applicator, ensuring it is
positioned at the correct distance and angle to focus energy effectively.

D. **Dosage**:

- Dosage is determined by adjusting the power level, duration of treatment, and size of the
applicator.

- Treatment sessions typically last from 10 to 30 minutes, depending on the condition and
treatment goals.

E. **Physiological & Therapeutic Effects**:

- **Increased Blood Flow**: Heating increases circulation, promoting healing.

- **Pain Relief**: Reduces pain by relaxing muscles and alleviating joint stiffness.

- **Muscle Relaxation**: Loosens tight muscles, reducing spasms.

- **Tissue Healing**: Enhances metabolic activity and oxygen delivery, speeding up tissue
repair.

F. **Dangers**:

- **Overheating**: Risk of burns if power settings are too high or the applicator is not
positioned properly.

- **Tissue Damage**: Excessive heat can cause damage to tissues, particularly in areas with
poor blood supply.

- **Electromagnetic Interference**: Can interfere with pacemakers or other implanted

electronic devices.

- **Eye Injury**: Microwaves can cause damage to the eyes if applied too close or at an
improper angle.
### CHAPTER C: ULTRASOUND THERAPY

#### 1. Definition:

Ultrasound therapy is a therapeutic modality that uses high-frequency sound waves (typically
between 1-3 MHz) to treat musculoskeletal injuries by promoting tissue healing, reducing pain,
and improving circulation. These sound waves are transmitted through tissues, creating thermal
and non-thermal effects for therapeutic purposes.

#### 2. Bio-Physics of Ultrasound:

Ultrasound works by producing sound waves that penetrate the tissues, causing mechanical
vibrations. The alternating pressure of these waves creates a thermal effect, which increases
blood flow and helps with tissue healing. Additionally, non-thermal effects like cavitation and
acoustic streaming enhance cellular activity and aid in recovery.

#### 3. Indications & Contraindications of Ultrasound:

- **Indications**:

- Soft tissue injuries (e.g., sprains, strains)

- Tendinitis

- Bursitis

- Scar tissue management

- Joint inflammation

- Muscle spasms

- Chronic pain conditions

- **Contraindications**:

- Over areas of malignancy

- Near the eyes, reproductive organs, or the heart

- Over pacemakers or other implanted electronic devices

- Over areas with active infections or open wounds

 - Pregnancy (especially over the abdomen or lower back)

- Fractures (unless specifically indicated)

#### 4. Properties of Ultrasound:

- **Reflection**: Ultrasound waves reflect off surfaces such as bones or air pockets, which can
result in energy loss.

- **Transmission**: The waves are transmitted through soft tissues, with different tissues
allowing different levels of penetration based on their density.

- **Absorption**: Ultrasound energy is absorbed by tissues, with higher absorption rates in

tissues with higher protein content (e.g., tendons, ligaments).

#### 5. Ultrasonic Field:

The ultrasonic field is the area in which the ultrasound waves are effective. It consists of the
**near field (Fresnel zone)** and the **far field (Fraunhofer zone)**, with the intensity varying in
the near field and becoming more uniform in the far field.

#### 6. Coupling Media:

Ultrasound requires a coupling medium (such as gel, water, or a water-filled bag) to effectively
transmit sound waves from the ultrasound head into the body tissues. This prevents reflection
of the waves off the skin and allows better penetration.

#### 7. Production of Ultrasound:

Ultrasound waves are produced by a transducer (ultrasound head) that contains a piezoelectric
crystal. When an electric current passes through the crystal, it vibrates, generating sound waves
that are transmitted into the tissues.

#### 8. Technique of Application of Ultrasound:

A. **Testing of Machine**:
 - Ensure the ultrasound machine is functioning correctly, with proper calibration and output.

- Test for consistent delivery of sound waves from the transducer head.

B. **Application of Ultrasound**:

1. **Direct Contact Method**:

The transducer head is placed directly on the skin with a coupling medium (gel) to ensure
efficient transmission of sound waves.

2. **Water Bath Method**:

The body part (typically a small area like a finger or wrist) is immersed in a water bath, and the
transducer head is placed in the water, allowing for uniform treatment without direct contact
with the skin.

3. **Water Bag Method**:

A water-filled bag is placed between the transducer and the treatment area, especially useful
for irregular surfaces, ensuring good transmission of ultrasound waves.

C. **Treatment Parameters**:

1. **Intensity**:

- Low intensity for acute conditions.

- Higher intensity for chronic conditions or deep tissue heating.

2. **Mode**:

- **Continuous**: Delivers constant ultrasound waves, producing thermal effects for deep
heating.
 - **Pulsed**: Ultrasound waves are delivered in pulses, creating non-thermal effects such as
tissue repair and pain relief.

3. **Frequency**:

- **1 MHz**: Used for deeper tissues (up to 5 cm depth).

- **3 MHz**: Used for superficial tissues (up to 2.5 cm depth).

4. **Treatment Duration**:

Typically 5 to 10 minutes, depending on the size of the treatment area and the condition being
treated.

5. **Pulsed Mark: Space Ratio**:

- The ratio of the "on" time to "off" time in pulsed mode. Common ratios include 1:1, 1:4, etc.,
influencing the non-thermal effects.

### 1. Dosage:

Dosage is determined by adjusting intensity, frequency, and treatment duration based on the
specific condition being treated and the desired therapeutic effect.

### 2. Physiological & Therapeutic Effects of Ultrasound:

- **Increased Blood Flow**: Promotes tissue healing and reduces inflammation.

- **Pain Relief**: Ultrasound helps reduce pain through thermal and non-thermal effects.

- **Muscle Relaxation**: Loosens tight muscles and reduces spasms.

- **Tissue Repair**: Enhances collagen production and accelerates the repair of damaged
tissues.

- **Reduction of Scar Tissue**: Breaks down adhesions and softens scar tissue.
### 3. Dangers of Ultrasound:

- **Burns**: Excessive heat can cause burns, particularly in areas with poor blood flow.

- **Cavitation**: Rapid pressure changes can cause microbubble formation, which may lead to
tissue damage if applied improperly.

- **Periosteal Pain**: Discomfort near bones due to excessive heating.

### 4. Phonophoresis:

A. **Definition**:

Phonophoresis is the use of ultrasound to enhance the delivery of topical medications (such as
anti-inflammatory drugs or analgesics) through the skin and into deeper tissues.

B. **Principle of Working**:

Ultrasound waves increase the permeability of the skin, allowing medications to penetrate
deeper into tissues where they can exert their therapeutic effects.

C. **Drugs Used in Phonophoresis**:

Common drugs include:

- Hydrocortisone (anti-inflammatory)

- Lidocaine (local anesthetic)

- Dexamethasone (steroid)

D. **Techniques of Application of Phonophoresis**:

- A coupling medium containing the drug is applied to the skin, and ultrasound is administered
as usual. The ultrasound enhances the absorption of the drug into the tissues.

E. **Contraindications**:
- Same as general ultrasound therapy contraindications, with the addition of drug allergies or
sensitivity to the topical medications used.

ACTINOTHERAPY

### CHAPTER A: BASICS OF ACTINOTHERAPY

#### 1. Definition of Heat and Temperature:

- **Heat**: Heat is a form of energy that is transferred between systems or objects with
different temperatures, moving from the object with a higher temperature to one with a lower
temperature.

- **Temperature**: Temperature is the measure of the average kinetic energy of particles in a

substance. It determines how hot or cold an object is.

#### 2. Physical Effects of Heat:

- **Vasodilation**: Heat causes blood vessels to dilate, increasing blood flow to the area.

- **Increased Metabolic Activity**: Heat elevates the metabolic rate, enhancing the delivery of
nutrients and oxygen to tissues.

- **Muscle Relaxation**: Heat relaxes muscle fibers, reducing spasms and stiffness.

- **Pain Relief**: Heat stimulates thermoreceptors, which can reduce pain sensation.

- **Enhanced Tissue Healing**: By increasing circulation and metabolic activity, heat promotes
faster tissue repair.

#### 3. Transmission of Heat:

- **Conduction**: Heat transfer through direct contact between molecules. Example: applying a
hot pack to the skin.

- **Convection**: Heat transfer by the movement of fluids or gases, such as air or water.
Example: using a warm whirlpool.

- **Radiation**: Transfer of heat through electromagnetic waves without direct contact.

Example: infrared therapy.
- **Evaporation**: Heat loss through the conversion of liquid to vapor. Example: sweating.

#### 4. Radiation Energy and Its Properties:

- **Radiation**: The emission of energy in the form of electromagnetic waves or particles.

- **Properties of Radiation**:

- **Wavelength**: The distance between successive peaks of a wave.

- **Frequency**: The number of wave cycles that pass a point per second.

- **Intensity**: The amount of energy transmitted per unit area.

- **Penetration**: The ability of radiation to pass through materials; depends on the wavelength
and energy of the radiation.

#### 5. Electromagnetic Spectrum:

The electromagnetic spectrum represents all types of electromagnetic radiation arranged by

wavelength and frequency. Different forms include:

- **Radio Waves**: Long wavelength, used in communication.

- **Microwaves**: Shorter wavelength, used in heating and communication.

- **Infrared Radiation**: Heat-producing radiation used in therapeutic applications.

- **Visible Light**: The part of the spectrum that can be seen by the human eye.

- **Ultraviolet (UV) Radiation**: Can be used in medical therapy for skin conditions.

- **X-rays and Gamma Rays**: High-energy radiation used in medical imaging and cancer
treatment.

#### 6. Laws Governing Radiation:

- **Inverse Square Law**: The intensity of radiation decreases with the square of the distance
from the source. This means that if you double the distance from a heat source, the intensity of
the radiation is reduced to one-fourth.

- **Law of Reflection**: Radiation striking a surface at an angle is reflected at the same angle.
- **Law of Absorption**: The absorption of radiation depends on the nature of the surface and
the wavelength of the radiation. Darker or denser materials absorb more radiation.

- **Cosine Law**: The effectiveness of radiation is greatest when it is perpendicular to the

surface, decreasing as the angle deviates from 90 degrees.

- **Bunsen-Roscoe Law**: The total effect of radiation is determined by the intensity and
duration of exposure.

#### 7. Skin – Structure, Depth of Penetration, Functions:

- **Structure**:

- **Epidermis**: The outermost layer, consisting of keratinized cells, which provides a

protective barrier.

- **Dermis**: The thicker middle layer containing blood vessels, nerves, hair follicles, and sweat
glands.

- **Subcutaneous Tissue**: The deepest layer, composed of fat and connective tissue, which
insulates and protects underlying muscles and organs.

- **Depth of Penetration**:

- Radiation penetrates the skin based on the wavelength and energy of the radiation. Longer
wavelengths (such as infrared) penetrate deeper, while shorter wavelengths (like UV) tend to
affect only the superficial layers.

- **Functions**:

- **Protection**: Acts as a barrier against infections, chemicals, and mechanical injuries.

- **Regulation**: Helps regulate body temperature through sweating and blood vessel dilation.

- **Sensation**: Contains receptors that detect temperature, pain, and pressure.

- **Excretion**: Excretes waste products like urea and salts through sweat.

- **Synthesis**: Produces vitamin D when exposed to UV light.

Actinotherapy, by using radiation such as UV or infrared light, interacts with the skin’s structure
to provide therapeutic benefits such as pain relief, tissue healing, and skin condition treatment.

### CHAPTER B: INFRARED RADIATIONS (IRR)

#### 1. Definition:

Infrared Radiation (IRR) is a form of electromagnetic radiation with wavelengths longer than
visible light but shorter than microwaves, typically between 760 nm to 1 mm. It is primarily used
in therapeutic applications for heat generation, providing both superficial and deep tissue
heating.

#### 2. Production - Types of Generators (Luminous & Non-Luminous), Working:

- **Luminous Generators**:

- Produce both visible light and infrared radiation.

- Consist of incandescent lamps, which use a tungsten filament to emit IR radiation when
heated to high temperatures.

- They generate shorter wavelengths (near-infrared) that penetrate deeper into tissues.

- **Non-Luminous Generators**:

- Produce only infrared radiation, without visible light.

- They use electrical resistance elements like ceramic or carbon heaters to emit far-infrared
radiation.

- Non-luminous IR lamps generate longer wavelengths that mainly affect superficial tissues.

#### 3. Indications & Contraindications:

- **Indications**:
 - Muscle spasms and tension

- Joint stiffness and pain (e.g., arthritis)

- Chronic soft tissue injuries

- Wound healing in certain conditions

- Increasing circulation to promote tissue repair

- Subacute and chronic inflammation

- **Contraindications**:

- Acute inflammation

- Areas with impaired sensation (due to the risk of burns)

- Malignancies (risk of stimulating cancerous cells)

- Areas with circulatory problems (e.g., varicose veins)

- Over metallic implants (may overheat)

- During pregnancy (especially over the abdomen)

#### 4. Physiological & Therapeutic Effects of IRR:

- **Physiological Effects**:

- **Vasodilation**: Increases blood flow to the treatment area, promoting oxygen and nutrient
delivery.

- **Increased Metabolism**: Enhances cellular metabolic activities, supporting tissue repair.

- **Muscle Relaxation**: Reduces muscle tension and spasms by relaxing muscle fibers.

- **Enhanced Lymphatic Drainage**: Helps reduce swelling by promoting lymph flow.

- **Increased Perspiration**: Promotes sweating, aiding in the elimination of toxins.

- **Therapeutic Effects**:
 - **Pain Relief**: Through increased circulation and muscle relaxation.

- **Reduction of Stiffness**: Loosens stiff joints and muscles.

- **Tissue Healing**: Promotes faster healing by improving oxygenation and nutrient delivery to
tissues.

- **Scar Tissue Softening**: Helps to break down and soften scar tissue over time.

- **Anti-inflammatory Effect**: Reduces chronic inflammation by improving circulation.

#### 5. Dangers:

- **Burns**: Prolonged exposure or too close application of IR radiation can cause burns,
especially in patients with reduced sensation.

- **Overheating**: Can lead to dehydration, fatigue, or excessive sweating, particularly in

sensitive individuals.

- **Eye Damage**: Direct exposure to infrared radiation can damage the eyes, so proper
protection is necessary.

- **Overstimulation**: Excessive treatment can overstimulate the circulatory system and cause
discomfort.

#### 6. Technique of Treatment:

A. **Choice of Apparatus**:

- Select between **luminous** or **non-luminous** generators based on the depth of heat

required.

- Luminous generators are ideal for deeper tissue heating, while non-luminous generators are
suited for superficial warming.

B. **Arrangement of Lamp and Patient**:

- Position the infrared lamp at an appropriate distance (usually 45-60 cm from the skin) to
prevent burns.
 - The angle and positioning of the lamp should allow uniform heating of the treatment area.

- Ensure the patient is comfortable and properly supported during the treatment session.

C. **Preparation of Patient**:

- The treatment area should be exposed and free of any clothing or jewelry, as metal objects
can cause burns.

- Protect sensitive areas, such as the eyes, by providing goggles or shielding.

- Inspect the skin for any contraindications, such as rashes or open wounds.

D. **Application of Treatment**:

- Begin treatment by slowly adjusting the intensity and distance of the lamp to avoid excessive
heating.

- Rotate or reposition the lamp if necessary to ensure even heat distribution over the treatment
area.

- Continuously monitor the patient’s skin response to the heat, checking for signs of redness
or discomfort.

E. **Treatment Frequency and Duration**:

- Typical treatment sessions last between **15 to 30 minutes**.

- Treatments can be administered daily or several times per week depending on the condition
being treated.

- Adjust the frequency and duration based on the patient's response to therapy and the
severity of the condition.

Proper application of IR radiation is essential to ensure safety and maximize the therapeutic
benefits for the patient, especially in reducing pain and enhancing tissue recovery.

### CHAPTER C: ULTRA VIOLET RADIATION (UVR)

#### 1. Definition:

Ultraviolet Radiation (UVR) is a form of electromagnetic radiation with wavelengths ranging

from 100 to 400 nm, shorter than visible light but longer than X-rays. UVR is used therapeutically
for its effects on the skin and immune system, and it is commonly applied in the treatment of
skin disorders and certain metabolic conditions.

#### 2. Classification:

UV radiation is classified based on its wavelength:

- **UVA (320–400 nm)**: Also known as long-wave UV, penetrates deeper into the skin and is
used for conditions like psoriasis and eczema.

- **UVB (280–320 nm)**: Medium-wave UV, primarily responsible for erythema and skin tanning,
and often used in therapeutic doses for skin conditions like psoriasis.

- **UVC (100–280 nm)**: Short-wave UV, germicidal in nature and not commonly used for
therapeutic purposes because of its harmful effects on the skin.

#### 3. Production of UVR:

1. **Mercury Vapor Lamp**:

- **Air-Cooled Medium Pressure Mercury Vapor Lamp (Alpine Sun Lamp)**:

- Produces UVA and UVB rays.

- Commonly used for general body exposure in therapeutic settings.

- Air cooling ensures the lamp does not overheat during use.

- **Water-Cooled Medium Pressure Mercury Vapor Lamp (Kromayer Lamp)**:

- Produces high-intensity UV light, especially UVB, used for small and localized areas.

- The water cooling system helps prevent overheating and maintains the effectiveness of the
lamp during prolonged use.
2. **Fluorescent Tube (Theraktin Tunnel)**:

- A fluorescent tube designed to emit UV radiation, commonly used in a tunnel configuration

for full-body exposure.

- Often used for treating conditions like psoriasis and vitiligo.

- Emits a broad spectrum of UVA and UVB radiation.

1. **Tridymite Formation**: This refers to a high-temperature crystalline form of silica used in

lamp construction to enhance UV transmission efficiency.

2. **Cooling of Lamp**: Essential for maintaining the optimal performance and lifespan of the
lamp. Air or water cooling systems are used to prevent overheating during prolonged treatment
sessions.

#### 4. Technique or Principle of Application of Treatment:

A. **Preparation of Patient**:

- Assess the patient for any contraindications or sensitivity to UV light.

- Expose the area to be treated, ensuring that sensitive areas (e.g., eyes) are protected with UV
-blocking goggles or coverings.

- Apply sunscreen to areas not being treated to prevent unwanted UV exposure.

B. **Preparation of Apparatus**:

- Ensure the UV lamp is in proper working condition.

- Verify that the cooling system is functioning properly, whether air-cooled or water-cooled.

- Set the apparatus for the desired UV wavelength (UVA or UVB) based on the treatment
protocol.

C. **Setting Up**:
 - Position the lamp at an appropriate distance from the patient, typically 30-60 cm depending
on the strength of the lamp.

- Adjust the angle of the lamp to ensure even coverage of the treatment area.

- Monitor the patient's skin response throughout the session.

D. **Application**:

- Start with a **test dose** to determine the patient’s sensitivity to UVR.

- Progressively increase the dosage according to the treatment protocol, based on skin type
and response to the initial dose.

- Shorter wavelengths (UVB) require shorter exposure times compared to longer wavelengths
(UVA).

E. **Progression**:

1. **Test Dose**: A minimal erythema dose (MED) test is conducted to determine the smallest
dose of UV radiation that causes slight redness after 24 hours.

2. **Calculation of Progression of Dosage**: Dosage is gradually increased based on the

patient’s skin type, treatment goals, and response to the previous doses. The exposure time is
increased cautiously to avoid burns or overexposure.

#### 5. PUVA Apparatus:

PUVA (Psoralen + UVA) therapy combines the administration of a photosensitizing drug

(psoralen) with UVA radiation. The apparatus emits UVA radiation and is used primarily in the
treatment of psoriasis, vitiligo, and other skin conditions.

#### 6. Care of Lamp:

- Regular cleaning to remove dust and debris that can interfere with UV emission.

- Periodic replacement of bulbs to maintain consistent output.

- Ensuring proper functioning of the cooling system to avoid overheating.

#### 7. Sensitizers, Photosensitization, Filters:

- **Sensitizers**: Chemical agents (such as psoralen) that increase the skin's sensitivity to UV
radiation.

- **Photosensitization**: The process by which the skin becomes more sensitive to light, leading
to enhanced therapeutic effects.

- **Filters**: Used to selectively block certain wavelengths of UV light, depending on the specific
treatment goals.

#### 8. Erythema, Pigmentation, Penetration:

- **Erythema**: Reddening of the skin caused by UVB radiation, often seen after therapeutic
exposure.

- **Pigmentation**: Long-term exposure to UVR can lead to increased melanin production,

resulting in skin tanning.

- **Penetration**: UVA penetrates deeper into the skin than UVB, making it more suitable for
deeper skin conditions.

#### 9. Indications & Contraindications:

- **Indications**:

- Psoriasis

- Eczema

- Vitiligo

- Acne vulgaris

- Alopecia areata and totalis

- Ulcers and pressure sores

- Rickets (due to vitamin D deficiency)

- **Contraindications**:

- Skin cancer or history of skin cancer

- Systemic lupus erythematosus

- Recent radiotherapy

- Photosensitive skin conditions

- Use of photosensitizing medications

#### 10. Physiological & Therapeutic Effects of UVR:

- **Physiological Effects**:

- Stimulation of vitamin D synthesis.

- Erythema and skin tanning as part of the skin’s defense mechanism.

- Thickening of the epidermis to protect against further radiation.

- **Therapeutic Effects**:

- Reduction of hyperproliferation in skin conditions like psoriasis.

- Anti-inflammatory effects.

- Stimulation of the immune response in localized areas.

- Promotion of wound healing.

#### 11. Demonstration of UVR for Specific Conditions:

- **Acne**: Applied to the affected areas such as the shoulders, back, and chest to reduce
bacterial load and inflammation.

- **Alopecia Areata & Totalis**: UVR can stimulate hair growth in areas of hair loss by improving
local circulation.

- **Psoriasis**: UVA and UVB therapy helps reduce plaque formation and inflammation.
- **Ulcer & Pressure Sore**: UVR promotes healing by enhancing local circulation and the
immune response.

- **Rickets**: UVB exposure stimulates vitamin D production, aiding in the treatment of rickets.

- **General Body Bath**: Used for conditions like psoriasis and eczema to treat larger surface
areas of the body.

This chapter provides an overview of the principles, techniques, and therapeutic applications of
UV radiation in the medical field, particularly for dermatological conditions. Proper application
and dosage are key to maximizing benefits and minimizing risks.

### CHAPTER D: LASER

#### 1. Definition:

Laser (Light Amplification by Stimulated Emission of Radiation) is a device that emits light
through a process of optical amplification, producing a highly focused, intense, and coherent
beam of light used for various medical and therapeutic applications.

#### 2. Properties of Laser:

A. **Monochromaticity**:

- The laser emits light of a single wavelength or color, making it different from ordinary light,
which consists of multiple wavelengths. This property allows lasers to target specific tissues
with precision.

B. **Coherence**:

- The waves of light produced by the laser are in phase, meaning they move together in a
uniform direction. This coherence allows for a highly focused and organized beam of energy.

C. **Collimation**:

- The laser light is emitted in parallel beams that do not spread out as they travel. Collimation
ensures that the laser energy is concentrated over long distances, increasing its effectiveness in
both therapeutic and surgical applications.

#### 3. Production of Laser:

A. **Lasing Medium**:

- The lasing medium is the substance within the laser that emits light when stimulated. It can
be a solid (e.g., ruby crystal), a gas (e.g., helium-neon), a liquid (e.g., dye), or a semiconductor
(e.g., diode).

B. **Resonating Chamber**:

- The lasing medium is placed inside a resonating chamber, which consists of two mirrors:
one fully reflective and one partially reflective. The mirrors reflect the light back and forth,
amplifying it until it reaches a high enough energy level to escape through the partially reflective
mirror as a laser beam.

C. **Energy Source**:

- The energy source provides the necessary power to excite the atoms or molecules in the
lasing medium. This can be electrical energy, optical energy, or chemical reactions, depending
on the type of laser.

#### 4. Types of Laser:

A. **Ruby Laser or Crystal Laser**:

- One of the earliest types of lasers, using a ruby crystal as the lasing medium.

- Emits red light at a wavelength of 694.3 nm.

- Used for applications like tattoo removal and dermatology treatments.

B. **Helium-Neon Laser or Gas Laser**:

 - Uses a mixture of helium and neon gases as the lasing medium.

- Emits visible red light at 632.8 nm and is often used for low-level laser therapy (LLLT) for
pain relief and wound healing.

C. **Diode Laser or Semiconductor Laser**:

- A type of laser that uses a semiconductor as the lasing medium.

- It is compact, efficient, and commonly used for therapeutic purposes, including dental and
dermatological treatments.

- Emits a range of wavelengths depending on the material used in the semiconductor.

#### 5. Technique of Application:

A. **Grid Method**:

- The treatment area is divided into a grid, and the laser is applied systematically to each
section. This ensures even coverage of the entire treatment area.

B. **Scanning Method**:

- The laser is moved continuously across the treatment area in a scanning motion, allowing for
quicker application but requiring careful attention to avoid overlapping or missed areas.

#### 6. Dosage Parameters:

- **Area of Treatment**: The size of the area to be treated affects the total energy applied and
the duration of treatment.

- **Energy Density**: Measured in joules per square centimeter (J/cm²), energy density is the
amount of laser energy delivered per unit area.

- **Pulse Repetition Rate**: The frequency at which laser pulses are emitted, measured in hertz
(Hz).
- **Power Output**: The amount of power emitted by the laser, measured in watts (W) or
milliwatts (mW).

- **Irradiation**: The total amount of energy delivered to the tissue, usually in joules (J).

#### 7. Indications & Contraindications:

**Indications**:

- Pain relief (e.g., musculoskeletal pain, arthritis)

- Wound healing

- Scar reduction

- Skin rejuvenation (e.g., acne scars, wrinkles)

- Treatment of inflammatory conditions (e.g., tendinitis, bursitis)

- Vascular lesions and pigmentation disorders

- Tattoo and hair removal

**Contraindications**:

- Active cancer or tumors in the treatment area

- Pregnancy (avoidance of laser over the abdomen)

- Patients with photosensitivity or taking photosensitizing medications

- Areas with infections or open wounds (except for wound healing protocols)

- Direct exposure to the eyes (risk of retinal damage)

#### 8. Physiological & Therapeutic Effects:

- **Physiological Effects**:

- **Cellular Repair and Growth**: Laser therapy stimulates the production of ATP, leading to
enhanced cellular activity, repair, and growth.

- **Pain Relief**: Lasers can modulate nerve conduction and reduce the sensation of pain by
affecting the release of neurotransmitters.

- **Anti-inflammatory**: Lasers can reduce inflammation by promoting the release of anti-

inflammatory cytokines.

- **Increased Circulation**: Laser therapy promotes vasodilation, increasing blood flow to the
treated area and accelerating healing.

- **Therapeutic Effects**:

- **Wound Healing**: Lasers enhance tissue repair and regeneration by promoting collagen
production and accelerating the healing process.

- **Pain Management**: Low-level laser therapy is used to alleviate pain in chronic conditions
such as arthritis and back pain.

- **Scar Reduction**: Lasers can break down scar tissue and stimulate the growth of healthy
tissue in its place.

- **Skin Rejuvenation**: Laser treatments stimulate collagen production, improving skin

elasticity and reducing wrinkles.

#### 9. Dangers:

- **Eye Injury**: Direct exposure to laser beams can cause permanent eye damage, including
retinal burns or blindness. Eye protection is mandatory.

- **Burns**: Improper use of high-power lasers can cause burns to the skin or underlying tissues.

- **Hyperpigmentation/Hypopigmentation**: Inappropriate settings can lead to changes in skin

pigmentation, especially in individuals with darker skin tones.

- **Tissue Damage**: Excessive energy density or prolonged exposure can lead to tissue
damage or necrosis.

- **Pain and Discomfort**: Some patients may experience temporary pain or discomfort during
or after treatment.
Proper precautions, including appropriate dosages and protective measures, are essential for
safe and effective laser therapy.

### CHAPTER E: SUPERFICIAL HEAT MODALITIES

#### 1. Moist Hot Packs:

- **Definition**: Moist hot packs are therapeutic devices that apply heat to specific areas of the
body, typically for muscle relaxation, pain relief, and to increase local blood flow.

- **Working**: Moist hot packs retain heat and deliver it to the body via conduction. They are
usually filled with a gel or bentonite clay that retains moisture and heat for prolonged periods
when heated in water.

- **Technique of Application**:

1. Heat the moist hot pack in a hydrocollator (water temperature between 70°C - 75°C) for
about 20-30 minutes.

2. Remove the pack using tongs or protective gloves and wrap it in 6-8 layers of towels to avoid
burns.

3. Apply the wrapped pack to the affected area for 15-20 minutes.

4. Check the skin periodically to avoid burns and discomfort.

#### 2. Hydrocollator Pack:

- **Definition**: Hydrocollator packs are heat-retaining packs used in physical therapy to deliver
moist heat to sore muscles and joints, helping to relax the muscles and promote healing.

- **Apparatus**: The hydrocollator pack consists of a canvas cover filled with a heat-retaining
substance (usually silica gel or bentonite clay). The hydrocollator is a stainless steel tank that
heats and stores the packs in water.

- **Working**: Hydrocollator packs are heated by immersion in water at temperatures between

70°C and 75°C. The moist heat is then applied to the body.

- **Technique of Application**:

1. Heat the hydrocollator pack in the water bath for 20-30 minutes.

2. Remove and wrap the pack in towels to provide insulation.

3. Place the pack on the affected area for 15-20 minutes.

4. Monitor the patient’s skin for any signs of overheating or burns.

#### 3. Paraffin Wax Bath:

- **Definition**: A paraffin wax bath is a treatment that uses heated wax to provide therapeutic
heat to small areas like the hands, feet, or joints. It is used to relieve pain and stiffness in
conditions such as arthritis and joint injuries.

- **Apparatus**: The paraffin wax bath consists of a tank that melts and maintains the wax at a
therapeutic temperature (around 50°C - 55°C).

- **Technique of Application**:

1. Clean the treatment area thoroughly.

2. Immerse the affected part (e.g., hand or foot) into the paraffin wax bath and remove it
immediately.

3. Repeat the dipping process 6-10 times to create layers of wax.

4. Cover the wax-coated area with a plastic wrap and a towel to retain the heat.

5. Leave it in place for 15-20 minutes before peeling off the wax.

#### 4. Whirlpool Bath:

- **Definition**: A whirlpool bath is a therapeutic water bath that uses jets of warm water to
massage and treat areas of the body. It is commonly used to reduce muscle soreness, improve
circulation, and relax tight muscles.
- **Apparatus**: A whirlpool bath consists of a water-filled tank with motorized jets that
circulate the water, creating a massaging effect.

- **Technique of Application**:

1. Fill the whirlpool bath with warm water (temperature between 35°C - 40°C).

2. Submerge the affected part of the body (or the entire body in large whirlpool tanks).

3. Adjust the jets to the appropriate strength and position for the area being treated.

4. Keep the patient in the whirlpool for 15-30 minutes, monitoring for comfort and skin reaction.

#### 5. Hubbard Tank:

- **Definition**: A Hubbard tank is a large, full-body immersion hydrotherapy tank designed for
treating patients with severe or widespread musculoskeletal injuries, burns, or for rehabilitation
exercises.

- **Apparatus**: The Hubbard tank is a stainless steel or fiberglass tub equipped with whirlpool
jets, temperature controls, and sometimes a hoist for assisting patients in and out of the tank.

- **Technique of Application**:

1. Fill the Hubbard tank with water at a therapeutic temperature (around 33°C - 36°C).

2. Assist the patient into the tank using a hoist or transfer device if necessary.

3. Adjust the jets for massage and ensure the patient’s comfort.

4. Allow the patient to relax in the tank for 20-30 minutes, or guide them through rehabilitative
exercises while submerged.

5. After treatment, assist the patient out of the tank and dry the area thoroughly.

These superficial heat modalities help increase local blood circulation, reduce pain and stiffness,
and prepare muscles and joints for further therapeutic interventions.
CRYOTHERAPY

Here’s an overview of cryotherapy and contrast baths:

### 1. Definition

**Cryotherapy** involves the use of cold temperatures to treat injuries, reduce inflammation,
and alleviate pain. It can be applied locally or systemically to achieve therapeutic effects.

### 2. Biophysics

Cryotherapy works on the principle that cold temperatures reduce blood flow and metabolic
activity in the targeted tissues. This can help decrease inflammation, numb pain, and facilitate
faster recovery. Physiological effects include:

- Vasoconstriction: Reduces blood flow to the area, which decreases inflammation and swelling.

- Decreased metabolic rate: Slows cellular processes and can limit tissue damage.

- Analgesic effect: Numbs the area, providing pain relief.

- Reduced muscle spasm: Helps in relaxation and recovery of the muscle.

### 3. Indications & Contraindications

**Indications:**

- Acute injuries (e.g., sprains, strains)

- Chronic pain and inflammation (e.g., arthritis)

- Post-surgical recovery

- Muscle soreness or spasm

- Sports injuries

**Contraindications:**

- Hypersensitivity to cold
- Poor circulation or vascular conditions (e.g., Raynaud's disease)

- Open wounds or infections

- Cold allergies or cryoglobulinemia

- Severe cardiovascular conditions

### 4. Technique of Application

**A. Ice Pack**

- **Definition:** A cloth or gel pack filled with ice or a cold substance.

- **Technique:** Apply to the injured area for 15-20 minutes. Protect the skin with a towel to
prevent frostbite.

**B. Ice Massage**

- **Definition:** Direct application of ice in a circular motion on the skin.

- **Technique:** Use an ice cube or frozen cup, massaging the area for 5-10 minutes.

**C. Cold Pack**

- **Definition:** Similar to ice packs but may contain a gel or other cold-retaining materials.

- **Technique:** Apply for 15-20 minutes, ensuring a barrier between the pack and the skin.

**D. Cold Whirlpool**

- **Definition:** Immersion of the body part in a tub of cold water.

- **Technique:** Submerge the area in cold water (50-60°F) for 15-20 minutes. Ideal for larger
body areas or multiple areas at once.

**E. Cryo-Cuff**
- **Definition:** A device that combines ice and compression therapy.

- **Technique:** Apply the cuff around the affected area and use the attached ice reservoir for
cooling and compression.

**F. Cold Spray**

- **Definition:** A spray that delivers a cold mist onto the skin.

- **Technique:** Spray onto the affected area from a distance of about 6 inches for a few
seconds, typically used before stretching or exercise.

**G. Cryo Stretch**

- **Definition:** Combining cold therapy with stretching.

- **Technique:** Apply ice while performing gentle stretching exercises to the affected area to
reduce pain and increase flexibility.

**H. Cryo Kinetics**

- **Definition:** The use of cryotherapy combined with exercise.

- **Technique:** Apply cold therapy until numbness is achieved, followed by a period of exercise
or rehabilitation to improve mobility and function.

### 5. Contrast Bath

**Definition:**

Contrast bath therapy involves alternating between hot and cold water immersion to promote
circulation and reduce swelling.

**Principle:**

The alternation between hot and cold water creates a "pumping" effect in the blood vessels,
which helps to enhance blood flow, reduce swelling, and accelerate the healing process.
**Technique of Treatment:**

- Alternate immersion between hot water (104-110°F) and cold water (50-60°F) for about 1-4
minutes each.

- Typically involves 3-4 cycles of hot and cold immersions, ending with cold immersion.

**Indication:**

- Chronic pain and muscle soreness

- Post-exercise recovery

- Minor injuries and swelling

- Enhancing circulation

**Contraindication:**

- Open wounds or infections

- Severe vascular conditions

- Extreme sensitivity to temperature changes

- Certain cardiovascular conditions

This overview should cover the key aspects of cryotherapy and contrast baths. Let me know if
you need more details on any specific technique!