Presentator: Albertus Bouw

Azka hayati
Pembimbing: dr. Julius Aliwarga, Sp.KFR
 THERAPEUTIC HEATING MODALITIES
Primary Mode of Modality Depth
Heat Transfer
Conduction Hot Packs Superficial Heat
Paraffin Bath
Convection Fluidotherapy Superficial Heat
Hydrotherapy
Moist Air
Conversion Radiant Heat Deep Heat
Laser
Microwaves
Shortwaves
Ulltrasound

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen‘s Handbook of PM&R,4th ed,1990
  Diathermy: the application of high-frequency
electromagnetic energy that is primarily used to
generate heat in body tissues.
 Diathermy may also be used to produce
nonthermal effects.
 Diathermy:
 shortwave diathermy
 microwave diathermy

William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
 SWD is the therapeutic application of high- frequency
current
▪ the machines have three basic components of the
circuitry :
- POWER SUPPLY
- OSCILLATING CIRCUIT
- THE PATIENT’S CIRCUIT
▪ The frequencies that are allowed for SWD by the
Federal Communication Commision (FCC) :
 27,12 MHz (‫= ג‬11 m )
 13,56 MHz (‫ =ג‬22 m)
 40,88 MHz (‫ =ג‬7,5 m)

William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
  Shortwave diathermy:
 Continuous shortwave diathermy has
been used in the treatment of a variety of
conditions for some time.
 Pulsed shortwave diathermy has received
renewed interest and research
documenting its clinical efficacy.

William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
 Formula :

‫ =ג‬V/N

 ‫ = ג‬wavelength  22 ; 11 ; 7,5 meters

V = velocity of light  11 meters
N = frequency of oscillation  27,33 MHz

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy, Krusen's
Handbook of PM&R,4th ed,1990 6
7
  THERMAL EFFECTS
The wavelengths are much too short in duration
 not capable of producing depolarization and
contraction of skeletal muscle.
The physiologic effects are primarily
thermal, resulting from high-frequency vibration
of molecules.

William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
  rising tissue temperature  changes in some enzyme
 increased blood flow reactions
 dilation of the blood vessels  alterations in the physical
properties of fibrous
 increased filtration and
diffusion through the  a certain degree of
different membranes muscle relaxation
 increased tissue metabolic  a heightened pain
rate threshold
 decreased joint stiffness  enhanced recovery from
injury

William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
 BIOLOGICAL EFFECT OF SHORTWAVE
DIATHERMY
 Late 1940s: the FFC (Federal
Communications Commission) designated
specific operating frequencies for SWD (13.56
MHz, 27.12 MHz & 40.68 MHz) and MWD
(2450MHz & 915 MHz ).
 At present, 27.12MHz is utilized most widely
for SWD.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
  Biological action of SWD, E.Schliephake et al.(1926):
1. Marked vasodilatation of capillaries and
arterioles
2. Deep penetration of mild heating
3. Germicidal and antitoxic actions
4. Resolution of the inflammation without pus
formation
5. Pain relieving and sedative effect

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
 Techniques of application
Condenser techniques
 The affected part of the patient to be treated
is placed between two capacitor plates
 Four modification are used :

1. Space plates are capacitor plates enclosed

in rigid plastic material  a plastic ring
surrounding the condenser plate is
adjustable & provides proper spacing
between body surface & condenser plates

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 2.The capacitor plates are covered by a glass
envelope.
 In order to avoid sweat accumulation &
selective heating of the area  the glass
cover should not be in direct contact with
the skin.
 The position of the condenser plate within
the glass envelope, and thus the distance
between the body surface & the condenser
plates, is adjustable

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 3. The rubber or plastic materials called
condenser pads
 Proper spacing between the skin & the
electrode is provided by a 1- to 2-inch
layer of terry cloth between the skin & the
pads

4. Internal metal electrodes are inserted into

the vagina or rectum after applying a
water soluble lubricant

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 Application to spesific part of the body
1. Shoulder  condenser plates may be used

2. Hip  the usual method is application with pads

3. Elbows, knees, ankles, arms, feet & hands 

condenser plates & pads are commonly used
4. Hands  application of condenser plates in the
form of pads or space plates
5. Back  condenser plates or pads are used

6. Neck  condenser plates or pads are used

7. Pelvic organs  application with internal

electrodes

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
  The temperature elevation is measured with a
thermometer inside the electrodes
 Temperature up to 45°C have been
recommended  duration of application: 5-
30”
 Start with a lower temperature & shorter
duration  observe the tolerance of the
patient
 The more acute the process to be treated 
the less the tissue temperature elevation
should be & the shorter the duration of the
treatment

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 Capacitor Field
a. Contraplanar: electrodes are placed on opposite
sides of the part, to treat deeply placed structures,
e.g.joints
a. Using 2 rigid electrodes
b. Using 1 rigid and 1 flexible electrodes
b. Coplanar: electrodes are placed on the same side
of the part to treat more superficial structures, e.g.
the spinal musculature
a. Longitudinal
b. Transversal

John Low, Ann Read. Electrotherapy Explained

Principle and Practice. 2nd ed. Butterworth
Heinemann.
 c. Cross – fire: half the treatment is given with
the electrodes in one contraplanar position
and for the second half the electrodes are
repositioned at right angles.
This technique is used for deeply placed
organs in the pelvis and for air-fillled cavities
such as the frontal and maxillary sinuses
a. Anteroposterior field: sacrum - symphisis pubis
b. Superior-inferior field: lumbar - pelvic outlet

John Low, Ann Read. Electrotherapy Explained

Principle and Practice. 2nd ed. Butterworth
Heinemann.
  Inductive (magnetic) field technique through
a conductor (usually a coil) produces an
energy of magnetic field  heats the treating
tissue placed near the conductor.
 The effect of magnetic field technique is
restricted to superficial tissues.
 The therapeutic effect of inductive field
technique is similar to that of MWD.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
  Three types of applicators:
 Cable
 Drum (minode or monode)
 Contour (diplode)

 It is easy and convenient to use the drum-

shaped coil-conductor.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
 Induction coil application
 The induction coil may be applied  “drum”
 The coil is enclosed in a plastic container that is
flexible at the hinges & can be molded to fot the
body  provides proper spacing between the
skin and loops of the cable
 Another applicator is “monode“ which operates
on the same basic principle but is not flexible
 Precautions: avoid direct contact between the
plastic housing & the skin, since it interferes with
the heat exchange

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 Application to specific parts of the body
1. Shoulder  the drum or monode
2. Elbows & knees  wrap-around coils or
the monode
3. Hands & feet  monode or drum
4. Back  the pancake coil or the drum
5. Neck  the drum or monode
6. Hip  the drum or pancake oil
7. Knees & ankles  wrap-around coil

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 Inductothermy
a. Coil: wound round the
circumference of a limb
a. Using ends of cable
b. Using middle of cable
b. Helix: for a flat surface, e.g. the
lumbar spine or incorporated in a
monode

John Low, Ann Read. Electrotherapy Explained

Principle and Practice. 2nd ed. Butterworth
Heinemann.
 Capacitive Coupling
 The higher the water content, the better the
conductivity
 Guy and co-workers : Capacitor (condenser)
applicators have the fundamental characteristic
of inducing greater power absorption in
subcutaneous fat than in deep muscle tissue
Inductive Coupling
 Inductive coil applicators, produce higher
power absorption in the deeper high water
content tissues than in the subcutaneous fat
 Circular electrical fields or eddy currents are
induced in the tissues by the applied magnetic
fields

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 Mechanism of heat production in the
condenser field:
 When the electrolytes such as tissues
containing some fluids (blood, blood vessels
and muscles) lie in the electric field 
vibration of ions and rotation of dipoles
 Fat which has poor conductivity produces
molecular distortion
 Subcutaneous fatty tissues with poor
conductivity are heated up more intensely
than muscles

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
  In the magnetic field poor conductive tissues
(skin or fat) will have more reduced
temperature increase.
 In the inductive field eddy currents are
induced in the body  converted into heat.
 The heat distribution of coil field is very
similar to a microwave field.
 Condenser field shortwave therapy carries
out simultaneously same effects on two
symmetrical body sections e.g. both eyes,
ears and tonsils etc.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
  Lately non-thermal therapy with pulsed
mode, on which high-output short wave
energy is delivered in repeated pulses.
 This provides deep penetration of heat
avoiding heat sensation of the skin and
protecting possible burns.
 The shortwave therapy unit with pulsed
operation mode is prevalent now.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
THERAPEUTIC APPLICATIONS
 Specific characteristic of SWD: immediate
depth effect to penetrate the body with heat.
 Other effects: direct weakening of virulence
or destruction of the germs activation of the
body's own resistance power  good effect
on the infectious inflammatory process .

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
  SWD have to be used in combination
with the adequate drug therapy.
 Acute stage inflammation  applying of
weak dose i.e. "creeping" dose is
recommended.
 No difference between coil field SWD
and MWD, both are indicated to the
treatment of body areas located close to
the surface.
 Condenser field therapy can be applied
in all cases to treat all inner organs.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
 THE APPARATUS FOR SHORTWAVE
THERAPY
Commonly prevalent specifications:
MODEL SW-180
 Operating Frequency 27.12MHz

 RF Peak Output 80W on Pulsed Mode, 40W on

Continuous Mode
 Pulse Frequency 25 ~ 900Hz, Pulse Width 0.65 ~15.2ms

 Size &Weight 835 (H)x380(W)x320(D)mm, 23Kg

 Note: Generally shortwave therapy unit made in Europe

adopts an output of 200W. An output of ca.400W may be
necessary for hyperthermy of the entire body.

Mamoru SHIIDA M.D. Manual Of Shortwave Diathermy.

THOM,H. Introduction to shortwave and microwave therapy. 3rd Edition, Springfield,C.C Thomas,1966.
 APPLICATION TECHNIQUE
 Patient’s electrical impedance becomes
part of the impedance of the patient’s
circuit
 It is necessary for any given therapeutic
application to retune the patient’s circuit to
resonance after the patient has been
inserted into the circuit
 Thus the frequency of the patient’s circuit
is made equal to the frequency of the
oscillating circuit of the machine

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
  Tuning is often accomplished by adjusting
a variable capacitor
 The power meter on the panel of the
machine will indicate maximal flow of
current when the resonance of frequency
is obtained in the patient’s circuit
 The need for tuning has been eliminated
in some machines by using an automatic
device

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
  After the machine has been tuned, the
current flow through the patient’s circuit
can be regulated. One way of doing this is
to change the inductive coupling of the
patient’s and the high-frequency
oscillating circuits
 The effectiveness of the equipment for
deep-heating purposes largely depends
on the quality of the mode application

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
  The value of the deep-heating capability is
best expressed by the ratio of the specific
absorption rate (SAR) in muscle to SAR in fat
 Better deep-heating is indicated by :
 A larger ratio
 electrostatic shielding of the applicator seems to
produce better deep heating

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
 DOSIMETRY
 Diathermy treatment doses are not precisely
controlled, and the amount of heating the patient
receives cannot be accurately prescribed or
directly measured
 Heating occurs in proportion to the square of the
current density and in direct proportion to the
resistance of the tissue
Heating = current density2 x resistance

William E. Prentice PhD, PT, ATC. Therapeutic Modalities In Rehabilitation - 3rd Ed. (2005)
 DOSIMETRY
 Depends largely on biological factors-the
therapist is guided by the feeling of warmth
on the part of the patient
 High dose : the patient’s feeling of warmth
goes up to tolerance
 Medium dose : the patient feels comfortably
warm
 Minimal dose : the patient just barely feels
warmth

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold Therapy,
Krusen's Handbook of PM&R,4th ed,1990
 Temperature distribution as modified by
technique of
Application

• H = spesific absorption
rate
H = I² / • I = induced electrical
current
G • G = electrical
conductivity of the
tissues

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 STANDARDS FOR EQUIPMENT
The standard should :
1. Assure the user that the equipment is
powerful enough to produce vigorous
heating effects
2. The user has adequate information as to
where the highest temperature is produced
in the tissues when the various available
applicators are used
3. The equipment has been built to assure
safety both to the patient treated and to the
personnel administering the treatment
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
 PRECAUTIONS
 All metallic objects, such as watches or jewelry,
should be removed
 The patient should be positioned on a wooden
plinth or chair
 The accumulation of sweat beads should be
prevented by using terry cloth
 Tuning of the patient circuit should always be
done at the low output level to prevent excessive
heating from an uncontrolled surge of current
through the patient
 The output of the machine should be adjusted to
the desired level

De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990
  Metallic implants, including surgical
implants, cardiac pacemakers and
electrophysiological braces should not be
exposed to short wave diathermy
 Finally, contact lenses should be removed,
since they may cause hot spots
 It should be noted :
 Applied to the lower back has been observed
to increase menstrual flow
 Pregnant women should not be treated with
pelvic diathermy using internal electrodes
because of possible damage to the fetus
 There is also some controversy about
treatment of children around the bone growth
zones
De Lateur BJ, Lehmann JF in Diathermy & Superficial Heat, Laser & Cold
Therapy, Krusen's Handbook of PM&R,4th ed,1990