SHORT-WAVE DIATHERMY

PRESENTER : Neha A. Brahmane

GUIDED BY: Dr. Deepali Patil Mam
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 Learning Objectives

At the end of the lecture the learning should be able to understand :

1. What is short wave diathermic current

2. What is pulsed shortwave diathermy
3. Types of diathermy applicators
4. Circuit and mechanism production of SWD
5. Types of electrodes
6. Method of placement of electrodes
7. Dosage, indication, contraindication and dangers
 W H AT I S S H O RT- WAV E D I AT H E R MI C C U R R E N T ?

• A short-wave diathermic current has a frequency of between 10 7 and 108

Hz and sets up radio waves with a wave-length of between 30 and 3 m.
The use of any current within this range is classed as short-wave
diathermy, but that commonly used for medical work has a frequency of
27120000 Hz (27.12 MHz) and sets up radio waves with a wave-length
of 11m.This current is generated in a machine circuit, which is in turn
coupled to a patient (resonator) circuit which is used to treat the patient.
• Provided a suitable method of application is chosen, short-wave
diathermy provides as a deep form of heat.

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 What is shortwave radiation and microwave radiation?

Short wave radiation Microwave radiation

It is within the radiofrequency range that is
3 kHz to 300 MHz and wavelength of 1m to
100 km
It is between ELF and microwave radiation It has a frequency between that of
radiofrequency and IR radiation
The 27.12 MHz band is most commonly MWD has been allocated a frequency of
used for SWD devices as it has a widest 2450 for medical application
band width

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 INTRODUCTION

• Diathermy, from the Greek meaning “ through heating “, is the application of

shortwave (10 to100 MHz frequency and 3 to 300 m wavelength.
• It is a deep heating modality
• Application of high-frequency electromagnetic energy
• Short Wave Diathermy (SWD) devices has been allocated the 3 frequency bands
centered on 13.56, 27.12 and 40.68 MHz with ranges of ±6.78, 160 and 20 kHz
respectively.
• The 27.12 band is most commonly used for SWD device because it has the widest band
width and is therefore the easiest and least expensive to generate
• federal communications commission (FCC) determines which frequencies of
shortwave diathermy and microwave radiation that can be used for medical
applications.
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 What is pulsed shortwave diathermy?

• Both SWD and MWD can be delivered in a continuous or pulsed mode and, when
delivered at a sufficient average intensity can generate heat in the body.
• when delivered in a pulsed mode at low average intensities, heat is dissipated before
it can accumulated however, pulsed low-intensity electromagnetic energy in the
shortwave or microwave frequency range is also thought to produce a number
physiological effects by nonthermal mechanisms. pulsed SWD, when applied at non-
thermal levels, is generally referred to as pulsed shortwave diathermy (PSWD).

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TYPES OF DIATHERMY APPLICATORS

There are three different types of diathermy applicators:

• inductive coils
• capacitive plates, and
• magnetron.
Inductive coils or capacitive plates can be used to apply SWD, while a
magnet on is used to apply MWD. All PSWD devices available at this
time use inductive coil applicators in a drum form. PSWD devices deliver
very short pulses of energy to avoid any cumulative increase in
temperature within the tissues.

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 SHORT WAVE DIATHERMY CIRCUITS

• Machine circuit : composed of a high frequency generator, amplifier,

oscillator coil.
• Patient circuit: composed of a resonator coil, variable capacitor,
electrodes and the treated tissue.
1. (oscillator circuit) which produce high frequency current coupled with.
2. The patient circuit ( resonator circuit) through inductors to transfer the
electrical energy to the patient.

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Machine circuit
1. Main supply: it connected with AC mains that gives 220 to 240 V and
frequency of 50 cycles /second
2. Transformer:
a) step down transformer whose secondary coil is connected to the
triode valve filament produces potential of 20 V causes emission of
electrons from the cathode through thermionic emission
b) Step up transformer secondary coil is connected to triode valve via
oscillator circuit
3. Triode valve: Thermionic valve which allows electrons to move in
one direction when electric current flows through the filament from
cathode towards anode provided the grid is connected with the grid leak
resistance.
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• 4. Grid leak resistance: consists of a resistance coil
connected to the grid of triode valve at one end and the
filament of cathode at other end.
• 5. Oscillator: a stable condenser and oscillator coil gives
high magnitude, high frequency oscillating currents to the
resonator circuit.
• 6. Ammeter/ Neon lamp: when oscillator and resonator
circuit are tuned it shows maximum reading / maximum
glow. some machines are auto tuned.
• 7. part of the body: between two electrodes act as a
dielectric of a condenser.

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Ravi Nair Physiotherapy College
The Patients circuit

1. An indicator light on the equipment either comes on or changes color.

2. An ammeter wired into the resonator circuit shows a maximum reading, which
is diminished by turning the knob controlling the variable capacitor either way.
3. A tube containing a small amount of neon gas placed within the electric field
between the electrodes or the ends of the cable will glow at maximum intensity
when the circuits are in resonance.

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EFFECTS OF HIGH-FREQUENCY CURRENTS ON THE TISSUE :-

• The major effect of induced currents of sufficient intensity at frequencies

above 1MHz is to cause heating.

• High-frequency currents induced in tissue increases the kinetic energy of

molecules of body & produces heating

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 SWD- METHODS

CAPACITOR FEILD
INDUCOTHERMY / CABLE
METHOD/ CONDENSER
METHOD
METHOD

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 TYPES OF ELECTRODES

1)Flexible pads
2) Space electrode
3) Monode
4) Minode
5) Diplode
6) Coil Minode and monode are called “drums”

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1) flexible pad electrodes
• consist of metal electrode encased in rubber and
produce an electrostatic field.
• when using them you should insure it is in full contact.
• We have to wrap it in towel that is 2 cm thick, less than
that could cause a burn, more than that will affect the
amount of heating created in the body.
• Distance between the electrodes should be equal the
diameter of the electrode, if it is less than that there will
be a shock.

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2) Capacitor (Pad Electrodes)
• Greater Electrical Field Patient Part of Circuit Must Have
Uniform Contact (toweling) Spacing Equal To Cross-
sectional Diameter of Pads Part To Be Treated Should
Be Centered.
• types of electrode in SWD Air space
electrodes or Space plates : consist of a rigid metal
electrode encased in a Plastic cover electrostatic field.
• Two metals Plates Surrounded By Plastic Guard
Can Be Moved 3cm Within Guard

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Air Space Electrodes:
They come in different sizes.
Can be used in almost every part of the body, but because they are
rigid they will not fit every contour. It can be put on either side of the
limb, or can be used in the same side.
If the electrodes are placed on the same side there should be a
distance between the electrodes, because if there is no distance there
would be a shock, so we need to put a distance equal the diameter of
the electrode

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• Skin – electrode Distance :
• It is the distance between the electrode and the skin. If we place two
electrodes at the same distance there will be even heating. If we
placed one electrode closer to the skin than the other, the heating
won’t be even, it will be more near the closer electrode. If we used
a large electrode and a small one the heating will be more near the
small.
• Sensation Of Heat In Direct Proportion To Distance Of Electrode
From Skin Closer Plate Generates More Surface / superficial Heat

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The Monode
flat, rigid coil encased in Perspex cover electromagnetic field.
• More Monopolar Coils Rigidly Fixed In A Housing Unit.
• May Use More Than One Drum Depending On Area Treated.
• Penetration
• Deeper Soft Tissues
• Toweling Important

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The minode :
• The conical rigid coil encased in Perspex cover

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The diplode:
• or drum electrode , consists of a flat coil electrode encased in a
Perspex cover with two wings electromagnetic field

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Drum Electrodes :
It is known to heat the deeper tissue without heating the superficial tissue.
Penetration to 3cm.
Make sure that the fat layer of the patient is not more than 2cm, because the
penetration will be limited and the absorption of heat will accumulate in the
fat layer which might cause a burn.
The tissues that are heated are blood vessels, muscles and sweat

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• Coil or cable Usually used for limbs Used in two ways:

• 1) wrapped around the part being treated.

• 2) Pancake (usually used on the back). When wrapping, the space between
one turn and the other should be 5 to 10cm and it is insure by felt spacers
(comes from the manufacturer). It is known to heat the deeper tissue without
heating the superficial tissue

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continuous SWD

Capacitance technique- creates a stronger electrical field rather than

a magnetic field.
• The part is placed in-between the electrodes and becomes part of
the circuit.
• Thus, the tissues that provide the most resistance inhibit the amount
of heat transfer to the body. So areas of the body that have lower
amounts of body fat tend to receive better electrical transmission.
• Capacitance uses air space plates and pad electrodes to administer
treatment

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METHODS OF PLACEMENT OF ELECTRODES –
• 1. COPLANAR METHOD In this electrodes can be placed side by side on the same
aspect of the part, provided that there is adequate distance between them.
• Increasing the space and Increase The Depth Of Penetration. But Will Decrease The
Current Density Capacitive Method Good for Treating Superficial Soft Tissues

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CONTRAPLANAR METHOD
• In this electrodes are placed on opposite sides of the treatment part. Most
satisfactory method for deeply placed structures. E.g. - Joints

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CROSSFIRE METHOD

• In this first half of the treatment is given with

the electrodes in one contra planar position &
for the second half the electrodes are repositioned
at right angles to it.

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MONOPOLAR METHOD

The Active electrode is placed over the site of the lesion & the
indifferent electrode is applied to some distant part of the body.

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CONTINUOUS SWD

Induction technique- creates a stronger magnetic field

and a lesser electrical field.
• Induction methods create a eddy currents, small
circular fields, within the tissues that cause heat
generation.
• In this method the patient is not part of the circuit but
part of a parallel circuit where the current will flow
through the tissues that provide the least amount of
resistance.
• Induction uses cable and drum electrodes to distribute
treatment.
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Dosage

• The treatment dosage should have an intensity that causes sufficient warmth
(thermal dosage) of the tissues and the duration of the treatment should be 20-30
minutes. The treatment may be given daily or on an alternate day.

• As a general rule, for the treatment of acute inflammation or any recent injury the
intensity of the treatment should be less but it should be carried out more
frequently, i.e. twice daily. The current used may be that which produces mild
warmth (mid-thermal) and may be reduced to the point at which no warmth is felt
(sub- thermal or non thermal). The duration of treatment is reduced to 5-10
minutes.
FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D

• 1- Spacing: • It allows the lines of force in the electrostatic field to diverge before
entering the tissues. • This prevents concentration of heat in the super-facial tissues and
ensures more heating through the part.
• Spacing provided by: • 1- wrapping flexible pads in towel. • 2-flat felt spacing pads
between pad electrode and skin. • 3-air when using space plates.
• a- Normal spacing even field distribution. • b- Increased spacing deep field
concentration. • c- Decreased spacing superficial concentration
• About 4 cm distance will give heating of the deep tissues. • Conversely the minimum
skin electrode distance is about 2 cm, will give superficial heating. • Note: the spacing
refers to the distance of the metal electrode, not the plastic cover, from the skin.

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Position of electrode relative to the tissue - Electrode parallel to skin surface Uniform
field - The distance between electrodes less than the combined skin electrode distances
Most of field passes through air space - Electrode isn't parallel to skin surface
Superficial heat under closest part of electrode
2.Electrode size : • If the electrodes are too small than the diameter of treated part line
of force will be concentrated superficially. • -If the electrodes are markedly larger the
line of force will be lost in the air. • Ideally, the electrodes should be slight larger than
the area treated.
When Choosing The Size of Electrode We Should Consider: 1) The size of the area
treated. 2) Location of the area to be treated. 3) The depth of the targeting tissue. 4)
Treatment goals. 5) The contraindications
3. Metal • metal causes the lines of force to concentrate on the metal
4. Air in cavities: • As sinuses or uterus, the lines of force deviate to avoid air as it
offers a high resistance. • As a result only the sides of air cavity will be heated.

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Indications of SWD
• A condition that could benefit from a specific modality. • Disorders of Musculoskeletal
System: Low back pain, O.A., R.A., Sprain, Strain, Muscle & Tendon tear, Capsule lesion,
Joint stiffness, Hematomas, frozen shoulder, myalgia, traumatic arthritis, ankylosing
spondylitis, Chronic Inflammatory Conditions; • Tenosynovitis, Bursitis, Synovitis,
Sinusitis, Fibrositis, Myositis)
• 2. Sports injury: muscular strain of rectus femoris, hamstrings, tensor facia lata etc..,
contusion of thorax.
• 3. Surgical conditions: infected surgical incisions, stitched abscess
• 4. ENT: chronic sinusitis, chronic otitis media
• 5. non specific pelvic inflammatory diseases.
• 6. Chest disorders: To relieve muscle spasm in some forms of bronchial asthma. Sub-acute
and chronic bronchitis.
• 7 - Neurological disorders: Neuritis, Sciatica.
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Contraindications –
• condition that could be adversely affected if a particular modality is used. Metal implants or
metal jewelry (be aware of body piercings) – Concentration of the field. Cardiac pacemakers –
Interference with function Ischemic areas – The inability of the circulation to disperse heat could
result in high temperature – Burns.
• Perspiration and moist dressings : The water collects and concentrates the heat. • Tendency to
hemorrhage, including menstruation – Increase vasodilatation, prolong hemorrhage. • Pregnancy –
Miscarriage • Hyperpyrexia
• Sensory loss / Impaired thermal sensation • Cancer / Malignant tissues – Accelerate the rate of
growth & Metastasis • Active TUBERCULOSIS – Increase the rate of development of the
infection. • Recent Radiotherapy – Skin sensation & Circulation may be decreased.
• Dermatological Conditions – Will exacerbate • Severe Cardiac conditions – Greater demand of
Cardiac output. • DVT
• Areas of particular sensitivity: Epiphysis plates in children The genitals Sites of infection The
abdomen with an implanted intrauterine device (IUD) The eyes and face Application through the
skull

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Therapeutic Effect of SWD –
• 1- Pain relief: Stimulation of Sensory heat receptors – Pain Gate Mechanism.
• 2-Muscle spasm Heating Secondary Afferent muscle spindle – Inhibitory influence
to motor pool.
• 3- Inflammation : Assists in removal of cellular debris and toxins. Nonthermal:
Alters diffusion rate across the cell membrane Thermal: Increases intramuscular
metabolism
• 4- Accelerate wound healing : by increase cutaneous circulation, Vasodilatation
increases: Blood flow ,Capillary filtration, Capillary pressure ,Oxygen perfusion
• 5- Infection : increase circulation and increase white blood cells and antibodies –
Reinforcing body’s normal defense mechanism.
• 6- Fibrosis : increase extensibility of fibrous tissues such as tendons, joint capsule
and scars. Alters collagen properties, allowing it to elongate
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 Physiologic Responses to SWD
Tissue Temperature Increase

Increased Blood Flow (Vasodilatation)

Increased Venous and Lymphatic Flow

Increased Metabolism

Changes In Physical Properties of Tissues

Muscle Relaxation

Analgesia
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Uses

Thermal Effects

Deep heat Increased blood flow Increased cell metabolism Increased tissue
extensibility Muscular relaxation Possible changes in enzyme reactions

Non-thermal Effects

•Edema reduction
•Lymphedema reduction
•Superficial wound healing
•Treatment of venous stasis ulcers

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•Dangers and Precautions
1- Burn - Heat burn caused by SWD so word 'burn' use to warn the patient for this
possible danger. burn occur if the patient is unaware of the heat mild case tissues are not
destroyed but a bright red patch is seen and blister will occur. in severe case coagulation
occur followed by destruction of tissues results in white patch surrounded by a reddened
area of inflammation. damage should be visible on removal of electrodes after completion
of the treatment.

• burns may occur due to 1) concentration of electric field 2) leads touching the skin 3)
use of excess current 4) hypersensitivity of the skin 5) impaired blood flow
1) concentration of electric field: this causes overheating of the tissues in the affected
area. if in the field a material of high dielectric constant is present like metal or moisture
which will concentrate the electric field and burn occur. it depends on the size, shape and
orientation of the metal with respect to the field.
1. • allmetals are relatively low resistance conductors and even enclosed in plastic
will provide a low impedance pathway. • e.g. armpiece of spectacles, metal in
clothing- hooks, zip fasteners, buckles, earing's, ornaments, keys, embroidery, etc. •
a long slender pointed piece of metal like a key lies parallel to the line of force of
the field touching the skin at its point provide a good conductor concentrating the
current at contact point results in burn due to maximum heating.
2. Leads touching the skin: if a lead approaches close to the patient's body heat is
produced in the area can cause burn. if spacing between two electrodes is inadequate
concentration of field occurs at the electrode nearer to the skin results in burn.
3) excess current: the patient's sensation is the only indicator of the intensity of the
application and burn occur due to • patient does not understand the high intensity of
current • defective thermal cutaneous sensation • fall asleep during treatment session •
unconscious patient
• 4) Hyper sensitive skin: due to x-ray therapy or recent use of liniment skin
become hypersensitive where SWD dose which is normally be safe may cause
damage to the tissues.
• 5) Impaired blood flow: the blood circulating through the tissues normally
dissipates the heat and prevent excessive rise of temperature. due to impaired
blood flow this is not possible result in heat at the area to be treated. Heat
accelerates chemical changes including metabolic process in the tissues which
increases the demand for oxygen.
 Knee Osteoarthritis
• Positioning of the Patient:
Long sitting with back support and the affected leg is rest on a stool with a pillow.
• Placement of Electrodes:
1. Contra-planar technique (Medial and lateral view)
2. Crossfire technique (Med × Lat side; Sup × Inf side).
• Duration: Acute - 1st day to 10th day
Subacute - 2nd weeks to 6th month
Chronic - More than 6th month
• Duration of Treatment :
Acute – 10 to 15 mins
Subacute – 15 to 20 mins
Chronic – 20 to 30 mins
• Dosage : Acute – Mild thermal
Subacute – Sub-thermal
Chronic - Thermal
 References

1. Claytons electrotherapy 9th edition

2. Low and Reed
3. Cameron ; physical agents in rehabilitation
4. Jagmohan
Thankyou