Electrical muscle stimulation (EMS), also known as neuromuscular electrical stimulation (NMES) or electromyostimulation, is the elicitation (to bring)

of muscle contraction using electric impulses. The impulses are generated by a device and delivered through electrodes on the skin in direct proximity to the muscles to be stimulated. The impulses mimic the action potential coming from the central nervous system, causing the muscles to contract. The electrodes are generally pads that adhere to the skin. EMS is both a form of electrotherapy and of muscle training. It is cited by important authors[1] as complementary technique for sport training, and there is published research[2] on the results obtained. In the United States, EMS devices are regulated by the U.S. Food and Drug Administration (FDA).[3] EMS causes adaptation, i.e. training, of muscle fibers.[16] Because of the characteristics of skeletal muscle fibers, different types of fibers[17] can be activated to differing degrees by different types of EMS, and the modifications induced depend on the pattern of EMS activity.[18] These patterns, referred to as protocols or programs, will cause a different response from contraction of different fiber types. Some programs will improve fatigue resistance, i.e. endurance, others will increase force production.[12] [edit]Use EMS can be used both as a training[19][20][21] and a therapeutic[22][23] tool. Electro Muscle Stimulation ELECTRO MUSCLE STIMULATION Electro stimulation is a technique which, by means of electric impulses that act on the muscle's motoneuron points, provokes muscular contraction responses similar to voluntary contractions (exercise). Most on the muscles in the human body belong to the striated or voluntary muscle category, of which there are about 200 on each side of the body (about 400 in all). The physiology of muscle contractions The skeletal muscle performs its functions by way of a contraction mechanism. When a person decides to make a movement, the motor centre of the brain sends an electric signal to the muscle which must contract in order

to affect the motion the person has decided on. When the signal reaches the muscle the motor plate of the muscle surface produces the depolarisation of the muscle's membrane and the release of CA++ ions into it. The Ca++ ions, reacting with the actins and myosin, activate the contraction mechanism which consequently results in the shortening of the muscle. The amount of energy needed for this contraction is provided by the adenosine triphosphate (ATP) and is sustained by an energy recharging system based on aerobic and anaerobic energy mechanisms which consume carbohydrates and fat. In other words, electric stimulation is not a direct source of energy but functions as a tool to set off a muscular contraction. The same type of mechanism is activated when the contraction, or twitching, is set off by the electro muscle stimulator (EMS); they perform the same function as an impulse naturally transmitted by the motor nervous system. When the contraction is over, the muscle relaxes and returns to its original state. Isotonic and isometric contractions An isotonic contraction manifests itself when, during a movement, the interested muscles exceed resistance from the outside by shortening, thus provoking a constant state of tension in the ends of the tendons. When outside resistance impedes its movement, the muscular contraction, instead of provoking a shortening effect, brings about an increase in the tension at the extremes; this is called isometric contraction. In the case of electro stimulation normally a stimulation for isometric conditions is used, due to its ability to provoke a more powerful and efficient contraction. The distribution in the muscle of different types of fibres The rapport between the two principle categories (type I and type II) can vary noticeably. There are muscle groups which are typically made up of type I fibres, like the soleus, and muscles which are made up of only type II fibres, like the orbicular muscle, but on the whole the muscles in the human body are composed of a combination of the two types. Studies conducted on the distribution of the fibres in muscle mass have

brought to light the close relationship which exists between the motoneurons (tonic or fascicle) and the characteristic functions of the fibres they innervate and have shown how a particular motor action (particularly sports) can provoke a functional adaptation to the fibres and can bring about a change in their metabolic characteristics. Type of motor unit Tonic ST Fasic FT Fasic FTb Type of twitching Twitching frequency Slow twitching I 0 - 50 Hz Fast twitching II 50 - 70 Hz Fast twitching II b 80 - 120 Hz

Electro stimulation, thanks to its ability to stimulate with specific frequencies, lets you specifically work those fibres which intervene in the gesture you want to train (rapid fibres for explosive gestures, slow fibres for long duration action) or to transform the metabolism and characteristics of the intermediate fibres in order to make them more adapted to the motion you want to perform. Heat Therapy in Pain Management January 22, 2009 By Dr Arun Pal Singh Leave a Comment Local application of heat can provide pain relief and reduce muscle spasm. Most chronic pain patients are aware of superficial heat applied locally in the form of a hot water bottle, or generally in the form of a hot bath or shower. There are different ways by which heat therapy can be provided. They are broadly classified as: Superficial heat therapy  Paraffin wax  Infrared radiation  Heat pad  Hot moist packs Deep heat therapy  High frequency currents  Medium frequency currents  Low frequency currents

The superficial heat can reach up to 1 to 2 cm depth, while deep heat has the reach beyond this. This superficial heat produces different response including changes in neuromuscular activity, blood flow, capillary permeability, enzymatic activity and pain. The deep heat delivers energy directly to deeper tissue, which improves muscular function, blood flow and local reflexes by suppressing sympathetic over-activity. Superficial Heat Therapy Paraffin Wax This wax has a low melting point and is contained in a bath controlled between 40 degree Celsius and 44 degree Celsius. The wax heats more slowly but retains its heat for a longer period than water. As the wax solidifies on the skin, the energy released by the latent heat of fusion results in heating of the tissues. It completely surrounds the part being treated and there is very little danger of burns. It is difficult to apply extremities and hence its main use will be for hands and feet. Indications Painful conditions like  Pain after trauma  Degenerative joint disease  Chronic inflammatory arthritis Contraindications  Open wounds  Skin infections Infrared Radiation the electromagnetic rays beyond 770 mm to 1000 mm are termed as infrared radiation. The infrared radiations can reach only up to superficial epidermis. When these radiations hit the body, the radiant heat is converted into heat. Any part of body can be treated, but the patient must be positioned so that the rays strike the part at 90 degree Celsius for maximum absorption. However it has drawback of providing heat on one aspect only and patient has to remain in one position for treatment.  Tissues are heated directly on one aspect only.

Patient should remain in one position throughout the treatment. Indication  Large superficial areas can be treated.  Promoting healing in uninfected wound  Relieving pain and muscle spasm following trauma.  Chronic arthritis. Heat Pads Heat pads supply dry heat. A heating pad has three levels of heat, and heat passes to tissues by conduction. However, dry heat is conducted less uniformly than moist heat. It is very useful in neck and back pain. Hot Moist Packs These are canvas bags filled with a hydrophilic substance and stored in a thermostatically controlled cabinet of water between 75 degree Celsius to 80 degree Celsius. The packs vary in size and shape and are returned to the cabinet for reheating after use. The area to be treated should be totally covered by the pack, which is moulded to the contour of the body. Layers of towels must be placed round the pack to separate it from the patients skin. The superficial tissues are heated by conduction, relieving pain and muscle spasm. Heat in this is conducted more uniformly than dry heat. These packs are useful on uneven surfaces because they can be easily molded to the surface. But they are heavey and discomforting. eep Therapy The electromagnetic fields are applied in electrotherapy to tissues at different frequencies for therapeutic effect. All these frequencies are used for different benefits.


These electric fields are classified in the following way on the basis of frequencies generated. High frequency (10,000 Hz and above) High frequency currents cannot stimulate skin or muscle because of their high frequencies. They can produce only thermal effects, e.g., short wave diathermy, microwave diathermy. Medium frequency currents (1000 Hz to 10,000)

These currents reduce the skin resistance (frequency and skin resistance are inversely proportional) and hence require low current intensity to achieve the desired effects. Because of low intensity it results in less sensory discomfort, e.g., interferential therapy. Low frequency currents (1 Hz to 1000 Hz) The low frequency require high intensity current to overcome the skin resistance. This high current leads to marked sensory stimulation to the patient, e.g., faradic and direct current. High Frequency Currents Short wave diathermy Short wave diathermy is an application to tissues of electrical field which oscillates at a frequency of 27.12 MHz and a wavelength of 11.06 M. This field generates heat within the tissues by movement of molecules and ions. The heat distribution depends on arrangement of field of electrical impedance of tissues. The diathermy may be applied in a continuous fashion or pulse wave form. The therapeutic effect of continuous mode is same as pulsed mode. Short wave diathermy produces a greater and more rapid raise in temperature than the conductive methods of heat to a depth of 3 to 5 cm. Advantages  Both superficial and deep lesions can be attended  Large areas can be treated  Useful for soft tissue injuries Indications  Soft tissue injuries  Inflammatory arthritis  Degenerative arthritis Microwave diathermy This is an application of electromagnetic radiations with a wavelength of 12.25 cm and frequency of 2450 MHz. When these microwaves are absorbed in the tissues, heat is produced. The depth of penetration is up to 3 cm which is more superficial than shortwave diathermy. These waves are absorbed by fluid tissues

such as muscles and less by fat and bone. This therapy is good for superficial tissues. Medium Frequency Currents Interferential therapy In this therapy two medium frequency currents at constant intensity but different frequencies are applied to the body at the same time, the intensity of the combined current will increase and decrease rhythmically. Indications  Chronic degeneration arthritis  Backache  Complex regional pain syndrome  Soft tissue injuries Low Frequency Currents Low frequency currents stimulate both motor and sensory component of nerve. If these currents are not modified, they an produce titanic contractions. Most often these currents are used for reduction of muscle contraction which must be normally innervated to respond to these currents. These currents other wise do not find much use in clinical practice, because of their sensory stimulation.

How Heat Therapy Works Many episodes of lower back pain result from strains and over-exertions, creating tension in the muscles and soft tissues around the lower spine. As a result, this restricts proper circulation and sends pain signals to the brain. Muscle spasm in the lower back can create sensations that may range from mild discomfort to excruciating lower back pain. Heat therapy can help relieve pain from the muscle spasm and related tightness in the lower back. Heat therapy application can help provide lower back pain relief through several mechanisms: y Heat therapy dilates the blood vessels of the muscles surrounding the lumbar spine. This process increases the flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue.

Heat stimulates the sensory receptors in the skin, which means that applying heat to the lower back will decrease transmissions of pain signals to the brain and partially relieve the discomfort. y Heat application facilitates stretching the soft tissues around the spine, including muscles, connective tissue, and adhesions. Consequently, with heat therapy, there will be a decrease in stiffness as well as injury, with an increase in flexibility and overall feeling of comfort. Flexibility is very important for a healthy back. There are several other significant benefits of heat therapy that make it so appealing. Compared to most therapies, heat therapy is quite inexpensive (and in many circumstances its free - such as taking a hot bath). Heat therapy is also easy to do - it can be done at home while relaxing, and portable heat wraps also make it an option while at work or in the car. For many people, heat therapy works best when combined with other treatment modalities, such as physical therapy and exercise. Relative to most medical treatments available, heat therapy is appealing to many people because it is a non-invasive and non-pharmaceutical form of lower back pain relief.
y

Transcutaneous electrical nerve stimulation (TENS) currently is one of the most commonly used forms of electroanalgesia. Hundreds of clinical reports exist concerning the use of TENS for various types of conditions, such as low back pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, bladder incontinence, neurogenic pain, visceral pain, and postsurgical pain. Because many of these studies were uncontrolled, there has been ongoing debate about the degree to which TENS is more effective than placebo in reducing pain.[1, 2, 3, 4] The image below depicts a TENS unit.

TENS (Transcutaneous Electrical Nerve Stimulator). Image courtesy of Wikimedia Commons. The currently proposed mechanisms by which TENS produces neuromodulation include the following:

y y y y

Presynaptic inhibition in the dorsal horn of the spinal cord Endogenous pain control (via endorphins, enkephalins, and dynorphins)[5] Direct inhibition of an abnormally excited nerve Restoration of afferent input The results of laboratory studies suggest that electrical stimulation delivered by a TENS unit reduces pain through nociceptive inhibition at the presynaptic level in the dorsal horn, thus limiting its central transmission. The electrical stimuli on the skin preferentially activate low-threshold, myelinated nerve fibers. The afferent input from these fibers inhibits propagation of nociception carried in the small, unmyelinated C fibers by blocking transmission along these fibers to the target or T cells located in the substantia gelatinosa (laminae 2 and 3) of the dorsal horn. Studies show marked increases in beta endorphin and met-enkephalin with low-frequency TENS, with demonstrated reversal of the antinociceptive effects by naloxone.[6] These effects have been postulated to be mediated through micro-opioid receptors. Research indicates, however, that highfrequency TENS analgesia is not reversed by naloxone, implicating a naloxone-resistant, dynorphin-binding receptor. A sample of cerebral spinal fluid in those subjects demonstrated increased levels of dynorphin A. The mechanism of the analgesia produced by TENS is explained by the gate-control theory proposed by Melzack and Wall in 1965.[7] The gate usually is closed, inhibiting constant nociceptive transmission via C fibers from the periphery to the T cell. When painful peripheral stimulation occurs, however, the information carried by C fibers reaches the T cells and opens the gate, allowing pain transmission centrally to the thalamus and cortex, where it is interpreted as pain. The gate-control theory postulates a mechanism by which the gate is closed again, preventing further central transmission of the nociceptive information to the cortex. The proposed mechanism for closing the gate is inhibition of the C-fiber nociception by impulses in activated myelinated fibers.

Technical Considerations A transcutaneous electrical nerve stimulation (TENS) unit consists of 1 or more electrical-signal generators, a battery, and a set of electrodes. The TENS unit is small and programmable, and the generators can deliver trains of stimuli with variable current strengths, pulse rates, and pulse widths. The preferred waveform is biphasic, to avoid the electrolytic and

iontophoretic effects of a unidirectional current. The usual settings for the stimulus parameters used clinically are the following:
y y y

Amplitude - Current at a comfortable, low intensity level, just above threshold Pulse width (duration) - 10-1000 microseconds Pulse rate (frequency) - 80-100 impulses per second (Hz); 0.5-10 Hz when the stimulus intensity is set high When TENS is used analgesically, patients are instructed to try different frequencies and intensities to find those that provide them with the best pain control. Optimal settings of stimulus parameters are subjective and are determined by trial and error. Electrode positioning is quite important. Usually, the electrodes are initially placed on the skin over the painful area, but other locations (eg, over cutaneous nerves, trigger points, acupuncture sites) may give comparable or even better pain relief. The 3 options for the standard settings used in different therapeutic methods of TENS application include the following:

Conventional TENS has a high stimulation frequency (40-150 Hz) and low intensity, just above threshold, with the current set between 10-30 mA. The pulse duration is short (up to 50 microseconds). The onset of analgesia with this setup is virtually immediate. Pain relief lasts while the stimulus is turned on, but it usually abates when the stimulation stops. Patients customarily apply the electrodes and leave them in place all day, turning the stimulus on for approximately 30-minute intervals throughout the day. In individuals who respond well, analgesia persists for a variable time after the stimulation stops. In acupuncturelike settings, the TENS unit delivers low frequency stimulus trains at 1-10 Hz, at a high stimulus intensity, close to the tolerance limit of the patient. Although this method sometimes may be more effective than conventional TENS, it is uncomfortable, and not many patients can tolerate it. This method often is considered for patients who do not respond to conventional TENS. Pulsed (burst) TENS uses low-intensity stimuli firing in high-frequency bursts. The recurrent bursts discharge at 1-2 Hz, and the frequency of impulses within each burst is at 100 Hz. No particular advantage has been established for the pulsed method over the conventional TENS method. Patient comfort is a very important determinant of compliance and, consequently, of the overall success of treatment. The intensity of the impulse is a function of pulse duration and amplitude. Greater pulse widths

tend to be more painful. The acupuncturelike method is less tolerable, because the impulse intensity is higher. The amount of output current depends on the combined impedance of the electrodes, skin, and tissues. With repetitive electrical stimuli applied to the same location on the skin, the skin impedance is reduced, which could result in greater current flow as stimulation continues. A constant current stimulator, therefore, is preferred in order to minimize sudden, uncontrolled fluctuations of current intensity related to changes in impedance. An electroconductive gel applied between the electrode and skin serves to minimize the skin impedance. Medical complications arising from use of TENS are rare. However, skin irritation can occur in as many as 33% of patients, due, at least in part, to drying out of the electrode gel. Patients need to be instructed in the use and care of TENS equipment, with particular attention to the electrodes. In some cases, individuals react to the tape used to secure the electrodes. Skin irritation is minimized by using disposable, self-adhesive electrodes and repositioning them slightly for repeated applications. The use of TENS is contraindicated in patients with a demand-type pacemaker, because the stimulus output of the TENS unit may drive or inhibit the pacemaker. A variety of newer transcutaneous or percutaneous electrical stimulation modalities have emerged. They include the following:
y

Interferential current therapy (IFC) is based on summation of 2 alternating current signals of slightly different frequency. The resultant current consists of a cyclical modulation of amplitude, based on the difference in frequency between the 2 signals. When the signals are in phase, they summate to an amplitude sufficient to stimulate, but no stimulation occurs when they are out of phase. The beat frequency of IFC is equal to the difference in the frequencies of the 2 signals. For example, the beat frequency and, hence, the stimulation rate of a dual channel IFC unit with signals set at 4200 and 4100 Hz is 100 Hz. IFC therapy can deliver higher currents than TENS can. IFC can use 2, 4, or 6 applicators, arranged in either the same plane, for use on such regions as the back, or in different planes in complex regions (eg, the shoulder). Percutaneous electrical nerve stimulation (PENS) combines advantages of electroacupuncture and TENS. Rather than using surface electrodes, PENS uses acupuncturelike needle probes as electrodes, with these placed at dermatomal levels corresponding to local pathology. The main

y y

advantage of PENS over TENS is that it bypasses local skin resistance and delivers electrical stimuli at the precisely desired level in close proximity to the nerve endings located in soft tissue, muscle, or periosteum.[3] Neurogenic pain (eg, deafferentation pain, phantom pain), sympathetically mediated pain, postherpetic neuralgia, trigeminal neuralgia, atypical facial pain, brachial plexus avulsion, pain after spinal cord injury (SCI) Musculoskeletal pain - Examples of specific diagnoses include joint pain from rheumatoid arthritis and osteoarthritis, acute postoperative pain (eg, postthoracotomy), and acute posttraumatic pain.[10, 11, 12, 13, 14, 15, 16] After surgery, TENS is most effective for mild to moderate levels of pain, and it is ineffective for severe pain. The use of TENS in chronic LBP and myofascial pain is controversial, with placebo-controlled studies failing to show statistically significant beneficial results. A literature-study report from the American Academy of Neurology recommended against the use of TENS for the treatment of chronic LBP, stating that the strongest evidence indicates that it is ineffective against this condition (Level A).[17] Uncertainty also exists about the value of TENS in tension headache. Visceral pain and dysmenorrhea - TENS has been successfully applied to these conditions as well.[18] Diabetic neuropathy - A literature-study report from the American Academy of Neurology stated that TENS is probably an effective therapy for painful diabetic neuropathy and should be considered for use in the treatment of this disorder (Level B).[17] Other disorders - TENS has been used successfully in patients with angina pectoris and urge incontinence, as well as in patients requiring dentalanesthesia.[19, 20] Reports discuss the use of TENS to assist patients in regaining motor function following stroke, to control nausea in patients undergoing chemotherapy, as an opioid -sparing modality in postoperative recovery, and in postfracture pain.[21, 22, 23, 24, 25, 26, 27]

Contraindications for the use of TENS

TENS should not be used in patients with a pacemaker (especially of the demand type). TENS should not be used during pregnancy, because it may induce premature labor. TENS should not be applied over the carotid sinuses due to the risk of acute hypotension through a vasovagal reflex.

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TENS should not be placed over the anterior neck, because laryngospasm due to laryngeal muscle contraction may occur. The electrodes should not be placed in an area of sensory impairment (eg, in cases of nerve lesions, neuropathies), where the possibility of burns exists. A TENS unit should be used cautiously in patients with a spinal cord stimulator or an intrathecal pump. TENS Transcutaneous Electrical Nerve Stimulation (TENS) is the stimulation, for analgesic purposes, which is applied by means of pulses which penetrate through to the peripheral nervous system via electrodes placed directly on the areas to be treated. TENS stimulation is typically achieved by applying biphasic and symmetrical (square wave) currents with frequencies which can vary from 8 to 200 Hz. This type of analgesic stimulation, which fights pain without reverting to the use of pharmaceuticals, makes use of two different physiological mechanisms to obtain the following results: 1. Endogenous beta-endorphin and encephalon production due to the activation of the endorphin system by low frequency stimulation (< 8 Hz). This type of stimulation, which has a low insurgence factor, produces a generalised analgesic effect. 2. The production of serotonin and the blockage of pain signals (gate control) headed in the direction of the central nervous system. Higher frequency levels of stimulus are applied in this case (starting from 80 Hz). The serotonin and gate control mechanism have a very rapid analgesic effect, but is of short duration. APPLICATION METHOD TENS, which uses a biphasic symmetric compensated current, has two different applications: - segmented sensitivity inhibition against acute localised pain - liberation of endorphins for the treatment of chronic and diffuse pain. ANALGESIC EFFECT FOR SEGMENTED SENSITIVITY INHIBITION In the human body there are two types of afferent nervous fibres, meaning fibres which transmit peripheral information to the encephalic part of the brain. The first type are wide diameter fibres, called A-Beta

fibres, which are responsible for transmitting tactile sensitivity information from the peripheral to the central nervous system. The second type, called A-Delta fibres, have a smaller diameter and transmit pain sensations to the encephalic part of the brain. Another factor differentiating these two types of fibre is the fact that the first has a low excitement level, while the second shows a much higher excitement threshold. Along the path which conducts the pain signal from the periphery to the centre there is, in spinal marrow, an interneuron inhibitor which serves as a selector of the signal. The TENS current, as it stimulates the wide diameter A-Beta fibres, excites the interneuron inhibitor. Its activation, or excitement, which impedes pain signals from reaching the encephalic part of the brain, blocks the transmission of pain. This mechanism has been called, by Melzack and Wall who were the first to identify this phenomenon in 1965, gate effect or Gate control. figure 1. In this mode TENS stimulation current impulses should be of short duration (< 1 msec) with a frequency from 80 to 150 Hz. The intensity should be comfortable (non painful) and produce only a slight tingling sensation (tactile sensitivity threshold). In order to be efficacious the treatment should last at least 30 minutes. ANALGESIC ACTION FOR THE LIBERATION OF ENDORPHINES Endorphins and encephalines are proteins produced in the brain, have functions similar to those of morphine and are present in various parts of the central nervous system. For this reason they are particularly efficient in the sedation of pain. These endogenous morphines are the body's natural analgesic neuro mediators and can affix reticulated tissue on cellular structures, such as the thalamus, producing a sedative effect which can be compared to morphine. Electro stimulation with TENS currents can stimulate the liberation of these morphine-like endogen substances. Research has, in fact, shown that 30 minute treatment sessions with low frequency currents of high intensity able to produce rhythmic muscular shocks near to the pain threshold can increase the levels of endorphins by 20% over normal level. This increase in endorphin levels is maintained for 30 minutes after the end of the treatment.

Micro Current MCR Microcurrent electrical neuromuscular stimulation or MENS, as opposed to conventional electrotherapy where mA currents are administered, uses currents whose intensity varies between 10 and 500 A (microamperes, of millionths of an ampere). Much scientific research shows that the ATP (adenosine 5'-triphosphate) synthesis level is increased by the application of microcurrents, whilst on the other hand these later seem to undergo a slowing down when endogenous mA currents are applied. In particular, the increment of the ATP synthesis reaches its maximum levels thanks to the administration of 500 A currents while, beyond this level of intensity, it rapidly decreases. In view of this, it is important to remember that ATP represents the principle source of intracellular chemical energy in every single living organism and can be used in a wide variety of biological activity, including in the healing processes of damaged tissue. Another very interesting aspect regarding the application of MENS is due to the fact that the capitation of alpha-Aminobutyric acid increases noticeably thanks to the application of an hexogenous current starting with an intensity level of 10 A while, on the other hand, starting with an intensity level of 750 A there would be an inhibitory effect. Seeing as the capitation of alpha-Aminobutyric acid is essential to the protein synthesis mechanism (which are at the roots of tissue repair processes) an increase of its level by 30-40%, like that which is affected thanks to MENS applications, could play an essential role in cellular reconstruction processes. The base mechanism which determines an increase in ATP synthesis is essentially constituted by the fact that, during MENS induced electro stimulation a proton gradient is created, that is, a variation of proton concentration, which determines the beginning of a flow of protons from the anode to the cathode. This proton flow through the mitochondrial membrane determines an increase in ATP formation which, in turn, stimulates the transport of amino acids, two factors essential to incrementing protein synthesis. MENS Therapy MENS therapy normally involves two distinct phases, the first of which is aimed at the lessening of the pain felt by the patient, while the second

phase promotes protein and ATP synthesis, thereby speeding up the process of tissue healing. Treatment duration is normally 15 to 30 minutes for the first phase and between 5 to 10 minutes for the second phase. The most frequently used parameters, which, however, vary according to the type of pathology being treated, are, for the first phase: intensity levels of between 1 and 5 A, with a frequency of about 5 Hz and with 250 millisecond wide pulsations, whereas for the second phase the normal parameters applied are as follows: an intensity level of between 10 and 200 A with a frequency of between 0.3 and 1 Hz with a pulse width of 100 millisecond at least. The efficiency of MENS therapy has been scientifically proven in the following fields: Reduction of oedemas and swelling of the traumatised area. Osteoarthritis Stimulation of the production of cartilaginous proliferation processes. Acceleration of tendon repair processes. Osteogenisis process facilitation. Interferential Currents This type of current is called interferential because it forms and interferes with the soft tissue at the point where the two alternating medium frequency currents intersect. Interferential current (IFC) is a medium (2500 Hz 4000 Hz 10000 Hz) frequency alternated sinusoidal current of wide modulation characterised by its ability to effect deep tissue penetration and is easily tolerated even by those patients most sensitive to pain. The analgesic action of the bipolar interferential current, with a modulating frequency of between 0 and 200 Hz, is sent to the gate control mechanism, to stimulate the inhibitive mechanism, to block the peripheral pain transmission, and to remove the pain stimulators of the affected area, just like a transcutaneous electro nerve stimulation (TENS) current. Varying the frequency of the modulation used a motor exciting effect can be produced which contributes to the return of venal blood flow by activating the muscular pump . Clinical Applications Interferential current is particularly adapted for use in treating deep

joint arthritis (hip, lumbar rachis), deep seated tendonitis and muscular hypotrophy of deep seated normally innervated muscles. Interferential current therapy is usually applied in physiotherapy for motor excitement and for its analgesic effects. Therapeutic effects Motor excitement effects: it provokes the contraction of deep seated normally innervated muscles. Analgesic effects: It can provoke the dilation of blood vessels which, due to the increase in blood flow, could remove pain stimulators from the tissue. It is used for the treatment of the following pathologies: Arthritis (hip, lumbar and cervical rachis) Tendonitis: Hip and shoulder tendonitis Denervated Muscles Current for denervated muscles or partially denervated muscles The stimulation of a denervated muscle, as opposed to stimulation of a healthy muscle, is different because the muscle fibre must be activated by special currents. When there is a traumatic lesion to the peripheral nerves the mesurement of cronassia values helps to establish if the level of denervation is scarce, partial or complete. The aim of motor exciting treatment is to maintain trophism and limit muscular sclerosis to allow the muscle to be as functional as possible after the re-ennervation treatment programme, which can sometimes last for as long as a few months. The efficacy of this type of treatment is very dependant on the correct imposition of the stimulation parameters; they must be very specifically defined for each individual patient and must evolve in time. RECTANGULAR CURRENT A rectangular current is characterised by a single rectangular pulse, which varies rapidly from zero to the maximum value to which it is set, for a duration which is equal to the duration of the impulse, from a rest period which corresponds to the time in which the muscle returns to normal. The rectangular form of the pulse causes the muscular

contraction; the pulse duration determines the selective contraction of the denervated fibre and the medium zero value of the pulses (alternate polarity) avoids any ionization phenomenon on the skin. Rectangular pulses are principally used on completely denervated muscles. The programme varies in accordance with the width of the pulse and the length of the rest period. TRIANGULAR CURRENT A triangular current reaches its maximum intensity value when set up on a linear ascension scale which, combined with relatively long duration pulses, provokes a valid contraction response of the denervated fibres (commanded by damaged nerves) without provoking any stimulus in the adjacent healthy innervated fibres. Naturally, it being a motor exciting current, the triangular pulse responsible for the contraction of the denervated fibre must be followed by a rest period in which the current is without value. The polarity of the pulses is alternated to avoid the phenomenon of ionisation on the skin. The capacity of the nervous fibre for accommodating the slow increase of stimulus intensity and the lack of pain felt by the patient explains the use of the triangular current for the muscular stimulation of totally denervated muscles and partially denervated muscles. The selective stimulation of the fibres comes about without affecting the healthy nerved fibres, which can be the source of problems when using an alternated rectangular pulse due to the rapid increase of the pulsation. The programme varies in accordance with the width of the pulsation and the length of the rest period. TRAPEZOIDAL CURRENT Trapezoidal currents are used primarily on muscles which are only partially denervated. The programme varies in accordance with the width of the pulsation and the length of the rest period. Iontophoresis Iontophoresis is a non-invasive method of propelling high concentrations of medication or bioactive-agents transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle. It is based on the ionic disassociation quality of certain low molecular

weight medical substances when these are dissolved in water. It is of fundamental importance to know whether the active part of the medicine to be assumed is positively or negatively charged once it has been disassociated in ionic form in order to be able to position it correctly with regards to the electric flow. The medicine's ions are transferred to the inside of the body through those skin zones which offer low resistance to current in order to reach the cell membranes which consequently undergo change electrically. The Iontophoresis mechanism The objective of iontophoretic therapy is to be able to transfer, through the skin, an pharmaceutically active substance into tissue, thereby transferring the medicine directly to the interested part of the body. The advantages of this mechanism lie in the fact that the medicine required can be administered in lower doses, thus also diminishing the possible collateral effects on the body. The substantial therapeutic value can be essentially ascribed to the confluence of two factors: the first of which is the analgesic and vasomotorial effect of the constant current administered, and the second are the benefits derived from the medicine itself being introduced directly to the area of the body afflicted. It is for this reason that iontophoresis therapy is often chosen as a treatment method for superficial inflammation. It isable to act as an anti-inflammatory and sedative and is an alternative to the hypodermic injection of ionic solutions. Iontophoresis is especially indicated for use in treating the afflictions of superficial joints, where the density of the subcutis and muscle mass are particularly thin. Quantification of the transported substance The relationship between transdermal migration ionic absorption and the intensity of the current administrated is theoretically expressed in Faraday's Law: D= I M/ZF where D represents the transdermal ionic absorption I current intensity, M the molecular weight of the medicine, Z the number of charges per each molecule of medicine F the Faraday constant (96,487 C/mol).

SURGICAL INSTRUMENTS

Diathermy In the natural sciences, the term diathermy means "electrically induced heat" and is commonly used for muscle relaxation. It is also a method of heating tissue electromagnetically or ultrasonically for therapeutic purposes in medicine. Surgical uses Surgical diathermy is usually better known as "electrosurgery." (It is also referred to occasionally as "electrocautery", but see disambiguation below). Electrosurgery and surgical diathermy involve the use of high frequency A.C. electrical current in surgery as either a cutting modality, or else to cauterize small blood vessels to stop bleeding. This technique induces localized tissue burning and damage, the zone of which is controlled by the frequency and power of the device. Some sources[1] insist that electrosurgery be applied to surgery accomplished by high frequency A.C. cutting, and that "electrocautery" be used only for the practice of cauterization with heated nichromewires powered by D.C. current, as in the handheld battery-operated portable cautery tools. diathermy [diah-ther me] the use of high-frequency electromagnetic currents as a form of PHYSICAL THERAPY and in surgical procedures. The term diathermy is derived from the Greek words dia and therma, and literally means heating through. adj., adjdiathermal, diathermic. Diathermy is used in physical therapy to deliver moderate heat directly to pathologic lesions in the deeper tissues of the body. Surgically, the extreme heat that can be produced by diathermy may be used to destroy neoplasms, warts, and infected tissues, and to cauterize blood vessels to prevent excessive bleeding. The technique is particularly valuable in neurosurgery and surgery of the eye. The three forms of diathermy employed by physical therapists are short

wave, ultrasound, and microwave. The application of moderate heat by diathermy increases blood flow and speeds up metabolism and the rate of ion diffusion across cellular membranes. The fibrous tissues in tendons, joint capsules, and scars are more easily stretched when subjected to heat, thus facilitating the relief of stiffness of joints and promoting relaxation of the muscles and decrease of muscle spasms. Short wave diathermy machines utilize two condenser plates that are placed on either side of the body part to be treated. Another mode of application is by induction coils that are pliable and can be molded to fit the part of the body under treatment. As the high-frequency waves travel through the body tissues between the condensers or the coils, they are converted into heat. The degree of heat and depth of penetration depend in part on the absorptive and resistance properties of the tissues that the waves encounter. The frequency allowed for short wave diathermy operations is under the control of the Federal Communications Commission. The frequencies assigned for short wave diathermy operations are 13.66, 27.33, and 40.98 megahertz. Most commercial machines operate at a frequency of 27.33 megahertz and a wavelength of 11 meters. Short wave diathermy usually is prescribed for treatment of deep muscles and joints that are covered with a heavy soft-tissue mass, for example, the hip. In some instances short wave diathermy may be applied to localize deep inflammatory processes, as in pelvic inflammatory disease. Ultrasound diathermy employs high-frequency acoustic vibrations which, when propelled through the tissues, are converted into heat. This type of diathermy is especially useful in the delivery of heat to selected musculatures and structures because there is a difference in the sensitivity of various fibers to the acoustic vibrations; some are more absorptive and some are more reflective. For example, in subcutaneous fat, relatively little energy is converted into heat, but in muscle tissues there is a much higher rate of conversion to heat. The therapeutic ultrasound apparatus generates a high-frequency alternating current, which is then converted into acoustic vibrations. The apparatus is moved slowly across the surface of the part being treated. Ultrasound is a very effective agent for the application of heat, but it should

be used only by a therapist who is fully aware of its potential hazards and the contraindications for its use. Microwave diathermy uses radar waves, which are of higher frequency and shorter wavelength than radio waves. Most, if not all, of the therapeutic effects of microwave therapy are related to the conversion of energy into heat and its distribution throughout the body tissues. This mode of diathermy is considered to be the easiest to use, but the microwaves have a relatively poor depth of penetration. Microwaves cannot be used in high dosage on edematous tissue, over wet dressings, or near metallic implants in the body because of the danger of local burns. Microwaves and short waves cannot be used on or near persons with implanted electronic cardiac pacemakers. As with all forms of heat applications, care must be taken to avoid burns during diathermy treatments, especially to patients with decreased sensitivity to heat and cold. surgical diathermy ELECTROCOAGULATION with an electrocautery of high frequency; often used for sealing blood vessels or stopping the bleeding of incised vessels. UV Curing Lamps We provide a wide range of UV curing & metal halide lamps in various sizes ranging from 4" to 70" and various in power range ranging from 200 W per inch to 500 W per inch. These lamps also known mercury arc lamps are the workhorse of the light curing industry as they combine cure efficiency with design versatility and cost-effectiveness. An electrode type medium pressure lamp consists of three major components:
y y y

A quartz glass sleeve Electrodes sealed into the end of the quartz sleeve Fill material, typically argon and precisely dosed amount of liquid mercury

Working Process: A high voltage is applied to the lamp across the electrode terminals. The voltage field ionizes the argon and produces heat to vaporize the mercury, which creates a pressure of about two atmospheres. This pressure is needed to maintain a balance between the required high intensity while maintaining the spectral output essentially in the UV region. The mercury vapor arc exhibits the unique property of high emission of light in the ultraviolet region of the spectrum. In particular, intense emission occurs in the 240-270 nm and 350-380 nm areas, which is where typical UV photoinitiators absorb. This intense light beyond the violet region of the visible spectrum has sufficient energy to interact with photoinitiators and cause their fragmentation, which initiates polymerization. Some visible light and infrared radiation are also generated. Physical and biophysical background to light sensitivity 3.3.1. Physical background The power (energy emitted per second) of a radiant source is expressed in watts (W), but light is expressed in lumens (lm) to account for the varying sensitivity of the eye to different wavelengths of light. The derived relevant units are the radiance (luminance) of a source in W/m2 (lm/m2) in a certain direction per steradian (unit of solid angle; all around is 4 steradians), and the irradiance (illuminance) of a surface in W/m2(lm/m2 or lux). The human eye does not register the exact spectral composition of light, but perceives colour on the basis of three kinds of receptors with different spectral sensitivities. Due to the importance of the sun, as a broad spectrum light source, all technical sources can be characterised by their Correlated Colour Temperature which corresponds to the surface temperature of black body radiator (sun or star) which generates a similar colour sensation on the human observer. Typical incandescent lighting is 2700K which is yellowish-white. Halogen lighting is 3000K and daylight is around 5000K.

The Correlated Colour Temperature is an important characteristic for the impact of light on the human observer and on the way the human observer film or digital cameras captures images of objects and scenery. Obviously, through vision, this also affects the recognition and perception of external stimuli which leads to a wealth of effects in humans. Electromagnetic radiation such as light can, through a number of processes, interact with matter where elastic processes (i.e. without loss of energy in movement) are of very limited effect on the atoms and molecules, whereas inelastic processes will transfer photon energy (photon absorption), which may excite electrons to higher energy levels in atoms and thus lead to secondary processes such as:
y y

Heat Formation ("dissipation") Fluorescence / Phosphorescence / Radical Formation / Light induced chemical reaction Ionisation (electron emission from an atom or molecule)

Absorption of electromagnetic radiation is typically related to warming of the tissue exposed which has mostly indirect consequences. However, radiation of shorter wavelengths, due to the higher characteristic photon energy, can excite electrons such that chemical processes are initiated which may have detrimental side effects. A well known mechanism is the detrimental effect of UV radiation on living cells. Ionizing radiation consists of high-energy photons that can detach (ionize) at least one electron from an atom or molecule. Ionizing ability depends on the energy of individual photons, and not on their number. The ability of photons to ionize an atom or molecule varies across theelectromagnetic spectrum. X-rays and gamma rays can ionize almost any molecule or atom; far ultraviolet light can ionize many atoms and molecules; near UV, visible light, IR, microwaves and radio waves are non-ionizing radiation. Ionisation starts with wavelengths shorter than 200 nm and needs at least 6 eV, but more likely up to 33 eV (Hall and Giaccia 2006). An exception is the ionisation by (pulsed) lasers with high intensities (>1011 W/cm2; Robinson 1986). There are significant biological effects of ionisation where the most critical target is the DNA (strand breaks and chromosomal aberrations). Such DNA damage may lead to mutations and

therefore cancer induction. Importantly however, ionisation is not generally produced by radiation in the visible/IR/UV range at wavelengths that are longer than 200 nm. 3.3.2. Light-tissue interactions Like sunlight on water, UV, visible and IR radiation can be partially reflected from the outer surface of the skin and eyes, and as it penetrates the tissue it can be scattered in various directions (including backwards) from microscopic particles and structures such as fibers (e.g., present in the dermis of the skin). In the tissue, radiation may also be absorbed by various molecules. In comparison to UV and long-wavelength IR radiation, visible radiation is generally not strongly absorbed by the bulk tissue, but it is strongly absorbed by certain components like pigments and blood. The net result of backscattered and absorbed visible radiation determines skin color, the white of our eyes, and the multi-colored irises that we see (too little light re-emerges from the pupil, except on photographs taken with a strong flash light directed straight into the eyes). The long-wavelength IR radiation is not scattered but strongly absorbed by water the main constituent of soft tissues and this contributes to the heat sensation when the skin is exposed to sunlight. Ultraviolet radiation, especially with short wavelengths, is strongly absorbed by bulk tissue, i.e. by organic molecules like proteins, lipids and DNA. Most of the UV-B radiation is therefore absorbed in the outermost superficial layer (the epidermis of the skin). The absorbed energy from UV radiation is not only converted into heat (i.e. thermal energy from increased movement of molecules), as is the case with IR radiation, but it can also drive photochemical reactions. In the eye, visible radiation is absorbed by special photo-pigments that trigger electrochemical stimuli to optical nerves, enabling us to see, but potentially also mediating adverse effects. With a few exceptions (most notably the formation of pre-vitamin D3), most photochemical reactions caused by UV radiation in the skin and eyes are detrimental: proteins and DNAbecome damaged and dysfunctional, either by directly absorbing UV radiation or by being damaged through an intermediary step, such as reactive oxygen species generated from another UV-absorbing molecule. Hence, UV radiation can be considered harmful. Overly damaged cells will die and disassemble in a well-orchestrated manner (a process dubbed apoptosis). Large numbers of cells in apoptosis may cause notable defects that literally

surface after a few days in a process we know as peeling. Fortunately, our skin is well adapted to UV-induced damage which also arises upon exposure to the sun. Cells react, alarm signals are produced (i.e. stress responses mediated through cascades of molecularreactions), and the damaged molecules and cells are repaired or replaced. The UV-induced damage and alarm signals can evoke an inflammatory reaction (attracting immune cells from the blood to the site of the toxic insult) as part of a normal sunburn reaction in the skin, or snow blindness (or welders flash) in the eyes (the redness is caused by widening of superficial blood vessels, and some swelling occurs because of a higher permeability of the vessel walls facilitating the trafficking of white blood cells). In some cases such sunburn reactions may already arise after extremely low UV exposures, revealing an enhanced UV toxicity. Alternatively abnormal allergy-like skin reactions may occur, indicating a pathologic immune response to UV exposures.

Short Wave diathermy current is a high frequency alternating current. The heat energy obtained from the wave is used for giving relief to the patient. Its frequency is 27,120,000 cycles per second and the wavelength is 11 metre. Types of Applications 1. The condenser field method (commonly used) 2. Cable method Where useful? 1. 2. 3. 4. 5. 6. 7. 8. Inflammation of shoulder joint Inflammation of Elbow Joint (Tennis Elbow) Degeneration of joints of neck (Cervical Spondylosis) Degeneration of joints like knee and hip (Osteoarthritis) Ligament Sprains in knee joint Low Back Ache Plantar fascitis (Heel Pain) Sinusitis

Where it should not be used? General 1. High Fever 2. Fluctuating Blood Pressure

3. Very sensitive Skin 4. Persons with Untreated Fits 5. Persons using Cardiac Pace Maker 6. Severe kidney and heart problems 7. Pregnant Women 8. Mentally Retarded Individuals 9. Tuberculosis of Bone 10. Malignant cancer Local If the treatment area has: 1. 2. 3. 4. Open wounds Skin disease Unhealed scars Recent burns

Advantages 1. Relaxation of the muscles 2. Effective in bacterial infections 3. Relief of pain Treatment Time Initial Stage - 5-10 minutes Moderate Stage - 10-20 minutes Severe State - 20-30 minutes Disadvantages 1. 2. 3. 4. 5. 6. Burns Scalds (Boils) Overdose Shock Electric Sparking Faintness

OPERATING MODES: EMS, RUSSIAN STIMULATION

4 Channels(4000R), Channels Isolated Waveform: Biphasic or Mono-Phasic Standard Mode Frequency: 2 - 140 Hertz Russian Stimulation Mode: 2500 Hertz @ 50 PPS Reciprocation: Yes Pulse Width: 200 microseconds Ramp Time: 3 Seconds Contraction Time: variable 3 to 45 Seconds Relaxation Time: variable 3 to 45 Seconds
y

Power Output: 0 - 34.3 microColumbs (100 volts)

Power: 110V US AC-DC Power adapter Pads: Eight 4" Round and Four 2.5" Round Eight Velcro Straps and 2oz tube of Vital Gel Dimensions: 3 1/4"(H) x 8" (W) x 8" (L) Fuse: 250V 4A slow blow FREE Four Pack of 3" Round Self Adhesive Electrodes

Deep heat is produced when energy is converted into heat as it passes through body tissues.[1] Energy sources include (1) high-frequency currents (shortwave diathermy), (2) electromagnetic radiation (microwaves), and (3) ultrasound (high-frequency sound). The temperature distribution in the tissues heated by any of these modalities results from the pattern of relative heating, which is the amount of energy converted to heat at any given location. The practitioner should choose a heating modality that produces the highest temperature at the site of concern without exceeding the temperature tolerance at the affected site or in tissues above or below that site. The temperature rise depends on the properties of the tissue, including the specific heat, thermal conductivity, and the length of time that the heating modality is applied. The temperature rise and distribution of heat that are associated with these modalities are superimposed on the physiologic temperature distribution in the tissues prior to diathermy application. Usually, the superficial temperature is low at the skin surface and higher at the core.

The physiologic effects of temperature occur at the site of the application and in distant tissue. The local effects are caused by the elevated temperature response of cellular function by direct and reflex action. Locally, there is a rise in blood flow with associated capillary dilatation and increased capillary permeability. Initial tissue metabolism increases, and there may be changes in the pain threshold. Distant changes from the heated target location include reflex vasodilatation and a reduction in muscle spasm (as a result of skeletal muscle relaxation). Vigorous heating produces the highest temperature at the site where the therapeutic result is desired. The tissue undergoes a rapid temperature rise, with the temperature coming close to the tolerance level. Vigorous heating is used for chronic conditions that require deep structures, such as large joints, to be heated. When acute inflammatory processes are occurring, deep heating requires extreme care, because it can obscure inflammation. Local tissue temperature is maintained during mild heating, the primary effect being the production of a higher temperature at a site distant from the heating modality's application. Reflex vasodilatation occurs when the rise in temperature is slow for short periods, such as during a subacute process. With the proper application, superficial and deep heating methods can accomplish mild heating. Shortwave diathermy The best method for large-area deep heating is shortwave diathermy. This modality is useful for various indications. The following problems can be treated with shortwave diathermy, depending on the individual condition of each patient and the desired treatment goals:
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Localized musculoskeletal pain Inflammation (joint or tissue)[2] Pain/spasm Sprains/strains Tendonitis Tenosynovitis Bursitis Rheumatoid arthritis[2] Periostitis Capsulitis

Microwave diathermy Because microwave diathermy selectively heats muscles and deep heat improves the flexibility of collagen tissues, muscle contractures can be treated with this modality (in combination with a physical therapy stretching program). Microwave diathermy can also be used to reduce secondary muscle spasm under a trigger point. In addition, this modality can effectively treat the superficial joints of the hands, feet, and wrist because of the thin soft-tissue layer overlying these joints. Ultrasonography Therapeutic ultrasonography is ideal for providing deep heat to large joints. For example, it is effective in treating the shoulder or hip, because a standing wave is produced as a result of the curved reflection of the glenoid or the acetabulum; this effect concentrates heat energy at the articular surfaces of the joint. In combination with a physical therapy program utilizing range of motion (ROM) and stretching activities, the localized, intra-articular heating produced by ultrasonography greatly facilitates the mobilization of joint adhesions or capsular restrictions caused by tightness or scarring. Ultrasonography is also used to treat osteoarthritis, tendinitis, and bursitis.[3] Ultrasonographic deep heating has not been found to be effective for the preventive management of posteccentric exercise, delayed-onset muscle soreness.[4] Most of the indications for therapeutic ultrasonography are similar to those for other deep heating modalities. Additional indications for ultrasonography include the following:
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Joint contracture Joint adhesions Calcific bursitis Hematoma resolution Neuromas Other conditions that may be treated by ultrasonography, although with limited therapeutic benefit, include the following: Fibrosis

y y y y

Phantom limb pain Myofascial pain Reflex vasodilatation Ulcer debridement Shortwave diathermy has the following precautions or contraindications:

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Malignancy Sensory loss Tuberculosis Metallic implants or foreign bodies Pregnancy Application over moist dressings Ischemic areas or arteriosclerosis Thromboangiitis obliterans Phlebitis Cardiac pacemakers Contact lenses Metal-containing intrauterine contraceptive devices Metal in contact with skin (eg, watches, belt buckles, jewelry) Use over epiphyseal areas of developing bones Active menses In addition, extreme care must be used with pediatric or geriatric patients. The literature is not clear on the amount of heating that occurs in the case of metal surgical clips; in addition, the effect of shortwave diathermy on actual bony growth plates is not known with certainty. The most common complication of shortwave diathermy is the development of burns, which may be caused by a number of factors, including the following: Faulty equipment Improper technique Inadequate patient supervision Inappropriate positioning of the patient Microwave diathermy The previously mentioned contraindications to shortwave diathermy also apply to microwave diathermy. Additional precautions include synovitis with joint effusion, systemic/local infection, and use over bony prominences.

y y y y

Ultrasonography Precautions to be noted in the use of therapeutic ultrasonography are the same as those for most other deep heating modalities. Although the literature for physical therapy and for physical medicine has differing opinions, therapeutic ultrasonography can be used over metal implants with caution and with constant motion of the ultrasonographic head. Additional contraindications for the use of ultrasonography include conditions in which the application of deep heat would require direct exposure of the eye, pregnant uterus, spine, laminectomy sites, brain, heart, or known ischemic areas, which can result in detrimental cavitation and heating of those tissues. Shortwave diathermy This deep heat modality involves the therapeutic application of highradiofrequency electrical currents. The electromagnetic field is usually at a radio frequency of 27.12 MHz ( = 11.06 m). Hyperemia, sedation, and analgesia are the basic physiologic effects.[5] The reduction in muscle spasm resulting from muscle relaxation is caused by an increased vascular supply to the treated area. A transverse technique is applied to treat a larger anatomic area, with the primary concentration at the midpoint between electrodes. Proper application and tuning are required for this modality. The patient's electrical impedance becomes part of the impedance of the patient's own circuit. The patient's circuit must be set to resonance, so the patient's circuit frequency is equal to that of the machine. The patient should feel only a comfortable heat. For therapeutic benefit, the tissue temperature should be elevated to between 40 and 45 C. Continuous supervision and observation of the patient are required. The treatment time is usually 20-30 minutes. At clinically relevant energies, shortwave diathermy can increase subcutaneous fat temperature by 15 C and muscle temperature by 4-6 C at a depth of 4-5 cm. Patients should be placed on a wooden table or chair when shortwave diathermy is applied. One means of applying shortwave diathermy is through the condenser method. In this, the treatment site is placed between 2 electrodes functioning as capacitor plates. Monitoring of patient movement is required, because movement can affect the amplitude of the heat concentration being applied. Another technique, the inductive coil method, involves coil applicators that selectively heat superficial musculature (unless these

applicators are used on joints with minimal overlying soft tissue, resulting in selective heating of the joint). Inductively coupled units use induced eddy currents to heat tissue, especially tissue, such as muscle, with high water content. Units joined to provide aggregate capacity use electrical fields to heat tissue with low water content, such as fat. Self-adjusting resonators minimize the positioning effect. Felt or plastic spacers should be used with the condenser method. When the condenser or inductive coil method is applied, a towel should be used to absorb perspiration, thereby avoiding localized heat concentration. The patient must be instructed to remain motionless. The output of the machine should be adjusted to a desired level so that movement does not change the impedance circuit and increase current flow (which would mean a greater risk of a dose increase and resultant burns). The shortwave diathermy unit should be tuned to low power as per patient tolerance, and the meter readings should be properly documented. Heating localization depends on the coupling of radio waves to the patient. Microwave diathermy Microwave diathermy, which employs a form of electromagnetic radiation, is another deep heat modality that selectively heats tissues with high water concentration.[6, 7] Hyperemia, sedation, and analgesia are the physiologic effects, similar to the results of shortwave diathermy.[5, 8] Secondary, local vascular dilatation results in increased local metabolism. The 2 frequencies designated for microwave diathermy are 915 MHz and 2456 MHz, with the former being the most commonly used. Because the frequencies are higher than those used in shortwave diathermy and the wavelengths are the same size as the applicator, microwave diathermy can be focused more easily than can shortwave diathermy. The lower frequency is preferred because it provides selective heat deep into muscle, and less energy is converted to heat in the subcutaneous fat.[7] Direct contact applicators with full aperture skin contact are optimal for improved coupling and for reducing stray radiation. A microwave director is used to aim the microwaves at the area of treatment, allowing observation of the treatment site. Heat can be reduced by increasing the distance of the microwave director from the treatment site. As with shortwave diathermy, microwave diathermy can result in hot spots and burns; these can occur secondary to localized perspiration

associated with selective heating of the treatment zone. The microwave diathermy equipment should be adjusted to provide comfortable heating, with treatment time ranging from 20-30 minutes. Ultrasonography Ultrasonography is a deep heating modality that uses high-frequency acoustic vibrations; the frequencies employed are above the human audible spectrum, that is, they are greater than 17,000 Hz. Therapeutic ultrasonography uses a frequency range of 0.8-1.0 MHz. Ultrasonographic energy is generated by the piezo-electric effect; electrical energy is applied to a crystal, causing the crystal to vibrate at a high frequency and thereby produce ultrasound. Ultrasound is delivered by continuous or pulsed waves (the goal being to produce nonthermal effects, such as streaming and cavitation) and provides a high heating intensity.[9, 10] Ultrasonographic energy is absorbed and transformed into heat energy as it propagates through tissue. The therapeutic dose is computed by the power output (total W) and the size of the ultrasonographic head. The usual initial dose is 1 W/cm2 and is adjusted to patient tolerance, as well as to the treatment goals. The practitioner must select the wave form (continuous or pulsed), intensity, and duration. The patient should experience a comfortable heating or no sensation at all. The treatment time is 5-10 minutes, taking into account the patient's tolerance and comfort. After the skin is cleansed, a coupling agent, such as an ultrasonographic gel, is required to provide effective conduction between the ultrasonographic head/transducer and the skin surface. To avoid hot spots, the ultrasonographic head must be continuously moved over the treatment site. Therapeutic ultrasonography produces the following biologic effects:
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Temporary analgesia[5, 11, 3] Increased peripheral blood flow Increased vascularity with associated hyperemia/inflammatory response[5] Increased cell membrane permeability Peripheral nerve conduction changes (reversible conduction block with high-intensity ultrasonographic exposure) Relief of muscle spasms[3] The following factors influence the propagation of ultrasound in biologic tissue: Transmission

y y y

Absorption Refraction Reflection As mentioned above, the nonthermal effects of ultrasonography include cavitation, which disrupts chemical and cellular bonds, thereby assisting with the treatment of fibrous tissue, scar tissue, and joint capsule adhesions. A form of ultrasonography known as phonophoresis is used to diffuse a topical medication, such as a steroid, analgesic, or anesthetic in a gel, into the subcutaneous tissue.[11]

In the last few decades or so, many medical professionals have found that there are several ways to help their patients heal without the use or with limited use of long term pain medication use. Things like therapeutic massage, neuromuscular stimulators, and therapeutic ultrasound have revolutionized the way the medical community can aid patient healing. Another type of technology that has shown real worth in the clinical setting is shortwave diathermy. This method of controlling pain and increasing the blood flow to damaged muscle areas acts with deep heat as opposed to sound wave like the therapeutic ultrasound. In conjunction with other non medication based therapies, shortwave diathermy can help a large number of patients with varying degrees of injury as well as different types of injury. Take a closer look at what your practice can expect to get from the inclusion of this kind of medical technology. Therapeutic ultrasound is fantastic for reaching a very specific region of the body. However, there are times when a medical professional is going to need to reach a larger area of the body. Among other benefits, shortwave diathermy machines can be used to apply heat to a much larger area of the body. This is especially helpful for treating back muscle problems. In addition to the classic back problems a huge number of the population has to deal with, shortwave diathermy also is beneficial for treating things like neuritis, tendonitis, and muscle strains of all kinds. Also know as SD, this method of applying heat to the deep underlying tissue of the body is also wonderful for providing relief to patients who suffer from osteoarthritis and rheumatoid arthritis as well. Another common use of the shortwave diathermy that is likely to be one of the most commonly used applications is sports medicine. From amateurs to professional athletes, the common and not so common sports injuries

are often made better and heal faster when heat is part of the equation. Things like inflammation of the elbow, shoulder, and knees are improved with the use of the shortwave diathermy. Lower back pain, ligament sprains, and even neck joints benefit from therapeutic heat as well. However, as useful as the shortwave diathermy is on all sorts of common injuries and diseases, there are cases when this type of intense heat should be avoided. Women who are pregnant arent good candidates for this kind of therapy. Mentally handicapped individuals are also considered to be poor candidates for shortwave diathermy. Other preexisting conditions that can eliminate a person as a candidate for this method of healing and pain relief are severely fluctuating blood pressure, people who have pace makers, and those with kidney or heart problems. Even when a person is ordinarily a good patient for this treatment, the presence of a high fever can eliminate them from this therapy until the condition clears up. Therapeutic ultrasound refers generally to any type of procedure that uses ultrasound fortherapeutic benefit. This includes HIFU, lithotripsy, targeted ultrasounddrug delivery, trans-dermal ultrasound drug delivery, ultrasound hemostasis, and ultrasound assistedthrombolysis.[1] Physical Therapy Therapeutic ultrasound in physical therapy is alternating compression and rarefaction of sound waves with a frequency of >20,000 cycles/second. Therapeutic ultrasound frequency used is 0.7 to 3.3 MHz. Maximum energy absorption in soft tissue is 2 to 5 cm. Intensity decreases as the waves penetrate deeper. They are absorbed primarily by connective tissue: ligaments, tendons, and fascia (and also byscar tissue).[2] Therapeutic ultrasound may have two types of benefit: Thermal effects and non thermal effects. Thermal effects are due to the absorption of the sound waves. Non thermal effects are from cavitation, microstreaming and acoustic streaming. Cavitational effects result from the vibration of the tissue causing microscopic air bubbles to form, which transmit the

vibrations in a way that directly stimulates cell membranes. This physical stimulation appears to enhance the cell-repair effects of the inflammatory response.[3] Therapeutic ultrasound is sometimes recommended for muscle as well as joint pain. Characteristics of therapeutic ultrasound Ultrasound consists of inaudible high frequency mechanical vibrations created when a generator produces electrical energy that is converted to acoustic energy through mechanical deformation of a piezoelectric crystal located within the transducer. The waves produced are transmitted by propagation through molecular collision and vibration, with a progressive loss of the intensity of the energy during passage through the tissue (attenuation), due to absorption, dispersion or scattering of the wave [21]. The total amount of energy in an ultrasound beam is its power, expressed in watts. The amount of energy that reaches a specific site is dependent upon characteristics of the ultrasound (frequency, intensity, amplitude, focus and beam uniformity) and the tissues through which it travels. Important terminology with respect to the characteristics of ultrasound and variables that may affect the dose delivered are given in Tables 1 and 2 . Therapeutic ultrasound has a frequency range of 0.753 MHz, with most machines set at a frequency of 1 or 3 MHz. Low frequency ultrasound waves have greater depth of penetration but are less focused. Ultrasound at a frequency of 1 MHz is absorbed primarily by tissues at a depth of 35 cm [22] and is therefore recommended for deeper injuries and in patients with more subcutaneous fat. A frequency of 3 MHz is recommended for more superficial lesions at depths of l 2 cm [22, 23]. Tissues can be characterized by their acoustic impedance, the product of their density and the speed at which ultrasound will travel through it. Low absorption (and therefore high penetration) of ultrasound waves is seen in tissues that are high in water content (e.g. fat), whereas absorption is higher in tissues rich in protein (e.g. skeletal muscle) [24]. The larger the difference in acoustic impedance between different tissues, the less the transmission from one to the other [25]. When reflected ultrasound meets further waves being transmitted, a standing wave (hot spot) may be created, which has potential adverse effects upon tissue [26]. Such effects can be minimized by ensuring that the apparatus delivers a uniform wave, using pulsed waves (see below), and moving the transducer during treatment [24].

The larger the diameter of the effective radiating area of the transducer face, the more focused the beam of ultrasound produced. Within this beam, energy is distributed unevenly, the greatest non uniformity occurring close to the transducer surface (near zone). The variability of the beam intensity is termed the beam non uniformity ratio (BNR), the ratio of the maximal intensity of the transducer to the average intensity across the transducer face. This should optimally be 1:1 and certainly less than 8:l [27]. Coupling media, in the form of water, oils and most commonly gels, prevent reflection of the waves away at the soft tissue/air interface by excluding air from between the transducer and patient. Different media have different impedances. Any coupling medium should have an acoustic impedance similar to that of the transducer, should absorb little of the ultrasound, remain free of air bubbles and allow easy movement of the transducer over the skin surface [28]. Ultrasound dosage can also be varied by alteration of wave amplitude and intensity [the rate at which it is being delivered per unit area of the transducer surface (watts/cm2)]. Machines differ with respect to the definition chosen for their intensity setting (Table 1 ). In addition, therapeutic ultrasound can be pulsed or continuous. The former has on/off cycles, each component of which can be varied to alter the dose. Continuous ultrasound has a greater heating effect but either form at low intensity will produce non thermal effects.

Ultrasound is a therapeutic modality that has been used by physical therapists since the 1940s. Ultrasound is applied using a round-headed wand or probe that is put in direct contact with the patient's skin. Ultrasound gel is used on all surfaces of the head in order to reduce friction and assist in the transmission of the ultrasonic waves. Therapeutic ultrasound is in the frequency range of about 0.8-3.0 MHz. The waves are generated by a piezoelectric effect caused by the vibration of crystals within the head of the wand/probe. The sound waves that pass through the skin cause a vibration of the local tissues. This vibration or cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, such as a fresh injury with acute inflammation, the ultrasound can be pulsed rather than continuously transmitted. Ultrasound can produce many effects other than just the potential heating effect. It has been shown to cause increases in tissue relaxation, local

blood flow, and scar tissue breakdown. The effect of the increase in local blood flow can be used to help reduce local swelling and chronic inflammation, and, according to some studies, promote bone fracture healing. The intensity or power density of the ultrasound can be adjusted depending on the desired effect. A greater power density (measured in watt/cm2 is often used in cases where scar tissue breakdown is the goal. Ultrasound can also be used to achieve phonophoresis. This is a noninvasive way of administering medications to tissues below the skin; perfect for patients who are uncomfortable with injections. With this technique, the ultrasonic energy forces the medication through the skin. Cortisone, used to reduce inflammation, is one of the more commonly used substances delivered in this way. A typical ultrasound treatment will take from 3-5 minutes depending on the size of the area being treated. In cases where scar tissue breakdown is the goal, this treatment time can be much longer. During the treatment the head of the ultrasound probe is kept in constant motion. If kept in constant motion, the patient should feel no discomfort at all. If the probe is held in one place for more than just a few seconds, a build up of the sound energy can result which can become uncomfortable. Interestingly, if there is even a very minor break in a bone in the area that is close to the surface, a sharp pain may be felt. This occurs as the sound waves get trapped between the two parts of the break and build up until becoming painful. In this way ultrasound can often be used as a fairly accurate tool for diagnosing minor fractures that may not be obvious on x-ray.

Some conditions treated with ultrasound include tendonitis (or tendinitis if you prefer), non-acute joint swelling, muscle spasm, and even Peyronie's Disease (to break down the scar tissue). Contraindications of ultrasound include local malignancy, metal implants below the area being treated, local acute infection, vascular abnormalities, and directly on the abdomen of pregnant women. It is also contraindicated to apply ultrasound directly over active epiphyseal regions (growth plates) in children, over the spinal cord in the area of a laminectomy, or over the eyes, skull, or testes. Ultrasound (US) has been a widely used and accepted adjunct modality for the management of many musculoskeletal conditions. It was first introduced as a therapeutic modality in the 1950s, when both animal and human studies demonstrated its ability to safely heat tissue several centimeters below the skin. In the late 1960s and 1970s, reports on the non-thermal therapeutic effects of US, primarily in the area of enhanced tissue healing, further bolstered its popularity (1). Despite the years of clinical use, the lack of studies confirming its benefits has led scientists to question the traditional view of its therapeutic benefits (2). Several papers reviewing the available literature have been published concerning the biophysical effects, application, and efficacy of therapeutic ultrasound, as well as the safety and calibration of ultrasonic equipment (2-7). The purpose of this paper is to present a general overview of these findings.

Uses

According to a survey of orthopedic certified specialists, the most common uses for US were to decrease soft tissue inflammation, increase tissue extensibility, enhance scar tissue remodeling, increase soft tissue healing, decrease pain, and decrease soft tissue swelling. Other uses were to deliver medication for soft tissue inflammation, pain management and soft tissue swelling (1). Biophysical Effects

Therapeutic ultrasound is the use of alternating compression and rarefaction of sound waves for therapeutic benefit. When ultrasonic energy is induced into an attenuating material such as tissue, the amplitude of the wave will decrease with distance. This attenuation is due to either the absorption or the scattering of sound waves (8). Ultrasound therapies can be divided into high power or low power therapies where high power applications include high intensity focused ultrasound (HIFU) and lithotripsy; low power applications include sonophoresis, sonoporation, gene therapy, and bone healing (4). Biophysical effects of ultrasound are traditionally separated into 2 types: a thermal effect from absorption and a non-thermal effect from scattering. The absorption of the ultrasonic sound energy leads to tissue heating. The scattering is thought to be that portion of ultrasonic energy that changes direction and leads to the non-thermal effects (9). Thermal effect: When ultrasound travels through tissue a percentage of it is absorbed, leading to the generation of heat within that tissue. The basis of HIFU is to raise the temperature of tissue to a therapeutic level. The amount of absorption depends upon the nature of the tissue, its degree of vascularization, and the frequency and intensity of the applied ultrasound. Tissues with high protein content absorb ultrasound more readily than those with high fat content. Thus, tissue with high water content and low protein such as blood and fat content absorb little of the US energy while those with lower water content and higher protein content such as ligament and tendon will absorb US more efficiently. Although cartilage and bone have the highest protein content, their densities cause problems with wave reflection and a significant proportion of US energy striking their surfaces is more likely to be

reflected. The best absorbing tissues in terms of clinical practice are those with high collagen content: ligament, tendon, fascia, joint capsule, and scar tissue (4;10). Another key point is that the higher the US frequency, the greater the absorption rate. Raising the temperature above normal thermal levels by a few degrees may have a number of beneficial physiological effects (4). Most common frequencies used are in the range from 0.7 to 3.3 MHz (4). Maximum energy absorption depth in soft tissue is between 2 to 5 cm (3). Non-thermal effect: Therapeutic ultrasound produces a combination of non-thermal effects that are difficult to isolate from the thermal (11). Non-thermal effects have been divided by ter Haar into cavitations and other mechanical effects such as acoustic streaming and micro streaming (4). Cavitations refer to the behavior of bubbles within an acoustic field. They are defined as the physical forces of the sound waves on micro-environmental gases within a fluid. As the sound waves propagate through the medium, the characteristic compression and rarefaction causes microscopic gas bubbles in the gas to contract and expand. The thought is that the rapid changes in pressure in and around the cell may alter the function of the cell. Acoustic streaming has been described by ter Haar as localized liquid flow in the fluid around the vibrating bubbles (12). This has been defined as the physical forces of the sound waves that provide a driving force capable of displacing ions and small molecules. At the cellular level, organelles and molecules of different molecular weight exist. Many of these are free floating and may be driven to move around more stationary structures (11). Microstreaming is set up in the fluids around acoustically driven bubbles. This purports to lead to shear stresses on cell membranes in the vicinity, which can create transient pores through which ions and molecules may be transported (4). This increased permeability of both individual cell membranes and the endothelium is thought to enhance therapeutic uptake, and can locally increase the activity of drugs by enhancing their transport across membrane (13). Acoustic Spectrum

Audible sound is what humans hear in the approximate frequency range between 20Hz and 20 kHz. The ultrasound frequency range starts at a frequency of about 20 kHz. Most medical equipment operates in the ultrasonic frequency range between 1 to 15 MHz. (8). Therapeutic ultrasound has a frequency range of 0.75-3 MHz, with

most machines set at a frequency of 1 or 3 MHz. Low-frequency ultrasound waves have a greater depth of penetration but are less focused. Ultrasound at a frequency of 1 MHz is absorbed by tissues at a depth of 3-5 cm and is recommended for deeper injuries and in patients with more subcutaneous fat. A frequency of 3 MHz is recommended for more superficial lesions at depths of 1-2 cm (14). Thermal Dose

Healthy cellular activity depends upon chemical reactions occurring at the proper location at the proper rate. The rate of chemical reactions and thus of enzymatic activity are temperature dependent. An immediate consequence of a temperature increase is an increase in biochemical reaction rates. When the temperature becomes sufficiently high (i.e., approximately = 45 C) enzymes denature (8). With this in mind, therapeutic applications require that the exposed target tissue undergoes reversible or irreversible change, depending on the goal of the treatment (4). Application in a clinical environment is a combination of the selectable machine parameters: frequency, power density, duty cycle and treatment time. Ultrasound dosages are also varied by alteration of wave amplitude and intensity (Watts/cm2) which can be pulsed or continuous. Continuous ultrasound has a greater thermal effect but either form at low intensity will produce non-thermal effects (14). Studies utilizing continuous and pulsed frequencies at 1MHz and 3MHz confirm that ultrasound results are time and dose dependent. The 3 MHz frequencies increased tissue temperature at a faster rate than the 1MHz frequency (11). For example, a 2004 in vivo study concluded that pulsed ultrasound (3MHz, 1.0 W/cm2, 50% duty cycle, for 10 minutes) produces similar intramuscular temperature increases as continuous ultrasound (3MHz, 0.5 W/cm2, for 10 minutes) at a 2-cm depth in human gastrocnemius muscles (15). Coupling Media

Sound waves are transmitted through a round-headed wand that is applied to the skin; however, the waves may be reflected at the metal/air interface found at the treatment head. It is therefore necessary to provide a medium through which the ultrasound can pass freely to reach the tissue without absorbing or changing the direction of the waves. This medium should be sufficiently fluid to fill all available spaces, relatively viscous so that it stays in place, have impedance appropriate to the

media it connects, and should allow transmission of ultrasound energy with minimal absorption, attenuation or disturbance (3). For therapeutic applications, a number of methods are used to couple the sound into the tissue. Where the acoustic window is relatively flat, and the transducers emitting surface is flat, aqueous gel may be used between the sources front face and the skin. For irregular tissue surfaces and/or irregular transducers, water may provide a better coupling medium (4). In 2004, Casarotto et al compared 4 coupling media: gel, mineral oil, white petrolatum, and degassed water for density and temperature variation. The results showed that the water and gel presented the highest transmission coefficient, the lowest reflection, and an attenuation coefficient and acoustic impedance close to that of the skin. However, when using direct contact and thin layers of coupling agents, any product may be used, because the effect of the attenuation coefficient does not play a significant role when layers are very thin (16). Calibration and Safety

The need to measure and calibrate physiotherapy ultrasound machines was indentified in the early 1960s, and specification standards for carrying out such measurements were put in place by the International Electro-technical Commission (IEC) (7). In 2003, Daniel and Rupert tested 45 ultrasound units at various chiropractic clinics and found that 44% of the units failed either calibration or electrical safety inspection (17). The calibration standard for power output is monitored by the FDA code of federal regulation title 21, part 1050.10 which states that temporal-average ultrasonic power shall not exceed 20% for all emissions greater that 10 % of the maximum emission (18). The IEC standard for physiological equipment includes two limits for the purpose of patient protection. The first limits the temperature of the frontal face of the transducer to no more than 41 C when operated under water with initial temperature 25C. A test involving three, 3 minute cycles is specified. The second limit applies to ultrasound intensity. The effective intensity shall not exceed 3 Wcm2. Extended exposure of tissue to this intensity causes temperature increases which can result in tissue damage, particularly at the surface of bone. Protection of non-target tissue regions is achieved from appropriate placement of the beam (6).

Light is defined as the electromagnetic radiation with wavelengths between 380 and 750 nmwhich is visible to the human eye. Electromagnetic radiation, such as light, is generated by changes in movement (vibration) of electrically charged particles, such as parts of heatedmolecules, or electrons in atoms (both processes play a role in the glowing filament ofincandescent lamps, whereas the latter occurs in fluorescent lamps). Electromagnetic radiation extends from rays and X-rays through to radio waves and to the long radio waves. This is often referred to as the electromagnetic spectrum which is shown on the figure below (modified from American Chemical Society 2003):

The electromagnetic spectrum An alternative physical description of light is to consider radiation as being emitted as discrete parcels of energy, called photons, which have dual nature that of a particle and a wave. The fundamental parameter that distinguishes one part of the electromagnetic spectrum from another is the wavelength, which is the distance between successive peaks of the radiated energy (waves). Photons energy levels are determined by measuring their wavelength (expressed in units of length and symbolized by the Greek letter lambda ). Of the two waves shown below, the left one has a wavelength that is two times longer than the one shown on the right:

The energy of a photon is directly proportional to the photons frequency, and inversely proportional to its wavelength. Frequency is measured in number of cycles (wave peaks) per second and is expressed in Hz. So,

rays consist of very high-energy photons with shorter wavelengths and higher frequencies compared to radio waves. In addition, light is characterized by its intensity. For example, the blindingly intensive red light on a theater stage may consist of photons of the same energy and wavelength as the red stoplight at a street corner; however, stage light is different in terms of the quantity of photons emitted. The higher the number of photons irradiated, the higher the amplitude (the height) of the wave of these photons. The figure below shows photons of the same wavelength ( ),frequency and energy which have two different levels of intensity:

The amplitude is a quantitative characteristic of light, while wavelength (intrinsically linked to photons energy and frequency) characterises the nature of light qualitatively. Light is a very small component of the electromagnetic spectrum and is the part that can be perceived by the human eye. Radiation just beyond the red end of the visible region is described as Infra-red (IR), and radiation of shorter wavelength than violet light is called Ultra-violet (UV). The UV portion of the spectrum is divided into three regions: UVA (315 400 nm) UVB (280 315 nm) UVC (100 280 nm) (Some investigators define UVB as the waveband 280 320 nm.) Sunlight is attenuated as it travels through the earths atmosphere. This means that all radiation with a wavelength below 290nm is filtered out before it reaches the earths surface.

Characteristic for every light source is its spectrum, i.e. a graph of the radiant energy emitted at each wavelength. Depending on the characteristics of the light emitting system, the emitted spectrum can be broad or it can have sharp lines at certain wavelengths; the former is the case for the sun, for incandescent and halogen lamps, and is related to the temperature of the source. The latter is usually related to specific changes in energy levels of electrons in certain atoms. Lamps used in lighting applications need to cover the visible range of wavelengths for proper white perception. By the physical principles of light generation, thermal sources like heated filaments of different types [historically Cfibre, W-filament, Halogen protected W-filaments, and electrically induced high temperature plasmas (arc lamps)], as well as the sun and other stars, generate a spectrum of a so called black body radiator which peaks at a certain characteristic frequency corresponding to the temperature of the emitter and follows a well described spectrum between the reddish glow of charcoals (~1000C) and the white light corresponding to the surface temperature of the bright sun (~6000C). Various spectra are generally recognised by their characteristic colour by a human observer. For example, due to an increase in scattering of short wavelengths (i.e. blue light) with an increased path length of the sunrays through the atmosphere, the sun takes on more and more of a red hue as it sinks toward the horizon. Light is indispensable to life on the planet and consequently affects humans and other creatures alike. Notably there are important physical effects through the interaction of light with our skin and our eyes leading to the warm (red light) and cold (blue light) sensation as well as the side effects through our accommodation to the periodic changes each day and with the season which contribute to the regulation of activity/rest cycles.