Free ebooks ==> www.Ebook777.

com

High Frequency
4 Currents

Diathermy
Diathermy is a Greek word meaning through heating.
Diathermies are of following types:
1. Short wave diathermy
2. Microwave diathermy
3. Long wave diathermy.

Short wave diathermy

Short wave diathermy (Fig. 4.1) is the use of high frequency electromagnetic waves of the
frequency between 107 and 108 Hz, and a wavelength between 30 and 3 m to generate heat
in the body tissues. It provides the deepest form of heat available to the physiotherapist.

Fig. 4.1: Short wave diathermy

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

152 Textbook of Electrotherapy

The therapeutically used frequencies and wavelengths are 27.12 MHz and 11 m
(commonly).
The less common frequencies and wavelengths are 40.68 MHz and 7.5 m and 13.56 MHz
and 22 m.

Principles
It is not possible to produce high frequency currents by some mechanical device which
produces sufficient rapid movements. This type of current can only be produced by
discharging a condenser through an inductance of low ohmic resistance. If a current of
very high frequency is required, the capacitance and inductance should be small and if a
current of low frequency is required the capacitance and inductance should be large. This
is the mechanism of production of high frequency current.

Construction
The system consists of two circuits:
1. The machine circuit
2. The patient circuit.

The machine circuit

It consist of two transformers, whose primary coils are connected to source of AC. One is
a step-down transformer and its secondary coil supplies current to the filament heating
circuit of triode valve. The other is step-up transformer and connected to Anode Circuit.
Anode circuit carries the current produced by valve. Here it consists of triode valve and
oscillator circuit (Fig. 4.2). Oscillator circuit consists of condenser (XY) and inductor or

Fig. 4.2: Circuit for short wave diathermy

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

High Frequency Currents 153

oscillator coil (CD). Current of different frequencies are obtained by selecting suitable
condensers and inductances. To produce a current of high frequency the capacitance
and inductance used must be small and is made to charge and discharge repeatedly and
for obtaining this an oscillator is incorporated in to machine circuit along with valve
circuit.
Another coil AB lie close to oscillator coil (CD) and has one end connected to the grid
of the valve and other through grid leak (GL) resistance to the filament.

The patient circuit

The patient or resonator circuit is coupled to machine circuit by a inductor coil (EF) lying
close to oscillator coil (CD) and also consist variable condenser (HK) which is usually in
parallel to patient terminal. A matching high frequency current is produced in the reso-
nator circuit by electromagnetic induction. For this to happen the oscillator and resonator
circuits must be in resonance with each other, which requires that the product of induc-
tance and capacitance must be the same for both circuits.

Working
The AC from main passes through primary coils of the transformers and EMF is induced in
secondary coils. An EMF of 20–25 volt is set-up in secondary coil of step-down transformer
and produces current through filament of the valve. The filament is heated and thermionic
emission takes place and current flows through valve.
The EMF of about 4000 volts is induced in the secondary coil of step-up transformer
and provided that anode of valve is positive and filament is negative, current flows in
anode circuit. The electrons flows from filament to anode through valve, through oscillator
coil in direction C to D and to transformer back to filament.
The electron form in CD will induce EMF in coil AB in direction that electrons
will move to grid of valve making it negative thus blocking the flow of electrons from
filament. This will lead to dying of current in anode circuit. This reduction in current
will lead to self-induced EMF. According to Lenz law, this EMF will try to prevent fall in
current by offering resistance to flow of current. This will charge condenser X (positive)
and Y (negative) polarity opposite to earlier one. Now when self-induced EMF totally
dies away, condensers again discharges through oscillator coil, but in opposite direction
(D to C).
Flow of current from D to C induce an EMF in AB such that electrons move from A to B
and grid loses its negative charge and anode current flows again. This sequence continues
and each time condenser charges and discharges through oscillator circuit leading to
production of high frequency current (SWD).
Grid Leak: When the current flows across the valve some electrons are caught on the grid
and grid leak is provided to enable these electrons to escape back to the filament.
The resonator coil (EF) lies within the varying magnetic field set-up around the oscil-
latory coil, so provided that two circuits are in resonance high frequency current is
induced in it. The current is similar to that in the oscillator circuit and is supplied to
patient.

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

154 Textbook of Electrotherapy

Methods of Applications
The transfer of electrical energy to the patient tissues occurs either by electrostatic field or
by electromagnetic field. Therefore, two methods of applications are used:
1. Condenser/capacitor field method
2. Cable method.
When short wave diathermy is applied by the condenser field method, the electrodes
and the patient’s tissues form a capacitor. The capacitance of such a capacitor depends
upon:
1. The size of electrodes
2. The distance between the electrodes
3. The tissue between the electrodes.
When short wave diathermy is applied by the cable method, the cable and the patient’s
tissue forms an inductance, the value of which varies according to its arrangement.
Consequently, either the capacitance or inductance of the patient’s circuit is varied
at each treatment, and so a variable condenser is incorporated in the patient’s circuit to
compensate for this.
Tuning of the circuit: When the electrodes are arranged in position with the patient’s body,
the capacitance of the variable capacity is adjusted until the product of inductance and
capacitance of the resonator circuit is equal to that of the oscillator circuit. Thus, when
the oscillator and the resonator circuits are in tune with each other, there is transfer of
maximum energy into the patient’s body parts.
Indications of tuning are:
1. Indicator light on the equipment either comes ‘on’ or changes its color, and attains a
specific color on tuning, generally blue.
2. An ammeter is used in the circuit to register the resonance between oscillator circuit
and resonator circuit by showing maximum deflection on turning the tuning knob.
3. A tube containing neon gas placed within the electric field between the electrodes or
the ends of the cable glows at maximum intensity when the circuits are in resonance.
Nowadays, modern machines have automatic resonator or tuners in it which automati-
cally searches for and selects the adjustment of the variable capacitor to ensure maximum
energy transfer to the patient’s body.

Capacitor field method

The electrodes are placed on each side of the part being treated. The electrodes are sepa-
rated by the skin by means of an insulating material. The electrodes act as the plates of the
capacitor, while the patient’s tissues together with the insulating material which separates
them from the electrodes for the dielectric.
When the current is applied, rapidly alternating charges are set-up on the electrodes
and gives rise to a rapidly alternating electric field between them. The electric field also
influences the material which lies within it.

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

High Frequency Currents 155

Effects of Electric Field on Conductors, Insulators and Electrolytes

As we know, conductors are the substances in which electrons can easily be displaced
form their atoms. When such a material lies within a varying electric field, there is rapid
oscillation of electrons and heat is produced.
An insulator is a substance in which the electrons are so firmly held by the central
nuclei that they cannot be easily displaced and results in the distortion of molecules when
varying electric field is applied.
An electrolyte is a substance which contains ions and when a varying electric field is
applied, the ions tends to move from one direction to the other. Electrolytes also contain
diploes which contain two oppositely charged ions, when a varying electric field is applied,
they rotate their direction. These dipoles are electrically neutral, but one end bears positive
and the other a negative charge. As a result of electric field they rotate themselves and come
in an alignment with the electrodes (Fig. 4.3).
Thus, the electric field influences the
material that lies between the plates; this
causes the oscillation of the ions, distortion
of molecules and rotation of dipoles. This
causes production of heat in the tissues by
the electric field of short wave diathermy,
which is the primary function of short
wave diathermy. The heat production is in
accordance with Joule’s law, i.e. Q = I2RT,
Fig. 4.3: Rotation of dipoles
but depends upon the distribution of the
electric field.

Effects of Electric Field on Dielectric Constants of the Body Tissues

The dielectric constants of the various tissues differ considerably. The tissues of low
impedance such as blood and muscles have higher dielectric constants. The tissues of high
impedance such as fibrous tissues and fat have low dielectric constant.
The relative arrangement of the tissues in the body coming in the pathway of electric
field affects the distribution of the lines of forces and the heat production. If the different
body tissues lie parallel to the electric field, the density of the field and thus the heat
production is greatest in the tissues of low impedance. Thus, when the field is passed
longitudinally through the limb, blood is heated most because of low impedance.
If the different body tissues lie transversely to the electric field, the density of the field and
thus the heat production is greatest in the tissues of high impedance. Thus, when the field
is passed transversely through the limb, fat is heated most because of its high impedance.
Actually, the arrangement of the tissues in the body is such that they do not offer a
true parallel or series (longitudinal or transverse) arrangement, but in fact the mixture
of the two. As the deep tissues generally lie parallel to the field, heating is less in deep
tissues. Also, the heating is more in the tissues of low impedance such as blood. Tissues
in contact with those in which heat is produced, heat are transferred by means of conduc-
tion. For example, when muscles surrounding a deeply placed joint are heated some heat
is transmitted to the joint. Also, when blood is heated in the part being treated, it provides

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

156 Textbook of Electrotherapy

the heat to other tissues like muscles, etc. and thus the heat is carried away. This helps in
prevention of overheating in the part being treated. Also it helps in heating other tissues
which are not in direct contact with the electric field. Therefore, intensity of electric field or
any other form of heat needs to be gradually increased so as to allow vasodilatation of the
vessels and to avoid overheating.
When short wave diathermy is applied by the capacitor field method the production
of heat is determined by the distribution of electric field, and it tends to be greatest in the
superficial tissues and the tissues of low impedance.
The aim is to achieve an even electric field as far as possible throughout the superficial
and deep tissues so as to obtain even heating in the tissues. To obtain desirable therapeutic
effects the selection and placement of electrodes should be proper. The selection or placement
of electrodes should be based on:
1. Type of electrodes
2. Size of electrodes
3. Spacing of electrodes
4. Positioning of electrodes.

Type of Electrodes
There are various types of electrodes. Electrodes could be pad electrodes, plate electrodes
and disk electrodes. Each electrode consists of a metal plate surrounded by some form of
insulating material.
One type of electrode consists of a thin malleable metal plate covered with a rubber
pad. This has an advantage to get moulded according to the body part. Electrodes of this
type are separated from the skin by perforated felt pad and their position is maintained
by the weight of the body. Undue pressure of the body part should be avoided as this
may crack the plate inside and may hamper the blood supply. The insulating felt pad is
perforated so that it contains a small quantity of air inside, which is preferably the best
spacing material. Thus, it has a disadvantage of not having completely air spacing between
the pad and the body.
Another type of electrode consists of a thick rigid metal plate coated with a thin
layer of insulating material made up of rubber or plastic. The property of an electric
charge is that it concentrates at the edges of a conductor than at anywhere else. Thus,
these plates are frequently convex at the edges which provide a more even electric
field than a flat disk. These plate electrodes are held at a distance from the skin by an
adjusting device, thus provides air as an insulating material which is most preferable
one (Figs 4.4A and B).
The third type of electrode is a disk type electrode. These are having a transparent
plastic cover within which a metal plate is present. These electrodes are commonly circular

Figs 4.4A and B: Electric fields produced by Flat (A) and (B) Convex electrodes

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

High Frequency Currents 157

in shape, but special shapes can be used for irregular areas. The position of metal plate
inside the disk can be adjusted. It is advisable to leave small gap between the cover and the
skin to allow for the better circulation of the air.

Size of Electrodes
1. If the two electrodes are of different sizes, they will behave as a capacitor of different
sized plates. The different quantities of electricity are required to charge them to the
same potential. This puts an uneven load to the machine. The charge will concentrate
on the part of larger electrode which lies opposite to the smaller electrode (Fig. 4.5).

Fig. 4.5: Electrodes of different sizes

2. If the electrodes are little larger than the area treated, the outer part where the spread is
greatest is deliberately not utilized. The part of the body to be heated lies in the central
part of the field, which is more even. For treatment of the limbs, the electrodes should
be larger than the diameter of the limbs and for trunk and back electrodes should be as
large as possible (Fig. 4.6).

Fig. 4.6: Correct size of electrodes

3. If the diameter of the electrodes is smaller than that of the limbs, the lines of forces
spread in the tissues, causing more heating of the superficial than of deep structures
(Fig. 4.7).

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

158 Textbook of Electrotherapy

Fig. 4.7: Smaller electrodes

4. If the diameter of the electrodes is far larger than that of the diameter of the limb, some
of the lines of force bypass it completely and thus results in wastage of energy (Fig. 4.8).
Thus, as a general rule the electrodes should be equal in size and slightly larger than
the area to be treated.

Fig. 4.8: Electrodes too large

Spacing of Electrodes
1. If the distance between the plates is small and the material between them is of high
dielectric constant, the lines of forces spread as they pass between the plates of a
charged condenser (Fig. 4.9).

Fig. 4.9: Distance too small

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

High Frequency Currents 159

2. When the distance between the electrodes is large, the spreading out of the electric
field is minimal, while the use of spacing material of a low dielectric constant also
limits the spread of the field (Fig. 4.10).

Fig. 4.10: Adequate distance

3. When the electrode spacing is narrow, the superficial tissue lies in the concentrated
part of the field close to the electrode are thus heated more than the deep tissues,
where density of the field is less (Fig. 4.11).

Fig. 4.11: Electrodes closer to the body

4. If the two electrodes are placed at an unequal distance from the body, the one electrode
is placed nearer to the body than the other then there is a greater heating effect under
the closer electrode than under the farther one. The lines of force under the farther
electrode have a greater distance in which to spread before reaching the body than
those under the nearer one. They therefore cover a greater area of skin and their
density is less than under the nearer electrodes (Fig. 4.12).

Fig. 4.12: Electrodes at uneven distance

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

160 Textbook of Electrotherapy

If the distance between two electrodes is less than the width of two pads, then the lines
of force will travel through pads only and do not produce heat in the body tissues (Fig. 4.13).

Fig. 4.13: Spacing between two electrodes

Thus, the spacing between the electrodes and the patients body tissues should be as
wide as possible as the machine allows and the material between the electrodes and skin
should be of low dielectric constant, air being the most preferable one.

Positioning of the Electrodes

The positioning of electrodes is different for different structures to be treated. It depends
upon the impedance of the structures and line of electric field. If the structures are of high
impedance (fat and white fibrous tissue) the electrodes should be arranged in such a way
that different tissues lies in series with each other, i.e. at right angles to electric field. If the
structures are of low impedance (blood and muscles), the electrodes should be arranged in
such a way that different tissues lies in parallel with each other and with the electric field.
When treatment is to be given to the ankle joint, the electrodes should be placed on the
medial and lateral sides, so that tissues lie in series with each other and heating the joint
is obtained. If the electrodes are placed longitudinally, tissues lie parallel to the field and
heating of blood vessels and muscles is obtained. In injuries of soft tissues, longitudinal
method may be used, where soft tissues need heating.
Common positioning of electrodes used are:
1. Coplanar positioning of electrodes
2. Contraplanar positioning of electrodes
3. Monopolar method
4. Crossfire technique.
1. Coplanar positioning of electrodes: This method is used over larger area of the body, e.g.
spine and is also called parallel method of placement. It is important that the distance
between the electrodes should be more than the total width of spacing otherwise
electric field will not pass through the tissues at all and will pass directly between the
electrodes (Figs 4.14A and B).

Figs 4.14A and B: Coplanar arrangement of electrodes:

(A) Correct spacing and (B) incorrect spacing

This method is particularly suitable for the superficial structures.

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

High Frequency Currents 161

2. Contraplanar positioning of electrodes: This method is used for those structures where
through and through heating is required, e.g. hip, shoulder joint. The electrodes are
placed over the opposite aspects of the limb or joint, i.e. medial and lateral aspect or
anterior or posterior aspect.
This method is particularly suitable for the deeper structures or tissues.
3. Monopolar method: Only one electrode is placed over the treatment area and other
electrode is placed at a distance site or is not used at all. The electrode used produces
a radial electric field (Fig. 4.15).

Fig. 4.15: Monopolar electrode with radial effect

The density of electric field becomes less as the distance from the electrode increases
and thus the heating is superficial.
4. Crossfire technique: In this technique, half of the treatment is given with the placement
of electrodes in one direction, i.e. medial or lateral aspect and another half is used
with the placement of electrodes in other direction, i.e. anterior or posterior aspect.
This method is commonly used for the treatment of the knee joint, sinuses (frontal,
maxillary and ethmoidal) and for pelvic organs (Fig. 4.16).

Fig. 4.16: Crossfire technique for sinus

Cable method or inductothermy

In this method, a thick insulated cable is used for treatment purposes. Electric field or
magnetic field or both are achieved by the use of cable method. When the high frequency
current oscillates in the cable, a varying electrostatic field is set up between its ends and a
varying magnetic field around its center. The cable is coiled around the patient’s body and
is separated from the patient’s body by a layer of insulating material.

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

162 Textbook of Electrotherapy

The electrostatic field: Electrostatic field is produced at the end of the cable and the effects
are similar when the current is applied by a condenser method. The heating is more in
superficial tissues and those of low impedance, also some heating is obtained in deeply
placed structures of high impedance if suitable placing is done.
The magnetic field: The magnetic field varies as the current oscillates and an emf is
produced by electromagnetic induction. If the conductor is a solid piece of conducting
material, the emf gives rise to eddy currents. Such currents are produced specially in the
tissues which lie close to the center of the cable. The eddy currents produce heat and their
effect confines only to the tissues of low impedance, thus heating of fat and white fibrous
tissue is avoided. The currents are produced primarily near the surface of the conductor,
where the magnetic field is strongest and the superficial tissues are heated most. Some heat
is transferred to adjacent tissues by conduction and by the circulation of blood, but the
heating effect is primarily on superficial tissues of low impedance.
Effect of Relative Fields: If the cable is coiled around the material of high impedance the
electric field predominates, while the current produced by the electromagnetic induction
are strongest when the material around which the cable is of low impedance. Thus, when
treating an area of high impedance, particularly if deep heating is required, the electric field
between the ends of the cable is utilized in preference to the magnetic field at its center.
When treating an area of low impedance, particularly if superficial heating is required,
the eddy currents set up by the magnetic field at the center of the cable are utilized in
preference to the electric field. Alternatively, both the effects can be utilized at the same
time; if the whole cable is arranged in relationship to the patient’s tissues, an electric field
is set up between its ends and eddy currents near its center.
For treatment of the limbs, the cable is coiled around the part. If the area is large, e.g.
the whole of a limb all the cable is used and both electrostatic and electromagnetic fields
are utilized. When treating the smaller area the whole of the cable may not be required;
either the ends or the center may be used, according to the depth of the heating required
and the impedance of the tissues. If the area is of high impedance the electrostatic field
between the ends of the cable is most effective, e.g. for the knee joint, two turns may be
made with each end of the cable, which lies above and below the joint. When treating
two joints both shoulders, a few turns may be made with one end of the cable round one
joint and a similar arrangement of the other end around the other joint. If the area to be
treated is of low impedance, e.g. muscles and blood the eddy currents produce satisfactory
heating so the center of the cable is used.
To treat a flat surface’ like back, the cable can be arranged in a flat helix, two helices can
also be made from its ends, or a grid arrangement may be used. With the grid the magnetic
field is complex and does not penetrate deeply into the tissues, so heating is mainly by the
electric field, but with the other two methods the tissues are heated with eddy currents.
This flow at right angles to the magnetic lines of forces and the heating produced by a
single helix is therefore in the form of a hollow ring in the tissues lying under the coil.

Advantages of cable method

The cable method is useful:
1. for the treatment of an extensive area which could not be included between the
condenser electrodes.

www.Ebook777.com
 Free ebooks ==> www.Ebook777.com

High Frequency Currents 163

2. when the area is irregular.

3. when it is desirable to avoid heating of the subcutaneous fat.

Disadvantage of cable method

The impossibility of using air spacing:
Monode electrode: The main benefit of using a monode electrode is that it uses air spacing.
The monode works on the principle of a cable. It consists of a flat helix of a thick wire
mounted on a rigid support, a condenser is lying parallel with the coil making it possible
to use shorter length of wire than that required for the cable. Heating is produced by the
eddy currents.

Dosage
The treatment dosage should have an intensity that causes sufficient warmth (thermal
dosage) of the tissues and the duration of the treatment should be 20–30 minutes. The
treatment may be given daily or on an alternate day.
As a general rule, for the treatment of acute inflammation or any recent injury the
intensity of the treatment should be less but it should be carried out more frequently, i.e.
twice daily. The current used may be that which produces mild warmth (midthermal)
and may be reduced to the point at which no warmth is felt (subthermal or athermal). The
duration of treatment is reduced to 5–10 minutes.

Physiological Effects of Heating the Tissues

The principal effect of short wave diathermy to the body is heating of tissues. This is the
modality which provides deepest heating of the tissues. The main physiological effects
due to heating of the body tissues are:
1. Effects on metabolism of the body
2. Effects due to increased blood supply
3. Effects of heat on the nervous tissues
4. Effects of heat on the muscular tissue
5. Effects of heat on the sweat glands.

Effects on metabolism of the body

As the Van’t Hoff’s statement states that ‘any chemical change which is capable of
being accelerated is accelerated by the rise in temperature’. Therefore, all the chemical
changes of the body that can be accelerated are accelerated by heat. The metabolism of
the body itself is accelerated. Both the anabolism as well as catabolism is enhanced. The
oxygen supply to the tissues is increased, removal of waste products is enhanced, the
nutritional supply to the tissues is increased and thus the healing of damaged tissues is
accelerated.

www.Ebook777.com