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Therapeutic Effects of Low

Frequency Currents on
Tissues
Lecture IV
Dr. Amal Hassan Mohammed Ibrahim
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OBJECTIVES
Review on the difference
between high, medium, and low
frequency currents and their
therapeutic/clinical implications
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OBJECTIVES
Enumerate the characteristics of
the three types of low/medium
frequency currents
Formulate guidelines in the
selection and/or prescription of
the most appropriate
(low/medium frequency current)
electrical modality
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OBJECTIVES
Know the main therapeutic effects
of low and medium frequency
currents used by physiotherapists
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A review on the differences
High Frequency Currents
Medium Frequency
Currents
Low Frequency Currents
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HIGH FREQUENCY CURRENTS
Frequency is >6000 H
Short wavelengths (<10 mm)
Effects occur only at superficial
structures
General effect = HEATING
Sample modalities:
US, MWD, SWD, IRR, UVR, LASER

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MEDIUM and LOW FREQUENCY
CURRENTS
Frequency ranges from 1 to 6000
Hz
Longer wavelengths (>10 mm)
Effects occur at deeper
structures
General effects:
MFC: blocks pain
LFC: nerve stimulation

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MEDIUM and LOW FREQUENCY
CURRENTS
Sample modalities:
Electrical stimulators,
Diadynamics, Biofeedback,
Iontophoresis, TENS, IF, Faradic
and HVPGS
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Therapeutic Effects of Low
Frequency Currents on
Tissues
When therapeutic low frequency electric
pulses passed through tissues there are some
effects on the excitable tissues (nerves and
muscles) and on the non excitable tissues
(cellular level).
The Effects of Low Frequency Currents
on The Excitable Tissues



Pain is an unpleasant subjective feeling can
be ranged from mild irritation to severe
intolerable pain that can be beyond
endurance.
The sensory receptors (nociceptors) are
responsible for painful stimuli which are free
nerve endings found in almost all types of
body tissues.

Why feel pain?
Gives conscious awareness of tissue
damage
Protection:
Remove body from danger
Promote healing by preventing further
damage
Avoid noxious stimuli
Elicits behavioral and emotional responses



Nociceptors
Nociceptors are special receptors that respond
only to noxious stimuli and generate nerve
impulses which the brain interprets as "pain".


1- Modifying pain perception in the
central nervous system.
The nociceptors are of two afferent types:
Small diameter myelinated nerve fiber, A
delta (A ) which is responsible for sharp,
pricking, acute, and fast pain.
Small diameter non-myelinated nerve fiber (C
fiber) which is responsible for dull, throbbing,
burning, chronic, and slow pain.

1- Modifying pain perception in the
central nervous system
Both of nociceptors are responding to a
variety of stimuli (mechanical, thermal, and
chemical) that can damage tissues.
The activated nociceptors and damaged
tissues release some chemical mediators like
substance P, histamine, bradykinin, serotonin
and prostaglandins.

Central Pathway of Pain
Both group A and C
afferent neurons are
found in the dorsal
root ganglia and enter
the spinal cord via the
dorsal root except
30% of C fibers which
return to the
peripheral nerve and
enter the cord via the
ventral root.
Central Pathway of Pain
C fibers synapse in
lamina I and II and A
fibers in lamina I and V
of the substantia
gelatinosa (SG).
Some of the axons end
in the spinal cord and
brain stem.

Central Pathway of Pain
The rest ascend in the
antrolateral funiculus,
including the lateral
spinothalamic tract, and a
few in the postrolateral
section of the cord. Some
of the ascending fibers go
to the thalamus and then
to the post-central gyrus
and other parts of the
cortex.
Central Pathway of
Pain
Many go to the
reticular formation,
while others go to
the hypothalamus
and the
periaqueductal grey
matter. The synaptic
transmitter of the
primary afferent pain
fibers is substance P
Control of pain by electrical
stimulation
The modulation of pain transmission
by altering afferent input to the
spinal cord is known as the gate-
control theory, which was
established by Melzack and Wall in
1965.

Control of pain by electrical
stimulation
Electrical stimulation
with current of high
frequency (100-
200Hz) and low
intensity will
stimulate large
mechanoreceptors
fibers found on the
skin.
Control of pain by electrical
stimulation
These low threshold
mechanoreceptors (A) pass
up in the posterior column of
the spinal cord without
synapse and give collaterals
to the A and C fibers in
lamine I and II of the
posterior horn. It is believed
that stimulation of A inhibit
the excitability of the A and
C fibers through pre-synaptic
inhibition.
Control of pain by electrical
stimulation
Electrical stimulation
with high intensity low
frequency current will
stimulate A which
connect with
interneuron in the
substantia gelatinosa
(lamina II) and stimulate
it to release morphine
like substance
(encephalin and
endorphin).
Control of pain by electrical
stimulation
This encephalin
produced by
interneuron in the
posterior horn will
damp down C fibers
to inhibit it. This is
reputed to be the
mechanism by which
acupuncture works.
Control of pain by
electrical stimulation
Stimulation by high
intensity low
frequency current of
A fibers may
provoke impulses in
the midbrain then
travel back down the
spinal cord to inhibit
nociceptors neurons
at the original level.
Control of pain by
electrical stimulation
This system also
generates encephalin in
the substantia gelatinosa.
The A in the
spinothalamic tract gives
off collateral branches to
the periaqueductal grey
matter in the midbrain.
Descending neurons from
this region use serotonin
as neuro transmetter.
2- Electrical stimulation of innervated
muscles
Before discussing the difference between
voluntary contraction and contraction by
using electrical stimulation we must know
some scientific facts:
- There are two types of muscle fibers have
these characteristics
2- Electrical stimulation of innervated
muscles
Types of muscle fibers.

Muscle type Type I Type II
2- Electrical stimulation of innervated
muscles
The structure of living muscle is variable.
There is a balance between synthesis and
breakdown of muscle proteins (about 10% of
muscle fibers). These process occurring at
higher rate in type I slow twitch than in type II
fast twitch.
More anabolic than catabolic will lead to
muscle hypertrophy.
More catabolic than anabolic lead to muscle
atrophy.
2- Electrical stimulation of innervated
muscles
An individual muscle
is made up of many
motor units of
different types, giving
the muscle its
particular
characteristics.
- Motor unit is
consists of an anterior
horn cell, alpha motor
neuron and all muscle
fibers it supplies.
2- Electrical stimulation of innervated
muscles


- The number of muscle
fibers supplied by motor
neuron varies according
to the function of the
muscle (fine movements
like eye movement
needs few numbers
while postural muscles
need large number).
2- Electrical stimulation of innervated
muscles
All the muscle fibers
supplied by one
motor unit are of the
same type that
means each motor
neuron supplies
group of muscle
fibers of the same
type.

2- Electrical stimulation of innervated
muscles

- During voluntary contraction of muscle there
is smooth contraction due to asynchronous
firing of motor neuron.
- Force of contraction is graded by an increase
in the number of motor unit recruited (spatial
summation) and increase in frequency of
nerve impulse (temporal summation).
2- Electrical stimulation of innervated
muscles
Electrical stimulation to produce muscle
contraction is differing from voluntary
contraction in these points:
- Synchronous firing of all motor neurons
stimulated.
- Large diameter motor neurons (type II) are
stimulated first.
- The frequency of firing is fixed unlike voluntary
contraction.
- Sensory nerves are inevitably stimulated.
2- Electrical stimulation of innervated
muscles
Electrical stimulation of muscle through motor
nerve will lead to rapid muscle fatigue due to
fixed stimulated number of motor units and
stimulation of type II fast muscle fibers first.
- The degree and duration of muscle fatigue is
directly related to the extent of the electrical
stimulation.
Uses of electrical stimulation for
innervated muscle
Strength muscles as shown by Hon Sun Lai et
al. (1988) that electrical stimulation of
muscles for 3 weeks gain more muscle
strength in group treated with high intensity
current than other group treated with low
intensity current. The force of isometric
contraction showed greater gain than that of
concentric contraction. Eccentric contraction
showed no significant gain.
Uses of electrical stimulation for
innervated muscle
Reduce of muscle atrophy by maintenance of
protein synthesis in muscle rather than
preventing protein breakdown in cases of
inhibited muscle contraction due to pain (as to
stimulate quadriceps muscle after knee injury
or surgery) or during splinting to maintain
muscle power.
Uses of electrical stimulation for
innervated muscle
Stimulation of muscles very difficult to be
under voluntary control like pelvic floor
muscles and lumbricals in postural flatfoot.
Stimulation of muscle or motor nerve has
been transplanted to new action.
Later stage of recovery of peripheral nerve
lesion.
For hysterical paralysis.
Uses of electrical stimulation for
innervated muscle
In cerebral palsy to enhance muscle contraction.
Increase ranges of motion by stretch shorten and
contracture muscles as in cases of hemiplegia and
scoliosis.
Electrical stimulation of innervated muscle will lead to
increase metabolism and blood flow (increase oxygen
uptake, carbon dioxide, lactic acid, and local
temperature).
Increasing muscle contraction by electrical stimulation will
lead to increase venous return and lymphatic flow which
help in reducing odema.
Uses of electrical stimulation for
innervated muscle
Increasing muscle contraction by electrical stimulation
will lead to increase venous return and lymphatic flow
which help in reducing oedema.
Electrical stimulation to reduce spasticity by
stimulating agonist muscle or antagonist or alternating
approach to stimulate agonist and antagonist.
The most current used for stimulation of innervated
muscle is faradic current or similar electrical pulses
applied to cause muscle contraction.
Uses of electrical stimulation for
innervated muscle
Use of electrical stimulation for long term to
change the contractile properties of the
muscle fiber (convert fast twitch muscle
fibers to slow twitch muscle fiber in animals
by using of low frequency current). The
changes started in the muscle membrane and
capillary circulation and completed with
exchange of fast to slow type myosin.
Uses of electrical stimulation for
innervated muscle
These effect have also demonstrated in
humans by Scott et al., 1985, by using low
frequency current (10 Hz) to stimulate
popliteal nerve, for one hour three times
daily for 6 weeks at a sufficient intensity to
give visible contraction of the tibialis
anterior. This lead to significant increase in
resistance to fatigue suggesting a change in
the properties of type II muscle fibers.
Uses of electrical stimulation for
innervated muscle
Eutrophic electrotherapy is the record of
frequencies of the motor unit action
potential by electromyogram and used to
determine the frequency of the muscle to
improve the functional ability. Eutrophic
electrotherapy used in Bells palsy and
applied to quadriceps muscles of elderly
subjects with disuse atrophy.
3- Electrical stimulation of denervated
muscle
When muscle is denervated many structural
and functional changes occur like loss of
voluntary and reflex activity, atrophy,
degeneration and fibrosis. In addition to these
changes fibrillation and spontaneous
contraction occur.
3- Electrical stimulation of denervated
muscle
There are many differences between electrical
stimulation of innervated and electrical
stimulation of denervated muscles including:
- Denervated muscle contract due to direct
stimulation of the muscle fibers because there
is no nerve supply.
- Muscle tissue is less excitable than nerve so
that more electric charge is needed.
3- Electrical stimulation of denervated
muscle
Current with sufficient pulse duration (more
than 30 ms) and appropriate intensity in a
square wave form is suitable for stimulation of
denervated muscle.
- Pulses with short duration need more
intensity to provoke muscle contraction
(strength duration curve).
3- Electrical stimulation of denervated
muscle

The rate of contraction and relaxation of
denervated muscle is slower than
innervated muscle. The contraction of
denervated muscle by using electrical
stimulation is called worm-like
contraction.
3- Electrical stimulation of denervated
muscle
Muscle fibers have less ability to accommodate than
nerve (nerve accommodation is due to slow rising
pulses which provide slow ionic changes), so that
slow changes can stimulate muscle fibers by means
of slow rising triangular pulses.
- Electrical stimulation for denervated muscle
maintain it healthy as possible as we can (used as
artificial exercises until reinnervation occur).
Questions????????