Dr.

BHAKTI
 Faradic currents
• Short duration interrupted direct current
• Pulse duration- 0.1-1 ms – for stimulation of
innervated muscles
• Frequency- 50-100 Hz

• The term faradism was previously used to signify

type of current produced by first faradic coil and
was unevenly alternating current with each cycle
consisting of 2 unequal phases.
• 1)Low intensity & long duration
2)high intensity & short duration

• Faradic coils have now been replaced by

electric stimulators which have same
physiological effect but differs in waveform.
 Modified faradic current (surging of
faradic type of current)
• Faradic currents are always surged for
treatment purpose.
• It produce near normal tetanic contractions
and relaxation of muscles.
• The current is surged so that the intensity of
successive impulses increase gradually, each
impulse reaching a peak value greater than
preceding one.
• Then falling either suddenly or gradually
Forms of faradic currents
• Various forms of surges are available
corresponding to the trapezoidal, triangular,
saw tooth impulses.
• The most suitable surge needed for the
particular patient must be selected.
• Accommodation:

• When a constant current flows the nerve adapts

itself, the effect is known as accommodation.
• When the current rises, the impulse is initiated
but a fall in current can also initiate an impulse.
• Because the nerve has a power of
accommodation, a current which rises or fall
suddenly is more effective in initiating an
impulse than one which changes slowly.
• Effect of nerve stimulation:

Sensory nerve – downward travelling impulse has

no effect while upward travelling impulse is
appreciated when it reaches conscious levels of
the brain
Motor nerve – upward travelling impulse unable
to pass the first synapse but downward
travelling impulse passes to the muscles causing
them to contract
Motor nerve trunk – impulses passes all muscles
supplies below the point stimulated
• Effects of frequency of stimulation:

Single stimuli – impulse pass simultaneously to a

number of motor units – sudden brisk
contraction – immediate relaxation
Succession of stimuli-each produced isolated
contraction and time for complete relaxation.
Further increases in frequencies reduces amount
of relaxation and contraction becomes tetany
• Strength of contraction:

Depends on number of motor points activated

and the rate of change of current
Intensity of current rises suddenly – no time for
accommodation
Intensity of current rises slowly – time for
accommodation (saw tooth, trapezoidal,
triangular)
 Physiological effects
1) Stimulation of sensory nerves :

• When applied to the body, mild prickling type

of sensation felt due to stimulation of sensory
nerves.
• Sensory stimulation causes reflex
vasodilatation of superficial blood vessels so
that there is slight reddening of skin.
2) Stimulation of motor nerves :

• Stimulates motor nerve and causes contraction of

muscles supplied by it.
• Stimuli are repeated for 50 times/sec, the
contraction is tetanic.
• If this type of contraction is maintained for short
period, muscle get fatigue so the current is surged
for relaxation.
• When the current is surged, the contraction
gradually increases and decreases in strength.
3) Effects of muscle contraction :

• When muscle contracts with stimulation,

there is - increased metabolism
increase in O2 demand
increase output of waste products
• Metabolites cause dilatation of capillaries and
arterioles so increase in blood supply of
muscles.
• As the muscles contract and relax they exert
pumping action on veins and lymphatic
vessels.

• If the muscle contractions are strong to cause

joint movement also exert pumping effect so
there is increased venous and lymphatic
return.
4) Stimulation of denervated muscles :
• Faradic stimulation is not used for denervated
muscles.

5) Chemical effects :
• When the current is alternating, the ions move
one way during one phase and in reverse
direction during another phase.
• The chemical changes would cause electrolyte
burns.

• If the impulses are very short duration the

chemical formation does not cause burns.
Facilitation of muscle contraction :

• When a patient unable to produce muscle contraction or

finds it difficult to do, electrical stimulation assist in voluntary
contraction.
• Muscle contraction – excitation of small efferent fibres,
which causes contraction of the intrafusal muscle fibers.
- stretching of the muscle spindle which stimulates the
primary nerve endings and therefore sends information to
the large anterior horn cells causing excitation of extrafusal
muscle fibres
- inhibition of the anterior horn cells supplying the
antagonistic muscle group
• Electrical stimulation of motor neurons reduce pain inhibition
so, facilitate transmission of voluntary impulses to muscle
and induce relaxation of antagonists.
2) Re-education of muscle action :

• Inability to contract muscle voluntarily due to long

illness or prolonged disuse, faradic stimulation is
used to produce contraction so to restore the
sense of movement.
• The brain appreciates the movements not the
muscle actions, so the current should be applied in
such a way that it causes the movement that the
patient is unable to perform.

• Active contractions should be attempted at the

same time as stimulation.
3) Training a new muscle action :

• After tendon transplantation or reconstruction

surgery, a muscle required to perform different
action.
• With faradic stimulation new action is
performed and patient can concentrate on
new movement by doing voluntary contraction
with stimulation.
4) Neuropraxia :

• Impulses from the brain are unable to pass the site

of the lesion to reach the muscles supplied by the
affected nerve. i.e. no degeneration of the nerve.
• So if it is stimulated with faradism below the site
of lesion, impulses pass to the muscles, causing
them to contract.
5) Severed motor nerve :

• Degeneration takes several days, and for a few

days after the injury a muscle contraction may
be obtained with the faradic current.

• Faradic current is used to exercise the muscles.

6) Improved venous and lymphatic drainage:
• Increased venous and lymphatic return by
pumping action of alternate muscle
contraction, relaxation and joint movement.

7) Prevention and loosening of adhesions :

• If adequate exercise is not possible, stimulation
is used for muscle contraction to stretch and
loosen the adhesions.
 Contraindications and precautions
• Cardiac pacemaker or arrhythmias
• Unconscious patients
• Recent radiotherapy
• Carotid sinus
• Pregnancy
• Early tendon transfer or repair
• Malignancy
• Infected wounds and skin lesions
• Hemorrhage
• Superficial metal
• Infections
 Cardiac pacemaker or arrhythmia:
Electrical stimulation may interfere with
functioning of the cardiac pacemaker and
could alter heart rate.
It can aggravate the unstable arrhythmia.
• Unconscious patient:
Unconscious patient can not report about
any discomfort and skin when electrical
stimulation applied to such patients may easily
leading to burn.
As the patient is unconscious the muscle
contraction if produced may increase demand
on cardio respiratory system.
• Recent radiotherapy:
The tissues are devitalized following
radiotherapy and cannot bear the stress due
to enhanced metabolic activity brought about
by the electrical stimulation.
• Carotid sinus:
Avoid placement of electrodes directly on
the anterior neck, in the areas over the carotid
sinus, as stimulation on that area may cause a
rapid fall in the blood pressure and may cause
patient faint. This is an absolute
contraindication.
• Pregnancy:
Electrical stimulation over the pelvis, low
back, abdomen and trunk should be avoided
as it carries the risk of fetal damage. This is an
absolute local contraindication.
• Early tendon transfer or repair:
Faradic stimulation in early tendon repair
can cause damage to the tendon due to strong
muscle contraction.

• Malignancy:
It may accelerate secondary metastasis
(spread). This is an absolute contraindication.
• Infected wounds and skin lesions:
There can be the chances of infection and
skin burns on these areas.

• Hemorrhage:
Electrical stimulation is contraindicated over
bleeding parts, as the muscle contractions may
lead to more bleeding.
This is an absolute local contraindication.
• Superficial metal:
Metal in the pathway of the current will
concentrate it and may cause a burn.

• Infections:
Infections must not be treated with low
frequency currents because of the danger of
spreading the infection or exacerbating the
condition.
 Technique
• Receiving patient
• Check general contraindications
– Fever
– Hypertension
– Epileptic patients
– Non co-operative patients
– Mentally retarded patients
• Check local contraindications
– Loss of sensation
– Open wounds
– Recent fractures
– Skin grafts
– Acute inflammation
– Metal implant
– Tumor
– Hypersensitive skin
• Preparation of tray :
– Mackintosh
– Lint pads
– Pad or plate electrodes, pen electrode
– Leads
– Straps
– Cotton
– Gel
– Saline water
• To stimulate group of muscles, 2 pad or plate
electrodes are used.
• To stimulate particular muscle, 1 pad or plate
and 1 pen electrode are used.
• Active electrode- smaller than inactive electrode
and should be kept on motor point.
• Inactive electrode- placed proximally on nerve
trunk or plexus.
• Motor point:
It is the point over the muscle, where the
main motor nerve enters it.

Generally this point lies at the junction of the

upper one third and lower two thirds of the
fleshy belly of the muscle.
• The plate(metal) electrode is covered with lint cloth.

• 8 layers of lint pads should be there.

• Folded evenly with no creases to avoid discomfort.

• They should be thick enough to make good contact

with tissues and with electrode and to absorb
chemicals which are formed.
• The size of the pad must be at least 1cm larger
from all the sides, than the electrodes to avoid
direct contact of electrode(metal) to the skin.

• Then soak the pads of the electrodes in the

water or saline to reduce the resistance of the
current flow.

• If rubber electrodes are used the electrode gel is

applied on the electrodes to reduce the
resistance.
• Preparation of apparatus :

 Check all the knobs should be at 0(zero).

 Check pins, plugs and switch turn off.
 Check insulation of wire.
 Check switch of stimulator is working or not.
 Check the fuse of the apparatus.
• Positioning of patient :

Patient should be in comfortable position.

Part to be treated should be exposed and should
be at adequate distance from apparatus.
Positioning of physiotherapist.
Explain to the patient about
- advantage of the treatment and
- course or duration of the treatment.
• Checking the apparatus :

Self test has to be done.

Place electrodes on palmar surface of hand or
forearm.
Switch on and gradually increase intensity.
Feel the prickling sensations.
Correct placing of the electrodes.

Switch on the machine and gradually increase

the intensity.

Ask the patient to inform to the Physiotherapist

if there is any discomfort or burning.
Termination of treatment:
As the treatment gets over ,
 Reduce the intensity to zero
 Remove the electrodes from the part
 Clean the skin again with cotton.
• Faradism can be used to obtain either a group
action or the contraction of an individual
muscle.
 Group muscle stimulation
• Stimulation which makes all the muscles of the
group work together.

• E.g. - Quadriceps muscle stimulation

• Position the patient on a plinth with the affected

knee supported in the desired degree of flexion.

• Placement of electrodes - one electrode placed

over femoral triangle and another at the motor
point.
• The patient should be encouraged to contract
the muscles voluntarily as the current is applied
and active exercises may be interspersed with
the electrotherapy.

• Once the patient can achieve a voluntary

contraction, discontinue the electrical
stimulation.
 Faradic foot bath
• Small muscles of the foot can be re-educated
and facilitated by faradic stimulation under
saline water, where foot- water bath is used,
because it is difficult to stimulate foot muscles
by motor point or group muscle stimulation as
foot has got four layers of muscles.
• Foot conditions like - Flat foot, Painful foot
conditions with the muscular causes treated
with faradic foot bath.
Preparation for faradic foot bath
• Position the patient in sitting on plinth or chair
with back well supported.
• Place the patient’s foot in the bath or plastic tray
containing warm water to cover the toes (water
level touches the medial malleolus of foot).
• To stimulate lumbricals, place 2 electrodes
transversely across the bottom of the bath i.e. one
under the heel and other obliquely under the
metatarsal heads.
• To stimulate plantar Interossei, place 1 electrode
on each side of foot at level of metatarsal shafts.
• Produce several gentle contractions to allow
the patient to become accustomed to the
current and then gradually increase the
intensity until a strong contraction is achieved.
• Encourage the patient to perform foot and
finger movements with the current.

• Abductor hallucis- place one electrode under

the heel and stimulate motor point with pen
electrode.
 Pelvic floor muscles stimulation
Indicated in prolapsed of pelvic organs and
stress incontinence.
-Vaginal electrode is used.

In male patients with incontinence after

prostectomy,
-Rectal electrode is used.
 Patient positioning in side lying with pillow between
2 legs.

 Indifferent electrode is placed over the lumbosacral

area.

 Sterilized lubricative jelly is rubbed on vaginal or

rectal electrode then inserted into vagina or rectum.
If vaginal electrode is not available then large
pad electrode is placed over urogenital area or
anal region.

These muscles are very thin and fatigue rapidly

so the duration of the treatment should be
short.
 Faradism under pressure

• Useful in reduction of edema.

• Electrical stimulation of muscles act as the

muscle pump combined with compression and
elevation of the limb to increase venous and
lymphatic return and relieve edema which is
known as Faradism under pressure.
• Position of limb in elevation so that gravity assist
venous and lymphatic return.

• Contraction of many muscles are required so place

the electrodes at the motor points of main muscle
groups involved in the muscle pump.
E.g. for lower extremity, one electrode over calf
muscles and other on plantar aspect of foot.
For upper limb, place electrodes over flexor aspect
of forearm and arm.
• Then apply elastic bandage starting distally.

• It should be firm but not tight, avoid gaps

between the turns.

• The bandage increases pressure on the vessels

when muscle contract and as muscles relax it
recoil exert pumping effect.
• The rate of contraction must be slow to allow
maximum contraction of the muscles.

• The repetition rate is slow to give time for

relaxation and to allow vessels time to refill.

• 2-3 minutes contraction followed by rest of 5

minutes.

• A total per session of up to fifteen minutes

contraction of muscles gives an overall treatment
time of approximately 35 minutes.
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