SHORTWAVE DIATHERMY

Introduction:

This deep heat modality involves the therapeutic application of high-radiofrequency electrical

Hyperemia, sedation, and analgesia are the basic physiologic effects. 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 40º 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.

APPLICATIONS

The following problems can be treated with shortwave diathermy, depending on the individual
condition of each patient and the desired treatment goals:

 Inflammation (joint or tissue)

 Pain/spasm

 Sprains/strains

 Tendinitis

 Tenosynovitis

 Bursitis

 Rheumatoid arthritis

 Periostitis

 Capsulitis
Effects of shortwave Diathermy:

The ReGear is as induction cable device where the shortwave diathermy is applied through an
induction cable, covered by a nylon garment. This type of shortwave diathermy heats tissues that
are good electrical conductors, such as blood vessels and muscle. Adipose tissue receives little
heating by induction fields because an electrical current is not actually going through the tissues.
Induction diathermy is now the most common form of shortwave unit currently being marketed.

Electromagnetic fields arise from the cable, causing ions (an atom or group of atoms that has lost
one or more electrons) to oscillate and create an eddy current ( a circular current of fluid, often
moving against the main flow). Friction caused by the movement of the ions produces heat. The
amount of heat produced depends on the amount of electromagnetic field (EMF) and the distance
between the source and type of tissues. The majority of the heat is produced near the source and
just below the fat/muscle interface. The more fat there is, the less the rate and magnitude of the
muscle heating.

High frequency electromagnetic energy (greater than 10 MHz) passing through the patient’s
body is absorbed by the tissues. The friction causes the movement of ions thus producing the
heat and its effects. Ions in the treatment field are attracted to either the positive or negative pole
on the ions. The negatively charged pole is attracted to the positive pole and the positively
charged pole is attracted to the negative pole. Some of the molecules have ions that only move
within the cell membrane, causing a dipole reaction in which the ions in the membrane align
themselves along the charges (creating eddy currents). The heating effects of the diathermy occur
as a result of friction between the moving ions and the surrounding tissues are similar to those of
therapeutic ultrasound.

Non-thermal effects

Non thermal effects include:

• Reduction of intracellular edema

• increased micro vascular perfusion

• Activation of fibroblast growth factors (leading to wound healing)

• increased macrophage activity

Thermal Effects

Thermal effects include (over the area of the diathermy drum or induction coil):

• increased extensibility of collagen fibers in tendons and joint capsules

• reduced viscosity of fluid element within the tissues

• decreased joint stiffness

• reduced muscle spasm

• diminished pain perception

• Increased metabolism

• increased blood flow

• Vasodilatation

• Relaxation

• increased membrane filtration and diffusion

• Changes in some enzyme reactions

Injury response process

The healing properties of shortwave diathermy are similar to those of other forms of heat
application, but tend to occur deep in the tissues (like ultrasound). Heating is based on the
treatment intensity, number of pulses per second and pulse width.
Inflammation

Non-thermal effects of shortwave diathermy are assumed to alter the rate of diffusion (the
random movement of molecules or ions or small particles in solution or suspension toward a
uniform distribution throughout the available volume) across the cell membrane. The thermal
effects increase the rate of metabolism. An inductive shortwave diathermy preferentially heats
tissues high in protein, such as muscle. A 10°C increase in intramuscular temperature wills
approximately double the rate of cell metabolism.

The cellular effects of shortwave diathermy in concert with increased blood flow result in
increased delivery and concentration of white blood cells. Increased cell membrane permeability
assists in the removal of cellular debris and metabolic toxins that may have collected in the area.

Blood and Fluid Dynamics

The heat produced by shortwave diathermy application results in a vasodilation that increases
blood flow, increases capillary pressure, increases oxygen perfusion and increases capillary
filtration. Due to the increased blood flow, increased fibroblastic activity. Increased collagen
deposition, and new capillary growth are stimulated deep in the tissues. The depth of effective
heating and volume of tissue affected also makes shortwave diathermy useful in the resolution of
a hematoma (localized mass of extraverted blood that is relatively or completely confined in an
organ or tissue, a space or a potential space: the blood is usually clotted and depending on how
long is has been there, may manifest various degrees of organization and decolorization).

Tissue Elasticity

Shortwave diathermy is capable of reaching temperatures over 4°C at a depth of 3cm. Tissue
elongation is established by altering the viscoelastic properties of collagen rich structures by
increasing the temperature and applying an external force (stretching or joint mobilization).
Tissues heated with shortwave diathermy obtain decay at a rate of three times slower than
thermal therapeutic ultrasound.
Single treatments of heat and stretch are not sufficient for elongating tissues, however; single
treatments of shortwave diathermy and joint mobilizations have demonstrated increased range of
motion over 10 degrees in the shoulder.

Wound healing

Shortwave diathermy increases white blood cell infiltration and increases phagocytosis
(phagocytosis is where neutrophils and macrophages engulf cellular debris left over from
inflammation. Think of it like the old Packman video game. The yellow circle-shaped guy chases
ghosts around a screen. When the little yellow guy reaches a ghost, he eats the ghost. The little
guy is the neutrofils and macrophages and the ghosts are cellular debris). This results in more
rapid healing and decreased need for pain medication.

The number and quality of mature collagen bundles are increased in the treated area, the result of
increased adenosine triphosphate* (ATP) activity, and the proportion of necrosed muscle fibers
decreases. * Adenosine triphosphate (an important source of energy for intracellular
metabolism).

Optimal heating

One source indicates that tissue temperature must be raised to a level of 40-45°C for a minimum
of 5 min for most thermal effects to occur. Evidently temperatures at 45°C or higher can cause
tissue damage. (Incidentally in our lab at BYU we have never raised deep tissue temperature
higher than 43°C.)

CONTRAINDICATIONS

 Malignancy

 Sensory loss

 Tuberculosis

 Metallic implants or foreign bodies

 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 (e.g., watches, belt buckles, jewelry)

 Use over epiphyseal areas of developing bones

 Active menses
References

1. Draper DO, Gage M: A regimen of pulsed shortwave diathermy and joint mobilizations
restore full range of motion to a patient with adhesive capsulitis: A case study. Athletic
Training & Sports Health Care. 2010,2(1),31-35 s)
2. Draper DO, Van Patten J. Induction cable diathermy and joint mobilization restore range
of motion in a post operative ACL patient. Athletic Therapy Today; 2010,15 (1) 39-
41Seiger C,
3. Draper DO. Use of Pulsed Shortwave Diathermy and Joint Mobilizations to Increase
Ankle Range of Motion in the Presence of Surgical Implanted Metal: A Case Series.
Journal of Orthopedic and Sports Physical Therapy. 2006; 36(9) 669-677.
4. Draper DO, Castel JC, Castel D. Low-Watt Pulsed Shortwave Diathermy and Metal-
Plate Fixation of the Elbow. Athletic Therapy Today. 2004; September: 27-31.
5. Draper DO, Castro J, Schulthies SS, Feland JB, Eggett D. Pulsed short-wave diathermy
and low-load, long-duration stretching increase hamstring flexibility more than low-load,
long-duration stretching alone. Journal of Orthopedic and Sports Physical Therapy. 2004;
34(1) 13-19.
6. Draper DO. Shortwave diathermy. Advance for Directors in Rehabilitation. October,
2003. [editorial review]
7. Draper DO. A winning combination: When used together, ultrasound and joint
mobilization is a powerful pair for improving range of motion. Rehab Management. Nov.
2003, 18-21. [editorial review]
8. Draper DO, Miner L, Knight KL, Ricard MD. The carry-over effects of diathermy and
stretching in developing hamstring flexibility. J Athl Train. 2002;37(1):37-42. Peres S,
9. Draper DO, Knight KL, Ricard MD: Pulsed shortwave diathermy and prolonged stretch
increases dorsiflexion range of motion more than prolonged stretch alone. J Athl Train.
2002;37(1):43-50.
10. Draper DO. Interest in diathermy heats up again. Biomechanics. 2001; 8(9):77-83.
[editorial review]
11. Draper DO, Knight K, Fukiwara T, Castel JC. Temperature change in human muscle
during and after pulsed short wave diathermy. J Ortho Sports Phys Ther. 1999; 29 (1) 13-
22.
12. Therapeutic Modalities: The Art and Science. Kenneth L. Knight & David O. Draper.
Wolters Kluwer/Lippincott Williams & Wilkins, Baltimore, MD. Published, October,
2007. 433 pages Starkey C. Therapeutic modalities (3rd Ed). F.A. Davis, Philadelphia.
2004