1. USING THERAPEUTIC MODALITIES Electrotherapy

2. ELECTROTHERAPY Electrical current String of electrons that pass along a conductor Intensity of current = WATTS (amps x volts) Threshold for Depolarization (first -> last) Sensory, motor, pain

3. ELECTROTHERAPY UNITS Transcutaneous Electrical Nerve Stimulators (TENS) Stimulate peripheral nerves Neuromuscular Electrical Stimulator (NMES) Electrical current stimulates the muscle directly Microcurrent Electrical Stimulators (MENS)/Low Intensity Stimulator (LIS) Use currents too small to excite peripheral nerves

4. CURRENTS Monophasic (DC) Direct current Used for pain modulation, muscle contraction or to produce movement Biphasic (AC) Direction of the current flow reverses once during each cycle Used for pain modulation, muscle contraction Polyphasic (Pulsatile) Contains three or more pulses grouped together with a short interruption period repeated at regular intervals

5. CURRENTS Modulation Ability of the E-Stim unit to change magnitude or duration of the waveform Continuous, surged, interrupted Intensity Voltage output of stim unit Increased intensity = increased depth of penetration Pulse duration Length of time the current is flowing Frequency Number of waveforms emitted over the course of a second

6. INDICATIONS Pain modulation Gate control – decreased pain during stimulation Descending pain control – intense stimulation of small fibers at trigger points cause stimulation of descending neurons which interrupts pain signal at the spinal cord Opiate Pain Control – stimulation releases beta endorphins from the pituitary gland Muscle contraction Muscle pumping- circulation is stimulated by pumping fluid and blood through the venous and lymphatic channels back to the heart Muscle strengthening – high frequency current creates a muscle contraction, this should be combines with maximal active contractions Muscle reeducation – athlete will watch and feel the contraction and attempt an active contraction