1. Deep Heat Ultrasound & Diathermy

2. Frequency 3MHz 0-1cm 2 MHz 1-2 cm 1 MHz 2-3 cm 3 MHz 2 MHz 1MHz .5 cm
Bone

3. Transducer: Choose an area that is an appropriate size
no greater than 1.5 to 2 times the ERA
Speed of rotation will vary the heat

4. Therapeutic Applications

5. US Application Time
Continuous: A duty factor of 100% is needed to elevate tissue temperature to physiologically significant temperature ( degrees F)
This results in a reduction of pain and muscle spasm as well as an increase in tissue extensibility and increase blood flow.
Pulsing: the sound wave will decrease the depth of US delivery
Current machines have % pulsed, thus you can modify depth of delivery

6. Application Techniques
Coupling Medium: US energy will not pass through the air or skin without the presence of a coupling medium. The ideal coupling medium should have the following qualities:
High transmission and low absorption of US energy
Exclude air, minimal air entrapment
good impedance
low drag coefficient
good viscosity
low salt content
economical cost
easy to use

7. Coupling Agents Gel Water Immersion
Bladder Method (water filled balloon)
Phonophoresis

8. Application Techniques
The best medium is aqueous gel (different from electrical stim. gel)
Water meets all of the criteria, good for irregular or small body parts (aqueous gels are mainly water)
Biofreeze or Flex-all does not allow as great a healing effect
Phonophoresis “jury still out”

9. Water Immersion Bath
Use room temperature degassed water in a plastic treatment tub
Do not use in a metal tank!
The transducer should be applied in a moving technique as close as possible, but still remaining perpendicular to the treatment area.
Precaution is advised when immersing the clinician’s hand into the water bath during treatment or when removing bubbles from the transducer's face since the dangers of long term exposure to US are not known at this time.

10. Stretching Stretching window is 3 minutes
After 3 minutes the tissues temperature drops past tissue extensibility

11. PreHeating Preheating should be a decision based on patient comfort
Research indicates that pre heating (HP, emersion) increased superficial heat temperatures significantly
Deep tissues are unaffected

12. PreCooling
Research has indicated that precooling retard increase of heat in the tissue
Cooling may also anesthetize the area limiting sensation

13. Diathermy

14. Diathermy
Uses energy similar to broadcast radio waves with shorter wavelength.
Energy is alternating current lacking properties to depolarize motor sensory nerves
Fiction caused by the movement6 of ions from the High Frequency electromagnetic energy causes heating

15. Diathermy
Tissues with high water content (Fat, blood and muscle) are selectively heated at depth of 2-5cm.
Local tissue temp. may reach 107ºF, but fat layer dissipated heat secondarily heating muscles
Deep heating effects last longer than US due to large area heated

16. Delivery of Diathermy Pulsed Continuous Acute and subacute conditions
heating related to rations of time “on” and “off”
Heating occurs when total amount of energy delivered is greater than 38 watts, below this receive non-thermal effects
Continuous
Mainly used
For chronic injuries

17. Effect on Injury Response
Response similar to effects of heat
Skin temp raises 4.3ºF
Intra-articular temp raises 2.5 ºF
Blood flow increases
fibroblastic activity, collage deposition and new capillary growth stimulated
muscle spasm is resuced by sedation of sensory and motor nerves
local increase in cellular metabolic rate

18. Set-up and Application of Diathermy
Condenser and Induction Method will be demonstrated in lab
General Prep.
No metal (including removal of all rings, watches, hairpins etc.)
Cover area with terrycloth towel to eliminate sweat
Explain to patient warmth should be felt, but no unusual sensations

19. Diathermy Set-up Duration of Tx Indications 20-30 minutes 2 weeks
when using higher tx temp, decrease the duration of tx and apply on alternate days
Indications
Joint Inflammation
Larger areas than US
Fibrosis
Myositis
Subactue and Chronic Inflam.
Oasteoarthritis

20. Diathermy Precautions
Physician's Prescription (some states)
Never allow cables to touch (short circuit)
Do not allow for perspiration
Never allow direct contact with skin
Excessive fat in area may overheat area
Difficult to tx localized areas
Overheating tissues may cause damage
deep acing
fat neurosis
burning

21. Diathermy Contraindications
Sensory loss
Pregnancy
Cardiac pacemakers
Areas of particular sensitivity
epiphyseal plates
genitals
infection
abdomen
eyes and face
Ischemic Areas
Peripheral vascular disease
Metal Implants
Perspiration
Tendency to hemorrage including menstration
Cancer
Fever

22. Dosage Parameters