PART FOUR: Electrotherapy
So I feel like this mini series is maybe turning into a maxi series and dragging out for some time. Apologies for that, but I think its good for everyone to have a good understanding of what therapies are available. Further apologies for the delay in getting this out too, it seems to have been mega busy lately - not complaining but there's defiantly been less time for social media-ing!
So onto the next. . .Electrotherapy. I'd like to start by stating there are many many electrotherapies available to us, some more beneficial than others. In todays blog I'm really just going to cover the modalities that I chose to use. That's not to say others aren't good, but just that I don't have them available to me at the moment.
Here I will cover the following;
1. Neuromuscular stimulation (NMS)
2. Transcutaneous Electrical Nerve stimulation (TENS)
3. BioMag Magnetic therapy / Low-frequency pulsed electro-magnetic fields (PEMF)
4. LASER Class 3b therapy.
Neuromuscular stimulation (NMS)
Electrical stimulation can be used for both innervated muscle (normal muscle) and for functional electrical stimulation (FES) whereby a movement may not otherwise be possible due to nerve injury. For example in horses; Swenny (injury to the subscapular nerve).
NMS for innervated muscle could include strengthening of normal muscle (often whilst working against normal movement e.g. the NMS is producing a contraction whilst you are trying to induce lengthening of the muscle. It can also be used post surgery, for re-education of muscle control and maintaining or increasing joint range of movement. It works by stimulating the motor nerves to obtain a muscle contraction.
To stimulate a denervated muscle direct stimulation of the muscle fibres is required. Therefore a higher electrical charges necessary due to reduced excitability by comparison to motor nerves. We need to aim to maintain a contraction to increase muscle strength and fatigue resistance.
For me I mostly use it on small animals post surgery with or without nerve injury. For horses I mostly use for range of movement, particularly round the lumbosacral junction.
Transcutaneous Nerve Stimulation (TENS)
TENS is a second form of electrical stimulation and can be used effectively for pain relief. Two types of pain receptors known as nociceptors, exist in the skin. The first are fast nerve fibres known as the A- δ fibres. These respond to strong mechanical stimulation such as a sharp prick, the second are C-fibres, these give the sensation of deep aching pain, such as a headache and are much slower to respond. These two types of pain cannot be felt at the same time. This can explain why pressing your temples helps to relive a headache, whilst there is still pain relief is felt due to the different type of pain. This is known as the pain-gate theory.
TENS works by stimulating this pain response. A sharp tingling sensation replaces the deep pain sensation, thus relieving the pain Studies have shown that this pain relief can last up to 30mins. It can therefore be useful in cases where it is pain relief is required to build strength and stamina in order to reverse the pain cycle (see previous blogs)
BioMag Magnetic Therapy / Low frequency pulsed magnetic fields.
Magnets have been used for centuries to help relive pain. . .be careful though, many of the cheaper rugs boots etc are no stronger then the earths magnetic field (0.5G (or 0.05mT)), so in actual fact have no effect whatsoever. You really want to be used a pulsed magnetic field in order to create the best effects.
The theory is that the magnetic field affects the signal transduction pathway, ion binding and ion transport. Ca ++ binds to CaM (calmodulin). Myosin light chain kinase (MYLK or MLCK) is an enzyme strongly associated with muscle activity, calmodulin activates this enzyme, so if the magnetic field effect increases Ca++ ion transport, resulting in a change of calmodulin activity, and thus an alteration of enzyme activity, a potential chain reaction linking therapy to biological effect can be recognised. MIND BLOWN! Check out Tim Watsons website for more on this theory . .http://www.electrotherapy.org/modality/magnetic-therapy
I mostly use it for pain relief, particularly if a horse is very sore over it lumber/SIJ region, I find the muscle appears to relax allowing deeper hand on work to be completed after a 15min session. I have also used it on arthritic joints such as hock spavins/DJD to good effect and it can also be used for bone healing such as fractures and splints as well as for wound healing and swelling.
I use a Class 3b Omega LASER, also known as PhotoBioModulation (PBM). It works by stimulating the body's natural healing mechanisms Although there is ongoing research into the exact process three key effects have been identified.
1. Healing growth factor response through:
Increased ATP and protein synthesis
Improved cell proliferation
Change in cell permability to calcium up-take
2.Pain Relief through
Increased endorphin release
Suppression of nociceptor action
3. Immune system support through
Increasing levels of lymphocyte activity
Photomodulation of blood.
It can therefore have a number of uses with equine and canine physiotherapy. For equine I primary use it for pain relief, where it can be beneficial to first ease muscle tension prior to hands on mobilisation (see previous blog post). However I have also used it successfully in the treatment of specific injuries such as tendinopathies, post surgery such as interspinous ligament desmotomies (for kissing spine) and wound healing. For canine I primarily use it for pain associated with osteoarthritis or post surgery.
With all the above electrotherapies I believe that they cannot be used effectively as a stand alone treatment. For me they are all adjuncts to a rehabilitation program specifically tailored to the horse or dog in front of me. The settings that I use with each one will be very dependent upon the findings of my assessment and the horse or dogs tolerance to the treatment.
If you would like any further information on any of the electrotherapies discussed please do not hesitate to contact me. I have also put in some useful website references below.