Shortwave and Microwave

Diathermy

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 Diathermy
• Application of High-Frequency
Electromagnetic Energy
• Used To Generate Heat In Body Tissues
• Heat Produced By Resistance of Tissues
• Also Used For Non-Thermal Effects

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 Physiologic Responses To
Diathermy
• Not Capable of Producing Depolarization and
Contraction of Muscles
– Wavelengths Too Short

3
 Physiologic Responses To
Diathermy
• Physiologic Effects Are Those of Heat In General
– Tissue Temperature Increase
– Increased Blood Flow (Vasodilation)
– Increased Venous and Lymphatic Flow
– Increased Metabolism
– Changes In Physical Properties of Tissues
– Muscle Relaxation
– Analgesia

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 Diathermy Heating
• Doses Are Not Precisely Controlled Thus
The Amount of Heating Cannot Be
Accurately Measured
– Basically means amount of heating patient
receives cannot be directly measured
• Heating= Current2 X Resistance

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 Non-Thermal Effects
• Pulsed SWD Used To Treat Soft Tissue Injuries and
Wounds
• Related To Depolarization of Damaged Cells
– Loss of Cell Division
– Loss of Proliferation
– Loss of Regenerative capabilities
• Repolarization Corrects Cell Dysfunction
• Generates A Magnetic Field To Increase Na Pump
Activity

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SWD Physiological Events Summary
Electromagnetic Radiation

CSWD PSWD

Electromag. Energy absorption

Incr. molecular KE cell ion-binding properties, protein

synthesis, ATP production

Thermal Effect Athermal Effect

Increased cell metabolism and function

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Enhanced soft-tissue healing
 Shortwave Diathermy
• Radio Transmitter With FCC Assigned
Frequencies
– 27.12 MHz at 11 M
– 13.56 MHz at 22 M
– 40.68 MHz at 7.5 M

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 Shortwave Diathermy Unit
• Power Supply Powers Radio Frequency
Oscillator (RFO)
• RFO Provides Stable Drift-Free Oscillations at
Given Frequency
• Power Amplifier Generate Power To Drive
Electrodes
• Output Resonant Tank Tunes In The Patient
for Maximum Power Transfer
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 Possible Shortwave Diathermy Unit

• A=Power Switch
• B=Timer
• C=Power Meter(monitors current from power supply not current entering patient-volume
control)
• D=Output Intensity(%max power to patient)
• E=Tuning Control(tunes output from RFO)

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 Shortwave Diathermy Unit
• Power Output Should Provide Energy To
Raise Tissue Temp To Therapeutic Range
(40-45 deg C) (80-120 watts)
• Should Exceed SAR-Specific Absorption
Rate (rate of energy absorbed /unit area of
tissue mass)

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 Adjusting Resonance of SWD Unit
(Tuning)
• Manual vs Automatic Tuning
– When patient’s circuit (biologic tissue) oscillates at same
frequency as device frequency
– Only when tuned will is the electromagnetic energy fully delivered
– Most automatic
– Can lose tuning due to movement at skin/electrode interface
• Manual Tuning (adjusts patient circuit)
– Set Output Intensity at 30-40%
– Adjust Tuning Control Until Power Output Meter Reaches Max
– Then Adjust Down to Patient Tolerance Which Is About 50%
– If More Than 50% Patient Is Out of Resonance 12
 Shortwave Diathermy Unit
• Generates Both an Electrical and a
Magnetic Field
• Ratio Depends on Characteristics of Both
The Generator and the Electrodes
– SWD Units at 13.56 MHz= Stronger Magnetic
Field
– SWD Units at 27.12 MHz = Stronger Electrical
Field
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 SWD Electrodes
• Capacitor Electrodes
• Inductor Electrodes
• Selection of Appropriate Electrodes Can
Influence The Treatment

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Capacitor (Condenser) Electrodes
• Create Stronger Electrical Field Than Magnetic
Field
• Ions Will Be Attracted Or Repelled Depending on
the Charge of the Pole

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Capacitor Electrodes
• Electrical Field Is The Lines
of Force Exerted on
Charged Ions That Cause
Movement From One Pole
To Another
• Center Has Higher Current
Density Than Periphery

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Capacitor Electrodes
 Patient Is Between
Electrodes and Becomes
Part of Circuit
 Tissue Is Between
Electrodes in a Series
Circuit Arrangement

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 Electrical Field
• The Tissue That Offers The Greatest
Resistance To Current Flow Develops The
Most Heat
– Fat Tissue Resists Current Flow
– Thus Fat Is Heated In An Electrical Field
– Precaution: electrical field may overheat area
with large fat content

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Capacitor Electrodes
(Air Space Plates)
• Two Metal Plates Surrounded
By Plastic Guard
• Can Be Moved 3cm Within
Guard
• Produce High-Frequency
Oscillating Current

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Air Space Plate Electrodes

• Area To Be Treated Is
Placed Between
Electrodes Becoming
Part of Circuit

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 Air Space Place Electrodes

• Sensation Of Heat In Direct Proportion To Distance

Of Electrode From Skin
• Closer Plate Generates More Surface Heat
• Parts Of Body Low In Subcutaneous Fat Best Treated

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Capacitor Electrodes
(Pad Electrodes)
• Greater Electrical Field
• Patient Part of Circuit
• Must Have Uniform
Contact (toweling)
• Spacing Equal To Cross-
sectional Diameter of
Pads
• Part To Be Treated
Should Be Centered
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Pad Electrodes
• Increasing The
Spacing Will Increase
The Depth Of
Penetration But Will
Decrease The Current
Density
• Capacitive Method
Good for Treating
Superficial Soft
Tissues
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 Induction Method
• Creates A Stronger Magnetic Field Than
Electrical Field
• A Cable Or Coil Is Wrapped
Circumferentially Around An Extremity Or
Coiled Within n Electrode

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 Induction Electrodes

• Passing Current Through A Coiled Cable Creates

A Magnetic Field By Inducing Eddy Currents
(small circular electrical fields) That Generate
Heat
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 Induction Electrodes
• Patient In A Magnetic Field Not Part Of A Circuit
• Greatest Current Flow Through Tissue With Least
Resistance
– Tissues react like a parallel circuit
– Fat does not provide as much resistance to
electromagnetic energy
• Tissue High In Electrolytic Content Respond Best
To A Magnetic Field
– Muscle and blood
• Precaution: Not as much superficial sensation of
heat with electromagnetic 26
Induction Electrodes
(Cable Electrode)
• Two Arrangements:
– Pancake Coils
– Wraparound Coils
• Toweling Is Essential
• Pancake Coil Must
Have 6” in Center Then
5-10cm Spacing
Between Turns
• Best Frequency
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Induction Electrodes
(Drum Electrode)
• One Or More
Monopolar Coils
Rigidly Fixed In A
Housing Unit
• May Use More Than
One Drum Depending
On Area Treated
• Penetration
– Deeper Soft Tissues
• Toweling Important 28
 Heating With Continuous SWD
• Patient Sensation Provides Basis For
Recommendations Of Continuous SWD
• Dose I (Lowest) (<38 W) - No Sensation of Heat
• Dose II (Low) (~80 W)- Mild Heating Sensation
• Dose III (Medium) (80-300 W) - Moderate or Pleasant
Heating Sensation
• Dose IV (Heavy) (>300 W) -Vigorous Heating Within
Pain Threshold

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 Pulsed SWD
• Referred To By Different Names
– Pulsed Electromagnetic Energy (PEME)
– Pulsed Electromagnetic Field (PEMF)
– Pulsed Electromagnetic Energy Treatment
(PEMET)

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Pulsed SWD

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PSWD Mean Power Calculations
• Pulse Period (Pulse on + off time) =
– Peak Pulse Power (W) / Pulse Rep Freq (Hz)

• Percentage On Time =
– Pulse Duration (msec) / Pulse Period (msec)

• Mean Power =
– Peak Pulse Power (W) / Percentage on Time
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 Example
• Peak Pulse Power = 800 W
• Pulse Duration = .4 ms
• Pulse Frequency = 200 Hz
• Pulse Period = 800 W / 200 Hz = 4 ms
• % on time = .4 / 4 = .10 or 10%
• Mean Power = 10% of 800 = 80 W
– End Result = thermal effect
– < 38 W = no heating

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 Pulsed SWD
• Interrupted Output Delivered In Series Of
High-Frequency Bursts (40-400 usec)
• Pulse Rate Selected With Pulse Frequency
Control (1–1000 Hz)
• Off-Time Longer Than On-Time
• Low Mean Power Output
• Uses Drum Electrode
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Shortwave Diathermy vs.Ultrasound

 Pulsed SWD Produces The Same Magnitude And Depth

Of Muscle Heating as 1MHz Ultrasound (Draper, JAT
1997) 35
 Treatment Time
• Most Typically SWD Treatments Last For
20-30 Minutes
• Remember As Skin Temperature Rises
Resistance Falls

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 When Should Diathermy
Be Used?
 If

If The
The Skin
Skin Or
Or Some
Some Underlying
Underlying Soft
Soft
Tissue
Tissue Is
Is Tender
Tender And
And Will
Will Not
Not Tolerate
Tolerate
Pressure
Pressure
 In

In Areas
Areas Where
Where Subcutaneous
Subcutaneous FatFat Is
Is Thick
Thick
And
And Deep
Deep Heating
Heating Is
Is Required
Required
Induction
Induction method
method
 When

When The
The Treatment
Treatment Goal
Goal Is
Is To
To Increase
Increase
Tissue
Tissue Temperatures
Temperatures Over
Over AA Large
Large Area
Area 37
 SWD Guidelines
• Indications
– Continuous and Pulsed
• Precautions
• Contraindications

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 Microwave Diathermy
• Two FCC Assigned Frequencies-2456 MHz and 915 MHz
• MWD Has Higher Frequency and Shorter Wavelength Than
SWD
• Generates Strong Electrical Field and Relatively Little
Magnetic Field
• Advantage: better focus wave on body, thereby more local
heating affects
• Disadvantage: Depth Of Penetration Is Minimal In Areas
With Subcutaneous Fat > 1 cm

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 Microwave Diathermy Unit

• A= Power Switch
• B=Timer
• C=Output Meter (indicates relative output in watts
• D= Power Output Level Knob
• E= Amber Light-Warming up / Red Light- Ready

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 MWD Applicators (Electrodes)

• Circular Shaped Applicators

– 4” or 6”
– Maximum Temperature At Periphery
• Rectangular Shaped Applicators
– 4.5 x 5” or 5 x 21”
– Maximum Temperature At Center

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 Microwave Applicator Set-Up
• Microwave Applicator Beams Energy To Patient
• Must Pay Attention To Cosine Law
• In 915 MHz Units Applicators Placed 1 cm
From Skin
• 2456 MHz Units Have Manufacturer
Recommended Distances and Power Outputs
(Uses Antenna)

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 Best Treated areas for Microwave

• Tendons of foot, hand and wrist

• AC and SC joints
• Patellar tendon
• Distal tendons of hamstrings
• Achilles tendon
• Other areas of low subcutaneous fat

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