High Intensity Electrical Stimulation for Pain Management

Purpose: Focal areas of in tendon and non contractile tissue (e.g., synovium, joint capsule) can be isolated during a physical therapy evaluation and the patient's pain complaint can be reproduced. The purpose of this special interest presentation is to describe the use of high intensity electrical stimulation to resolve pain in these structures. Description: The affected area is identified by palpation, prepared with alcohol and bounded by a pair of small electrodes 1cm x 2cm in area. "Russian" current (i.e. 2500Hz sine wave, modulated to 50 bursts/sec at a 50% duty cycle), with a 12 sec on/8 sec off cycle is used. The intensity of the current is increased to the patient's maximum tolerable limit. Treatment durations range from 5-15 minutes. Observations: We routinely use this modality on infra patellar, biceps, Achilles, infraspinatus, iliotibial band and common extensor tendinitis. We have also had promising results on painful patellar plica, plantar fascitis and deQuervain's syndrome. Once recent case involved a patient with bilateral Achilles tendinitis and plantar fascitis. He had been treated for a total of 8 treatments of ultrasound (US), massage, ice and stretching. On the 9th treatment, high intensity stimulation was substituted for the US and ice. The patient reported complete relief of his symptoms after 2 treatments to the Achilles tendons and after 3 treatments to the plantar fascia. Conclusions: The use of electrical stimulation in this manner has allowed us to rapidly progress to active treatments (e.g. exercise, mobilization)in patients whose progress is limited by pain. Although the explanation for the long term positive effect of this type of electrical stimulation is elusive, interelectrode analgesia may account for the immediate post treatment response.
Manal T, Dougherty S, Snyder-Mackler L. Physical Therapy Clinic, University of Delaware, Newark, DE, [...]