Combination therapy involves applying ultrasound and electrical stimulation simultaneously. It has several advantages, including reducing accommodation effects from interferential therapy, treating deeper lesions more effectively, and localizing ultrasound treatment. The mechanism is that ultrasound reduces the nerve membrane resting potential, bringing it closer to firing threshold, while electrical stimulation induces depolarization with a smaller current due to ultrasound potentiation. Diagnostic use specifies parameters like 0.5W/cm2 ultrasound at 1MHz with 100Hz interferential current. Therapeutic use follows individual modality doses tailored for each lesion.

1. COMBINATION THERAPY
A.THANGAMANI
RAMALINGAM

2. combination therapy involves the
simultaneous application of
ultrasound (US) with an electrical
stimulation therapy

3.  In Europe- Diadynamic Currents
 In US- bipolar Interferential Therapy

4. MAIN ADVANTAGES
 Accommodation effects that accompany IF
treatment are reduced
 Lower intensities are used to achieve the effect
 Localizing lesions (especially chronic) ie.Diagnostic
use
 Localization of US treatment - to provide increased
accuracy/effectiveness in treating deeper lesions
 Treating trigger points

6. MECHANISM
 Exposure of a peripheral nerve to US reduces the
membrane resting potential by increasing its
permeability to various ions (especially Sodium
(Na+) and Calcium (Ca++). By virtue of this
adjusted permeability, the nerve membrane is taken
closer to its threshold (the point where it
depolarizes), though doesn’t usually make the
nerve fire. The simultaneous application of the
Interferential current through the nerve induces the
depolarisation potential, though it will take a smaller
current than usual to achieve this due to the
potentiation effect of the ultrasound

8. DIAGNOSTIC USE
 that a continuous US output of 0.5W/cm2 should be
used
 A frequency of 1MHz is preferable
 IF output is most commonly set to 100Hz (with no
sweep) using a bipolar output.
 maximal sensitivity is assumed to be the focal point
of the lesion

9. THERAPEUTIC USE
 The individual doses for the US and IFT should be
those which are appropriate for the lesion and the
required effects
 advantages remain anecdotal at the moment
 no specific contraindications for combination
therapy other than those for the individual
modalities.
 ref: Tim Watson 2010