1. TENS would be used to manage the pain from osteoarthritis of the knee. Specifically, conventional/high TENS with a high frequency of 40-150 Hz, low intensity current of 10-30 mA, and short pulse duration of up to 50 microseconds would be applied for 30-60 minutes. 2. Conventional TENS works by pre-synaptic inhibition to suppress pain signals to the brain and encourage the body's natural painkillers. It can help control arthritis pain without additional drugs. 3. TENS is a safe and effective first-line treatment for many pain conditions, including osteoarthritis of the knee.

1. ELECTROTHERAPY
CLINICAL CASES

2. Case 1
• 62-year-old right-handed female
housewife who fell and fractured her left
distal radius 7 weeks ago. Had ORIF cast
was removed last week. She has not yet
returned to any ADL’s. Her physician’s
prescription for therapy says “Evaluate
and treat.” No limitations are prescribed.
• Evaluation?
• Which electric current used?

3. Case 1

4. Case 2
• A 65 year old female has edema at
her right elbow due to inflammation.
• No pacemakers or heart surgeries
done
• Method of treatment?
• Which electric current used?

5. Case 2
• Intervention : Method of treatment for the inflammation due to the
edema on right elbow will include the use of Cryotherapy means
“treatment using low temperature” In which cold pack would pe
applied Cold packs are made by wrapping flaked eyes in damp terry
towels. Applied to the body part to be treated for 20 mints. To numb
and inflammation Reduce swelling. The therapist should monitor the
time of application and amount of cold to avoid damaged to tissue
• Which electric current used?
• FARADIC CURRENT
• The short duration interrupted direct current
• In this treatment we use FARADIC CURRENT because faradic current
helps in Oedema reduction: The increase venous and lymphatic
return should be encouraged by the pumping action of the alternate
muscle contraction and relaxation so it reduces the oedema. This
process is called faradism under pressure. which help in the increase
the blood supply to the muscle and provide oxygen and nutrients
• Frequency 80–150 pps
• pulse Duration 20–200 s
• Duration of Rx Twenty minutes of stimulation

6. Case 3
• 30 year old male with complaint of
inability to grip and flex the wrist
known case of neuropraxia of
median nerve but nerve is intact
there is no degeneration of nerve.
• Which type of current is suitable for
muscles stimulation??

7. Case 3
• Which type of current is suitable for muscles stimulation?
• Russian current
• Russian Current is a sinusoidal waveform. it is known as medium
frequency, burst alternating current.
• It is a type of electrical stimulation that delivers medium frequency
current in alternating pulses or bursts of energy. This type of
stimulation generates a motor response which can be used to
strengthen muscles and muscular re-education. Russian Current can
also be used to stimulate an analgesic effect in the muscles, making it
effective in reducing pain as well as increasing muscular strength.
• Carrier Frequency 2,500 Hz
• Frequency 75 burst/second (bps)
• On/Off Time 10 seconds on 50 seconds off (10/50)
• Duration of Rx 15 minutes

8. Case 4
• 26 year old male came to PT OPD with
c/o foot drop having history of RTA
known case of severe nerve damage
which type of current of current
would you apply for muscle
stimulations?

9. Case 4
• In this case the treatment plan will include the use of Tens Russian current and
faradic current for the re education nerve damage and muscle stimulations
• Current Application for Nerve damage and muscular stimulation
Electrode application
• 1. Always clean and prepare the skin prior to use and monitor throughout
treatment
• 2. Electrodes should be placed so the flow of current can reach the target tissue
• 3.Conduct current uniformly
• 4 . Maintain uniform contact
• 5. Allow for movement of the skin and muscle
• Transcutaneous electrical nerve stimulation (TENS) a low-voltage electrical
current is delivered to the skin on painful area through the electrodes This can
produce analgesia and decrease acute and chronic pain Transcutaneous
electrical nerve stimulation (TENS) currently is one of the most commonly used
forms for pain management

10. Case 4
 Russian Current
– a medium-frequency current it is used TO IMPROVE MUSCLE
STRENGTH and Re educate the group of muscle after a
nerve supply pathway has been damaged Russian Current
can also be used to stimulate an analgesic effect in the
muscles, making it effective in reducing pain as well as
increasing muscular strength
• Faradic current :
– Faradic current cause the Stimulation of the nerve is due to
producing a change in the semi-permeability of the cell
membrane This is achieved by altering the resting
membrane potential. When it reaches a critical excitatory
level, the muscle supplied by this nerve is activated to
contract., the muscle contraction may be obtained with
faradic current.

11. Case 5
• 28 y/o female with c/o gradually increasing
neck and upper trapezius pain over the past
6 weeks. She reports that her pain is worse
at the end of her workday as a
supermarket checker. She has been
evaluated by a physician, and her cervical
spine x-rays were negative. She has no
history of cardiac arrhythmias and does not
have a pacemaker.
• How do you manage her pain?

12. Case 5
• in this case the method of treatment will include the use of
Transcutaneous electrical nerve stimulation (TENS) as a
treatment for neck pain due to musculoskeletal disorders
for the stimulation to decrease the pain to the painful area
of neck and upper trapezius
• TENS treatment is an effective treatment for neck pain due
to musculoskeletal disorders. On the other hand, TENS
showed an effective pain relief with subjects who have a
mild neck pain rather than those with severe symptoms
• Amplitude - Current at a comfortable, low intensity level,
• Pulse width (duration) - 10-1000 microseconds
• Pulse rate (frequency) - 80-100 impulses per second (Hz); 0.5-10
Hz when the stimulus intensity is set high

13. Case 6
• 30 year old male came to the opd
with known case of trigeminal
neuralgia which modality is suitable
for him and why?

14. Case 6
• TENS should be considered as safe, simple, and reusable first line of
treatment for many pain conditions including trigeminal neuralgia
patients were given continuous bursts of current for 20 minutes daily for
20-40 days over the path of the affected nerve with a portable
transcutaneous electric nerve stimulation machine Out of the two
electrodes, one was applied to the cutaneous area of the distribution of
the affected nerve and other was applied to temple to complete the
circuit.
• Pre TENS doses of carbamazepine were tapered off in the next 2-3
weeks. Patients were subsequently evaluated at 1 month and 3 months
intervals for pain by visual analogue scale (VAS) (0-10), verbal pain scale
(VPS) (0-4), category point scale (CPS) or functional outcome scale for
main daily activities viz. sleep, chewing, talking or washing face (0-10 for
each activity).
• Article from National Center for Biotechnology Information website
Role of transcutaneous electric nerve stimulation in the management of
trigeminal neuralgia

15. Case 7
• 45 year old female with difficulty in
prolonged sitting that causes severe
back pain for 2 to 3 days came to
opd.
•How would you manage her pain?
•TENS?
•Type of TENS

16. Case 7
• Conventional TENS /high tens
• During a TENS treatment for back pain, electrodes are placed on the skin over
an area of pain in the back. This creates electrical impulses that travel along
nerve fibers The pulses suppress pain signals to the brain and encourage the
body to produce higher levels of its own natural pain killing chemicals -
endorphins and encephalins.
• Regulating the current:
• Gradually increase the current
• For relief of pain, a frequency of 80-100 Hz rhythmic is use
• This mechanism is called pre-synaptic inhibition by Hi-TENS or traditional or
conventional TENS.
• Dosage and timing:
• Conventional TENS with recommended duration from 30 to 60 minutes, once
or twice a day or may be used for all 24 hours of the day

17. Case 8
• Old lady with history of knee OA for last few
years want us to manage her pain with TENS.
– What type of TENS you use?

18. Case 8
• Transcutaneous electro stimulation for osteoarthritis of the knee
• Osteoarthritis is the most common form of joint disease and the leading cause of pain and
physical disability in the elderly. Transcutaneous electrical nerve stimulation (TENS),
interferential current stimulation are used widely to control both acute and chronic pain
arising from osteoarthritis of the knee transcutaneous electrical nerve stimulation
therapy, can help to control arthritis pain without the use of additional drugs as well as
reduce the amount of medication and related side-effects
• Conventional TENS /high tens
– Conventional TENS has a high stimulation frequency (40-150 Hz)
– low intensity, just above threshold, with the current set between 10-30 mA.
– The pulse duration is short (up to 50 microseconds).
– treatment duration from 30 to 60 minutes,
• Article from National Center for Biotechnology Information website