The lecture covers Transcutaneous Electrical Nerve Stimulation (TENS), including its definition, types, and the pain gate mechanism. TENS is a noninvasive analgesic technique that applies electrical current through the skin to manage pain, categorized into high rate, low rate, and brief intense TENS. The pain gate mechanism, proposed by Melzack and Wall, explains how pain is modulated in the spinal cord.

1. DEPARTMENT OF ELECTROTHERAPY
AND ELECTRODIAGNOSIS
DATTA MEGHE COLLEGE OF
PHYSIOTHERAPY

2. LECTURE 1

3. DR. NEHA INGALE-
CHAUDHARY
MPT NEURO
PROFESSOR (HOD)
ND
T.E.N.S.
DEFINITION AND TYPES

4. PURPOSE OF LECTURE
 At the end of lecture students should understand
the definition and types of tens.

5. LEARNING OBJECTIVES
Sr.no Learning
objectives
domain level criteria
1 DEFINE
TENS
Cognitive Must know All
2 EXPLAIN
VARIOUS
TYPES OF
TENS
Cognitive &
Psychomotor
Must know All
3 EXPLAIN
THE PAIN
GATE
MECHANIS
M
Cognitive &
Psychomot
or
Must know All

6. WHAT IS TENS?

7. TENS
 TENS- TRANSCUTANEOUS ELECTRICAL
NERVE STIMULATION.
 TRANS-CUTANEOUS: THROUGH SKIN
 ELECTRICAL: WITH THE USE OF ELICTRIC
CURRENT
 NERVE
 STIMULATION: INDUCTION OF STIMULUS,
EXCITATION, ACTIVATION.

8. DEFINITION
It is the application of a pulsed
rectangular wave current via surface
electrode on the patient’s skin -
Clayton’s electrotherapy.
It is a simple noninvasive analgesic
technique used for the symptomatic
management of acute and

9. TYPES
 High rate TENS/ conventional TENS
 Low rate TENS/ acupuncture TENS
 Brief intense TENS

10. HIGH RATE TENS/
CONVENTIONAL TENS
 High frequency
 Short duration
 Amplitude modulation strong but below motor
threshold.
 Stimulates large diameter A BETA fibers without
concurrent activation of A DELTA and C fibers.

11. LOW RATE TENS/ ACUPUNCTURE
TENS
 Low frequency
 Long duration
 Amplitude modulation at or above motor
threshold
 Stimulated A DELTA fibers.

12. BRIEF / INTENSE TENS
 High frequency
 Long duration
 Amplitude modulation highest tolerable
 Stimulates small diameter noxious afferents

13. PARAMETERS HIGH RATE/
CONVENTIONA
L TENS
LOW RATE/
ACUPUNCTUR
E TENS
BRIEF/
INTENSE TENS
FREQUENCY HIGH
80-120 Hz
LOW
2-5 Hz
HIGH
125-250 Hz
PULSE
DURATION
SHORT
=50 µS
LONG
>300µS
LONG
200-250 µS
AMPLITUDE STRONG
TINGLING BUT
BELOW MOTOR
THRESHOULD
AT OR ABOVE
MOTOR
THRESHOULD
HIGHEST
TOLERABLE
USE FOR
EXTENDED
PERIOD OF
TIME
UPTO 45 MIN.
AFTER THAT
MUSCLE
FATIGUE
OCCURS
15 MIN OR
LESS
STIMULATES LARGE
DIAMETER Aβ
FIBRES
LARGE
DIAMETER Aδ
FIBRES
SMALL
DIAMETER Aδ
FIBRES

14. PAIN GATE MECHANISM
WHAT IS PAIN GATE
MECHANISM?

15.  Proposed by Melzack and Wall in 1965.
 The pain gate is supposed to be at substantia gelatinosa
and nucleus proprius of posterior horn of spinal cord.
 Pain gate closes at 3 levels:-
1. By traffic signal phenomenon
2. At the presynaptic level by –presynaptic inhibition.
3. Descending pain suppression systems -by release of
endorphins and enkaphelins by descending neurones of
PAG and Raphe nucleus.

17. REFERENCES
 Claytons electrotherapy edition 9
 Low and reed : edition 4
 Electrotherapy evidence based practice: 12th
edition.

18. THANK YOU…