Powerful PT Modalities: What Makes a Difference?

Electrical Stimulation, TENS, Neuromusclature Re-education and Ultrasound are PT modalities. If you’ve ever been to physical therapy, that’s a chance you’ve heard of these terms, or possibly experienced them yourself. Here’s a better breakdown of what each of these terms mean.

E-Stim (NMES or Electrical Muscle Stimulation)

Neuro Musculature Electrical Stimulation (NMES) is often used for muscle re-education due to an injury and muscle atrophy or after a stroke or other neurological conditions improve muscle imbalances and nerve communication to the muscle. When being set up to NMES the goal is to target the muscle belly of which you want to activate. It is set to an ON and OFF cycle for a duration of time. When the unit is ON your physical therapist will direct you to contract your muscle with the help of the machine and when it is OFF, you can relax with working to the point of fatigue. Muscle soreness can be expected.

TENS (Transcutaneous Electrical Nerve Stimulation)

Transcutaneous Electrical Nerve Stimulation (TENS) is commonly used for acute pain control with most effects only lasting for the duration of the treatment. Multiple modes are available with this unit. Burst mode is a gradual increase in intensity, then peaks, then decreasing in intensity and cycles on/off. Modulated mode is a pattern variation of frequency, pulse width, intensity, randomly set by the unit.

Knee Interferential Therapy with Electrode Brace Pads. Electrotherapy.

IFC (Interferential Current)

Interferential Current (IFC) is very commonly used in physical therapy as it helps control pain and swelling with longer-lasting effects than TENS and can be used to cover a larger area. IFC can be used for both chronic and acute pain and injuries.

Ultrasound

Ultrasound can be used to see images of organs or babies, but in physical therapy it has a little different meaning. It still uses high-frequency sound waves (>20,000 Hz) to cause a physiological effect. There are two types of settings including thermal and non-thermal. Thermal effect used for increased tissue temperature to improve collagen and range of motion, improve circulation, increase cellular metabolism, and decrease pain or muscle spasm. Non-thermal does not increase tissue temperature, but does increase cell permeability, and decrease inflammation. Ultrasound uses a sound head that has a crystal inside that converts electrical energy into sound by alternately contracting (compressing) and expanding (rarefaction) which creates a vibration and into current for treatment. Ultrasound requires a transmission medium such as gel or water. The treatment area should be no larger than 4x the size of sound head and constant motion is required to prevent hot spots.

Are These PT Modalities Right for Me?

Are these modalities appropriate for me? Every patient is considered as an individual to see if modalities are a good fit for your recovery, but each of these have guidelines of when to use them and when not to (contraindications). These all share very similar contraindications such as; pacemaker, deep vein thrombosis (DVT), use over the eyes, unstable fractures, over carotid sinus. Precautions are also similar with using with caution for impaired sensation, impaired cognition, skin irritation or open wounds, cardiac disease, malignancy or cancer, epiphyseal plates, breast implants.

There are also some possible adverse reactions such as electrical burns, skin irritation from adhesive, pain, sensitivity to e-stim (rash or redness) or infection through contamination (wounds).