Physiotherapy - Electrical Muscle Stimulation

Often referred to as "muscle stim," the therapy involves low levels of electrical impulses delivered to the injured, painful tissues to reduce pain and speed healing. Because the body's nerves are electrical conductors, medical professionals have long held that stimulating nerve endings with small electrical current can produce beneficial results.
The theory behind electrotherapy as part of chiropractic care is that such stimulation to affected nerves and muscles encourages the body to release pain-killing chemicals, such as opiates and endorphins, and blocks pain signals from being transmitted to the brain.

Electrotherapy is a pain management technique, and as such, is part of an overall chiropractic treatment regimen. Electrotherapy is usually involved in the early treatment stages, especially right after an injury. Ice and heat therapy may be combined with electrotherapy to boost its pain-killing powers.

Electrotherapy normally involves placing small adhesive pads on the skin at various points on the body. Electrotherapy is generally not painful. The adhesive pads may cause a minor skin irritation after being removed, and in some instances, patients may feel a mild stinging after therapy.

Common types of electrotherapy include:

• Galvanic stimulation (GS) - High voltage pulsed galvanic stimulation has been used in acute low back pain to reduce muscle spasm and soft tissue edema (swelling). It is commonly used despite the lack of hard scientific evidence for its efficacy. Its effect on muscle spasm and pain is felt to occur by its counter-irritant effect, effect on nerve conduction, and a reduction in muscle contractility.
• Radiofrequency rhizotomy - Normally used for chronic cases of facet joint syndrome, a degenerative condition in which joint cartilage wears thin, causing stiffness, inflammation, muscle spasms, and later osteoarthritis. This procedure applies heated radio-frequency waves to the joint's nerves that carry painful impulses.
• Transcutaneous Electrical Nerve Stimulation (TENS) - This is the most common type of electrical stimulation used today. TENS therapy is normally used to treat chronic, or long-term pain in the lower back. Small electrodes are placed inside an elastic-type belt worn around the lumbar region. Percutaneous electrical nerve stimulation (PENS), an enhanced and newer type of pain management therapy, makes use of very thin needles (much like those in acupuncture), which are inserted in the lower back by the chiropractor. Small, battery-powered TENS units also are available for use at home, work, or other activities. The patient is able to control the level and frequency of stimulation, and self-administer impulses during episodes of pain.
• Interferential current (IFC) - This is a kind of TENS therapy in which high-frequency electrical impulses are introduced deep into the tissues near the center of the pain.

Ultrasound

This treatment should not be confused with diagnostic ultrasound, often used in prenatal screening. Diagnostic ultrasound can also be used to look at joints, nerve roots, tendons, ligaments and muscles and pinpoint signs of inflammation and scar tissue. In some cases, ultrasound helps the chiropractor identify the proper course of treatment.

However, there is also a therapeutic ultrasound procedure that utilizes sound waves to treat injured muscles, joints, and soft tissues. The sound waves vibrate the tissues back and forth, creating a deep, micro-massage effect. In the case of a recent injury, this helps to decrease scar tissue and adhesion formation, which would otherwise interfere with the body's healing process. The sound waves also decrease inflammation by destroying unwanted inflammatory cells. The sound waves also accelerate healing by stimulating the activity of the cells responsible for cellular and tissue repair. In chronic cases, special settings are used to create a deep-heating effect, heating the tissues far below the skin's surface. This heat, along with the vibrations that are caused by the ultrasound, help to "melt away" the muscle spasms and "knots" felt in our muscles.
The fast-moving waves essentially massage soft tissues effortlessly, and in most cases, painlessly.

Therapeutic ultrasound:

• Alleviates muscle spasms
• Reduces inflammation and swelling
• Improves range of motion
• Helps increase blood flow
• Lowers pain and stiffness

Therapeutic ultrasound is typically applied using a small, hand-held wand. Therapeutic ultrasound is often used as one method to treat lower back pain. It is not used to treat acute inflammatory conditions or in patients who have had a laminectomy.

Traction

Whether applied manually or mechanically, the benefits of traction are similar. It is an excellent therapy choice to reduce pressure on cervical (neck) or lumbar (lower back) discs. Traction effectively reduces joint and nerve pain, pressure, and inflammation, caused by bulging or herniated discs. This procedure is quite comfortable, and lasts several minutes.

Ice Therapy

Ice massage, or cryotherapy, is effectively used to treat many kinds of injuries, including those associated with back or neck pain. It is often thought of as the therapy of choice for acute injuries. Actually, the application of ice over any painful tissue is usually effective at any stage of treatment for an injury.

Ice causes the veins in the affected tissue area to constrict. This reduces the flow of blood while acting as kind of anesthetic to numb the pain. It is very important to use ice correctly. It should be used for a maximum of 20 minutes, but may be applied each hour. Also, it is important that you do not apply the ice directly to the skin. Instead, wrap the ice pack in a paper towel or thin damp cloth prior to applying to the injured area.
But when the ice is removed (and this is key), the veins compensate by opening large, allowing a greater volume of blood to rush to the affected area. The blood brings with it important chemicals that aid in the healing process.

Back and neck injuries frequently involve muscle sprains and strained ligaments, which can spasm and become inflamed.

Ice massage can provide a number of benefits, including:

• Assisting the body in minimizing tissue damage
• Mitigating muscle spasms
• Reducing or eliminating pain by numbing sore soft tissues
• Slowing and reducing inflammation and swelling

Ice therapy is not recommended as a form of treatment for any kinds of rheumatoid arthritis, Raynaud's Syndrome (a circulatory disorder of blood vessels of the extremities), colds or allergic conditions, paralysis, or areas of impaired sensation.

Heat Therapy

While ice therapy is used to reduce swelling, heat therapy is used to relax the muscles and increase circulation. Both kinds of therapy help reduce pain.

The use of heat is effective in treating conditions that are more chronic in nature. It is not recommended that heat be used within the first few days or weeks of a new injury, especially when any signs of swelling are present. The best forms of heat are in the form of a warm bath/shower or a moist heating pad. However, heat therapy can involve many kinds of methods, from simple heating pads, wraps, and warm gel packs, to sophisticated techniques, such as therapeutic ultrasound.

As with ice therapy, apply the heat for a maximum of 20 minutes per hour. Never go to sleep with a heating pad, as this can result in increased pain and tissue damage.

Heat therapy:

• Dilates the blood vessels of the affected muscles, allowing them to relax and begin healing
• Helps lower discomfort by reducing the amount of pain signals going to the brain
• Increases the ability of your muscles to easily flex and stretch, thereby decreasing stiffness

Heat therapy, as well as ice therapy, are normally a part of an overall chiropractic treatment plan and rarely accomplish maximum results without it.

Heat therapy is not used on swollen or bruised tissues, or in patients who have dermatitis, deep vein thrombosis, diabetes, peripheral vascular disease, open wounds, cardiovascular conditions such as hypertension.