Chronic low back pain can cause many lost work days.
Electrotherapy is the use of electricity as part of an active physiotherapy treatment program. Various forms of electrotherapy have been in use since the days of Rome, and it has a long, well-established role within the practice of physiotherapy. The different methods of electrotherapy should be used in conjunction with physiotherapy treatment modalities such as massage, range of motion exercises, and the application of heat and ice packs. The use of electrotherapy as a vital adjunct to physiotherapy provides the most beneficial and effective treatment program for the patient.
Transcutaneous Electrical Nerve Stimulation (TENS)
Massage is an effective treatment modality.
This is a small, pocket-sized device that is easy for a patient to use at home. It helps relieve chronic pain by stimulating nerves and muscles through the skin, encouraging the production of the brain’s natural pain relievers, endorphins. The electrodes can be placed where they are most effective, directly over the painful area or the nerve supplying it, or even on the opposite side of the body. The intensity of stimulation can be adjusted by the patient, and some units have high frequency capabilities of 60 to 200 Hz or low frequency stimulation, less than 10 Hz. Studies have shown that low frequency stimulation can become uncomfortable, but it provides longer-lasting pain relief.
Galvanic Stimulation (GS)
Combining galvanic stimulation with physiotherapy is effective for new injuries.
Guillaume Duchene, the developer of electrotherapy, learned that the application of alternating current applied to muscle will produce strong contractions, regardless of the condition of the muscle itself. During World War II, it was found that this would prevent muscle atrophy (deterioration) and was helpful in restoring muscle mass after wounds and injuries. High voltage GS reduces muscle spasms and soft tissue swelling, thus reducing pain. It is most effective during the initial stages of treatment when combined with other forms of physiotherapy, like ice, heat and range of motion and strengthening exercises.
Interferential Current (IFC)
Physiotherapy and electrotherapy combine to successfully treat muscle strains.
This form of electrotherapy is similar to TENS, but delivers a high frequency, 4000 Hz, carrier waveform that penetrates the skin more deeply, causing less discomfort. It blocks transmission of pain signals along nerves while stimulating endorphin production. IFC often relieves the chronic back pain of patients who have not been helped by TENS.
Ultrasound
Exercise programs are part of the treatment plan.
This method of electrotherapy effectively relieves pain in deep joints and muscle tissues. Its deep heat softens and stretches connective tissue, increasing mobility and full use of the joints. Ultrasound is effective in treating chronic low back pain and recurrent, decreased range of motion in a segment of the spine. It is most effective used in conjunction with a gradual muscle stretching and exercise regimen.
Side Effects and Precautions
Side effects are rare, but occasionally there may be transient pain after using the TENS or IFC units. The adhesive pads on the units may cause minor skin irritation.
The pads of the TENS, IFC or GS leads should never be placed over the heart or over a pacemaker or its leads, as this could cause cardiac arrhythmia. Placing the pads over the throat might lower blood pressure, and putting them over a pregnant uterus could damage the fetus.
