Electrotherapy

Electrotherapy is the use of electrical energy in the treatment of impairments of health and a conditions of abnormal functioning. It is basically composed of the use of electric currents, referred to as "Tesla currents" , in therapeutic applications.

History
The history of electrotherapy and electrical stimulation of the body, as anything more than a novelty, began in the mid-18th century with the invention of the Leyden Jar that permitted static electrical charges, generated by a device invented in the 17th century by Otto von Guericke, to be accumulated for a vigorous shock. Benjamin Franklin experimented with the arrangement, and his method of treatment became known as Franklinism. Franklin himself judged the device creative of more pain than healing. At about this same time Luigi Galvani observed a frog's leg mounted on metal hooks twitch when a Leyden Jar was discharged nearby, and he noted the same thing when he touched a scalpel to that leg. He hypothesized 'animal electricity' was involved, or vis viva, the fluid of life, an electrical fluid. In 1800 Alessandro Volta demonstrated that what was involved was nothing 'vital', but instead the reaction between two metals. Galvani's speculation about animal electricity, dismissed by ignorant scientists of the time, could not have been appreciated for over a century, when the role of the electron in chemical bonding and the periodic table of the elements was understood in the 1920s. For Alessandro Volta and generations after him, electricity was a fluid whose nature was poorly understood. That biological organisms functioned by the action of this electrical fluid, this Galvanic animal electricity, was taken by some to discredit vitalism when the more scienfific approach would have been to conclude that Galvanic current, or DC like that from a battery, was the key to understanding the vitalist world.

In the meantime, the field of electrotherapy became populated by quacks and hucksters, and genuinely interested experimenters who investigated the effects on health of electrical shocks. It was widely accepted, by the 1830s, amongst physiologists, that the nervous system was electrical, a conclusion following from repeated witnessing of muscles twitching when stimulated.

In 1855 Guillaume DuChenne, who later became known as the father of modern electrotherapy, pronounced that AC was better than DC for electrotherapy. At the time, and for long after, it was taken as evidence of the working of electroshocks that muscle contractions were elicited upon stimulation, and it was concluded that such shocks were a way to act upon the nervous system. DuChenne noticed that with AC, a type of current discovered by Michael Faraday involving induced electrical flow from a conductor passing through a magnetic field [Faradic Current], the current could be applied to the body of the patient, and the muscle would contract as long as the current ran, without leaving any damage to the skin. On the other hand he noticed that with DC, the current would have to be turned off an on, with the contraction momentarily occurring with the start of current flow. The skills of a telegrapher were needed to make a muscle contract repeatedly using DC, and this was cumbersome for those who sold therapeutic sessions to the trusting and desperate, or researched the effects of electrical stimulation on the body and mind. Furthermore, Galvanic Current would cause the skin to blister and pit. Because AC was easier to work with and did not have the skin problems for the patient, DuChenne, not having any idea what electricity was about, said AC was better than DC for electrotherapy. This ended the brief history of electrotherapy as a potentially powerful treatment for a wide range of disorders, including DuChenne's muscular dystrophy. For Galvani was right about one thing, animal electricity or DC, was the way the body works. DC is chemical energy, and the body is chemical, not mechanical. Discharging a battery into the body supplemented the energy of that body, and triggered chemical reactions needed for the building of tissue. None of this was possible with AC.

The difference between the two types of current is readily apparent when voltage waveforms for the two types of current are considered. In the case of AC the waveform, when graphed as voltage versus time, is biphasic, which means that the curve of the voltage rises above and drops below the x axis, the axis for time. The area between the curve and the axis is the same above and below the axis. The area between the curve and the axis is the amperage or rate of flow of electrons. With AC the area above the x axis is canceled by negative area below the axis, so that the amount of amperage passed, no matter how long the current runs, is no more than that for any single pulse. With DC, on the other hand, the curve is monophasic, that is, the area is either above, or below the axis, but not both. Amperage is not repeatedly introduced and removed. Instead it is either introduced at the anode, or removed at the cathode. To get this effect with AC the AC must be changed into DC, or rectified.

At the beginning of the 20th century physiological researchers steeped in the understanding of electricity that informed DuChenne's abortive speculation, and prior to the understanding of the role of the electron in electricity and chemical bonding by the physical scientists, cobbled together a version of bioelectricity as ion movement since it was thought that cathode rays [as electrons were known at the time] had no place in biology. Vitalism's place in medical science was assured by this account, which lent it superficial scientificity through the introduction of mathematics. Whereas Galvani's animal electricity has been found to be DC current, in 1902 Julius Bernstein defined a new sort of animal electricity based upon the idea of ionic currents, and, to explain the nature of this new sort of animal electricity, Bernstein called upon a thermodynamic equation of Walther Nernst devised in 1888. The equation has not a single electrical term in it, except 'volts', the term used at the time for pressure. Nernst insisted his equation was not about electromagnetism, and that the volts were not expressions of electrical pressure, but were instead expressions of entropic pressure, that is, the pressure for two solutions of different concentration of an atom or molecule or substance, to mix so that concentration was uniform.

But biologists were not about to give up the idea that there was something magically special about life, something vital. So Nernst's provisos were disregarded. Instead biological understanding of the nervous system's organization and functioning was based upon extensive electrical work by people like Sir Charles Sherrington who, knowing nothing about electricity, published a treatise on the nervous system's electrical functioning in 1906 [Reflex Activity of the Spinal Cord] that was re-printed and considered authoritative, for the next 50 years. 1906 was still two decades away from understanding on the part of physical scientists of the role of the electron in electricity, the periodic table of the elements, and chemical bonding. Known as cathode rays in 1906, the role of the electron in electrification was only beginning to be grasped. Sherrington and Bernstein could not possibly have understood electricity, and, since the neurotransmitter acetylcholine had not yet been discovered, there was just no way their work could have been even close to modeling or describing electrical or electrochemical nervous functioning. Both ideas are still taught today. Clinical neurologists still check for 'reflex arcs' in a patient before rendering a diagnosis that is almost always followed with the words "There's nothing we can do but hope." The Nernst equation figures prominently in all physiological and neuroscientific textbooks, accounting for the electrical functioning of the nervous system in terms of Bernstein's animal electricity. The belief still prevails that biological electricity is somehow special and beyond the province of the physical sciences.

The superficiality of Bernstein's and Sherrington's accounts of the electrical functioning and organization of the nervous system were repeatedly re-enforced by the Nobel Prize Committee of the Swedish Academy of the Sciences and the Karolinska Institute. This bit of biological sophistry was possible only because of the intervention of organized medicine which saw to the stamping out of electrical medicine as quackery and hoax during the 1930s. This intervention effectively shut the door through which the life and physical sciences could have met. In 1937 the American Medical Association banished electrical medicine as something to be considered a healing modality. In England, at Guys Hospital, a promising mode of therapy being researched and involving the use of electroplating techniques to deliver electrical charge to broken limbs, was terminated despite positive findings. In the 1940s what later became known as the Veterans Administration conducted research on hands withered from disuse following a severed nerve in the arm of soldiers wounded in action that had been repaired surgically. The technique involved what was called 'galvanic exercise'. It was found that those who received this treatment in addition to physical therapy, restored muscle mass, strength, and use, far faster than those who received just physical therapy. The findings were noted, and filed away. The next decade one of the researchers, Ernest Guttman, even denied the findings, making the claim that no sort of electrical stimulation could affect atrophy.

Since muscle contraction is taken to be the evidence that electrical stimulation is having an effect on the body, it is curious to find that the Food and Drug Administration of the USA (FDA), in its regulations on electrically-powered muscle stimulators, states clearly that it has no guidance from the medical community as to what works to build muscle. Consequently, in its concern for safety, the FDA prohibits stimulators that pass more than one half of one milliampere, in keeping with the 1855 proviso of DuChenne advising against the use of DC or Galvanic Current. In other words, electrochemistry is not allowed by FDA regulations. This is why, if an electrotherapy device has been approved for muscle stimulation by the FDA for marketing, it cannot in principle cause the chemical changes necessary for the protein synthesis that underlies muscle building. Chemical bonds needed for the building of tissue cannot be triggered by voltage changes; they can only be triggered by amperage.

Electrical power is the product of voltage and current flow. When electrical power is put to the patient using a biphasic voltage waveform [as with a TENS unit], it comes down hard on the side of V, while minimizing the role of I where I is the I of the physicists, rate of flow of electrons measured in amperes. This is seen in TENS units that, in addition to doing nothing, do it safely, according to the FDA, by delivering a 400 volt shock that has very, very little I behind it, that is, very low amperage, thereby eliminating electrochemistry as a consideration. Furthermore, when DC is used, the poles are changed back and forth with each pulse so that a biphasic wave is achieved using DC, and a monophasic wave is avoided. Voila, AC from DC, little or no amperage passed, no electrochemistry, no chemical effects, no results.

This is the world of electrotherapy, and, despite the gatekeeping role of organized medicine to prevent quackery, quackery still abounds in the field of electrotherapy where certificated physicians disregard lab research that shows things like FES [functional electrical stimulation] do not in fact build muscle tissue at all. These physicians advocate the use of FES for the handicapped to build muscle when, if it actually did this, it would be certainly be used by athletes, bodybuilders, orthopedists, and NASA. But it isn't. This is why the FDA claims it has no guidance from the medical community as to what works and what doesn't, in the world of electrical muscle stimulators. Electrotherapy should be contrasted with electrochemistry. The latter still has no place in medicine, a discipline devoted to surgery, pharmaceuticals and radiation, and noted for its ineffectiveness at treating chronic, nervous, and degenerative disorders of all sorts, including cancer.

The importance of electrochemistry for life and metabolism is clearly shown in the allometric scaling equation relating metabolic rate to body mass and metabolic efficiency, called Kleiber's Law. The equation is MR = W(4μ-1)/4μ where MR is metabolic rate, W is mass of the organism (whether cell or whale), and μ is metabolic efficiency. μ is the ratio of the rate of capture and use of energy by organism of mass W, to the rate at which this energy is available for capture and use by that organism. The denominator of this ratio, the rate at which energy is available, is expressed in amperes. The numerator is just how many of those amperes the organism of mass W is able to capture and use to trigger tissue-building, anabolic reactions, and motor activity. μ is basically a statement of the efficiency of what is called redox coupling, where redox stands for oxidation-reduction reactions. This is an electrochemical term for the movement of electrons from an oxidation reaction to a reduction reaction, as the former gives off energy that is captured by the latter. Oxidation reactions are found in batteries, but also what characterize the connection between the stomach and the nervous system, where food energizes activity. Reduction reactions are what is triggered by the battery's power. Discharging a battery into the body to trigger anabolic reduction reactions there similar to those triggered by the nervous system, is akin then to having a second stomach, without the food. This is electrochemistry. To the extent that the exponent μ can be even slightly increased by increase of its numerator, without corresponding increase of the denominator, metabolic rate can be advanced greatly. But this option is not available to electrotherapy as currently permitted and practiced by organized medicine which has effectively outlawed the clinical application of electrochemistry.

Below an earlier author has detailed the working of TENS units and Interferential Current, the sort of thing the AMA prohibited as not medicine, in 1937, but which has crept back into the field of medicine, despite having little or no effect, because of the enduring ineffectiveness of medicine at treating pain. These modalities are poorly understood not because they have not been investigated. These modalities have been around in various forms, researched and used for decades, though without any predictable and repeatable affect. They are poorly understood and perpetuated not because of the complexity of the subject matter, but because of the poor understanding of electricity endemic to medicine and biology for whom they are a last resort. Neurophysiological understanding of electricity is so lacking in scientific rigor, and the field so hobbled by the collegiality that prevents self-examination and criticism, that cries of quackery about electrical medicine are heard only for those who are not certificated. It is a shame that galvanic stimulation is tarred with the same speciousness.WP:Patent nonsense 66.215.123.233 01:52, 10 February 2007 (UTC) Gregory O'Kelly

Several different electrical stimulation devices exist, each producing different frequencies, waveforms, and effects. Electrical modalities include


 * 1) Transcutaneous Electrical Nerve Stimulation (TENS) (the most commonly used)
 * 2) Interferential Current (IFC)
 * 3) Galvanic Stimulation (GS)

Transcutaneous electrical nerve stimulators (TENS)
A person may use a TENS is not a unit at home for pain relief on a long-term basis. TENS units allow the user to adjust the intensity of the stimulation; some units also allow the user to select high-frequency stimulation (60 - 200 Hz) or low-frequency stimulation (<10 Hz).

High frequency stimulation, sometimes called "conventional", is tolerable for hours, but the resultant pain relief lasts for a shorter period of time. Low-frequency stimulation, sometimes called "acupuncture-like", is more uncomfortable and tolerable for only 20-30 minutes, but the resultant pain relief lasts longer.

Interferential current (IFC)
Interferential current is essentially a deeper form of TENS. In essence, IFC modulates a high frequency (4000 Hz) carrier waveform with the same signal produced by a TENS unit. The high frequency carrier waveform penetrates the skin more deeply than a regular TENS unit, with less user discomfort for a given level of stimulation. Deep in the tissues, the carrier waveform is cancelled out,{{Fact}] resulting in a TENS-like signal deep under the skin.

Anecdotal evidence suggests that the IFC units may be useful for patients who have not had relief from TENS. However, IFC devices tend to be more expensive than TENS units.

Galvanic stimulation (GS)
Galvanic stimulation, also known as galvanic revivification, involves the discharge of a battery into the body. To achieve the maximum affect of this form of supplementation of metabolic energy, the discharge should be delivered, transcutaneously, to the site of the neuromuscular junction, also called the motor end plate region. While open circuit voltages can be as high as 100 volts DC, the current passed should not exceed 5 to 50 milliamperes, and should be delivered in pulsed form, in simulation of the way the nervous system delivers energy to post synaptic structures, be they organs or muscles. These pulses can be as brief as 1/4 of a millisecond, and the frequency of pulses can be as high as 900 Hz. This transcutaneous delivery can be achieved using a wand, or merely immersion into water containing one of the electrodes, while the other is attached to the body outside of the water. The pulse delivered to the motor endplate region comes from the anode, not the cathode. The cathode should be allowed to corrode so that the electrical charge delivered to the body is greater than the electrical charge removed from the body by the cathode. The balance comes from the corroding cathode and the battery.WP:Patent nonsense

There is an equation from mathematical biology that fully supports this analysis. This equation relates metabolic rate to body mass and metabolic efficiency. The equation is P = W(4μ-1)/4μ where P is metabolic rate, W is body mass, and μ is metabolic efficiency. Metabolic efficiency is just the efficiency with which a biological organism of mass W is able to capture and use energy available to it. It is a ratio of the rate of reduction reactions to the rate of flow of electrons from oxidative reactions. In other words it is the statement of the efficiency of redox coupling between the organism and its cells, and the energy available to it from food and intracellular chemical reactions involving oxygen. Metabolic efficiency is therefore a statement of electrochemical efficiency, an efficiency which may be supplemented by oxidative reactions in a battery which make energy available for the numerator of the ratio, without increasing the denominator. The effect is exponentially increased metabolic rates.WP:Patent nonsense

When values are run through the equation ranging from -13e grams to +10e grams, and from 0% efficiency to 100% efficiency, the resulting graphs and tables clearly model the appearance of life from chemistry, and its evolution from bacteria to whales, in terms of metabolic rate. Metabolism preceded and was a requirement for the appearance of RNA and DNA, and its evolution. Metabolism holds the key to the aging process, and how to intercede in it with a battery to extend life and health.WP:Patent nonsense

Galvanic Revivification is not electrotherapy. It is not medicine. It is not physiology. None of these things are soundly based in modern understanding of electricity. Galvanic revivification is chemistry and physics and mathematics, and contrasts starkly with the life sciences which are still in the 19th century with regard to electricity. The mathematics clearly show that if a 75 kg. human being were to boost metabolic efficiency from 32%, which translates to a 90 year life span, to 32.6% using galvanic revivification, that human could live a fit existence until the age of 120.WP:Patent nonsense

On the other hand, if that 75kg. human being's metabolic efficiency should drop from 32% to 30%, then that human being should die from metabolic problems like cancer or heart disease by the age of 58.WP:Patent nonsense And electrotherapy, radiation, surgery, pharmaceuticals, and prayer will do nothing to alter or slow that deterioration or eliminate or prevent those problems. WP:Patent nonsense

Applications and fields
Various cells in the body are influenced by electricity, these include fibroblasts, macrophages, neutrophils and erythrocytes, along with bone, cartilage, ligaments and tendons. It is believed that stimulating these cells can promote healing in injured tissue.

Electrotherapy, in the form of transcutaneous electrical nerve stimulation (TENS) is increasingly used in the management of certain types of pain, although there is still much debate regarding its actual effectiveness. Some research has reported TENS to be as much as 65% effective in reducing pain in acute injuries.

Other forms of electrotherapy include Scenar, Ultrasound (US), Pulsed Shortwave Diathermy (PSWD), Interferential Therapy (I/F), TECAR therapy, Laser Therapy and Combination therapy.

Proponents of electrotherapy argue that the different modalities affect different tissues, e.g. ultrasound affects small areas such as ligaments and tendons and has no effect on muscles. Pulsed shortwave, however, can have a therapeutic effect on muscles.

From a treatment perspective, the questions with electrotherapy are related to the type of injury (sprain, haematoma, fracture, etc.) and the stage the injury is at (acute, repair phase, remodeling phase). From that position we must decide what type of cells we want to stimulate and what is the best way to influence them.

== See also ==
 * Neuromuscular diagnostics
 * Neuromuscular stimulation
 * Galvanic bath
 * Frequency Specific Microcurrent

==References and notes==

External links and articles

 * Further readings
 * Watkins, Arthur Lancaster, "A manual of electrotherapy.". 2d ed., thoroughly rev. Philadelphia : Lea & Febiger, c1962. 272 p.
 * Scott, Bryan O., "The principles and practice of electrotherapy and actinotherapy". Springfield, Ill., C.C. Thomas, c1959. 314 p. LCCN 60004533 /L
 * Neuroelectric Conference (1969 : San Francisco, Calif.), " Neuroelectric research; electroneuroprosthesis, electroanesthesia and nonconvulsive electrotherapy". Editor, David V. Reynolds and Anita E. Sjoberg. Springfield, Ill., Thomas, 1971. LCCN 75115389 (ed. Selected papers presented at the 1969 Neuroelectric Conference, the second annual conference of the Neuroelectric Society.)


 * Websites
 * Electrotherapy on the Web Tim Watson's website on electrotherapy, containing in-depth discussion and dose calculations.
 * The Turn of The Century Electrotherapy Museum

Elektrotherapie Elektroterapia