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Video showing English physiotherapist treating patient with interferential therapy for pain control and muscle rehabilitation. Comments follow on using Infrex Plus portable interferential tens unit at home.
The above video was filmed in an English physiotherapy dept. and has some very good comments about how to use interferential therapy and what the theories are behind using for pain and muscle stimulation. The below comments are intended to fill in some additional information about the video to better understand the application and tools available.
Comments on Video:
- The original treatment using an applicator and gel seems to be ultrasound therapy which is a separate treatment. You see this on the first patient in the video. Ultrasound units can also be rented or purchased for home use.
2. Suction cups are used to:
- keep the electrodes on
- actually bring blood to the area which helps conduct the interferential current
- can increase "current density" which may be uncomfortable and is not for people with sensitive skin
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The purpose of muscle stimulation in most instances is to help a patient relearn how to move muscles to restore function, such as the simple process of picking up a cup of coffee. The correct term for this type of function restoration is to use a "Functional Electrical Stimulator" or F.E.S. unit. Most FES units are prescribed by a physician to be used following a stroke, or in some situations an injury that resulted in partial denervation, some nerves destroyed or damaged but not all and some have remained intact.
When there are surviving intact nerves then our body, through a process known as "muscle reeducation" , learns how to use the surviving nerves to accomplish tasks that formerly were easy to do. The brain, with the use of the FES unit, is taught how to use the nerves to be able to pick up and drink a cup of coffee for an example. The stimulator actually stimulates the nerves which in turn is also teaching the brain what impulses to send to the surviving nerves so the task can be accomplished.
Most "muscle stimulation" is for the purpose of reducing swelling or in the case of a casted patient, to retard some of the disuse atrophy. The stimulation of muscle nerves for the edematous patient causes the muscles to "pump" and that action restricts the area of the swelling and the fluid is physically pumped out of the area quicker than the normal process would be.
This video explains the functions of muscle stimulators and functional electrical stimulators:
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Video on Electrode Placement For Knee Pain Using Tens or Interferential Therapy
The Infrex Plus combination unit has interferential and tens modes which can be used to treat chronic knee pain. The electrode placement for tens and Interferential therapy are shown in this video.
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Video On Carryover Pain Relief - Why Interferential Therapy Provides Carryover Pain Relief and Tens Therapy Does Not
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This video and article explain what is a muscle stimulator and why the term itself is incorrect in practical application. The correct term is Functional Electrical Stimulator, FES unit) and a main use of a FES unit is to aid in stroke rehab. This video explains how to use a FES unit and what is important.
A muscle stimulator is not the proper name for what this type device is designed for. The proper name is a Functional Electrical Stimulator or FES unit for short. Tens units are not muscle stimulators, tens units are used for pain. Muscle stim. units are used to regain function such as post stroke rehabilitation, or to retard disuse atrophy, and in some situations to reduce swelling and edema. Basically any electrical device, microamperage unit excluded, can be powered up enough to stimulate motor, muscle, nerves. That is a function of the amount of energy necessary to "fire" a motor nerve.
That is generally not the goal when one refers to muscle stimulation. It's very misleading for a tens machine distributor or manufacturer to refer to their tens units as muscle stimulators.
The purpose of a FES unit, functional electrical stimulator, is to help a patient regain control of the major and minor muscle functions so the patient can resume daily activities themselves and not be dependent on others to achieve simple tasks like walking, drinking from a cup, or turning knobs and buttons. The movement process generally involves the primary activation of small motor nerves for fine control, and then progresses to major activation of motor nerves for movement of larger muscle groups. In many situations the goal of the use of a FES unit is to help the patient's brain learn new ways to achieve tasks. When a patient uses a F.E.S. unit it is imperative that the patient work with the unit as the learning process is a voluntary process and requires patient involvement in accomplishing tasks.
For example, if one wanted to pick up a cup and all the motor nerves, small and large were stimulated at once, then there would be no function. What one would have is a catastrophe as the muscles would not work together, but separately, and the function of picking up the cup would be lost. The brain would not be re-educated as to how to accomplish the task of picking up a cup, but all the muscles would be spastically stimulated. A true FES unit slowly activates certain muscle nerves and then slowly activates the larger nerves to achieve a synchronous movement. The process repeated over and over, with the patient's active participation helps the patient relearn and gain self control. As previously stated this application is generally indicative of helping a stroke patient regain function.
Of course there are other applications for a functional electrical stimulator such as edema or swelling reduction, retarding disuse atrophy and also for increasing blood flow. All of these functions are appropriate for what is called a muscle stimulator or functional electric stimulator. Tens units are not appropriate for the major functions of muscle stimulation.
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Many patients who deal with chronic or recurrent sciatic pain are often prescribed a tens unit, transcutaneous electronic nerve stimulator, or go to a clinic for an interferential treatment. Both of these devices require the placement of what are called "reusable electrode patches" on the body to modify or eliminate the pain impulse. In the clinical setting the placement is not as important to the patient since a physical therapist, Doctor, Chiropractor or a clinical person places the electrodes in the most appropriate location depending upon the input from the patient.
Today with the advent of self treatments with interferential, as well as tens, it is becoming imperative that any patient suffering from sciatica that is using a tens or portable interferential unit be properly educated on what the goals are and how to achieve the treatment objectives. No portable pain machine is any good whatsoever unless the patient has been shown how to use the device properly and were properly educated on the reasons for the electrode placements.
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A project of any significant size is normally going to need more than a single step to accomplish. High-value projects and goals almost invariably require careful planning, several steps during a period of time and perseverance to stick with it and see the project right through to the finish. Aiming to attack the layers of chronic pain isn't any exception. To attack chronic pain conditions such as RSD (reflex sympathetic dystrophy), sciatic pain, chronic low back pain (CLBP), neuralgia, neuropathies, headache pain is not a single step project either. But here's how to achieve that in five simple steps.
Step 1. Realize that much of the pain is now what we call secondary or tertiary pain.
These painful areas are not the same areas as the original pain and in fact may now be more painful than the original precipitating painful condition. For the chronic pain patient the pain actually starts a process called "layering" in which guarding, postural changes, lack of movement creates stress in other areas of our body that, over time, results in creation of a second layer of pain. This is important because when chronic pain is treated there usually is more than one area of pain and the easiest to treat are the secondary layers of pain that have emerged over time. When you decide not do this step, tertiary.
Step 2. Treat the secondary pains with the armada of treatment options you have.
Let's take one of the most common second layers of pain for the back pain patient. That's usually a sciatic, or radiating leg pain
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Short video introduction on where and why to place tens electrodes or interferential electrodes for pain relief. Introductory video is about 2 minutes long and below this video is a longer, 11 minute video, for additional information on electrode placement for tens pads, pain pads, if you desire more information.
Longer explanation video on tens unit electrode placement and interferential electrode placement for pain relief.