TENS / Transcutaneous Electrical Nerve Stimulation

 Hey guys.... welcome back to my another blog. In the previous blog I talked about 'Bones & Joints'....

For the new people who doesn't know about this blog page..

Hi this is "PhysioZon" , here I give you guys various information about physiotherapy..

Today's topic based on electrotherapy which is "TENS or Transcutaneous Electrical Nerve Stimulation"...

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# What is Electrotherapy?

: Electrotherapy is the use of electrical energy as a medical treatment.

 Electrotherapy is primarily used in physical therapy for-

• relaxation of muscle spasms.

• prevention and retardation of disuse atrophy.

• increase of local blood circulation.

• muscle rehabilitation and re-education.

• electrical muscle stimulation.

• maintaining and increasing range of motion.

• management of chronic and intractable pain including diabetic neuropathy^[2].

• acute post-traumatic and post-surgical pain.

• post surgical stimulation of muscles to prevent venous thrombosis.

• wound healing , etc.

 Various types of electrical equipments are present in physiotherapy for treatment, like - UST, IFT, TENS, UVR, SWD, IRR, LASER, etc. 

 Today's topic is TENS. I will explain other topics in future blogs...stay tuned...

# What is TENS?

: TENS or Transcutaneous Electrical Nerve Stimulation is the application of a pulsed rectangular wave current via surface electrodes on the patient's skin.

•Pulse shape = usually rectangular,

•Pulse width = it is often fixed at 100μs or 200μs. It also can vary from 50μs-300μs.

•Frequency = it is 2Hz-600Hz. Commonly used 150Hz.

•Intensity = it can be varied from 0mA-60mA.

# Types of TENS?

: There are 4 types of TENS. They are -

1) High TENS -

•Pulse shape = bipolar asymmetric.

•Pulse width = 50μs-100μs.

•Frequency = 50Hz-100Hz.

•Duration = 20-60 minutes for one sitting.

2) Low TENS -

•Pulse shape = monophasic.

•Pulse width = 150μs-300μs.

•Frequency = 1Hz-5Hz.

•Duration = 20-30 minutes per sitting.

3) Brief intense TENS -

•Pulse shape = monophasic.

•Pulse width = 50μs-250μs.

•Frequency = 80Hz-150Hz.

•Duration = 15 minutes per sitting.

4) Burst TENS -

•Pulse shape = asymmetric biphasic.

•Pulse width = 50μs-200μs.

•Frequency = 50Hz-100Hz.

•Duration = 20-30 minutes per sitting.

# How does it work?

A) TENS apparatus = i) Large mains units are available to produce the current, but often small units made to be placed in the patient's pocket and utilising batteries are preferred.

ii) Current is often generated by battery operated machines in which circuits modify the battery's output in such a way that it will have a stimulatory effect.

iii) Many different types of TENS apparatus are manufactured and consequently some knowledge of the parameters within which a particular unit operates is required by the therapist.

iv) Conductive rubber electrodes covered with a conductive gel in order to gain good skin contact are placed on the patient's skin.

v) The electrodes can be bandaged onto the patient or fixed with adhesive tape. The wires connecting the electrodes to the unit can be strategically concealed by clothing.

B) Positioning of electrodes = 

i) Electrode positioning is an area of considerable debate and a number of approaches may be used. 

ii) Make sure the machine is switched off before attaching the pads to skin. Position of the pads side of the painful area, at least 2.5 cm apart. 

iii) Pads can be placed over acupuncture points,motor points or trigger points. It can be placed over the appropriate dermatome or spinal segment.

iv) Also can be placed over the appropriate peripheral nerve. This also determined by the taget muscle or muscle group either single or in relation to other muscles.

C) Electrode placement pattern = 

i) Unilateral placement - it allow the stimulation of one limb or half of a muscle pair.

ii) Bilateral placement - it allow the stimulation of both limbs or both halves of a muscle pair. 

iii) Unipolar - only one of two essential leads and the electrode connected to it are placed over the target area affected by the stimulation,this electrode is treatment electrode.

iv) Qadri-polar - involve the use of two sets of electrodes each originating from its own channel. It may be considered the concurrent application of two bipolar circuit. This technique could be used with stimulation of agonist and antagonist.

v) Also could be used in crossed pattern for large flat area as back.

D) Methods of applying TENS =

Once the electrodes have been placed, the TENS can be applied and one of two methods used. They are,

i) High TENS : When TENS is applied in this way, the stimulation will cause impulses to be carried along large diameter afferent nerves, and this can produce presynaptic inhibition of transmission of nociceptive Aδ and C fibers at the substantia gelatinosa of the pain gait. There is also the possibility that as the frequency of stimulation is sufficiently high a physiological block of transmission could be caused in the nociceptive fibers. Thus the patient is aware of the strong tingling sensation but nociceptive traffic is reduced.

This high intensity will produce a tetanic muscle contraction.

ii) Low TENS : When TENS is applied in this way, the nociceptive stimulus is carried towards the cerebrum, its passage through the mid brain will cause the PAG (periaqueductal area of grey matter) and raphe nucleus to interact to cause the release of opiate like substances at cord level. The enkephalins and β-endorphins released have the effect of blocking forward transmission in the pain circuits. This mechanism operates when pain relief is attained with acupuncture.

Low TENS gives a sharp almost nociceptive stimulus and possibly a muscle twitch.

# Indications of TENS :

1) Frozen shoulder, movement restrictions.

2) Post operative pain.

3) Menstruation pain.

4)Low back pain, headache.

5) Arthritis, neuralgia.

6) Sports injuries. etc.

# Contraindications of TENS :

1) Over head,neck,eyes,etc.

2) Patient with pacemaker.

3) Patient with cardiac conditions (the chest wall).

4) Patient who has allergic response.

5) Patient with open scars.

6) Patients who are unable to co-operate with therapist.

7) Patient with metal implant.

8) Over pelvis, abdomen,trunk during pregnancy. etc.

References= Clayton's Electrotherapy, Textbook of Electrotherapy by Jagmohan Singh.

Hope these information will help you a lot...

Other topics will be in future blogs...

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Bones & Joints

Hey guys.... welcome back to my another blog. In the previous blog I gave you guys 'Anatomy Introduction'....

For the new people who doesn't know about this blog page..

Hi this is "PhysioZon" , here I gave you guys various information about physiotherapy..

Today's topic is about 'Bones & Joints'...

Before starting this blog , make sure you follow "PhysioZon", also follow on FB page (PhysioZon) & insta (physiozon.sm)

Let's start...

# What is Bone ?

: Bones are specialized connective tissue known as "sclerous tissue". Bone is one-third connective tissue. It is impregnated with calcium salts which constitute two-thirds part.

   There is 270 bones at birth. This total decreases to around 206 bones by adulthood after some bones get fused together.

# What are the bones of human body ?

: There are 206 bones present in adult human body. They are divided into several sections...

1) Skull bones names:-

i. Cranial bones: Frontal bone(1), Parietal bones(2), Occipital bone(1), Temporal bones (2), Sphenoid bone(1), Ethmoid bone(1).

ii. Facial bones: Zygomatic bones(2), Maxilla bones(2), Mandible bone(1), Vomer bone(1), Nasal bones(2), Lacrimal bones(2), Palatine bones(2), Inferior nasal concha bones(2).

iii. Middle ear bones: Malleus bones(2), Incus bones(2), Stapes bones(2).

2) Spine bones names:-

i. Cervical vertebrae (7),

ii. Thoracic vertebrae (12),

iii. Lumber vertebrae (5),

iv. Sacrum vertebrae (5 bones at birth, fused into 1 after adolescence),

v. Coccygeal vertebrae (4 bones at birth, fused into 1).

3) Thorax (chest) bones names:-

i. Hyoid bone(1),

ii. Sternum bone(1),

iii. Ribs(24 in total).

4) Arm bones names:-

i. Upper arm bones: Humerus bones(2), Scapula bones(2), Clavicle bones(2).

ii. Lower arm bones: Radius bones (2), Ulna bones(2).

iii. Bones of hand: a} Carpal bones =>

• Proximal row : Scaphoid bones(2), Lunate bones (2), Triquetrum bones(2), Pisiform bones(2).

• Distal row : Trapezium bones (2), Trapezoid bones(2), Capitate bones(2), Hamate bones(2).

b} Metacarpal bones(10 bones in total; 5 on each side)

c} Phalanges=>

• Proximal bones(10 bones in total; 5 on each side)

• Intermediate bones(8 bones in total; 4 on each side)

• Distal bones(10 bones in total; 5 on each side).

5) Pelvic girdle bones names:-

i. Ilium bone(1)

ii. Ischium bone(1)

iii. Pubis bone(1).

6) Bones names of Leg:-

i. Femur bones(2)

ii. Tibia bones(2)

iii. Fibula bones(2)

iv. Patella bones(2)

v. Foot bones: a} Tarsal bones=>

Calcaneus bones(2), Talus bones(2), Cuboid bones(2), Navicular bones(2), Medial cuniform bones(2), Intermediate cuniform bones(2), Lateral cuniform bones (2).

b} Metatarsal bones(10 bones in total)

c} Phalanges=>

Proximal bones(10 bones in total), Intermediate bones (8 bones in total), Distal bones (10 bones in total).

# Classification of bones...

There are 5 types of bones.

1) Long bone :-

• Features: Cylinder like shape, longer than it is wide.

• Functions: Leverage.

• Examples: Femur,tibia,fibula, humerus,radius,ulna,metacarpals,metatarsals,phalanges.

2) Short bone :-

• Features: Cube like shape, approximately equal in length,width and thickness.

• Functions: Provide stability, support while allowing for some motion.

• Examples: Carpals, tarsals.

3) Flat bone :-

• Features: Thin and curved.

• Functions: Points of attachment for muscles, protectors of internal organs.

• Examples: Sternum,ribs,scapulae, cranial bones.

4) Irregular bone :-

• Features: Complex shape.

• Functions: Protect internal organs.

• Examples: Vertebrae,facial bones.

5) Sesamoid bone :-

• Features: Small and round, embedded in tendons.

• Functions: Protect tendons from comprehensive forces.

• Example: Patellae.

# What is Joint ?

: Joint is a junction between two or more bones, or cartilage with bones, or cartilage with cartilage.

There are more joints in a child than in an adult because as growth proceeds some of the bones fuse together.

Example: The ilium, ischium and pubis to form the pelvic bone.

# What are the joints of human body ?

: I) Main joints: Shoulder joints, elbow joints, wrist joints, hip joints, knee joints, ankle joints.

II) Other joints: Sterno-clavicular joints, acromio-clavicular joints, superior radio-ulnar joints, inferior radio-ulnar joints, intermediate radio-ulnar joints, radio-carpal joints, inter-carpal joints, carpo-metacarpal joints, inter-digital joints, inter-tarsal joints, tarso-metatarsal joints, metatarso-phalangeal joints, inter-digital joints, etc.

# Classification of joints.....

: Joints divided into two parts - 

1) By function: it is also divided into three parts - i} Immovable joints/ Syn-arthrosis joints, ii} Slightly movable joints/ Amphi-arthrosis joints, iii} Fully movable joints/ Di-arthrosis joints.

2) By structure: it is also divided into three parts - 

i} Fibrous joints: it's subdivided into three parts - •Suture joints, •Gomphosis joints, •Syndesmosis joints.

ii} Cartilagenus joints: it's subdivided into two parts - •Synchondrosis joints, •Symphysis joints.

iii} Synovial joints: it's subdivided into six parts - •Condyloid joints, •Gliding joints, •Hinge joints, •Pivot joints, •Saddle joints, •Ball & socket joints.

# Description and examples of all of the above joints....

: 1) Joints grouped by their functions -

i} Immovable joints / Syn-arthrosis : Skull sutures, the articulation between teeth and mandible, the joint found between the first pair of ribs and the sternum.

ii} Slightly movable joints / Amphi-arthrosis : Distal joint between tibia and fibula, pubic symphysis of the pelvic girdle.

iii} Fully movable joints / Di-arthrosis : Elbow joint, shoulder joint, ankle joint.

2) Joints grouped by their structures -

i} Fibrous joints : Fibrous joint is thick connective tissue between the articulation, that's why most fibrous joints are immovable. They are 3 types -

• Sutures: These are non-moving joints that connect bones of the skull.

• Gomphosis: These are the articulation between the teeth and the mandible,maxilla.

• Syndesmosis: It is a joint in which a ligament connects 2 bones, allowing for a little movement (Amphi-arthrosis). The distal joint between the tibia and fibula is an example of Syndesmosis.

ii} Cartilagenus joints : These joints that unite bones with cartilage. There are 2 types-

• Synchondrosis: It is an immovable cartilaginous joint. The joints between the first pair of ribs and sternum is the example of it.

• Symphysis: It is a compressible fibrocartilaginous pad that connects two bones. This allows for some movement. Hip bones connected by the pubic symphysis, the vertebrae connected by intervertebral discs are the examples of it.

iii} Synovial joints : These are characterized by the presence of an articular capsule between the two jointed bones. There are 6 types of synovial joints-

• Gliding joints: These moves against each other on a single plane. Major gliding joints include the intervertebral joints and the bones of the wrist and ankles.

• Hinge joints: These move on just one axis. These joints allow for flexion and extension. Major hinge joints includes the elbow and finger joints.

• Pivot joints: This provides rotation. At the top of the spine, the atlus and axis from a pivot joint that allows for rotation of the head.

• Condyloid joints: It allows for circular motion, flexion and extension. The wrist joint between the radius and the carpal bones is an example of a condyloid joint.

• Saddle joints: It allows for flexion, extension and other movements,but no rotation. In the hand, the thumb is saddle joint (between the first metacarpal and the trapezium) lets the thumb cross over the palm, making opposable.

• Ball and socket joints: These are freely moving joint that can rotate on any axis. The hip joint and shoulder joint are the examples of the ball & socket joints.

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Anatomy Intro

 Heyy guys... Welcome back to my another blog. Today you will get to know about some introduction of anatomy.

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Let's begin....

# What is human anatomy?

:  Human anatomy is a science that related with the structural features of the human body.

  The term 'Anatomy' is derived from a Greek word 'anatome' meaning cutting up. The term 'dissection' is a latin equivalent of the Greek anatome. But the anatomy and dissection are not synonymous.

  There are various branches of it, some of them are...

Gross anatomy, micro-anatomy, clinical anatomy, embryology, radiological anatomy, surface anatomy etc.

# What are the postures in anatomy?

:  I) Anatomical position : In this position a person is standing erect, eyes looking towards horizon, arms is by the side of the trunk, palm facing forwards.

  II) Fundamental position : This is like anatomical position except the palm is on the side of the trunk which is the usual position in our posture.

Patients are examined in this position.

  III) Supine position : Subject is lying on the back with face up.

  IV) Prone position : Subject is lying with the face down and belly on the table.

  V) Lateral position : The side of the subject is adjacent to the table.

# What are the anatomical planes ?

:  I) Sagittal plane : This divides the body into two equal halves, running length wise from front to back.

  II) Coronal plane : This divides the body into anterior and posterior portion, running length wise from side to side. It is also known as frontal plane.

 III) Transverse plane : This is a cross wise plane divides the body into upper and lower parts. It is also known as horizontal plane.

# Some anatomical terms with examples....

• Superior = The head is superior to the neck.

• Inferior = Navel is inferior to the chest.

• Anterior or ventral = Navel is anterior or ventral.

• Posterior or dorsal = Spine is posterior or dorsal.

• Medial = Towards the midline of the body.

• Lateral = Away from midline of the body.

• Proximal = Closest to the trunk (shoulder joint).

• Distal = Away from the trunk (wrist joint).

• Superficial = Closest to the body surface (skin).

• Deep = Away from the body surface (muscles).

# What do we learn in anatomy ?

:  In anatomy we learn about human body.

  We learn about skeleton, skeletal system of human body, bones of human body, joints of human body, muscular system of human body, muscles of human body, nervous system of human body, arterial system of human body, veins of human body, lymphatic system of human body, visceral organs of human body etc.

#What is skeleton ? 

:  Skeleton is formed by bones and cartilages. It is the main supporting framework of the body. It is primarily designed for a more effective production of movements by the attached muscles.

  It is composed of 270 bones at birth. This total decreases to around 206 bones by adulthood after some bones get fused together.

# What is skeletal system ?

:  It is a network of many different parts that work together to help to move.

  The main part of skeletal system is the skeleton and the joints.

# What is bone?

:  Bones are specialized connective tissue known as sclerous tissue. Bone is one-third connective tissue. It is impregnated with calcium salts which constitute two-thirds part.

  Bones give shape and support to the body. It store 97% of the body calcium and phosphorus.

  There are various types of bones present in the human body. You will know about them in further blogs..stay tuned...

# What is joint ? 

:  Joint is a junction between two or more bones, cartilages with bones or cartilage with cartilage.

  There are more joints in a child than in an adult because as growth proceeds some of the bones fuse together.

•Example= the ilium, ischium and pubis to form the pelvic bone.

# What is muscle ? 

: "Muscle" name came from Latin word "mus" which means mouse like appearance.

  Muscle is a tissue which has the special contractile property due to presence of abundant actin and myosin protein filament.

  Muscle cells are known as myocytes.

# What is muscular system ? 

:  The muscular system is an organ system consisting of three types of muscles = skeletal muscle, smooth muscle and cardiac muscle.

  It permits movements of the body, maintains posture and circulates blood throughout the body.

# What is nerve ?

:  A nerve is a cable like bundle of fibers called axons, surrounded by a sheath, sends messages between the body and the brain by chemical and electrical changes in the cells (neurons).

# What is nervous system ?

:  Nervous system is the main controlling and coordinating system of the body.

  It controls and regulates all activities of the body. The structural and functional unit of nervous system is neuron.

  Nervous system divided into central nervous system (CNS) and peripheral nervous system (PNS). Functionally,it is again divided into somatic nervous system and autonomic nervous system.

# What is artery ?

:  Arteries are the blood vessels that deliver oxygenated blood from the heart to the tissues of the body.

# What is vein ?

:  Veins are a type of blood vessels that carries deoxygenated blood from the tissues of the body to the heart.

# What is lymph ?

:  Lymph is a clear to white like fluid, made of white blood cells.

# What is viscera?

:  Viscera are the internal organs of the human body.

•Example = lungs, liver, pancreas etc.

Hope these information will help you a lot...

I will share more details about everything in further blogs....

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