The therapeutic effects of electrical energy have been known for years. Electrotherapy has been found to be effective in treating conditions such as relaxation of muscle spasms, increasing local blood circulation, muscle re-education, increasing range of motion, prevention or retardation of disuse atrophy, symptomatic relief of chronic intractable pain, and management of post-traumatic or postsurgical pain.

In addition to the benefits it can bring to your patients, electrotherapy can also bring a nice secondary profit to your practice by expanding the number of services you offer.

But with the various types of electotherapy out there, choosing the right one for your practice can be a challenge. Chiropractic Products contacted three experts to get more information about the equipment. Doug Schultz is vice president of sales for HESSCO in Saukville, Wis. Mark Mettler is vice president of Mettler Electronics Corp in Anaheim, Calif. Mike L. Pavia is regional sales manager for Dynatronics Corp in Salt Lake City.

Which products are the most versatile for chiropractors who want to incorporate various types of electrotherapy, such as interferential, transcutaneous electrical nerve stimulation (TENS), and microcurrent?

Schultz: There are several quality units available that offer multiple modalities, including interferential current, Russian, biphasic, microcurrent, high-volt, ultrasound, and even phototherapy.

Mettler: Mettler's Sonicator® Plus products, as well as the Sys*Stim® 294, have the most versatility for chiropractors who want to use a wide range of waveforms in their practices. For those chiropractors who like simplicity, we have a wide variety of neuromuscular stimulators to choose from.

Pavia: Chiropractors need tools to help them address the various types of patients and injuries that they see, such as pain, edema, muscle re-education (including denervated muscle), and circulation. These tools should include products that offer multiple waveforms and variable parameters, including interferential and premodulated therapy, high-voltage pulsed stimulation, Russian and biphasic therapies, and microcurrent and direct-current treatments. In addition, look for features that give the practitioner a distinct advantage, such as three-frequency ultrasound (1 MHz, 2 MHz, and 3 MHz), infrared light/laser probe applications, and the ability to target interferential therapy directly to the site of pain.

What issues should chiropractors keep in mind when considering combination therapy (electrotherapy/ultrasound) products? Which combination therapy products offer the most useful features?

Dynatronics’ Solaris 709 5-channel combination unit includes electrotherapy, ultrasound, and optional light therapy.

Schultz: Issues to be concerned with include: Will I be treating in one room like a physical therapy room, or will I need the units in each of my treatment rooms? Which modalities do I really need? How much money do I have budgeted for this part of my practice? What kind of training do I get with the unit?

Mettler: Ease of use and reliability should be the key factors in making a choice in a combination therapy product. Our Sonicator Plus 930 offers the most popular stimulation waveforms as well as 1- and 3-MHz ultrasound. All Mettler combination units feature direct crystal-to-patient ultrasound applicators, which grant the most efficient transfer of ultrasonic energy to the patient.

Pavia: With combination therapy devices, the most important issues involve the usability of the modality. Purchase devices that give you the ability to use any available channel on the device for combination therapy. Also, request a device where ultrasound can be used with any of the electrotherapy waveforms. The ultrasound parameters are just as important. Make sure the device allows multiple frequencies (1 MHz, 2 MHz, 3 MHz) for different depths of penetration. Many doctors find it useful to have devices that allow multiple patient treatments. Make sure your device can deliver electrotherapy to one patient while delivering combination therapy to another.

What type of regular maintenance is required on the equipment, and how can a chiropractor make accessories such as electrodes last as long as possible?

Schultz: Most manufacturers recommend yearly calibration of their units, and in today's litigious society, that's not a bad recommendation to follow. The most important thing you can do to extend the lifetime of the self-adhesive electrodes that most doctors use is to make sure to put them back in the Ziploc bags when you are not using them.

Mettler: Regular maintenance includes inspection of all cables for wear and electrode replacement when necessary. Following the package instructions on the self-adhesive electrode package and effective cleansing of the skin prior to application ensures long life for the electrodes. The ultrasound accuracy must be checked annually according to FDA regulations.

Pavia: There is some basic maintenance that can and should be done to keep your equipment working properly. You should inspect accessories and lead wires on a daily basis for any wear or damage. Lead wires and carbon electrodes should be replaced at least every 6 months. Self-adhesive electrodes should not exceed more than 15 times of use. To maximize usage, you should store the electrodes in a tightly sealed pouch in between treatments. The patient's skin should be thoroughly cleaned and free from oils or flakiness prior to placing the electrodes. Also, an ultrasound calibration inspection should be performed on an annual basis.

All Mettler combination units, such as the Sonicator Plus 930, feature direct crystal-to-patient ultrasound applicators, which grant the most efficient transfer of ultrasonic energy to the patient.

Which electrotherapy product would be recommended to get the highest value for the price?

Schultz: This completely depends on the doctor's intended use for the product. Talking to an experienced rep in this field can help doctors get the product that fits their needs best.

Mettler: Our Sonicator Plus 930 would give you the best value for the price. It is easy to use with a highly affordable price.

Pavia: One should look for the equipment that offers the most versatility. Having features such as seven types of electrical-stimulation waveforms, multifrequency ultrasound (1 MHz, 2 MHz, 3 MHz) and even light/laser therapy gives chiropractors the most "bang for their buck." This type of versatility will not only save the chiropractor time and space, but more importantly, money.

What is the length of warranty for the various products, and what should the warranty cover? Is an extended warranty available, and is it recommended?

Mettler: Most of our products have a 2-year warranty on the device itself with a 1-year warranty on applicators and cables. Mettler offers a 2-year extended warranty program (1 additional year on applicators and cables).

Pavia: Most equipment of this type comes with some form of warranty. The standard in the industry is a 2-year warranty. This warranty should cover all parts and labor for the full two years. Extended warranties are available if desired. However, not many are purchased.

Where do you see a need for improvement in electrotherapy products?

For more on TENS therapy, go to the August 2006 article titled, "Count on TENS."

Schultz: Education. Letting the doctors know what the many available modalities can do for them. Make sure to contact a rep who has experience in this area and who can get this information to you so that you get the most out of the product you purchase.

Mettler: Electrotherapy products need to be simplified to make them easier to use in the clinic. Displays that allow the clinician to monitor the progress of a treatment at all times are essential.

Pavia: The improvements that have been made in the past few years involve new applications and the combination of modalities in the same device. We need to continue down this path and develop new features that give doctors more flexibility to treat their patients.