Chiropractors are reporting success with various types of electrotherapy. Examples of electrotherapy in use at chiropractic offices include transcutaneous electrical nerve stimulation (TENS), interferential current (IFC), pre-modulated and high volt, Russian stim, and alpha-stim.

Interviews with several DCs show the penetration and diversity of electrotherapy in the world of chiropractic.

Ken Ross, DC, Orlando, Fla, frequently uses low/high volt therapy for pain management—especially the high volt for acute pain—and the more deeply penetrating interferential for muscle spasms, swelling and inflammation, and pain. He also occasionally uses TENS and Russian stim, the former for pain relief and the latter for more complex muscle re-education to strengthen weakened muscles.

On Different Wavelengths

"The difference is the current, even though they may feel the same to the patient." Ross says, explaining how various wavelengths perform different functions. Several currents can be incorporated into one machine—Ross has "combos" made by Chattanooga and Amrex that offer premodulated, high volt, interferential, and Russian waveforms, as well as ultrasound, all in the same unit. The Chattanooga Intelect Legend Combination System permits choosing between 2-channel and 4-channel modes.

Ross draws an analogy between wavelengths and vitamin supplements. "Just as in nutrition different vitamins have different properties and functions, so do different wavelengths play different roles in electrotherapy," Ross says.

Everyday use of electrotherapy is commonplace in Ross' office, and he prefers to use the interferential because of its healing properties. He feels that TENS, on the other hand, can only block the pain impulse coming from the brain, and is generally ineffective once the machine is turned off. Interferential, with its criss-cross deep-penetrating pattern, has a "lot of therapeutic value," according to Ross, and can be used on a range of musculoskeletal problems including trauma, disk degeneration, and inflammation, whether chronic or intermittent, mild or acute.

"Usually, it takes 7 to 21 days to reduce severe inflammation when electric stim is used in combination with adjustments and physical therapy," Ross says.

One improvement in electrotherapy that Ross would like to see is "better methods of application," so that the patient can get an optimal therapeutic result with as little discomfort as possible.

Alpha-Stim

Alpha-stim is a type of microcurrent that produces a proprietary electrical waveform and has been approved for transcranial applications or cranial electrical stimulation. Steven Gould, DC, DACBR, Cheney, Kan, who also uses the interferential system extensively, has begun using Alpha-Stim microcurrent technology. "Alpha-Stim has been around for 15 to 17 years, but I first encountered it just two months ago at the Kansas Chiropractic Convention," Gould says.

Terry Shaw, DC, has six interferential units and says interferential therapy can be used for acute, subacute, and chronic problems.

The Alpha-Stim unit, about as big as a deck of cards, passes a small, safe current (usually 100 Hz) across the head via transcutaneous electrodes to achieve lowering of the alpha bandwidth and normalization of the electrical activity of the brain. Consistent daily treatment over a relatively short period—usually 2 to 3 weeks—can relieve physical pain and emotional conditions such as anxiety and depression.

Gould has used the Alpha-Stim 100 successfully in treating migraine headaches and shoulder pain resulting from hemi-arthroplasty (partial shoulder replacement), as well as in an interesting case of an amputee with both "phantom" and real leg pains. The woman, who, for 14 years, had been suffering from "lightning-like pains" shooting up into her thigh from a lower-leg amputation, experienced total relief during and after Alpha-Stim treatment. In this case, the electrodes, which are normally attached at the base of the skull or on the earlobes, were also placed on her leg just above the missing lower limb.

Combos

Melina Youngs, DC, Cape Coral, Fla, uses the combo EMS and ultrasound machines to administer various treatments, including pre-modulated, interferential, Russian stim, and high-volt electrotherapy.

She has four Chattanooga Intelect Legend units, each of which can treat two patients at a time, so she is capable of treating eight patients at once in the facility's therapy bay. She also cautions that patients with pacemakers cannot receive EMS.

"Patients are requesting the treatment," Youngs says. She often combines the treatment with moist heat or with ice packs. "These days, physicians and MDs are getting these units and offering the treatment," Youngs says. "They're getting into the physical therapy aspect because of the effectiveness of electrotherapy in reducing pain and inflammation, and in the case of Russian stim, of strengthening atrophied muscles."

She notes that muscles that have weakened because of being in a cast can benefit from the muscle re-education technology of Russian stim.

A recent case of a woman with hip bursitis illustrates the effectiveness of electrotherapy. "She had a lot of pain but didn't want to go on medication," Youngs says. "We used high-volt EMS with ice on her hip and gluteal area. The treatments lasted 12 to 15 minutes. After one treatment, she felt about 20% better, then came back about six or seven times. She's 90% better now."

Youngs wishes that insurance companies would provide more reimbursement. "Some will pay only seven or eight dollars, making it hardly worthwhile to administer the treatment," Youngs says. "Others pay $20 or more. It just depends on the company."

Youngs says she would also like to see more affordable EMS units in the future for both the office and the home.

Richard A. Snow, DC, Overland Park, Kan, uses microcurrent electrical neuromuscular stimulation (MENS) and specializes in combining electrotherapy with classical Chinese medicine by using the body's acupressure points. "The aim is to treat the causes of problems, not just the symptoms," Snow says. "We want to heal the injury and help to prevent recurrence, not just block the pain."

Manipulations to correct vertebral subluxations are also part of this approach, but they are "low force, very gentle spinal adjustments." Some of the afflictions Snow has treated include wounds, migraines, and problems resulting from surgical scars, especially Caesarian sections. Snow explains that scars can create imbalances in the body's energy flow, which can be restored by application of microcurrents at precise acupuncture points. Snow uses high-volt electrotherapy after injury accidents to relax the muscles.

Terry Shaw, DC, Quincy, Ill, prefers the interferential type of electrotherapy. His office has six units supplied by Dynatronics and LSI, which he uses with 90% of his patients. He says that inferential electrotherapy can be used for acute, sub-acute and chronic problems, and that it is "well-accepted, with no problems."

The Dynatronics units, Shaw says, have the capability to sight the target in a cross area and to use one's finger on the screen. "You can also set the current for slow or faster and move it around from the center point. It has good diversity," he says. But the LSI unit is notable for "ease of use and good price point." CP

Alan Ruskin is a staff writer for Chiropractic Products. Contact him at .