SWD

[Link] Bhagat
MPT(cardiopulmonary)

A short wave diathermic current has a frequency of

between 107 and 108 Hz and sets up radio waves with a
wave length of between 30 and 3 m.

The use of medical current within this range is classed as

short-wave diathermy, but that commonly used for
medical work has a frequency of 27.12MHz and sets up
radio waves with a wave length of 11m

this current is generated in a machine circuit which is in

turn coupled to a patient circuit which is used to treat the
patient

It provides the deepest form of heat available to the

physiotherapist
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principles

This type of current can only be produced by discharging a

condenser through an inductance of low ohmic resistance

If a current of very high frequency is required, the

capacitance and inductance should be small and if a
current of low frequency is required the capacitance and
inductance should be large

This is the mechanism of production of high frequency

current
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Construction
1.

The machine circuit

2.

The patient circuit

The machine circuit (Oscillator circuit)

Consist of a condenser and an inductance

Currents of different frequencies are obtained by

selecting suitable condensers and inductance

In order to produce the high frequency current, the

condenser must be made to discharge repeatedly, and to
achieve this the oscillator is incorporated in a valve circuit

The patient circuit (Resonator circuit)

This is coupled to the machine circuit by inductors, i.e. a

matching high frequency current is produced in the
resonator circuit by electromagnetic induction

For this to happen the oscillator and resonator must be in

resonance with each other, which requires that the
product of inductance and capacitance must be the same
for both curcuits

When short wave diathermy is applied by the condenser

field method, the electrodes and the patients tissues
form a capacitor, the capacitance of which depends on the
size of the electrodes and on the distance and material
between them, and so is different for each application

When the cable electrode is used it forms an inductance

the value of which varies according to its arrangement

Consequently either the capacitance or the inductance of

the patients circuit is varied at each treatment, and a
variable condenser is incorporated in the patient circuit to
compensate for this
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When the electrodes have been arranged in position, the

capacitance of the variable condenser is adjusted(the
process of tuning) until the product of the inductance and
capacitance of the resonator circuit is equal to that in the
oscillator circuit

When the oscillator and resonator circuits are in tune with

each other, there is maximum power transfer to the
patient circuit

Indications:
1.

An indicator light on the equipment either comes on or

changes color

2.

An ammeter wired into the resonator circuit shows a

maximum reading, which is diminished by turning the
knob controlling the variable capacitor either way

3.

A tube containing a small amount of neon gas placed

within the electric field between the electrodes or the
ends of the cable will glow at maximum intensity when
the circuits are in resonance

Physiological effects of diathermy

current

A high frequency current does not stimulate motor or

sensory nerves

The shorter the duration of the impulse the less is the

effect on the nerves, 0.01ms being the shortest duration
of impulse generally used

A high frequency current has a frequency of more than

approximately 500kHz. This provides one million impulses
per second, so each has a duration of 0.001ms, which is
beyond the range used for nerve stimulation
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Thus when such a current is passed through the body there

is no discomfort and no muscle contractions are produced

The current is evenly alternating, therefore there is no

danger of chemical burns

Consequently it is possible to pass through the tissues

currents of a much greater intensity than can be used with
low frequency currents

The intensity of the current can be great enough to

produce a direct heating effect on the tissues

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Methods of application
1.

Capacitor field method

2.

Cable method

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Techniques of short wave diathermy

Testing of the machine:

Condenser electrodes- are arranged opposite to each

other with a gap in between. The operator places her
hand between the electrodes, switches on and tunes the
machine, then increases the current until a comfortable
warmth is felt

Cable- may be arranged in single loop and tested with a

neon tube which lights up when the two circuits are in
resonance, or the operator may place her hand between
the ends of the cable and tur up the current until warmth
is felt
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Preparation of the patient

The couch, chair or table that is used for supporting the

patient should not contain metal, as this is liable to
distort the electric field and to be heated by currents
which may be induced in it

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Clothing should be removed from the area of treatment,

for a number of reasons

It may be slightly damp from perspiration, and its presence

would interfere with the circulation of air, which aids the
evaporation of any sweat which may form during treatment

Tight clothing may interfere with the flow of the blood

through the area, causing overheating

If the clothing is not removed, the necessary inspection of

the skin before and after treatment is not possible, and the
skin-electrode distance and position of electrodes cannot be
judged accurately

Difficult for the patient to appreciate the sensation of

warmth
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Metal objects in the clothing may easily pass

undetected. Metal and moisture both have a high
dielectric constant, and a localized are of either causes
concentration of an electric field, with consequent overheating

Metal objects, and anything that is damp, should be

removed from the vicinity of the area to be treated

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Wounds and sinuses must be cleansed and covered with

a dry dressing before commencing treatment

The area to be treated must be dry, if the area is damp,

the moisture on the surface of the skin is heated quickly
and gives rise to a sensation of warmth which limits the
intensity of current that can be applied

The patient must be comfortable and the part to be

treated must be fully supported, as movement may alter
the skin electrode distance

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The ammeter is no guide to the amount of heating of

the tissues, merely of value for tuning the circuits

The dose is important for the patient to understand the

degree of warmth that he should feel, that undue heat
should be reported, and there is a danger of burns if the
heat becomes excessive

Skin sensations must be tested before the first

treatment

Hearing aid must be removed and left well away from

the machine, induced currents may cause severe damage
to them

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Types of electrodes

1.

Several types, but each consist of a metal plate

surrounded by some form of insulating material
One type has a cover within which the position of the
metal plate can be adjusted

Commonly circular, but special shapes are made for some

irregular areas like axilla

Arranged in position on supporting arms and it is advisable

to leave a small gap between the cover and the skin to
allow for the circulation of air
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2.

Another type of electrodes consist of a rigid metal plate

coated with a thin layer of insulating material, either
rubber or plastic

Frequently convex at the edges, which provides a more even

electric field than a flat disc

Because an electric charge concentrates at the edges of a

conductor and sets up a more intense electric field in this
area than elsewhere; with the convex electrodes the edges
are further from the skin than is the centre so the peripheral
part of the field has room to spread before reaching the skin

This electrodes are arranged in position on supporting arms

and separated from the skin by an air gap

Have an adjustable device projecting from the centre to

ensure correct spacing
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3.

Third type of electrode consist of a malleable metal plate

covered with a thin layer of rubber

Can be moulded to the part, but should not be bent sharply

or the metal plate may crack

Separated from the skin by perforated felt and their position

is maintained by body weight

Undue pressure, which would interfere with the blood flow

should be avoided

Felt is perforated so that it contains a proportion of air,

which is the most satisfactory spacing material, but the
impossibility of entirely air spacing is one of the
disadvantage

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4.

The cable electrode consists of a thick wire covered with

rubber

Separated from the skin by at least four layers of dry

Turkish toweling, forming a thickness of at least 1 cm

Toweling is necessary to absorb any perspiration which

may be produced by the heat and result in a scald

Turns of the cable should be at least 2.5 cm apart and

may be secured wit spacers made of insulating material

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Position and size of the electrodes

The position of the electrodes should be chosen with the aim
of directing the electric field through the structures to be
treated
If the structure is of high impedance the electrodes should
be arranged, as far as possible, so that the different tissues
lie in series with each other, i.e. at right angles to the
electric field
To heat a structure of low impedance it is most satisfactory
if the tissues are parallel to the field
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If the tissues lie in parallel to the field the heating is in

fact mainly confined to the blood vessels and muscles

Such heating is therefore satisfactory for treatment of the

soft structures

The electrodes should be placed parallel to the skin,

otherwise the field concentrates on the area of tissue
lying closet to the electrode

Placing the electrodes parallel to the skin may result in

their not lying parallel to each other, but provided that
the electrode is through the body tissues, this has little
effect on field distibution
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Distance between the should be greater than the total

spacing

Electrodes should be placed over an even surface of the

body

if the surface is irregular, the field tends to concentrate

on the more prominent parts

Where an irregular surface cannot be avoided, the

concentration can be reduced by using wide spacing

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1.

Contraplanar

2.

Coplanar

3.

Cross-fire

4.

Monopolar

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1.

Contraplanar positioning of electrodes-

. Most

satisfactory method for the treatment of deeply

placed structures

. Placed

over opposite aspects of trunk or limb so that the

electric field id directed through the deep tissues

2.

Coplanar positioning of electrodes-

. Placed

side by side on the same aspect of the part,

provided that there is adequate distance between them,
as the pathway through the tissues offers less impedance
to the lines of forces than through the air between the
electrodes
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The distribution of the resulting electric field

The distance between the electrodes is more than the

total width of spacing, otherwise the electric field will
not pass through the tissues at all

Heating is more superficial than with the contraplanar

method

Method is particularly suitable for the treatment of

superficial structures where some factor contraindicates
the placing of an electrode immediately over the lesion

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3.

Cross-fire method-

. Half

the treatment is given with the electrode in one

position, then the arrangement is changed so that the
electric field lies at right angles to that obtained during
the first part of the treatment

. Used

to treat the walls of cavities containing air, e.g. the

frontal, maxillary and ethmoid sinuses

. The

lines of force pass through the tissues between the

electrodes but avoid the cavity, as the air within it has a
low dielectric constant

. Thus

those walls of the cavity which face the electrodes

are not treated
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If the position of the electrodes is then changed so that

the field lies at right angles to previous one, these walls
are heated

Contact lenses should be removed because the heating

effect may cause melting of the lens

May also be used for deeply placed structures, particularly

if they lie in extensive vascular areas, e.g. pelvic organs

The dielectric constant of the vascular tissues is very high

and the cross sectional area of the part is larger than the
electrodes, so the field spreads in the deep tissues, which
consequently receive less heating than the superficial
ones
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By passing the field through the area in two directions,

thee deep tissues receive twice as long an exposure as the
skin

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4.

Monopolar technique-

. The

active electrode is placed over the site of the lesion

and the indifferent electrode is applied to some distant
part of the body, or may not be used at all

. A

separate electric field is set up under each electrode,

the lines of force radiating from the electrode

. Thus

the density of the field becomes less as the distance

from the electrode increases, and the heating is
superficial

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Connecting leads

The leads or the cable must be of the correct length for

the particular electrodes and machine that are used

The leads should lie parallel to each other, at least as far

apart as the terminals of the machine, and not approach
close to any conductor

Currents may induced in any conductor which lies near to

the leads, with consequent loss of energy from the leads
and possible damage to the conductor from over-heating

Must be separated from pts skin by a distance at least as

great as the electrodes spacing, otherwise they induced
currents in the tissues and cause heating in this area
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Application of current

When the pt, electrodes, and leads are in position, the

current is turned on and the circuits tuned

The current is then turned up slowly, to allow

vasodilatation to occur and for the patient to appreciate
the degree of heating

The operator should remain within call of the patient

throughout the treatment, and turn the current off
immediately if the heating becomes excessive
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A the end of the treatment the controls are turned to

zero, the current is switched off and the electrodes are
removed

Skin may be faintly pink, but there should be no strong

reaction

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Dosage

Intensity of the application should be sufficient to cause a

comfortable warmth and the duration of the treatment
should be 20-30 minutes (except for the treatment of
chronic inflammatory lesions, when a duration of at least
30 minutes is desirable)

Daily or on alternate days

For the treatment of acute inflammation, or recent injury,

the application should be less intense than that suggested
above, but may be carried out more frequently
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The current used may be that which produces a mild

sensation of warmth, or it may be increased until mild
warmth is felt then reduced to the point at which the
sensation is no longer perceptible

The duration is limited to 5-10 minutes; the dose is

increased progressively but cautiously according too the
effects observed

When the inflammation is within a confirmed space, such

as the air sinuses of the face, it is particularly important
that excess treatment should be avoided, as rise in
tension in such an area seriously aggravates the
symptoms
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Therapeutic uses of SWD

Effects on inflammation

Dilatation of the arterioles and capillaries

Increased blood flow to the area

Available a increased supply of oxygen and nutritive

materials, more antibodies, and WBCs

Vasodilatation increases the exudation of fluid into the

tissues and followed by increased absorption which,
together with the increased flow of blood through the
area, assist in the removal of waste products

Helps to bring resolution of inflammation

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In acute stage of inflammation, caution should be

exercised in applying the treatment to areas in which
there is already marked vasodilatation and exudation of
fluid, as an increase in these processes may aggravate the
symptoms

In sub acute stages, stronger doses may be applied with

considerable benefit

When the inflammation is chronic, a thermal dose of fairly

long duration must be used to be effective

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Effects in bacterial infections

Inflammation is the normal response of the tissues to the

presence of bacteria, the principle features being
vasodilatation, exudation of fluid into the tissues, and an
increase in the concentration of WBCs and antibodies in
the area

Heating the tissues augments these changes and so

reinforces the bodys normal mechanism of dealing with
the infecting organisms, therefore SWD may be of value
in the treatment of bacterial infections such as boils,
carbuncles and abscesses

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Treatment in the early stages may occasionally bring

about resolution of the inflammation without pus
formation occurring, failing this, the development of the
inflammatory response is accelerated

Until there is free drainage, the treatment should be given

cautiously, as in all cases of acute inflammation

When the abscess is draining freely, stronger doses may be

applied, the increased blood supply assisting the healing
processes once the infection has been overcome

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In some cases SWD appears to aggravate the condition,

but increased discharge for a few days is an indication of
acceleration of the changes occurring in the tissues, and
not a contraindication to treatment

However, should the increased discharge persist it may be

an indication that the bodys defense mechanism is
already taxed to its uttermost, so that it is impossible to
reinforce its action

This is most likely to occur in case of long standing

infection, and under these circumstances no benefit is
derived from the application of SWD

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Traumatic conditions

Effects of SWD on traumatic lesions ae similar to those

produced in inflammation

The exudation of fluid (followed by increased absorption)

and the increased flow of blood through the area assist in
the removal of waste products, while the improved blood
supply makes available more nutritive materials, so
assisting the healing process

Recent injuries should be treated with the same caution as

acute inflammation, as excessive heating is liable to
increase the exudation of fluid from the damaged vessels

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Stiff joints and other after effects of injury require

stronger doses, the treatment being a preliminary to the
exercises which is usually the essential part of the
treatment

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Reducing healing time

To promote the healing of, for instance, a wound, an

increased blood supply to the tissues may be of assistance,
provided that the vascular responses to heat are normal

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Relief of pain

A mild degree of heating is effective in relieving pain,

presumably as a result of a sedative effect

Pain may be due to the accumulation in the tissues of the

waste products of metabolism and that the increased flow
of blood through the area assist in removing these
substances

When pain is due to inflammatory processes, resolution of

the inflammation is accompanied by relief of pain

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However, strong heating in these cases may cause an

increase of pain, especially in acute inflammation, if the
increased blood flow and exudation of fluid cause an
increase of tension in the tissues

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Effects on muscle tissue

The heating of the tissues induces muscle relaxation, so

SWD may be used for the relief of muscle spasm
associated with inflammation and trauma, usually as a
preliminary to movements

Increased efficiency of muscle action should also aid the

satisfactory performance of active exercises

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Dangers
Burns

In severe cases there is coagulation and destruction of the

tissues, and the burn appears as a white patch surrounded
by a reddened area of inflammation

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