SWD (SHORTWAVE DIATHERMY)

DIATHERMY INTRODUCTION
The word diathermy means through heat (dia and therm).
Diathermy is the application of high-frequency electromagnetic
energy that is primarily used to generate heat (Deep) in body
tissues.
Diathermy may be used to produce non-thermal effects.
Diathermy as a therapeutic agent may be classified as 2 distinct
modalities, shortwave diathermy and microwave diathermy.
SHORTWAVE DIATHERMY (SWD) INTRODUCTION
Shortwave diathermy (SWD) is non-ionizing radiation from the
radio frequency portion of the electromagnetic (EM) spectrum,
used to deliver heat & energy to deep tissues.
Shortwave diathermy may be continuous or pulsed.
The physiologic effects of continuous shortwave diathermies
are primarily thermal, resulting from high-frequency vibration of
molecules. Pulsed shortwave diathermy has been used for its
nonthermal effects in the treatment of soft-tissue injuries and
wounds.
SWD Frequency most commonly used is:
27.12 MHz at wavelength of 11 M
It can go deeper than other modalities, such as hot packs. It
heats larger areas than ultrasound (US).
Structures with high water content, like blood, muscle and
adipose tissue, are selectively heated at depths of 2 5 cm.

Possible Shortwave Diathermy Unit :

A=Power Switch

B=Timer

C=Milliameter (monitors current from power supply, not current

entering patient-volume control)
D= Intensity (%max power to patient)
E=Tuning Control (tunes output from RFO)

Generation of High Frequency SWD :

SWD have two main circuits;
1. Machine circuit which produces high frequency current, and
amplifies its intensity.
2. Patient circuit which is coupled to the machine circuit by
inductors, and transfers the electrical energy to the patient in the
form of an electrostatic or electromagnetic field.
The electrostatic field:
This is seen in the condenser-field method.
The electrostatic field is created by including the patient's
tissues in the patient circuit as part of a condenser.
Two electrodes (flexible pad or space plates electrodes) are
applied to the part, with spacing between the electrode & the
skin, so that the electrodes are the condenser plates & the
patient's tissues together with the spacing are the dielectric
of the condenser.

 The high frequency alternating current is applied to the

electrodes. The electric field will be concentrated between
the 2 electrodes in the patient's tissues.
The electromagnetic field:
This is seen in the inductothermy method.
The electrode used (Cable or Drum electrodes) is a thick
insulated cable which completes the circuit from the machine.
The cable is coiled in close relationship to the tissues, but
separated from them by spacing.
As the high frequency current alternates in the cable, an
electromagnetic field is set up around the center of the cable,
while an electrostatic field is set up between its ends.
Because of the proximity of the patient's tissues, the 2 fields
will be concentrated in the tissues.
Biophysical and biochemical effects of SWD:
The effects of SWD on tissues occur as a result of the effects of
the electrostatic &/or electromagnetic field on the tissue
particles:
A. Effects of an electrostatic field:
1) As the charged ions alternate on the condenser plates, free ions
in the tissue fluid move backwards & forwards along the lines of
force of the field. Because the charge alternates at a high
frequency, the movement is minimal (Vibration of ions),
leading to friction between ions and produce heat.
2) The dipolar molecules in the tissue (as water molecules) will
orient themselves towards the opposite charge on the
condenser plates. As the charge is changing rapidly, a rotation
of the dipoles will occur. As the molecules are coupled loosely
with each other, a friction between molecules will occur,
resulting in the production of heat in the tissues.
3) The non-polar molecules in the tissue (as fat), undergo
distortion of their electron cloud. As the field is alternating
rapidly, the electron clouds oscillate back & froth. Minimal
friction and molecular movement occur, so little heat is
produced.
B. Effects of an electromagnetic field:
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The electromagnetic field produces eddy currents, which are

circular currents at right angles to the lines of force. The friction
of the tissue particles produced by these currents, & by the
associated electrostatic field, results in the production of heat.
Heat production: Heat will be produced in all tissues affected
by the electrostatic and/or electromagnetic field, but will be
concentrated in the tissues of low resistance, such as those of
high fluid content (blood & muscle). Very little heat will be
produced in tissues of high resistance, such as fat & bone.
Some heat will also be conducted to adjacent areas of lower
temperature.

Physiologic Responses to SWD : (= Thermal effects of SWD):

Tissue Temperature Increase
Increased Blood Flow (Vasodilatation)
Increased Metabolism
Increase extensibility of collagen tissues.
Muscle Relaxation (Reflex reduction of muscle tone)
Analgesia

Therapeutic Effects of SWD :

1- Pain relief: By
Stimulation of Sensory heat receptors Pain Gate Mechanism.
2- Reduce Muscle spasm: By
Heating Secondary Afferent muscle spindle Inhibitory
influence to motor pool.
Relieving pain.
3- Accelerate Resolution of Chronic Inflammation: By
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 Increase in blood supply

Increases venous return from the area &
Aids absorption of edema.
4- Accelerate wound healing: by
Increase in cutaneous circulation (Vasodilatation)
5- Assist in control of Chronic Infection: By
increase in circulation
increase white blood cells and antibodies brought to the area
to fight the infective organism Reinforcing bodys normal
defense mechanism.
6- Fibrosis: Heat increases extensibility of fibrous tissues such as
tendons, joint capsule and scars by from 5 to 10 times. Alters collagen
properties, allowing it to elongate.

Dosage Guidelines :
Patient sensation provides the basis for recommendations of
continuous shortwave diathermy dosage and thus varies considerably
with different patients. The following dosage guidelines have been
recommended:
Dose I (lowest): No sensation of heat, it is used in acute
inflammatory process.
Dose II (low): Mild heating sensation, used in subacute
inflammatory conditions
Dose III (medium): Moderate (pleasant) heating sensation
Dose IV (heavy): Vigorous heating within pain threshold, used
for chronic conditions

Duration of treatment :
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 The optimum treatment time is 20 minutes

For dose I & II: use 15 minutes of treatment
For dose III & IV: use 15 30 minutes of treatment
Frequency of treatment :
Factors which determine the frequency of treatment include the
response to treatment & availability of the patient.
Treatment may be given daily or on alternate days as indicated.
Ideally treatment would be most beneficial if given daily or twice
each day.

Indications of SWD:
Disorders of Musculoskeletal System as:
( Sprain, Strain, Muscle & Tendon tear, Capsule lesion, Degenerative
joint disease, Chronic Rheumatoid Arthritis, Joint stiffness,
Hematoma)
Chronic Inflammatory or Infective Conditions as:
(Tenosynovitis, Bursitis, Synovitis, Sinusitis, Infected Surgical
Incisions, Carbuncles, Abscess, Sinusitis, Dysmenorrhoea, Fibrositis,
Myositis)

Contraindications of SWD :
Over Malignant tissues (Cancer): The increase in metabolism
could Accelerate the rate of growth & Metastasis
Over Ischemic tissues: The inability of the circulation to
disperse heat could result in high temperature Burns. Also,
the inability of circulation to provide the increased oxygen
requirement could result in Gangrene.

 Moderate & Excesive edema: Aggravated by heat.

Over Wet Dressings & Adhesive tape: The water collects and
concentrates the heat Burns.
Metal Implants or metal jewelry: Any metal within the field of
SWD will concentrate of the heat Burns.
Cardiac pacemakers: SWD interfere with function of some
pacemakers.
Hemorrhagic area: e.g. in hemophilia and menstruation -The
increase in circulation will increase the degree of hemorrhage.
T.B Joints: the increase in temperature will increase the rate of
development of infection increase joint damage.
Impaired thermal sensation (Sensory loss): could result in
high intensities being applied tissue destruction.
Unreliable patient: e.g. very old or very young patient.
Recent Radiotherapy: Skin sensation & Circulation may be
decreased for up to 3 months following ttheraputic radiotherapy.
Hypersensitivity to heat: e.g where liniment
applied.

has been

Acute Infection or Inflammation: may exacerbate by heat.

Analgesic Therapy: the thermal sensation may be diminished.
Venous Thrombosis or Phlepitis: the increase in circulation by
heat may dislodge clots.
Pregnancy: SWD to the pelvis may induce hemorrhage or
miscarriage
Dermatological Conditions: may exacerbate by heat.
Severe Cardiac conditions: heating may require an increase in
Cardiac output.

 Blood pressure abnormalities: may be exacerpated by

application of heat to large area.
Dangers and Precautions in SWD :
1- Burn (Thermal Burn): can be avoided by:
a) Checking all contra-indications and area to be treated.
b) Test of thermal skin sensation.
c) Taking care during application over a bony prominence.
d) Never apply SWD over clothing.
e) Making sure that the skin is dry.
f) If you apply over two skin surfaces in contact e.g. axilla, they
must be separated by absorbent material towel.
g) Making sure that the leads from the machine are not touching or
within 25 mm of the patient , the machine or any conducting
material electromagnetic field around the lead burn.
h) Making sure that there is adequate spacing between the
electrodes and the skin. The minimum safe amount of spacing
is 25 mm.
i) Allowing 2 or 3 minutes on each intensity setting maximum
heat production for that setting, before increasing to the next
intensity setting.
2- Shock can be avoided by:
a) Not increasing intensity unless the leads and electrodes are
connected to machine.
b) Making sure that the machine is earthed.
c) Not touching the machine.
d) Making sure that there is no metal within the range of 300mm
e.g. hairpins or jewellery distract the field.
e) If the patient is wearing a hearing aid switch it off.
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Types of Electrodes in SWD:

Flexible pads: consist of metal electrode encased
in rubber and produce an electrostatic field.
Space plates: consist of a rigid metal electrode
encased in a Perspex cover electrostatic field.
Coil or cable electrode: consists of a thickly
insulated wire with plugs at either end
electromagnetic field.
Monode: consists of a flat, rigid coil encased in
Perspex cover electromagnetic field.
Diplode or Drum electrode: consists of a flat coil
electrode encased in a Perspex cover with two
wings electromagnetic field

Electrodes that produce primarily an electromagnetic field (cable

& Monode) are only suitable for treatment of superficial lesions.

FACTORS INFLUENCE FIELD DISTRIBUTION IN S.W.D :

1- Spacing:
Allows the lines of force in the electrostatic field to diverge
before entering the tissues. This prevents concentration of heat
in the super-facial tissues and ensures more even heating
through the part.
Spacing provided by:
a) Wrapping flexible pads in towel.
b) Placing felt spacing pads between the pad electrode and skin.
c) Air when using space plates.
Effects of spacing:
a) Normal spacing even field distribution.
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b) Increased spacing deep field concentration.

c) Decreased spacing superficial field concentration.
It has been suggested that for most short wave sources at
maximum output spacing of about 4 cm to the maximum that will
give the greatest absolute heating of the deep tissues.
Conversely the minimum skin electrode distance is about 2 cm
will result in superficial heating.
Note:
The spacing refers to the distance of the metal electrode, not
the plastic cover, from the skin.
Unequal spacing of electrodes superficial heating under closer
electrode.
2. Electrode size:
If the electrodes are smaller than the diameter of treated limb
the lines of force will be concentrated superficially greater heat
in superficial tissues.
If the electrodes are markedly larger than the diameter of
treated limb some of the lines of force will be lost in the air &
their effects will be lost.
Ideally, the electrodes should be slightly larger than the
diameter of limb to be treated even distribution of the lines of
force & thus, even tissue heating throughout the tissues.
3. Metal: metal causes the lines of force to concentrate on the metal
burning of adjacent tissues.
4. Air in cavities: such as sinuses or uterus, causes the lines of force
to deviate to avoid air as it offers a high resistanse only the sides of
an air-filled cavity will be heated in a single application.
Technique of application of SWD:
1. Condenser-field method.
2. Inducto-thermal method.

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Methods of Placement of Electrodes Condenser-field method:

1. COPLANAR METHOD
In this electrodes can be placed side
by side on the same aspect of the part,
provided that there is adequate
distance between them.
Distance between the adjacent edges
of the electrodes must be greater than
the sum of the skin-electrode distance;
otherwise the lines of force will pass
directly between the electrodes rather
than through the tissues.
2. CONTRAPLANAR METHOD
In this electrodes are placed on
opposite sides of the treatment part.
Most satisfactory method for deeply
placed structures. E.g. - Joints
3. CROSSFIRE METHOD
In this first half of the treatment is given
with the electrodes in one contra
planar position & for the second half
the electrodes are repositioned at right
angles. E.g. - Sinuses
4. MONOPOLAR METHOD
The active electrode is placed over the
site of the lesion & the indifferent
electrode is applied to some distant
part of the body.
Methods of Placement of Electrodes Inducto-thermal method:

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1. Wraparound Coils:
The coil is wound evenly & firmly
around the limb primarily heats
superficial tissues
2. Pancake Coils
The coil is wound into a flat
pancake, which is placed over the
area to be treated heat
superficially.

Pulsed Short Wave Diathermy (PSWD)

PSWD is short wave at the frequency of 27.12 MHz, which is
pulsed at a rate selected by the therapist.
The pulse frequency range is from 15 to 200 Hz.
The maximum intensity is 1000 watts.
The pulse duration is constant at 0.4 ms & square pulses are
used.
The advantage of pulsed S.W.D. is that a very high intensity of
power can be administered with no or minimal thermal effects.

By pulsing the output of the machine the thermal effects

produced by one pulse is of very short duration, as it is
dissipated by the circulation before the next pulse occurs. Thus
there are no cumulative thermal effects. However the other
bioloogical effects produced are cumulative.
Uses Drum electrode.
Technique of application pf PSWD:
3. Condenser-field method.
4. Inducto-thermal method.
Biological (Physiological) Effects of PSWD :
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The effects of pulsed SWD are the same as those produced by nonpulsed SWD, with the exception of the increase in temperature in the
tissues. The effects are summarized as follows:
1.
2.
3.
4.
5.
6.

Increase metabolism by 2 to 4 times.

Relief of pain.
Stimulates the peripheral circulation.
Stimulates the early closure of wounds.
Decrease the rate of hematoma formation.
Relaxes muscle spasm.

Indications of PSWD:
Pulsed SWD is particularly useful in the treatment of acute
postraumatic & infective conditions for which non-pulsed SWD would
be contraindicated due to its thermal effects. Such conditions include:
1. Sprains.
2. Contusions.
3. Ruptures
4. Haematoma.
5. Bursitis.
6. Sinusitis.
7. Synovitis
8. Sports Injuries
9.Low back Pain
10.Others: Otitis media, bronchitis,
infammatory diseases of the pelvis.

COPD,

Prostatism,

&

Advantages of PSWD:
1. Used in conditions where non-pulsed SWD is contraindicated.
2. Effective in treatment of post traumatic & Infective conditions
Contraindications of PSWD:
1.
2.
3.
4.
5.

Cardiac Pacemakers.
High fever.
Tumour.
Metal in the area.
Pregnant Women.
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SUMMARY
1. Diathermy is the application of high-frequency electromagnetic
energy that is primarily used to generate heat in body tissues.
Diathermy as a therapeutic agent may be classified as two distinct
modalities, shortwave diathermy and microwave diathermy.
Shortwave diathermy may be continuous or pulsed.
2. The physiologic effects of continuous shortwave are primarily
thermal, resulting from high-frequency vibration of molecules. Pulsed
shortwave diathermy has been used for its nonthermal effects in the
treatment of soft-tissue injuries and wounds.
3. A shortwave diathermy unit that generates a high-frequency
electrical current will produce both an electrical field and a magnetic
field in the tissues. The ratio of the electrical field to the magnetic field
depends on the characteristics of the different units as well as on the
characteristics of electrodes.
4. The condenser-field method, using condenser electrodes (air space
plates and pad electrodes), creates a strong electrical field that is
essentially the lines of force exerted on charged ions by the
electrodes that cause charged particles to move from one pole to the
other.
5. The inductothermy method, using induction electrodes (cable
electrodes and drum electrodes), creates a strong magnetic field
when current is passed through a coiled cable. It may affect
surrounding tissues by inducing localized secondary currents, called
eddy currents, within the tissues.
6. Pulsed short wave diathermy is created by simply interrupting the
output of continuous shortwave diathermy at consistent intervals.
Generators that deliver pulsed shortwave diathermy typically use a
drum type of electrode to induce energy in the treatment area via the
production of a magnetic field.
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7. The diathermies have been used in the treatment of a variety of

musculoskeletal conditions, including muscle strains, contusions,
ligament sprains, tendinitis, tenosynovitis, bursitis, joint contractures,
and myofascial trigger points.
10. Effective treatments using the diathermies require practice in
application and adjustment of techniques to the individual patient.

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