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Ultrasound & Electrotherpy (inc. combination, interferential, NMES, Medi-wave, microcurrent)

My combination therapy machine allows both Ultrasound or Electrotherapy Stimulation to be used independently, or together, enhancing the effect of each modality. In ‘true’ combination therapy the ultrasound transducer becomes electrode 1, and the electrotherapy current flows from a nearby electrode, to the transducer head. This has an added advantage that it allows the client to ‘feel’ tissue lesions, allowing more accurate location assessment, and better treatment targeting.

Ultrasound Therapy is a form of mechanical (vibration) energy, not really ‘true’ electrotherapy but it does fall into the electro-physical agents grouping of musculoskeletal treatment machines. Ultrasound is very popular with physiotherapists and sports therapists as it can be effectively used to assist the healing of sports injuries in the bodies ‘soft tissues’ (muscles, tendons & ligaments). Although ultrasound in best known for the treatment of these strains & sprains, it is also very useful in the treatment of many chronic conditions such as tendonitis, fascitus, bursitis, tenosynovitis, scar tissue and fibrosis. Ultrasound is also very useful in helping to prepare body tissue with stiff/stuck fascia for treatment with myofascial release, enhancing the positive effects and tissue remodeling of myofascial work. Ultrasound also has the advantage of being able to get ‘deep into the tissue’, to areas you cannot reach with your hands (eg. under the acromium in shoulder impingement syndrome).


The machines treatment head creates high frequency ‘ultrasound’ vibrations which are transmitted into the body’s tissue through a gel medium. These vibrations cannot be felt, but trigger a number of biological processes in the body tissue to promote effective healing. Effects on the body’s tissues include:

*Increased blood/nutrient flow
*Micro-massage of soft tissue
*Increased fluid & gaseous interchange
*Loosening & extensibility of scar/fibrous tissue
*Increased permeability of cell membranes
*Mobilisation of white blood cells involved in tissue healing
Ultrasound increases the speed of recovery from soft-tissue injury, encourages healthy remodeling of scar tissue and aids the treatment of chronic pain conditions.


My EMS-Primo Combination Therapy machine also runs a wide range of electrotherapy stimulation programs, applied to the client using wires and sticky electrode pads. The following stimulation modalities are especially useful in clinic for the treatment of various musculoskeletal issues:

Inferential (2 & 4 Pole): In the West, Inferential is the ‘go to’ electrotherapy stimulation modality for the management of acute and chronic pain. Considerable research has demonstrated IF’s effectiveness in this area; it is also effective in triggering muscle contractions (neuro-muscular electrical stimulation-NMES), reducing oedema, and stimulating blood flow increase (helping poor circulation or tissue repair).

Russian NMES: (burst mode) The Russian program produces a 10 second ‘burst’ of NMES electrotherapy, triggering a smooth but prolonged muscle contraction in the targeted area. This contraction is followed by a 10-50 second ‘rest’ period, depending on requirements & muscle fatigue. Russian is slightly more comfortable than Faradic NMES, but less flexible in its setup parameters. Russian NMES can be used to strengthen weak/atrophied muscles in rehabilitation.

Faradic NMES: Faradic NMES is used to stimulate muscle contractions, the ‘surge’ type & rate can also be modified to suit different conditions (eg. mild > severe injury). Faradic NMES is useful in the treatment of strains & sprains, where muscle strengthening, movement and increased blood flow are indicated to aid healing.

MediWave: Mediwave is a specialist type of NMES which results in controlled rhythmical (pumping) contractions of the skeletal muscles. This muscle movement helps drain tissue lymph, reducing oedema (swelling). Mediwave helps gently stimulate weak & underused muscles without the fatigue of harsher programs.

Microcurrent: Microcurrent is a relatively new form of electrotherapy stimulation which uses smaller currents (less than 1 milliampere) to affect the tissues to ease pain and facilitate tissue repair. Microcurrent stimulation has been shown to increase cell energy (ATP) production and amino acid exchange for processes such as tissue regeneration, it is also effective in pain management for various conditions.

Galvanic: Galvanic muscle stimulation has the advantage that it stimulates muscle contraction in muscles with compromised nerve supply, which would not react to other electrotherapy NMES modalities. Galvanic stimulation can therefore be used in rehabilitation of injuries involving nerve/spinal damage, to strengthen or tone tissues with compromised nervous supplies.

TENS: Although I do not use TENS in clinic to treat patients, the TENS function on my machine does allow me to help clients to program their own pocket TENS machine, to suit their pain management needs.

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