S H O R T W A V E TR EAT ME NT M E T H O D S E X T R A C T S F R O M A L E C T U R E -D E M O N S T R A T IO N G IV E N B Y M is s E. M . M E R E D I T H , M .C .S .P ., (T ea ch er's C ertificates) M e m b er o f th e T e a c h in g Staff o f th e P re to ria School o f P h y sio th e rap y , to th e M e m b ers o f th e N o rth e rn T ra n s v a a l B ra n c h , o f th e S o u th A fric a n Society o f P h y sio th e rap y , in N o v e m b er, 1959. D iagram s b y : M iss J. W O O D (P re to ria D ip lo m a ). S H O R T W A V E D IA T H E R M Y F O R B O T H A R M S A N D C E R V IC A L S P IN E A T S A M E T IM E . AV E R Y sa tisfac to ry tre a tm e n t c a n be given by using a long in d u cto th erm y c able, a n d a n u m b e r o f v a ria tio n s a re possible. T h e p a tie n t, w earing a vest only a bove th e w aist, is w ra p p ed in a b la n k e t below th e a rm s, leaving a rm s a nd sh o u ld e rs free, a n d is th e n seated on a c h air, w ith each a rm f u lly su p p o rte d by pillow s o n a sm all ta b le o r a rm b a th s ta n d . . T w o pieces o f th in b lan k e t, a p p ro x im a te ly 48 x 36 inches each, a re needed fo r spacing, a n d a re ap p lie d (w ith the o p e ra to r sta n d in g b e h in d th e p a tie n t) as fo llo w s:— T h e to p c o rn e r o f sh o rt end o f o ne is placed fro m the b a ck over, say R . Clavicle, m id w ay betw een a c ro m io n a n d neck, th e length o f the blan k e t lying a lo n g the L. a rm . T h is a rm is g e ntly lifted a nd su p p o rte d while th e low er c o rn e r o f th e sam e sh o rt end is b ro u g h t u n d e r th e L. A x illa a n d u p o ver th e L. C lavicle fro m in fro n t. N ext the low er (long) side o f the b lan k e t is w rapped u p o ver p a rt a n d to p o f w hole length o f th e a rm (see D ia g ra m A ) a n d th e n th e u p p e r long sid e o ver this first layer d o w n w ard s a n d u n d e r, so th a t th e w h ole a rm has tw o lay ers o f covering. T h e o th e r b lan k e t is ap p lie d in th e sa m e w ay o v e r the R . a rm , so th a t th ere a re no w tw o layers o v e r b ack o f n eck also. I f a rm s a re to be tre a te d to a p p ro x im a te ly th e sam e e xtent, b u t L. sh o u ld e r is m o re p ainful th a n R . sh o u ld e r, th e m iddle o f th e c ab le is fo u n d a n d placed a t back o f neck, a n d o n e end w o u n d spirally ro u n d th e L . a rm , the first tu rn c o m in g o v e r to p o f sh o u ld e r fro m b e hind, and th e coil e x tending as fa r as re q u ire d . T h e a rm , o f course, m u st be fully su p p o rte d th e w h o le tim e th is is being d o n e , a nd be m oved as little as possible. T h e o p p o site h a lf o f th e c ab le is w o u n d in the sam e direction as th e first, ro u n d th e R . a rm , i.e. as th e first tu rn w as b ro u g h t a b o v e th e L . S h o u ld e r th a t o f th e second h a lf m u st c om e below R . A xilla, so th a t w hole coil is w o u n d in a n ti-clockw ise d irec tio n , very careful ch eck in g is needed b e fo re c u rre n t is tu rn e d on, to e n su re th a t sufficient blan k e t is in the axilla so th a t n o b a re tu r n lies a g a in st th e chest w all, th a t coils a re evenly spaced, a nd th a t th e e nds o f the c ab le betw een p a tie n t a n d a p p a ra tu s a re o f e q u al length. O n e a d v a n ta g e o f th is a rra n g e m e n t is th a t all o f b o th arm s w ithin the coil is h e ated , a n d also a cro ss b a c k o f sh o u ld e rs a n d base o f neck. A n o th e r a d v a n ta g e is th a t a lm o st a n y p o sitio n o f arm s is sa tisfac to ry , i.e. a n y degree o f a b d u c tio n a n d / o r flexion o f sh o u ld e r th a t is c o m fo rta b le fo r p a tie n t. T h e only p o in t to w a tch is th a t if th e a rm is flexed th a t piece o f c ab le to a p p a ra tu s does n o t c o m e in to c o n ta c t w ith tu rn s ro u n d the arm . M odifications. I f m o re h e at is re q u ire d in th e neck, the m id d le o f the coil can be a rra n g e d in a vertical lo o p o r zig-zag w ith a lo o p re ac h in g as h igh as is needed. T h is c a n be held in j place by a sh o rt b a n d a g e being tied to th e m iddle o f the lo o p a n d passed ro u n d th e p a tie n t’s fo reh e a d , w hile th e d istan c e betw een th e loops is m a in tain ed by plastic spacers. (See D ia g ra m B). It is a lso very sim ple to vary th e e xtent o f e ith e r a rm being tre a te d , e.g. o ne m ay be tre a te d fro m fingers to sh o u ld e r a n d th e o th e r w ith th e sh o u ld e r only. I f R . sh o u ld e r is m o re affected th a n L. sh o u ld e r coil is w o u n d in o p p o s ite d irec tio n , clockw ise, being first placed o ver R . sh o u ld e r. Tf b o th a re eq u ally p a in fu l a n d need sam e intensity, th e to p coil on th e second a rm c a n b e ’ b ro u g h t to to p o f sh o u ld e r, a n d held by sp a c er betw een it a n d th a t p a r t o f th e c ab le acro ss the b ack (see D ia g ra m B). W ith th is m eth o d cause— cervical lesion— a n d sy m p to m — p ain in a rm s— c an be trea te d a t the sam e tim e, a n d this u sually has a very beneficial effect o n p a tie n t, re lief o f p ain being p ro d u c ed m o re q u ick ly th a n if cervical spine only is treated. S H O R T W A V E T O H I P J O I N T . O n e m e th o d th a t is va lu a b le to all cases w hen h ip jo in t is to be tre a te d , a n d is th e m eth o d p a r excellence if th ere is flexion defo rm ity , is to give a co-axial c u rre n t by using o n e large flexible e lectrode, a n d a s h o rt in d u c to th e rm y c able as a c o n d e n se r electrode. T h e p a tie n t is fully su p p o rte d in h a lf lying on a p linth, a n d can w ear a vest a n d c o tto n knickers. T h e tru n k a nd thighs sh o u ld be as n early a t right a ngle as th e c o m fo rt o f th e p a tie n t will allow . T h e flexible p ad w ith 2 o r 3 felt spacers is p laced behind th e affected hip, well dow n. (A n e qual thickness o f pillow o r tow eling sh o u ld be placed b e hind th e o p p o site h ip so th a t p re ssu re is even). T h e c ab le is c o n nected to th e a p p a ra tu s by one e nd o nly, th e o th e r end being heavily in sulated by a ru b b e r b a n d ag e o r o th e r eq u iv a len t. It is then w o u n d a b o u t 3 tim es ro u n d R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) March, 1960 P H Y S I O T H E R A P Y Page 7 th e th igh, th e free end being n e a re r th e hip th a n th e knee. T h e effect o f this is to p ro d u c e a v irtu a l co n d en ser e lectrode placed a t cross se c tio n o f the lim b, i.e. parallel w ith one b eh in d th e hip w ith th e jo in t on th e axial line betw een th e m ; a n d a lon g itu d in al o r co-axial c u rre n t will pass fro m o ne to th e o th er. T h ere is little o r n o m agnetic effect so th a t the tu rn s o f th e coil c a n be close to o n e a n o th e r. T h e o p p o site thigh m u st o f c o u rse be sufficiently se p a ra ted fro m th e coil by a ir, a pillow o r tow eling. A s field c o n c e n tra tio n on skin is very m uch dim inished a n d p a th w ay is w ide m o re c u rre n t c a n be given, a n d P atients say they can feel th e w a rm th deep, really “in ” the hip, a n d find it m ost c o m fo rtab le . A n a p p a ra tu s w ith a n a d e q u a te o u tp u t a n d v a ria b le c o n d en ser is essential as th e ele ctro d e -p atie n t c ap a city is large. If, how ever, tu n in g is difficult b ecause va ria b le c o n d en ser is in ad e q u ate , sm aller pad ele ctro d e a n d /o r w ider sp acing o f the tu rn s o f th e coil will p ro b a b ly d im inish th e c ap a city e nough to m ak e tu n in g possible. T h e a p p a ra tu s is placed a t side o f p a tie n t so th a t th ere ! is n o tro u b le in k e eping leads p arallel a n d u ncrossed, b u t generally sp eak in g th e length o f cable betw een pa tie n t a n d a p p a ra tu s sh o u ld be sh o rte r th a n the lead o f th e pad, b u t this will depend u p o n the p o sitio n o f v o lta g e a n tin o d e in th e cable. [f th ere are different so ck ets fo r co n d en ser a nd c able electrodes th o se fo r th e c o ndensers a re used as a rule. CASE HISTORY NOTES ( Taken fr o m the P a tie n t's own report.) M r. M . developed p ain in the right eye in 1945, w hich becam e severe a n d g ra d u a lly sp re ad to the m o u th , to ngue, soft p la te a nd rig h t side o f th e h ead, c au sin g the eye to w ater, to n g u e to swell, a n d p ro d u c in g a heavy d ischarge fro m th e rig h t n o stril; a lso p e rsp ira tio n on th e right side o f fo reh e a d a n d tem ple d u rin g a n a tta c k o f p a in . T hese a tta c k s o f p a in b ecam e very freq u e n t a n d o f v arying lengths o f d u ra tio n . T h e y w ere b ro u g h t o n by activities o f the a rm s a nd neck, such as lifting, golf, lying in a c oncave bed, d riv in g a m o to r c a r a n d th ro u g h e m o tio n a l upsets. V a rio u s diagnoses w ere m ad e a n d th e a p p ro p ria te tr e a t­ m en ts given, b u t all w ere o f n o avail. D ru g s su c h as asp irin a n d o th e rs m u c h m o re p o te n t a ffo rd e d n o relief. L a te r follow ing th e diag n o sis o f T ic d o lo re u x a lc o h o lic injections in to th e trig e m in a l nerve, p ro d u c ed n e gative re su lts, as d id a sy m p a th e cto m y a n d a n ti-h istam in e tre a tm e n ts fo r m igraine. . E v en tu ally th e p a tie n t w as referred to M r. M . D . O liver, M .C .S .P . o f C a p e T o w n w ith d iag n o sis “ u n k n o w n ” , except th a t a n o te w as m ad e o f a n old in ju ry to the n e ck a n d b a ck som e tw enty years p re v io u s while p lay in g rugby. Treatm ent b y P hysiotherapist: S u sta in ed T rac tio n by m eans o f th e R o ssly n tra c tio n c o u ch . A p ull o f 2 0 /2 5 lbs. gave slight relief b u t a p u ll o f 45 lbs. w hich w as felt right d o w n the sp in e p ro d u c ed c o n sid era b le im p ro v e m en t and n o d isc o m fo rt w as ex­ perienced. P ostural E xercises. T h e p a tie n t had fo r y ears sto o d in a sto o p e d p o sitio n because th is seem ed to ease the p a in . C o rre ctiv e p o stu ra l exercises w ere ta u g h t a n d these gave tre m e n d o u s relief. Shoulder a nd N e c k M obilising E xercises. T h e ra n g e o f n eck a n d sh o u ld e r m o v em e n t w as very lim ited a n d by excessive m ovem ent a n a tta c k o f p a in could be p ro d u c e d . T h e p a tie n t was ta u g h t v a rio u s self m obilising exercises to increase th e ra n g e o f n eck a n d sh o u ld e rs and these w ere strictly a d h ere d to. R esult. D u rin g th e last 6 m o n th s th e re has been n o recu rre n ce o f th e p a in a n d d isc o m fo rt experienced fro m 1945 to th e end o f 1958. 1 valuable assistance during convalescence with the aid of a wheel chair or crutches hired from Clinical Emergencies, Johannesburg, who also have 'walking machines', infra red lamps, etc., for hire. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )