Electrotherapy Contraindications
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Electrotherapy on the Web - Contraindications
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Contraindications There has been on ongoing controversy over the various and diverse contraindication for electrotherapy modalities over recent years. Many of the widely held beliefs in this area have been challenged in that there appears to be little by way of 'concrete evidence' for many and a lot of anecdotal evidence and supposition about some of the others. If you look in a selection of the major texts, they tend to provide a 'sircular reference list' in that they all X refer to each other without getting to grips with the original work. A group, under the auspices of the Chartered Society of Physiotherapy in the UK have spent some time working through as much of the original evidence as we could find in order to establish what actually is and what is not a contraindication for the most commonly employed modalities. A group in Aurstralia have undertaken a similar exercise. The CONTRAINDICATION GRID is probably the most useful quick reference guide, and although I used to have it up on the web page, it seems like this new format really does not like large tables, so have given up trying to reproduce it here for the moment. It is still available as a download file (.pdf - good for printing if you want a copy for the department / clinic). The information below is a summary of the CSP group outcomes (published in October 2006) - contact the CSP (www.csp.org. uk)or [email protected] if you want a copy - which is fully referenced. For copyright reasons, I can't reproduce it is full here. I have a lot of additional material; that I am trying to pull together to explain some of the commonly held misconceptions with regards the contraindications, precautions and dangers relating to electrophysical agents, but in the meantime, the grid that follows will provide a quick and easy summary about the key issues.
NOTES : Where there is no entry in the grid below, it means that there is no known / demonstrated detrimental effect Where an entry relates to a 'LOCAL CI' in relates to whether the applied energy would reach the tissue in question The current issues regarding the use of TENS during pregnancy is dealt with in some considerable detail in a specific TENS During Pregnancy document which can be obtained from the download page.
Ultrasound (non thermal)
Pulsed Shortwave (non thermal)
Low frequency Electrical Stimulation
Microwave
Infra Red
Hot Packs
http://www.electrotherapy.org/modalities/contragrid.htm (1 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Laser
TENS
Interferential
Wax
Biofeedback
Shortwave (Continuous / Pulsed - Thermal)
Cold Therapy
Ultrasound (continuous / Thermal)
Ultra Violet Radiation
Non Thermal Applications
Ultrasound (low dose, non thermal, pulsed)
Pregnancy (local)
CI
Local Circulatory Insufficiency
PRECAUTION
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
LOCAL CI
TESTS
LOCAL CI
Thermal Skin Test
Metal Implant Sharp/Blunt Skin Tests
Pulsed Shortwave (Low dose, non thermal application) http://www.electrotherapy.org/modalities/contragrid.htm (2 of 12)2/23/2009 6:26:29 AM
ONLY IF THERMAL
Electrotherapy on the Web - Contraindications
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
CI
Local Circulatory Insufficiency
CI
Epilepsy
CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
PRECAUTION
Sharp/Blunt Skin Tests
PRECAUTION
ONLY IF THERMAL
Laser Therapy
Pregnancy (local)
Local Circulatory Insufficiency
PRECAUTION
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
http://www.electrotherapy.org/modalities/contragrid.htm (3 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
TESTS
CI
Thermal Skin Test
PRECAUTION
Sharp/Blunt Skin Tests
Electrical Stimulation
TENS
Pregnancy (local)
CI ** SEE NOTE
Local Circulatory Insufficiency
PRECAUTION
Epilepsy
CI NECK
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
Interferential http://www.electrotherapy.org/modalities/contragrid.htm (4 of 12)2/23/2009 6:26:29 AM
Sharp/Blunt Skin Tests
YES
Electrotherapy on the Web - Contraindications
Pregnancy (local)
CI ** SEE NOTE
Local Circulatory Insufficiency
PRECAUTION
Epilepsy
CI NECK
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
Sharp/Blunt Skin Tests
YES
Other Low Frequency (e.g. muscule stim, diadynamics etc)
Pregnancy (local)
CI ** SEE NOTE
Local Circulatory Insufficiency
PRECAUTION
Epilepsy
CI NECK
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
Pregnancy (general)
Malignancy
Specialised Tissues
http://www.electrotherapy.org/modalities/contragrid.htm (5 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
CI
TESTS
CI
Thermal Skin Test
Metal Implant
Sharp/Blunt Skin Tests
YES
Heat
Infra Red
Pregnancy (local)
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
EYE
Active Epiphysis
Active Implants (incl Pacemakers)
Tissue Bleeding
PREAUTION
TESTS
CI
Metal Implant
http://www.electrotherapy.org/modalities/contragrid.htm (6 of 12)2/23/2009 6:26:29 AM
Thermal Skin Test
Sharp/Blunt Skin Tests
YES
Electrotherapy on the Web - Contraindications
Wax
Pregnancy (local)
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
EYE
Active Epiphysis
Active Implants (incl Pacemakers)
Tissue Bleeding
PREAUTION
TESTS
CI
Metal Implant
Thermal Skin Test
YES
Sharp/Blunt Skin Tests
Shortwave (Continuous, Thermal)
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
CI
Local Circulatory Insufficiency
CI
Epilepsy
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
http://www.electrotherapy.org/modalities/contragrid.htm (7 of 12)2/23/2009 6:26:29 AM
CI
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
CI
TESTS
CI
Thermal Skin Test
CI
Sharp/Blunt Skin Tests
YES
Ultrasound (continuous / thermal)
Pregnancy (local)
CI
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI LOCAL
TESTS
CI
Thermal Skin Test
CI LOCAL
Sharp/Blunt Skin Tests
Microwave
http://www.electrotherapy.org/modalities/contragrid.htm (8 of 12)2/23/2009 6:26:29 AM
YES
Electrotherapy on the Web - Contraindications
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
CI
Local Circulatory Insufficiency
CI
Epilepsy
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
CI
Sharp/Blunt Skin Tests
CI
YES
Hot Pack
Pregnancy (local)
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
PREAUTION
EYE
Active Epiphysis
LOCAL CI
http://www.electrotherapy.org/modalities/contragrid.htm (9 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
TESTS
CI
Thermal Skin Test
PRECAUTION
Sharp/Blunt Skin Tests
YES
Others
Biofeedback (with no adjunctive stim)
Pregnancy (local)
Local Circulatory Insufficiency
Pregnancy (general)
Epilepsy
Malignancy Devitalised Tissues
Specialised Tissues Active Epiphysis
Active Implants (incl Pacemakers)
TESTS
Tissue Bleeding Thermal Skin Test
Metal Implant Sharp/Blunt Skin Tests
http://www.electrotherapy.org/modalities/contragrid.htm (10 of 12)2/23/2009 6:26:29 AM
CAUTION WITH VISUAL FEEDBACK MODES
Electrotherapy on the Web - Contraindications
Cold Therapy
Pregnancy (local)
PRECAUTION
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
EYE
Active Epiphysis
Active Implants (incl Pacemakers)
PREAUTION
TESTS
Tissue Bleeding Thermal Skin Test
Metal Implant
PRECAUTION
YES
Sharp/Blunt Skin Tests
Ultraviolet Radiation
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
Local Circulatory Insufficiency
PRECAUTION
SEE MODALITY SPECIFIC ADVICE
Epilepsy
CI
LOCAL CI
Devitalised Tissues
LOCAL CI
EYE
Active Epiphysis
PRECAUTION
http://www.electrotherapy.org/modalities/contragrid.htm (11 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
TESTS
CI
Thermal Skin Test
Metal Implant
Sharp/Blunt Skin Tests
(C) Tim Watson 2009
http://www.electrotherapy.org/modalities/contragrid.htm (12 of 12)2/23/2009 6:26:29 AM
SPECIALIST SKIN SENSITIVITY TESTS REQUIRED
Home
Modalities
Healing
Concepts
Publications
Manufacturers
ElectroNews
Courses
Links
Download
Contraindications
Books
Contact
FAQ's
SEARCH
Contraindications There has been on ongoing controversy over the various and diverse contraindication for electrotherapy modalities over recent years. Many of the widely held beliefs in this area have been challenged in that there appears to be little by way of 'concrete evidence' for many and a lot of anecdotal evidence and supposition about some of the others. If you look in a selection of the major texts, they tend to provide a 'sircular reference list' in that they all X refer to each other without getting to grips with the original work. A group, under the auspices of the Chartered Society of Physiotherapy in the UK have spent some time working through as much of the original evidence as we could find in order to establish what actually is and what is not a contraindication for the most commonly employed modalities. A group in Aurstralia have undertaken a similar exercise. The CONTRAINDICATION GRID is probably the most useful quick reference guide, and although I used to have it up on the web page, it seems like this new format really does not like large tables, so have given up trying to reproduce it here for the moment. It is still available as a download file (.pdf - good for printing if you want a copy for the department / clinic). The information below is a summary of the CSP group outcomes (published in October 2006) - contact the CSP (www.csp.org. uk)or [email protected] if you want a copy - which is fully referenced. For copyright reasons, I can't reproduce it is full here. I have a lot of additional material; that I am trying to pull together to explain some of the commonly held misconceptions with regards the contraindications, precautions and dangers relating to electrophysical agents, but in the meantime, the grid that follows will provide a quick and easy summary about the key issues.
NOTES : Where there is no entry in the grid below, it means that there is no known / demonstrated detrimental effect Where an entry relates to a 'LOCAL CI' in relates to whether the applied energy would reach the tissue in question The current issues regarding the use of TENS during pregnancy is dealt with in some considerable detail in a specific TENS During Pregnancy document which can be obtained from the download page.
Ultrasound (non thermal)
Pulsed Shortwave (non thermal)
Low frequency Electrical Stimulation
Microwave
Infra Red
Hot Packs
http://www.electrotherapy.org/modalities/contragrid.htm (1 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Laser
TENS
Interferential
Wax
Biofeedback
Shortwave (Continuous / Pulsed - Thermal)
Cold Therapy
Ultrasound (continuous / Thermal)
Ultra Violet Radiation
Non Thermal Applications
Ultrasound (low dose, non thermal, pulsed)
Pregnancy (local)
CI
Local Circulatory Insufficiency
PRECAUTION
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
LOCAL CI
TESTS
LOCAL CI
Thermal Skin Test
Metal Implant Sharp/Blunt Skin Tests
Pulsed Shortwave (Low dose, non thermal application) http://www.electrotherapy.org/modalities/contragrid.htm (2 of 12)2/23/2009 6:26:29 AM
ONLY IF THERMAL
Electrotherapy on the Web - Contraindications
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
CI
Local Circulatory Insufficiency
CI
Epilepsy
CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
PRECAUTION
Sharp/Blunt Skin Tests
PRECAUTION
ONLY IF THERMAL
Laser Therapy
Pregnancy (local)
Local Circulatory Insufficiency
PRECAUTION
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
http://www.electrotherapy.org/modalities/contragrid.htm (3 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
TESTS
CI
Thermal Skin Test
PRECAUTION
Sharp/Blunt Skin Tests
Electrical Stimulation
TENS
Pregnancy (local)
CI ** SEE NOTE
Local Circulatory Insufficiency
PRECAUTION
Epilepsy
CI NECK
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
Interferential http://www.electrotherapy.org/modalities/contragrid.htm (4 of 12)2/23/2009 6:26:29 AM
Sharp/Blunt Skin Tests
YES
Electrotherapy on the Web - Contraindications
Pregnancy (local)
CI ** SEE NOTE
Local Circulatory Insufficiency
PRECAUTION
Epilepsy
CI NECK
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
Sharp/Blunt Skin Tests
YES
Other Low Frequency (e.g. muscule stim, diadynamics etc)
Pregnancy (local)
CI ** SEE NOTE
Local Circulatory Insufficiency
PRECAUTION
Epilepsy
CI NECK
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
Pregnancy (general)
Malignancy
Specialised Tissues
http://www.electrotherapy.org/modalities/contragrid.htm (5 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
CI
TESTS
CI
Thermal Skin Test
Metal Implant
Sharp/Blunt Skin Tests
YES
Heat
Infra Red
Pregnancy (local)
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
EYE
Active Epiphysis
Active Implants (incl Pacemakers)
Tissue Bleeding
PREAUTION
TESTS
CI
Metal Implant
http://www.electrotherapy.org/modalities/contragrid.htm (6 of 12)2/23/2009 6:26:29 AM
Thermal Skin Test
Sharp/Blunt Skin Tests
YES
Electrotherapy on the Web - Contraindications
Wax
Pregnancy (local)
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
EYE
Active Epiphysis
Active Implants (incl Pacemakers)
Tissue Bleeding
PREAUTION
TESTS
CI
Metal Implant
Thermal Skin Test
YES
Sharp/Blunt Skin Tests
Shortwave (Continuous, Thermal)
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
CI
Local Circulatory Insufficiency
CI
Epilepsy
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
http://www.electrotherapy.org/modalities/contragrid.htm (7 of 12)2/23/2009 6:26:29 AM
CI
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
CI
TESTS
CI
Thermal Skin Test
CI
Sharp/Blunt Skin Tests
YES
Ultrasound (continuous / thermal)
Pregnancy (local)
CI
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI LOCAL
TESTS
CI
Thermal Skin Test
CI LOCAL
Sharp/Blunt Skin Tests
Microwave
http://www.electrotherapy.org/modalities/contragrid.htm (8 of 12)2/23/2009 6:26:29 AM
YES
Electrotherapy on the Web - Contraindications
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
CI
Local Circulatory Insufficiency
CI
Epilepsy
LOCAL CI
Devitalised Tissues
PREAUTION
EYE, TESTIS
Active Epiphysis
LOCAL CI
CI
TESTS
CI
Thermal Skin Test
CI
Sharp/Blunt Skin Tests
CI
YES
Hot Pack
Pregnancy (local)
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
PREAUTION
EYE
Active Epiphysis
LOCAL CI
http://www.electrotherapy.org/modalities/contragrid.htm (9 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
Metal Implant
TESTS
CI
Thermal Skin Test
PRECAUTION
Sharp/Blunt Skin Tests
YES
Others
Biofeedback (with no adjunctive stim)
Pregnancy (local)
Local Circulatory Insufficiency
Pregnancy (general)
Epilepsy
Malignancy Devitalised Tissues
Specialised Tissues Active Epiphysis
Active Implants (incl Pacemakers)
TESTS
Tissue Bleeding Thermal Skin Test
Metal Implant Sharp/Blunt Skin Tests
http://www.electrotherapy.org/modalities/contragrid.htm (10 of 12)2/23/2009 6:26:29 AM
CAUTION WITH VISUAL FEEDBACK MODES
Electrotherapy on the Web - Contraindications
Cold Therapy
Pregnancy (local)
PRECAUTION
Local Circulatory Insufficiency
CI
Pregnancy (general) Epilepsy
Malignancy
Specialised Tissues
LOCAL CI
Devitalised Tissues
EYE
Active Epiphysis
Active Implants (incl Pacemakers)
PREAUTION
TESTS
Tissue Bleeding Thermal Skin Test
Metal Implant
PRECAUTION
YES
Sharp/Blunt Skin Tests
Ultraviolet Radiation
Pregnancy (local)
Pregnancy (general)
Malignancy
Specialised Tissues
Local Circulatory Insufficiency
PRECAUTION
SEE MODALITY SPECIFIC ADVICE
Epilepsy
CI
LOCAL CI
Devitalised Tissues
LOCAL CI
EYE
Active Epiphysis
PRECAUTION
http://www.electrotherapy.org/modalities/contragrid.htm (11 of 12)2/23/2009 6:26:29 AM
Electrotherapy on the Web - Contraindications
Active Implants (incl Pacemakers)
Tissue Bleeding
TESTS
CI
Thermal Skin Test
Metal Implant
Sharp/Blunt Skin Tests
(C) Tim Watson 2009
http://www.electrotherapy.org/modalities/contragrid.htm (12 of 12)2/23/2009 6:26:29 AM
SPECIALIST SKIN SENSITIVITY TESTS REQUIRED
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