Question
Are you aware of evidence of the usage of ultrasound versus diathermy?
Answer
I could give a whole separate class on diathermy. There are two types of diathermy available and known these days. There is electrical diathermy or capacitive diathermy where you place a patient’s limb between two plates. Diathermy uses electromagnetic energy and it heats up the tissue much deeper. If you have two plates touching the lateral and the medial knee, you would get heating 5 cm deep on one plate and 5 cm deep on the other plate. It does heat deeper than ultrasound and treats a larger area than ultrasound. Diathermy has gotten a bad rap. A study which came out of the Netherlands had a number of therapists who used diathermy regularly and it was shown that those female therapists had a slight increase in incidence of miscarriages. Keep in mind that this study was from about 15-20 years ago. The diathermy machines that were used back then were big machines with a lot of stray diathermy energy. The diathermy energy did not stay between the two plates, it created energy all over the area. Diathermy would be more advantageous then ultrasound if you are trying to treat a bigger area and need for deeper penetration of heat. Diathermy has been shown to be effective in osteoarthritis of the knee, joint range of motion especially at the ankle for dorsiflexion, hamstring flexibility, rheumatoid arthritis, low back pain, etc. To my knowledge there has not been a direct comparison of ultrasound and diathermy. Diathermy has made a name for itself with chronic inflammatory pelvic disease in female for treating pain. There is a lot of literature from Europe and Africa on this.
There is also single plate diathermy which uses a pulsed magnetic field to treat tissues. It also treats about 5 cm deep. Diathermy as well seems to treat tissue that has more water a little more preferentially. It does not really heat up fat (adipose tissue) and tends to direct itself towards muscle and the fluid within a joint space. In that aspect, diathermy seems a little superior over ultrasound.
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