University of the Pacific University of the Pacific Scholarly Commons Scholarly Commons University of the Pacific Theses and Dissertations Graduate School 1986 A comparative study of positive versus negative polarity in the A comparative study of positive versus negative polarity in the treatment of acute ankle sprains utilizing high voltage treatment of acute ankle sprains utilizing high voltage electrogalvanic stimulation electrogalvanic stimulation Lauren Michelle Wells University of the Pacific Follow this and additional works at: https://scholarlycommons.pacific.edu/uop_etds Part of the Medicine and Health Sciences Commons Recommended Citation Recommended Citation Wells, Lauren Michelle. (1986). A comparative study of positive versus negative polarity in the treatment of acute ankle sprains utilizing high voltage electrogalvanic stimulation. University of the Pacific, Thesis. https://scholarlycommons.pacific.edu/uop_etds/2122 This Thesis is brought to you for free and open access by the Graduate School at Scholarly Commons. It has been accepted for inclusion in University of the Pacific Theses and Dissertations by an authorized administrator of Scholarly Commons. For more information, please contact mgibney@pacific.edu.
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University of the Pacific University of the Pacific
Scholarly Commons Scholarly Commons
University of the Pacific Theses and Dissertations Graduate School
1986
A comparative study of positive versus negative polarity in the A comparative study of positive versus negative polarity in the
treatment of acute ankle sprains utilizing high voltage treatment of acute ankle sprains utilizing high voltage
Follow this and additional works at: https://scholarlycommons.pacific.edu/uop_etds
Part of the Medicine and Health Sciences Commons
Recommended Citation Recommended Citation Wells, Lauren Michelle. (1986). A comparative study of positive versus negative polarity in the treatment of acute ankle sprains utilizing high voltage electrogalvanic stimulation. University of the Pacific, Thesis. https://scholarlycommons.pacific.edu/uop_etds/2122
This Thesis is brought to you for free and open access by the Graduate School at Scholarly Commons. It has been accepted for inclusion in University of the Pacific Theses and Dissertations by an authorized administrator of Scholarly Commons. For more information, please contact [email protected].
Literature cited ..................................... 26
iii
ACKNOWLEDGEMENTS ~--
I would like to thank Stockton Orthopaedic Medical M---
Group for referring patients for treatment. Without their
support, proper medical care and follow-up, the study would
not have been possible. Also, I would like to thank Gerry
Solberg for his assistance in developing the treatment pro-
tocol. My thesis committee has also been helpful in
completing this study. In particular, I would like to thank !o-l-----
Dr. Funkhouser for her support and understanding of some-
times difficult situations and circumstances. Last, but not
least, I would like to thank my parents for the opportunity
and encouragement necessary for me to complete this degree.
;--,-- ------ ---
i n
g
iv
TABLE
1.
2.
LIST OF TA.BLES
Ankle-Foot Volume and Range of Motion measurements of patients treated with negative polarity of high voltage electrogalvanic stimulation. Data presented as volume (ml), dorsiflexionplantorflexion (degrees of movement) •..........
Ankle-Foot Volume and Range of Motion measurements of patients treated with positive polarity of high voltage electrogalvanic stimulation. Data presented as volume (ml), dorsiflexion-plantarflexion (degrees of movement) .......... .
mise, other systemic disease). These factors acting in con-
junction may lead to higher original volumes. For example,
the second largest initial volume measured was that of a
patient who had venous insufficiency and suffered from
swollen ankles independant of trauma (Bi).
An acute injury is more likely to respond to treatment
than a chronic injury because secondary damages caused by
excessive bleeding, adhesion formation and weakness have not
developed. The longer the tissues remain edematous the more
stretched the tissues and associated vessels become. The
accumulation of extracellular fluid is therefore greater in
regions which are loose in texture and where the skin is
readily stretched. In persons with firm resistant skin,
edema makes its appearance later and is less pronounced. If
edema can be prevented from forming and stretching the
tissues, the initial volume is lower and there is less to
'---'-------
-- -- -- ---
21
reduce. Those patients in the study who were seen imrne-
diately post-injury were those who participated in high
school atheletics (Cr, Me, Ha, Lu, De, Cr), one seen in the
emergency room (An) and two in the office (Gu, Do). In
general younger patients have more elastic and resilient
tissues than older patients.
There are some significant muscle changes that occur
with aging that may affect an individual's recovery from
injury. These include: "Gross muscular atrophy secondary to
the loss of both number and size of muscle fibers" (Payton
and Poland, 1983:43). This "muscular atrophy may be
differentially attributed to a decrease in the number of red
fibers" (McCarter, 1978:17). Muscle atrophy is always
associated with weakness.
In the lower extremities, venous return is aided by the
muscular pump. The stronger the contraction the more effi-
ciently the muscular pump works to return blood to the heart
(against gravity). When an i'ndividual becomes less active
because of weakness they do not "pump" as effectively as an
individual without weakness.
Weakness may also result from an increasing proportion
of skeletal muscle free fat being replaced by fibrous
tissue. Nevertheless, the primary cause of loss of strength
appears to be a change in lifestyle and decreased use of the
=----=-~:__ __ ~ __ ~
EO :=:;--
=== i---=i
E ~ --- --
~----
22
----
neuromuscular system. Osteoarthrosis is a result of an Fi-- ---- -- --
imbalance between the stress a joint receives and the abi- :==.-~~- -=-=----~-
;___;;
lity of the physiological shock absorbers in that joint to
absorb the stress (Radin, 1976). This is accompanied by a
marked decrease in tensile stiffness and fracture strength
with increasing age. On the average, strength begins to
decline around age 40 (Raven & Mitchel, 1980).
These musculoskeletal changes which occur with aging
are accompanied by cardiovascular changes. Both the heart
and the smooth muscle of vascular tissue decrease in sym-
pathetic responsiveness in people of advanced age (Lakotta,
1980). Associated with the aging cardiovascular system is a
decline in lipid catabolism, which generates lipid accumula-
tion; this process may underlie the development of ------
atherosclerosis (Kritchevsky, 1980).
These changes associated with aging coupled with the
degree of injury account for some differences in recovery
time and initial volumes. When these factors are considered
in conjunction with the time between injury and first treat-
ment, the test subjects are further divided into the
following subgroups: young subjects with acute injuries;
young subjects with chronic injuries; old subjects with d- -
acute injuries; old subjects with chronic injuries; patients
with complicating factors. The sample size of each subgroup
23
is so small it is difficult to draw conclusions about the
effect of the polarity of treatment.
The other major complicating factor is the amount of
home follow-up. Each patient was instructed in a home exer-
cise and icing program to be done three times per day. The
amount of compliance cannot be verified. Each patient
reported about their compliance level, which was frequently
less than the amount prescribed. Standardizing and quan-
tifying the amount of home follow-up is difficult. One
patient may have overdone his home program in an attempt to
get back to the football field faster, while another patient
may have underdone her home program because the exercises
may be painful and she does not tolerate pain well (by
admission of patient). In essence, data from each patient
can only be considered as an individual case study making it
impossible to arrive at any significant conclusions from
this study.
To help eliminate the variability which prevented
conclusions from being drawn from this study, the following
suggestions are offered.
It is essential to have (1) a large number of patients,
(2) of similar age. The investigator should (3) adopt a set
of standards related to the degree of injury (for example,
decide on limits of talar-tilt), (4) obtain patients with
~--~--
F~
~~~-
..... ____ ------------------
f§-
24
---
comparable injuries who are (5) seen no later than 24 hours
post injury (6) before initial treatment. ~-
One way to achieve most of these goals would be to per-
form the study out of an emergency room rather than from a
private practice. The number of acute patients is greater
during a given time period in an emergency room and they are
less likely to have received previous treatment. They may
then be referred to a physical therapist directly. A larger ---
------
initial number of patients would facilitate selection for
age and comparable degree of injury.
There is probably no reasonable way of insuring that
patients keep their appointments and perform the home
follow-up treatment and exercises. However, a large enough,
initial sample might provide enough data to eliminate some
of the individual differences.
~'---
25
Summary t ____ _
The goal of this study was to determine whether one [___, --
pole of high voltage electrical stimulation is more effec-
tive than the other in edema reduction of acute ankle
sprains.
Patients were seen initially by a physician of the
Stockton Orthopedic Medical Group and referred to Physical
Therapy for treatment. Range of motion and volume of the
affected ankle were measured during initial treatment, and
follow-up measurements were taken until time of discharge.
The first eight patients who attended 75% of their scheduled
appointments were treated with negative pole and the second
eight patients with positive pole.
Range of motion and volume data from each subject and
from each group were analyzed by linear regression and
t-tests. No significant difference was found between the
range of motion and volume of individuals in the two treat-
ments. The small sample size prohibits any conclusions
being drawn regarding the relationship between polarity and
edema reduction.
-
~
Literature Cited
Alon, G., Synopsis and High Voltage Stimulation, Chattanooga, TN, Chattanooga Corporation, 1981.
26
Benton, Laurel A., Baker, Lucinda L., Bowman, Bruce R., and Waters,'Robert L., Functional Electrical Stimulation A Practical Clinical Guide. The Professional Staff Association of the Rancho Los Amigos Hospital, Inc., Downey, California, 1981
Brobeck, John R., Best and Taylor's Physiological Basis of Medical Practice. Williams & Wilkins, Baltimore/ London, Tenth Edition, 1979, pg. 9-9.
Brown, Sam C.P.T., "Ankle Edema and Galvanic Muscle Stimulation," The Physician and Sports Medicine, Vol. 9, No. 11, November 1981, pg. 137.
Cyriax, James, Textbook of Orthopaedic Medicine, Vol. 1, Diagnosis of Soft Tissue Lesions, Baillere Tindall, London, 1978.
Esch, Dortha, Lepley, Marvin, Evaluation of Joint Motion: Methods of Measuring and Recording. University of Minnesota Press, Minneapolis, Minnesota, 1974.
Floriani, Lawrence P., MD, "Ankle Injury Mechanism and Treatment Guides," The Physician and Sports Medicine, September 1976, pg. 72-78.
Francis, Kennon T., "The Role of Endorphins in Exercise: A Review of Current Knowledge," Vol. 4, No. 3, JOSPT, Winter 1983, pp. 169-173.
Grava, William A., MD, Schelberg-Karness, Eileen, RPT, "How I Manage Deep Muscle Bruises," The Physician and Sports Medicine, Vol. 11, No. 6, June 1983, pp. 123-127.
Hoppenfeld, Stanley, Physical Examination of the Spine and Extremities, Appleton-Century-Crofts, New York, 1976.
Instruction Manual for High Voltage Electrogalvanic Stimulator. Electro-Med Health Industries, Miami, FL, 1977
Johnson & Johnson, Athletic Uses of Adhesive Tape, 1983.
~ ------
=---
Killian, Clyde, Seminar on High Voltage Electrogalvanic Stimulation, Ralph K. Danes Hosp., San Francisco, CA 1985.
27
Kritchevsky, D.: "Age-related Changes in Lipid Metabolism," Proc. Soc. Exp. Biol. Med. 165: 193-199, 1980.
Lakotta, E. G., "Age-related Alterations in the Cardiovascular Response to Adrenergic Mediated Stress," Fed Proc. 39: 3173-3175, 1980.
Lehmann, Justus F., MD, Warren, Gerald C., MTA, and Steward, Scham, M., MD, "Therapeutic Heat and Cold," No. 99, Vol. 3-4, Clinical Orthopaedics and Related Research 1974, pp. 207-245.
McCarter, R., "Effects of age on Contraction of Mammalian Skeletal Muscle." In Kalkor, G., DiBattista, W. J. (Eds.): r Aging in Muscle. New York, NY, Raven Press, 19 7 8, pp. 1-2 2 .
Newton, Roberta A., Karselis, Terence c., "Skin pH Following High Voltage Pulsed Galvanic Stimulation," Vol. 63, No. 10, Physical Therapy, October 1983, pp. 1593-1595.
Nirschl, Robert P., MS, MD, Sobel, Janet, BS, RPT, "Conservative Treatment of Tennis Elbow," The Physician in Sports Medicine, Vol. 9, No. 6, 42-54, June 1981.
Osborne, S.L., Holmquest, H.J. Technic of Electrotherapy and Its Physical and Physiological Basis, Bannerstone House Springfield, Illinois. Second Edition, 1944, pg. 38.
Paris, David L., Baynes, Frank, Grucker, Barbara, "Effects of the Neuroprobe on the Treatment of Second-Degree
·Ankle Inversion Sprains," Physical Therapy, Vol. 63, No. 1, January 1983, pp. 35-40.
Payton, Otto D., Poland, James L., "Aging Process Implications for Clinical Practice," Physical Therapy, Vol. 63, No. 1, January 1983, pp. 41-47.
Quillen, Williams, Rouillier, Leon H., "Initial Management of Acute Ankle Sprains with Rapid Pulsed Pneumatic Compression and Cold," Vol. 4, No. 1, JOSPT, Summer 1982, pp. 39-43.
~----
28
Radin, E., "Aetiology of Osteoarthrosis," Clin. Rheum. Dis., 2: 509-522, 1976.
Raven, P. B., Mitchell, J., "The Effects of Aging on the Cardiovascular Response to Dynamic and Static Exercise," In Weisfelt, M. L. (Ed.), The Aging Heart, New York, NY, Raven Press, 1980, pp. 269-296.
Roy, Steven, MD, "How I Manage Planta Fascilitis," The Physician and Sports Medicine, Vol. 11, No. 10, October 1983, pp. 127-131.
Smith, Wayne, ATL, RPT, "A Case Report: High Galvanic Therapy in the Symptomatic Management of Acute Tibial Fracture," Athletic Training, Spring 1981, reprint.
Sohn, Norman, MD, FACS, Weinstein, Michael A., MD, FACS, Robbins, Richard P., MD, FACS, "The Levator Syndrome and its Treatment with High-Voltage Electrogalvanic Stimulation," The American Journal of Surgery, Vol. 144, November 1982, pp. 580-582.
Tappan, Frances M., Healing Massage Techniques: A Study of Eastern and Western Methods. Reston Publishing Company, Inc., 1978.
Wolf, Steven L. (Ed.), "Applications of Low and High Voltage Electrotherapeutic Currents," Clinics in Physical Therapy: Electrotherapy, Chapter 1, Churchill, Livingston, New York, Edinburgh, London, and Melbourne, 1981.
~~---=-=--==-
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Table 1. Ankle-foot volume and range of motion measurements of patients treated with negative polarity of electrogalvanic stimulation. Data presented as volume (ml), dorsiflexion-plantarflexion (degrees of movement).
Patient/ TREATMENT DAYS diagnosis/
time post- Sex/ iniurv age Initial Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Gu/acute M/17 180 ml 100 ml 90 ml 24 hours 0-30° 50-300 lQD-300
An/acute M/53 180 ml 160 ml 110 ml 24 hours -30-300 -30-300 00-300
Table 2. Ankle-foot volume and range of motion measurements of patients treated with positive polarity of e1ectrogalvanic stimulation. Data presented as volume (ml), dorsiflexion-plantarflexion (degrees of movement).
Patient/ TREATMENT DAYS diagnosis/
time post- Sex/ injury age Initial Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Ga/acute M/35 170 ml 160 ml 160 m1 72 hours 00-350 00-350 oo-350 Bi/chronic vascular in- f/37 260 ml 100 ml 80 ml sufficiency 00-400 00-450 00-450
Va/chronic f/62 130 ml 130 ml 90 m1 70 ml 50 ml 2 weeks -50-300 -50-300 -50-300 -50-350 00-350
Do/acute M/33 10 ml 24 hours 5°-50° Th/acute fracture M/42 270 ml 200 ml 24 hours -15°-30 00-300
Br/acute f/28 160 ml 80 ml 72 hours 00-300 00-350
De/acute M/18 60 ml 25 ml 24 hours 00-400 00-450
Cr/acute M/18 60 ml 50 ml 24 hours 10°-45° 10°-45°
... 1 I
Slof!e b Day 8 Day 9 Day 10 Volume ROM
100 ml - 6.9 .476 00-400
14 days .26581 0 ml - 16.50
00-450
80 ml - 5.93 1.8688 00-400
No Slope
100 ml - 21.12 2.3468 00-350
40 ml - 14.28 1.8877 00-450
- 8.75 1.25
- 3.33 0
- 10.97 l.?Q.4
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1 1 ~ l ~ ~ 1 ~ ~ lo TREATMENT DAIS ------->
FIGURE 2 - RANGE OF MOTION
Change in range of motion (R.O.M.) of all subjects during treatment with either negative (x) or positive (o) polarity following acute ankle sprain.
:lillll I I ! Ill I I
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FI GORE 3 - VOLUME CHANGE
Change in ankle-foot volume (Volume - ml) of all subjects during treatment with either negative (x) or positive (o) polarity following acute ankle sprain.
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TREATMENT DAYS ------~>
FIGURE 4- SUBJECT lGu
Change in ROM and volume of subject GU during treatment with negative polarity following acute ankle sprain. X = volume, o = ROM
'II , I r1::1•,
6CJ
Sel ;;u • 0
4eJ • ::3: •
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scr
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TREATMENT DAIS ------->
FIGURE 5- SUBJECT lAn
Change in ROM and volume of subject An during treatment with negative polarity following acute ankle sprain. x = volume, o = ROM
6~
SeJ ;:u • C)
4CJ • 3: •
3eJ a.. rt> \0 ,
2Cl ro (I) tJl .......
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II
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i TREATMENT DAIS ------->
FIGURE 6 - SUBJECT lCr
Change in ROM and volume of subject Cr during treatment with negative polarity following acute ankle sprain. x = volume, o = ROM
1.0 CV)
! 'I
,, ' I I ',,. :•1 II
i I
'': ll"'i'lit·:ji-•111 l:l"l
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....----~..e..------ ~-
. --------------------- --e
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lCJCJ
~CJ ~-----------------x I f I f I I I I I --t 1 2 3 4 5 5 7 8 9 lei
TREATMENT DAYS -------~
FIGURE 7 - SUBJECT lSm
Change in ROM and volume of subject Sm during treatm~nt with negative polarity following acute ankle sprain. . x = volume, o = ROM
Change in·ROM and volume of subject Lu during treatment with negative polarity following acute ankle sprain. ___ ~-J<:. =_y9~uii1~ { _ o = ROM
iii ' 1::
5C'J
sa ;;o • 0
4Cl :::s: •
3LJ 0... ro
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I I I -1 . --t- I I 1 2 3 4 5 5 7 8 9 1~
TREATMENT DRYS ------->
FIGURE .12 - SUBJECT 2Ga
Change in ROM and volume of subject Ga during treatment with positive polarity following acute ankle sprain. X = volume, o = ROM
5eJ
5fJ
4fJ
3(J
2el
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TREATMENT DAYS -------1
FIGURE ·13 - SUBJECT 2Bi
5Cl
5CJ
4!J
3!J
2(j
l(j
I I I -l-g lel
Change in ROM and volume of subject Bi during treatment with positive pol?rity following chronic ankle sprain with vascular insufficiency. x = volumer o = ROM
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-t---+ 9 l(j
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TREATMENT DRYS -------/
FIGURE 14 - SUBJECT 2Va
Change in ROM and volume of subject Va during treatment with positive polarity following chronic ankle sprain. x = volume, o = ROM
I i I
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'<:!' 3~CJ '<:!'
le ,... 25~ ><·
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TREATNENT DAYS ----->
FIGURE _15~ SUBJECT 2Do
Change in ROM and volume of subject Do during treatment with positive polarity following acute ankle sprain. X = volume, o = ROM
. l ---------------------- =:::::..:-·--··--Sel a--- . --~~--
1
-~---- .. ___ _
I 1 I 3 I ·
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RERT ~1ENT PRYC I 9 -+ ! 5 T 6 ,
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FIGURE 16 - SUBJECT 2Th
Change in ROM and volume of subject Th during treatment with positive polarity following acute ankle sprain with an associated fracture. X = volume, o = ROM