Clinical case 7 russian currents

PHATHOLOGY: Muscle strain (muscle pull or tear)

OBJECTIVE: Accelerate recovery time

TREATMENT: Russian Currents

CONCEPTS

PHATHOLOGY

OBJECTIVE

TREATMENT

PHATHOLOGY

What is it? The muscle tear is an injury of muscle tissue which is accompanied by bleeding due to rupture of blood vessels throughout the affected muscle, causing severe pain that prevents collapse it. Happens for a super elongation (exceeding the muscle beyond its ability to stretch), by a sharp contraction (faster), or making more than the biological capacity of tensile stress.

What structures are affected? The internal structure (muscle fiber) of the affected muscle and the blood vessels around the lesion (if it's a severe muscle strain).

What happens in this structures after injury? Sudden, sharp and intense but momentary pain, accompanied generally of a bruise. In the most serious cases (to crush total of the muscle) there takes place a very extensive bruise and more pronounced inflammation, which immobilizes the affected region that is experienced as a temporary paralysis (contraction of neighbor muscle to the injury). If the pain is very intense a component of shock can appear - though it is slightly frequent-, with dizziness and cold sweat .

OBJECTIVE

The goal of this treatment is accelerating the process to return to work activity. Muscle reeducation:

Increase strength Increase endurance Increase speed of contraction Decrease atrophy. Training new muscle action.

TREATMENT: Russian Currents STRENGTH TRAINING PARAMETERS: Kotz carried out many experiments to establish the best protocols for strengthening. The following are based on his findings.

Frequency = 2500 Hz. "carrier" frequency that is burst modulated at 50 bursts per second

Pad placement = Bipolar technique over the motor point Intensity = As strong a motor level as the patient can tolerate. Patient’s effort = The patient performs as isometric contraction of at least

50% of their maximal voluntary isometric contraction (MVIC) along with the stimulation

Duty cycle = 1:5 ratio Ramp time = 2 seconds Timing (Duty cycle) =

Ramp Rise Time: 2 seconds (concentric contraction) On Time: 10 seconds (isometric contraction) Ramp Fall Time: patient's comfort (eccentric contraction) Off Time: 50 seconds (replenish ATP levels)

Repetitions = 10 to 25 repetitions per session (isometric contraction along with stimulation)

Frequency of exercise = Treatment daily with 2 days off to led the muscle relax

This approach has come to be called: "Russian Stim" "Rehabilitation" "EMS" (Electrical Muscle Stimulation) "FES" (Functional Electrical Stimulation)

WHY THESE VALUES?

Russian Currents or Burst Mode Alternating Current (BMAC)

Waveform: Medium Frequency Sine Wave. Sine wave produced in burst mode with 50% duty cycle. To make intensity of current tolerable it is generated in 50-burst-per-second envelopes with an interburst interval of 10 ms.

Frequency: 2500 Hz. "carrier" frequency that is burst modulated at 50 bursts per second because is high enough to recruit muscle fibers but low enough not to suffer fatigue

Pad Placement: Bipolar technique over the motor point to achieve a greater effect.

Intensity: As strong a motor level as the patient can tolerate. The patient's discomfort is reduced as they produce a voluntary contraction. The intensity may be increased on subsequent contractions.

Patient's Effort: The patient performs as isometric contraction of at least 50% of their maximal voluntary isometric contraction (MVIC) along with the stimulation.

TREATMENT: Russian Currents

Russian Currents Russian Currents or Burst Mode Alternating Current (BMAC)

Duty Cycle: This duty cycle with an On: Off ratio of 1:5 was found to be optimal because it allowed the muscle time to regenerate the necessary levels of ATP for maximum contraction.

Ramp time: We want work the strength in this patient for that we use 2 seconds because lower ramp times allow more muscle fiber recruitment, and because we are working with very high intensity and it can be uncomfortable for the patient, we don't want that the muscle will be fatigued.

Timing (Duty circle): With this ramps we are going to get a isometric contraction of the muscle we are treating, in fall ramp we relax the muscle and we provoke that in off time ATP restored getting muscular strengthening with the repetitions. The session will be held with maximum force without fatigue. Ramp Rise Time: 2 seconds (concentric contraction) On Time: 10 seconds (isometric contraction) Ramp Fall Time: patient's comfort (eccentric contraction) Off Time: 50 seconds (replenish ATP levels)

Repetitions: From 10 repetitions we can say that the muscle start to strength, but we have to treat maximum with this contractions (20 contractions) because otherwise the muscle is fatigued, being prejudicial for the patient.

Frequency of exercise: We must have continuity to get the muscle strengthening that’s why we made the treatment daily with 2 days off to led the muscle relax.

Because it is a fast oscillating AC current, as soon as nerve repolarizes it is stimulated again, producing a current that will maximally summate muscle contraction

TREATMENT: Russian Currents

PHYSIOLOGICAL EFFECTS: • Contraction of innervated or partially innervate muscle. • Decreased edema. • Decreased muscle spasm. • Decreased pain. • Increased circulation. • Increased muscle strength. • Increased muscle speed. • Increased muscle endurance.

BIBLIOGRAPHY - Shivani Chowdhury Salian (PT), Nikita Hingane, Sujata Yardi. A Randomized Control Trial to

Compare the Effects of Russian Currents and Strengthening Exercises in Asymptomatic Young Adults.. International Journal of Science and Research (IJSR) Volume 3 Issue 5, May 2014

- Belanger, A. Y. Therapeutic Electrophysical Agents: Evidence Behind Practice 2nd Ed., Lippincott Williams & Wilkins; 2009

- Michelle H. Cameron. Physical Agents in Rehabilitation - From Research to Practice 4 Ed., Elsevier; 2012.

- Wikipedia la enciclopedia libre. Desgarro muscular [document on the Internet]. [2014 Dic 1]. Available from: http://es.wikipedia.org/wiki/Desgarro_muscular (traslated to english)

- Electrotherapy on the web © Prof. Tim Watson 1995-2014. Russian Stimulation and Burst Mode Alternating Current (BMAC). [document on the Internet]. [2014 Nov 28]. Available from: http://www.electrotherapy.org/modality/russian-stimulation-and-burst-mode-alternating-current-bmac

- Rehab Clinical Pocket Guide: Rehabilitation Medicine. Kimberly A. Sackheim. Springer. (Ed.); 2013

- McGraw-Hill Higher Education - Physical Education page. Electrical Stimulating Currents. [document on the Internet]. [2014 Dec 2]. Available from: http://www.mhhe.com/hper/physed/athletictraining/powerpoint/chappower/Chap%205-%20Electrical%20Stimulating%20Currents.ppt