THE THERAPY THAT GIVES NEW LIFE TO TISSUE METABOLISM
The use of heat as a cure for various pathologies has been known for many years: it provides relief in chronic, traumatic and inflammatory conditions, increases blood flow by improving cell nourishment and oxygenation, and accelerates the elimination of toxins; improves the extensibility of connective tissue, reduces joint stiffness, muscle pain and spasm, and facilitates the absorption of haematomas and edemas.
Tecartherapy is an extraordinary physical technique that assists the intervention of the physiotherapist; it is definitely the most used by physiotherapists in Italy and one of the most prescribed by orthopaedists, physiotherapists and sports doctors alike.
Some essential questions therefore should be addressed:
How should tecartherapy be properly used?
How should an effective tecartherapy treatment be planned?
How can power and other tecartherapy parameters be managed?
How are the most suitable accessories for effective tecartherapy treatments chosen?
In this guide we will analyse all the elements needed by the physiotherapist in order to that Tecartherapy can be used in a professional way.
The application of an electric field to a biological tissue, equipped with the appropriate characteristics of power, frequency and waveform, provides energy to the substrate thus restoring the chemical-electrical balance compromised by the onset of the pathology. This is the theory that justifies its use in physiotherapy. Every single cell participates in the regenerative function of tissue through morphological and chemical-electric interactions.
The thermal action, which gives immediate relief to the inflamed or damaged area, clears the field for mechanical action, which allows for a longer treatment duration and deeper application and, unlike the therapeutic indications of classical methodology, can be repeated in subsequent sessions as well as being placed close together without risk of interference on the tissues.
The new Fisiowarm® devices are capable of delivering energy by using a different form of interaction between electric fields, which refers to the physical model of the capacitor, without using a high voltage. The transfer methods are multiple and customizable, they are characterized mainly by the fact that heat is generated directly inside the tissues thus managing to treat
- Treatment area and tissue to be targeted by tecartherapy
- Tecartherapy Treatment, Capacitive or Resistive?
- Geometries for effective tecartherapy treatments
- Using Tecartherapy Accessories
- Managing the parameters of tecartherapy systems
- The conductive cream used in tecartherapy
- Therapeutic associations with tecartherapy
Too often the patient ends up on the bed and is ironed out like a shirt! Using Tecartherapy as an “iron” hurts not only the Tecartherapy brand but also physiotherapy as a whole. The physiotherapist must first have the expertise in understanding the patient’s clinical background and only after this can the appropriate treatment be planned out. During the courses of the A.I.T. (Italian Academy of Tecartherapy) we use as an evaluation an Anglo-Saxon extraction technique with a score sheet that includes:
- History and clinical background the development of symptoms, in particular those that give us important indications regarding the patient’s prognosis
- Specific questions to understand pain (topography, intensity and quality of symptoms, time and frequency of appearance etc.) and questions about activities or postures that decrease or eliminate pain and also questions about intensity based on the time of the day.
- Body Chart An anatomical table where the topography can be established and the quality of the symptoms pinned to the timeline in which they appear.
- Specialised Questions. Illnesses, medication, recent or important medical conditions or surgeries in order to have criteria for the evaluation of any contraindications and/or red flags.
- Specific Tests orthopedic tests for specific body district, neurological and neurodynamic tests.
- Medical Exams CT scan, MRI, x-ray or ultrasound that the patient has which may have relevant significance to our clinical reasoning.
Only after clinical reasoning is it possible to identify the origin of the symptoms and understand which tissue or part of the body we need to focus on, and create an integrated and modern treatment plan; MANUAL THERAPY + PHYSICAL THERAPY + THERAPEUTIC AND/OR FUNCTIONAL EXERCISE
“Impedance in medicine is the characteristic of every tissue that allows the passage of current”
How many times, using Tecartherapy, have we decided to use the Capacitive or Resistive in the same session because we were not sure which one to choose?
Many companies, perhaps too many, have recommended 10 minutes of Capacitive treatment in order to open and close the session, and 10 minutes of resistive treatment with a presumed greater antalgic effect.
We need to get something clear! The electric current, which is what we what we are talking about, travels around the body and releases more energy into areas which have great impedance variation. This happens more specifically at the interface between high and low impedance where more energy is released (e.g. between bone and soft tissues).
The current always chooses the less difficult path (low impedance), so it will never pass inside a bone but will release energy in the outer portion according the principles we have just explained. In assimilating this concept it is easy to understand the difference between Resistive and Capacitive.
The Resistive is a non-isolated metal electrode that will tend to yield energy where it encounters a difference of impedance.
If it is below the electrode, a high-impedance tissue is immediately identified (such as a bone or a large tendon) and much of the energy will be dissipated more on the surface; if, on the other hand, the difference between high and low impedance is identified at a greater depth, a greater attention will have to be given to the path of the current. This current path is determined by the position between the plate and the electrode. From this, it can be immediately understood how the resistive is necessary so as to know how to work well with geometries.
Unlike the resistive, the surface of the Capacitive in contact with the body is normally covered with a layer of insulating material. This insulation constitutes the interface at a high/low impedance as a result of the intrinsic characteristics of the material itself once it comes in contact with the skin.
In this way it generates energy in the surface areas underlying the electrode, regardless of the biological tissue between the capacitive electrode and the neutral plate. However, this constructive solution requires using very high voltages (in the order of 1000 Volts) applied to the electrodes. This can result in damage or wear and tear to the insulation film or the capacitive cable/handle in the form of major shocks or electrical burns both for the patient and/or operator.
Fisiowarm overcomes this criticality by adopting the innovative technology SAFE at a LOW VOLTAGE CAPACITIVE that makes capacitive therapy safe and its result more efficient, without further risk to the operator or patient.
Geometries in Tecartherapy are often mentioned, but what are they actually?
By Geometry in Tecartherapy, we mean the path the current takes in the patient’s body with respect to the position between the plate and the electrode.
There are so-called “Correct Geometries” which are those that see the parallel positioning between plate and electrode, where the geometric projection of the electrode ends in the centre of the return plate.
Treatment scheme of “Correct Geometry”
With this type of geometry the passage of the current within the body and how the energy will be yielded is very clear. In fact, in a treatment using the resistive system in correct geometry, we will only have to know the anatomy of the structures that are between the plate and electrode, and according to the different features of the tissues we will know where and how the energy will be yielded.
To better understand this important concept, imagine the flow of current as if it were a stream of water, the riverbed as a muscle and the pylon of a bridge over this river as if it were the bone. Now, imagine that you are on the bridge and looking down near the pylons that support the bridge: you will see that the water that strikes them will produce turbulence in their vicinity.
Va ricordato sempre che il sistema capacitivo avrà una percentuale importante di sequestro energetico direttamente nei primi strati sotto l’elettrodo, quindi la posizione della piastra di ritorno ha una rilevanza minore nel trattamento.
Tecartherapy treatment produces a higher intensity in the areas of interface between a high-impedance and a low-impedance tissue.
This turbulence will be greater the more the river bed is narrow (the water has little chance of escape), while it will be less the more the river bed is wide (the water will flow away from the pylons creating less turbulence): similarly, this is what happens in our body.
In going back to the example of the correct geometry, it is therefore necessary to consider that if the geometry is also correct but the bone surface is minimal with respect to that of the muscle present in the same regions, the current, as we know, will choose the simplest path and therefore the muscles will produce an insignificant amount of heat in the bone/muscle interface.
It should always be remembered that the capacitive system will have an important percentage of energy seizure directly in the first few layers under the electrode, so the position of the return plate will have minimal relevance during the treatment.
When it is not possible to work in “correct geometry” it is necessary to be very careful of the path that the current will take.
If the path between the plate and electrode is too distant there is a risk of losing energy to tissues not directly connected to the problem and more generally a greater power is needed; It is therefore useful to select a short path that includes the target application and takes the anatomy of the affected area of the body into account.
In conclusion, it is useful to remember that, it is preferable that all electrodes (capacitive, resistive and neutral) not be placed directly onto bone surfaces but onto “soft” surfaces for the benefit of the patient’s comfort but above all for a more homogeneous diffusion of current.
The application of Tecartherapy can take place in several ways:
- As a basic application
- As an integrated application in conjunction with Massotherapy
- As an integrated application in conjunction with Manual therapy
- As an Integrated application in conjunction with therapeutic exercise
Let’s look at what each of these modes consists of.
In the basic application, the physiotherapist, after having positioned the plate, moves the electrode onto the area to be treated so as to create a homogeneity of energy in that target area. An application can last 15/20 minutes for a single body part but this may take longer if it is a larger area, such as the entire back.
In the integrated application with massotherapy the physiotherapist adds basic massotherapy maneuvers to the application in order to increase effectiveness, especially to muscle tissue.
The application of Tecartherapy with massotherapy allows the physiotherapist to continuously perceive what is muscle tension and to act more intensely whenever necessary.
The comfort of the treatment is one of the strengths of the treatment especially in this combination.
In the integrated application with manual therapy, the physiotherapist uses the electrode as if it were the extension of his hand by moving the joints, which had stiffened because of degenerative or traumatic processes, and associating the therapeutic effect of tecartherapy with specific joint movement.
Obviously, in order to carry out the treatment mode in combination with Kinesitherapy, manual therapy or therapeutic exercise, the physiotherapist could choose particular geometries between the plate and electrode pads or special accessories to facilitate the movement of the joints.
In the integrated application with therapeutic exercise the physiotherapist can choose plate and electrode pads or use two handpieces to ensure the patient can perform active exercises during the therapeutic session.
The last mode is extremely powerful as it allows for working directly on movements that can be limited or painful and thus producing a faster functional recovery.
In recent years, FisioWarm has created an extraordinary line of accessories that has inspired many other companies.
The accessories improve the treatment and energy application to all regions of the body and lend themselves to different therapeutic integrations:
With the Neutro Dinamico® system the physiotherapist is given the possibility to create the best geometries for each and every treatment area.
Neutro Dinamico® as the name suggests, involves the use of two handpieces, one of which houses the active electrode while the other neutral electrode in actual fact becomes “dynamic”. This particular configuration allows the therapist and the patient greater freedom of treatment with all the therapeutic benefits that this brings:
- It is possible to carry out the application while the patient performs exercises or follows the directions received by the physiotherapist as neither patient nor physiotherapist are physically attached to the classic neutral plate electrode;
- The application benefits from the ability to channel energy in a more selective way and only where necessary with adequate power thus avoiding the involvement of other areas not subject to treatment;
- During the same treatment, the physiotherapist may vary the “path” of the current by adapting it from time to time so as to obtain the best therapeutic result;
- It makes treatments such as the three-dimensional treatment of the joint possible, which until now have been unthinkable.
The Neutro Dinamico® kit comes with other special accessories such as “handheld” that makes the work of the physiotherapist more comfortable and the movement of the electrode on the patient even more natural. The evolution of these accessories is continuous and is only possible by comparing FissioWarm users in Italy and around the world. Tecartherapy FisioWarm is actually distributed in more than 25 countries around the world and thanks to user feedback is constantly evolving technologically.
The static automatic kit was created to allow the patient to work actively during the Tecartherapy treatment.
The electrodes can function as active electrodes or neutral electrodes depending on how they are applied.
The energy provided by Tecartherapy facilitates the extensibility of collagen, increases blood perfusion in tissues and has an antalgic effect as a result of the applied heat. This enables specific exercise sequences to be created for each patient by combining the effects of physical therapy with those of movement.
In this way, not only can you make the most of the patient’s dynamism but the physiotherapist has also the advantage of being able to choose whether to accompany the patient during the exercises with both hands or to manage other therapeutic aids (e.g. the ball).
This results in more dynamism, more comfort and a more effective treatment especially in sports patients during post-traumatic recovery.
The bipolar resistive electrode profile (registered design/trademark) originates from an original Golden Star idea and encloses the two active/neutral electrodes in a single structure. Featuring movable heads that can faithfully follow the profile of the underlying body surface, it makes the application easier for the operator, better targeted and focused, and more pleasant for the patient. This application mode enables the treatment of surface areas of the regions of the body where it is more difficult to use the neutral plate.
For tendon pathologies of the hand, wrist, elbow, shoulder and knee, its use is recommended. This electrode is also called paravertebral, in fact its conformation and orientable heads allow for the treatment of the muscle and tendon structures of the spine located closer to the surface.
In soft tissue-specific pathologies, especially in tendinitis, better results are obtained by limiting applications as much as possible to the location of injury or inflammation.
The bipolar capacitive electrode: this particular electrode allows for the application of Tecartherapy without the need to use the return plate. It is very effective for the treatment of surface problems, especially for the treatment of scars or lymphatic drainage work.
The bipolar capacitive electrode can also be used in combination with pre-race massage at sporting events, the absence of the plate allows a greater simplicity of application especially when dealing with multiple body regions and muscle groups in a short time.
Power, power, power! It seems to be the most important parameter for a physiotherapist who is about to buy a new or second-hand Tecartherapy device.
Is it really that important? Or are there any other parameters that can have a major impact on the effectiveness of a treatment? Frequency, for example, is a very important parameter, but there needs to be some clarity. Some companies believe they have identified frequencies that are more effective than others. These frequencies are all between 400,000 and 500,000 Hz (between 400 and 500 KHz).
First of all, it should be clarified that there are no existing patented frequencies and that the clinical evidence and the very small number of significant studies on Tecartherapy produced over time have always referred to different frequencies. In addition, especially the equipment produced until just a few years ago, had error rates in the delivery of declared frequencies, of the order of at least 5-10%.
The history of “original or unoriginal” frequencies seems more of a commercial argument than a scientific one.
However, we can say that frequencies of around 500 KHz are definitely the most used and the lowest frequencies (up to 300 KHz) are effective for deep treatments. Higher frequencies, up to 1000 KHz are used for the most superficial treatments. In fact, as the frequency is increased, the electric current tends to become principally distributed on the surface of the conductor it passes, the so-called “skin effect”. Another important parameter in the setting of the treatment is the pulse of the signal (duty cycle), which expresses the relationship between the emission time and the break time.
The pulsed mode in Tecartherapy is useful for the management of the thermal gradient (ATHERMY) which will be progressive for pathologies ranging from acute to chronic. In the case of an acute pathology, when using old-fashioned devices, it was limited to keeping the delivery intensity to a minimum, obtaining very few good results with the device almost turned off.
Nowadays, with Fisiowarm you can choose between different athermy gradients while maintaining the biological effects of the passage of current and at the same time keeping damaging thermal effects in the acute phases to a minimum. The introduction of this new parameter allows for the modulation of treatments specifically for each therapeutic phase. Finally, the introduction of the SUPERPULSATA dispensing mode (available on the 400 model) in the complete absence of heat represents the new frontier of Tecartherapy.
Conductive cream is a fundamental element for proper and effective application; its composition is designed to ensure excellent electrical conductivity and to maintain the right density during the course of the therapy by limiting excessive absorption by the body and softening the skin without anointing.
It is important that the cream used for Tecartherapy treatments has a special CE certification.
Yes, the price of tecartherapy cream is important for the management of a Medical Practice but it is more important that it is a certified product of high quality, tested and approved as the best to ensure a correct application performance with chosen devices and certified by the manufacturer to not be damaging to electrodes, handles or cables.
It is something that deserves great attention and for this reason more and more health inspectors are verifying the presence of this certification during audits of medical structures. Tecartherapy cream is not a mere cost to be incurred on which to seek savings but it is a matter of research by companies and attention which needs to be paid to the performance and health of the patient by the physiotherapist.
During the treatment the amount of cream should always be constant as the cream’s composition promotes conductivity and hence energy transfer.
Using insufficient or not using sufficient cream or is an incompetent error that compels you to work at higher energies and hence increases the amount of energy applied to the patient for no apparent reason. An insufficient amount or a low quality cream can cause a non-homogeneous supply of current (especially for capacitive treatment) with the typical and annoying “pin prick” sensation that occurs in the part below the used electrode.
Another incorrect practice, which runs the risk of burning, is to perform Tecartherapy treatments without applying any conductive cream on the return plate.
Tecartherapy did not originate with the purpose of transporting substances around the body and there is currently no scientific evidence to this. Nevertheless, even if some specific products that are used topically are easily ionized, whilst containing the active ingredients, they can be more easily absorbed locally due to the effect of the micro-circulation increase.
The achievable result is one of modest improvement of absorption when compared with the topical application of the same product alone. The most important feature of the cream to optimize the treatment is electrical conductivity.
Another important element is the behaviour of the cream at high temperatures. Some creams produce an “oil effect” at the end of the treatment, which is well appreciated by physiotherapists. Smoothness is an important element but sometimes certain creams under the effect of electric current and heat produce chemical reactions and variations in “ph” that can damage the electrodes and perhaps even be harmful to the health of both the patient and operator’s skin. Therefore, it is preferable to always buy products from companies having experience in this area.
Going into Fisiowarm 7.0 product in more detail, the conductive cream Fisiowarm Cream is a Class I medical device, an actual accessory to the equipment itself, which is a fundamental part for its proper functioning. It guarantees security in its application and compatibility with its accessories. The use of creams other than Fisiowarm Cream results in the waivering of the warranty as regards accessories (electrodes, cables, handles).
Until a few years ago manual therapy and osteopathy seemed a long way from Tecartherapy. Let’s be honest, the contrast between physical therapy and manual therapy is a way to win over the minds of young physiotherapists and therefore condemn them forever in not conducting therapeutic integration.
Nowadays, with the right physical parameter settings and with the use of modern accessories (hand pieces and electrodes) it is possible to carry out high-level integrated treatments. Those who have more than 20 years of experience and have lived, studied and practiced physical therapy and in particular Tecartherapy know how useful it can be in the assistance of manual therapy treatments.
Today, Tecartherapy is safer and more effective than it was 20 years ago. At the same time that physiotherapists have developed clinical framing capabilities have also developed as a result of manual therapy. Having understood the origin of the symptoms, which is the basis of our work, we can and must apply the most effective techniques and tools for our patients.
The Italian Academy of Tecartherapy (A.I.T.) is the Tecartherapy course which has an educational plan designed to promote therapeutic integration between manual therapy, Tecartherapy and other high-tech physical approaches.
Many osteopaths are also starting to use Tecartherapy as an adjuvant for fascial and visceral treatments. We are on the verge of a new season of Tecartherapy, where Fisiowarm 7.0 stands tall as a technology in the service of physiotherapists, who can now optimize their therapeutic projects regardless of the type of approach being adopted.
Heat provides relief in chronic traumatic and inflammatory conditions, increases blood flow by encouraging cellular nourishment and the disposal of toxins, and improves the elasticity of connective tissue.
The vasodilation obtained with the use of heat leads to an increase in the exchange of substances that promote the drainage of the inflamed site and the local influx of cells responsible for restorative processes.
- CONTUSIVE OR DISTORTIVE TRAUMA
- POST-SURGICAL REHABILITATION
- SPORTS TRAUMATOLOGY
- MUSCLE AND TENDON PATHOLOGIES
- SCARRING OUTCOMES
- PATHOLOGIES OF THE SPINE AND PERIPHERAL JOINTS
- PATHOLOGIES OF THE VASCULAR AND LYMPHATIC SYSTEM
- PATHOLOGIES OF THE NERVOUS SYSTEM OF ORTHOPAEDIC ORIGIN
- REHABILITATION OF THE PELVIC FLOOR
The energy delivered by Fisiowarm 7.0, by using specific modes and electrodes dedicated to each treatment area, promotes an important biological stimulus of the treated tissues, facilitating a greater influx of oxygen and nutrients and thus favouring the elimination of inflammatory substances and excess fluids.
For more than 20 years tecartherapy has been highly effective also in the field of aesthetic medicine and in the post-surgical stages of plastic surgery. The bio-stimulating of tissues contributes to the repairing of skin, lightening of scars, firming up of the dermis by also stimulating the disposal of toxic catabolites and the elimination of free radicals.
✔ FOR THE FACE: As a result of Tecartherapy’s cellular stimulation action, the skin receives an increased blood supply and consequential improved oxygenation, which has a positive impact on surface cells as well as on the deep part of the dermis. It has an immediate lifting effect on collagen fibres, resulting in a relaxed effect of the treated area.
✔ TO CURE CELLULITE: By increasing the speed of blood flow, Tecartherapy generates an increase in oxygen production that promotes metabolic activities and the disposal of toxins. By reducing inflammation, problems of venous and lymphatic stagnation through synergistic use with specific massage techniques can be improved.
✔ FOR THE FIRMING OF THE TISSUE: Tecartherapy uses specific power, frequency and treatment time settings and stimulates the microcirculation of blood and lymphatic system that results in an improvement in the toning of the treated skin. Result optimization is also achieved with the tensor effect carried out by muscle groups underlying the area that can be trained during treatment.
To achieve important and long-lasting results, it is always advisable to create multidisciplinary therapeutic pathways that include an improvement in the patient’s lifestyle, a correct nutritional plan, a targeted therapeutic exercise and if necessary the inclusion of other physical therapies advising the treatment.
The most innovative approach to Pelvic Floor issues is with Tecartherapy. This method, which has widely been used over the years for all other muscles, has finally entered the service of the Perineum.
It is very commonly used in Spain for all pelvic problems as a result of its ability to oxygenate tissues, restore balance to muscles and mucous, for its great effectiveness in increasing vascularization and muscle relaxation, and because of its antalgic action, it is the ideal treatment for the functional recovery of the pelvic-perineal area.
During the rehabilitation cycle the physiotherapist can also use specific accessories for the internal and external treatment of the area, for the reinforcement of the internal muscles and for manual treatment in combination with tecartherapy.
The rehabilitation of the pelvic floor is a clinical practice with a long history but it has only been a few years that it has experienced an acceleration in its diffusion, at least in Italy: why is this?
Among the main reasons is the fact that the whole sphere of the pelvic floor and what concerns it (genital organs, reproductive and excretory organs) and are still taboo. You hardly hear about physical issues during sexual intercourse, urine loss after giving birth or pain during the menstrual cycle.
Surely this is given by the fact that these are intimate topics, but at the same time the insufficient amount of information there is condemns many people to remedies that are only palliative, or that are intended to “limit the damage”, just because they do not know that there could be a definitive or perhaps more complete solution with the aid of a specialized physiotherapist. All too often “only” a specific program of exercises can result in great satisfaction!
Named for its location, the Pelvic Floor is the structure that closes the bottom of our pelvis. It is composed of ligaments, fasciae and muscles, which cooperate together in providing its functions: support, continence, ability to contract and relaxation.
It has the shape of a hammock, above which are the pelvic organs. Its shape and position make it subject to the pressures that are generated within the abdomen when it contracts.
More generally, the rehabilitation of the pelvic floor not only affects women but also men. Among the main features is in fact the treatment, the prevention and cure of incontinence, whether it be fecal or urinary that can be present in both females and males.
The element that characterizes this aspect of physiotherapy is certainly having the awareness of this part of the body, which is very often unknown. Tecartherapy is an important ally of the physiotherapist for the treatment of the main pathologies of the pelvic floor.
For this reason the first great work that the physiotherapist does in this area must be to use a series of strategies that allow the patient to become aware of the pelvic muscles, to become accustomed to them, and then to move on to specific exercises, which have the purpose to strengthen or relax the muscles.
✔Risk Factors for the pelvic floor are:
- pregnancy and childbirth
- Iatrogenic factors such as surgical interventions
- being overweight
- prolonged upright standing position
✔The risk factors in humans are mainly of the iatrogenic type such as for prostate and/or urethral surgery.
The main dysfunctions of the pelvic floor are:
– urinary incontinence;
– prostate hypertrophy;
– anatomic-functional disorders of the sexual sphere;
– pelvic pain and postpartum recovery;
– functional disorders of menopause;
– vaginal dryness;
– muscle tone dysfunctions (hypotonus/hypertonus).
Given the complexity of this functional region, it is necessary that the operator is adequately trained and has the ability to create specific therapeutic pathways for each clinical case.
Fisiowarm with the AIT (Italian Academy of Tecartherapy) follows physiotherapists in their training path with monothematic didactic events throughout the national territory and through FAD courses.