Pulsed Electromagnetic Energy:
A New Therapeutic Modality in Podiatry
|
Six Month Clinical Evaluation
by
GUSTAVE S. BRAUN, .D.S.C*
Reprint from Volume 55, Number i 0
Journal of the American Podiatry Association
October 1965, pp. 700-705 |
Podiatry has embraced an impressive armamentarium of modalities
for the management of foot pathosis. Often the success or failure
of any modality is in direct proportion to the operator’s
knowledge of the modality’s potential, its limitations,
and its intelligent application.
The purpose of this paper is to evaluate a NEW modality in podiatry
and to observe its usefulness in the foot problem. The modality
is pulsed electromagnetic energy, Diapulse®. I do not believe
there is any other modality which requires more complete understanding
In ORDER to fully realize its over-all therapeutic potential
Pulsed electromagnetic energy was originally designated as Pulsed
high frequency current and was compared to diathermy, which
is continuous high frequency. But studies have disclosed that
the pulsed high frequency current produces electromagnetic energy
without heat, or as Nadasdi (1) reports, "a non-thermal,
specific electric action.’’
While both diathermy and pulsed electromagnetic energy equipment
operate on the same assigned medical frequency of 27.12 megacycles,
no other similarities can be drawn. Diathermy is continuous
high frequency (short wave) and produces heat from the current
itself, and from the tissues’ resistance to its normal
flow. In the Diapulse apparatus, this continuous high frequency
current is pulsed (interrupted at controlled properly spaced
intervals); the concomitant heat is dissipated, so that the
electromagnetic energy itself exerts an unhindered beneficial
action.
Application of diathermy is difficult, often impractical, sometimes
impossible, and always dangerous. Application of Diapulse is
simple clothing need not be removed, no area of the body is
inaccessible (the energy even penetrates plaster casts), and
there arc no reported contraindications. |
| The Apparatus |
Time Diapulse unit emits high frequency electromagnetic
energy in intermittent bursts, timed in microseconds, so that
each pause between pulses is at least 23 times that of the energy
pulse. This allows dissipation of any heat, which may be produced
by the energy pulse, thus permitting high intensity and deep
penetration without significant rise in temperature, either
locally or systemically. Even at maximum intensity of 973 watts
peak instantaneous output, heat build-up is minimal. The manufacturer
furnished this technical data.
The rate of pulsation is controlled by dial settings in six
steps ranging from 80 to 600 per second; and penetration, by
dial settings from 1 to 6, representing varying levels of intensity.
The electromagnetic energy is transmitted from a drum-shaped
treatment head mounted on an adjustable bracket. This treatment
head is directed so that the area to he treated is in the electromagnetic
field, and tuned to resonance by adjusting to maximum brilliance
a small bulb on the treatment head. |
| Therapeutic Effects of Interest
In Podiatry |
Impressed by the apparent technical advantages
of Diapulse, I undertook a comprehensive review of all the literature
available on the therapy. Of particular interest was Erdman's
(2) report on increased rate of blood flow to the extremities
with Diapulse therapy. It has always been my opinion that the
support or re-establishment of adequate blood supply throughout
the entire extremity, rather than local hyperemia, has been
a missing factor in the complete management of many foot problems.
Erdman reported that a 20- to 40-minute application of Diapulse
over the epigastrium produced aim average volume increase of
1.75-fold at settings of 400 pulses per second and penetration
4, in average sized individuals.
Therefore, I decided to use this technique to support circulation
wherever indicated.
Ginsberg's (3) report was also especially interesting. He stated
that in bursitis 01’ time shoulder a 10-minute application
of Diapulse over the affected area, and 10 minutes each over
the adrenals and time liver, ‘‘has produced impressive
clinical results with demonstrable reduction of calcification,
without drugs or other therapeutic modalities."
Since bursitis, gout, etc., are frequent and often troublesome
podiatric problems, I decided to use Ginsberg’s technique
on these and other foot problems with metabolic predisposing
factors.
Nearly all the literature suggested some degree of host benefit
from Diapulse therapy, aside from time specific local result.
This suggested a significant metabolic response, which I intended
to watch for during my evaluation. |
| General Discussion |
Diapulse was integrated into my practice
and was used extensively in my effort to become fully oriented
to the modality. Over 600 treatments were given during a 6-month
period, covering every clinical condition from dermatosis to
irreparable deformity. Diapulse was used locally, over time
epigastrium, adrenals, liver, and time sacrum. My intention
was to compare findings, through personal experience, with those
reported in the literature.
The literature made little mention of patient sensation during
treatment. I was particularly interested in this. For the most
part, treatment over any area produced virtually no sensation
when it was reported, it was minimal. Of the patients who experienced
sensation, about half reported indistinct, intermittent tingling
from local application. A few reported gentle warmth.
During epigastric application, which I arbitrarily set at 13
minutes, the patients who reported sensation said that after
about 5 minutes they experienced a warm feeling in the stomach,
as though they had taken a warm drink. During the next 5 minutes,
there was a vague and indistinct tingling in the feet amid legs,
which I concluded was evidence of increased blood flow through
the area. During time last 5 minutes of epigastric application
there was a feeling of gentle warmth throughout the extremities.
In a few instances, the extremities were warmer to the touch
after the treatment.
Liver application gave a mild "drawing sensation"
when felt at all, but no patient reported this as objectionable.
No sensation was reported from application over the adrenals
except occasional gentle warmth.
From sacral application, in the majority of cases, sensation
n was positive. (There was a slight feeling of warmth over the
sacrum, and a distinct tingling throughout the path of the sciatic
nerve into the legs, feet and toes.)
In all instances, Diapulse proved to be a subtle modality. In
severe pain, relief did not usually occur until several hours
after treatment and then seemed to be manifested fundamentally
as relaxation. Diapulse appeared to exert a tranquilizing effect,
in the form of "less awareness" of pain, rather than
conscious absence of pain." This response was noted with
both local and systemic application. Anxiety and apprehension,
when present, were diminished, amid it was not unusual for the
patients to fall asleep during treatment.
I do not intend the reader to infer that these were "case
treatments." During the early investigative period, Diapulse
was not being used as a specific. At this stage, I was treating
symptoms rather than total cases, in order to develop sound
clinical judgment of the therapeutic effect of Diapulse. The
observations amid knowledge gained were intended to lay the
groundwork for more specific techniques in the future.
In noting time various clinical conditions and the results obtained
with Diapulse, it is important to remember that most of these
patients received only minimal treatment. Time, and time conduct
of a normal practice, did not usually permit more than ‘‘clinical
curiosity," but even under these circumstances the observations
were encouraging.
Since my principal interest is in adequate support of circulation,
my efforts were largely in this direction. I was not so interested
in local application. Podiatry has many modalities of proven
merit in this area. I was more concerned with what appeared
the more virginal area of general circulatory and metabolic
support.
During this period in my evaluation, I used Diapulse over the
epigastrium in chronic arthritis for symptomatic relief, rather
than for alleviation of the total condition. Epigastric application
was also given in cases of vascular insufficiencies, intermittent
claudication, arteriosclerosis, diabetic neuritis, and chronic
deformities.
It must be remembered that these were largely "spot treatments,"
and should not be construed as optimal care since I was investigating
the therapeutic potential of Diapulse); but even under such
minimal care, there was unmistakable evidence that circulation
was being favorably influenced.
In one arthritic, who received more sustained Diapulse therapy,
there was noticeable improvement in skin tone, color, and temperature.
Excrescences, which in time past had regularly tended toward
suppuration, were positively affected. All time other conditions
mentioned above showed similar evidence of improved circulation,
in direct ratio to the frequency and duration of treatments.
The weight of this evidence suggested that optimum treatment
of this class of conditions would be that which would bring
the circulation to a "peak" and maintain it for a
sufficient time to ‘‘flush" time extremity.
It. is my opinion at this time that in aim average case, approximately
six treatments in a week period will support circulation satisfactorily.
Although treatments of longer than 15 minutes’ duration
may be indicated, this is not always practical in office routine.
However, the treatment method out lined above gives a satisfactory
result and provides significant circulatory benefits. |
Clinical Discussion of Specific
Applications
Weak Foot Syndrome |
Weak foot syndrome, unfortunately, is an
ambiguous term and means many things to many people. For the
purpose of this study, it is intended to describe the moderately
imbalanced foot with limited motion and generalized muscle spasm.
A group of seven cases was selected for study.
My usual treatment routine for such cases has been sine wave,
muscle stretching and manipulation, amid corrective fulcral
blockings with appropriate strapping. Diapulse therapy was added
to this regimen. The clinical judgment of its therapeutic potential,
which I had developed suggested a treatment schedule of six
treatments in a 2-week period.
A routine was set up as follows: Diapulse over the epigastrium
for 15 minutes, followed with 5 minutes of rapid sine, muscle
stretching and manipulation, and felt fulcral blocking with
appropriate strappings. Six treatments were scheduled over a
2-week period. Diapulse was given at each treatment, but the
full regimen was given only on the first, third, and sixth treatments.
This regimen adequately prepared all seven cases under study
for rehabilitation The feet were asymptomatic, an acceptable
range of joint motion had been restored, musculature was almost
completely relaxed, and it was possible to realign the foot
and adequately control it with blocking and strapping. At this
stage, treatments were scheduled at 2-week intervals.
In the past, my experience had dictated that a surging sine
wave was the most important modality at this point in treatment,
to restore muscle tone and re-educate musculature. However,
the success of epigastric application of Diapulse in stimulating
peripheral circulation suggested a similar approach for possible
nerve stimulation. I decided to try sacral application in an
effort to tone the entire sciatic nerve. Results of a 10-minute
application over the sacrum were very encouraging. Patient sensation
mind reaction, were positive. There was a marked tingling throughout
the entire path of time sciatic nerve, through the legs, feet,
and toes.
The result was a tonic effect on the entire musculature of the
extremity lasting from 1 to 3 days. This seems to indicated
a more sound biologic approach to restoration of muscle tone
than the largely mechanical action of sine wave. More study
is planned in this direction.
At present, these seven cases are being adequately maintained
with monthly Diapulse treatments over the epigastrium amid sacrum.
No dressings were used, and a prognosis of complete resolution
iii 6 months, without prosthesis, seems reasonable. |
| Bursitis |
Perhaps one of the most troublesome problems
in podiatry is the painful heel syndrome, calcaneal bursitis,
etc. Five cases were selected to be treated using Ginsberg’s
technique. Four were typical unilateral cases with well-defined
spurs. The fifth was bilateral tenobursitis and plantar bursitis
with moderate calcification at all sites. All were treated with
Diapulse for 10 minutes locally and over each adrenal.
One case showed no response after three treatments, amid considerable
patient resistance to the therapy. Diapulse was discontinued
and replaced with ultrasound, amid the condition was accommodated
with prosthesis. Response in the other three must be rated as
poor. Local application of Diapulse was replaced with ultrasound,
but adrenal application was continued. Response from this point
was routine, but in one case, due largely to the patient’s
occupation, prosthesis was used.
The fifth case merits fuller discussion. At the time of examination,
the patient anticipated the diagnosis mind reported a history
of recurrent attacks in the shoulders and hips, but no previous
foot involvement. The shoulder and hip sites were asymptomatic
at time of examination, but the patient reported that both sites
were "slightly stiff."
Response to time local foot problem was positive, with 10 minutes
of Diapulse locally amid over the adrenals. Treatments were
administered twice weekly, with definite and steady improvement.
Complete resolution was accomplished in nine treatments over
a 4-week period. Of special interest in this case, the patient
reported that the stiffness had left the shoulder and hip sites,
and that shine had more freedom of motion throughout her entire
body than she had had in years. In her-own words, "I feel
looser all over."
This seems to attest to the general metabolic effect that many
other authors have reported in the literature. 1mm general,
however, response in this class of conditions must be rated
as poor. Ginsberg’s report on shoulder bursitis is quite
positive, but admittedly he was working with a non-weight bearing
and considerable less traumatized area. More study seems indicated
in this condition. |
| Gout |
Very encouraging results were achieved in
gout. Three cases were observed, with dramatic response in two.
These two cases were moderately severe and were given 10-minute
applications of Diapulse locally and over the liver. One case
cleared after three treatments in 1 week; the other, after six
treatments in 2 weeks. No other therapy was used.
The third case was acute and severe. The first treatment produced
such gratifying relief from pain that the patient, a waitress,
went back to work against my orders. She returned the next day
with her condition greatly aggravated. The foot was markedly
swollen amid red, with considerable temperature. The patient
was given colchicine and ordered off her feet. She received
daily Diapulse treatments for the next 3 days, then three more
on alternate days. At this time, she was permitted to return
to work with a mild accommodative bandage. Within the next week
the condition was completely resolved. |
| Raynaud’s Syndrome |
One case of Raynaud’s syndrome was
observed. Diapulse treatments were given for 20 minutes over
the epigastrium. The patient was able to come for treatment
only once a week, and this was considered inadequate; but even
at this interval, the patient reported improved adaptation to
temperature changing after time third treatment.
It would be interesting to observe this condition under optimum
care. |
| Cellulitis |
| Two cases of cellulitis were observed, following severe upper
respiratory infections. Both were treated with Diapulse, locally
and over the liver for 10 minutes each. Both responded without
event with three treatments in i week. No other therapy was
used. |
| Summary |
In reporting the results achieved iii this
study with Diapulse, arm effort has been made to spotlight those
conditions most commonly encountered in routine podiatry practice.
Local application of Diapulse reduces pain without reaction;
it does not replace pain with another sensation. There is no
change in appearance of the part, no local hyperemia, no rise
in temperature. Relief occurs fundamentally as relaxation, usually
about i hour after treatment.
There seems to be positive evidence that Diapulse application
over the epigastrium can significantly affect circulation in
the entire extremity, with the promise of a more satisfactory
prognosis in a large class of foot pathoses.
Metabolic support from Diapulse therapy, while more difficult
to document, seems evident from the observed improvement mini
cases inn which there is a metabolic factor.
In an over-all consideration of this evaluation, there is no
doubt in my mind that Diapulse provides host benefits above
and beyond the local problem. These are intangible, and difficult
to discuss briefly or to document, but the effects were observed.
In instances of sustained Diapulse therapy, the patients frequently
reported noticeable improvement in general well-being.
Gustave S. Braun, .D.S.C
27 Lincoln Way West
Chambersburg, Pennsylvania |
| About Dr. Braun |
Dr. Braun reports the results of therapy
with pulsed electromagnetic energy (Diapulse), which permits
high intensity and deep penetration without significant local
or systemic rises in temperature.
In this evaluation the author used Diapulse locally, as well
as over the epigastrium, adrenals, liver, and sacrum, for every
clinical condition from dermatosis to irreparable deformity.
As a result of his studies, Dr. Braun concluded that Diapulse
therapy resulted in improved circulation, which was evidenced
by improvement in skin tone, color, and temperature, and by
restoration of muscle tone. Also, Diapulse appeared to exert
a tranquilizing effect, and patients reported "less awareness"
of pain and diminished anxiety and apprehension.
*Children’s Service Bureau, Pittsburgh, Pennsylvania.
® Manufactured by Diapulse Corporation of America, Empire
State Building, New York, New York. |
| References |
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Orthop., 3: 336, 1961.
2. Erman, W. J.: Peripheral blood flow during application of
pulsed high frequency currents. Amer. J. Orthop., 2: 196, 1960.
3. Ginsberg, A. J.: Pulsed short wave in the treatment of bursitis
with calcification. Int. Rec. Med., 174: 71, 1961.
4. Liebesne, P.: Athermic short wave therapy. Arch. Phys. Ther.,
736: (Dec.), 1938.
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of high frequency currents upon living organisms. Presented
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Atlantic City, New Jersey, October 19—23, 1959.
6. Smith E. M. AND Blackberg, S. N.: Management of rheumatic
diseases in general practice. Southern Med. J., 56: 6, 1963.
7. Steinberg, M. D.: Diapulse therapy in general podiatry practice:
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wave: a preliminary clinical report. Physiotherapy 11ev., 23:
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Presented to the General Motors 26th Medical Conference at the
Industrial Health Conference, Pittsburgh, Pa., April 12, 13,
1964.
10. CAMERON, B. M.: Experimental acceleration of wound healing.
Am. J. Orthop., 3:336, 1961.
11. STUEE’1’, D.: Post operative hip joint infections
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(Film).
12. LOBELL, M. J.: Pulsed high frequency and routine hospital
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a preliminary report. Clin. Med., 69: 8, 1962.
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frequency, radio short waves (Diapulse), 646 patients. Am. J.
Orthop., 6:72, 1964.
14. HAZEN, M. AND REBY, M.: Diabetic ulcer of the foot; a new
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15. Levy, H.: Pulsed short wave in sinus and allied conditions
in childhood. Western Med., 2: 246, 1961. |
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