Original Editor - Professor Tim Watson
Top Contributors -
Introduction & IFT Production
The basic principle of Interferential Therapy (IFT) is to utilise the strong physiologicaportable iftl effects of low frequency (<250pps) electrical stimulation of nerves without the associated painful and somewhat unpleasant side effects sometimes associated with low frequency stim.
To produce low frequency effects at sufficient intensity at depth, patients can experience considerable discomfort in the superficial tissues (i.e. the skin). This is due to the impedance of the skin being inversely proportional to the frequency of the stimulation. In other words, the lower the stimulation frequency, the greater the impedance to the passage of the current & so, more discomfort is experienced as the current is ‘pushed’ into the tissues against this barrier. The skin impedance at 50Hz is approximately 3200* whilst at 4000Hz it is reduced to approximately 40*. The result of applying a higher frequency is that it will pass more easily through the skin, requiring less electrical energy input to reach the deeper tissues & giving rise to less discomfort.
The effects of tissue stimulation with these 'medium frequency' currents (medium frequency in electromedical terms is usually considered to be 1KHz-100KHz) has yet to be established. It is unlikely to do nothing at all, but in terms of current practice, little is known of its physiological effects. It is not capable of direct stimulation of nerve in the common context of such stimulation.
Interferential therapy utilises two of these medium frequency currents, passed through the tissues simultaneously, where they are set up so that their paths cross & they literally interfere with each other. This interference gives rise to an interference (beat frequency) which has the characteristics of low frequency stimulation – in effect the interference mimics a low frequency stimulation.
The exact frequency of the resultant beat frequency can be controlled by the input frequencies. If for example, one current was at 4000Hz and its companion current at 3900Hz, the resultant beat frequency would be at 100Hz, carried on a medium frequency 3950Hz amplitude modulated current.
By careful manipulation of the input currents it is possible to achieve any beat frequency that you might wish to use clinically. Modern machines usually offer frequencies of 1-150Hz, though some offer a choice of up to 250Hz or more. To a greater extent, the therapist does not have to concern themselves with the input frequencies, but simply with the appropriate beat frequency which is selected directly from the machine.
Nerves will accommodate to a constant signal & a sweep (or gradually changing frequency) is often used to overcome this problem. The principle of using the sweep is that the machine is set to automatically vary the effective stimulation frequency using either pre-set or user set sweep ranges. The sweep range employed should be appropriate to the desired physiological effects (see below). It has been repeatedly demonstrated that ‘wide’ sweep ranges are ineffective in the clinical environment
Note : Care needs to be taken when setting the sweep on a machine in that with some devices, the user sets the actual base and top frequencies (e.g. 10 and 25Hz) and with other machines the user sets the base frequency and then how much needs to be added for the sweep (e.g. 10 and 15Hz). sweep triangle sweep rectangle sweep trapezoidal (A) Triangular sweep pattern
(B) Rectangular Sweep Pattern
(C) Trapezoidal Sweep Pattern
The pattern of the sweep makes a significant difference to the stimulation received by the patient. Most machines offer several sweep patterns, though there is very limited ‘evidence’ to justify some of these options. In the classic ‘triangular’ sweep pattern, the machine gradually changes from the base to the top frequency, usually over a time period of 6 seconds – though some machines offer 1 or 3 second options. In the example illustrated, the machine is set to sweep from 90 to 130Hz (figure A) employing a triangular sweep pattern. All frequencies between the base and top frequencies are delivered in equal proportion.
Other patterns of sweep can be produced on many machines, for example a rectangular (or step) sweep. This produces a very different stimulation pattern in that the base and top frequencies are set, but the machine then ‘switches’ between these two specific frequencies rather than gradually changing from one to the other. The diagram (figure B) illustrates the effect of setting a 90 – 130Hz rectangular sweep.
There is a clear difference between these examples – even though the same ‘numbers’ are set. One will deliver a full range of stimulation frequencies between the set frequency levels and the other will switch from one frequency to the other. There are numerous other variations on this theme, and the ‘trapeziodal’ sweep is effectively a combination of these two.
The only sweep pattern for which ‘evidence’ appears to exist is the triangular sweep. The others are perfectly safe to use, but whether they are clinically effective or not remains to be shown.
Physiological Effects & Clinical Applications
It has been suggested that IFT works in a ‘special way’ because it is ‘interferential’ as opposed to ‘normal’ stimulation. The evidence for this special effect is lacking and it is most likely that IFT is just another means by which peripheral nerves can be stimulated. It is rather a generic means of stimulation – the machine can be set up to act more like a TENS type device or can be set up to behave more like a muscle stimulator – by adjusting the stimulating (beat) frequency. It is often regarded (by patients) to be more acceptable as it generates less discomfort than some other forms of electrical stimulation.
The clinical application of IFT therapy is based on peripheral nerve stimulation (frequency) data, though it is important to note that much of this information has been generated from research with other modalities, and its transfer to IFT is assumed rather than proven. There is a lack of IFT specific research compared with other modalities (e.g. TENS).
Selection of a wide frequency sweeps has been considered less efficient than a smaller selective range in that by treating with a frequency range of say 1-100Hz, the effective treatment frequencies can be covered, but only for a relatively small percentage of the total treatment time. Additionally, some parts of the range might be counterproductive for the primary aims of the treatment.
The are 4 main clinical applications for which IFT appears to be used:
- Pain relief
- Muscle stimulation
- Increased local blood flow
- Reduction of oedema
In addition, claims are made for its role in stimulating healing and repair.
As IFT acts primarily on the excitable (nerve) tissues, the strongest effects are likely to be those which are a direct result of such stimulation (i.e. pain relief and muscle stimulation). The other effects are more likely to be secondary consequences of these.
Stimulation can be applied using pad electrodes and sponge covers (which when wet provide a reasonable conductive part), though electroconductive get is an effective alternative. The sponges should be thoroughly wet to ensure even current distribution. Self adhesive pad electrodes are also available (similar to the newer TENS electrodes) and make the IFT application easier in the view of many practitioners. The suction electrode application method has been in use for several years, and whilst it is useful, especially for larger body areas like the shoulder girdle, trunk, hip, knee, it does not appear to provide any therapeutic advantage over pad electrodes (in other words, the suction component of the treatment does not appear to have a measurable therapeutic effect. Care should be taken with regards maintenance of electrodes, electrode covers and associated infection risks (Lambert et al 2000).
Whichever electrode system is employed, electrode positioning should ensure adequate coverage of the area for stimulation. Using larger electrodes will minimise patient discomfort whilst small, closely spaced electrodes increase the risk of superficial tissue irritation and possible damage / skin burn.
The bipolar (2 pole) application method is perfectly acceptable, and there is no physiological difference in treatment outcome despite several anecdotal stories to the contrary. Recent research evidence supports the benefit of 2 pole application (e.g. Ozcan et al 2004).
Recent Related Research (from Pubmed)
- Application of low frequency and medium frequency currents in the management of acute and chronic pain-a narrative review.
- Efficacy of the addition of interferential current to Pilates method in patients with low back pain: a protocol of a randomized controlled trial.
- Upper trapezius relaxation induced by tens and interferential current in computer users with chronic nonspecific neck discomfort: An electromyographic analysis.
- Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study.
- Analgesic effects of transcutaneous electrical nerve stimulation and interferential current on experimental ischemic pain models: frequencies of 50?hz and 100?hz.
- Immediate therapeutic effect of interferential current therapy on spasticity, balance, and gait function in chronic stroke patients: a randomized control trial.
- ↑ Lambert I, Tebbs SE, Hill D, Moss HA, Davies AJ, Elliott TSJ (2000). Interferential therapy machines as possible vehicles for cross-infection. J Hosp Infect. 44(1), 59-64.
- ↑ Ozcan J, Ward AR, Roberson VJ (2004). A comparison of true and premodulated interferential currents. Arch Phys Med Rehab. 85(3): 409-415.
Evidence Based Practice
Learn about Evidence Based Practice in this month's members learn topic with book chapters from Practical Evidence-Based Physiotherapy 2012 & Evidence-Based Practice Across the Health Professions 2013