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The objective of this blog is to create a locale for discussions and a repository of evidence about the use of physical therapy modalities. We have also created a YouTube channel where students have demonstrated the use of several physical therapy modalities. Please feel free to post links to current articles, reflections about modality usage, or feedback about the site. The YouTube link is: http://www.youtube.com/user/PTModalities?feature=mhee

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Saturday, March 3, 2012

Russian Electrical Stimulation

The Russian protocol is a modality of electrical stimulation that has been employed for muscle strengthening.  It was originally developed for strengthening of Russian Olympic athletes by Yadou Kots.  This type of electrical stimulation is a medium frequency polyphasic AC waveform with burst modulations.  There are typically 50 bursts per second with 50 pulses per burst.  The application is 10 seconds on, 50 seconds off, for a duration of 10 minutes.  The intensity is adjusted to elicit a tetanic contraction and is usually uncomfortable to the patient.  There are several studies to indicate that this protocol may have some benefit in muscle strengthening.  However, there are studies which also indicate that adjustments can be made to the original work of Kots which may be more appropriate and comfortable.

Articles Refuting Russian Electrical Stimulation

In an article by Alex Ward, Electrical stimulation using kilohertz-frequency alternating current, the effects of burst-modulated alternated currents were reviewed.  Russian current is a type of burst-modulated alternating current that has been claimed to be beneficial for muscle strengthening.  A single case study demonstrated significant strength gains with this protocol; however, there was also one study did not demonstrate any strength gains.  In the study reporting strength gains, the parameters were 2.5 kHz AC applied in 10 millisecond bursts with a frequency of 50 Hz and 10 seconds on followed by 50 seconds off.  Later studies have shown that short duration bursts are more comfortable for the same force output. The author concluded that the parameters used for Russian protocol are suboptimal for strengthening.  Parameters that might be more beneficial would include a shorter duration of 2-4 millisecond burst of kilohertz AC.  The author recommends a frequency of 1 to 2.5 kHz with a burst duration of 2 milliseconds for maximum muscle torque production.   

According to the article: The effect of duty cycle and frequency on muscle torque production using kilohertz frequency range alternating current. by Ward et al. there are suggested optimal parameters for Russian e-stim when it comes to subject comfort and subject maximal torque production. In regards to maximal torque production, the article suggests the best results are seen with a duty cycle of 20% or less, as compared to the more commonly adhered to 50% duty cycle setting, which is popular in many clinics. When comfort is taken as priority a frequency of 2.5 kHz is optimal, but for maximum torque production, 1 kHz should be considered.

In the study, Effect of Burst Frequency and Duration of Kilohertz-Frequency Alternating Currents and of Low-Frequency Pulsed Currents on Strength of Contraction, Muscle Fatigue, and Perceived Discomfort, the authors set out to determine if Russian electrical stimulation elicited a greater strength of muscle contraction than low frequency pulsed currents (LPC). This study showed no difference in the force of the contractions elicited by the LPC or Russian stimulation but the LPC fatigued muscles less. This study also showed no difference in the amount of discomfort experienced by patients when using either the LPC or Russian stimulation.

 

Sources
Ward, A. R. (2009). Electrical stimulation using kilohertz-frequency alternating current. Physical therapy, 89(2), 181-90. doi:10.2522/ptj.20080060
Ward, A. R., Robertson, V. J., & Ioannou, H. (2004). The effect of duty cycle and frequency on muscle torque production using kilohertz frequency range alternating current. Medical engineering & physics, 26(7), 569-79. doi:10.1016/j.medengphy.2004.04.007
Laufer, Yocheved, and Michal Elboim. "Effect of Burst Frequency and Duration of Kilohertz-Frequency Alternating Currents and of Low-Frequency Pulsed Currents on Strength of Contraction, Muscle Fatigue, and Perceived Discomfort ." Journal of the American Physical Therapy Association. 88.10 (2008): 1167-76. Web. 2 Mar. 2012. <http://ptjournal.apta.org/content/88/10/1167.long>.
 
Articles Supporting Russian Electrical Stimulation
 The study, Torque responses in human quadriceps to burst-modulated alternating current at 3 carrier frequencies, examined the effects of frequency of burst-modulated current on the electrically induced torque of the quadriceps femoris muscle.  The researchers used three groups to compare frequencies of 2500 Hz, 3750 Hz, and 5000 Hz.  It was found that the electrically induced torque measures of the 2500 Hz frequency group were significantly greater than the 3750 Hz and 5000 Hz groups.  Clinically, this information can be used on healthy subjects who are able to tolerate high stimulation intensities.  The 2500 Hz frequency is more beneficial in generating greater electrically induced torques which is useful if strengthening is the goal of therapy.
In the article Interferential and burst-modulated biphasic pulsed currents yield greater muscular force than Russian current, by Bellew et al. Russian current was compared to interferential and burst-modulated biphasic pulsed currents to determine which method of electrical stimulation could produce the most amount of muscle force/torque by eliciting knee extension. The parameter of pulse duration was kept constant with each method, with a setting of 200 microseconds. Russian was delivered at 2500 Hz, burst modulated at 50 Hz, using 10msec burst duration and 10msec interburst interval. Biphasic pulsed was a symmetrical biphasic square wave delivered in bursts at 50 Hz. Quad IFC was delivered using currents of 2500 and 2550 Hz, yielding a 5050 Hz beat frequency.  Treatments were administered 1 week from each other, and performed using optimal electrode placement. Results were compared with each healthy subjects’ previously recorded maximal voluntary isometric contraction (MVIT), showing that biphasic pulse, interferential, and Russian elicited 62.5%, 66.1%, and 35.8% of MVIT respectively. Therefore using the same pulse duration, Russian elicited significantly less torque and muscle force than biphasic pulsed, and interferential treatments.
In the article, Strength Changes in the Normal Quadriceps Femoris Muscle as a Result of Electrical Stimulation, the authors set out to find if Russian electrical stimulation alone could increase muscle strength.  They used three experimental groups: a control group which did not exercise, a group that did an isometric workout, and a group that received Russian electrical stimulation. This study found that both the isometric and the electrical stimulation groups had a 2% increase in strength compared to the control group after a 5 week long program.

 Sources
Parker, M. G., Keller, L., & Evenson, J. (2005). Torque responses in human quadriceps to burst-modulated alternating current at 3 carrier frequencies. The Journal of orthopaedic and sports physical therapy, 35(4), 239-45. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15901125
Bellew, J. W., Beiswanger, Z., Freeman, E., Gaerte, C., & Trafton, J. (2011). Interferential and burst-modulated biphasic pulsed currents yield greater muscular force than Russian current. Physiotherapy theory and practice. doi:10.3109/09593985.2011.637286
 Laughman, R. Keith, James Youdas, Tom Garrett, and Edmund Chao. "Strength Changes in the Normal Quadriceps Femoris Muscle as a Result of Electrical Stimulation." Journal of the American Physical Therapy Association. 63.4 (1983): 494-5. Web. 2 Mar. 2012. <http://www.physther.net/content/63/4/494.full.pdf>.

Angie M., Luke G., and Ethan Q.

6 comments:

  1. Brandon/Korbyn
    In the article, "Effects of Russian current and low-frequency pulsed current on discomfort level and current amplitude at 10% maximal knee extensor torque," the objective was to compare discomfort and current amplitude between low-frequency pulsed current (LFPC) and Russian current (RC) to achieve a knee extensor torque 10% of the maximal isometric voluntary contraction (MIVC). For this study, 22 healthy subjects were subjected to three electrically elicited knee extensor submaximal contractions (10% MIVC) that were sustained for 10 seconds. The current amplitude required to achieve 10% MIVC and subjective discomfort were assessed directly by the electrical stimulator and with the Visual Analog Pain Scale, respectively. A paired t-test was used to determine differences between the electrical currents. The results showed that LFPC required significantly lower current amplitude (15%) and a lower discomfort level (50%) to achieve 10% of MIVC compared to RC. Therefore, this study concludes that LFPC seems to be more effective than RC with respect to discomfort level and current amplitude to produce 10% of MIVC.

    The article, "Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial," compared the efficacy of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. To perform this analysis a control group consisting of a home exercise program was compared to a second and third group who received electromyographic biofeedback or electrical stimulation therapy to the quadriceps in addition to the home exercise protocol. They reported that the electrical stimulation used was a Russian current. The comparison between the groups was made on the evaluation of muscle power and functional status following the meniscectomy.
    This article referenced a previous study comparing the effectiveness of electrical stimulation and isometric exercise for quadriceps muscle after a meniscectomy, which found that muscle volume and muscle power loss were less 4 weeks after surgery and were on crutches for a shorter time with electrical stimulation. In this study it was found that the best results were found in the biofeedback group, who had significantly shorter times for use of a walking aid that the home exercise group. However, the electrical stimulation group also had a shorter time using a walking aid than the home exercise group but longer than the biofeedback group, but the differences were not significant. In addition, another study reported, isokinetic quadriceps power increased for all groups with the greatest improvement in peak torque power of quadriceps muscle in isokinetic measurement and active knee extension in favor or the biofeedback group. This article found no significant difference detected among groups in terms of active knee extension, and no superiority in terms of pain severity, but Lysholm Knee Scoring Scale score and improvement in muscle power was found in the electrical stimulation group compared to the home exercise group. It was also found that the electrical stimulation group and biofeedback groups exhibited significant progress in knee flexion 6 weeks postoperative compared to 2 weeks, where the home exercise program displayed deterioration in active knee flexion. All three groups had a significant decrease in pain during walking in the second and sixth postoperative weeks.

    ReplyDelete
  2. Brandon/Korbyn continued
    Overall the addition of electrical stimulation showed superiority over the home exercise group in terms of shorter time using a walking aid and better recovery in knee flexion. However, these differences were not clinically significant and electrical stimulation did not have superiority in pain, gait velocity, time using a walking aid, muscle power, and progress in functional status compared to the biofeedback group.

    Sources

    Vaz, M.A., Aragao, F.A., Boschi, E.S., Fortuna, R., & Melo, Mde O.(2012). Effects of Russian current and low-frequency pulsed current on discomfort level and current amplitude at 10%
    maximal knee extensor torque. Physiother Theory Pract.; 28(8): 617-23.

    Akkaya, N., Ardic F., Ozgen M., Akkaya S., Sahin F., Kilic A. (2012).Efficacy of electromyographic biofeedback and electrical
    stimulation following arthroscopic partial meniscectomy: a randomized controlled trial. Clinical Rehabilitation: 26(3) 224-236

    ReplyDelete
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