Diathermy use in Operating theater presentation

Taylor Baldwin, Erika Stinchcomb
Dr. Valerie Moody
Comparing the Effects of Static
Stretching and Pulsed Short Wave
Diathermy on Shoulder Range of Motion
DTM

 Background
 Methods
 Results
 Discussion
 Limitations
 Future Research
Overview of Presentation

 Baseball, tennis, handball and other overhead sports
require repetitive overhead motions that use the
posterior rotator cuff musculature to decelerate the
arm
 Impingement and reduced internal rotation reflect
posterior shoulder tightness
 Tightening of posterior shoulder capsule leads to
approximation of humeral head and the acromion,
causing impingement
Mcclure et al. 2007; Borsa et al., 2008
GIRD/ ERG

 Static-stretching is traditionally a part of a
warm-up to enhance subsequent
performance, reduce the risk of injury and
alleviate muscle soreness symptoms. (Bacurau et
al., 2009 )
 Decrease in maximal strength; not good for
sports needing high amounts of force
 Posterior capsule stretching important for the
overhead athlete in particular
(Prentice, 2004; Roberts, Wilson, 1999)
Static Stretch

Advantages
 Increases in ROM
 Easy and safe
 Short duration lower
intensity static
stretching is good for
sports that need a
high degree of
flexibility to minimize
impairments
 Time consuming
 Decrease in performance
(strength and power)
 Uncomfortable
Stretching
Disadvantages

Heats deeper tissues (3-5 cm)
Effects:
 Circulation
 Metabolism
 Inflammation
 Analgesic
 Collagen Extensibility
 Muscle Spasm
 Joint/Tissue Stiffness
Deep Thermotherapy

Advantages
 Provides deepest
heating
 Larger treatment size
than ultrasound
 Don’t need to stay
with the patient
 Longer lasting heating
 Expensive
 Large machines
 Misinformation
 Lacks research
Pulsed Short Wave Diathermy
Disadvantages

 Vigorous heating is used to increase extensibility of
collagen fibers (Knight & Draper, 2013)
 Intensity is sufficient to sufficient to cause increases
in tissue temperature because of long wavelengths
 Better at heating large muscle groups for longer than
ultrasound (Garrett et al., 2000)
Pulsed Short Wave Diathermy

 To compare the effects of a deep
heating modality (PSWD) to static
stretching on their ability to improve
shoulder ROM
Purpose

 Most thermotherapy research focuses on
improving ROM of the lower extremity
 To date, little research exists comparing the
different between PSWD and Static Stretching
on shoulder ROM
 Provide clinical evidence if PSWD increases
shoulder ROM as much as or more than Static
Stretching
Significance

IRB approval through the University of Montana
Incentive provided
Participants
 Ten participants
5 males, 5 females
No upper extremity injury in the last 6 months
Methods
Participants Age (yrs) Height (in) Weight (lbs)
All (n =10) 22.5 + 3.0 66.9 + 5.9 155.1 + 19.3
Males (n =5) 24.0 + 3.8 70.8 + 4.2 169.6 + 12.4
Females (n =5) 21.0 + 1.0 63.0 + 4.7 140.6 + 12.6

 Weightlifting (general)
 Volleyball
 Crossfit
 Baseball
 Rock Climbing
Sports and Activities

 Static Stretch
 4 trials 15 seconds on 15 off
 Crossover, Overhead, Towel, Sleeper,
Door stretch
(Prentice, 1990; Mcclure et al., 2007; Morrison et al., 1997;
Laudner et al., 2008; Sauers et al, 2007)
Methods

 Pulsed Short Wave Diathermy
 Intelect SWD 100 Model 1600 Shortwave
Diathermy
 Diplode
 Heats 3-5 cm deep without heating
superficial tissues
 Dose IV
 800 Hz
 Pulse Width: 400 µsec
 Avg Output: 48 watts
Methods

 4 testing conditions completed over 1 month
 Random order of conditions
 Control, SS, PSWD, PSWD+SS
 ROM measurements completed before and after
each testing condition
 Posterior Shoulder Tightness, Lateral Scapular
Slide, Internal and External Rotation
 3 measurements were recorded
 Inclinometer reading taken by same researcher
(TB)
 Order of ROM measurements was also
randomized
Methods

 Digital Inclinometer
 Provides a real-time digital
 reading of angles
 Can be used in either a
 horizontal or vertical reference
 Is accurate up to 0.1°
 Carpenter’s Square
Instrumentation
 Tape Measure

Inclinometer Measurements
 Internal and External
Rotation (Laudner et al, 2008)
 Supine
 Shoulder and elbow
in 90° of abduction
and flexion,
respectively
 Inclinometer aligned
with the ulna
 Actively rotate
shoulder

Lateral Scapular Slide Test
Position 1
Position 3
Position 2
 Kibler, 1998

Other Measurements
 Posterior Shoulder
Tightness
 Side lying
 Researcher stabilizes
scapula while the
participant pinches
scapulas and passively
move into horizontal
adduction
 Measure distance from
table to medial epicondyle
Tyler et al. 1999; Mcclure et al. 2007

Data Analysis
 2 x 4 Repeated
Measures ANOVA
(time x condition)
 Internal rotation
 External rotation
 Lateral Scapular Slide
Tightness
 IBM SPSS version 21
 Microsoft Excel 2010

Results
 Internal Rotation
 2 x 4 ANOVA not
significant (p = 0.96)
 Clinical significance of
2-3 degrees
 External Rotation
 2 x 4 ANOVA not
significant (p = 0.98)
 Lateral Scapular Slide
 2 x 4 ANOVA not
significant (p=.74)
 Numbers are stable
Tightness
 2 x 4 ANOVA not significant
(p=.638)
 Main effect for time (p= .08)

Control Stretch Diathermy Diathermy +
Stretch
52
53
54
55
56
57
58
Internal Rotation
Pre
Post

Stretch
102
104
106
108
110
112
114
External Rotation
Pre
Post

Stretch
0
1
2
3
4
5
6
7
8
9
10
Lateral Scapular Slide Test
Pre
Post

* Main effect time p = 0.08
Stretch
0
1
2
3
4
5
6
7
8
9
Posterior Shoulder Tightness
Pre
Post
*

 Thermotherapy has often been a choice for
warming up tissues and muscles prior to activity
 PSWD is effective in decreasing pain and increasing
shoulder ROM for conditions like frozen shoulder and
rotator cuff tendinopathy. (Rabini et al, 2012; Lueing,
Cheing,2008)
 Literature of diathermy on lower extremity indicates
stretching with diathermy produces more ROM and
flexibility gains than stretching alone. (Peres et al. 2002 ;
Knight et al. 2001; Draper et al., 2004)
Discussion

 Static stretching is extremely effective in improving in
flexibility and range of motion.
(Prentice, 2004)
 Cool-down or independent stretches may be better for
gains in flexibility without loss of power or strength
prior to event
(Frederick, Szymanski, 2001 ; Behm, Chaouachi, 2011 ; Schilling, Stone, 2000)
 Our results suggest that there were no differences
between PSWD, stretching or a combination of the
two on acute gains for shoulder ROM
Discussion

 Measurement error
 Small sample size
 Limiting Overhead activity
 Fitness levels
 Different people stabilizing
Limitations

 Overhead athletic population
 Larger sample size
 See if multiple treatments
improves effect on ROM
 Change parameters
Future Research

 Stretching alone is just as effective as
stretching combined with diathermy
 However in this study neither treatment
produced significant acute gains in ROM
Conclusion

 Awan R, Smith J, Boon A.J. Measuring Shoulder Internal Rotation Range of Motion: A
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83(9): 1229–1234.
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a Ballistic and Static Stretching Exercise Bout on Flexibility and Maximal Strength. Journal
of Strength and Conditioning Research. 2009; Volume 23(1): 304-308.
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Performance. European Journal of Applied Physiology. 2011; 111(11): 2633-51.
 Borsa, PA. Laudner, KG. Sauers, EL. Mobility and Stability Adaptations in the Shoulder of
the Overhead Athlete. Sports Medicine Journal. 2008; 38(1): 17- 36
 Clarkson, H.M. Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle
Strength. Baltimore, MD: Lippincott Williams & Wilkins; 2000.
 Draper, DO. Castro, JL. Feland, B. Schulthies, S. Eggett, D. Shortwave Diathermy and
Prolonged Stretching Increase Hamstring Flexibility More than Prolonged Stretching Alone.
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References

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Wave Diathermy and Ultrasound Treatments. Journal of Athletic Training. 2000; Volume 35(1),
50
 Kibler, BW. The Role of the Scapula in Athletic Shoulder Function. The American Journal of
Sports Medicine. 1998; 26(2): 325- 336
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Lippencott Williams & Wilkins. 2008; 205.
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Shoulder. Journal of Rehabilitation Medicine . 2008; 40(2): 145.
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References

 Peres, SE. Draper, DO. Knight, KL. Ricard, MD. Pulsed Shortwave Diathermy and Prolonged
Long- Duration Stretching Increase Dorsiflexion Range of Motion More Than Identical
Stretching Without Diathermy. Journal of Athletic Training. 2002; Volume 37(1): 43–50.
 Prentice, WE. Therapeutic Modalities in Sports Medicine. St. Louis, MO: Times Mirror/
Mosby. 1990; 90-92.
 Rabini, A. Giombini, A. Dragoni, S. Agnello, L. Ripani, M. Saraceni, VM. Maffulli, N. Effects of
Local Microwave Diathermy on Shoulder Pain and Function in Patients With Rotator Cuff
Tendinopathy in Comparison to Subacromial Corticosteroid Injections: A Single-Blind
Randomized Trial. The Journal of Orthopedic and Sports Physical Therapy. 2012; 42(4): 363.
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Extremity. British Journal of Sports Medicine. 1999; Volume 33: 259-263.
 Saures, E. August, A. Snyder A. Fauls Stretching Routine Produces Acute Gains in Throwing
Shoulder Mobility in Collegiate Baseball Players. Journal of Sports Rehabilitation. 2007;
16(1):28-40.
 Schilling, BK. Stone, MH. Stretching: Acute Effects on Strength and Power Performance.
Strength and Conditioning Journal. 2000; 22(1): 44-47.
 Tyler, TF. Roy, T. Nicholas, SJ. Gleim, GW. Reliability and Validity of a New Method of
Measuring Posterior Shoulder Tightness. Journal of Orthopedic and Sports Physical Therapy.
1999; 29(5): 262-274.
 Prentice, WE. Rehabilitation Techniques for Sports Medicine and Athletic Training. 4th
Edition. New York City, NY: McGraw-Hill Companies Inc. 2004.
References

 Davidson Honors College
 Dr. Valerie Moody
Thank You….

Diathermy use in Operating theater presentation

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