Physiotherapy 2

General physiotherapy.
Physiotherapy (physis - nature) is a science about using of external environmental

factors with therapeutical aim. These factors may be natural or modified.
Physical factor may have its first action in the organism on the level of afferent nerves
or at the level of sensitive molecular groups. The reactions to factors include local physico-
chemical changes in the tissues & general reactions: reflex or humoral.
So, there are two types of reactions: specific and nonspecific.
All physical factors have nonspecific action. It means the all factors may regulate two
main physiological functions of organism, & may be as adaptogenes, which help the organism
to fight against different unfavorable factors.
Specific action of factors depends on their nature & differs this factor from other.
Both actions influence on organism together, but the main action is a specific
component. Using the dose of physical factor we try to maximize specific action and minimize
nonspecific. Counterreactions for physical factors are individual. They are divided into
physiological, pathological reactions (general, local) and increasing of the pathological process
activity.
That is why the physiotherapeutical procedures must be prescribed individually
according to the etiology & pathogenesis of the disease.
Physiotherapeutic prescription includes the individual plan of treatment.
Structure of physiotherapeutic prescription:
1) The name of physical factor;
2) The region of action;
3) The method of treatment;
4) Dose of physical factor (intensity of action);
5) Duration of procedure;
6) The frequency of actions;
7) The number of procedures for whole course of treatment.

Classification of physical factors (by professor A.N.Obrosov):
I. Electrical agents:
1) Direct current of low voltage (galvanization, electrophoresis)
2) Pulse current with
a) Constant direction & low frequency of impulses: electrostimulation,
electrodiagnostic method, diadynamotherapy;
b) Alternating direction and moderate frequency of impulses: interferential
current, sinusoidal modulated current (SMT);
3) Alternating current & alternating electromagnetic fields of high voltage:
a) Of high frequency: darsonvalization, ultratonotherapy, inductotherapy;
b) Electromagnetic field of ultrahigh frequency: UHF-therapy;
c) Electromagnetic field of super high frequency: microwave therapy
4) Direct electrical current of high voltage (franklinization);
II. Magnetic fields:
a) Of constant direction
b) Of alternating direction & low frequency
III. Electromagnetic radiation:
a) Infrared radiation
b) Visible radiation
c) Ultraviolet
d) Lasers
IV. Hydrotherapy:
a) Fresh water
b) Mineral & medical waters
c) Gaseous waters;
V. Thermotherapy:
a) Medical mud
b) Paraffin
c) Ozokerite
d) Naphthalane
VI. Mechanical energy:
e) Vibration
f) Ultrasound
VII. Artificial air environment:
a) Aeroions & hydroaeroions
b) Aerosols & electroaerosols
c) Barotherapy (changeable air pressure)
General contraindications for the use of physical agents:
• Malignancy & suspicion for malignancy, including haemoblastosis;
• Hormonoactive tumors of women in growthstage or tumors, required surgery
(mastopathy, endometriosis, uterine myoma);
• Cachexia;
• Febrilis temperature of the body;
• Pulmonary tuberculosis, if the stabilization of the process is not achieved;
• Systemic lupus erythematosus;
• Acute phase of myocardial infarction;
• Acute phase of stroke;
• Prominent atherosclerosis (of heart & brain vessels);
• Aneurysm of aorta & other large vessels;
• Severe arterial hypertension with systolic pressure more than 180 mm Hg;
• Complex & severe arrhythmias and disorders of myocardial conductivity;
• Epilepsy with frequent seizures;
• Severe deficiency of organs (heart failure II-III stages, chronic renal failure);
• Presence of large metal chips near the large vessels and nerves in zone of
physiotherapeutic action;
• Individual intolerance to this type of energy;
• Long professional contact with this type of energy.
Electrotherapy.
Electrical current is the flow of charged particles, such as electrons (in metals) or ions
(in electrolytes). In solutions & in the human body, an electrical current stimulates the
movement or flow of ions.
Any substance can be considered to be electrically conductive if it allows the passage
of charged particles. Resistance is the opposition to the flow of charged particles, & is affected
by the nature & structure of the material. Conductance is the ability to transmit charged
particles & is the reciprocal of resistance. The liquor and the blood plasma have a high
conductance; the less conductive tissues of body are whole blood, muscles, parenchimatosis
organs. The bones, fat, fascias, tendons & other connective tissue elements cannot transmit
charged particles. Dry skin, hair can be considered to be dielectrics.
Galvanization.
The main physical agent is direct current of low voltage (60-80 V) & low strength (< 50
mA). Apparatus:
• AGN (wall galvanization apparatus)
• AGP (portable galvanization apparatus)
• AGS (stomatological galvanization apparatus)
• GR (galvanization of oral cavity)
• "Potok"
The main biophysical processes.
Galvanic current goes into the tissues throw the ostia of the oil and perspiratory
glands, hair follicles, intercellular spaces. Also the passage of charged particles in the tissues
may be through the skin, if the agent has prolonged action. Sometimes it is necessary to pass
current throw the mucous membranes or wounds.
Later electrical current goes, generally, through the blood or lymphatic vessels in
different tissues.
Scheme of ion's movement during galvanization: 1- electrodes; 2 -linings

Polarization is the process of ion concentration near electrodes according their charge.
The positive ions move toward the cathode (negative), where they pick up electrons, & the
negative ions move toward the anode (positive), when they give up electrons. "Current flow is
considered to be from the anode to the cathode, that is, opposite to the direction of electron
flow.
After this process of electrolysis on the electrodes there is a great amount of acid &
alkaline, that is why this method needs cloth padding between electrodes & skin.
In the body ions are concentrated near cell membranes, because of their increased
resistance. The ions are concentrated near membranes so generating polarization zones and
field inside tissues. The polarization potential reaches to maximum (200-500 mV) in 25-30 min
after action beginning. It is diminished after turning off an electrical current.
Diffusion is the ion movement from the place of their large concentration to the small
concentration. Osmosis - is a movement of water from the place of small ion's concentration to
the place of their large concentration. So, physiological diffusion and osmosis in human tissues
are intensified due to electrical current.
The main physiological reactions and their medical effects.
The physiological reactions due to direct electrical current are based on the ion
excitation theory. According to this theory for excitation the quantitive correlation between
ions K+ and Na+ and Ca2+ and Mg2+ is very important. Mobility of ions mainly depends on
their hydrate cover size, i.e. connected dipole-molecules of water. Bivalent ions with a great
hydrate cover move slower than monovalent ions. As all enumerated ions have a positive
charge they move from the anode to the cathode. In a certain time the relative prevalence of
more mobile ions K+ and Na+ will be under the cathode. The concentration of less mobile ions
Mg and Ca will be higher inversely under the anode.
The concentration of an enumerated ions and their concentration have a great
significance for excitative processes. The electrotonus is an excitability change in the electrical
current at the moment of electrical chain backing up the membrane penetrance of tissue is
increased, and their electrical resistance is decreased under the cathode.
This change of excitability under the cathode is called catelectrotonus. The
anelectrotonus is a decreasing of membrane under the anode and increasing of membrane
resistance. These particularities o excitability changes under the cathode and anode are used
in a direct electrical current application. The anode is an active electrode to decrease the
excitability of tissue. To increase the excitability of tissue it is necessary to use cathode.
The direct electrical current is transferred to the tissue by means of electrode,
applicated on the skin. The great part of voltage appears in the skin due to high skin
resistance. On this skin region the patient feels slight burning, creeping sensation, which are
connected with irritation of sensitive nervous fibers. Edema and skin hyperemia are observed
under the electrodes. These changes are not connected with thermal effect of electrical
current. Because of an electrical current, used in galvanization, has so insignifical strength, so
the mechanism of hyperemia is neuroreflective. Due to local reflective-segmentative reactions
the vessels are dilated. Through the appropriate skin regions it is possible to influence on
internal organs. The changes in the organs will be the same - increasing membrane
penetrance, intensification of diffusion & osmosis. The direct electrical current may be used to
influence on central nervous system. In the brain & spinal cord the high-laid centers have
positive charge and the low-laid - negative charge. This condition is called physiological
anelectrotonus, it is necessary for normal activity of nervous system. It may be increased by
means of direct electrical current. The positive electrode is located in the forehead zone, and
the negative electrode - in the interscapularis region. This action improves coordinative and
regulative functions of brain, which is useful at cortico-visceralis diseases.
As a result of direct electrical current influence the stimulation of phagocyting
macrophages system is observed, which increases an effectivity of protective reactions.
The main indications for this method:
1) Inflammatory processes (without purulence) in the stage of resolution
2) Diseases & traumas of peripheral nervous system
3) Degenerative-dysthrophic diseases of the musculo-sceletal system
4) Dyskinesias of internal organs
5) Functional disorders of central nervous system.
The main contraindications for this method:
1) Acute stages of inflammation, purulence;
2) Injured skin (abrasions, scratches);
3) Acute & subacute eczema, other dermatitis in the region of electrodes application;
4) Presence of skin irritative symptoms after procedure;
5) Acutest pain syndrome because of trauma of peripheral nervous fibers.
Dosage depends on:
1) Density of electrical current (0,01-0,1 mA for 1 cm2 of electrode cloth padding)
2) Patient's sensation (slight tingling, burning sensation)
3) Duration of procedure (from 15 to 30 minutes)
4) Frequency of procedures (every day or every other day)
5) Duration of treatment course (10-15 procedures, possibly to 30).
Drug electrophoresis (iontophoresis).
Electrophoresis of medicines (iontophoresis) is the transcutaneous delivery of ions into
the body to therapeutic purposes using an electrical current. Iontophoresis is an alternative to
oral or parenteral (e.g, needle injection) methods of drug delivery. This method is called
electropharmacological because of combination of medication's & electrical current's effects.
But medication & galvanic current's effects is not simply summarized in this method.
This factors together increase effects of each other. Responsive reaction firstly depends on
pharmacological characteristics of drug.
The rate of transcutaneous drug movement in electrical field of direct current is near 1
cm/hour. So, during the procedure drug goes not so deeply & is concentrated in skin, & partly
in subcutaneous fat.
This method has a number of specialities & advantages in comparison to other
methods of drugs delivery:
1) Gives a possibility to make a superficial pathological region a high concentration of
drug, to make a local effect;
2) Drugs delivered by iontophoresis give adverse reactions rarely in comparison to
drugs delivered orally & parenterally;
3) This method is not painful, doesn't give skin deformation, disturbances of the
microcirculation; the irritation of mucous tissue of gastro-intestinal tract is absent;
4) The ions of drug delivered by iontophoresis show their maximal activity;
5) Drugs act in the tissues, changed by galvanic current; in these conditions their
effect is more significant even in small concentration.
Some drugs are electrically neutral, so they lose their activity in electrical field. To
choose the needed drug for electrophoresis the doctor should use special list of medications
permitted for this method. This list includes information about recommended concentrations of
drugs, active ion, and polarity of the delivery electrode. The substances which have complex &
different ion composition are delivered from both electrodes.
The medications not dissolved in the water or in the spirits are delivered with
dimethylsulfoxide (DMSO). DMSO is the universal dissolver. For the ferment electrophoresis
(lidasa, tripsin) buffers are used.
Nowadays the small concentration of medications (up to 5%) is used. The study about
ionic reflections, developed by A.E.Scherbut, explains the mechanism of the electrophoresis
action on the organs & systems. According to this study, skin receptors are irritated by drug's
ions & direct current. Locally the ions influence through the vegetative nervous tracts on
internal organs. That is why the electrodes should be laid on the skin regions connected by
vegetative innervation with internal organs.
Using electrophoresis it is possible to make a high concentration of drug directly in the
place of damage, laid superficially, not to saturate the whole body.
The method of drug elimination from blood using galvanic current is called "intratissue
electrophoresis". It is used in internal diseases. In the beginning the drug is delivered in blood
circulation (usually intravenously). Then galvanization of appropriate organ or tissue begins.
The electrodes are placed transversely, so the pathological area is located between the
electrodes. During this procedure the elimination of drug from blood, flowed through the
damaged organ or tissue, takes place.
Indications depend on pharmacological characteristics of medication & indications to
galvanization.
Contraindications are the same to galvanization. The additional contraindication for
this method is an idiocratic reaction to drug.
Dosage is carried out as at galvanization.
II. Medical application of direct pulse current
Under action of an electrical current the living tissues are stimulated. The main
response to direct constant electrical current - motor reaction, that is reduction of muscle.The
muscle responds to each impulse by reduction. That greatest number of impulses, to each of
which a muscle reponds by reduction, N.E.Vvedensky has named as a measure of lability. The
skeletal muscle is capable to respond by separate reductions to impulse frequencies up to 100
per one second. At higher frequency of influence its tetanic reduction occurs.
The pulse currents used in physiotherapy are distinguished by the form of pulses:
rectangular, triangular, exponential, half-sine (fig. 3), according to frequency of pulses,
according to duration of each pulse in millisecond (msec).
Fig. 3 Graphic image of direct pulse electrical currents: 1 - triangular form; 2 -

rectangular form; 3 - exponential form; 4 - half-sine form.
1. Electrodiagnostics and electrostimulation.
Electrodiagnostics is a research of stimulation of neuromuscular system by an irritation
by an electrical current. Electrostimulation is a method of influence by an electrical current on
the neuromuscular system. At realization of electrodiagnostics and electrostimulation the pulse
electrical current of a low voltage (60 - 80 v) and small force (up to 50 mA), pulses various in
form and duration is used in constant direction. Devices: - UEM (universal electropulse of
mountains), now is not made;
• "Neuropulse";
• SLPM (sinusoidal low-frequency pulse modulated);
• "Tonus";
• "Amplipuls";
• "Stimulus".
The basic biophysical processes are the same, as at galvanization. Because of fast
increase of force of a current processes of diffusion and osmosis have no time to compensate
infringements of ionic concentration in tissues. These infringements are more significant, than
in case of influence of galvanic current of the same force. The basic physiological reactions and
medical effect: the expressed irritating action of a pulse electrical current is observed.
Responcse reaction to this irritation is reduction of a muscle fiber. At the moment of short
circuit the reduction of a muscle under the cathode comes at smaller force of a current, rather
than under the anode. The healthy muscle gives thus flash-like reductions.
Electrodiagnostics is used for definition of a degree of weight of a defeat neuro-
muscular system. At easy defeats the quantitative changes are observed first of all: the
reference intensity of an electrical current inducing a muscle to reduction is increased. In
heavier stages the reactions of regeneration are observed, at which the quality of reduction
changes. It becomes flabby, worm-like, there comes a fast exhaustion of a muscle.
The excitation of activity of a muscle by a pulse electrical current interferes with
progress of reactions of regeneration, keeps a muscle to the period of reinnervation. At
electrostimulation restoration of the injured nervous fiber is also accelerated.
The basic indications to application:
1. Primary atrophy of muscles connected to damage of peripheral
neuron; languid paralyses and paresis.
2. Secondary atrophy of muscles connected with long immobilization,
illnesses of joints.
3. Myopathic paralyses and paresis.
4. Paralyses and paresis of muscles of larynx.
5. Hypomotor dyskinesia of internal organs.
Contra-indications to application: spastic paralyses and paresis.
Dosage: at realization of electrodiagnostics we receive information about functional
lability of a muscle, achieving its minimal, but clearly seen reduction. As a result the
parameters of an electrical current for procedure of electrostimulation are established, that is
the doze is defined by results of electrodiagnostics. Procedure of electrostimulation of muscles
is measured out according to:
1) force of an electrical current (up to 50 mA);
2) form, frequency and duration of pulses;
3) duration of procedure (from 5 to 25 minutes);
4) repetition factor of realization of procedures (daily or every other
day);
5) number of procedures for the course of treatment (from 10 up to 25).
The restrictions in quantity of procedures can be connected with irritating action of an
electrical current on a skin.
The note: as electrodiagnostics of unstriped muscles is impossible (item 5 of the
indications to application), the doze of an electrical current is selected empirically, it is
specified in the directories and manuals on phisiotherapy.
2. Diadynamic currents.
Diadynamic currents (Bernard’s currents) - influence by current with constant direction
of a low voltage (60 - 80 v) and small force (up to 50 mA) in a pulse mode. Pulses of half-sine
form with frequency 50 or 00 Hz
Two kinds of diadynamic currents (50 hz and 100 hz) apply at the following fixed kinds
of modulations (fig. 4):
1) half-wave continuous current;
2) full-wave continuous current;
3) Current modulated by the short periods;
4) Current modulated by the long periods ;
5) half-wave rhythmic current.
6) half-wave wave current.
7) full-wave wave current.
Devices:
- SLPM (sinusoidal low-frequency wave pulse modulate)
- "Tonus";
- "Dyadynamic" (Poland, France).
The basic biophysical processes: same, as at galvanization. The movement of ions in
the same direction occurs during the period, when there is an electrical current there.
The basic physiological reactions and medical effect: same, as at galvanization. The
pulse electrical current with frequency 50 hz causes burning pain, pricking, sensation of large
vibration, which is painful and irritating. The electrical current with frequency 100 hz causes
sensation of fine vibration, which is endured much more easily. Basis of effect of diadynamic
currents is anesthetization. The mechanism of this action is considered from positions of the
doctrine of N.E. Vvedensky about features of reaction of a tissue to monotonous irritation. In
the first phase of influence the excitation is observed, at accustoming to excitation there
comes a phase of inhibition, then -phase of parabiosis. The phase of inhibition caused by
influence of diadynamic currents, proceeds within 2-4 hours after procedure, and parabiotic
phase is short-termed. The decrease of excitability and functional mobility of nervous
receptors results in anesthetization. At alternation of influence by currents with frequency 50
and 100 hz of accustoming to irritant does not come. The irritation of receptors of
neuromuscular system comes into the central nervous system. According to the doctrine of
A.A. Ukhtomsky in cerebral cortex the majorant of rhythmic irritant is formed which suppresses
painful majorant. In a zone of influence occurs hyperemia of skin, blood circulation and
lymphokinesia, trophism of tissues are improved. The influence occurs mostly on superficial
receptors. Before realization of procedure it is necessary to find pain points, zones of
distribution of pain and to impose electrodes on these areas. The mentioned above reactions
are expressed in the greater measure under the cathode, therefore it is necessary to influence
zones of morbidity by a negative pole.
Diadynamic currents can be used also for electrostimulation of muscles, including
influence on unstriped muscles of internal organs in case of their hypomotor dyskinesia by
half-wave rhythmic current (former name - rhythm syncope).
The basic indications to application.
1. Pain syndrome at defeat of peripheral nerves.
2. Pain syndrome at traumas: bruises, stretching of ligaments and muscles.
3. Pain syndrome at degenerative dystrophic defeats of joints and backbone.
4. Local vegetovascular disorders: migraine, Raynaud's syndrome, paresthesia
etc.
5. Dyskinesia of internal organs of hypomotor type.
_________________Basic contra-indications to application.
_________________________
1. Acute stages of inflammatory process, especially purulent.
2. Unfixed fractures of bones, dislocations of joints (up to reposition), complete
breaks of ligaments and muscles.
3. Trombophlebitis(in a zone of prospective influence).
4. The presence of stones in a gall-bladder and urinary tracts (if there supposed
influence on the appropriate zones).
Dosage:
1) according to force of an electrical current (up to 50 mA):
2) according to sensations of the patient (light pricking, burning, vibration or rhythmic
reduction of muscles);
3) according to duration of procedure (influence on one field no more than 7
minutes; during one procedure influence no more, than on three fields);
4) acording to repetition of realization of procedures (two times a day with a
break not less than 4 hours, daily, every other day);
5) By quantity of procedures on a rate of treatment (not more than 10).
3. Electrosleep
Electrosleep - influence on the central nervous system by a pulse electrical current of a
constant direction, low frequency (from 1 up to 180 hz) and small force (up to 10 mA in peak
value). Pulses of the rectangular form by duration from 0,2 up to 2 msec. At influence by this
current one doubled electrode (cathode) we put on the closed eyes other doubled electrode
(anode) - on area of mastoid (fig. 5).
Fig. 5 Fixing of electrodes at treatment by electrosleep. Devices: - "Electrosleep"

Physiological action: diffuse inhibition in cerebral cortex transforming into sleep. This
action considered from positions of neuro-reflex and direct influence on formations of brain.
Neuro-reflex mechanism is connected to an irritation of receptors of skin, eye-socket and
upper eyelid. The irritation from this reflexogenic zone is transferred into subcortex formations
and cerebral cortex, causing reinforcement of processes of inhibition.
At direct influence the electrical current will penetrate through foramens of eye-
sockets, being distributed alongside the vessels into subcortex formations. The electrical
activity and functional condition of limbic system changes. As a result of it there are favorable
changes in psycho-emotional sphere.
________________Basic indications to application.
________________________
1. Infringement of night sleep of any etiology.
2. Corticovisceral diseases and functional disorders of the central nervous system.
3. After-effects of craniocerebral trauma, tick-borne encefalitis; diencephalic
syndrome.
4. Mental diseases: borderline state, reactive psychosis, schizophrenia.
5. As a component of complex treatment of alcoholism, drug addiction.
6. Pain syndromes of any etiology.
7. Enuresis, nightmares, children's logoneurosis.
8. Exhaustion at intensive intellectual work, work in extreme situations.
The electrosleep can be indicated at many diseases, as the illness breaks a functional
condition of the central nervous system, physiological mechanisms of regulation,
corticovisceral relationship.
The main contraindications to application:
1. Acute infectious deteats ot eyes anapenocularcellular tissue.
2. Detachment of retina of an eye.
3. High degree myopia.
4. Adhesive arachnoiditis.
5. Expressed hysteria.
6. Basic glaucoma.
Dosage:
1) according to force of an electrical current (up to 10 mA);
2) according to sensations of the patient (occurrence of the first sensations as light
vibration etc.);
3) according to duration of procedure (from 20 minutes up to 1-2 hours);
4) according to repetition of realization of procedures (daily, 4 days in
succession and 2 days of a break, every other day);
5) according to quantity of procedures (10 - 15, maximum is 30).
The electrosleep can be used in a variant named «central electroanalgesia". In this
method of treatment the devices "Lenar", "Elektronarkon", generating electrical pulses of the
rectangular form by size up to 5 mA are used. Frequency of following impulses from 150 up to
2000 hz, duration of pulses from 0,2 up to 0.5 msec. The procedure will be carried out at
forehead-neck arrangement of electrodes. The application of higher frequency of pulses, than
in procedure of electrosleep, allows removing sensations under electrodes. Central
electroanalgesia is intended for potentiation of action or replacement of analgesic and
antianxiety pharmaceutical substances, it is used for treatment of pain syndrome and
emotional stresses.
III. Medical application of a pulse electrical current of a variable direction.
In the medical techniques connected to application of the specified physical factor, the
tissues are influenced by a variable sine wave electrical current of average frequency (from
2000 up to 5000 hz). The resistance to this current from the side of skin is much less,
approximately 100 times, than current of low frequency, it will penetrate the tissues more
deeply. In this connection the small part of electrical energy is absorbed by skin, an irritation of
skin receptors sharply decreases, hyperemia does not arise.
Mid-range alternating current is modulated in a current of low frequency. In physics
under modulation (modulatio change, measure) we understand change of amplitude or
frequency (or that and another simultaneously) fluctuations caused by imposing of fluctuations
of lower frequency. In this case modulations represent periodic increases and reduction of
amplitude of fluctuations of an electrical current. Separate series of fluctuations ("beat") low
frequency are formed. The medical effect is connected with influence of these "beats" of low
frequency on the neuromuscular apparatus and tissues, which is similar to influence of a pulse
electrical current of a constant direction. Considerably higher carrier frequency provides sharp
decrease of irritating action on receptorsp of a skin. It allows to use an electrical current of the
greater force, than in techniques of electrostimulation of muscles and diadynamic therapy.
1. Interferential currents.
The treatment by interferential current therapy represents influence on tissues by two
sinusoidal alternating electrical currents, which are brought to tissues with the help of two
pairs of electrodes (fig. 6).
Fig. 6 The scheme of setting of electrical currents in two independent circuits to a body
of the patient: 1 - first circuit; 2 - second circuit; 3 -electrodes; 4 - surface of a body; 5 -
direction of excitation; 6 - area of stimulating action.
The frequency of the first current is constant, it makes in different devices 4000 or
5000 hz. The frequency of the second current is adjusted in limits from 4001 up to 4100 hz or
5001 - 5100 hz accordingly, i.e. the difference of frequencies of two currents makes from 1 up
to 100 hz. Their interaction in tissues consists in interference of fluctuations. Some fluctuations
are summarized and amplitude of fluctuations of a current grows, others - are mutually
extinguished and their amplitude decreases up to zero. As a result of such interaction in
tissues the third current of low frequency - interferential, representing "packs" of impulses,
"beats" (fig. 7) This current has the basic biological activity.
Fig. 7 The graphic image of formation of interferential currents:

1 - current of the first circuit of frequency 4000 hz; 2 - current of the second circuit of
frequency 4100 hz; 3 - interferential current with constant quantity of beats, which frequency
is 100 hz.
Types of interferential currents used in physiotherapy:
1) interferential current of constant frequency in a range from 0 up to
100hz;
2) interferential current with rhythmically varying frequency. Within 15
seconds the frequency of pulses gradually accrues and decreases in a
range:
• From 0 up to 10 hz;
• from 25 up to 50 hz;
• from 50 up to 100hz; from 90 up to 100hz;
• from 0 up to 100hz.
Devices:
- "Interdin",
- "Interferentspuls".
Basic indications to application is the same, as at diadynamic therapy. As against it is
possible to influence more significant area and depth of tissues by interferential currents. The
local imposing of electrodes is unessential that allows influencing areas closed by bandages,
including plaster. For example, at influence on elbow joint the electrodes are imposed on a
shoulder and forearm.
Basic contra-indications to application same, as at diadynamic therapy.
Dosage according to:
2) on sensations of the patient (painless vibration);
3) duration of procedure (influence on one field about 10 minutes; during one
procedure influence no more, than on three fields, no more than 10 minutes on each field - in
this case general duration of procedure about 30 minutes);
4) repetition factor of realization of procedures (two times a day with a break not
less than 3 hours, daily, every other day);
5) quantity of procedures on a rate of treatment (up to 10, at influence with the
purpose electrostimulation of muscles - up to 20).
2. Sine wave modulated currents.
The sine wave modulated currents (SMC) represent a sine wave variable electrical
current by frequency 5000 hz, which is modulated as pulses by frequency from 10 up to 150
hz. Thus series of fluctuations of an electrical current are formed which are similar to "beats"
arising in tissues at interference of two alternating sine wave currents of different frequencies.
As against interferentional currents formed in tissues, SMC are received with the help of the
device and already generated pulses are brought to tissues with the help of electrodes. SMC
combine positive properties of diadynamic and interferential currents.
The kinds of SMC, used in physiotherapy, are represented in a fig. 8.
Fig. 8 Graphic images of the sine wave modulated currents: I - first sort of work (CM); II
- second sort of work (SP); III - third sort of work (SN); IV – fourth sort of work (AF); A - variable
mode of operations;B -straightened mode of operations.
I sort of work (current CM - constant modulation): the carrier frequency of a sine wave
current 5000 hz is modulated by any frequency chosen from a range from 10 up to 150 hz.
II sort of work (current SP - sending of a pause): sending (series of pulses) of sine wave
current modulated by any frequency from a range from 10 up to 150 hz, alternate with pauses.
III sort of work (current SN - sending of the modulated and not modulated fluctuations):
sending of a sine wave current modulated with any frequency from a range from 10 up to 150
hz, alternate with sendings of the not modulated sine wave current of frequency 5000 hz.
IV sort of work (current AF - alternating frequency): in one of sendings of sine wave
modulated current frequency from a range from 10 up to 150 hz is chosen, in other sending
the frequency of the modulated current makes 150 hz.
The duration of sendings and pauses is adjusted separately in limits from 1 about 6
seconds. All kinds of modulations can be generated in the variable and straightened mode of
an electrical current. The straightened mode of operations, i.e. influence by pulses of half-sine
form, are used when influence by an electrical current combine with influence of medicinal
substance (SMC - electrophoresis). Devices: - "Amplipuls" (peak pulsations).
Biophysical processes in fabrics and basic physiological reactions same, as at influence
by diadynamic currents. As against them there are no unpleasant sensations of burning and
pricking under electrodes. The basic part of energy is absorbed by deeply laying tissues,
mainly by muscles. There, at cellular membranes and semipermeable membranes, there
appeare short-term changes of ionic concentration causing short-term excitation of nervous
and muscular fibres. There is a sensation of fine painless vibration. The faltering character of
influence of series of fluctuations of an electrical current raises stimulating action of SMC, that
is most expressed at II sort of work. Basic indications to application same, as at diadynamic
therapy.
SMC have no irritating action on a skin, which considerably increases endurance of
procedure. It allows using them more widely, than diadynamic currents. The application of SMC
is more preferable for children, elder people.
Contra-indications are the same, as for diadynamotherapy. Dosage according to:
2) sensations of the patient (painless vibration);
3) duration of procedure (influence on one field up to 10 mines) i.e: during one
procedure influence no more, than on 3 fields);
4) repetition factor of realization of procedures (two times per day with a break
not less than 3 hours, daily, every other day);
5) quantity of procedures on a rate of treatment (up to 10, at influence with the
purpose of electrostimulation of muscles up to 20).
IV. Medical application of alternating electrical currents and alternating
electromagnetic fields of high, ultra high and superhigh frequencies.
Under influence of a variable electrical current and variable electromagnetic field the
charged particles make oscillatory movements. The frequency of fluctuations corresponds to
frequency of an alternating current or field. With increase of frequency the displacement of
ions becomes less meaningful. At high frequencies it makes only 0,01-0,001 diameters of an
ion. As ion concentration is not broken, irritating action of these physical factors is not
observed. These features of action allow passing through tissues an electrical current of
significant force and electromagnetic high-power fields. In fabrics thus is allocated meaningful
amount of heat, the thermal effect becomes prevailing. Heat is formed inside tissues and
refers to endogenic.
At application of electromagnetic fields of ultra high and superhigh frequencies the
reactions are observed which are impossible to explain only by heating of tissues. The persons
professionally connected to influence of these factors, can have general disorders as neurosis
vegetovascular dystonia, endocrinopathy. At powerful influences the hair can drop out, lens
can become dim. The study of such reactions has resulted in representation about oscillator
effect, which is considered as specific, characteristic for the certain frequency of fluctuations.
The absorption of energy of electromagnetic waves in tissues due to fluctuation of ions does
not depend on their frequency; the absorption due to molecules is increased with increase of
frequency of fluctuations. This increase occurs up to the frequency, determined for even one
molecule, and in the maximal degree will be shown at concurrence of frequency of the
enclosed fluctuations to own frequency of fluctuations of molecules (phenomenon of a
resonance, resonant frequency). It was found out, that there is "shaking" of lateral circuits of
protein molecules, their relaxation.
At high-power influences the fiber can be denaturated, which is accompanied by
damage and destruction of those structures, into which it is included. At small capacities used
in physiotherapy, there is an activation of protein molecules, and accordingly activation of
those cells and structures, into which this molecule is included. Hence, considering individual
techniques of treatments connected with use of electrical currents and electromagnetic fields
of various frequencies, in each case it is necessary to estimate as thermal, and oscillator
effects to represent, which of them prevails. The indications to application will depend partially
on it at various pathological processes.
Fig. 9 The circuit of an oscillatory contour and influence by its various parts on tissues
of the patient (explanation in the text).
In all physiotherapy devices for reception of fluctuations of various frequencies the
generator of high frequencies is used, which basic element is the oscillatory contour. In a fig. 9
the principle of influence on a tissue of the patient by various parts of an oscillatory contour in
some methods of electrotherapy is shown. At darsonvalism and treatment by currents of
hyperacoustic frequency we influence by an electrical current, the tissue of the patient is
connected thus to a site of an electrical circuit (1). At inductothermia we influence by a
magnetic field, tissue of the patient is located in area of the coil of inductance (2). At ultra
high-frequency therapy influence by an electrical field, the tissue of the patient is located
between facing of the condenser (3).
1. Darsonvalism and currents of hyperacoustic frequency.
Darsonvalism is the influence by a variable pulse sine wave electrical current of high
frequency (110 or 440 hz), high pressure(voltage) (20 kv) and small force (0,02 MA), The
frequency of pulses 50 hz, amplitude of a current in each pulse gradually accrues and
decreases, i.e. the electrical current is modulated on amplitude. The high voltage is made to
tissues with the help of a glass vacuum electrode, in which air is rarefied up to 0,1- 0,5 mm
mercury. The name of this electrode is condenser. Under action of a high voltage air in an
electrode is ionized, the electrical current passes through the ionized gas. It is possible to
assimilate conducting part of electrode and a body of the patient to facings of the condenser,
the glass is dielectric. At transition of an electrical current from the ionized gas and capacity of
a glass plate on air arises the spark discharge - disruption of the condenser, and then the
electrical current through the patient goes to the ground. Devices: - "Iskra".
The basic biophysical processes: the effect darsonvalism is connected with irritating
action of the spark discharge on superficial layers of a skin and mucous environments. As the
current of very small force is used, the heating of tissues does not occur. As the influence is
carried out by an alternating current of high frequency, the changes of ion concentration in
tissues are not observed, the actions of muscle fibers does not come to light.
Basic physiological reactions and medical action in case of local darsonvalism are local
or have segmentation character. The silent electrical category irritates nervous receptors,
causing their functional changes, that results in small sedative analgesic effect. As a result of
nervous - reflex reactions the arterial part of capillaries extends, their venous part is narrowed,
the arterial inflow of blood is increased. Thereof the intensity of exchange processes is
increased, regenerative effect is observed. The appreciable general reactions do not arise. At
increase of an air backlash between an electrode and skin the increase of a voltage submitted
on an electrode is required. Capacity of the electrical discharge in this case raises and
becomes spark. The spark discharge causes not only local functional changes, but also renders
cauterizing action, causes inflammatory leukocyte infiltration with moderate edema of tissues.
At repeated influences of the spark discharge signs of damage occur as the centers of
micronecrosis of epithelium and of adjacent connective tissues.
1. Pain syndrome, paresthesia, connected with a defeat of peripheral nervous
system.
2. Trophic defeat of a skin, skin itch, loss of a hair.
3. Varicose veins of extremities, haemorrhoidal veins.Lymphostasis.
4. Vegeto-vascular disorders accompanied by peripheral angiospasm (migraine,
Raynaud's syndrome).
5. Trophic ulcer, sluggish wounds.
6. Parodontosis, stomatitis, vasomotor rhinitis.
7. The functional disorder of the central nervous system, at which
influence on collar zone, hairy a part of a head (neuro-circulatory dystonia, results of
craniocerebral injury etc).
Contra-indications to application: general contra-indications to realization of
physiotherapy. The specific contra-indications are not present.
1) intensity of influence, which is adjusted by capacity of the spark discharge
designated on a scale of the device in conditional figures (to specify it in 'watts' is not
accepted):
• Small intensity (figure 1-3),
• Average intensity (figure 4-5),
• Large intensity (figure 6-8);
2) sensations of the patient (silent discharge - very weak pricking, spark
discharge - expressed pricking, which at high intensity can be painful);
4) realization of procedures (daily or every other day);
5) quantity of procedures for a rate of treatment (from 3 up to 30).
The current of hyperacoustic frequency represents a variable sine wave electrical
current of high frequency (22 hz), high voltage (4 kw) and small force. Devices: - "Ultraton".
The same as and at darsonvalism, the influence is carried out with the help of glass
vacuum electrodes. There appeares a silent electrical discharge and sensation of light heat.
Biophysical processes in tissues and physiological reactions are the same, as at darsonvalism.
This treatment should be considered as variant of darsonvalism with less expressed subjective
sensations. The basic indications to application are the same. Dosage according to:
1) capacity of influence:
• Small (up to 3 wt, there correspond to division 4 scales on the panel of the
device);
• Average (4-6 wt, corresponds to 5-7 divisions of a scale), - large (7-10 wt,
corresponds to 8-11 divisions of a scale).
2) sensations of the patient (very light heat);
4) repetition factor of realization of procedures (daily or every other
day);
5) quantity of procedures on a rate of treatment (from 3 up to 30).It is noticed,
that hyperacoustic currents possess antiinflammatory and absorbable effect. They are
applied as at presence of infiltration without attributes of suppuration, at comissure processes
in a small palvis and abdominal cavity, chronic inflammatory gynecological diseases, genital
infantilism (appropriate cavity electrode is used).
2. Inductothermy
Inductothermy is influence on a tissue by high-frequency (13.56 Mhz) variable
magnetic field, which is formed by an electrical current, passing through the coil (solenoid).
Thus except for magnetic the electrical field making up to 20 % of made energy is formed. At
an explanation of action of inductothermy this electrical component is usually neglected. But
strictly speaking, the influence is carried out by an electromagnetic field of high frequency.
Fig. 10. Inductor-disk:

1 - general view;
2 - in the disassembled kind.
Fig. 11 Inductor-cable as a flat spiral.
Magnetic field is brought to tissues with the help of a inductor-disk and inductor-cable. An
inductor-disk (the fig. 10) represents a flat spiral consisting of three coils of a copper wire
made in a plastic skeleton. The inductor-cable is a copper wire in rubber isolation, it is possible
to make a various kind of a spiral of it (fig. 11) - flat, cylindrical or as a loop. Between inductor
and body of the patient leave a backlash in 1 -2 cm which is provided with that on a part of a
body, that undergoes the influence, under inductor we put combined in some layers a towel or
a sheet. The creation of a backlash considerably reduces heating of superficial tissues, which is
connected with the influence of an electrical field.
At use of an inductor-disk, inductor-cable as a flat spiral or loop a magnetic field penetrates in
a tissue on depth 5-8 cm. At use of inductor-cable as a cylindrical loop the magnetic field
influences all the volume of a tissue (of extremity or trunk). Devices: - "IKV" (short-wave
inductothermy).
The device is supplied with inductor-disks (small and large) and inductor-cable. By the
additional order the complete set of gynecological applicators is delivered: vaginal, lumbar
(small, average and large), collar.
The basic biophysical processes. The magnetic field, penetrating the tissues, induces in
them electrical currents named as induction currents, vortical currents or currents Fuko. The
more is the electroconductivity of a tissue, the current of greater force is formed in it. The
occurrence of vortical currents is accompanied by heating of tissues. The more
electroconductive is the tissue, the more intensively it will be heated up. First of all lymph,
blood and parenchymatous organs will be heated up. The skin is heated up unsignificantly, its
hyperemia does not arise. Probably, the formation of heat in a skin mostly depends on action
of an electrical component of an electromagnetic field. Non-thermal (oscillatory) effect in
inductothermia is expressed poorly, but it should be taken into account.
The basic physiological reactions and medical effect are connected first of all with
effects of heat, which defines the indications to application of this method in physiotherapy.
These effects are the following: antispasmodic, sedative, intensifying blood and lymph
circulation and metabolism. Resorbable and regenerative effect of heat (in particular at
inflammatory processes) is connected with the last effect. In connection with available
oscillatory effect it is possible to indicate inductothermy at earlier stages of inflammatory
process, than heat therapy. For the account of oscillatory effect it is possible to relate some
side-effects of inductothermia: deterioration of coronary blood flow at ischemic disease of
heart, deterioration contractility and conductivity of myocardium at diseases of a muscle of
heart, reduction of arterial pressure. On the other hand, with oscillatory effect is connected
activation of glucocorticoid function of adrenal glands, increase of phagocytic function of
neutrophyls, in some researches the increase of a titer of antibodies in blood is shown. The
basic indications to application.
1. Inflammatory processes (without suppuration) in a stage of the
resolution.
2. Degenerative-dystrophic and inflammatory diseases of musculoskeletal system.
3. Disease and trauma of peripheral nervous system.
4. Hypermotor dyskinisia of internal bodies.
5. Vegeto-vascular disorders shown by peripheral vasoconstriction.

The basic contra-indications to application.
6. Children up to 5-year's age.
7. Acute stages of inflammatory process, purulent inflammation.
8. Expressed hypotonia, bent to orthostatic collapse.
9. Infringement of thermal sensitivity of skin.
10. Presence of metal subjects in a zone of influence.
1) capacity of a magnetic field, which depends on force of an electrical current
submitted on inductor. On the panel of the device "IKV" it is designated by conditional figures
from l to 8. At work with the large inductor-disk it corresponds to force of a current from 160
up to 280 mA and capacity from 40 up to 200 wt;
2) sensations of heat:
• low-heat doze (figure 1-3; 160-200 MA; 40-90wt);
• Thermal doze (figure 4-6; 220-250 MA; 110-160 wt):
• Intensively thermal doze (figure 7-8; 260-280 MA; 185-200 wt);
3) duration of procedure (10-20 minutes, sometimes about 30 minutes);

4) repetition of realization of procedures (daily or every other day):
5) quantity of procedures on a rate of treatment (up to 15).
3. Ultra high-frequency therapy.
Ultra high-frequency (UHF) therapy is an influence on tissues by a variable
electromagnetic field of ultra high frequency (40.68 or 27.12 Mhz). And the advantage is given
back to influence of an electrical field. The magnetic component of made capacity is much less
than electrical one. The specified field is made to tissues with the help of electrodes
representing disk condenser plates.
The electrical field UHF penetrates tissues through, penetrating to any depth and being
distributed in environmental space on distance up to 150 meters. The condenser plates,
between which the electrical field is formed, have with an air backlash. The size of a backlash
in the sum should not exceed 6 CM at use of portable devices and 8 cm - at use of stationary
devices (for example. 2 CM under one plate and 4 cm - under another). Sometimes for creation
of a backlash use felt linings. At a small backlash the capacity of an electrical field
concentrates in superficial tissues, at the large backlash it is distributed more regularly in
superficial and deep tissues. Hence, the size of a backlash is defined by depth of an
arrangement of pathological process. The metal bodies which have got in a zone of influence
"attract" an electrical field. It is hundred properties use for protection of the medical personnel
against influence of an electrical field, placing devices with target capacity more than 100 wt
the shielded cabins. Devices: - "UHF" (portable, capacity up to 100 wt);
• "Screen" (stationary, capacity up to 300 wt);
• "Pulse".
Each device "UHF" is supplied with three pairs of disk condenser plates: N 1 - diameter
of 36 mm, N 2 diameters of 80 mm and N 3 - diameter of 113 mm. The devices "Screen" are
completed four pairs disk electrodes (50. 100, 150 and 180 mm in a diameter), having the
terminator fixing size of a backlash, and also three pairs of flexible rectangular electrodes
(130 x 80 mm. 180 x 110 mm and 270 x 180 mm).
The basic biophysical processes. The energy of an electrical field is absorbed
mainly in tissues having the large capacitor resistance that is in tissues badly conducting an
electrical current. There is an interaction to molecules having dipole structure. These
molecules turn around of an own axis according to changes of polarity of an electrical field.
Besides there is an interaction with electrones, which outside layer is displaced within the
limits of a molecule or atom that results in electronic polarization without formation of an
electrical current. Other kinds of polarization are observed also: ionic, dipole, macrostructural.
At significant frequency of a variable electrical field of dipole molecule have not time to make
complete turn, but only change around of the average position. Simultaneously occurs
pendular movement of ions, but infringement of ionic concentration at influence of the
specified frequency does not occur, the irritating action is absent. The different molecules have
various own frequency of fluctuations. Mostly those molecules will change, the own frequency
of which fluctuations coincides with frequency of a variable electrical field-resonance effect.
The fluctuations of molecules is called oscillation, and effect connected to these fluctuations, is
called oscillatory. At UHF-therapy oscillatory effect is realized mainly at a level of protein
molecules, from which the amino-acids are rifted. Dispersiveness of protein raises, pH of
environment deviates to the acidic side. Oscillatory effect is connected with a thermal one. The
allocation of heat is most expressed in tissues having high specific resistance.
Electroconductive tissues get warm due to a magnetic component of an electromagnetic field,
but this effect is small because of its low power. The basic physiological reactions and medical
action are connected with specific oscillatory and nonspecific thermal effects. Oscillatory
effect is most important in UHF-therapy. Its influence was studied most of all at inflammatory
processes. With oscillatory effect are connected activation of cellular reactions, formation of a
protective barrier around of the center of an inflammation consisting of crates and elements of
a connective tissue, increase of phagocytic activity of neutrophyls and macrofages. In the
center of an inflammation walls of capillaries are condensed due to mobilization of calcium and
loss of fibrin, that promotes reduction of exudation. Bacteriostatic effect is observed. The given
reactions define use of UHF-therapy at acute inflammatory processes, including purulent
inflammation. For reception of anti-inflammatory action thermal effect is reduced to a
minimum, definitely dozing procedure. At later stages of a purulent inflammation the UHF-
therapy promotes maturing of abscess, its separation from environmental tissues, then
cleaning of its cavity (necessary condition -presence of outflow of pus). At repeated influences
the formation of a connective tissue is activated.
The electrical field of UHF renders relaxing effect upon smooth muscles of internal
organs. At influence on the limited site of a nervous trunk first of all blocking of sensitive fibres
is noticed, painkilling effect is connected with this fact. The regeneration of the damaged
nervous trunk is accelerated.
At UHF-therapy the diverse general reactions are observed, first of all from the side of
cardiovascular system: decrease of arterial pressure, bradycardia, and delay of auricle-
ventricular and intraventricular conductivity, reduction of intensity of coronary blood flow. The
high dozes of UHF, exceeding recommended medical, oppress cellular activity, can cause
resistent paretic expansion of vessels, hemorrhage. At high dozes the regenerative ability of
nervous trunks is opressed, the pain in the center of an inflammation amplifies.
1. Inflammatory processes at acute stage, including proceeding with suppuration.
2. Degenerative-dystrophic diseases of organs of movement.
3. Disease of peripheral nervous system accompanying with a pain, including
traumatic damage of nervous trunks.
4. Occlusion defeat of peripheral arteries in an initial stage of disease, peripheral
vasoconstriction.
5. Bronchial asthma, gastric ulcer and duodenal ulcer at a stage of aggravation.
1. Sacculated purulent processes.
2. Ischemic disease of heart: progressing stenocardia, heart attack of
myocardium.
3. Acute disorders of cerebral blood flow.
4. Expressed arterial hypotony, bent to orthostatic collapse.
5. Pregnancy.
6. Presence of metal subjects in a zone of influence by size more than 4 cm2.

1) target capacity of an electrical field, measured in watt. The influence is not
recommended: on area of a head and neck more than 40 wt; on area of thoracic and
abdominal cavities - more than 100 wt; on shoulder joints, elbows, arms - more than 40, 70, 80
wt accordingly; on joints of coxal and knee - more than 70 and 100 wt accordingly;
2) sensation of heat:
• pre-heat dozes,
• low-heat dozes,
• Thermal dozes;
3) On duration of procedure (from 7 to 15 minutes);
4) On repetition factor of realization of procedures (daily or every other
day);
5) By quantity of procedures on a rate of treatment (from 5 up to 15, on
the average 7-10 procedures).
4. Microwave therapy.
The microwave therapy is an influence on tissues of organism by a variable
electromagnetic field of superhigh frequency (microwave). From here other name of this
method of treatment - microwave -therapy. For reception of an electromagnetic field of a
microwave the vacuum device magnetron, combining function of an electronic lamp and
oscillatory contour is used. The source of electrons in magnetron is served by the cathode. The
electrical field between the cathode and anode accelerates movement of electrons. The small-
sized constant magnet, which magnetron is supplied with, creates a magnetic field directing
movement of electrons. The electromagnetic field of a microwave is brought to tissues with the
help of special oscillators of the directed effect, which represent dielectric aerial. Oscillators
are used on contact and remote techniques of influence. At remote influence the device is
established in the shielded cabin so that oscillator was directed to outside wall.
Used in physiotherapy domestic devices generate an electromagnetic field of
frequency 2450 mHz (length of a wave 12,24 cm), 2375 mHz (length of a wave 12,6 cm), 450
mhz (length of a wave 65 cm). The waves of length 12,24 and 12,6 cm concern to a
centimetric range, and wave of length 65 cm - to decimeter. From here name of two kinds of
microwave therapy: cantimeter wave therapy (CW-therapy) and decimeter wave therapy (DW-
therapy). The microwaves have properties of reflection, refraction, interference, diffraction.
They can be concentrated in a narrow bunch.
Devices:
a) For CW-therapy:
• "Beam - 58", "Beam - 11", stationary, capacity up to 150wt;
• "Beam - 2", "Beam - 3", portable, capacity up to 20 wt.
b) for DW-therapy:
• "Volna", stationary, capacity up to 100 wt;
• "Romashka", portable, capacity up to 12 wt;
• "Ranet", portable, capacity up to 25 wt.
At application of stationary devices the influence will be carried out on a remote
technique. At use of the device "Beam - 58" or "Beam - 11" the air backlash between oscillator
and surface of a skin makes 5-7 CM, at use of the device "Wave" - 3-4 cm. The portable devices
are completed by oscillators for remote influence, and for contact as well. Three oscillator of
the cylindrical form for contact influence through skin are included into set: by a diameter of
20 mm (N 1), 35 mm (N 2) and 115 mm (N 3), and also two cavity oscillators, filled by
ceramics, which are not heated up at realization of procedure: vaginal (N 3) and rectal (N 4).
The basic biophysical processes essentially do not differ from those at UHF-therapy. The
resonant absorption of microwaves by separate parts of protein molecules, relaxation of their
lateral circuits is observed. Electrical active elements of cells change, on which the
permeability of membranes depends. The influence on polypeptides, some aminoacids is
carried out.
The energy of microwaves is absorbed mainly by molecules of water, their dielectric
permeability in this connection is insignificant. At influence of microwaves of a centimetric
range dipoles of water have time to turn completely for one change of a mark of polarity. The
absorption of their energy occurs first of all in tissues, rich in water. The degree of reflection by
surface of skin is significant, but it is not possible to take it into account at dozing of
procedure. Depending on thickness of subcutaneous fatty layer and features of an
arrangement of oscillator is reflected from 25 up to 75 % of energy of microwaves, on the
average about 40 %. Their reflection from borders of other tissues is significant: skin
-hypodermic cellular tissue, hypodermic cellular tissue - muscle. Thus the formation of so-
called "standing" waves in tissues is possible. They are formed at reflection of a wave from
border of two environments and imposing reflected on the next falling wave. Such process
occurs repeatedly in the same place. Under the laws of physics the "standing" wave is formed
in case if distance between borders of two environments makes more than a quarter of length
of a wave. This situation can arise at thickness of subcutaneous fatty layer more than 2 cm.
The microwaves of a decimeter range are approximately 2 times less intensively
reflected by a surface of skin. They to a lesser degree, than wave of a centimetric range, are
absorbed by water, as the phenomena of a resonance of dipoles of water at this frequency of
an electromagnetic field are less expressed. The energy of these waves in process of
penetration into depth of tissues fades twice more slowly in comparison with centimetric
waves.
The specified biophysical processes are accompanied by allocation of heat in tissues
sated with water. Is present oscillator effect indissolubly connected with thermal.
The basic physiological reactions and medical action are connected with specific
oscillatory and nonspecific thermal effects. With oscillatory the effect is connected anti-
inflammatory action of microwaves, antiallergic effect, positive influence on immunogenesis. In
spite of the fact that the action of microwaves is distributed to small volume of tissues, the
general reactions can be observed. They are realized mainly through amplification of function
parasympatic department of vegetative nervous system: decrease of arterial pressure,
decrease of number of reductions, delay of intraventricular conductivity to heart. Stimulation
of synthesis of some prostaglandines is observed. The warming up of tissues at CW-therapy
occurs on depth of 3-5 cm. At formation of "standing" waves there is a significant local
increase of temperature of a tissue down to a burn. This overheating of a tissue is
accompanied by sensation of bursting open, burning, rheumatic pains that requires immediate
reduction of a doze of influence or termination of procedure. The uncontrollable overheating
can arise at influence on hydropic tissue.
At DW-therapy the warming up of tissues occurs on more significant depth making 8-
10 cm. The probability of formation of "standing" waves is insignificant also warming up of
tissues is more uniform. To thermal effect of microwaves are connected anti-spastic and
sedative action, intensification of blood- and lymph-circulation in tissues, intensification of
metabolism. It is necessary to remember, that oscillatory and thermal effects are
inseparable, are shown simultaneously.
_____________________Basic indications to application.
_____________________________
The choice of CW- or DW-therapy depends on depth of an arrangement of pathological
process.
1. Inflammatory processes in acute, subacute and chronic stages proceeding
without suppuration.
2. Degenerative-dystrophic and inflammatory injuries of the
musculoskeletal system.
3. Disease of perypheral nervous system accompanying with a pain, including
traumatic damage of nervous trunks.
4. Hypermotor dyskinesia of internal organs.
5. Occlusive defeat of peripheral arteries in an initial stage of disease, peripheral
angiospasm.
1. Children up to 5-year's age.
2. Ischemic disease of heart: progressing stenocardia, cardiac infarction.
3. Acute disorders of cerebral blood circulation
4. Disorder of thermal sensitivity of skin.
5. Presence of metal subjects in a zone of influence by size more than 4 cm2.

1) target capacity of an electromagnetic field, measured in watt;
2) sensation of heat;
At a remote technique of influence the following dozes are distinguished:
• weakly thermal, up to 40 wt;
• thermal, from 40 up to 60 wt;
• intensive thermal, more than 60 wt.
At a contact technique of influence the following dozes are distinguished:
• weakly thermal, up to 3 wt;
• Thermal, from 3 up to 6 wt;
• intensive thermal, more than 6 wt.
4) On repetition factor of realization of procedures (daily or every other
day);
5) By quantity of procedures on a rate of treatment (from 5 up to 20).
Magnetotherapy.
Magnetotherapy is a medical influence by a magnetic field on organism as a whole or
its separate tissues. The magnetic fields arise where an electrical current passes. The power
lines of a magnetic field as the closed concentric circles surround a trajectory of a driven
electrical charge. The direction of power lines of a magnetic field depends on a direction of an
electrical current.
At use of a constant electrical current there is a constant magnetic field (field of a
constant direction). At use of a variable electrical current there is a variable magnetic field
(field of a variable direction), which frequency is defined by frequency of an electrical current,
having it. In physiotherapy a magnetic field of frequency up to 200 hz is more often used. The
constant and variable magnetic fields can be applied as in continuous and faltering modes.
The basic power characteristic of a magnetic field is the magnetic induction, which is
measured in Teslaes (Tl). In physiotherapy the thousand parts of Tesla - milliTeslaes (mTl) are
used. In process of removal from a conductor of an electrical current the induction of a
magnetic field decreases directly proportionally to square of distance. Source of a magnetic
field in physiotherapeutic equipment is multiturn coil from a metal wire. The influence is
carried out with the help of a inductor-electromagnet and inductor-solenoid.
The inductor-electromagnet (fig. 12) consists of ferromagnet core and metal winding
around it, on which the electrical current moves. Greatest density of power lines of a magnetic
field is created on face parts of inductor,which are used at treatment. These inductors are
intended for realization of local procedures.
Fig. 12 Inductor-electromagnet and its magnetic field: 1 - core; 2 - winding.
The inductor-solenoid (fig. 13) represents multiturn coil from a metal wire without the
core, on which the electrical current moves. Maximal density of power lines of a magnetic field
is created inside the solenoid. This inductor is intended to influence extremities and trunk of
the patient, which are located inside of the solenoid. In some devices the electrical current
moves on separate coils of the solenoid consistently, with a delay on a phase. Thus "running"
of an electrical current along the inductor occurs in form of wave that creates a so-called
running magnetic field.
The voltage of electrical current feeding inductors is not more than 40 wt. The form of
a magnetic field depends on the characteristics of an electrical current feeding the inductor.
The constant magnetic field (CMF) is raised by a constant continuous electrical current, has a
constant direction of magnetic power lines and constant magnetic induction (1 in a fig. 14).
Fig. 13 Inductor-solenoid and its magnetic field.

The variable magnetic field (VMF) is raised by a variable electrical current of the sine
wave form, is characterized by a variable direction of magnetic power lines and varied
meaning of a magnetic induction (2 in a fig. 14). The pulse magnetic field (PMF) is raised by
pulses of a constant electrical current, it is usual half sine wave form, the direction of magnetic
power lines is constant, the magnetic induction varies under the pulse law, periodically
reaching zero (3 in a fig. 14). Each of the forms of a magnetic field is used in continuous and
faltering modes of operations. The faltering mode is characterized by alternation of sendings
and pauses. Devices:
a) stationary:
- "Polus-g", influence by a variable magnetic field by frequency 50 hz or pulse (pulsing)
magnetic field by frequency 50 hz. Mode of operations continuous and faltering. At a faltering
mode duration of a sending 2 seconds, duration of a pause 2 seconds. Five inductors-
electromagnets of different size are included into a complete set. Use of two inductors
simultaneously is possible.
Fig. 14 Graphic images of the various forms of magnetic fields: 1 -constant magnetic
field (CMF); 2 - variable magnetic field (VMF); 3 - pulse magnetic field (PMF). Modes of
operations: And - continuous; - faltering.
- "Polus-2", differs from the previous model only by that enables to change frequency
of a magnetic field from 10 up to 50hz.
- "ALIMP-G" (device for treatment by a pulse magnetic field), influence
by a running pulse magnetic field, frequency of pulses 10 or 100 hz, form of pulses is half-sine
wave. Eight inductor-solenoids, large and small are included into a complete set. Inside of the
large solenoid we put injuried extremity. Small solenoids we put on a surface of a body, thus it
is possible to use an extra packing with pockets, in which we place solenoids.
- "Avrora MK-G" (development of the Ryazan radio engineering
academy) - influence by a running pulse magnetic field, frequency of pulses from 1 up to 100
hz, and running constant magnetic field. Inductor-solenoids are made out as a survival suit, in
which extremities, trunk and head of the patient are located. It is intended for influence on all
organism or its separate parts by a combination of the specified magnetic fields. 6) Portable.
• "MAG - 30", one of the simplest designs for magnetotherapy. The bottom
surface of the device is its working part. The influence is carried out by a variable magnetic
field by frequency 50 hz with the help of the inductor-electromagnet which has been built in
the device. The parameters of a having electrical current, and consequently also of magnetic
field, are not adjusted.
• "Polus - 101", influence by a variable magnetic field. The device is supplied
with two inductor-solenoid: N 1 generates VMF by frequency 1000 hz, N 2 - 700 hz. Mode of
operations is continuous or faltering. At a faltering mode duration of a sending 1,5 seconds,
duration of a pause 1,5 seconds. In work is used either one inductor, or both together (on
different extremities).
- "AVIMP" (device of influence by a pulse magnetic field), frequency of pulses from 10
up to 130 hz. Three inductor-electromagnets are included into a complete set. Mode of
operations is continuous. The basic biophysical processes.
Magnetic field passes through organs and tissues of the man freely. The influence can
be carried out through clothes, various bandages, including plaster. On a picture of a magnetic
field in air it is possible to judge about its distribution in tissues and depth of penetration in a
body of the man. At use of a inductor-electromagnet the depth of influence reaches 7-8 cm. At
use of the inductor-solenoid the influence is carried out on all volume of a tissue placed in the
solenoid.
The magnetic field causes the physico-chemical phenomena in tissues at a molecular
level. Thus the important role is played by magnetic and electrical properties of molecules
which are included in structure of biological structures.
Under action of a magnetic field in liquid environments of the organism, possessing
high electroconductivity, the electrical current is induced. In view of small intensity of a
magnetic field used in physiotherapy, the size of an electrical current is insignificant and
thermal effect practically does not arise. The constant magnetic field induces an electrical
current in blood driven along blood vessels, that effects condition of cellular and non-cellular
components of blood. This prompting in that case is most expressed, when the power lines of a
magnetic field are perpendicular to a direction of movement of blood.
The variable and pulse magnetic fields induce an electrical current first of all in resting
biological fluids, that results in change of volumetric electrical charges about membranes and
in areas adjacent to membranes. As a result of it the positive and negative charges are
distributed non-uniformly, macroscopic volumetric charges are resorped. All this has an effect
for permeability of membranes, intensity of exchange processes in cells.
Between an external magnetic field and driven electrical charge there is a mechanical
interaction as an attraction and pushing away. Such interaction is named a magnetomechanic
effect. It is caused by presence at a driven electrical charge of an own magnetic field.
Magnetomechanic effect is shown first of all at a level of nervous and muscular tissues, as
these fabrics are carriers of biocurrents, source of biomagnetic fields. This effect also is
accompanied by change of permeability of membranes, speed of cellular metabolism
processes and connected with them changes of activity of cells.
Probably, the effect of "magneting" of water participates in the mechanism of action of
a magnetic field. Specify, that optical density and some other properties change its
electroconductivity. Intracellular water, hydrate of covers of protein molecules is to the
greatest degree undergo these changes.
The basic physiological reactions and medical action.
At influence by a magnetic field the majority of the patients does not have any
sensations, as receptors of skin are not irritated, the meaningful quantity of endogenous heat
is not formed. The part of the patients marks in a zone of influence easy pricking or warming.
The energy of a magnetic field is to the greatest degree absorbed by a nervous tissue. At
influence on a head and collar area raises force of brake processes in the central nervous
system, that is shown by distinct sedative effect. The influence on hypothalamus - highest
vegetative centre is significant. The normalization of broken vegetative functions, stimulation
of production of hormones by peripheral endocrine glands is observed.
At influence on peripheral nervous system the increase of a threshold of sensitivity of
nervous receptors is marked, that is shown by moderate anesthetic effect. The acceleration of
restoration of the damaged nervous trunk is observed trophic and regenerative action.
The influence of a magnetic field on cardiovascular system is significant. At direct
influence on area of heart or its reflexosegmental zone moderate bradycardia develops, the
ratio between coronary blood flow and need of myocardium in oxygen is improved, that is
connected with moderate betaadrenoblocking action of a magnetic field. At influence on a
head and collar area the hypotensive effect is observed. Peripheral arteries of muscular type
such as arteriolas extend under influence of a magnetic field that is connected with its direct
myotopic effect on vessels. Aggregation ability of thrombocytes is simultaneously reduced;
raises fibrinolytic activity of blood, the content of free heparine in it is increased. All this
improves regionary blood flow and perfusion of tissues. The influence of a magnetic field on
peripheral blood flow is favorable. The specified effects promote wide application of a
magnetic field in treatment of diseases of peripheral vessels, arteries and veins. Its use is
especially popular at occlusive defeats of arteries of extremities and brain vessels, peripheral
vasoconstrictions.
Antiinflammatory effect of a magnetic field is noticed. It stimulates regeneration
processes in tissues, which integrity is broken inflammatory process. The healing and
restoration of function of a tissue is accelerated at any other reason of damage: traumas,
ulcerative processes, degenerative-dystrophic disease. All this allows speaking about
trophicostimulating action of a magnetic field. Appreciably this promotes improvement of
rheological properties of blood and intensification of microcirculation.
The antiallergic action of a magnetic field is described. It is connected, probably, with
stabilization of membranes of corpulent cells, that prevents process of their degranulation. The
influence of a magnetic field on the contents of T- and B - lymphocytes, level of
immunoglobuline of blood is marked also. In experiment immunocompetent organs have
appeared very sensitive to influence by a magnetic field.
Hence, the magnetic field has wide and diverse action on organism of the man in norm
and pathology. It is weaker irritant, than majority of factors used in physiotherapy, therefore its
action is very soft and physiologic.
The answer-back reactions are most expressed at influence by a pulse magnetic field
is especial at its frequency up to 20 hz. A more poorly variable magnetic field and the softest
action render a constant magnetic field. The physiological and medical effects of a magnetic
field are observed after repeated influences, but the achieved effect is kept within several
months. Magnetotherapy is one of the most sparing methods of influence, it is easily
transferred, it is not accompanied by any obvious subjective sensations and general reactions,
and it is well combined with influence of a number of other physical factors. All this allows to
apply magmetotherapy widely at the patients of various age, from children's up to senile,
including at presence the heavy accompanying pathology suffices.
1. Functional disorders of the central nervous system, corticovisceral disease.
2. Inflammatory processes in subacute and chronic stages proceeding without
suppuration.
3. Diseases of allergic genesis: bronchial asthma, vasomotor rhinitis, hives,
Quincke's edema.
4. CHD: stable stenocardia of a pressure of I - III of functional classes.
5. CVP: infringement of cerebral blood circulation, ischemic insult
(since the fifth week of disease).
6. Occlusive defeat of peripheral arteries, peripheral vasoconstriction.
7. Disease of peripheral veins: thrombophlebitis, chronic venous
insufficiency.
8. Degenerative and inflammatory defeat of musculosceletal system.
9. Disease of peripheral nervous system accompanied by pain.
Contra-indications to application.
1. Diencephalic syndrome.
2. The expressed disorderss of function of endocrine glands, especially
hyperthyroidism.
3. Arterial hypotony, susceptibility to orthostatic collapses.
Dosage acording to:
1) Size of a magnetic induction in milliTeslaes (mTl) on an exit from a surface of
inductor:
• Up to 35 mTl in devices "Pole - r" and "Pole - 2",
• Up to 30 mTl in the device "MAr-30",
• Up to 10 mTl in the device "ALIMP-1",
• Up to 5 mTl in the device " Avrora MK-1 ",
• Up to 1,5 mTl in devices "Pole 101" and "Avimp". Size of a magnetic induction is not
the same for inductors of different types from
a complete set for one device. The appropriate instructions are available in the
directories and instructions to use of the device;
2) The form of a magnetic field (constant, variable, pulse, running);
3) Mode of operations of the device (continuous, faltering);
4) Duration of procedure (from 10 to 30 minutes, at consecutive
influence on some fields about 60 minutes);
5) Repetition factor of realization of procedures (daily or every other
day);
Phototherapy
Phototherapy is use of artificially received light energy with the medical and preventive
purposes. The treatment by solar light (heliotherapy) is referred to section of climatotherapy.
Light flow (the optical radiation) represents electromagnetic waves, which as against
radiowaves are distributed not continuously, but as separate portions (quantums, photons).
Phenomena of refraction, absorption, dispersion, reflection from border of two environments
are peculiar to it. The range of light waves from 400 microns up to 180 nm is used in
physiotherapy. [1 micrometer (the micron) makes 1CG6 of meter, 1 nanometer (nm) -10
meters].
The optical range is divided into three areas: infra-red (from 400 microns up to 760
nm), seen (from 760 up to 400 nm) and ultra-violet (from 400 up to 180 nm). From infra-red
(IR) to ultra-violet (UV) to radiation length of a wave of electromagnetic fluctuations decreases,
the energy of quantum grows, that is the energy of quantum is back proportional to length of a
wave. The direct dependence between energy of quantum and depth of penetration of light
waves in a tissue of the man is not present. Long-wave IR rays have so small energy, that are
absorbed by a homy layer of skin. In process of reduction of length of waves and, according to
this, increase of energy of quantum the depth of their penetration in a tissue is increased,
reaching 4-5 cm in the field of short IR rays and red part of seen area. Further, despite of
proceeding increase of energy of quantum, the depth of penetration of light waves begins to
decrease, as the ability of tissues is increased to absorb a light flow. The rays of seen area will
penetrate into depth of tissues on 1-3 cm, and UV rays - not further than 1 mm.
1. Infra-red irradiation.
Source of IR rays is any heated up body. Its radiative ability is measured by capacity of
a light flow expressed in Watts. It is proportional to the fourth degree of temperature of the
heated up body (law of Stethen and Boltsman), that is at increase of temperature of a body
twice its radiative ability grows 2-16 times. Hence, for reception of a stable flow of IR rays
temperature of their source should be strictly constant.
Length of a wave of a light flow also depends on temperature of a body, radiating it.
Length of a wave, to which there corresponds maximum of radiation, is back proportional to
absolute temperature (law of Vien). Absolute temperature is expressed in Kelvin degree (1 *K
= - 273C). According to this law the maximum radiation of the sun is necessary on a green part
of seen area (0,52 microns). The body of the man radiates long-wave IR spectrum (9,6
microns).
IR light area is divided into some zones. In physiotherapy it is convenient to divide it
into two zones: nearest IR in length of a wave from 0,76 microns (760 nm) up to 1,5 microns
far IR in length of a wave more of 1,5 microns. The terms "nearest" and "far" zones reflect
affinity or remoteness from seen area. The rays of nearest IR zone will penetrate in a tissue on
more significant depth (4-5 cm), therefore first of all they are used in the medical purposes.
For reception of IR radiation use calorific sources. To requirements, showed to them, to
the utmost correspond incandescent lamps,used for illumination. Their string is warmed up to
2500 - 2800* K, maximum of a light flow, according to the law of Vien, falls on length of a wave
about 1 micron, that corresponds to nearest IR zone. About 75 % of energy consumed by
incandenscent lamps, is spent for production of IR rays, about 12 % - on seen light area, other
energy is lost by other ways. If we take into account only nearest IR zone, in a lamp by
capacity 100 wt it makes about 35 %, and in lamps from 500 up to 1000 wt - about 40 %. The
usual glass passes IR rays with length of a wave less than 2,5 microns. Hence, the
incandenscent lamps are favourable as sources IR rays and are unprofitable as sources of
illumination.
For reception of IR rays with length of a wave more than 3 microns use open radiators
as tungsten filament,wound on the ceramic core. Temperature of such radiator is selected
according to required length of a wave of radiation.
Devices:
- lamp "Sollux" (sol - sun, lux - light, Latin.) Stationary on a support or desktop
(portable);
• Lamp (reflector) of Minin;
• Local electrolight a bath. In different by size baths is used from 8 up
to 16 incandescent lamps by capacity 40 wt each;
• Lamp of infra-red rays, stationary on a support or desktop. Open radiator is
used in it.
The basic biophysical processes occur at a molecular level. The
molecules receive additional energy and their Brownian motion increases, they become more
active. Temperature of tissue raises. The part of IR rays is reflected from a surface of a skin,
their absorption on depth quickly accrues. The rays of length of a wave more than 1,5 microns
are especially intensively absorbed by water. The basic physiological reactions and medical
action are caused by thermal effect. This warmth is exogenous, IR rays are named also as
thermal rays. First of all receptors of skin and vessels of superficial tissues are irritated.
Externally it is shown by thermal erythema, of non uniform on intensity having indistinct
borders. Erythema occurs during an irradiation, keeps no more than 30 minutes after
termination of procedure. At an irradiation of the appropriate sites of skin it is possible to count
on reaction from the side of internal organs by the mechanism of vegetative-segmental
reflexes: expansion of vessels and connected with it intensification of blood circulation,
activation of metabolism. The effects of heat define the indications to application of IR rays:
antispasmodic and sedative action, intensification of blood and lymph circulation, exchange of
substances in tissues. Its effect is considerably less expressed in comparison with other
methods of physiotherapy, at which use formation of endogenous heat occurs. The general
answer back reactions usually are not observed. It allows applying IR rays at presence of quite
heavy general pathology.
_________________Basic indications to application.
_________________________
1. Inflammatory processes (without suppuration) in a stage of the
sanction.
2. Degenerative-dystrophic and inflammatory diseases of musculoskeletal system.
3. Disease of peripheral nervous system accompanied by pain.
4. Consequence of traumas with the purpose of pain-killing (bruises, stretching of
ligaments).
5. Contraction of muscles of spastic type (before medical gymnastics and massage).
1. Acute stages of inflammatory process, purulent inflammation.
2. Disorder of thermal sensitivity of skin.
1) sensation of heat, which is regulated or distance from a source of an
irradiation, or rheostat, giving an opportunity to adjust force of an
electrical current which is taking place through a source of IR rays and
by that to change its degree of incandescence .
2) duration of procedure (from 15 up to 60 minutes);
3) repetition factor of realization of procedures (two times per day or daily);
4) By quantity (amount) of procedures on a rate of treatment (up to 25).
2. Ultra-violet irradiation
For reception of UV rays we use luminescent light sources representing a lamp AMT
(arc mercury tubular). Its former name SMQ (straight line mercury-quartz). Lamp AMT is a tube
of cylinder form made of quartz or uviol glass, which passes UV rays. In end parts of tube
metal electrodes are soldered in for connection with a source of an electrical current. Air from
tube is removed and is replaced easily by ionized argon. In a tube there is a small quantity of
mercury turning during work of tube into vaporous condition. Through the tube passes an
electrical current of a voltage 120 v and force up to 4 A. Thus vapors of mercury begin to
shine. Up to 70 % of a light flow make UV rays, rest is seen area, mainly violet, light-blue and
green zone.
UV area of radiation is divided into three zones: long-wave from 400 up to 320 nm,
middle-wave from 320 up to 280 nm and short-wave from 280 up to 180 nm. From positions of
practical physiotherapy the allocation of a zone of long-wave ultra-violet rays (LUV) and zone
of short-wave ultra-violet rays (SUV) is important. LUV and SUV radiation are combined with
middle-wave one, which specially is not allocated.
The sources of UV radiation we divide into integrated and selective. The integrated
sources radiate all UV spectrum, selective any zone, which is short- or long-wave one. The
spectrum of radiations required for medical application, is provided with mode of operations of
a lamp in sources of an integrated flow or SUV rays, or special covering of its internal surface
detaining SUV rays, in sources of LUV rays. Devices:
a) sources of an integrated flow UV rays:
- IMQ (irradiator mercury-quartz) on a support;
- UGD (ultra-violet group desktop) irradiator, or IN (irradiator of
nasopharynx), stationary device for the group located irradiations of
tonsils, acoustical pass, mucous environments of a cavity of a mouth and
nose. It is completed by the appropriate tubes;
- irradiator such as "Mayak" for general group irradiations;
b) The sources of SUV rays, in which are established arc bactericidal (AB) lamp, or AMT
lamp , fed by an electrical alternating current UHF, MICROWAVE;
• BIR (bactericidal irradiator remote) on a support;
• BIP (bactericidal irradiator portable);
• SUVI (short-wave ultra-violet irradiator), for the individual located
irradiation of tonsils, auditory meatus, mucous environments of nasal cavity and mouth.lt is
completed by the appropriate tubes.
- BIS (bactericidal irradiator on a support), WBI (wall bactericidal
irradiator). BMI (bactiricidal mobile irradiator), are intended for an
irradiation of premises:
c) The sources of LUV rays, in which are established luminescent erythema lamp (EL):
- EGR (erythema group remote), for general group irradiations;
- EMI (erythema mobile irradiator), includes except EL lamp two
incandescent lamps with capacity of 500 wt; it is intended for general
group irradiations.
Except for the device EMI other devices for combined influence by UV and IR rays are
produced. For example, portable device «Electronics UFO-01-250H".
The basic biophysical processes occur at an electronic level. Electrones move from one
power level to the other, a higher one, having received energy from UV quantum for
overcoming an attraction of a nucleus. If the energy of UV radiation is great enough, electrone
is beaten out from an external orbit. The particle which has lost electrone, becomes positively
charged, and accepted the beaten out electron - negatively charged. These processes of
moving of electrones are named as photoelectric effect. As a result of such processes atoms
and the molecules are made active, the electrical properties and disperciveness of colloids of
cells change, that influences their ability to live. UV rays render photochemical action, which
displays processes of photoisomerization. In molecules there is an internal regrouping of atoms
without change of chemical structure of substance. Thus the biological object gets new
chemical and biological properties.
Under influence of UV rays there is a process of photooxidation strengthening of
oxidizing reactions in tissues.
Distinguish direct (local) and general action of UV rays. The general action includes
humoral, neuroreflex and vitaminoforming. Using various dosage and techniques of an
irradiation it is possible to receive prevalence of this or that action.
The direct action is shown in a skin, deep into with which UV rays will penetrate not
further 1 mm. Thermal action they don't have (" cold rays "). SUV rays are absorbed first of all
by proteins contained in a nucleus of a cell, LUV rays - by proteins of protoplasm. At intensive
enough and long influence comes denaturation and coagulation of protein, as the result is
necrosis of epidermis cells, aseptic inflammation. The lost protein is split by proteolytic
enzymes. Thus the biologically active substances are formed: histamine, serotonin,
acetylcholine and others, the quantity of products of oxidation, first of all lipids peroxides is
increased.
The externally local action is shown by formation of UV erythema, the skin becomes
slightly hydropic and painful, its temperature raises. This erythema is uniform, with precise
borders, occurs through the certain latent interval of time: under action of SUV rays in 1,5-2
hours, LUV rays in 4-6 hours. The maximal intensity it reaches in 16-20 hours, some days,
gradually dieing away keep. Erythema keeps longer, caused by LUV rays. The skin of a
stomach is most sensitive to UV rays. Further on a degree of decrease of sensitivity come: skin
of a breast and back (about 75 % in relation to sensitivity of skin of a stomach), outside
surface of a shoulder (75- 50 %), forehead, neck, hip, calf (50-25 %), back surface of hands
and feet (25 %).
At repeated influences on the same part of skin the accomodative reaction to action of
UV rays develops. It is shown by a thickening of a horn layer of skin and adjournment of a
pigment melanin. Melanin is formed in 3-4 days after occurrence erythema. Pigmentation is
possible without preliminary formation of erythema. Melanin protects more deeply laying
tissues from superheating, absorbing seen and IR rays. Melanin itself hardly protects from
influence of UV rays, as it is formed in basal layer of skin, where they will not penetrate. The
pigment is formed under action of UV rays. The rays of a zone SUV have powerful bactericidal
action; with this purpose they are mainly applied. UV rays stimulate activity of cellular
elements of skin that is confirmed by increase of quantity of mitosis. In result the processes of
epithelization are accelerated, the formation of a connective tissue is activated. In connection
with such action they are applied to treatment of slowly healing wounds and ulcers. The
activation of neutrophyls and macrophages increases resistibility of skin concerning an
infection that is used for treatment and preventive maintenance from pustular defeats. Under
influence of erythema dozes of UV rays the sensitivity of nervous receptors of skin is reduced,
the part of them collapses, subsequently being restored. Such action is the indication for
application UV rays with the purpose of pain-killing.
General humoral action of UV rays is connected with absorption and fall of biologically
active substances formed in skin into blood flow. This action is usual is considered on an
example of histamine, physiological antagonists which are catecholamine: adrenaline and
noradrenaline. If the quantity of histamine and other biologically active substances is so great,
that the activity of sympathoadrenal system is unsufficient for neutralization of their action,
the general pathological reactions prevail, that is observed at an irradiation by erythema dozes
of the large surfaces of skin. In this case can arise destructive changes in adrenal glands. The
repeated applications of medical dozes of UV rays stimulate by humoral mechanism of
sympathoadrenal and hypophysis-adrenal system, function of cortex of adrenal gland, thyroid
and sexual glands, that at the end raises their serviceability. Such influence creates effect of
training.
Among humoral effects of the special attention the activation of reactions of immunity
deserves stimulation of immunobiological protection of the organism. The following things are
noticed: the increase of the contents of immunoglobulines in blood, titer of complement at its
initially low size, phagocytory activity of neutrophiles of peripheral blood. Is found out, that UV
rays possess desensitizing action. General neuroreflex action of UV rays is connected with an
irritation of extensive receptor system of skin. As a result of regular general irradiations
answer-back of reflex reaction are improved, that is expressed in decrease of generalization of
reflex answer and amplification of local protective reactions. Anti-pain action of UV rays is
observable at a local irradiation, is connected not only with influence on receptors of skin, but
also creation of a majorant in the central nervous system. The small dozes at a general
irradiation stimulate receptors of skin and by reflex way stimulate activity of the central
nervous system. The influence on endocrine glands is realized not only by humoral
mechanism, but also by means of reflex of influences on hypothalamus.
With the account of so close interaction of humoral and neuroreflex mechanisms, the
theory of general action of UV rays we consider as neurohumoral.
Vitamin-forming action of UV rays consists in stimulation of synthesis of vitamin D. It is
connected with physico-chemical action of a zone LUV rays - process of photoisomerization.
From provitamines, taking place in fat of sebaceous glands of skin, the vitamin D is formed:
from ergosterin - vitamin D2, from 7-dehydrocholesterine - vitamin D3, from 2,2 -
dehydroergosterine - vitamin D4 is formed. The influence of UV rays on phosphoric-calcium
exchange, their antirachitic action is connected with formation of vitamin D. The rays of a zone
SUV do not have such effect.
_____________________Basic indications to application.
_____________________________
a) Local irradiation:
1. Limited defeats of skin and mucous environments with the purpose of
bactericidal action,stimulation of healing: infected wounds and ulcers, erysipelas of skin,
irradiation through a tube at diseases of palatinetonsils, mucous cavity of a mouth, gullet,
external auditory meatus.
2. Disease of peripheral nervous system accompanied by pain, first of all at
acute stage.
3. Arthritis (polyarthritis), hypertrophic arthritis, acute and exacerbation of
chronic ones.
4. Inflammatory diseases of internal organs in acute and subacute stages (for
example, organs of a small pelvis, bronchus, lungs); influence on appropriate reflexogenic zone
of skin.
5. For desensibilization (for example at bronchial asthma by fields on chest).
b) General irradiation:
1. Tempering, increase of stability to infectious diseases.
2. Indemnification of natural UV insufficiency (work in mines, underground, conditions
of north).
3. Rachitis of children - treatment and preventive maintenance; fractures of
bones in a stage of rehabilitation (with the purpose of mobilization of
phosphoric-calcium exchange through formation of vitamin D).
l. Increased sensitivity to UV rays.
2. Generalized dermatitis.
3. Toxic goiter, functional insufficiency of adrenal glands (in particular at
Addison's disease).
4. Acute and chronic glomerulonephritis.
5. Chronic active and autoimmune hepatitis.
1) a biodoze (erythema or suberythema);
2) repetition factor of realization of procedures (at a local irradiation in 2-3 days
on the same part of skin, at a general irradiation daily);
3) quantity of procedures on a rate of treatment (at a local irradiation 3-4
influences on the same site of skin, at a genera irradiation up to 25).
In physiotherapy the biological method of dozing of UV rays estimating individual
reaction of the man is used. Unit of a doze is one biological doze (1 biodoze).
1 biodoze is minimal time of an irradiations expressed in minutes, which is
enough for reception of threshold erythema. Threshold erythema is weakest (minimal)
erythema, but uniform and having precise border. For definition of a biodoze is used
biodosimeter of Gorbachev-Dolfeld, representing a plate with six rectangular apertures (fig.
15). It is fixed on skin of a stomach on the left or on the inernal side of forearm. A source of UV
rays, with which help the medical procedures will be carried out subsequently, establish on
distance 50 cm from a surface of skin, open the first aperture and irradiate it within 0,5
minutes. Further with an interval of 0,5 minutes consistently open other five apertures. Hence,
skin of the first site is irradiated 3 minutes, second - 2,5 minutes, third -
2 minutes, fourth - 1,5 minutes, fifth - 1 minute and sixth - 0,5 minutes.
Other day (in 18-20 hours) estimate intensity of received erythema on
different sites of skin and choose threshold.
Fig. 15 Biodosimeter
We distinguish the following types of dozes: suberythema, that is not causing
erythema of skin, and erythema. Suberythema doze is a part of a biodoze, which is accepted
for designating in simple fraction (from 1/8 up to 7/8 biodozes). Among erythema dozes
allocate small or poorly - erythema (1-2 biodozes), average or erythema (3-4 biodozes), large
or hypererythema (5-8 biodozes).
The general irradiation will be carried out usually suberythema dozes, and local -
erythema. By erythema dozes we irradiate during one procedure a site of skin, area isn't more
than 800 sq cm or some sites of the same total area.
3. Laser radiation.
The lasers are optical quantum generators. The name they have received from a
combination of the first letters of a phrase in English "Light amplification by stimulated
emission of radiation” ("LASER"), that the amplification of light is translated as "as a result of
the compelled radiation".
Atoms, of which the various substances consist, in the elementary kind represent
system consisting of a nucleus and rotating around it electrones. In usual conditions this
rotation occurs on constant, so-called basic (stationary) orbits. Thus the atom has a minimum
quantity of energy. The external influences can give to electrone the additional energy
allowing it to overcome an attraction of a nucleus and to proceed into more removed orbit. The
atom will proceed in the exited condition. But this condition is unstable. Through a very short
interval of time (about 10~b sec) electrone comes back to a former orbit, having allocated the
absorbed energy as quantum of light (photon). Such spontaneous transitions of electrone from
one orbit to another are accidental, are independent from each other, occur in different time.
In usual conditions the number of the atoms which are taking place in an exited condition, is
insignificant, therefore energy of spontaneous radiation is insignificant. In a fig. 16 the circuit
of the elementary optical quantum generator (laser) is submitted.
Fig. 16 Circuits of the optical quantum generator: 1 - working body (active substance);
2 - system of excitation ; 3 - power supply; 4-system of cooling; a 5-laser ray.
In lasers the main component is the working body, which represents by itself active
environment or active substance: various gases, liquids, firm bodies, semiconductors. The
substances understand activity of environment or their such condition, when the number of
the atoms which are taking place in an exited condition, exceeds number of atoms staying at
the basic power level, that is in a quiet condition. In the exited condition a working body
results more often by influence of optical or electrical energy.
The following stage of process - transition of atom from exited to the basic condition.
This transition can occur not only spontaneously, but also under action of electromagnetic
waves. Artificial influence by electromagnetic irradiation upon working part allows making the
process a controlled one. In this case according to the principle, formulated by Einstein, the
exited atoms irradiate photons with the same frequency, phase and in the same direction as
the electromagnet waves provoking this irradiation. Transitions of electrons under the
influence of external irradiator are called forced ones, and corresponding irradiation is also
forced one. At presence of great amount of quanta of external irradiation and great amount of
exited atoms in the working part their transformation from exited to primary state occurs and
this leads to laser irradiation. In semiOconductor lasers occurs the direct transformation of
electric energy into laser irradiation that allows making the device quite small.
As distinct from other types of light flow laser irradiation is monochromatic, coherent
(it means that phase of waves of light coincide in space and time). High degree of coherence
difines strict direction of laser irradiation, letting to concentrate it at small area.
Lasers are classified according to the following physico-technical parameters:
1) Active substance (working body) - solid-state, gas-state, fluid, semi-conductive.
In physiotherapeutic devices most frequently are used helium-neon lasers and carbon dioxide
lasers;
2) The length of wave of irradiation - UV range, visible range, IR range, multiple-
tuned range;
3) Mode of irradiation - continuous, impact.
Devices:
- “Yagoda", laser physiotherapeutic plant (LPP). Helium-neon laser, mode of irradiation
is continuous with power up to 10mWt, length of wave is 0,63mkm;
• "Raskos", helium-neon laser, mode of irradiation is continuous
with capacity up to 15mWT, length of wave is 0,633mkm;
• "Galamed" is similar to "Raskos", but the capacity is up to 20 mWt;
• "Uzor" is laser therapeutic device (LTD), arsenid-gallic laser, mode of
irradiation is impact (80, 150, 300, 1500, 3000 Hz), capacity of impulse is up to 2 wt, length of
wave is 0,89mkm (IR range). Nowadays there are many types of devices are produced. There
are also universal, which are made for use in physiotherapy and in surgery, for example
"Rasbor" LGM-2. Some devices are
completed by optical fibers for introduction into vein, for example LDBI (Laser device of blood
irradiation). There are devices for combined influence by laser irradiation and other physical
phactors, for example MLTD (Magnet-infrared laser therapeutic device) for treatment by
constant magnet field, non-coherent light flow of IR sphere and laser impact irradiation of IR
range.
Irradiation is brought to tissues distantly or by contact. Different types of irradiators
are grouped by prof. V.I. Korepanov (1994) in the following way:
a) contact
b) contact with compression (compression provides greater depth of
penetration of irradiation)
c) contact-mirror (special reflectors help maximum absorption of
irradiation by tissues, it does not influence the staff)
d) intravascular
e) intraorganic (optical fiber is inside stomach, urinary bladder etc)
f) intracavitary (optical fiber is in pleural or abdominal cavity, cavity
of cyst, abscess etc);
g) extracorporal (distant irradiation of infusion medium, auto- and
donor blood).
The basical biophysical processes.
Thermal effect of laser irradiation is studied well enough. It has a lot in common with
thermal effects of other sources of light of visible and IR range, but thermal effect of laser
irradiation has a number of specific peculiarities. Different biological objects absorp irradiation
of different length of wave. Laser irradiation is monochromatic, its absorption is selective. IR
irradiation of remote zone is absorbed first of all by water. Irradiation of visible sphere of long
wave about 7mlm is absorbed by pigmental formations, molecules of hemoglobin quite well.
Irradiation of the nearest IR zone warms up the membranes of the cells strongly. As a result of
local warming of membranes there appeares gradient of temperature in paramembrane areas
that evokes thermodiffusion outflow of sodium and potassium ions. As a result of it the canals
of cellular membranes open up, the transport of ions and active molecules increases. Changed
electro-chemical ionic balance increases the energy of cell. At influence with impact laser
irradiation the formed warmth has no time to spread upon the neighbouring tissues and fluids.
At great capacity of impulse the momentary warming evokes a kind of explosion of elements
of tissue.
Photochemical reactions are stimulated by visible and UV irradiation. Molecules turn
into excited state as a result of inner transformation of position of atoms. There is observed
the change of membranous potential of cell, charge of its electric field. Free radicals are
formed in tissues intensively. Laser irradiation as distinct from usual light provides selectivity
of stimulation of biochemical compounds, having narrow stripes of absorption.
Mechanical action is peculiar to laser irradiation of high capacity in impact mode. As a
result of direct influence of impulse there appears blast wave in tissues. Its consequence is
formation of sites of compression and depression, spreading deep into tissues. There are
different theoretical possible reasons of mechanical strain in tissues may be considered: a)
light pressure, the value of which is maximum, if the whole irradiation is absorbed at the
surface of tissue; b) pressure of feedback - emission of substance from a surface of irradiated
object towards to a laser ray and occurrence of a pulse of feedback working on a direction of a
ray; c) electrosticking - redistribution of a charge in dielectric, that conducts to occurrence of
the mechanical rotating moment; d) sudden overheating of the irradiated site of a tissue
accompanied by its fast volumetric expansion, that results in occurrence of elastic fluctuations
of a ultrasonic range in boundary areas.
The depth of penetration of laser radiation into tissues depends mainly on two factors;
the spectral characteristic of radiation and structure of tissues absorbing it. The same laws
here are observed, as well as at influence of a usual light flow of IR, seen and UV areas. In the
whole penetrating ability of laser rays is estimated in 2-3 mm, but the rays of nearest IR range
with length of a wave from 0,8 up to 1,2 microns allow to influence depth 5-6 cm. The share of
the reflected radiation can make from 5 up to 40 %. In physiotherapy the radiation of nearest
IR and red part of visible range is used mainly.
The large capacities of laser radiation destroy tissues due to heating and mechanical
action. They are used in surgery: "laser scalpel ", designed in 1964. In physiotherapy the
radiation of low power, so-called low intensity laser radiation is used. Its influence on tisssue
and organism as a whole in many respects reminds action of usual light of appropriate length
of a wave. But the special physical characteristics of laser radiation define a number of other
laws of its action, its higher activity. The basic reactions are observed in skin and superficial
tissues. As a whole low intensity laser radiation is stimulator of cellular activity nonspecific
biostimulator of reparative and metabolism processes in tissues. In cells enzymatic system is
activated, the accumulation of DNA and glycogene is accelerated, the respiratory activity of
mitochondrion raises. The consumption of oxygen by tissues is increased. The stimulating
action is especially precisely shown in tissues which are taking place in a condition of
reparative regeneration. At local application can be observed antiinflammatory action of laser
radiation. The formation of cellular shaft around of the center of an inflammation due to
stimulation of activity of neutrophils and macrophages, acceleration of prolypheration of
fibroblast is made active. Edema of tissues decreases and the broken microcirculation is
normalized. The certain meaning has bacteriostatic effect. The laser radiation influences on
nervous receptors, changing their excitability and rendering anesthetic effect. The effect of
stimulation of regeneration of a nervous tissue is clearly shown. Alongside with local changes
of tissues the laser radiation stimulates non-specific protective systems of organism and
adaptive response by neuroreflex and humoral to mechanisms. Such stimulation is expressed
at more extensive influences, rather than local, punctated. The irritation of receptors of skin in
area of reflexogenic zones changes character of impulses into cerebral cortex and subcortical
structures. In reply to it is formed regulating reaction from the side of the central nervous
system. At the same time hypothalamohypophysial suprarenal system and other endocrine
glands are active. Compensatory and adaptive reactions are directed to restoration of broken
homeostasis. These effects depend on an initial condition of this or that system that explains
apparent universality of therapeutic action of laser radiation at various diseases. The activation
of system of immunity, desensibilizing effect, increase phagocytic activity of neutrophils and
macrophages is observed also. All taken together raises protective adaptive reaction of
organism. Thus, the influence of laser radiation at all levels of organization of living matter is
established: subcellular, cellular, tissue, organ, system and organism. This complex and
multivariate action is investigated not completely.
1. Lingering non- healing wounds, trophic ulcer.
2. Purulent - inflammatiry processes in soft tissues (at presence of a drainage):
furuncules, phlegmones, abscess.
3. Skin diseases: eczema, neurodermatitis, psoriasis, herpetic infection.
4. Infammatory, traumatic, metabolic-dystrophic diseases of musculoskeletal system,
including fractures of bones (for acceleration of consolidation), defeat of periarticular tissues
and sinews.
5. Inflammatory diseases of mucous environments of a cavity of a nose,
gullet, mouth, including tonsillitis.
6. Diseases of peripheral nervous system, including the ones accompanied by pain.
7. Diseases of internal organs: stomach and duodenal ulcers, inflammatory defeats of
bronchus lungs system, essential hypertension (influence from the appropriate skin zones).
Specific contra-indications to application of cold laser radiation are not revealed. Look
section "General contra-indications to physiotherapy". Dosage according to:
1) density of a flow of capacity of radiation in mWt on 1 sq cm of the area (from 0,3 up
to 10 mWt/sq cm);
2) duration of procedure (influence on one field about 5 minutes, on
some fields - total time of influence about 30 minutes);
3) On repetition of realization of procedures (daily);
The note: at intravenous irradiation of blood capacity at an end face of light-carrying fiber up
to 5 mWt, time of an irradiation is about 30 minutes. The procedures daily or with breaks of
some days are possible. Take into account that the restoration of structure of endothelium
after a 30-minute irradiation occurs in 6 hours.
Ultrasound therapy.
Ultrasound is a version of mechanical energy and represents mechanical fluctuations
of elastic environment by frequency more than 16 khz, which are not perceived by human ear.
These fluctuations are transferred as longitudinal waves, which cause alternate compression
and rarefaction of environment or substance (fig. 17). The more is capacity of transmitted
energy, the bigger is the amplitude of deviations of particles of environment from an initial
condition. Distance including one area of compression and one area of rarefaction, makes
length of a wave, which will be back proportional to frequency of fluctuations.
The ultrasonic waves of low frequencies are distributed spherically. In process of
increase of frequency of fluctuations and, according to this, reduction of length of a wave, the
beam of ultrasound waves becomes more rectilinear. The straightforwardness of distribution of
ultrasonic waves of high frequency (800 - 3000 khz) causes their application in physiotherapy.
These waves are distributed in parallel to each other, they can be concentrated on the limited
site. The law of distribution of high-frequency ultrasonic waves comes nearer to law of
distribution of light: absorption, refraction, reflection from border of two environments.
Absorption of ultrasonic waves in different tissues is various. For example, factor of
absorption of ultrasound for bone tissue is 12-15 times higher in comparison with muscular
tissue. As a whole the higher is frequency of fluctuations, the more intensive is absorption, the
less is the depth of penetration. Ultrasound of high frequencies is intensively absorbed by air.
Its slightest layers between radiator and surface of a skin detain ultrasonic waves. In this
connection at medical influence use vacuum contact environments: liquid paraffin, glycerin,
lanolin (fig. 18). When the dense contact between oscillator of ultrasound and surface of a skin
(area of hand, feet) is impossible, will carry out remote influence through water with a
backlash 1-2 cm.
Fig. 17 The graphic image of ultrasonic waves (condensation and rarefaction of

particles of substance): 1 - acoustic pressure; 2 - length of a wave; 3 - amplitude of a wave.
For reception of ultrasound the return piezoelectric effect is used. Piezoelectric effect is
the phenomenon of electrical polarization of crystals caused by their mechanical deformation:
compression, stretching, bend, torsion. Such properties have the crystals of quartz, barium
titanate, Rochelle salt and others. On the other hand, at putting of these crystals in a variable
electrical field they are compressed and are stretched depending on a direction of a field. The
frequency of the received mechanical fluctuations corresponds to frequency of fluctuations of
an electrical field. Thus, the device for reception of ultrasound consists of the generator of high
frequency and ultrasonic oscillator (vibrator, applicator), in which the plate of quartz or barium
titanate is placed.
Fig. 18 Circuits showing role of contact environment at influence by ultrasound: 1 -

oscillator; 2 - skin; 3 - air; 4 - contact environment.
Devices: - UZT (ultrasonic therapeutic), portable device. The model 1,01F radiates
ultrasound by frequency 880 khz, model 3,01-g -2640Hz; -" of Ultrasound - T5 ", the portable
device, radiates
Ultrasound by frequency 880 khz. The devices work in continuous and pulse modes,
the frequency of pulses 50hz, pulses of various duration, which is expressed in milliseconds.
The devices are completed by demountable vibrators with a radiating surface 1 and 4 cm 2. The
special devices for treatment of stomatological, urological, ophthalmological, ENT diseases and
others are produced.
The basic biophysical processes in tissues are connected to three main effects of
ultrasound: mechanical (mechanicodynamic), physicochemical and thermal.
The mechanical action is shown at cellular and subcellular levels. The influence by
ultrasound of the large intensity results in break of tissue with formation of microscopic
cavities, the time of which existence is commensurable with the period of ultrasonic
fluctuations.
This phenomenon is called cavitation (cavum-cavity), at application of therapeutic
dozes is not observed. The mechanical action of ultrasound of small intensity is used in
physiotherapy, consists in vibrating micromassage of tissues. Thus in cells and tissue
structures the processes of diffusion and osmosis amplify.
The physicochemical activity of ultrasound is connected to the complex electronic-
quantum phenomena at a molecular level. The movement of molecules is accelerated, the
formation of ions amplifies. In tissues the quantity of free radicals is increased, the formation
of biologically active substances and oxidation-redaction reaction is activated, raises dispersity
of colloids of cells. In therapeutic dozes of ultrasound is the catalyst of biochemical reactions.
The electronic-quantum phenomena sharply increase their own chemoluminescence of blood.
At application of large intensity of ultrasound (in dozes exceeding therapeutic ones many
times) is possible to observe decolouration of organic dyes, oxidation of potassium iodide that
also confirms the presence of physico-chemical effect.
The thermal effect is connected to transformation of mechanical energy into thermal;
here we talk about endogenous heat. Heat is allocated first of all in tissues intensively
absorbing ultrasound: a nervous tissue, bones. There happens heating of all tissues –
volumetric heating, the heat is also evolved on border of two environments of different
acoustic density - structural heating. As in physiotherapy the ultrasound of law intensity is
used, the noticeable increase of temperature of a tissue during procedure is not observed. The
thermal effect in this case plays a supporting role.
The basic physiological reactions and medical action. Depending on a used doze it is
possible to observe damaging, oppressing and stimulating action of ultrasound. In
physiotherapy we use dozes, which cause stimulating effect, do not cause destructive changes
in tissues. It is necessary to take into account, that the dozes ensuring stimulating action, are
very close to dozes causing an oppression of function. It is easy to overdose the medical
procedure.
The depth of penetration into tissue of ultrasound by frequency 800-1000 kHz is
estimated in 5-6cm, by frequency 2400 kHz is three times less. Best of all the ultrasound will
penetrate into a fatty tissue, lingers over mascular and nervous ones. The significant quantity
of ultrasound is absorbed on border of tissues with various acoustic density. 60 % of energy of
ultrasound, falling on bones is reflected. In small, subthreshold dozes of ultrasound can
penetrate on depth up to 20 cm, to what the given visualization of the waves, reflected from
this depth testify. This fact is used in ultrasonic diagnostics. The physiological answer-back
reactions connected to the basic biophysical effects are closely bound and cooperate. In
therapeutic dozes ultrasound renders in the whole stimulating influence on function of cells. In
an initial phase of influence is observed swelling of mitochondria, deviation in structure of
matrix, and the structure of cellular form becomes degraded. The irritation of a cell results in
activation of its ability to live, amplification of respiratory activity of mitochondria. As a whole
the effect biological stimulation is observed which keeps within several hours after unitary
influence. Higher dozes cause sudden changes of cellular microstructures, suppress activity of
a cell, there are attributes of damaging action.
At influence by ultrasound on a connecting tissue rejuvenation of its cellular and
fibrous structures is observed. There are cells with plentifully submitted protoplasm, in the
basic substance the quantity of elastic fibers grows and collagen formation is oppressed. At
influence on superfluous connecting tissues with the changed structure of ultrasound renders
scatting action that makes the scar more elastic. Ultrasound of small intensities accelerates
regeneration of the damaged nervous fiber, reduces sensitivity of receptors that is shown by
anesthetic action. Ultrasound works on receptor system of skin, not causing appreciable
subjective sensations. The skin of the person and stomach is most sensitive to its influence.
The influence on skin receptors of definite reflexogenic zones results in general answer-back
reactions, which are realized through high vegetative centers, hypothalamic-pituitary system.
According to this mechanism of action the ultrasonic therapy raises lability of the nervous
centers and adaptation-trophic function of the entire organism. In some medical procedures
this general action of ultrasound is used.
1. Commissural and cicatricial processes (burning injury, perivisceral complication,
stomach ulcer, inflammatory diseases of female sexual sphere).
2. Degenerative-dystrophic disease of joints of extremities and backbone.
3. Inflammatory diseases and traumatic defeat of the musculoskeletal system defeat of
para-articular tissues.
4. Inflammatory diseases of ENT-organs, female and man's sexual spheres.
5. Disease of peripheral nervous system, including defeats of facial and trigeminus.
6. Stomach ulcer and doudenal ulcer, bronchial asthma (influence of appropriate
reflexogenic zones).
1. Sharply expressed functional frustration of the central nervous system.
2. Thrombophlebitis (in a zone of influence).
3. Infringement of a rhythm of heart.
4. Influence on area of large vessels, cerebrum, displayed bone surfaces.
Dosage according to: 1) intensity of influence (from 0,05 up to 1,2 wt/cm2);
2) mode of influence (continuous or impact);
3) duration of procedure (from 2 about 6 minutes upon one part, at
influence on several parts total time is about 15 minutes);
4) area of irradiation (one field is not more than 250 sq. cm, per
the first day no more than two fields, the next days - up to five fields);
5) repetition factor of realization of procedures (daily or every
other day);
6) quantity of procedures on a rate of treatment (from 6 up to 14).
Phonophoresis is a combined influence of ultrasonic waves and medicinal substance
on tissues. Under influence of ultrasound raises adsorptive ability of a skin, through cells and
intercellular space begin to penetrate particles of medicinal substance in quantities, sufficient
for rendering of medical action. The depth of penetration is limited actually by skin, in which
medicine is deposited. The quantity of medicinal substance received by organism at
phonophoresis makes from 1 up to 5% its quantity used at realization of procedure.
Engineering of procedure of phonophoresis is the same, as at usual procedures of ultrasonic
therapy, but on contact environment the medicine is added. The orientation of action of
medicinal substance should coincide with an orientation of action of ultrasound. The medicinal
substance thus should not lose the pharmacological activity. Is most distributed is
phonophoresis of glucocorticoid (usually hydrocortisone) and nonsteroidal antiinflammatory
preparations at diseases of joints and para-articular tissues.
The procedures daily or with breaks of some days are possible. Take into account that
the restoration of structure of endothelium after a 30-minute irradiation occurs in 6 hours.
Thermotherapy
Thermotherapy - application with the medical purposes of the heated up bodies named
as heat-carriers. The heating of tissues occurs at direct contact to the heat-carrier.
Thermotherapy is one of the oldest and most widespread methods of physiotherapy. It
was applied before and the plenty of various heat-carriers offered as by folk, and official
medicine is applied now. The thermal influences cause change of metabolism. At increase of
temperature of a tissue for 1C the intensity of exchange processes in it grows approximately
by 10 %. For achievement of medical effect it is enough to increase temperature of a tissue for
4-5 C, but the heating should be long enough, and thermal flow uniform and stable. In this
connection the heat-carrier should have the certain physical properties, due to which such
heating is provided.
The preference should be given back to heat-carriers having large thermal capacity.
Thermal capacity is a quantity of heat expressed in small calories, which is required for
increase of temperature of 1 g of substance for 1 C. The more is the thermal capacity of the
heat-carrier, the more warmth is transferred to tissues. Other important characteristic of the
heat-carrier is thermal capacity, on which the ability of substance depends to transfer heat. At
contact with the heat-carrier in a tissue the thermal flow is directed, which intensity is
measured by quantity of heat which is taking place for a time unit through a unit of surface.
The more is the thermal capacity of the heat-carrier, the more intensive is the thermal flow. As
for reception of medical effect the large heating of a tissue is not required, the heat-carriers
with small thermal capacity are more preferable which provides a thermal flow of small
intensity. With thermal capacity the heat-retaining ability of the heated up body is closely
connected. The less is the thermal capacity, the longer time the heat-carrier remains heated
up, the longer time a thermal flow takes. The important meaning in processes of heat emission
has convection-mixing of cold and warm layers of the heated up substance or environment.
Heat emission of water, for example, is provided mainly by convection. In heat-carriers used in
physiotherapy, convectional flows are insignificant or practically are absent. At contact of such
heat-carrier to tissues its thin layer, directly adjacent to skin, is quickly cooled. Basic weight of
the heat-carrier gives back heat through this cooled layer by means of thermal conductivity. As
the heat-carrier has small thermal conductivity, the patient easily transfers high enough
temperature of heat-carrier.
Hence, as heat-carriers first of all are used substances having large thermal capacity
and small thermal conductivity in which convection is minimal or absent.
The basic physiological reactions and medical action of heat, basic indications and
contra-indications to its application were discussed in the previous chapters. We remind of the
following main effects of heat: antispastic, anodyne, intensifying blood- and lymph circulation
and metabolism in tissues. To last effect is connected absoptive and regenerative action of
heat, in particular at inflammatory processes.
The heat-carriers apply mainly as local influences - applications. The procedure is
dozed according to temperature of the heat-carrier and duration of influence (30 - 60 minutes).
The procedures are carried out daily or every other day, in quantity from 12 up to 20 on a rate
of treatment.
The basic indications to thermotherapeutic procedures:
1. Inflammatory processes (without suppuration) in a stage of the resolution
2. Degenerative-dystrophic and inflammatory disease of the musculosceletal system.
3. Disease and trauma of peripheral nervous system.
4. Consequence of traumas with the purpose of analgesia(bruises, stretching of
ligaments).
5. Hypermotor dyskinesia of internal organs.
6. Contracture of muscles of spastic type (before medical gymnastics).
The basic contra-indications to thermotherapy.
1. Acute and subacute stage of inflammatory process, purulent inflammation,
aggravation of chronic diseases.
2. Infringement of thermal sensitivity of skin.
1. Medical application of paraffin and ozokerite.
Paraffin (parumal This - ineffective, Lat.) is the mix of firm high-molecular hydrocarbon
of methanoic line, has a microcrystal structure. Paraffin is received by special processing of
some grades of petroleum. Depending on a degree of clearing of paraffin, the contents in it of
petroleum oils distinguish high-purity, cleared and crude grades. In physiotherpy we use high-
purity and cleared paraffins representing mass of white colour.
The melting point of different grades of paraffin changes over a wide range. In
medicine high-melting paraffins are used, which melting point is 52-55 C.
The paraffin has high heat capacity, very small heat conductivity and practically is
deprived of convection. In medical effect its special meaning has latent heat of melting -
quantity of heat spent on transformation of paraffin from a solid condition into liquid one. At
back transformation from a liquid condition into solid the latent heat of the hardening equals to
latent heat of melting. During this transition temperature of weight of paraffin used for
application, remains constant that provides a stable thermal flow for long enough time (fig.
19).
At heating of paraffin before medical procedure its temperature is brought up to 95 C.
For this purpose special paraffin-heaters with electric heaters are used, which works by a
principle of water-bath.
Fig. 19 Curves of cooling 75 g of substance at temperature of air 18 C: 1 - paraffin; 2 -

water. The following techniques of paraffinotherapy are applied.
1. Cuvette applicable method: enameled vat is used, which size corresponds to the
area of imposing of paraffin. In laid out by a medical oil-cloth vat we pour melted paraffin by a
layer of thickness 1-2 cm. Stiffened, but still soft paraffin take out from vat together with an
oil cloth, impose on a site of a bodies subject to influence, and cover with quilted jacket or
blanket. This method is most simple on engineering of performance, can be used in home
conditions. It is possible to transfer the vat to chamber and to carry out procedure outside of a
heat-therapy
room.
2. Napkin-applicable method: melted paraffin we put on a surface of a skin by a
brush up to thickness of a layer 0,5 cm. On this layer impose a napkin made of 8-10 layers of a
gauze, and moistened in melted paraffin. A napkin cover with an oil-cloth, then with blanket.
3. Method of lay-up: melted paraffin put on a surface of a skin by a brush up to
thickness of a layer 1-2 cm, cover with an oil-cloth, then with blanket
4. Method of a paraffin bath: are used for influence on a hand or foot, which cover
with paraffin by a method of lay-up. Then a hand or foot immerse into melted paraffin which
has been heated up till 60-65 C, with which is filled special tub or oil-cloth bag.
At paraffinotherapy it is necessary to watch, that skin influenced by paraffin should be
absolutely dry in avoidance of a burn. The hair should be shaved or appropriate site of a skin
to grease with vaseline, so that they did not stick to the cooled down paraffin.
At melting the paraffin mass is increased in volume on 10-15%. At hardening volume
of paraffin accordingly decreases. In case of use circular application of paraffin compression of
tissues is significant. At compression a lot of heat is transferred, at the same time this heat to
a lesser degree is transferred by blood to other organs and tissues. The same paraffin can be
used for heat therapy several times. Before a reuse paraffin should be sterilized by heating it
up to 110 C. Then heating is stopped.
The decrease of temperature of paraffin up to 100 C in usual room conditions takes
time, sufficient for its sterilization. For preservation of elastic properties of reusable paraffin it
is necessary to add 15-20 % of a fresh one to it. Such procedure is possible to repeat 3-4
times. After that the paraffin loses the elasticity, crumbles at cooling and further use is not
possible.
Ozokerite (ozo-to smell, heros-wax, Greek.)," smelling by wax ", mountain wax. It is a
product of a petroleum origin, consists mainly of a mix of solid high-melting hydrocarbons of a
paraffin series with a touch of liquid and gaseous hydrocarbons of the same series. Ozokerite is
natural rock. Its various deposits differ by chemical structure they are various in color: light
green, yellow, brown, black. At a long storage on air ozokerite darkens.
Ozokerite is received, evaporating rock in boiler or extracting by its organic
compounds. Then partial distillation of mineral oils is made, completely release it from water,
mechanical admixtures. After processing ozokerite reminds beeswax.
Melting point of ozokerite is from 52 up to 68 C. Its heat is higher, and heat
conductivity is lower, than the one of the paraffin. Heat retaining ability is much higher than
the one of the paraffin, convection of heat is practically absent.
Medical action of ozokerite is connected not only to its features as heat-carrier, but
also with presence in its structure of the biologically active substances penetrating through an
intact skin. They render acetylcholine-like action, raising tone of parasympathetic department
of vegetative nervous system. There are items of information about more active regeneration
of peripheral nerves at their diseases and traumas at treatment by ozokerite in comparison
with paraffin. It is mentioned about presence of ozokerite in folliculin-like substances, in this
connection its application is recommended at treatment of female sterility, connected with
underdevelopment of ovaries.
In the whole technique of treatment with ozokerite, indication and contra-indication to
its application are the same, as at paraffin-therapy.
2. Mud cure
Therapeutic muds or peloids (pelos - silt, clay, Greek.) represent natural formations
consisting of water, mineral and organic substances having fine-dispersed structure and pasty
consistence. On an origin they are subdivided into six types.
1. Silt sulphide muds - silt sediments of salty reservoirs.
2. Sapropels - silt sediments of stale reservoirs.
3. Peat muds - peat formations of bogs.
4. Clay silts - mineralized deposits of reservoirs with the small contents of organic
substances and absence of ferrum sulfides.
5. Mound muds - semi-fluid clay formations arising at destruction of mountain breeds,
disposable in gas-petroliferous areas.
6. Hydrothermal muds - semi-fluid clay formations arising in areas of active volcanic
activity.
Most widespread, investigated and used with the medical purposes are first three types
of muds: silt, sapropels and peat. In each type of a medical mud three components are
distinguished: a crystal skeleton, colloid fraction and mud solution.
Crystal skeleton - inorganic coarsely dispersed part of mud. It consists of smallest
particles of sand, clay, phosphates and calcium and magnesium carbonates, insoluble in water.
There can be a small quantity of the remains of a vegetative and animal origin. A diameter of
particles is not more than 0,25 mm. The large part of a crystal skeleton in a medical mud gives
to it granularity, friability, reduction of plasticity, which sometimes is required to be increased
by addition of water.
Colloid fraction is a fine part of mud, which connects separate parts of a crystal
skeleton and fills in all its intervals. It consists of complex inorganic and organo-mineral,
organic substances. The important part of it makes colloid ferrum hydrosulfide. Here are
available also ferrous hydroxides,aluminium hydroxides, silicon acid and other compounds.
Organic colloids are products of disintegration of plants and animals, which main part consists
of humic substances, nitrous compounds,organic acids. The important medical meaning have
such substances of an organic origin, as antibiotics, biogenic stimulants, enzyme-like and
hormone-like compounds. Colloid fraction defines plasticity of mud, its dense adjacency, bad
wiping off by water. The physical properties of mud as heat-carrier depend on it.
Mud solution - liquid part of mud consisting of water, mineral salts, dissolved in it,
organic substances, gases. It contains first of all sodium, magnesium chloride and phosphate,
magnesium sulphate, hydrogen sulfide, methane, carbonic gas. Here there are microelements
-iron, zinc, cobalt. The part of mud solution in a medical mud depends on the contents of
colloids in it, possessing hydrophilic properties. Mud solution basically corresponds to chemical
structure of brine - layer of water covering mud sediments. But the structure of brine can vary,
while the structure of mud solution differs by the large constancy. The soluble biologically
active substances are not only in colloid fraction, but also in mud solution. The separate
elements of mud solution, extracted from a medical mud, are applied as injections as biogenic
stimulants: FiBS, peloidodistillate (products of estuary muds), humisole (solution of fractions of
humine acids of sea muds), torphot (solvent stripper of a peat mud).
In destruction and processing of dead plants and animals participating in formation of
a medical mud, the main role plays microflora. The microorganisms make from 2 up to 6 % of
organic mass of mud. Here there are septic aerobes and anaerobes,damaging cellular tissue,
sulphate-reducing and butyric bacterium, various kinds of fungi. The large meaning have
sulphate-reducing bacteria forming hydrogen sulphide. Hydrogen sulphide combines with iron,
forming hydrotroilite, being one of the main components of silt sulphide mud.The pathogenic
for man microflora in medical mud is absent. Microflora participates in regeneration of mud,
that is in restoration of its physico-chemical, microbiological and sanitary - biological
parameters after medical use.
At storage in the certain conditions any type of mud is capable to regeneration, only
the terms of this process are different. For example, silt sulphide mud recycles within 3-4
months, and then it can be used again.
Silt sulphide muds are formed at the bottom of open salty reservoirs, where there is no
intensive excitement and currents. Depending on a site of such reservoir allocate continental
(for example, lake Tambukan in Stavropol Territory), lake-spring, formed in reservoirs, which
are fed be mineralized underground waters (lake of a Thermal resort Sergiyevskiye Mineral
Waters in the Samara area), seaside (lake Sakskoye in a steppe zone of Crimea), sea (ground
sediment in sea gulfs, bays, estuary).
The natural evaporation of water results in accumulation of inorganic salts in brine and
mud solution. The quantity of organic substances in this mud is insignificant, as bioweight of
these reservoirs is rather insignificant. Silt mud is rich by ferrum sulphide giving to it dark
coloring. It has a weak smell of hydrogen sulphide and ammonia. Mud possesses plasticity due
to significant quantity of colloids.
Sapropelic muds (sapros - rotten, pelos - silt, clay, Greek.) are formed at the bottom
of open stale reservoirs due to decomposition of lowest animals and vegetative organisms.
Due to it sapropels contain a plenty of organic colloids, having good hydrophily. In this
connection they differ from other muds by the large contents of mud solution, having a liquid
consistence, that sometimes require their upholding before the use. As in sapropels the
contents of organic substances is great, the significant quantity of biologically active
components in them is formed.
The peat muds are formed in overgrown reservoirs (bogs) at decomposition of
maximum plants in conditions of superfluous humidifying and difficulty of access of oxygen.
The structure of a peat mud depends on character of a water mode and plants - peat-makers.
The type of a peat muds depends on a degree of mineralization of a mud solution, contents of
sulphides.Sulphidless freshwater peat is met more often. The most rare type - mineralized
strong-acid peat, which contains significant quantity of salts of iron and sulfuric acid, has
astringent and cauterizing effect. One of deposits of such peat is in the area of Sapozhok of
Ryazan region. In a peat mud there is a lot of crystal fraction and a little of colloid one,
therefore it differs by friability and granularity. Peats contain a plenty of organic substances,
among which the important meaning have humic substances having high biological activity.
The mechanism of action of mud-therapy procedures.
The action of medical muds on organism of the man develops of the thermal and
chemical factors. At application of general mud baths the mechanical factor here is added.
Mud-therapy procedure causes local and general reactions.
Therapeutic value of medical mud as heat-carriers is caused by their high heat
capacity, little heat conductivity and almost completes absence of convection. These
properties allow using mud of concerning high temperature.
However it is established, that the temperatures at a level 38-40C causes the most
favorable changes in organism.
The special role in medical action of muds belongs to chemical and biologically active
substances. They will penetrate through the intact skin, rendering local and general action.
The permeability of a skin is increased at application of the heated up mud.
The medical mud due to adsorption properties clears skin, absorbing products of
metabolism and bacteria. It promotes increase adsorption and excretion function of skin. The
local skin reactions morphologically are characterized by proliferation of Malpighian and
thickening of cornean layers, increase of quantity of fibroblasts, formation of fibrous tissue. In
a skin the quantity of histiocytes, lymphocytes are increased. Excitability of skin receptors
after short-term increase is considerably reduced. The degree of intensity of the specified
changes is various at use of various types of a medical mud. For example, acidic Sopozhok's
peat causes more significant reactions in comparison with alcalescent silt tambukan mud.
The general action is realized on nervous - reflex and humoral mechanisms. The
chemical and thermal irritation of receptors of a skin causes answer-back reactions both in a
zone of the appropriate segment, and in other parts of a body, in the central nervous system
due to irradiation of excitation. The inclusion of hypothalamus in sphere of influence of mud-
therapy procedure activates hormonal a part of reflex-humoral system. Neurohormons,
developed by hypothalamus, stimulate activity of hypophysis, and hormones of hypophysis
activate adrenal cortex and other endocrine glands.
The chemical and biologically active substances, being soaked up through skin, get in
bloodflow, rendering general action. Their influence is especially appreciable at inflammatory
processes. The activation of cellular reactions, stimulaton of activity of fibroblasts promotes
restoration of tissues damaged by an inflammation. Braking processes of free - radical
oxidation is observed. In this connection after possible aggravation anti-inflammatory effect is
observed. The application of mud-therapy in a stage of fading of inflammatory process is most
expedient and during restoration of tissues. The action mud applications is favorable at
distrophyc processes, where more or less active phases are observed.
Hence, mud-therapy procedures render anti-inflammatory, resolving, regenerative,
analgetic action. They strengthen effect of antiinflammatory medicines.
The reaction of the organism on mud-therapeutic procedure depends on its functional
condition. At treatment of the same disease the positive effect can be received from the
different patients, applying various types of medical muds. The question of a choice of mud
and optimum of its dosage for the various forms of diseases remains urgent.
Methods and techniques of mud-therapeutic procedures.
Before the use a medical mud should be heated up on water or steam bath. On a couch
display cloth or blanket, on which put a medical oil-cloth, and on it linen sheet. On a sheet
impose mud mass of given temperature. The patient lays down on a mud mass. A site, subject
to influence, of a body is covered by mud also wrap up by the specified layers of tissues.
During procedure the medical sister observes of the patient, supervises pulse and breath. After
termination of procedure the patient is unwrapped, by palms remove from a body the mud and
he is washed under raining douche of temperatures 36-37 C without use of a soap and bast
whisp. Dried himself and having put on the clothes, the patient has a rest in a special room 30-
40min.
Duration of procedure 15-20 minutes, less often - 30 minutes. They will be carried out
daily, or every other day, two days in succession with rest for the third day. The rate of
treatment consists of 12-18 procedures.
Mud applications can be general and local. General applications are now applied
seldom, they can be shown at the very much widespread processes. In this case mud is
imposed on the whole body except for a head and area of heart by a layer of thickness 2-3 cm.
Local applications are put on definite part of a body: area of hands - "gloves", feet and
shins - "socks", pelvis and upper part of hips -"pants", pelvis and legs - "trousers", pelvis and
one leg -"semitrousers", chest and arms - "jacket", half of chest and one arm - "semijacket"; on
the area of abdomen or projections of its organs -stomach, liver, intestine; neck-collar area.
There are the following methods of influence on the definite part of body:
• local (focal), when application is made on the area of injure
• parafocal, when application is made beside the center of injure to avoid the
pathological process
• segment-reflex, in this case application is made on area of projection of the
corresponding spinal segment, the example may be influence on neck-collar area at
encephalitis, arachnoiditis;
• repercussion influence with account on metameric reflex, including reflected
changes in the area of one segment from the opposite side.For example in case of pathologic
process on the right extremity the mud application is made on the left one;
• combined influence on the area of pathological center and segment-reflex zone.
For example at influence on the stomach the mud applications are put on epigastric area and
back in the area of 7-10 thoracic vertebra.
In case of local applications the thickness of mud layer is 4-6cm for silt mud and 6-8cm for
peat mud. Also intracavitary mud therapy is used in form of vaginal and rectal mud tampons.
In this case the mud is cleaned from mechanic admixtures by rubbing through sieve or gauze.
The main indications and contra-indications to mud therapy are the same as to use of
the other heat procedures. Effectiveness of mud therapy is connected with combined and
correlation influence on the organism of heat and chemical factor.
In some cases the influence of chemical and biologically active substances prevails. This
peculiarity singles out the medical muds from the number of other heat-carriers. Mud therapy
traditionally concidered a type of heat therapy, but actually it is a special type of
physiotherapy. To the usual indications for mud therapy as for the other ones it is necessary to
add some other:
• diseases and consequences of traumas of central nervous system (consequences of wouns
and contusions, residual phenomena of encephalitis, myelitis, arachnoiditis,
polyomyelitis,disseminated sclerosis). Influence upon neck-collar area;
• causalgia - pains in extremities as results of wounds;
• vibrating disease. Indication of mud "gloves", "collars"
• sclerodermatitis in unactive phase;
• diseases of organs of digestion in acute and subacute stages: gastric
and duodenal ulcer, chronic gastritis, chronic cholitis, chronic cholecystitis etc.;
• chronic nonspecific bronchopulmonary diseases;
• diseases of female and male sex sphere
• urologic diseases.
Hydropathy
Under hydropathy is understood the use of water in medical preventive and
rehabilitation purposes with the help of the specially developed methods. Hydropathy includes
hydrotherapy, essential hydropathy -procedure with use of sweet water, and balneotherapy
(balneum bathing, bath, Lat.) - procedure with use of mineral water.
I. Hydrotherapy
The hydrotherapy is an outside application of fresh water as baths, showers, dousings,
rubdowns, wrappings. The influence can be general or local. In the specified procedures on
organism influence thermal and mechanical irritants. For amplification of external action of
fresh water the various substances can be added to it: a coniferous extract, condensate of
muskat sage, mustard, turpentine etc. The thermal factor in hydrotherapy is basic. It is shown
the more strongly, the more is difference of temperatures of water and surface of a body.
Depending on temperature distinguish the following kinds of hydropathic procedures:
• Cold (is lower 20 C);
• Cool (20 -33 C);
• Indifferent (34 - 37 C);
• Warm (38-39 C);
• Hot (40 C and higher).
Especially powerful influence has the contrast water procedures -alternate influence by water
of high and low temperature.
A little bit different ranges of temperatures determining a kind of hydropathic procedure can
be specified in manuals and directories on physiotherapy. For example, to hot water procedure
sometimes carry influence of temperature 38 C and more. Sometimes the same author of a
bath of temperature 35 C names both indifferent and warm. The temperature gradation of
baths and showers differ a little. For example the bath of indifferent temperature 34 - 37 C,
indifferent shower -35-37 C.
Water is characterized by high thermal capacity, exceeding those of paraffin, ozokerite and
therapeutic muds. It has good heat conductivity, it exceeds heat conductivity of air 30 times, it
also has high convection ability. Water is natural biological irritant, which the man meets
constantly in the daily life.
The cold water procedures show the large requirements to central regulatory mechanisms,
create significant loading on cardiovascular system. Even to the healthy people in the
beginning are indicated indifferent or cool influences, and then, gradually reducing
temperature of water, pass to cold. The first phase of reaction on cold water - spasm of vessels
of skin. In reply to cold irritation of skin receptors metabolism in internal tissues is accelerated,
first of all in muscles and liver. Temperature of these tissues raises. The second phase of
reaction is shown hyperemia of skin due to impulsing from thermoreceptors of internal bodies.
This reaction is accompanied by sensation of heat and vivacity, it should achieve at every
hydropathic procedure. The third phase of reaction comes at too long or very strong cold
irritation. In this phase occurs passive hyperemia of skin. The skin gets cyanotic discoloration
as a result of delay of bloodflow in it, tremor of muscles occurs. Such reaction shows an
excessive irritation and it cannot be supposed at hydropathy. The cold water procedures
decrease number of heart beats also increase their force, raise arterial pressure. The breath in
the beginning of procedures lingers over, then becomes frequent and further is slowed down,
goes deep. Tone of skeletal and smooth muscles is increased. Cold, as well as the cool water
procedures, render general stimulating action, raise reactivity and adaptive abilities of the
organism
The hot water procedures at the first moment cause spasm of vessels of skin, then very
quickly there comes their expansion. Internal temperature of a body raises, the exchange of
substances becomes more intensive. The hot water procedures increase frequency of heart
beats, reduce their force, reduce arterial pressure, the breath becomes frequent, and the
depth of respiratory movements decreases. Tone of skeletal and smooth muscles is reduced.
The hot water procedures at short-term influence stimulate nervous system, and at long -
cause its exhaustion.
Indifferent and the warm water procedures cause light hyperemia of skin, evoke a feeling of
calm, the general state of health is improved. As a whole they render braking action on
nervous system, causing sedative effect. It is necessary to take into account, that the
sensation of comfort depends not only on temperature of water, but also on adaptive
opportunities of thermoregulatory mechanisms, degree of stability of organism to thermal
irritants. Partly it explains distinctions in a range of indifferent temperatures brought by the
various authors. The repeated procedures with application of indifferent and warm water work
as monotonous and not intensive irritant, causing diffuse inhibition in cerebral cortex.
Mechanisms of thermoregulation, nervous and cardiovascular systems as though have a rest.
In subsequent their serviceability is increased. Last decades in hydropathy prefer softly
working procedures, which cause more favorable answer-back reactions. Hence, most
frequently are applied indifferent and warm water procedures. They render more expressed
training action on regulatory systems of the organism, promote restoration of adaptive
mechanisms. But it does not exclude an opportunity of use of cold, hot and contrast
temperatures at the appropriate functional condition of organism. They are recommended to
those persons, whom it is necessary to increase mobility of protective mechanisms,
considerably to change reactivity.
The mechanical factor in hydrotherapy influences alongside with thermal in any procedure.
Receptor system of skin is generated in conditions of air environment. In result of inhibition of
skin by fresh water and the pressure of its weight occur quantitative and qualitative changes of
physiological reactions on an irritation. The mechanical action is realized through
mechanoreceptors, supplementing action of the thermal factor.
1. Bath
Baths are hydropathic procedures, at which the body of the man is completely or partially
immersed in water of given temperature. Depending on volume of the shipped part of a body
distinguish general and local baths.
General baths. The patient is in a bath reclining. A head, neck and top part of a breast remain
open. The procedures will carry out daily, or two days in succession with a break for the third
day. On a rate of treatment 15-20 baths are required. Duration of baths of warm and
indifferent temperature from 8 about 15 minutes. The cold and hot baths are applied much
less often, duration them from 1 about 4 minutes. For contrast temperature influences two
small adjacent pools (fig. 20) are used, in which the patient can move. The movements are
obligatory in pool with cold water. On special stairs the patient passes from one pool in
another. The procedure begins with immersing of the patient in hot water for 2-3 minutes, and
then - in cold for 1 minute. The transitions from one pool in another repeat from 3 up to 6
times. If the tonic action is required, procedure finish by a cold bath, if the action should be
calming - hot. After procedure the patient is carefully pounded. The baths of gradually raised
temperature from 37 till 40-42 C which is a strong thermal irritant are also used but in our
country very seldom. The rate of treatment by such baths consists of 6 - 10 procedures,
duration by each of which about 20 minutes.
Fig. 20 Schematic images of a general view of contrast baths:

1 - bath for hot water; 2 - bath for cold water; 3 - disinfectant solution for legs.
The mechanical factor in a general bath is submitted by pressure of a pole of water,
component about 0,05 atm. For exception of action of mechanical pressure use foamy baths.
For their preparation on bottom pour small amount of hot water and add foam maker, usually
it is a special soap liquid or soap powder. By any mechanical way the formations of foam is
achieved. That the body of the patient did not adjoin to water at the bottom baths, he lies
down on a wooden lattice.
Temperature of foam is usually 8-10 lower than temperature of water which is taking place at
the bottom of a bath. The foamy baths apply when it is necessary to limit influence on
cardiovascular system. Duration of procedure is about 20 minutes. The mechanical action can
be strengthened, creating in a bath movement of water - vortical and vibrating baths. In
vertical baths the various technical ways create monotonous movement of water. In vibrating
baths the vibrating water waves with the help of the device "Volna-G", forming fluctuation by
frequency 50 or 100 hz are created, and device "Volna - 2 ", forming fluctuation, which
frequency can vary in a range from 10 up to 200hz. With the help of nozzles the vibration are
directed on the certain site of a body. Is revealed expressed analgetic action of such baths first
of all at radiculitis and polyateritis. In both types of baths, vortical and vibrating essential is
strict dozing of a mechanical component, as overdoze results in increase of pains.
Temperature of water is usual from 35 up to 38 C, the rate of treatment is limited to 10-15
procedures at their usual duration and periodicity (daily 8-15 minutes).
Local baths. At their use influence any part of a body: a hand or both hands, leg or both legs,
all extremities (four-chamber baths), basin. The sedentary baths will be carried out in special
capacities. The bottom part of a stomach, basin and top part of hips is immersed in water. Feet
of the patient lower into basin with warm water. Semibaths is conditionally possible also to
attribute to local baths, though frequently they are considered as a separate version of
hydropathic procedure. The patient sits in a bath, the level of water in which reaches his navel.
This procedure is usually combined with dousing and grinding.
The local baths can be applied, using gradually raising temperature (for example, bath
according to Gayffe). To carry out simultaneously vertical and vibrating influences with the
help of the same equipment, as in general baths.
3. Showers
Shower is hydropathic procedure, at which a surface of a body is influenced by a jet or many

jets of water of dozed pressure and temperature. The bringing of water to installations of
medical showers is carried out with the help of shower (hydropathic) platform (fig. 21). The
board of its management allows adjusting temperature and pressure of water.
Fig. 21 Shower (hydropathic) platform.
As well as baths, the showers of warm and indifferent temperature render general calming
action. The showers of cold and hot at short-term procedure work generally tonic at long
procedure reduce excitability of the impellent and sensitive nervous endings. Raise intensity of
an exchange of substances in tissues. After cool and cold showers the grinding by a rough
towel will be carried out. The physiological action of showers is appreciably caused by force of
a mechanical irritation. Distinguish showers with low pressure of water from 0.3 up to 1 atm..
Average - from 1,5 up to 2 atm. And high - from 3 up to 4 atm. On growing intensity of
mechanical influence showers are settled down in the following order: dispersive
douche,raining douche, needle-bath, fan douche, circular douche, stream douche. Dispersive
douche: on a surface of a body the drops, broken up to a fine water dust influence. For
reception of such shower we use a tip as a sphere, from which four depart under a direct
corner bent tube, apertures, having on the ends, of a small diameter (fig. 22). These apertures
are left by water as a water dust falling freely (without creation of additional pressure) on the
patient. The mechanical action it soul is minimal.
Fig. 22 Tip for dispersive douche.

Raining douche: water leaves numerous apertures of a special grid located at height 2 meters
from a floor (fig. 23). The fine jets of water (rain) by force of own weight influence a surface of
a body.
Fig. 23 Raining douche.
Needle-bath we receive with the help of a grid similar to a grid of raining shower, but into
every aperture of a grid is screwed a metal tube with a narrowed gleam, which target diameter
0,5 - 1 mm (fig. 24). Water moves under pressure 1-1,5 atm., causing sensation of an injection
of a needle. Duration of influence by this shower is from 1 about 5 minutes. 15-25 procedures
must be carried out daily.
Fig. 24 Grids for needle-bath.

Fan shower is a version of a stream one. For reception of a fan of water an aperture of a tip of
a hose squeezed by a finger or use special nozzle in form of shovel (fig. 25). Influence from
distance of 3-4 meters. The patient, facing shower platform under a fan of water, makes during
procedure 2-3 slow turns. A sequence of influence: a back surface of legs, back extended in
the parties of a hand, lateral surfaces of a body, starting with legs and finishing with pits, front
surface of legs, stomach. At the first procedures pressure of water is 1,5 atm., in subsequent it
gradually raise up to 3 atm. Procedures by daily duration ' from 1,5 to 3 minutes. On a rate of
treatment there are 15-20 procedures.
Fig. 25 Tips for fan-shower.

Circular shower represents a design from thin vertical pipes connected above and below by
incomplete rings. On the internal party of pipes the plenty of fine apertures (fig. 26) is located,
through which thin horizontal streams of water are directed on the patient under pressure 1-
1,5 atm. Procedures are daily, duration is from 2 to 5 minutes. On a rate of treatment there are
15-20 procedures.
Stream douche (Charcot's douche): a compact mobile jet of water. Which is thrown out from a
rubber hose through a metal tip under pressure from 1,5 up to 3 atm.The influence is made
from distance 3 -3,5 m. Procedure begin with fan-shower, directing a fan of water from legs to
a head at first behind, then in front. After that influence by a compact jet in the same
sequence, as at fan shower. Duration of procedure is from 1 to 5 minutes. On a rate of
treatment there are 15-25 daily procedures.
The Scottish shower is stream shower, the method of its realization, is same to Charcot's
shower. There is a difference that two jets of water of various temperatures are used
alternately. For this purpose on the panel of shower platform there are two hoses: one for hot,
another for cold water. Both jets should be thrown out under identical pressure. This procedure
on mechanical and thermal action most powerful among other kinds of hydrotherapy. Usually
procedure begins from influence by hot water and finish by cold. From procedure to procedure
a difference of temperatures increases. Duration of procedure is from 1 to 3 minutes. The rate
of treatment consists of 15-20 procedures, which will be carried out daily or every other day.
Fig. 26 Circular douche. Fig. 27 Ascending douche.

The douches are also used as local influences. Stream douches (Charcot's, Scottish
douches) can be applied locally. In this case rate of treatment can be increased up to 30 daily
procedures. A popular kind of local influence - ascending (perineal) douche (fig. 27). In this
procedure the same grid is used, as at raining douche, but its apertures are inverted upwards.
The patient sits on a special chair having in a seat a cut. Water, acting through a grid, under
pressure from 0,5 up to 1,5 atm gets on perineum. The procedures have duration from 2 to 5
minutes, they will be carried out daily. On a rate of treatment there are 15-20 procedures. The
basic indications to hydrotherapy.
1. Training of adaptive-accomodative mechanisms (hardening).
2. Functional frustration of nervous system: neurosis and neurosis-like conditions,
corticovisceral disease.
3. Dyskinesia of internal organs: biliary tracts, intestine, disorder of motility of a stomach.
4. The defeats of a muscle and valvular system of heart at absence of activity of process, in
a stage of indemnification or insufficiency of blood circulation not higher of I stage.
5. The diseases of organs of a support-motor apparatus, of peripheral nervous system (most
powerful influence have vortical and vibrating baths).
6. Chronic non-specific diseases of lungs, first of all chronic bronchitis, bronchial asthma.
7. Vegeto-vascular disfunctions, essential hypertension of I-II stage, arterial hypotony.
8. Diseases of pelvic organs, haemorrhoids, sexual weakness (first of all sedentary baths
and semibaths, ascending douches).
The basic contra-indications to hydrotherapy.
1. Acute and aggravations of chronic inflammatory diseases, purulent inflammation.
2. Essential hypertension of III stage, frequent hypertensive strokes, malignant clinical
course.
3. Defeat of a muscle of heart, including atherosclerotic one, at insufficiency of circulation of
II stage and more, infringement of conductivity and rhythm of heart, instable angina.
4. Recurrent trombophlebitis.
5. Disorders of skin:erysipelas, furuncules, trophic ulcers.
II. Balneotherapy.
Balneotherapy - medical application of mineral and gas waters, natural or artificially prepared.
They can be used outwardly, as baths, and inside: drinks, inhalation, enemas, various ways of
washings and irrigation. In balneotherapy except for the thermal and mechanical factors the
essential role is played by a chemical irritation caused by complex scale of mineral salts,
gases, microelements, organic connections contained in water. Medical mineral waters
are estimated according general mineralization, ionic structure, gas saturation and gas
structure, active reaction of water (pH), contents of microelements, radio-activity,
temperature.
According to general mineralization, expressed in grammes of mineral salts per 1 litre of
water, mineral waters are classified as follows:
• low-mineralized, up to 2 g/1;
• little mineralization, from 2 up to 5 g/1;
• average mineralization, from 5 up to 15 g/1;
• High mineralization, from 15 up to 35 g/1;
• brines, from 35 up to 150 g/1;
• Strong brines, over 150 g/1.
In mineral waters there are more 50 various ions, but as basic it is accepted to consider
sodium, chlorine, hydrogen carbonate (HCO 3) and sulphates (SO4). At definition of type of
mineral water by ionic structure take into account those ions, which quantity makes not less
than 20 equivalents - percents. According to this criterion by ionic structure we single out the
following basic waters:
• sodium chloride;
• hydrocarbonate magnesium-calcium;
• chloride-hydrocarbonate sodium.
According to gas saturation, expressed in ml of gas per 1 litre of water, allocate the following
mineral waters:
• high gas saturated, more than 1000 ml/1;
• middle gas saturated, from 1000 up to 100 ml/1;
• low gas saturated, from 100 up to 50 ml/1;
• poorly gas-saturated, less than 50 ml/1.
For reference of mineral water to the certain type of gas waters take into account those gases,
which quantity makes more than 10 % of total amount of the gases, dissolved of water. The
greatest medical meaning have waters:
• Carbonic;
• sulphate (at pH less than 6,5 - hydrogen sulfide);
• Nitric.
Depending on active reaction determined pH, allocate mineral waters:
• stron-acidic, less than 3,5;
• Sour, from 3,5 up to 5,5;
• low-acidic, from 5,5 up to 6,8;
• Neutral, from 6,8 up to 7,2;
• alkalescent, from 7,2 up to 8,5;
• Alkaline, more than 8,5.
In some mineral waters the medical value is defined by microelements (iron, arsenic, iodine,
bromine and others), radio-activity due to radon (Rn) or radium (Ra). These features find
reflection in the name of the appropriate water: ferruterous, iodide-bromine, radon etc. In all
mineral waters, especially of weak and small mineralization, there is a various quantity of
organic substances such as humines, bitumens and phenols, bringing the essential
contribution to medical action. The large and long-term work on generalization and
specification of criteria of an estimation of mineral waters has resulted in creation of
classification which is taking into account their structure and medical importance. 8 groups are
allocated: I (group A) - mineral waters, which action is defined by mineralization and ionic
structure which does not have specific components and properties;
II (group B) - carbonic waters;
III (group C) - sulphate (hydrogen sulfide) water;
IV (group D) - ferruterous waters, arsenious, with the high contents of magnesium,copper,
aluminium, zinc, lead;
V (group E) - bromine, iodine and iodine-bromine water;
VI (group F) - radon (radioactive) waters;
VII (group G) - siliceous terms (group of waters containing a silicon acid in quantity more 50
mg/1 and temperature more 35 C);
VIII (group H) - low-mineralized water with the high contents of organic substances.
Each group is divided into subgroups by gas structure, into classes by anion and subclasses by
cation structure.
Only some kinds of balneotherapy will be considered further, at which mineral water as
mineral or gas baths is used. The inorganic mineral substances, dissolved in water, influence
first of all on receptors of skin. The gas, dissolved in water, will penetrate through skin,
rendering action as on receptors of skin, and general action.
Hydrochloric baths are referred to mineral ones. The optimum concentration of
sodium chloride makes 20-30 g/1, (high general mineralization). At their artificial preparation
on a standard bath, which volume of 200 litres, is required about 5 kg of the cooking salt. Sea
or lake salt can be used, which contain except for sodium chloride other mineral substances. In
a nature sodium chloride waters in the pure state are not present.
Sodium chloride irritates receptors of skin, strengthening thermal action of a bath. The
dilatation of vessels of skin is expressed more considerably, than at influence of a fresh bath of
same temperature. The irritating action is kept after procedure, as on skin there is sunken salt
-" a hydrochloric raincoat".
Alongside with functional the morphological changes in skin and its nervous system are
observed also. The thickness of malpighian and horn layers is increased, after repeated baths
there appear sites of proliferation of cellular elements, intensively multiplied fibroblasts and
their transition in fibrocytes amplifies.
Nervous fibers grow thicker, fragmentation of axial cylinders going to epidermis is found out.
At mineralization of 60 g/1 and more in skin necrosis can be developed.
Sodium chloride bath stimulate by reflex way activity of adrenal cortex, activity of
sympathoadrenal system. Their antiinflammatory and hyposensitized action at some diseases is
noticeable, and their sedative analgesic effect is expressed obviously enough. They render
regulating action on the central nervous system, change central hemodynamics and peripheral
blood circulation. In particular, if the patient has chronic venous insufficiency, he observes
increase of tone of peripheral veins in a combination with moderate increase of arterial inflow.
As a whole sodium chloride bath render stimulating influence on function of various organs and
systems, improve adaptive-accomodating mechanisms.
The medical procedures will be carried out at temperature of a bath 35-38 C by
duration from 10 to 20 minutes every other day, or two days in succession with a break for the
third day. On a rate of treatment it is required from 12 up to 15 baths. The basic indications to
application.
1. Essential hypertentension of I - II stage.
2. Arterial hypotony.
3. Varicose veins, trombophlebitis (in 2-3 months after the ending of inflammatory
process).
4. Inflammatory, dystrophic and posttraumatic injure of the musculoskeletal system
(arthritis,arthrosis, spondylosis, results of damages of bones, muscles, sinews).
5. Disease of peripheral nervous system (radiculitis, raduculoneuritis, plexitis,
consequence of poliomyelitis).
6. Some skin diseases (psoriasis, neurodermatitis).
General contra-indications for hydropathy.
Iodine-bromine baths are concerned mineral ones. As against other mineral baths
iodine and bromine will penetrate through skin and lungs, taking part in interstitial exchange
processes.
In nature iodine-bromine waters in the pure state are not present. Usually ions of iodine
and bromine are contained in structure of sodium chloride waters. For medical application
waters containing iodine in quantity not less 5 mg/l and bromine - not less 25mg/l at average
genera mineralization of waters (10 -12 g/l) are used. Water of higher mineralization is diluted
by fresh water. Sodium chloride waters containing only bromine or only iodine, have the limited
distribution. At preparation of artificial iodine-bromine baths take for a basis structure of natural
mineral water of a resort Khadyzhensk (Krasnodar territory), spending on a bath of capacity 200
1 100 g of sodium iodide, 250 g potassium bromide and 2 kg cooking, sea or lake salt. The
action of iodine and bromine, accepting direct participation in exchange processes, is realized
on a background of action of sodium chloride, irritating receptors of skin. It is known, that the
biological activity of iodine is caused by its organic compounds in form of hormones of thyroid
gland. Bromine is collected in hypophysis, as the medical means matters in normalization of
functions of the central nervous system.
First of all it is necessary to note beneficial effect of iodine-bromine baths on function of
the central nervous system directed on strengthening of processes of inhibition. The broken
functions of vegetative nervous system are corrected. One of consequences of perfection of
activity of central regulatory mechanisms is the improvement of parameters of hemodynamics:
reduction of frequency of heart beats, some increase of their force, decrease of arterial
pressure, improvement of microcirculation. The influence on nervous system is realized in its
peripheral departments as increase of a threshold pain and tactile sensitivity that is shown by
pain-killing effect, normalization of muscle tone, of tendinous reflexes. Pain-killing action is
appreciable at neuralgia, especially at lumbosacral radiculitis.
Iodine-bromine baths actively influence function of endocrine system: the functional
activity of hypophysis to adrenal glands raises, the activity of sympathoadrenal system, thyroid
gland changes. In experiment and clinical picture we got proofs of inhibiting influence of these
baths on development of atherosclerosis. They render also some bacteriostatic action.
The medical procedures will be carried out at temperature of a bath 35-37 C by
duration from 10 to 15 minutes every other day, or two days in succession with a break for the
third day. On a rate of treatment it is required from 15 up to 20 baths.
________________Basic indications to application:
________________________
1. Functional disorders, consequence of traumas of the central nervous
system, hypothalamic syndrome.
2. Essential hypertention of I - II stages.
3. Disease of paripheral nervous system (radiculitis, radiculoneuritis,
plexitis, consequence of polyomyelitis).
4. Inflammatory and degenerative-dystrophic disease of the musculoskeletal system
(arthritis, arthrosis, spondylosis).
5. Endocrine diseases (hyperthyroidism of light and average difficulty,
hypophysial adiposity, endocrine caused female sterility).
6. Some skin diseases (psoriasis, neurodermatitis, and eczema).
General contra-indications for hydropathy.
Sulfide baths are referred to mineral, because they do not possess one of attributes of
gas baths: action of bubbles of gas upon the skin. In natural waters sulfides are present as ions,
mainly hydrosulfide (HS ~) and as the molecular form - hydrogen sulphide (HS). Ratio of these
components is defined by active reaction of water, depending on which sulfide waters are
subdivided into the following groups:
1. Hydrosulfuric,with pH less than 6.5 and hydrogen sulphide makes
more than 75 % of all sulfides.
2. hydrosulfuric-hydrosulfide with pH from 6,5 up to 7,0 and hydrigen
sulfide prevails the ion of hydrosulfide.
3. Hydrosulfide-hydrosulfuric,with pH from 7.0 up to 7,5 and the ion of
hydrosulfide prevails hydrogen sulfide.
4. Hydrosulfide,with pH more than 7.5 and the ion of hydrosulfide
makes more than 60 % of all sulfides.
The majority of natural waters concerns to hydrosulfuric-hydrosulfide and hydrosulfide-
hydrosulfuric. It is considered, that hydrogen sulfide renders more expressed biological action,
than ions of sulfides. To medical are referred waters containing not less than 10 mg/l of
sulfides. On concentration of sulfides, designated also by term " general hydrogen sulfide ",
mineral waters are divided into:
1. Weak hydrogen sulfide - from 10 up to 50 mg/1 (0.3 - 1,5 mmol/l).
2. Average - from 50 up to 100 mg/l (1,5 - 3,0mmol/l).
3. Strong - from 100 up to 250 mg/l (3,0 - 7,5 mmol/l).
4. Especially strong - more than 250 mg/l (7.5 mmol/l).
At preparation of artificial sulfide baths for a basis take structure of natural water of a
resort Matsesta (resort area of Sochi), of strong concentration. They are prepared by chemical
way, using sodium sulfide, sodium hydrocarbonate, hydrochloric acid and cooking salt. It is
necessary to mean, that hydrogen sulfide is toxic and at application of baths the combined
extract and input ventilation is necessary. Hydrogen sulfide is chemically aggressive,
especially in relation to metals, pipes and cranes from polythene therefore are used. All this
complicates application of sulfide baths out of resort conditions. The answer-back reactions of
organism to action of sulfide baths depend first of all on quantity of hydrogen sulfide, working
both on skin and mucous environments, and on internal tissues, where it gets throug skin and
lungs. Its high concentration is toxic.
The most favorable changes are observed at use of sulfide water of average
concentration.
Peripheral and central nervous structures are especially sensitive to action of sulfide
ions and hydrogen sulfide. Reactivity of nervous system of skin changes, the threshold of
excitability of the sensitive nervous endings is reduced, that is shown pain-killing action.
Hyperemia of skin occurs, which differs by appearance and keeps longer, than hyperemia,
caused by other mineral baths and temperature influence. The sharp border of a zone of
hyperemia at that level is appreciable, up to which the part of a body is shipped in a
bath.Hyperemia is connected with reflex reactions caused by influence of free hydrogen sulfide
on the nervous endings, and also formation of histaminoid substances in skin. Hydrogen sulfide,
getting in blood flow, influences on receptor zone, especially carotid sinus and aortic. It will
penetrate through blood-brain barrier and change a functional condition of cerebral cortex,
subcortex formations. The essential influence hydrogen sulfide renders on system hypophysis-
adrenal glands, weakening the phenomena of hypocorticism, restoring vascular reaction.
Central reflex and neuro-humoral change, and also the redistribution of blood flow from internal
bodies to periphery and effect functioning of cardiovascular system: the frequency of beats
decreases, their force is increased, arterial pressure is reduced.
Hydrogen sulfide is active reducing agent. Under its influence the quantity of sulfhydric
groups in tissues accrues, the activity of choline esterase, enzymes of reamination and
glycolysis raises, the processes of tissue breath amplify, the exchange of mucopolysaccarides is
normalized. The power resources of tissues raise. The specified changes alongside with neuro-
humoral influences, favorably have an effect on current of inflammatory process as change of
its intensity, the allergic reactions are reduced.
The influence of sulfide baths on atherosclerotic process is connected with activation
lipase, decrease of biosynthesis of greasy acids and cholesterol through suppression of activity
of a pentous cycle. In some experiments was observed even resorption of lipid plaques.
Thus, favorable influence on central and peripheral hemodynamics, immunological
reactions of organism, oxidation-reduction processes allow to use sulfide bath at treatment of
many different pathological condition.
The medical procedures should be carried out at temperature of a bath 35- 37C usually
on a so-called step technique: gradual increase of concentration of sulfides from 50 up to 100
and then up to 150 mg/l by increase of duration of a bath from 7 about 15 minutes. The baths
should be carried out in day or two days in succession with a break for the third day. On a rate
of treatment are required 12-14 baths.
1. Essential hypertension of I -II stage.
2. The diseases of a muscle and valvular system of heart in a stage of
indemnification or at insufficiency of circulation which is not higher than a stage, not earlier
than in 6 months after termination of active process.
3. Inflammatory and degenerative-dystrophic diseases of musculo-
sceletal system.
4. Diseases of peripheral nervous system (radiculitis, radiculoneuritis)
The contra-indications are general for hydropathy, and also active hepatitis and cirrhosis of a
liver, chronic glomerulonephritis, chronic bronchitis with bronchoobstructive syndrome,
bronchial asthma.
Radon baths are version of radon therapy. Radon waters are applied as
irrigations, lavements, so-called "dry" baths, inhalations, drinks. Radon is formed at
disintegration of radium and represents inert radioactive gas without a smell and color. The
period its half-decay is 3,8 days. Earlier these baths were referred to gas ones, but volume of
the gas, dissolved of water, is insignificant so it can not render action peculiar to gas baths. At
disintegration of radon a number of its short-
living affiliated products is formed, the period of thier half-decay makes on the average 35
minutes.
The majority of radon waters differs by low general mineralization (less than 2 g/1),
they quite often contain carbonic gas or nitrogen. Some Ural and Issyk-Kul radon waters have
mineralization 10-15 g/1, being on ionic structure sodium chloride or calcium-sodium chloride.
Radon waters are classified according to radio-activity, measuring system expresses in terms of
Bequerel (1 bequerel - 1 act of disintegration per one second), but quite often on former use
units of Curie. Medical radon waters should have minimum radio-activity about 0,2kbq/l
(kilobequerel per litre of water), that corresponds 5ncr/l (nanocurie per 1 litre of water).
Distinguished the following radon waters:
1. With small concentration of radon (weak radon) - from 0,2 up to 1,5 kbq/l or
from 5 up to 40 ncr/l.
2. With average concentration of radon (average radon) - from 1,5 up to 7,4 kbq/1
or from 40 up to 200 ncr/l.
3. With high concentration of radon (high radon) - is higher than 7,4 kbq/l or 200
ncr/l.
Earlier concentration of radon was expressed in terms of Maxe; 1 unit of Maxe
corresponds to 0,13 kbq/l or 3,64 ncr/l.
At preparation of artificial radon waters radium is used, which is kept as its soluble salts
in hermetic closed capacity supplied by leaden protection. Such design refers to the generator
of radon. In process of accumulation of radon in the generator it is transferred into the tightly
closed vessel; where radon is dissolved in water either spirit at shaking or hashing of the
solvent by the electropump. As a result of these operations receive the concentrated solution of
radon, which spill in tightly closed glass bottles of capacity 100 ml with such account that from
every bottle it was possible to prepare a bath of capacity 200 litres containing 1,5; 3,0 or 7,4
kbq/l of radon. Most frequently are used average radon bath with concentration of radon 1.5
and 3,0 kbq/1 (40 and 80 ncr/l). Now realizations radonotherapy needs creation of the
centralized laboratory, which should supply hydropathic establishments of city with the
concentrated solution of radon.
At reception of a bath on skin is besieged radon and products of its disintegration,
forming so-called active thin cover, which action is kept within several hours after an exit from
a bath. Very small quantity of radon and products of its disintegration will penetrate through a
skin and lungs into internal environments of the organism, being non-uniformly distributed in
tissues. In subsequent about 90 % of them is deposited in skin, fatty tissue. Among all internal
bodies the biggest amount of radon is found in lungs.
The biological and medical action of a radon bath is connected to radioactive radiation,
basically with alfa-radiation. In this connection radonotherapy is referred to version of alfa-
therapy. Under action of radiation there is an ionization of molecules of tussue and water. At
ionization of water the chemical radicals being powerful oxidizers are formed: atomic oxygen,
ozone, hydrogen peroxide and others. The direct action of alfa-rays oupon biostructures of cells
matters also. The reaction of skin to effect of radon baths is expressed in change of skin
sensitivity. In the skin analyzer begins to prevail processes of inhibition. The vessels of skin in
the beginning of procedure are narrowed so that it turns pale, in subsequent hyperemia occurs .
It is known, that a nervous tissue and endocrine system are very sensitive to ionizing radiation.
On the central nervous system radon bath render sedative effect reminding action of
tranquilizers. Analgesic action of these baths connect both to decrease of excitability of
peripheral receptors, and with blockade of ways of realization of pain pulses. Influence on alfa-
and beta-adrenoblockers results in change of activity of cardio-vascular systems. The bent to
tachycardia is observed, arterial pressure is reduced. Radon bath can render normalizing action
on frequency of beats, reducing it at tachycardia and increasing - at bradycardia, normalizing
action on a level of arterial pressure at hypertesion or hypotonia.
The influence upon endocrine system is shown by activation of sympathoadrenal
system through of adrenergic nervous endings. The function of cortex of adrenal glands is
stimulated, function of ovaries is normalized, function of thyroid gland is raised.
Radon bath influence upon metabolic processes at cellular level, influencing on all kinds
of an exchange. A number of enzymatic systems is activated, the pressure of oxygen in tissues
raises. The parameters of immunologic reactivity of the organism are normalized, there are
observed both hyposensibilizing, and immunomodulating effects depending on character of
pathological process. All this positively has an effect for current of inflamatory process,
including immunologically caused: its activity is suppressed, the reparation of tissue is
accelerated. Cicatricial tissue is sated by glycoseaminoglycones, that makes it more elastic, the
formation of rough scars is prevented.
As a whole is marked, that radon baths stimulate adaptive system of organism of the
patient, have expressed analgesic, antiinflammatory action, normalizing exchange processes.
The medical procedures should be carried out at temperature of a bath 35-37 C, daily or
every other day. Duration of procedure from 10 to 15 minutes. It is recommended to begin
treatment from a bath, of duration 10 minutes, to increase it by 1-2 minutes at the subsequent
procedures, having finished up to 15 minutes. On a rate of treatment it is required from 15 up
to 20 baths.
1. Inflammatory, degenerative-dystrophic and posttraumatic diseases of
musculosceletal system, including consequences of bone fractures with the slowed down
consolidation, steomyelitis.
2. Diseases of peripheral nervous system (radiculitis,
radiculoneuritis,polyneuritis, neuralgia).
3. Chronic inflammatory processes, in particular of female sexual sphere,
pyelonephritis.
4. Functional disorders and consequences of traumas of the central nervous
system.
5. Essential hypertension of I-II stage.

6. Some skin diseases (psoriasis, neurodermatitis).
Contra-indications to application, except for general to hydropathy,
pregnancy, stenocardia.
Carbonic acid gas bath are referred to gas ones.The typical feature of such bath is
oversaturation of water with gas, that evolves in bath in form of blebs
Except for carbonic baths are used oxygen, nitric, pearl (bath with raging in water blebs
of air).
To medical carbonic baths are referred the ones that contain not less than 0,75 g of
carbonic gas per litre of water, irrespective of its mineral structure. Natural carbonic waters
have very various general mineralization, making from 1-5 till 15-35 g/l. They are various on
their ionic structure. Sulfate (sulfate narzan), hydrocarbonate calcium-sodium, hydrocarbonate
magnesiun-calcium are distributed. Many of them contain biologically active microelements:
arsenic, iron, boron and others.
The artificial carbonic baths are prepared by physical or chemical methods. In a
physical method water is sated with carbonic gas leaving a cylinder, with the help of the special
device (AH-8, AH-9). After installation of the device its working mode is worked out. Thus check
by a chemical way concentration of carbonic gas in a bath at different pressure, duration of
saturation and temperature of water. On a ratio of these parameters develop modes of
operations of the device, at which it is possible to receive required concentration of carbonic
gas. The chemical method is based on a principle of replacement of carbonic gas by an acid
from carbonic salts. A source of it can be sodium hydrocarbonate, sodium carbonate, which
influence by a hydrochloric or sulfuric acid. In special manuals there are recipes and accounts of
preparation of carbonic baths of the given concentration. The optimum medical effect is
observed in a bath at concentration of carbonic gas 1,2-1,4 g/l, in which on 1 ml of water 60-70
blebs of gas are necessary. The mechanical and thermal factors in a carbonic bath, as well as in
other gas baths, have the features. Blebs of gas are deposited on skin, and then come off,
causing original tactile massage. More considerably, than in a fresh or mineral bath irritating
action on thermoreceptors of skin. Indifferent temperature of waters is 34-37 C, and carbonic
gas - 12-13 C. In the appropriate bath on a surface of a body work alternately gas perceived as
hotter, and water perceived as more cold. Besides on receptors and vessels of skin the carbonic
gas influences, plenty of which is deposited in skin. The fine vessels of skin extend, hyperemia
occurs. The activity of thermal thermoreceptors raises, and cold-receptors - is reduced. In spite
of the fact that because of strengthening of circulation in superficial tissues is increased heat
emission and temperature of a body is reduced, the carbonic baths of indifferent temperature
and even cool can be perceived by the patients as warm. Hence, there is a discrepancy of heat
sensation and thermal effect that is necessary to take into account at realization of procedures.
The expansion of superficial vessels results in redistribution of blood flow to periphery. The
carbonic gas gets into organism through skin and lungs in the increased amounts, its contents
in air above a bath is increased up to 1,2-2 %, that corresponds to pertial pressure 15-16 mm
mercury. Raising the respiratory centre, it promotes increase of minute volume of breath,
sticking action of chest and, as the consequence of it, venous inflow to heart is increased.
Hemodynamic effects of carbonic baths are shown first of all in lengthening of diastole,
substantial growth of cardiac emission, reduction of frequency of beats, that is especially
appreciable at previous tachycardia. The decrease of a pulse rate is regarded as an attribute of
adequacy of influence of a carbonic bath. On the central nervous system the carbonic gas
works excitingly. Vasomotor centers are raised maximum , that is shown by increase of arterial
pressure for the persons suffering from hypotonia. Especially it is appreciable at application of
cool and cold baths. At initial raised arterial pressure it can be reduced, is especial at
application of baths of indifferent temperature. However use of carbonic baths for treatment of
arterial hypertension is limited because of their stimulating central action, but they can appear
therapy of a choice at arterial hypotonia.
The carbonic baths are first of all method functional methods of pathogenetic therapy of
diseases of cardiovascular system. They stimulate mechanisms of indemnification of cardiac
activity, training myocardium, increase its adaptive ability to loadings. The medical procedures
begin from temperature of a bath 35 C gradually reducing it in the subsequent procedures up to
32 C, less often till 30-28. In process of downturn of temperature of water increase duration of
procedure from 7 minutes (sometimes from 5 minutes) to 12-15 minutes. The baths should be
carried out every other day or two days in succession with a break for the third day. On a rate
of treatment it is required from 12 up to 15 procedures.
1. The diseases of a muscle and valvular system of heart in a stage of
indemnification or at insufficiency circulation which is not higher than I
stage.
2. Arterial hypotonia.
3. Functional disorders of the central nervous system with the phenomena of
depression.
Contra-indications, except for general to hydropathy, hypersthenic form of
neurasthenia.

Physiotherapy 2

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Physiotherapy 2

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General physiotherapy.

Physiotherapy (physis - nature) is a science about using of external environmental

7) The number of procedures for whole course of treatment.

Scheme of ion's movement during galvanization: 1- electrodes; 2 -linings

Fig. 3 Graphic image of direct pulse electrical currents: 1 - triangular form; 2 -

Fig. 5 Fixing of electrodes at treatment by electrosleep. Devices: - "Electrosleep"

Fig. 7 The graphic image of formation of interferential currents:

Fig. 10. Inductor-disk:

5. Vegeto-vascular disorders shown by peripheral vasoconstriction.

• low-heat doze (figure 1-3; 160-200 MA; 40-90wt);

• Thermal doze (figure 4-6; 220-250 MA; 110-160 wt):

• Intensively thermal doze (figure 7-8; 260-280 MA; 185-200 wt);

3) duration of procedure (10-20 minutes, sometimes about 30 minutes);

6. Presence of metal subjects in a zone of influence by size more than 4 cm2.

Dosage according to:

5. Presence of metal subjects in a zone of influence by size more than 4 cm2.

Dosage according to:

Fig. 13 Inductor-solenoid and its magnetic field.

Fig. 17 The graphic image of ultrasonic waves (condensation and rarefaction of

Fig. 18 Circuits showing role of contact environment at influence by ultrasound: 1 -

Fig. 19 Curves of cooling 75 g of substance at temperature of air 18 C: 1 - paraffin; 2 -

Fig. 20 Schematic images of a general view of contrast baths:

Shower is hydropathic procedure, at which a surface of a body is influenced by a jet or many

Fig. 22 Tip for dispersive douche.

Fig. 24 Grids for needle-bath.

Fig. 25 Tips for fan-shower.

Fig. 26 Circular douche. Fig. 27 Ascending douche.

5. Essential hypertension of I-II stage.

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