Introduction

Shortwave diathermy (SWD) has been a treatment option for many Physical Therapists

when treating patients with knee osteoarthritis. Many individuals could argue that there is no

proof in its effect for treatment. Shortwave diathermy treatment involves the use of a machine

that emits electromagnetic radiation to a large, focused area on the body. Two types of SWD

exist. There is continuous shortwave diathermy (CSWD), and pulsed shortwave diathermy

(PSWD). CSWD is used mainly for its thermal effects on heating deep tissue structures such as

muscle, and PSWD exhibits athermal effects on heating superficial structures. When regarding

knee osteoarthritis, the patient experiences pain, swelling of the joint, limited range of motion,

and difficulty walking. This review will compare the effectiveness of PSWD and CSWD, along

with other treatment modalities such as ultrasound and exercise on the treatment of knee

osteoarthritis.

Against

In a double-blind randomized placebo-controlled equivalence trial, the benefit of

shortwave diathermy treatment was evaluated for post-menopausal women. There were 113

women aged 50-85 years old with knee osteoarthritis that participated in the study. They were

separated into a randomized control group and treatment group. Each group was instructed to

perform quadriceps exercises along with their given treatment. The exercises consisted of

isometric contractions in full knee extension for 5 seconds and isotonic resistive contractions in

knee flexion for 5 seconds. The shortwave diathermy treatment parameters consisted of 20-

minute sessions, 3 times per week, for a total of 3 weeks. A set of secondary outcome measures

consisted of walking speed, stair ascend and descend time, global assessment, patient
satisfaction, and adverse events. The outcomes were assessed at the beginning and end of each

treatment. Both the physician assessing the treatment and the patients were left unaware of the

group of treatment the patient belonged to, only the physical therapist was aware of the treatment

that was being provided. The outcomes were evaluated using the Western Ontario McMaster

Universities OA (WOMAC) index. The secondary outcomes were also evaluated and measured.

At the end of treatment, statistical analysis showed no differences between the control and

treatment groups for intention to treat. Based on the results obtained from the study, shortwave

diathermy treatment for post-menopausal women with knee osteoarthritis is not superior to

implementing an exercise program alone.

There are many different types of modalities that could be used to treat patients with knee

osteoarthritis in attempt to decrease acute and chronic pain. Three typical deep heating

modalities often used in physical therapy clinics consist of phonophoresis, ultrasound, and short

wave diathermy. A recent study conducted at Harran University Medical School compared these

options. A group of 101 patients with knee osteoarthritis were divided into three groups. Each

therapy began with 20 minutes of moist heat along with their specific treatment. The modalities

were applied 5 times per week for 2 weeks. After an overall evaluation, the study showed that all

three deep heating modalities showed improvement, but there were no significant differences. No

treatment was shown to be more superior to the others.

Other agents that may be considered to reduce pain due to osteoarthritis include electrical

stimulation. A study was conducted comparing shortwave diathermy, transcutaneous electrical

nerve stimulation, and interferential currents. Shortwave diathermy produces an electromagnetic

field, resulting in the movement of ions by the creation of eddy currents and production of heat
in deep tissues. Transcutaneous electrical nerve stimulation and interferential currents are forms

of electrical stimulation of afferent sensory fibers that inhibit the transmission of nocioceptive

pain fibers to the brain. The study consisted of 203 patients with knee osteoarthritis randomized

into 6 treatment groups. Treatments were administered 5 times per week for 3 weeks. Exercises

were performed in each group as well as the physical agents. All groups showed significant

improvement in decreasing pain.

Supporting

According to a study performed by Adebowale and colleagues, the parameters set for

knee osteoarthritis (OA) included pain, limited flexibility, and diminished range of motion at the

knee joint. When considering management of osteoarthritis of the knee, the signs and symptoms

mentioned above are the primary focus for treatment, along with addressing deformities.

Thermotherapy is a choice for treatment of the signs and symptoms mentioned. This study

focused on comparing two types of short wave diathermy (SWD): pulsed (PSWD) and

continuous (CSWD), or non-thermal and thermal, respectively.

This pretest and posttest study treated 24 patients from the Obafemi Awolowo University

Teaching Hospital Complex (OAUTHC) with knee OA. Each of the patients had a diagnosis of

knee OA for over 3 months via radiologic report. Patients were selected at random through

balloting and segregated blindly into 2 groups of 12, excluding those with metal implants or

pacemakers. Group 1 (mean age 58.77 years old) was treated with CSWD and Group 2 (mean

age 55.00 years old) was treated with PSWD for 20 minute treatments, twice a week for 4 weeks.

A Curaplus 967 SWD machine was used. After treatment, each participant was asked to rate
their pain level on a 10 point semantic scale. Active and passive range of motion was also

measured on a weekly basis before and after treatment. Axillary skin temperature and pulse rate

were also taken.

According to the results, CSWD was more effective than PSWD. Continuous SWD

treatment alleviated pain, along with increasing knee flexion range of motion to a greater extent

than PSWD. Skin temperature was elevated 0.61-0.63 C in participants receiving CSWD

compared to only 0.31-0.35C in those receiving PSWD. The rise in temperature implies

physiologic activity related to SWD treatment. Pulse rate did not differ significantly between the

groups. In conclusion, CSWD is more effective in eliciting the desired therapeutic results in knee

osteoarthritis patients than PSWD.

When regarding the effectiveness of short wave diathermy compared to other modalities

and itself, SWD appears to have its benefits for knee osteoarthritis. Continuous SWD is effective

in increasing knee range of motion and reducing pain. It is also successful in raising body

temperature, implying activation of physiological structures. According to a study performed by

zduran and colleagues including 132 participants with knee osteoarthritis, SWD appeared to

have no decreased effectiveness than that of ultrasound treatment. These studies support the use

of SWD as a treatment for knee osteoarthritis and show the desired therapeutic results.

Conclusion

Shortwave diathermy has a number of contraindications that must be considered before a

treatment is performed. Due to the time invested, contraindications, cumbersome equipment, and

cost associated with shortwave diathermy, other modalities may be the preferable treatment

option for patients with knee osteoarthritis. From the results above comparing other modalities to
SWD, there is no greater benefit in treatment of knee OA between modalities. Therefore, the

recommendation is short wave diathermy is not worth the investment for treatment of knee

osteoarthritis.
References

Adebowale AC, Bosede A, Ojoawo AO, Sunday OA, Teslim OA. Comparative effects of pulsed
and continuous short wave diathermy on pain and selected physiological parameters among
subjects with chronic knee osteoarthritis. Technology and Health Care. 2013;21:433-440. doi:
10.3233/THC-130744.

Akyol Y, Durmus D, Alayli G, Tander B. Bek Y. Canturk F. Tastan Sakarya S. Does short-wave
diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle
strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized
controlled clinical study. Eur J Phys Rehabil Med (2010); 46: 325-36.

Atamaz F. Durmaz B. Baydar M. Demircioglu O. Iyiyapici A. Kuran B. Oncel S. Sendur O.

Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation, Interferential
Currents, and Shortwave Diathermy in Knee Osteoarthritis: A Double-Blind, Randomized,
Controlled, Multicenter Study. Arch Phys Med Rehabil (2012); 93: 748-756.

Boyaci A. Tutoglu A. Boyaci N. Aridici R. Koca I. Comparison of the efficacy of ketoprofen

phonophoresis, ultrasound, and short-wave diathermy in knee osteoarthritis. Rheumatol Int
(2013); 33: 2811-2818.

zduran E, Sarifakiolu B, Yildirim Gzelant, A. The comparison of the effectiveness of short

wave diathermy and ultrasound in the treatment of gonarthrosis. Turkish Journal of
Osteoporosis. 2014;20(1):16-20. doi: http://dx.doi.org.cmich.idm.oclc.org/10.4274/tod.73636

Rattanachaiyanont M. Kuptniratsaikul V. No additional benefit of shortwave diathermy over

exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial.
Osteoarthritis and Cartilage (2008); 16: 823-828.