INTERFERENTIAL THERAPY Sagar Naik, PT

Interferential Therapy (Notes)

Sagar Naik, PT

.
Interferential therapy is a form of electrical treatment in which two
medium-frequency currents are used to produce a low-frequency effect. Interferential

ll..
current can be defined as the transcutaneous application of alternating medium-
frequency electrical currents, which are slightly out of phase through the tissues,
amplitude modulated at low frequency for therapeutic purposes such as relief of
pain, improve circulation and enhances healing process. Frequency used for
interferential therapy is 3500 Hz to 5000 Hz.
Z = 1 / 2Π f C
Where, Z = skin impedance or capacitive resistance or skin interface or reactance
4a resistance or skin resistance
f = frequency in Hertz (Hz)
C = capacitance of skin in microfarads
From above formula, skin impedance is inversely proportional to
frequency and capacitance of the skin. Capacitance of the skin cannot be changed;
hence by increasing the frequency the skin impedance can be lowered.
Skin impedance is of two types namely, ohmic resistance and capacitive
sio
resistance.
Ohmic resistance is developed due to skin and depends on following
factors:
y Ohmic resistance is inversely proportional to the size of the electrodes used.
y Ohmic resistance is directly proportional to the dryness of the skin.
y Ohmic resistance is directly proportional to the hairy and oily skin.
Capacitive resistance is developed deep in the tissues due to electrolytic
y

potential difference generated in the cell membrane.

Interferential currents have advantage of reducing the skin impedance
or resistance, and thus the discomfort normally incurred by traditional low-frequency
ph

currents, but still producing low-frequency effects within the tissues. They are used to
produce effects in deeper tissues of the body.

Ö Production of Interferential Current:

 Interferential current is essentially a medium-frequency current that rhythmically
increases and decreases in amplitude at low frequency.

1
 INTERFERENTIAL THERAPY Sagar Naik, PT

 The principle upon which interferential therapy is based is that which produces
the interference effect where two medium frequency currents cross in the
patient’s tissues.
 Two medium frequency currents are used to produce the interferential current.
They are known as carrier waves as they do not produce muscle nerve

.
stimulation and are just used to get the greater depth of penetration and to
produce the interferential current.

ll..
channel 2
channel 1

4a
channel 2
interferential
current
channel 1

 Interferential current is produced by mixing two medium-frequency currents

sio
that are slightly out of phase, either by applying them so that they interfere
within the tissues, or alternatively by mixing them within the stimulator prior to
application (premodulated current).
 Stimulus asynchronous is applied for production of interferential current so
Wedensky inhibition doesn’t takes place and thereby there is no accommodation
phenomenon. Stimulus asynchronous produces Gilde-Meister effect.
[In low-frequency currents, stimulus synchronous is used which causes
Wedensky inhibition and thus nerve or muscle gets accommodated to that
y

current.
Inability of tissue to respond during the refractory period due to stimulus
ph

synchronous current is known as Wedensky inhibition.]

 One current is normally of fixed frequency, for example at 4000 Hz, and other
current is adjustable, for example between 4000 Hz and 4250 Hz.
 Theoretically, the two currents summate or cancel each other out in a
predictable manner, producing the resultant amplitude-modulated
interferential current.

2
 INTERFERENTIAL THERAPY Sagar Naik, PT

 The frequency of the resultant current will be equal to the mean of the two
original currents, and will vary in amplitude at a frequency equal to the
difference between these two currents. This later frequency is known as the
amplitude-modulated frequency (AMF) or beat frequency.

Ö Amplitude-Modulated Frequency (AMF):

.
 It is also known as the beat frequency.

ll..
 AMF is defined as the difference between the frequencies of the two medium-
frequency currents, which is produced in the tissues at the point where the two
currents cross.
 Amplitude of AMF is always higher than the amplitude of the two medium-
frequency currents.
 Nerve or cell membrane does not coincide with the intensity of AMF of the
current, which we give to the tissues.
4a
 AMF is a low-frequency current, which is produced deep inside the tissues.
 For example, Circuit A
Circuit B
4000 Hz
3900 Hz
medium
frequency

Beat Frequency 100 Hz – low frequency

 AMF are of two types, which are as follows:
1) Static AMF:
sio
By varying the frequency of the second circuit relative to the constant
frequency of the first, it is possible to produce a range of beat frequencies deep
in the patient’s tissues. It can be constant or variable. It is used for the
treatment of localized or smaller areas. Constant beat frequency is also
known as selective beat frequency. Variable beat frequency is also known as
automatic beat frequency.
y 0 to 5 Hz stimulates sympathetic nerves
y 5 to 10 Hz stimulates parasympathetic nerves
y

y 10 to 50 Hz stimulates motor nerves

y 50 to 90 Hz produces sedative and spasmolytic effect
y 90 to 100 Hz produce analgesic or pain relief effect
ph

2) Dynamic or vector or scanning AMF:

By varying the intensity of the second circuit relative to the constant
intensity of the first, it is possible to produce the dynamic AMF. It is also
known as vector AMF or scanning AMF. This vector can be of 45° or 90°. It
is used for the treatment of larger areas.

3
 INTERFERENTIAL THERAPY Sagar Naik, PT

Ö Advantages of Interferential Currents:

 There is no accommodation of nerve or muscle due to stimulus asynchronous
current, which produces Gilde-Meister effect in the tissues.
 Skin resistance is very much lowered, hence there is no irritation of skin, and
thus interferential currents can be given for longer period of time.

.
 Interferential currents are used to treat deeper tissues as amplitude-modulated
frequency is produced deep in the tissue.

ll..
 It relieves pain by the pain gate theory.
 It can give sensory stimulation and motor stimulation.
 There are minimum chances of electrolytic burns with the interferential currents
as the amplitude of the current keeps on varying continuously.
 Interferential currents are used to treat larger area.

Ö Area of Interference:
4aIt is the area where interferential current is set-up. The pattern of the
interferential area may be static or dynamic.

channel 1
sio
channel 2 channel 2

clove leaf
channel 1 appearance

D Static Interference:
The area in which interferential current is set-up remains stationary is
y

known as static interference. This are of static interference gives an appearance

of clove leaf as a result of the vector addition of two currents and it lies to 45°
ph

angles to the perpendicular lines from each electrode.

D Dynamic Interference:
It is possible to move the area in which interference current is developed
in a to and fro manner through 45°. It is obtained by varying the current
intensity in suitable manner. Current is varied from 50 to 100%. This dynamic
are of interference is also called as vector sweep, vector scan, rotating vector, etc.
It can also be rotated through 90°.
4
 INTERFERENTIAL THERAPY Sagar Naik, PT

Ö Methods of Application:
D Quadripolar / Bipolar Application:
 Interferential currents may be produced either by applying the two medium
frequency currents via four electrodes (quadripolar method) so that they

.
intersect in the tissues, or alternatively by mixing the two currents in the
stimulator prior to application via two electrodes (premodulated or bipolar

ll..
method).
 A quadripolar application of interferential current produces modulated
current in a clove leaf pattern, with leaves set up at right angles to the two
medium frequency currents.
 Quadripolar interferential current is produced deep inside the tissues (AMF
is produced endogenously); hence there is lowered skin impedance. Thus it
is used to treat larger areas.
4a
 Bipolar interferential current will be distributed similarly to conventional
electrical stimulation, with maximal current intensities underneath the
electrodes, progressively decreasing with distance.
 Bipolar interferential current is produced inside the machine (AMF is
produced exogenously); hence there is increased skin impedance. Thus it is
used to treat localized area or smaller areas.
sio
D Vaccum (Suction) / Rubber (Plate) electrodes:
 Interferential current is often applied via electrodes that are held in place using
an intermittent suction unit. Alternatively, flat carbon rubber electrodes may
be used.
 Suction electrodes have advantage of allowing application to large flat areas
or to patients who are relatively immobile.
 The suction also stimulates cutaneous nerves and cause vasodilatation and
y

thus increases blood circulation to that area.

 Flat carbon rubber electrodes may be easier to apply to peripheral limbs, when
they may be held in position by bandages or elasticated Velcro straps. On
ph

other hand there may be anatomical areas that are less accessible and in these
cases the suction option may be advantageous.

D Constant / Dynamic AMF:

 If constant AMF type of current is given, then there are some chances of
getting nerve or muscle accommodation.

5
 INTERFERENTIAL THERAPY Sagar Naik, PT

 If dynamic AMF type of current is given, then there are no chances of

getting nerve or muscle accommodation.
D Scanning / Static Interference:
 If vector 45° or 90° (dynamic) is used, then larger area of the body can be
treated.

.
 If static type of interference is used than only smaller area of the body can
be treated.

ll..
D 2 KHz / 4 KHz:
 Mostly, 2 KHz frequency is used for the muscle stimulation and 4 KHz
frequency is used for pain relief.

Ö Selection of Pulse:
y Triangular – Acute cases
y Rectangular – Chronic cases
4a
y Trapezoidal – Subacute cases

Ö Intensity:
y Less than 8 mA – Sensory stimulation (4 to 8 mA)
y More than 8 mA – Motor stimulation (8 to 16 mA)

Ö Physiological Effects of Interferential Current:

sio
D Pain Relief:
 Interferential current is commonly used for electro-analgesia in various
musculoskeletal conditions.
 Pain relief may occur as a result of removal of irritant or pain substances.
 Interferential current can stimulate autonomic nerves, which results in
vasodilatation and improved circulation. Improved circulation can remove
the waste products or pain substances from the site of application.
y

 Pain relief may be due to release of endorphins or due to activation of pain

gate mechanism.
ph

 Pain relief may also occur due to placebo effect.

[Placebo Effect: A positive or negative response to a therapy resulting
from person’s expectations rather than from any real effects.]
 Pain may be relieved if a constant beat in the range of 0 – 100 Hz is used. This
causes a tingling sensation, which after fifteen minutes treatment can produce
relief of pain for upto one hour.

6
 INTERFERENTIAL THERAPY Sagar Naik, PT

D Motor Stimulation:
 Normal innervated muscles will be made to contract if a constant frequency
between 1 to 10 Hz is used.
 Muscle contraction can be achieved at higher current amplitude.
 Strong muscle contractions can be achieved without ay significantly

.
uncomfortable skin sensation.
 Interferential current can stimulate deeply situated muscles, as it is like a

ll..
low frequency current.
 The contraction is produced with minimal sensory stimulation and can be
deeply placed muscles, e.g., those of the pelvic floor.
D Effect on venous & Lymphatic Returns:
 This is accelerated by frequency of 1 – 10 Hz (rhythmic), as rhythmical
pumping action produced in muscle helps in improving the drainage of
blood and lymph.
4a
 Thus, this effect of interferential current is used in the treatment of oedema.
D Relief of Muscle Spasm:
 Interferential therapy can bring about relief of muscle spasm.

Ö Indications of Interferential Current:

 Interferential current is commonly used for pain relief, relief of muscle spasm,
promote tissue healing, relief from oedema and re-education of deeply situated
sio
muscles.
 Its use in the area of sports medicine is claimed to be particularly beneficial in
reducing pain and oedema.
 Interferential therapy has been used extensively in treatment of stress
incontinence, as it is possible by placing electrodes on lower abdomen and
inner thigh to produce good strong contractions of pelvic floor muscles.
D Conditions treated by Interferential Current:
y

 Peripheral vascular disease (PVD)

i. Vasoconstrictive disease (Raynaud’s Disease)
ph

A disorder wherein exposure to cold causes sudden contraction of

small arteries supplying the fingers and toes is known as Raynaud’s
disease.
ii. Venous insufficiency
Inability of veins to pump the blood towards the heart is known as
venous insufficiency.
iii. Buerger’s disease
7
 INTERFERENTIAL THERAPY Sagar Naik, PT

It is a combination of thrombosis, inflammation and obliteration of

small and medium sized arteries. The disease begins in distal small
arteries and spreads upwards.
 Facial nerve neuritis
Inflammation of facial nerve, which leads to oedema of the face and

.
results in further compression of the facial nerve.
 Orthopedic conditions

ll..
i) Osteotendinitis Eg:- Lateral epicondylitis
ii) Joint sprains
iii) Fracture complications like delayed union, non-union & retarded
callous formation
iv) Pseudus atrophy (dystrophy)
 Gynecological Problems
i) Stress incontinence
ii)

i)
ii)
4a Urinary frequency
iii) Pelvic floor dysfunction
 Pain (All types of musculoskeletal pains)
Low back pain
Brachial neuralgia
Severe pain in the course or distribution of a brachial nerve due to
irritation or damage to the brachial nerve is called brachial neuralgia.
sio
iii) Sciatica
Pain in the distribution of sciatic nerve due to lateral disc protrusion on L4
and/or L5 spinal nerve roots is called sciatica.
iv) Phantom limb pain
Pain felt as though arising in an amputated limb is called phantom limb
pain.
v) Myalgia
Pain in the muscles is known as myalgia.
y

 Muscle re-education and muscle strengthen

 Osteoarthritis
ph

Degenerative joint disease characterized by both degeneration of articular

cartilage and simultaneous proliferation of new bone, cartilage, and connective
tissue.
 Ankylosing spondylitis
A chronic inflammatory arthritis with a predilection for the sacroiliac
joints and spine is known as ankylosing spondylitis. It manifests by
progressive stiffening and fusion of the axial skeleton.
8
 INTERFERENTIAL THERAPY Sagar Naik, PT

 Spondylosis
A defect in the interarticular part of the vertebra is called spondylosis.
 Frozen shoulder
A painful stiff shoulder secondary to periarthritis of the shoulder joint is
known as frozen shoulder.

.
 Chondromalacia
Softening of the cartilage is called chondromalacia.

ll..
 Nocturnal incontinence
Inability to control the passage of natural discharges or evacuations as
urine or faeces during night or sleep is known as nocturnal incontinence.
 Myositis
Inflammation of the muscles is known as myositis.
 Following immobilization
 Bronchial asthma
4a
Bronchial asthma is a complex and heterogeneous syndrome
characterized by episodic intrathoracic airways obstruction, airways
inflammation resulting in occurrence of dyspnoea and wheezing which varies
widely over time either spontaneously or in response to treatment.
 Bursitis
Inflammation of a bursa is called bursitis.
 Tendinitis
sio
Painful inflammation of a tendon caused by injury, overuse or prolonged
pressure is called tendinitis.

Ö Hazards (Dangers) of Interferential Current:

D Adverse Effects:
A number of adverse effects have been reported with interferential current
treatment; these includes
y

 Burns
 Increased pain
 General malaise
ph

 Nausea
 Vomiting
 Dizziness / Faintness
 Migraine / Headache
 Neurological effects
D Contraindications:
 Cardiac pacemakers
9
 INTERFERENTIAL THERAPY Sagar Naik, PT

 Advanced cardiac disease

 Hypertension
 Hypotension
 Patients where disturbance of thrombus, spread of infection or cancerous
cells, hemorrhage might result

.
 Pregnant women (Interferential therapy is contraindicated in abdominal,
lumbosacral, and pelvic area as it may lead to uterine contractions.)

ll..
 Increased cellular metabolism
i) Neoplasm
A tumour; an abnormal growth serving no function is called neoplasm.
ii) Tuberculosis
An infectious disease caused by Mycobacterium tuberculosis. Lungs form
the common site of the disease.
iii) Infection
4a
The invasion of the body by microorganisms that reproduce and multiply
causing disease is called infection.
 Asthenic individuals (Children with small body mass should not be given
interferential current to rib cage.)
 Trauma
 Hyperpyrexia
Extremely high fever with a temperature above 41°C is known as
sio
hyperpyrexia.
 Senile or confused patients (Mentally retarded, Mentally confused or Elderly
patients)
 Loss of skin sensations
 Open wounds, cuts or skin lesions
 Nearby short wave diathermy (SWD) i.e., 15 feet.
The leads of interferential therapy may act as antenna and may collect
radio frequency energy from SWD and produce undesirable surging of
y

stimulus that patient receives.

Ö Precautions or Preparation before the Treatment:
ph

D Aims:
 To avoid dangers
 To increase positive outcome of the treatment
 To optimize patients complains
D Precautions:
 Evaluate the sensations like touch, pain, and temperature.
10
 INTERFERENTIAL THERAPY Sagar Naik, PT

 Prepare the skin to avoid ohmic resistance

i) Wash the skin
ii) Warm the skin
iii) Clip the hairs
 Don’t place the electrodes on cuts, abrasions, open wounds, scratches, or

.
denuded skin.
 Use equal size electrodes.

ll..
 Apply even pressure during trapping.
 Evenly moist the sponges.
 Apply enough and comfortable vaccum during vaccum electrodes to prevent
haematoma or ecchymosis.
[Haematoma: A collection of blood inside the body, caused by bleeding from
an injured vessel is called haematoma.
Ecchymosis: A purplish discolouration from extravasated blood into the skin
or mucous membrane. It follows bleeding from a large vessel.]
4a
 Optimal positioning of electrodes (Diagonal pattern).
 Educate the patient about the interferential current.
 Instruct the patient not to touch leads and apparatus during the treatment.
Ö Important Points of Interferential Current:
 2 KHz – Muscle Stimulation
4 KHz – Pain Modulation
sio
 High AMF (70 to 130 Hz) – Acute problems and pain
Low AMF (less than 50 Hz) – Chronic and Subacute problems where muscle
contraction is needed.
 Metal implants are not the contraindications of interferential therapy.
y
ph

11