Electrotherapy on the Web - Contraindications

Home Modalities Healing Concepts Publications

Manufacturers ElectroNews Courses Links Download
Contraindications Books Contact FAQ's SEARCH

Contraindications
There has been on ongoing controversy over the various and diverse contraindication for electrotherapy modalities over recent
years. Many of the widely held beliefs in this area have been challenged in that there appears to be little by way of 'concrete
evidence' for many and a lot of anecdotal evidence and supposition about some of the others. If you look in a selection of the
major texts, they tend to provide a 'sircular reference list' in that they all X refer to each other without getting to grips with the
original work.

A group, under the auspices of the Chartered Society of Physiotherapy in the UK have spent some time working through as
much of the original evidence as we could find in order to establish what actually is and what is not a contraindication for the
most commonly employed modalities. A group in Aurstralia have undertaken a similar exercise.

The CONTRAINDICATION GRID is probably the most useful quick reference guide, and although I used to have it up on the
web page, it seems like this new format really does not like large tables, so have given up trying to reproduce it here for the
moment. It is still available as a download file (.pdf - good for printing if you want a copy for the department / clinic).

The information below is a summary of the CSP group outcomes (published in October 2006) - contact the CSP (www.csp.org.
uk)or sue.finley@heartofengland.nhs.uk if you want a copy - which is fully referenced. For copyright reasons, I can't reproduce
it is full here.

I have a lot of additional material; that I am trying to pull together to explain some of the commonly held misconceptions with
regards the contraindications, precautions and dangers relating to electrophysical agents, but in the meantime, the grid that
follows will provide a quick and easy summary about the key issues.

NOTES :

Where there is no entry in the grid below, it means that there is no known / demonstrated detrimental effect

Where an entry relates to a 'LOCAL CI' in relates to whether the applied energy would reach the tissue in question

The current issues regarding the use of TENS during pregnancy is dealt with in some considerable detail in a specific TENS
During Pregnancy document which can be obtained from the download page.

Ultrasound (non thermal)

Low frequency Electrical Stimulation Microwave

Pulsed Shortwave (non thermal)

Infra Red Hot Packs

http://www.electrotherapy.org/modalities/contragrid.htm (1 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Laser
Wax Biofeedback

TENS
Shortwave (Continuous / Pulsed - Thermal) Cold Therapy

Interferential
Ultrasound (continuous / Thermal) Ultra Violet Radiation

Non Thermal Applications

Ultrasound (low dose, non thermal, pulsed)

Pregnancy (local) Local Circulatory

CI
Insufficiency PRECAUTION

Pregnancy (general)
Epilepsy

Malignancy
CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

Active Implants (incl

Pacemakers) LOCAL CI TESTS

Tissue Bleeding ONLY IF

LOCAL CI Thermal Skin Test
THERMAL

Metal Implant
Sharp/Blunt Skin Tests

Pulsed Shortwave (Low dose, non thermal application)

http://www.electrotherapy.org/modalities/contragrid.htm (2 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Pregnancy (local) Local Circulatory

CI
Insufficiency PRECAUTION

Pregnancy (general)
CI Epilepsy

Malignancy
CI Devitalised Tissues PREAUTION

Specialised Tissues
EYE, TESTIS Active Epiphysis LOCAL CI

Active Implants (incl

Pacemakers) CI TESTS

Tissue Bleeding ONLY IF

CI Thermal Skin Test
THERMAL

Metal Implant
PRECAUTION Sharp/Blunt Skin Tests

Laser Therapy

Pregnancy (local) Local Circulatory

Insufficiency PRECAUTION

Pregnancy (general)
Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues
EYE, TESTIS Active Epiphysis LOCAL CI

http://www.electrotherapy.org/modalities/contragrid.htm (3 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
CI Thermal Skin Test

Metal Implant
PRECAUTION Sharp/Blunt Skin Tests

Electrical Stimulation

TENS

Pregnancy (local) CI ** SEE

Local Circulatory
NOTE PRECAUTION
Insufficiency

Pregnancy (general)
Epilepsy CI NECK

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

Active Implants (incl

Pacemakers) CI TESTS

Tissue Bleeding
CI Thermal Skin Test

Metal Implant
Sharp/Blunt Skin Tests YES

Interferential

http://www.electrotherapy.org/modalities/contragrid.htm (4 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Pregnancy (local) CI ** SEE

Local Circulatory
NOTE PRECAUTION
Insufficiency

Pregnancy (general)
Epilepsy CI NECK

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

Active Implants (incl

Pacemakers) CI TESTS

Tissue Bleeding
CI Thermal Skin Test

Metal Implant
Sharp/Blunt Skin Tests YES

Other Low Frequency (e.g. muscule stim, diadynamics etc)

Pregnancy (local) CI ** SEE

Local Circulatory
NOTE PRECAUTION
Insufficiency

Pregnancy (general)
Epilepsy CI NECK

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

http://www.electrotherapy.org/modalities/contragrid.htm (5 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Active Implants (incl

Pacemakers) CI TESTS

Tissue Bleeding
CI Thermal Skin Test

Metal Implant
Sharp/Blunt Skin Tests YES

Heat

Infra Red

Pregnancy (local) Local Circulatory

Insufficiency CI

Pregnancy (general)
Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues
EYE Active Epiphysis

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
CI Thermal Skin Test YES

Metal Implant
Sharp/Blunt Skin Tests

http://www.electrotherapy.org/modalities/contragrid.htm (6 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Wax

Pregnancy (local) Local Circulatory

Insufficiency CI

Pregnancy (general)
Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues
EYE Active Epiphysis

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
CI Thermal Skin Test YES

Metal Implant
Sharp/Blunt Skin Tests

Shortwave (Continuous, Thermal)

Pregnancy (local) Local Circulatory

CI
Insufficiency CI

Pregnancy (general)
CI Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

http://www.electrotherapy.org/modalities/contragrid.htm (7 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Active Implants (incl

Pacemakers) CI TESTS

Tissue Bleeding
CI Thermal Skin Test YES

Metal Implant
CI Sharp/Blunt Skin Tests

Ultrasound (continuous / thermal)

Pregnancy (local) Local Circulatory

CI
Insufficiency CI

Pregnancy (general)
Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

Active Implants (incl

Pacemakers) CI LOCAL TESTS

Tissue Bleeding
CI Thermal Skin Test YES

Metal Implant
CI LOCAL Sharp/Blunt Skin Tests

Microwave

http://www.electrotherapy.org/modalities/contragrid.htm (8 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Pregnancy (local) Local Circulatory

CI
Insufficiency CI

Pregnancy (general)
CI Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues EYE,

TESTIS Active Epiphysis LOCAL CI

Active Implants (incl

Pacemakers) CI TESTS

Tissue Bleeding
CI Thermal Skin Test YES

Metal Implant
CI Sharp/Blunt Skin Tests

Hot Pack

Pregnancy (local) Local Circulatory

Insufficiency CI

Pregnancy (general)
Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues
EYE Active Epiphysis LOCAL CI

http://www.electrotherapy.org/modalities/contragrid.htm (9 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
CI Thermal Skin Test YES

Metal Implant
PRECAUTION Sharp/Blunt Skin Tests

Others

Biofeedback (with no adjunctive stim)

Pregnancy (local) Local Circulatory

Insufficiency

CAUTION WITH
Pregnancy (general) Epilepsy VISUAL FEEDBACK
MODES

Malignancy
Devitalised Tissues

Specialised Tissues
Active Epiphysis

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
Thermal Skin Test

Metal Implant
Sharp/Blunt Skin Tests

http://www.electrotherapy.org/modalities/contragrid.htm (10 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Cold Therapy

Pregnancy (local) Local Circulatory

PRECAUTION
Insufficiency CI

Pregnancy (general)
Epilepsy

Malignancy
LOCAL CI Devitalised Tissues PREAUTION

Specialised Tissues
EYE Active Epiphysis

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
Thermal Skin Test YES

Metal Implant
PRECAUTION Sharp/Blunt Skin Tests

Ultraviolet Radiation

Pregnancy (local) Local Circulatory

PRECAUTION
Insufficiency PRECAUTION

SEE MODALITY
Pregnancy (general) SPECIFIC
ADVICE Epilepsy CI

Malignancy
LOCAL CI Devitalised Tissues LOCAL CI

Specialised Tissues
EYE Active Epiphysis

http://www.electrotherapy.org/modalities/contragrid.htm (11 of 12)2/23/2009 6:26:29 AM

Electrotherapy on the Web - Contraindications

Active Implants (incl

Pacemakers) TESTS

Tissue Bleeding
CI Thermal Skin Test SPECIALIST
SKIN
SENSITIVITY
TESTS
REQUIRED
Metal Implant Sharp/Blunt Skin
Tests

(C) Tim Watson 2009

http://www.electrotherapy.org/modalities/contragrid.htm (12 of 12)2/23/2009 6:26:29 AM