Electrotherapy

In general, there is little evidence that electrotherapy is effective in the management of musculoskeletal conditions.[3] In particular, there is no evidence that electrotherapy is effective in the relief of pain arising from osteoarthritis,[4] and little to no evidence available to support electrotherapy for the management of fibromyalgia.[5]

A 2016 review found that, "in evidence of no effectiveness," clinicians should not offer electrotherapy for the treatment of neck pain or associated disorders.[6] Earlier reviews found that no conclusions could be drawn about the effectiveness of electrotherapy for neck pain,[7] and that electrotherapy has limited effect on neck pain as measured by clinical results.[8]

A 2015 review found that the evidence for electrotherapy in pregnancy-related lower back pain is "very limited".[9]

A 2014 Cochrane review found insufficient evidence to determine whether electrotherapy was better than exercise at treating adhesive capsulitis.[10] As of 2004, there is insufficient evidence to draw conclusions about any intervention for rotator cuff pathology, including electrotherapy;[11] furthermore, methodological problems precluded drawing conclusions about the efficacy of any rehabilitation method for impingement syndrome.[12]

There is limited, low quality evidence for a slight benefit of noxious-level electrotherapy in the treatment of epicondylitis. [13]

A 2012 review found that "Small, single studies showed that some electrotherapy modalities may be beneficial" in rehabilitating ankle bone fractures. [14] However, a 2008 review found it to be ineffective in healing long-bone fractures.[15]

A 2012 review found that evidence that electrotherapy contributes to recovery from knee conditions is of "limited quality". [16]

A 2004 Cochrane review found "weaker evidence" that pulsating electromagnetic fields could be effective in treating recurrent headaches.[17] A 2016 Cochrane review found that supporting evidence for electrotherapy as a treatment for complex regional pain syndrome is "absent or unclear."[18]

A 2015 review found that the evidence supporting the use of electrotherapy in healing pressure ulcers was of low quality,[19] and a 2015 Cochrane review found that no evidence that electromagnetic therapy, a subset of electrotherapy, was effective in healing pressure ulcers.[20] Earlier reviews found that, because of low-quality evidence, it was unclear whether electrotherapy increases healing rates of pressure ulcers.[21][22] By 2014 the evidence supported electrotherapy's efficacy for ulcer healing.[23]

Another 2015 Cochrane review found no evidence supporting the user of electrotherapy for venous stasis ulcers.[24]

Since the 1950s, over 150 published articles have found a positive outcome in using cranial electrostimulation (CES) to treat depression, anxiety, and insomnia.[25]

An early 20th century electrotherapy apparatus

Electrotherapy equipment has historically included:

• The electric bath for high-voltage static induction
• Oudin coil, a high-voltage induction coil, in use around 1900
• Pulvermacher's chain, a wearable electrochemical device mostly used by quacks, in use second half of 19th century
• Leyden jars, an early form of capacitor, for storing electricity
• Electrostatic generators of various sorts

Some important people in the history of electrotherapy include;

• Luigi Galvani, a pioneer of medical electricity
• Benjamin Franklin, an early proponent of electrotherapy who made it widely known, but mostly taken up by quacks and charlatans
• Golding Bird, mentioned above
• Charles Grafton Page
• Duchenne de Boulogne
• Jacques-Arsène d'Arsonval
• George Miller Beard
• Margaret Cleaves, a promoter of ozone therapy
• Many of the forms of electricity used in electrotherapy were named after scientists

• James Graham
• Franz Mesmer

In 1856 Guillaume Duchenne announced that alternating was superior to direct current for electrotherapeutic triggering of muscle contractions.[31] What he called the 'warming effect' of direct currents irritated the skin, since, at voltage strengths needed for muscle contractions, they cause the skin to blister (at the anode) and pit (at the cathode). Furthermore, with DC each contraction required the current to be stopped and restarted. Moreover, alternating current could produce strong muscle contractions regardless of the condition of the muscle, whereas DC-induced contractions were strong if the muscle was strong, and weak if the muscle was weak.

Since that time almost all rehabilitation involving muscle contraction has been done with a symmetrical rectangular biphasic waveform. During the 1940s, however, the U.S. War Department, investigating the application of electrical stimulation not just to retard and prevent atrophy but to restore muscle mass and strength, employed what was termed galvanic exercise on the atrophied hands of patients who had an ulnar nerve lesion from surgery upon a wound.[31] These galvanic exercises employed a monophasic (single-pulse) direct current waveform.

The American Physical Therapy Association, a professional organization representing physical therapists, accepts the use of electrotherapy in the field of physical therapy.[32][33]