When setting up your athlete, you always want to make sure they are in the most comfortable position. When you place the electrodes on the athlete, ask him where he feels the most pain and place the electrodes accordingly. Keep in mind that the farther apart the electrodes are, the deeper the penetration.
There are three basic programs that can be used to apply stim to various injuries. For an acute or subacute injury, the programs used are interferential and premodulated. These two types of ES are high frequency, sensory level currents which can be used to override the Gate Control Theory of pain. For chronic pain, you want to use the Russian Stimulation program. This is a low frequency, motor unit stimulus which produces a contraction in the muscle. The program can be used for muscle re-education, muscle strengthening, or to produce a muscle pumping action to reduce edema.
If the unit you are using has a dispersive pad to ground the patient, that must be set up. The first thing to do is wet a paper towel to place on the dispersive pad. This aids as a conductor. Let's say you are treating a quad injury. With the athlete sitting with his legs straight out on a table, the dispersive pad would be placed underneath the hamstrings.
When choosing interferential, you want to use the quadripolar set-up. With this, the electrodes are set up in a diagonal pattern. For this type of setup, you want to place the red electrodes diagonal of each other and the black electrodes diagonal of each other. With the premodulated setup, you can choose between monopolar, bipolar, or quadripolar. You will use the same high frequency setup as the interferential program.
If you choose interferential, the next step you want to do is to pick the frequency. For pain control, you should choose 80-150 MHz, for 15 minutes. The premodulated setup for a high frequency program will also give you the choice of 80-150 MHz for 15 minutes. After you select the program, push the start button.
The next step is to turn up the intensity. As you turn up the intensity, tell the athlete that he will feel a tingling sensation. Ask your athlete to let you know when he starts to feel the tingling. When they tell you, you can then ask them to let you know when to stop increasing the intensity as it reaches a comfortable level. Once this is set, come back every five minutes to check on the athlete and to increase the intensity if it isn't as strong.
Electrical stimulation can be used in conjunction with other treatments, such as ice or stim. Both of these treatments work together to override the Gate Control Theory of pain. Using two treatments at once saves time for both you and the athlete.
