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 in full 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.
Non Thermal Applications
Ultrasound (low dose, non thermal, pulsed)
Pregnancy (local) |
CI |
Local Circulatory 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 |
LOCAL CI |
Thermal Skin Test |
ONLY IF THERMAL |
Metal Implant |
|
Sharp/Blunt Skin Tests |
|
Pulsed Shortwave (Low dose, non thermal application)
Pregnancy (local) |
CI |
Local Circulatory 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 |
CI |
Thermal Skin Test |
ONLY IF 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 |
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 NOTE |
Local Circulatory Insufficiency |
PRECAUTION |
|---|---|---|---|
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
Pregnancy (local) |
CI ** SEE NOTE |
Local Circulatory Insufficiency |
PRECAUTION |
|---|---|---|---|
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 NOTE |
Local Circulatory Insufficiency |
PRECAUTION |
|---|---|---|---|
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 |
|
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 |
|
|
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) |
CI |
Local Circulatory 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 |
|
Ultrasound (continuous / thermal)
Pregnancy (local) |
CI |
Local Circulatory 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
Pregnancy (local) |
CI |
Local Circulatory 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 |
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 |
|
|---|---|---|---|
Pregnancy (general) |
|
Epilepsy |
CAUTION WITH 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 |
|
Cold Therapy
Pregnancy (local) |
PRECAUTION |
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 |
|
Thermal Skin Test |
YES |
Metal Implant |
PRECAUTION |
Sharp/Blunt Skin Tests |
|
Ultraviolet Radiation
Pregnancy (local) |
PRECAUTION |
Local Circulatory Insufficiency |
PRECAUTION |
|---|---|---|---|
Pregnancy (general) |
SEE MODALITY SPECIFIC ADVICE |
Epilepsy |
CI |
Malignancy |
LOCAL CI |
Devitalised Tissues |
LOCAL CI |
Specialised Tissues |
EYE |
Active Epiphysis |
|
Active Implants (incl Pacemakers) |
|
TESTS |
|
Tissue Bleeding |
CI |
Thermal Skin Test |
SPECIALIST SKIN SENSITIVITY TESTS REQUIRED |
Metal Implant |
|
Sharp/Blunt Skin Tests |
|
