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We will be discussing Pulsed Electromagnetic Field Therapy. Pulsed Electromagnetic Field, which is the second course in the series, leads to a Certificate in Electrophysical Therapy for Animals. If that is something that you would like to do, you can take the whole certificate. However, we have broken it down into smaller courses so that you can just take the ones that interest you.
I thought I would just do a little overview of Pulsed Electromagnetic Field Therapy, even for those of you that don’t want to take the course. It’s a little bit of information for you just to revise what you already know about it. If you do have the equipment, we will recap some information and we will be thinking about the research behind it and it is just a little overview.
Firstly, we will take a look at the electromagnetic spectrum and this is the range of all types of electromagnetic radiation. For those of you that have completed any courses with me before or have been on the photobiomodulation course or even studied electrophysical agents with me in the past, this is normally the first thing that we look at. It does help to have a look at the electromagnetic spectrum and see what regions we are working in.
The thing with Pulsed Electromagnetic Field therapy is that it can become confusing and there is quite a lot of confusion related to it. I am always trying to iron out any confusion for you because going out there and reading the literature and all the manufacturers details, and also speaking to different people, can become very confusing. Common questions include: What is this type/ piece of equipment? What frequency is it at? What does it do in comparison to this one? How does the research support this particular machine, but not this particular machine? PEMF is not just everything. The variables within the research as far the settings and treatment times and so on are concerned, they are very variable in the papers. So it is very confusing.
It is almost impossible to do a meta-analysis of the research that we have on this subject because it is all so variable. That means we have to sort of take it piecemeal and see what we can work out about it. It’s not like we can just go to PubMed or Google Scholar and search ‘Pulsed Electromagnetic Field horses’ and we are going to get a lot of papers. We’re not going to, so we need to know information when we are working with Pulsed Electromagnetic Field devices. We need to know what type of device we are working with, how it relates to other pieces, and if you are trying to compare it to other pieces, what the research is behind that (probably not necessarily always behind that actual piece of equipment but behind that frequency and that length of treatment).
This is what is covered in the course because it is very detailed, but I just wanted to give you an overview of it so that if you do have your own piece of equipment, you can make use of the information. You can go back to the manufacturers and say ‘What is this, this and this?’ and you can get a little bit more understanding. I am a very strong believer that if we are using anything, whether that be a modality or technique with our animals in our clinics, we must know what the research is to support it and back it up. I believe that is our responsibility to do that. You may be a nurse and you are working with physio and practice, a physiotherapist, a rehab therapist, or you may have any of this equipment. Whatever type of professional you are, you may have owners relying on you to recommend the best treatment for their animal without any knowledge of those treatments. It is our professional responsibility to understand what we are working with and how it works, and to try and decipher some of the actual research from the manufacturer’s details (which there can be quite a lot of as you all probably know).
We are now going to discuss the electromagnetic spectrum. Pulsed Electromagnetic Field Therapy is also known as PEMF, or some people refer to it as PMT (there are a lot of different names for it). When I’m talking about Pulsed Electromagnetic Field Therapy, I’m actually talking about being right down at the very, very lowest end of the electromagnetic spectrum at very, very low frequency. We are looking at extremely low frequency (between 1 and 300 Hertz). Some of the equipment is lower than this and is extremely low frequency (between 1 and 30 Hertz). This will vary between the different pieces of equipment that you might use, or even the settings in the piece of equipment that you use.
Generally in therapy for Pulsed Electromagnetic Field Therapy or extremely low frequency, we are looking at between 1 and 100 Hertz so we are right down at the lower end of the electromagnetic spectrum. Some people get confused because it is very difficult to pull it apart when the different papers use different terms and different manufacturers use different terms, and they quite often bundle it all under ‘Pulsed Electromagnetic Field’. All of the waves here and the electromagnetic spectrum are electromagnetic radiation and it is a term that can be used to cover anything really within the electromagnetic spectrum, but ‘Pulsed Electromagnetic Fields’ when we are talking about therapy, we are right down at this lower end.
There is also Radio Frequency Treatment, which is 448 kilohertz, but not all of it is. There is a bigger spectrum than that which is in the radio frequency region or radio wave region of the electromagnetic spectrum. But it tends to be the therapy devices that are radio frequency, 448 KHz (approximately) and for those, we are looking right up here. We also have Pulsed Shortwave Therapy or (Shortwave Therapy if it’s not pulsed) and very often, people will very often say ‘This is Electromagnetic Field Therapy’. Something like the Assisi loop would be 27.12 megahertz, so you are much further away on this spectrum than you are with the low frequency Pulsed Electromagnetic Field.
This isn’t necessarily a big problem. In fact, the manufacturers call it PEMF or TPEMF and it is not actually that big of a problem when it comes to the treatment because they are all good treatments. However, when you are looking at the research, you can’t quote some research on pulsed shortwave 27.12 megahertz and apply that to extremely low frequency at 30 Hertz. They are just two different things. You can’t state that the research says this works, but you are actually talking about something in a totally different frequency. That is where we need to be careful with the crossover and we as practitioners need to understand that difference and what type of device we are working with.
You are actually in a radio frequency region here when you are working with 27. 12 megahertz, and it is more appropriate that it will be called a Radio Frequency Treatment rather than a Pulsed Electromagnetic Field Treatment. But as I have previously stated, these are all interchangeable, but it is important that you do know the difference because they are different treatments and they do have different research or a different evidence base.
What are the benefits of using this therapy for animals? So let’s just think about Pulsed Electromagnetic Field Therapy (that extremely low frequency). It has been used for a long time with animals, for about 25 years. Magneto Pulse was what I worked with and it was a huge machine that you always needed to bring in on a trailer and it was plugged in. There were crates for dogs and they had the field in it. They have become a lot smaller as you can see here in this Respond Systems and FMBS image. On the FMBS image, there is also a very small control box and they are run by batteries so they are much smaller and more useful.
The huge benefit of this treatment is that it can be used at home and it can be and should be used regularly (the recommendations would be daily or up to three times a day for short bursts of treatment for 10 to 15 minutes). It is a very good way to give the owner something to do at home. It can be a beneficial revenue stream for your practice if you have equipment that you rent out to the owners, so they can have that equipment at home during the week or for two weeks between the times they see you or between their session times. They can have this equipment at home and you can have a number of these and you can be renting them out. It is a really good revenue stream and it is a really good thing to have for your practice. It’s also great that it can be used regularly at home.
There are a lot of anecdotal reports of animals seeking out their Pulsed Electromagnetic Field Mat, or if there is a specific area where they go for their treatment, they actually go and they ask for that treatment. I believe that to be true because I have seen that myself. If they go on it, they shouldn’t really feel anything happening or hear anything happening, but afterwards they feel better so they are going to want to seek that out so it is really useful to be able to give to people to use at home. It is non-invasive, you don’t have to put gel on, you don’t have to shave anything and you don’t have to poke anything in. There is a mat and they can lay on it and there’s a rug and you can just pull it over. Pulsed Electromagnetic Field will travel through bandages and bedding and things like that so if you have an animal that is nervous, you can lay it in their bed and cover it, and they can just come in and sleep on it and not really know what’s happening. So it’s very easy and very safe to use and it’s very non-invasive and very well tolerated by the animals.
So where are we and what are the clinical uses? We have little robust clinical trials with animals so we can always look at preclinical trials and say that they suggest this and that and the other, and it’s all wonderful. But for us to be very confident and to really be able to stand behind a treatment, clinical trials need to be carried out and they need to be positive. Obviously we don’t have that with animals. We have got a few and some are not positive or don’t show any change. We have a few that seem to be positive but when you actually pick the research paper apart, there are questions over the variables and they are not controlled trials. So it’s a bit limited as to what we can actually say. We cannot say ‘With animals, this will work’. We don’t have the evidence yet to say that and we need that so if anybody wants to carry out any studies, this is a good study to do.
We are going on preclinical and animal model studies (laboratory experiments and in vitro experiments). That has been carried over to the human clinical trials and there have been quite a lot of human clinical trials with PEMF and again, the variables are very different. Again, the settings will be different and the intensities will be different so it is very difficult to consider that and then say ‘Yes, it works’. No it doesn’t, and there are some really positive studies that show that this is a really good therapy and that it can have a very good effect. However, there are also some studies that are not necessarily negative, but don’t really show the positive effect that we think we could see or want to see.
There is a very good body of evidence in the preclinical and animal models studies and the human clinical trials that show you can have an influence on biological activities such as inflammation, pain transduction, tissue growth and repair, vasomotor tone (vasodilation is an effect that has been very well measured), and other physiological processes. So we can reasonably confidently say that we can hope to bring about those effects. We can’t yet say that we definitely can do that with animals, but the anecdotal evidence is very positive so we need to weigh everything up and it’s just something you need to be aware of.
If you have a PEMF device and you read the manufacturer’s information and instructions and it says it can do this, that, and the other and your horse is going to be wonderful and amazing, we think it probably is true. It is certainly very possible looking at what studies have been carried out on humans and also the preclinical studies, but we can’t actually say that it definitely does work with a horse or a dog because we just don’t have the evidence yet to prove that. It is just something to bear in mind with your wording, when you are using equipment, how you are thinking about it and how you are discussing it with your clients. You need to be a bit careful because if they actually asked you to show them evidence, you would struggle to show them the evidence.
For osteoarthritis, it is very useful to reduce pain and swelling. If we can reduce that pain and reduce that swelling, it is going to be the first stage of being able to get them moving and get some improvement with osteoarthritis. Another use is for bone healing and there are positive studies to show that PEMF can have a very good effect on non-union and acute fractures. Within the course, we cover all of this in a lot more depth and detail. It can be used for pain – chronic and acute pain. Again, going back to arthritis and also other forms of post-surgical pain and similar things like that has been studied. It is not very often used for wounds but it can be, and it can also be used for tendons and ligaments etc. If we can get that research carried out in the animal world and the animal clinical trials, then it would be really, really useful. For any of you that are currently at university and are thinking about a project to do, this would be a nice study to carry out.
Your actions for this week: Are you using PEMF? If you have a device in your clinic that you use and you believe it is PEMF, do you know it’s actually PEMF? Is it for extremely low frequency Pulsed Electromagnetic Field? If so, find out exactly what frequencies you are using and source the key research to back it up and support it. Anything you use, you should be able to pull out the research and tell somebody why you use it and how it’s backed up. If you are using it in practice, you must know the answers to that question or questions. If you are interested in providing PEMF but you don’t actually use it at the moment, then your action would be to start some research on the available modalities.
So I hope that helps this week just to cover PEMF and just give you a little bit of an overview of where we are as far as the research is concerned and the different frequencies. I hope that has helped.