Elsevier

Physiotherapy

Volume 88, Issue 8, August 2002, Pages 458-470
Physiotherapy

Scholarly paper
Pulsed Electromagnetic Fields for Treating Osteo-arthritis

https://doi.org/10.1016/S0031-9406(05)60848-6Get rights and content

Summary

Background

Osteo-arthritis, a painful joint disorder involving degenerative changes of the articular cartilage and subchondral bone, often results in progressive functional impairment and disability. One particular modality used by physiotherapists that shows very promising results in reducing the joint damage and pain found in osteo-arthritis is pulsed electromagnetic fields.

Objective

The present objective was to examine the rationale for, and the potential efficacy of, applying pulsed electromagnetic fields for reducing joint pain and other related symptoms of osteo-arthritis.

Methods

The related English language literature was extensively reviewed to examine whether changes in pain might be expected from the application of pulsed electromagnetic fields to an osteo-arthritic joint, and why.

Results

The basic and clinical research in this field, while somewhat limited, supports the insightful application of pulsed electromagnetic fields to ameliorate pain and disability due to osteo-arthritis.

Conclusion

Further basic and clinical research to validate the use of pulsed electromagnetic fields in facilitating function and possibly in facilitating joint reparative processes in osteo-arthritis, as well the lessening of osteo-arthritic joint pain and joint dysfunction is indicated.

Introduction

Osteo-arthritis, the most common form of arthritis, is usually accompanied by focal destruction of the articular cartilage lining of synovial joints, plus extensive subchondral bone remodelling and possible bone necrosis. It affects men and women equally, particularly in later life, and may involve one or more large peripheral joints and/or joints of the spine. The primary signs and symptoms of osteo-arthritis include pain and stiffness, weakness, joint instability, joint inflam-mation, joint deformity and a decreased range of joint motion. A general decrease in the ability to function physically occurs over time and may lead to impaired psychological function and social isol-ation, in addition to economic hardships.

Because there is no cure for osteo-arthritis, individuals with this disease, particularly those who have little benefit from prescribed medications or cannot use these drugs without hazard, are sent to physiotherapists for treatment to alleviate their symptoms and to restore optimal functional capacity.

Physical therapies commonly advocated for treating the symptoms of osteo-arthritis include exercise and a wide variety of electrotherapeutic modalities. Each shows some promise in improving one or more osteo-arthritic signs and symptoms even though adequate research in this field is sorely lacking.

In this respect, one electromagnetic modality constituted by low-frequency low-energy pulsed electromagnetic fields of single or pulse burst quasi-rectangular or triangular waveforms, which originated in its application to bone and wound healing, has been found to have prom-ising applications in this respect.

How effective pulsed electromagnetic fields are for treatment of joint pain, inflammation, bone damage and healing of articular cartilage and soft tissue lesions, which may all occur in people with osteo-arthritic joint disease, is the subject of this literature review. In particular we examine:

  • Existing rationale underlying the application of pulsed electromagnetic fields for treatment of painful osteo-arthritic joints.

  • Clinical effectiveness of therapeutic pulsed electromagnetic fields for treatment of osteo-arthritis and related conditions.

  • Possible mechanisms to explain how exposure of articular tissue to pulsed electromagnetic fields may yield beneficial clinical results for people with osteo-arthritic joint disease.

Section snippets

Articular Cartilage

Under normal conditions, articular cartilage – the joint structure most affected by osteo-arthritis – is constituted by cells known as chondrocytes, which account for less than 10% of its volume. These cells manufacture, secrete and maintain the organic component of the extracellular compartment, or cart-ilage matrix, composed of a dense col-lagen fibril network enmeshed in a concentrated solution of proteoglycans and water. The importance of these structural interactions is that they determine

Results

The present search method revealed 15 relevant articles, but one was not clearly related to the application of electro-magnetic therapy (Zizic et al, 1995). Another used an animal model (Ciombor and Aaron, 2001), one was not published as a full-length study (Perrot et al, 1998) and one was a retrospective study (Hershler and Sjaus, 1999). The remainder related to the use of pulsed electromagnetic fields for bone healing or relief of pain and inflammation. Only two randomised controlled trials

Discussion

In general, most clinical reports reviewed in this paper indicate that positive results, over and above a strong placebo effect, can occur in terms of pain reduction and bone healing by the application of pulsed electromagnetic fields to damaged or painful tissues and osteo-arthritic joints, regardless of method of stimulation. This was also the recent conclusion of Quittan et al (2000) who examined all categories of usage of pulsed electromagnetic field therapy that have been documented in the

References (53)

  • AaronRK et al.

    ‘Therapeutic effects of electromagnetic fields in the stimulation of connective tissue repair’

    Journal of Cellular Biochemistry

    (1993)
  • AaronRK et al.

    ‘The conservative treatment of osteonecrosis of the femoral head: A comparison of core decompression and pulsing electromagnetic fields’

    Clinical Orthopaedics and Related Research

    (1989)
  • BakerB et al.

    ‘A study of electrochemical enhancement of articular cartilage repair’

    Clinical Orthopaedics and Related Research

    (1974)
  • BassettCA

    ‘Beneficial effects of electromagnetic fields’

    Journal of Cellular Biochemistry

    (1993)
  • BassettCA et al.

    ‘Effects of pulsed electromagnetic fields on Steinberg ratings of femoral head osteonecrosis’

    Clinical Orthopaedics and Related Research

    (1989)
  • BorsalinoG et al.

    ‘Electrical stimulation of human femoral intertrochanteric osteotomies: Double blind study’

    Clinical Orthopaedics and Related Research

    (1988)
  • BrightonCT et al.

    In vitro growth of bovine articular cartilage chondrocytes in various capacitively coupled electrical fields’

    Journal of Orthopaedic Research

    (1984)
  • CiomborDM et al.

    ‘Modification of osteo-arthritis by electromagnetic field exposure’

    Arthritis and Rheumatism

    (2001)
  • DarendelilerMA et al.

    ‘Effects of static magnetic and pulsed electromagnetic fields on bone healing’

    International Journal of Orthodontics, Orthnographics and Surgery

    (1997)
  • DevereauxMD et al.

    ‘Chronic lateral humeral epicondylitis: A double-blind controlled assessment of pulsed electromagnetic field therapy’

    Clinical and Experimental Rheumatology

    (1985)
  • Foley-NolanD et al.

    ‘Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries: A double blind randomised controlled study’

    Scandinavian Journal of Rehabilitation Medicine

    (1992)
  • GrazianaA et al.

    ‘External electric fields stimulate the electrogenic calcium/sodium exchange in plant protoplasts’

    Biochemistry

    (1990)
  • HershlerC et al.

    ‘Pulsed signal therapy: Treatment of chronic pain due to traumatic soft tissue injury,’

    International Medical Journal

    (1999)
  • HongCZ et al.

    ‘Magnetic necklace: Its therapeutic effectiveness on neck and shoulder pain,’

    Archives of Physical Medicine and Rehabilitation

    (1982)
  • KennedyWF et al.

    ‘Use of electromagnetic fields in treatment of loosened cemented hip prostheses: A double blind trial,’

    Clinical Orthopaedics and Related Research

    (1993)
  • KonradK et al.

    ‘Therapy with pulsed electromagnetic fields in aseptic loosening of total hip prostheses: A prospective study,’

    Clinical Rheumatology

    (1996)
  • Cited by (0)

    View full text