The effect of electro-massage with interferential current therapy on pain and function following acromioplasty surgery

Experimental group: all subject received a conservatory treatment (1h and 40 min) and electro-massage (10min). The treatment were applied six Physiotherapy sessions, two times a week for three weeks. The duration was 1 hour and 40 min for the conservatory treatment and 10 min for the electro-massage. Description of the electro-massage that was performed by a specialist physiotherapist with more than 8 years of experience We use ENDOMED 482 (Enraf Nonius, Spain) for the elecro-massage. the current parameters are: frequency shift at 4000 Hz IFC, 100 Hz AMF in CV mode. We will gradually raise the current intensity until reaching a high level, but not so high as to cause pain or discomfort, nor evident muscle contraction, although a gentle vibration is allowed. The electro-massage was performed on the musculature of the shoulder and neck. Superficial rubbing: We place both electrodes in parallel, always keeping that one in our distal hand in distal position. We perform a smooth skating, with light compression, through the different structures in the cervical-scapulohumeral complex. Rubbing speed must be low, 2-3 cm per second. We perform this procedure both at the beginning and the end of the treatment. Treatment time: one minute (30 seconds at the beginning and 30 seconds at the end). Deep rubbing: we perform a slipping of the electrodes, now placing a higher compression over them. We place the fixed proximal electrode in the initial belly area; at the same time, we slip the distal electrode along the muscular belly, until reaching its insertion. Slipping speed is higher than that in superficial rubbing, 5-6 cm per second. We perform this procedure over the following muscles: anterior deltoid, middle deltoid, posterior deltoid, biceps, triceps, upper trapezius, supraspinatus, infraspinatus and rhomboid muscle. Treatment time: two minutes. Deep rubbing with gleno-humeral decoaptation: we perform the deep rubbing procedure, asking the patient to get the shoulder down. We keep the fixed proximal electrode placed on the upper trapezius. We perform the deep rubbing procedure using the distal electrode from the middle deltoid, through the arm lateral side to the epycondile. We ask the patient to get the shoulder down when we perform the slipping from proximal to distal, whereas he will not do so when we go back to proximal, establishing so a contraction-relax cycle. Treatment time: 1 minute and 30 seconds. Kneading: we place both electrodes in parallel in the initial belly area, keeping the one in our distal hand in distal position at all times; then, in the distal direction, we perform kneading on the muscular belly, moving the electrodes alternatingly front-to-back. Speed and compression over the electrodes will be the same as in deep rubbing. We perform this procedure on the following muscles: upper trapezius, anterior deltoid, middle deltoid, posterior deltoid, biceps and triceps. Treatment time: 1minute and 30 seconds. Stretching. First, we ask the patient to move the body segment undergoing stretching, placing it in pre-stretching position. We must take into account that we are working with patients with limited joint range motion, and therefore we should take care in not forcing stretching in any way. We will perform this previous step just over these muscles: superior trapezoidal, scapula elevator, supraspinatus and infraspinatus. Regarding the remaining muscles, the therapist will move the body segment while the stretching is being performed. We place both electrodes in parallel on the initial belly area, the one in our distal hand always in distal position, then, in distal direction, we will slip the distal electrode all along the muscular belly until reaching its insertion. Speed and compression over the electrodes will be the same as in deep rubbing. Besides, we will perform additional compression over the muscular origin all stretching long; this compression will equal that one in the distal electrode when this one reaches its insertion. We will then keep the stretching for 15-20 seconds, as if it were a manual passive stretching. We will perform this procedure over the following muscles: superior trapezoidal, scapula elevator, anterior deltoid, middle deltoid, posterior deltoid, supraspinatus, infraspinatus, biceps and triceps. Treatment time: 2 minutes and 30 seconds. Articular procedure for humeral head: we place both electrodes in the same position as in the beginning of the treatment (distal electrode on the shoulder anterior side, longitudinally, following the anterior deltoid muscular fibres direction, proximal electrode on the shoulder posterior side, longitudinally, following the posterior deltoid muscular fibres direction). Then, we will perform traction and slipping towards the humeral head retropulsion using the distal electrode. Such slipping will be performed until reaching the proximal electrode; this one will remain fixed. Once reached, the distal electrode will be placed again on its initial position, thus completing a retropulsion-relax cycle. Speed and compression over the electrodes will be the same as in deep rubbing. Treatment time: 1minute and 30 seconds.