(Published in ACPAT Newsletter April 2020)
In my 22 years of practice I have not come across anything as effective as INDIBA (capacitive and resistive monopolar radio frequency) in managing pain and injury in horses and people. I thought I would reflect on the impact it has had on my practice.
So why is it so effective?
The specific current of 448khz is delivered from a hand held electrode to a return plate on the horse’s sternum, the current travels through the animal. This means that you get a depth of treatment that other modalities cannot reach, they estimate a depth of delivery of at least 6cm. It is this depth of treatment that has enabled me to treat areas of the horse that I could not get to previously. We are all aware that pain in a proximal limb can be the driving force to a horse’s back pain and prior to using INDIBA I did not have many tools to address this, now I do. I find myself treating more and more joints such as stifles, hocks, fetlocks, shoulders and carpus, as well as backs, necks and sacroiliac joints.
How does it work?
The truth is we are not entirely sure. From stem cell studies we know that it effects proliferative and differentiating processes involved in tissue regeneration. It doesn’t fit into one electrotherapy category as it has multiple mechanisms of actions electric cur-rent, heat/thermal and magnetic.
Another aspect of INDIBA that is intriguing is that on a thermal setting it causes the tissues to generate heat. Once you remove the hand held electrode the electrode feels cool but the tissues remain warm. If you suspect a pathology in an area you will get a warming effect, if it is a non-pathological area the heating effect is less signifi-cant. From human studies they have shown that the heating effect lasts for at least 45 minutes after treat-ment.
INDIBA can be use on acute and chronic conditions ei-ther inducing bio stimulation or a thermal response. The indication of which depends on the stage of injury. In the human field, in high level sport, they can use it as early as 6 hours post injury. In the horse we often don’t get to them that quickly.
What does it feel like?
When I have applied it to my human patients they have all found the treatment exceptionally comfortable and relaxing. It could be described as hot water running through you.
The effect is pretty instant. For example I have used on an acute low back pain patient with a suspected disc herniation who instantly following treatment could cough again. She was not “cured” in one session but it did make a significant impact on her pain and mobility. The treatment is generally very well tolerated in horses (once they get over the large box outside their stable). You will also get a relaxed horse demonstrating an endorphin response.
How do I know it works?
Well that is always our challenge in physiotherapy without strong objective markers there is always an element of subjectivity. Also owners do like to do everything for their horse so there may be a variety of people involved in their management and therefore it is impossible to categorically say it was my treatment. But there are horses who I have done traditional physio and they don’t get the significant reduction in pain or muscle spasm they do with INDIBA. I have then used INDIBA and got the expected results. May be I am just not an effective physiotherapist. Things got better before INDIBA but they now get even better. The other indication to me that it works is that I don’t need to see the horses or people so frequently, months can go by before requiring further treatments. This was highlighted in the RCT study by Kumaran and Watson (2018), where by the use of INDIBA on OA knee lasted for at least 3 months.
In summary I can deliver an effective and deep treatment to a variety of msk conditions in horses and people. I get “feedback” from the horse and device (and people). Yes, a further evidence base is required but there is also a lack of evidence in many other treatments in the equine field, you have to start somewhere. I believe it also offers management options that reduce the need for invasive treatments. I still need all my physiotherapy skills in assessment, palpation and exercise rehabilitation. Another bonus is that my hands don’t hurt at the end of a day.
Polly Hutson will be one of our guests in our next webinar.
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