2. Pulsed Electromagnetic Fields
Almost the extreme opposite of ESWT from a patient-sensation standpoint, pulsed electromagnetic field (PEMF) generally are not “felt” during a treatment session, but the treatment effects typically will not disappoint. Our 2 favorite applications are for migraine head pain and non-healing bone fracture(s). Others have used PEMF for soft-tissue pathologies with varying severity, chronicity, and complexity. This is a very user-friendly modality for patients and does not usually involve direct provider-patient (attended) time other than to set up (Table 1).
Strength of Treatment
The clinical expectation when using PEMF is that the patient will get some sort of reaction post-treatment. The worst treatment response is no response at all. Patients who are recalcitrant to the various forms of physical therapeutics tend not to be responsive to many other medical options as well.
Ease of Treatment
The application and set up for PEMF that use the C-arm (ring) method are very user friendly, with an uncomplicated set of options that control intensity/frequency etc. The learning curve for the novice (new to the product) is not steep because the treatment mechanics are relatively uncomplicated.
Patient adherence and compliance with rehabilitation devices usually is tied into several factors, including perceived value/benefit, costs, side effects, and time/duration of treatment. PEMF scores high in this category because treatments are delivered efficiently in a streamlined manner and normally do not have significant adverse effects that might potentially scare off a patient.
The clinical units tested are not inexpensive. It is my belief that the much more affordable home options, including magnets and home EMF units, do not offer the same therapeutic benefits as the clinical units. The clinical units offer dynamic field generation and propagation, with better range of field strength and intensity controls.
Given that rating various products and technologies is highly subjective, when it comes to assessing the research support, we are looking for both quality and quantity. There is a paucity of publications on this technology. There is considerably more literature from European journals (translated), so assessing methodologic quality is challenging. In my opinion, if there is any technology that could benefit all stakeholders with expanded investigation it is directly applied electromagnetic field application. It is only a matter of time before we begin to gain a better understanding of this natural life force.