Contraindications to using IFC

[karma1031]

Hey everyone. I wanted to ask is being pregnant a contraindication for using IFC? I'm working as an aide at a small PT clinic. The PT tells me that it is okay for one of her pregnant patients to have IFC. The pregnant patient has piriformis syndrome and is in her first trimester. The PT explained that it is safe because the IFC currents do not travel through deep tissues, and the electrodes are placed far away from the fetus. I've looked in my therapeutic modalities book and it does state that pregnancy is a contraindication, but doesn't state for which body part or trimester. Is there evidence to show that IFC is harmful to a fetus? Any thoughts?

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[DancerFutureDPT]

I know we talked about it during our women's health physiology lectures, but I can't remember the specifics right now (and since I'm on spring break my notes are all in my apartment, and I am not haha). I feel like the contraindication is because of muscle contractions, specifically near the abs/back, but I'm not totally sure.

If there was any question in my mind, I wouldn't risk it.

 

[dizzy88]

I have an exam on this stuff in about 10 days lol.

Anyway, we learned that pregnancy is a contraindication. The effect of electrical current flow is unknown at this point, so placing electrodes over the low back, abdomen, pelvis, or hips is contraindicated.

 

[facetguy]

I wouldn't do it. In reality, the IFC is likely harmless. In the legal liability world, you will be hung out to dry if something, anything, goes wrong with that pregnancy. The slight benefits of IFC aren't worth it.

 

[Akiramay]

Just had this class, and pregnancy is definitely a contraindication!

 

[karma1031]

Thank you for the responses. I recently started working as an aide for the clinic, and her treatment philosophy is VERY different from the other outpatient clinics I have worked/volunteered/had treatment at. This was one issue that I didn't agree with, and she did feel slightly offended when I asked her if it was safe (there were no patients around when I asked her). I do agree with facetguy that it's a huge liability if anything happens to the baby. However, it is her own clinic and she's the only PT, so she's making the decisions regarding the treatment protocols for each patient.

 

[PTapp]

It could be a regional/relative contraindication, but I don't think it is an absolute contraindication.

 

[Coach Hoski]

According to the manual for physical agents by Karen Hayes: 5th edition, all electrical stimulation (including IFC) is contraindicated in the first trimester of pregnancy.

 

[jesspt]

Even if it was only a precaution rather than a contraindication, perhaps one might ask why would you even risk it, given the fact that sensory levle e-stim doesn't seem to improve patient's outcomes.

 

[PTapp]

Even if it was only a precaution rather than a contraindication, perhaps one might ask why would you even risk it, given the fact that sensory levle e-stim doesn't seem to improve patient's outcomes.

That, I agree with. I personally wouldn't risk it.

 

[rcheeley]

I'm curious as to why it states 1st trimester specifically? Does this apply to all body parts? I'm trying to remember what we said about it in PT school. I definitely remember no trunk e-stim, but I thought I remembered saying it was okay for extremities, much like someone w/ a pacemaker.

According to the manual for physical agents by Karen Hayes: 5th edition, all electrical stimulation (including IFC) is contraindicated in the first trimester of pregnancy.

 

[jesspt]

I'm curious as to why it states 1st trimester specifically? Does this apply to all body parts? I'm trying to remember what we said about it in PT school. I definitely remember no trunk e-stim, but I thought I remembered saying it was okay for extremities, much like someone w/ a pacemaker.

It's because miscarriages are most likely in the first trimester. Frankly, I think the e-stim is unlikley to effect the fetus in any way, but the last thing a clinician needs to do is apply a modality that is a close to worthless as any intervention we have at our disposal to a pregnant woman who then is unfortunate enough to miscarry. Say hello to litigation.

 

[Danae00]

According to the 2001 Australian Physiotherapist Association Guidelines for the Clinical Use of Electrophysical Agents any type of electrical stimulation is a local contraindication in the vicinity of the uterus.

This is pretty much what we were taught. We also were told the main reason for the contraindication is just that the effects are unknown. It does not mean that it is unsafe. But if something goes wrong.... yikes!

The piriformis is getting a bit to close to the utertus for me to be comfortable doing it. I also would want to do some research to see there is any decent evidence to even support the use of IFC for piriformis syndrome. My guess is "no".

 

[jesspt]

According to the 2001 Australian Physiotherapist Association Guidelines for the Clinical Use of Electrophysical Agents any type of electrical stimulation is a local contraindication in the vicinity of the uterus.

This is pretty much what we were taught. We also were told the main reason for the contraindication is just that the effects are unknown. It does not mean that it is unsafe. But if something goes wrong.... yikes!

The piriformis is getting a bit to close to the utertus for me to be comfortable doing it. I also would want to do some research to see there is any decent evidence to even support the use of IFC for piriformis syndrome. My guess is "no".

There is actually quite a bit of controversy regarding that diagnosis itself. I can't say that I have seen more than a handful of cases.

 

[Akiramay]

I guess I would also question the PT about why she's using IFC while saying that it doesn't reach deep tissues, because that is one of the features of IFC! It has a lower resistance to allow for a deeper penetration. So I'm confused why the PT said that...

 

[facetguy]

There is actually quite a bit of controversy regarding that diagnosis itself. I can't say that I have seen more than a handful of cases.

I agree, although I do find myself working on the piriformis quite a bit in sort of a 'just in case' fashion. A recent review goes over all the key points: http://www.ncbi.nlm.nih.gov/pubmed/20596735 They conclude there is no reliable way to diagnose it.

 

[Coach Hoski]

I agree, although I do find myself working on the piriformis quite a bit in sort of a 'just in case' fashion. A recent review goes over all the key points: http://www.ncbi.nlm.nih.gov/pubmed/20596735 They conclude there is no reliable way to diagnose it.

Interesting, and not to change the topic, but I wonder why NCV has not been more extensively used to differentiate sciatic pain originating from a true radiculopathy vs. sciatic pain resulting from piriformis syndrome.
This study, though of small statistical power, indicates that NCV was able to find increased sciatic nerve latencies across the piriformis while proximal latencies were similar to control.
http://www.ncbi.nlm.nih.gov/pubmed/17023248

 

[Coach Hoski]

I'm curious as to why it states 1st trimester specifically? Does this apply to all body parts? I'm trying to remember what we said about it in PT school. I definitely remember no trunk e-stim, but I thought I remembered saying it was okay for extremities, much like someone w/ a pacemaker.

I wish I knew, though two articles were cited (Gersh 1992 and Hayes 2000, neither of which I could find), a specific reason for that contraindication was unfortunately not given.

 

[facetguy]

I'm curious as to why it states 1st trimester specifically? Does this apply to all body parts? I'm trying to remember what we said about it in PT school. I definitely remember no trunk e-stim, but I thought I remembered saying it was okay for extremities, much like someone w/ a pacemaker.

I wish I knew, though two articles were cited (Gersh 1992 and Hayes 2000, neither of which I could find), a specific reason for that contraindication was unfortunately not given.

I'm guessing that it's because 1st trimester is when the most rapid cell division is happening, and if the e-stim were to damage, say, DNA it could be most catastrophic during that period?