As a physical therapist for over 40 years, I have developed a core set of values, chief among them is dedication to lifelong learning. And the more I learn the more I realize how much I don’t know it’s a humbling, frustrating, energizing, exciting and exhausting realization. But at the same time, the more I learn the more I realize how connected and integrated so many of the approaches to treatment of the human body really are. I have been through 40+ years of debate and discovery around mechanical, fascial, postural, functional, movement-based, neurological and psychological models of assessment and treatment, all of which claim not only to address what ails the dysfunctional, painful body, but to be THE ANSWER. My own experience has shown me that the assessment of dysfunction has to be broad enough in scope to include all of these contributing facets, and treatment has to be specific enough in scope to address the underlying dysfunction rather than the symptom, which are its byproduct.
As I have matured in my profession, I have distanced myself more and more from modalities (I cannot remember the last time I used an ultrasound or electrical stim unit), and relied more on more on my own two hands, neuromuscular re-education and prescriptive exercise to help resolve my patients’ issues. When it comes to treating low backs, for instance, my own professional trajectory mirrors what research is showing-manual work can impact acute pain but to resolve chronic pain, exercise is the only thing proven to make a difference. (To be perfectly transparent, cold laser is something that I have used pretty often in conjunction with manual treatment because it works at the cellular level and I have gotten very good results with it.)
Why am I sharing this biographical information? I do so because it sets the stage for sharing my experience with Winback TECAR (Transfer of Energy Capacitive and Resistive) Therapy, a modality that came into my life uninvited and quite by accident, and one that I cannot now imagine treating without. About a year and a half ago, I received a phone call from Harlan Pyes of Harlan Health, a distributor of rehab equipment for several highly reputable companies. I had known Harlan for many years as he had been the vendor of some high-end equipment at a couple of facilities in New York where I worked, and he had been the distributor on site for some Kinesio Taping courses that I had taught. He also sold me my laser unit. Nevertheless, I was surprised to hear from him out of the blue as I hadn’t talked to him in a few years. He called me with a proposition: having seen me teach the Kinesio Taping Method, he knew I could teach and was wondering if I would be interested in training physical therapy and chiropractic practice owners and their staff how to use this new modality he was selling called Winback TECAR Therapy. Having never heard of Winback TECAR, I responded with “I don’t know. What is it? What does it do? I’m not much of a modalities person-I would rather not train someone in something if I myself do not believe in it. I would have to see it, be trained in it myself, try it for a bit, and be convinced that it’s something that can contribute to better outcomes.” Harlan could hear my anxiety and trepidation-he would have had to have been deaf to miss it-and was quick to agree that I needed to be introduced to the machine to see if it was something in which I might be interested. He gave me a quick synopsis of the machine’s virtues over the phone, but in truth, I did not pay that much attention at the time. Like I said, modalities-meh. Nevertheless, we made a plan to get together-I met him some days later at a clinic where he was giving a demonstration and sales presentation to the clinic owner, so I could hear what the clinicians needed to know. This is where I began to be intrigued, because this was the first modality I had come across that delivered energy (radio frequency energy of 300hz, 500hz or 1000hz to be precise) into the body contemporaneously with manual work and exercise, rather than before or after. That was interesting to me. The notion that I could also run radio frequency energy through my own hands or through IASTM tools in my hands and introduce it into the patient that way also piqued my interest because it was such a unique feature of the machine and seemed to endow the clinician (me) with a super power. Wonder Woman, step aside. Fantastic Physio is taking over! (It’s very weird and scary being inside my head).
After the clinic demo, Harlan gave me a more in-depth explanation of the many electrodes that were available and what they were used for. I admit to having been quite overwhelmed at the time, because there were (are) so many options in using the many electrodes that I couldn’t process it all, particularly without using the thing myself. I am a tactile learner and if you talk at me about a physical experience without allowing me to feel what you are talking about in my own body, I just don’t get it. I asked Harlan if he could meet me at the home of a patient of mine who had had two knee surgeries in succession and was having a hard time regaining knee
extension because of scar tissue formation around the joint. Perhaps I could try the Winback on her and get a feel for what was happening. We met there a few days later and the difference between capacitive and resistive energies started to come alive to me as I treated my patient and received feedback from her. I used the capacitive movable electrode (Winback 1.0) on a high setting (50%) with deep manual work to heat the fibrotic tissue in an effort to make it more pliable and to increase circulation. This electrode gave the patient a profoundly and pleasantly
warm feeling in the tissues, according to her report. I followed the capacitive treatment with resistive energy using the bracelets (Winback 5.0) on my wrists at a lower intensity performing joint mobilization and passive exercises. The patient reported she could feel the warmth from my hands but the temperature was not as high as with the capacitive mode. After the treatment, I cooled down the areas with capacitive energy at 10% lowpulse setting for a couple of minutes and then asked the patient to get up and walk to see how her knee felt (I also cooled down my hands under running cold water following the treatment, as I had been advised to do). The patient reported that the feeling was like “night and day” following the treatmentshe walked comfortably up and down stairs without the nagging feeling of resistance at the back of her knee. While this was very exciting, it was only one patient and I had a great deal to explore with the machine before I could comfortably feel like I could endorse its regular use. Harlan was gracious enough to lend me the Winback for a week so I could experiment with it. As I mentioned, I have a private home care practice and at the time that I borrowed the machine, I had one patient that was status post rotator cuff repair, one that was recovering from a surgical repair for a traumatically torn quad, and another patient with chronic back and neck issues. I wanted to try the machine on all of them, and so I did. After the third day of using the Winback on my patients, I called Harlan and I said “I totally get this machine, I will teach it, and I want one!” Not only did Harlan get himself a clinical trainer that day, he had made a sale. The things that sold me on Winback in that very first week of having the opportunity to use it were how perfectly well it dovetailed with the way I treat, how quickly patients responded to the treatments and how much the patients seemed to value the addition of this cutting edge technology. My business model has been a cashbased business treating patients in their homes, and if I am going to ask people to pay out of pocket for a service covered by insurance, I have to provide a level of service above and beyond what anyone else with my credentials can provide. Not too many private home care PTs have a laser, and none have a Winback. My business card states on it “I bring my office to you,” and I have to mean it. Making the investment and providing Winback TECAR Therapy to my patients shows that I do. Each of the patients I treated that week that I had the Winback on trial had a different issue and each was at different phase of healing. This gave me the opportunity to problem-solve how to use the many choices of electrodes and to experiment with the myriad possibilities of settings. I could use two static electrodes and let the machine work leaving my hands free to treat or to have the patient perform exercise with the current running. I could use two moveable electrodes to give a joint three-dimensional input from the Winback and from my hands. I could use one static and one moveable electrode and do mobilization techniques while offering heat to reduce muscle guarding. I could go superficial or deep, use heat or not…there was certainly a learning curve, but somehow making these choices and integrating them into my manual therapy and exercise prescription was a natural and organic process.
Using concepts I learned from the Kinesio Taping Method, myofascial release and other manual therapy courses, the work of Dr. Jean-Claude Guimberteau and others, and understanding that no individual tissue works or moves independently of any other tissue and all of the body’s systems are interdependent, my assessment is geared toward determining which system is the primary driver of the dysfunction in the moment. Treatment is targeted accordingly. I quickly learned that the beauty of Winback TECAR Therapy, like Kinesio Taping, is that it is an extension and augmentation of the effects of what I choose to do with my hands. If I perform a
manual technique that is more superficial in nature, such as lymphatic drainage in a post-surgical condition, Winback TECAR allows me to direct the energy at the depth of tissue that I choose for this endeavor. With my acute, post-surgical patients, edema management was a primary concern. I didn’t want to heat the local tissue in this case, but I did want to create metabolic changes at the cellular level to speed healing. As I performed my manual lymphatic drainage techniques, I did use the diathermic effect of the capacitive electrode to dilate lymph vessels and vascular tissue proximal to the injury so that fluid drained from the surgical site would have an easier time of moving out. The local tissue, however, I treated at a much lower
intensity without heat but still introducing radio frequency energy contemporaneously with my manual treatment for the cellular metabolic effects. I used capacitive energy for the aqueous tissue and resistive energy for the harder tissue when I started my range of motion exercises. My outcomes were markedly better than what I had expected, with edema reduction and patients gaining range much faster than when I did not use the machine. And using my Kinesio Taping skills immediately following my treatments maintained the effects gained in the treatment session. As I have been using the Winback TECAR for just under two years now, I have come to appreciate its versatility for treating both acute and chronic problems. Many of my patients have chronic pain, which is a completely different animal from acute pain and often requires a completely different treatment approach. Acute pain goes away as soon as the injured tissue heals. Chronic pain lingers and often intensifies long after the wounded tissue has healed. And the longer chronic pain persists, the harder it becomes to resolve. There are many reasons for this. Tissue limitation or dysfunction anywhere in the body affects the function and movement of all other tissues because of the fascial and neural connections between them. Therefore, chronic pain in one area of the body may be the result of tissue dysfunction in a completely different area. Another likely reason may be a change that occurs in the neurological system known as “central sensitization” and “peripheral sensitization”. These phenomena occur when the nervous system becomes hyper-reactive to sensory stimuli and the brain responds by
misinterpreting benign sensory input as painful stimuli. Successfully treating chronic conditions takes time, patience and the ability to affect many systemslymphatic, nervous, myofascial, and psychological. Winback TECAR is uniquely useful for the treatment of chronic pain because it allows the clinician has to change depth of current penetration, to use heat or not, and to add an additional analgesic frequency. The Winback unit itself offers a placebo effect just because it looks so impressive and the clinician who competently uses it gives the patient a sense that they are in good hands (pun intended). Anyone contemplating an investment in this wonderful technology should feel free to contact me with questions at firstname.lastname@example.org and I will be happy to dialogue with you and give you my honest opinion as to whether or not this technology is right for your clinical setting and your needs. In the interest of full disclosure, I do get compensated from the distributor for teaching clinicians who purchase the machine how to use it properly and incorporate it into their treatments, and I do get compensated for writing these blogs. But I will never recommend any equipment that I either do not believe in or do not believe is appropriate for someone in his or her particular circumstance. I will never trade my reputation for money and I give you my word (which is my bond) that I will only give you the facts upon which you can make your own informed decisions regarding such an important and costly purchase.