**8. Temperature or biological effects**

The term diathermy already suggests that temperature is the main effect of electromagnetic waves in the body. But the cellular signaling effects that are produced are very important for the resolution of the lesions. We will now see the effects of temperature on tissues and electromagnetic energy on the cell. A general summary of biological effects is presented in **Figure 3**.

#### **8.1 Heat and hyperthermia**

Heat treatment in mammalian cells at temperatures above 40 °C produces multiple effects on cell metabolism. Hyperthermia inhibits protein synthesis. It induces the production of heat shock proteins and inhibits energy metabolism. At temperatures in the range of 50–60 °C it damages DNA and denatures it and at temperatures below 40–46 °C it produces chromosomal aberrations if the cell is in the S phase of mitosis.

An important role in this response is played by the Thermal Shock proteins (HSP), a superfamily of proteins highly conserved in evolution, which play an essential role in the conformational and functional protection of proteins within the cell. With molecular weights of 72 kDa, 73 kDa and 90 kDa they correspond to the largest classes of stress proteins expressed by the body.

Another effect of warming is the local effect. In general, the therapeutic range for sports medicine is assumed to be 41–45 °C, because this range causes the maximum increase in local blood flow [5] (Perez y Al 1993). Therefore, hyperthermia treatment is considered to provide effective therapeutic conditions. On the contrary, from a safety perspective, the possibility that treatment above 45 °C causes muscle damage cannot be ignored. The duration of heat treatment is also a concern in hyperthermia therapy. For example, in oncology, patients receive hyperthermia therapy at 45 ° C for 15 minutes if they do not feel pain. In short exposures 1–2 minutes of duration, temperatures of >45 °C can be reached, without the treatment causing damage to muscle tissue.

Concluding hyperthermia acts by producing an increase in heat shock proteins and increasing local blood flow.

**Figure 3.** *Effect of the electromagnetic field on the cell and the body.*

#### **8.2 Effect on cells**

Cells interact with their environment through the cell membrane. Among other functions, the cell membrane is responsible for the detection and subsequent transduction of external biochemical or other signals in the cytoplasmic space. The cell membrane is also considered the main site of interaction of EMF signals with cell systems.

A large body of literature has shown that various biological RF (Radio Frequency) effects can be produced without tissue heating, which are known as non-thermal biological effects of electromagnetic radiation.

The cell membrane is a 5–10 nm thick structure that surrounds and encloses the cell. It is made up of lipid and protein molecules. The most abundant membrane lipids are called phospholipids. The cell membrane is a lipid bilayer that allows the flow of ions through proteins that function as channels and ionic pumps. Ion flow can be stimulated with an external stimulus, to activate specific signaling pathways intracellularly. Although studies have applied electrical and magnetic stimuli to modify cell function, the parameters for stimulating the cell membrane are unknown.

The effects of exposure to an electromagnetic field can be understood as a chain of responses at different interrelated scales in the biological system. This chain of events begins with the interaction between the incoming wave and the charged atomic structure of biomolecules, mainly ions, especially outside the cell. This interaction leads to changes in the chemical composition and charge distribution of proteins and other macromolecules that are transduced into changes in biochemical signaling pathways.

#### **8.3 Effects on calcium**

Exposure to EMFs may act to cause excessive Voltage Dependent Calcium Channels (VGCC) activity in many cell types, suggesting that these may be direct targets of EMF exposure. Many of these studies specifically implicate L-type VGCCs, such that various L-type calcium channel blockers may block responses to EMF exposure. Stimulation of VGCC by the electromagnetic wave leads to an increase in intracellular Ca2+, which can act in turn to stimulate the two calcium / calmodulin-dependent nitric oxide synthases and increase nitric oxide [6] (Wooda and Karipidisb 2021). This nitric oxide acts in therapeutic or potentially therapeutic responses of EMF, through its main physiological pathway, stimulating Guanosine Monophosphate cyclic (cGMP) and protein kinase G. Nitric oxide can act in pathophysiological responses to exposure to EMF, acting as a precursor of peroxynitrite, with its dual role, producing both oxidative stress and free radical decomposition products (**Figure 4**).

For lymphocytes, Ca2+ mobilization is among the first detectable events to be triggered by binding of a ligand (e.g., Antigen, receptor antibody, mitogenic lectin) to an appropriate receptor structure exposed on the outer cell surface. The cascade of cellular reactions in lymphoid cells subsequent to ligand-receptor interaction is best understood for T cells and has been extensively reviewed. In summary, ligandinduced Ca2+ mobilization is reflected in an initial increase in Ca2+ that is caused by inositol 1,4,5-triphosphate-induced Ca2+ release from intracellular stores and followed by a sustained influx of Ca2+ mediated by receptors from the extracellular environment, including cell proliferation, secretion, motility, etc. or cytotoxicity. With regard to the effects of electromagnetic fields on the immune system, it is proposed that Ca2+ regulation in lymphoid cells could be similarly affected by appropriate signals from electromagnetic fields, leading to informed responses of electromagnetic fields. In cells, for example, on proliferation or cell-mediated cytotoxic agents [7] (Pall 2013).

*Use of an Evolution in Tecartherapy for Muscle Improvement and Treatment of Sports Injuries DOI: http://dx.doi.org/10.5772/intechopen.96776*

#### **Figure 4.**

*Mobilization of intracellular calcium after opening the voltage-dependent calcium channels by electromagnetic energy.*

Cellular Ca2+ mobilization in response to external EMF signals or interference of an EMF with Ca2+ regulatory processes is considered an important target of EMF action in tissues.

#### **8.4 Effect on fibroblasts**

Fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework of animal and human tissues, and plays a critical role in wound healing. Fibroblasts are the most common connective tissue cells in animals. The main function of fibroblasts is to maintain the structural integrity of connective tissues through the continuous secretion of precursors from the extracellular matrix, and as a result, this type of cell is critically involved in the wound healing process [8] (Aaron et Al 2013).

EMFs are known to play an important role in the cascade of processes that determine cell migration, adhesion, and differentiation. Electric currents and related

#### **Figure 5.**

*Intracellular signaling and stimulation of fibroblasts increasing the levels of both epithelial and angiogenic growth factors.*

fields are generated by passive absorption of Na<sup>+</sup> from the environment, leading to an internally positive transepithelial potential difference.

EMF can activate fibroblast migration. EMF has been shown to activate fibroblast proliferation. Activation of the expression of human fibroblast growth factor 1 (HFGF1), after exposure to EMF, showed that molecular wound healing pathways are activated in response to this resonant EMF in water (**Figure 5**).

For this reason, the application of EMF may have therapeutic relevance for wound healing and other pathologies.

## **9. Repair of collagen, hyaluronic acid and bone production**

Collagen is considered to be one of the most important biomaterials in cartilage repair. We have shown that exposure to pulsed radiofrequency, that is, with more energy and little heat, improves chondrogenic differentiation and protein synthesis of the extracellular matrix of cartilage. Collagens are proteins composed of three polypeptide subunits known as α chains that exist in a single triple helix. There are more than 20 types of collagen in animal tissue. Scientific research has confirmed the activity of EMFs (electromagnetic fields) in this tissue [9] (De Mattei et al. 2007). In vitro and in vivo studies have shown that EMF can change some physiological parameters of bone cells, such as proliferation [10] (De Mattei et al. 1999), differentiation [11] (Lohmann et Al 2000), synthesis of extracellular matrix components [11–13] (Lohmann et Al 2000, Heermeier et Al 1998, Harting et Al 2000) and production of growth factors. In addition, EMFs can stimulate osteogenesis in bone. This has been shown in many studies [14] (Thamsborg et Al 2005).

Clinical studies demonstrated that EMF exposure could be useful for the treatment of degenerative cartilage disorders such as osteoarthritis. Several studies have investigated the effects of electromagnetic fields on cartilage cells and tissue, showing that electromagnetic fields can stimulate chondrocyte proliferation and increase the amount of ECM (extracellular matrix) components of cartilage. EMFs stimulate proteoglycan (PG) synthesis in vivo and in vitro. TrPs are critical components of the cartilage, and loss of TrP from tissue is seen in OA. EMF can stimulate the synthesis of PG [15] (Goldring 2000).

Electromagnetic fields have positive effects on bone and cartilage tissue. Electromagnetic fields affect the mobility of K, Ca2+, Mg ions in bone and cartilage. They increase collagen synthesis [12] (Heermeier at Al 1998).

#### **9.1 Angiogenesis**

There is evidence to support the concept that radiofrequency acts by promoting angiogenesis through the coordinated release of fibroblast growth factor β-2 FGF-2 and, to a lesser extent, various other vascular growth factors angiopoietin-2 (Ang-2), thrombopoietin (TPO) and epidermal growth factor (EGF). This suggests that RF may facilitate healing by increasing blood vessel growth. This finding not only clarifies a novel mechanism for the action of RF, but also suggests widespread applications in the treatment of ischemic disease and a potential link between electromagnetic fields and increased tissue circulation.

#### **9.2 Lymphatic drainage**

When a sports injury occurs, the injury site reaction is inflammation, which is accompanied by edema. The phases of inflammation are, in order: organization of the hematoma, necrosis and finally, degeneration of the muscle fibers with

*Use of an Evolution in Tecartherapy for Muscle Improvement and Treatment of Sports Injuries DOI: http://dx.doi.org/10.5772/intechopen.96776*

#### **Figure 6.**

*Lymphatic drainage in the lower limb: The active plate, which delivers the energy, is placed on the sole and the passive plate, that takes it to the ground, is placed in the lumbar area. Lymph moves from one plate to the other.*

diapedesis of macrophages and phagocytosis towards the necrotic material. After increased blood flow by the action of temperature and EMF, waste substances accumulate in the area of injury and surrounding areas (**Figure 6**).

Magnetic field interactions with blood flow have been demonstrated. In addition to this, electrically charged proteins also move between the electric poles. An approximately linear growth of the flow rate of water with an electric field intensity has been studied.

The magnetohydrodynamic law explains that the force experienced by an enclosed charge moves fluids. Erythrocytes and proteins have charge and these elements are inside the blood vessels. The RF energy acts on these elements according to this law, and moves the fluids in the body with a speed under an applied electric field. The blood, as the most abundant fluid in the body, will act as a fluid conductor necessary to conduct the energy, as it increases its flow. It has been suggested that the magnetic characteristics of the blood can be used to improve the hemodynamic disturbances associated with atherosclerosis.

The elimination of the substances, which accumulate during inflammation, is achieved by performing a lymphatic drainage: the active plate is placed on the feet or hands and the passive plate in the lumbar area. The movement of blood and the lymph drags the waste substances towards the chest area to join the thoracic duct and circulation [16] (Cau et Al 2019).

#### **10. Effect on sports pathology**

#### **10.1 Effect on the muscles**

In sports medicine, diathermy devices for musculoskeletal use have been identified by the term "Tecartherapy". Tecartherapy stands for Transference of Capacitive and Resistive Energy. The Tecartherapy intervention improves the spatio-temporal biomechanical parameters in runners. A study by Duñabeitia in 2018 [17], indicates that the application of capacitive and resistive RF after an exhaustive training session, rather than passive rest, generates a more efficient running pattern, even though selected physiological parameter markers are not affected. These findings highlight the potential role of Tecartherapy in accelerating recovery from muscle fatigue in runners, which could lead to better performance. Differences were detected in the length of the step and the angle of the stride, the height and the frequency between the group of treatment with Tecartherapy and the control group, with an increase of these (**Figure 7**).

#### **10.2 Pain**

RF procedures in chronic pain utilize alternating current in the AM RF band to produce effects on pain pathways [18](Rea et Al 2011). In 2020 Bretelle y Col [19]

**Figure 7.** *The active plates can be used during physical exercise, which improves muscle performance.*

publish a Clinical Trial, where they report that RF treatment, showed a significant reduction in perineal discomfort while walking and could halve the use of analgesics, which could improve well-being during this sensitive period. RF treatment showed a significant reduction in perineal discomfort while walking and could halve the use of analgesics, which could improve well-being during this sensitive period. Musculoskeletal diseases comprise several conditions that are characterized by pain and limitations in mobility, dexterity, and functional capacity, reducing people's ability to work and participate in social roles with associated impacts on mental well-being. Some of the most common and disabling musculoskeletal diseases are osteoarthritis, back and neck pain, tendinopathy, fibromyalgia, and myofascial pain. Also, muscle injuries are the most common category of injuries in athletes and comprise approximately 10% to 55% of all injuries. Most muscle injuries (> 90%) are contusions or strains, while lacerations are much less common. The most serious types of musculoskeletal diseases can cause chronic pain, dysfunction, recurrence, and even compartment syndrome. Studies are in development with partial results. They have shown that these latest generation radiofrequency devices reduce the recovery time from injuries, by increasing blood flow, signaling, and especially by lymphatic drainage [20] (Tramuntana 2020).

Calcium/calmodulin-dependent kinase II (CaMKII) signaling is essential to maintain aberrant hyperexcitability of the dorsal horn neuron in the pain condition. RF signals have been shown to modulate CaM-dependent signaling pathways that orchestrate the release of cytokines and growth factors in cellular responses to injury. RF signals have been shown to modulate CaM-dependent NO signaling cascades in articular chondrocytes [21] (Pilla et Al 2011) and other cells using CaM antagonists, and NO downstream inhibitory.

#### **10.3 Trigger points**

Trigger points are specific sensitive areas in a muscle. They are part of a condition called myofascial pain syndrome, which involves muscle stiffness, tenderness, and pain that radiates to other areas, also known as referred pain [22] (Melzack et al., 1997). The term "myofascial" has evolved from the perspective that it is likely that both muscle and fascia may be contributors to symptoms [23] (Akamatsu et al.). Trigger points arise from the clustering of sodium-sensitive sites. In fact, the excitation processes of cells involve the entry of sodium through the membrane of

*Use of an Evolution in Tecartherapy for Muscle Improvement and Treatment of Sports Injuries DOI: http://dx.doi.org/10.5772/intechopen.96776*

the muscle fibers. Therefore, it is thought that most, if not all, pain points will be associated with sodium-sensitive sites.

The effects of magnetic, electric and electromagnetic fields on sodium / potassium ATP-handle have been studied extensively over the last quarter of a century by various researchers, but the most important for trigger points are the studies conducted by https://www.mendeley.com/download-desktop-new/, in addition to the Na ion transport mechanism, by K-ATPase, EMF interactions with transient electrons and protons that are released from the oscillating motion that affects the bonds of hydrogen (H) in hydrated proteins which could be involved in the mechanism of action. It is highly probable that the hydrogen bonding of water molecules with ions / ligands could be a hypothesis, for understanding the effects of magnetic fields on pain relief. Therefore, it would be logical to transfer these interactions to the discussion of trigger points as an acceptable mechanism for pain relief in myofascial pain [24] (Blank 2005) (**Figure 8**).

There is a study with patients with trigger points that prevented them from carrying out their daily activities and where capacitive radiofrequency (C-RF) was applied. The results found proved that C-RF is an effective solution to treat painful conditions with a limiting factor for daily activities.

#### **10.4 Muscle injuries**

After a muscle injury secondary to trauma, there is a rupture of blood vessels, bleeding at the injury site, and subsequent edema. Direct trauma to muscle fibers also causes rupture of the basal lamina and sarcolemma and subsequent degeneration of the sarcomeres in the affected area [25] (Hazlewood and Markov 2007). Diathermy produces a much faster increase in soft tissue temperature. Associated with the increase in tissue temperature there is an increase in blood flow. Elevated tissue temperatures improve blood flow and can relieve muscle spasms and pain [26] Karpati et Al 1982), and improve recovery from injury.

*Effect of electromagnetic energy on Na / K ATP ASA. Hydrogen bonds in protein release electrons and protons, which block the pump proteins.*

#### **10.5 Cartilage injuries**

The use of RF for the treatment of injured cartilage has increased enormously in recent years. The safety and effectiveness of this technique depend on an understanding of the physics behind RF. First, it is not electrocautery. During application, a high frequency alternating current flows from the uninsulated probe tip into the tissue. Ionic agitation occurs in tissue when the ions try to follow the directional changes of the alternating current. This agitation produces frictional heating so that the tissue around the electrode tip, rather than the electrode plate itself, is the main source of heat. The heat produced during the application of RF is the difference between the heat generated by the flow of RF current through the tissue surrounding the probe tip and the heat that is dissipated in this region [27] (Ryland et Al 2001).

### **10.6 Urinary incontinence in female athletes**

Urinary incontinence (UI) is defined as the involuntary loss of urine. When pressure inside the abdomen increases due to exertion, it is transmitted to the bladder causing the pressure within the bladder to be higher than in the urethra. For proper function of urination and urinary continence, intraurethral pressure must be higher than intravesical pressure both at rest and in activities that require effort. There is pelvic floor dysfunction in high-performance athletes associated with athletic activity and urinary incontinence. Eating disorders, constipation, family history of urinary incontinence, history of urinary tract infections and decreased flexibility of the plantar arch are associated with an increased risk of UI in elite female athletes. Pelvic floor physiotherapy as a treatment for urinary incontinence in elite female athletes, former elite female athletes and pregnant athletes who engage in regular aerobic activity leads to a higher continence gain than that obtained by nonathlete women [28] (Thyssen et al., 2002).

The use of radiofrequency with high power, which is a diathermic process generated by the radiation of an electromagnetic spectrum, resulting in an immediate retraction of existing collagen and the subsequent activation of fibroblasts causing non-ablative neocollagenesis. The female urethra is known for having a maximum length of five centimeters, and its anatomical structure and length justifies the use of radiofrequency on the external urethral meatus. Radiofrequency waves can reach a sufficient depth to induce collagen production in the whole urethra. RF has shown to be a treatment with low adverse effect. Patients reported no symptoms during or after treatment [29, 30] (Lordelo et Al 2017, Sodré et Al 2019). In **Figure 9**, the intracavitary electrodes are shown. E electrode (a) is the general one, to work vaginal and anal. The (b) is specific for pediatrics and vaginismus, because it is thinner for applications in which the (a) and it will be more difficult to apply. The (c) is rectal for anal application only. And the d is for specific rectal application, in specific and focused points. With this, the entire pelvic floor can be addressed intracavitary. These devices apply energy to the vagina in 360°.

The capacitive intracavitary device, shaped like a finger, allows not only the penetration of the energy that passes through the (**Figure 10**) pelvic floor structure

**Figure 9.** *Different capacitive intracacavitary vaginal devices.*

*Use of an Evolution in Tecartherapy for Muscle Improvement and Treatment of Sports Injuries DOI: http://dx.doi.org/10.5772/intechopen.96776*

**Figure 10.** *Diagram of the use of the intracavitary device. The movement of energy towards the passive plate can be observed.*

but also massages the vaginal region, allowing the vaginal introitus to reach the entire length of the vagina, which makes the urethra receive the necessary energy, to produce structural changes, to improve urinary incontinence.
