Tab.2. Claudication distances in meters:

In the second mentioned study MF1 and MF2 were compared with regard to application of SG and TW. It was found that optimum was the combination of MF1 with SG.

In the last study it was confirmed that even in cases of diabetic neuropathy PMF was highly effective; claudications and tiptoeing tests were markedly improved. It was interesting, that in those patients the best results were achieved with MF2.

From all the mentioned studies it is obvious that PMF belongs to the complex balneological treatment of ischaemic disorders of the lower extremities. PMF is simple, well tolerated and cheap.

Demecki & Kartashov (A2) used static magnetic field [ST] B=30mT and sinusoidal magnetic field [SIN] B=30mT, f=50Hz, [exposure time always 20', number of exposures 25] in atherosclerotic obliterations [AO] and endarteriitis obliterans [EO]. 198 patients were treated. Effect depended on the stage of diseases. If sinusoidal field was used in the Io. and the IIo. very good effect was reached in 66%, good effect in 21%, no effect in 13% of the treated patients. If static field was used, very good effect was observed in 60%, good effect in 21%, no effect in 17% and impairment in 2% of the patients. In patients with the IIIo of both the diseases neither objective nor subjective improvement was found. Duration of relief was reported from 8 to 10 months. Authors concluded that application of the sinusoidal magnetic field is more suitable than the use of static field.

Zhukov et al. (A25) used static magnetic field, B=10mT, exposure duration [not more than 30'] and number of exposures [not more than 20] according to clinical conditions. The 1st group [54 patients, age 18-66 years, duration of disease 3-13 years] suffered from venous varices of calves, compensated as well as decompensated, the 2nd group [67 patients, age 24-68 years, disease duration 2-40 years] with postphlebitic syndromes. In the first group pO2 of venous blood was observed together with tissue pO2 reduction - that informed about open arteriovenous anastomoses. Moreover, increased amount of capillary filtrate was found. It is obvious that magnetotherapy here is not suitable. In the second group no signs of clinical or laboratory improvements were found. However, if oedema was the leading symptom [regardless of the group], marked reduction of capillary filtration was observed, diminished extravasal protein loss and normalised colloid-osmotic ratio that resulted into reduced oedemas. This was accompanied by elevated tissue pO2. The authors recommend magnetotherapy in cases of venous insufficiencies with oedemas only.

Table 3. Arterial diseases

Table 4. Venous diseases

In the next chapters microcirculation improvement will be considered as the basic mechanism of action. Litvin et al. (A16) observed in oedemas in various pathological conditions improvement of rheovascular index by 5.25% and decrease of distal index by 15% as reflection of vascular tonus improvement. Detlavs et al. (A3) described a large study in more than 3000 persons suffering from various locomotor apparatus diseases. They used either ST [B = 10, 20, 30mT] or pulsed MF [ALPHA-PULSAR device B=0.3-1.5mT, f=80Hz, quasi rectangular pulse duration 0.5 ms]; exposure duration in tens of minutes, number of exposures up to 30. Usually cervical part of spine was exposed because of cervical osteochondritis. Even after the only one exposure increased number of open capillaries in the nail bed was observed and their elongation. Hypocoagulation was observed as well due mainly to suppression of thrombocytes' functions. With increased number of exposures the changes were more expressed.

Only one work on lymphatic vessels was found. Krylov et al. (A15) gave evidence on good efficacy of pulsed magnetic field with rectangular shape, B=20mT, exposure duration 20', number of exposures 15 in primary lymphoedemas. Not only clinical improvements were reported but also elastometry, plethysmography, lymphoscitigraphy and percutaneous pO2 showed improvement. By volume measurement of affected extremity reduction of oedema by 20-50% was found. Effect was noted in 41 from 43 patients .

Kirichenko (K7) studied influence of static magnetic field [B=15 or 25mT, exposure duration 20', number of exposures 10] on haemostasis in patients with ischaemic heart disease [IHD] and hypertension. Praecordium and Th3 - Th7 region were exposed. A group hypertension IIo consisted of 53 males and 24 females, age 37 -64 years. A group IHD II and III was composed of 43 males and 17 females, age 37 - 64 years. Except of these groups 30 healthy persons were included. The whole patients' group was divided into three subgroups. To the 1st subgroup [30 hypertonics and 25 persons with IHD] remedies were administered and in addition the patients were exposed to the field with B=25mT. The 2nd subgroup [24 hypertonics and 21 patients with IHD] was treated with drugs and was exposed to the field with B=15mT. The 3rd group [23 hypertonics and 14 with IHD] was treated with drugs only. At the beginning in all the patients tendency to hypercoagulation, increased thrombocytes' functions and antiheparin activity were found as well as elevated fibrinogen and fibrinogen B plasmatic concentrations. On the other hand fibrinolytic activity was depressed. After the treatment, except of subjective and clinical improvement expressed mainly in the group 2 (blood pressure depressed, pulse frequency slowed down, ECG curve improved, higher left ventricle output, better X-ray picture of heart and lungs), reduction of thrombocytes' functions were observed in hypertonics by 7.9%, in IHD by 19.1%. Aggregation was not significantly changed, however, PF-3 secretion was decreased in hypertonics by 10.6%, in IHD patients by 8.5%. PF-4 secretion by 2.2% and by 9.7%. In the 2nd group elevation of free heparin concentration was found in hypertonics by 37%, in IHD patients by 85.7% and depression of fibrinogen concentration by 12.5 and 19.1%. Moreover, activation of non-enzymatic fibrinolysis by activation of heparin-plasmin and heparin-plasminogen was observed. Number of basophilic leukocytes increased by 74.3 and 300%, respectively, and the cells had more granules.

Magnetotherapy was used [B=20mT, f=50Hz, exposure time 15', number of exposures 12, every other day] in the complex rehabilitation care in patients after myocardial infarction (K3). Region C4 - Th2 was exposed. 50 patients were exposed, 50 patients served as a placebo group, treated by non-energised device. At the beginning the submaximum load in this group was 89.0+3.14 W, in the exposed group 90.0+3.14 W. After the end of the therapy the submaximum load was in the control group 109.5+4.52 W, in the exposed group 133.0+4.14 W. Frequency of angina pectoris episodes was reduced in controls by 36.6%, in the exposed patients by 57.4%. Nitroglycerine administration was completely eliminated in 13 controls and in 27 exposed.

Degen (K2) described increased diuresis in cardiac patients treated with magnetic fields (see also chapter Animal experiments) that led to reduction of the amount of circulating blood and thus to the liver size reduction and blood pressure reduction in patients suffering from hypertension. In the hand and arm vasodilatation of small and middle arteries was observed and acceleration of blood perfusion. In cardiac patients no adverse effect has ever been found.

However, Klemenov (K9) described tachycardia onset in one patient after exposure of praecordium to magnetic field [B=35mT, f=50Hz] . Although this case was the only one, he recommended Bmax=10mT and the longest exposure time 5 - 7 minutes.

Muravev et al. (K12) observed sporadic palpitations and stenocardiae in older persons treated for IHD. This was accompanied by impairment of ECG curves. It was recommended to use magnetic fields here carefully with individual approach.

Table 5.

Tab. 6.

Gokhar-Kharmadyan and Salivarova (G2) described efficiency of magnetotherapy in gastric and duodenal ulcers. They used either static magnetic field [B=20mT] or sinusoidal field [B=7.5 or 19mT, 50Hz], exposure time always 12', number of exposure 10, epigastrium exposed. 151 patients were treated, age 30-50 years, disease duration up to 10 years. No effect was found if static magnetic field was used, while in cases of sinusoidal magnetotherapy with B=7.5mT the effect was prompt. Not only subjective and clinical improvements were reported but also depression of stomach acidity was found, complete healing was noted in 71 persons, in 38 marked reduction of ulcer size was found. By measurement of gastric and duodenal muscles potentials normalisation was found in majority of the tested persons, mainly in muscle rhytmicity. In hyperkinetic curves a voltage decrease, in hypokinetic curves an increase was found. Improved microcirculation was observed in the exposed area and even improved hepatic perfusion was noted. In laboratory tests lower levels of gamma-globulins, histamin and serotonin, higher levels of alpha-1 and alpha-2 globulins. Higher norepinephrine excretion in urine.

Tab.7.

Valentova (N25,N27) used PMT (JLM-3, f=25 Hz, 20', 10-12 exposures) in complex spa therapy in spastic patients and patients with Parkinsonism. For evaluation the author used simple tests for general locomotion and rising mechanisms. At the end of treatment the motoric tests improved significantly for walking (p<0.001) and for change of position (p<0.01). The subjective tension in muscles of lower extremities was reduced in 84.6%, vertebral complaints in 84.6% , general improvement was reported in 96% of the patients. No changes in reflexes of lower extremities were found. No intolerance with other types of procedures was noted.

Valentova & Dipoldova (N28) reported about efficacy of a single exposure to PMF (JLM-3, f=12.5 and 25 Hz, location Th and LS area and lower extremities, 10' exposure for each area) in 35 patients suffering from multiple sclerosis (MS). 3 parameters were evaluated: 1) time of walking for 10 meters, 2) time of walking upstairs (1 floor), 3) time of walking downstairs (1 floor).

Tab. 8.

:

Valentova (N26) described a group of 71 patients treated for MS. Therapy included water procedures (CO2 baths + whirling baths of extremities) - WP, reflex massages - M, kinesitherapy - K, and PMT (JLM-3, 12.5 Hz, exposures - see below). The group was divided into 3 subgroups with regard to the type of therapy.

Tab.9.

(p) = placebo exposure; 1) = Th-L region & lower extremities exposed 10'; 2) = exposures from shoulders to legs, in 3 regions, 10' each.

Evaluation: locomotor tests and subjective changes were evaluated. After the first half of treatment placebo effect was checked between groups 1 and 2.

Tab.10.

- = impairment; 0 = no effect; +1 = partial improvement; +2 = = improved; +3 = markedly improved

X2 for trend = 8.333; p = 0.080

At the end objective evaluation did not exhibit statistically significant improvements. But subjective improvement reported by the patients was the best in the group 3.

Tab.11.

X2group 1 * group 2 = 3.330; p = 0.069

X2group 1 * group 3 = 15.233; p = 9.501 x 10-5

X2group 2 * group 3 = 13.333; p = 2.607 x 10-4

The author concluded that magnetotherapy was always well tolerated and because this method is simple, it is possible to use it in the out-patient rehabilitation care in MS patients.

Dudyreva (N5) studied brain perfusion under influence of static magnetic field [B=30-40mT, exposure duration 20', number of exposures 10-15]. Magnetotherapy was used in 13 persons suffering from atherosclerosis cerebri, in 62 patients with cervical osteochondritis and in 47 patients with combination of both the diseases. In 106 of them stenosis of vertebral arteries was found with perfusion asymmetry and venostasis in vertebrobasilar region. Collateral development was found in temporal artery region.

A/ After the exposure of sinus caroticus:

Tab. 12. Vertebrobasilar region.

Tab.13. A.temporalis interna

Rheographic index unchanged.

B/ After exposure of suboccipital region.

Tab. 14. Vertebrobasilar region.

Tab. 15. A.temporalis interna

Rheographic index unchanged.

Gabrielyan et al. (N6) performed sinusoidal magnetotherapy with B=25mT, f=50Hz in patients with atherosclerotic encephalopathy. The first two exposures lasted 10', the next ones 15', total number of exposures 10-15. Applicators were localised bitemporarilly. Totally 120 patients were treated [79 males, 41 females], age 40-60. The 1st group [62 patients] suffered from the initial stage of the disease, the 2nd group [31 persons] had the II. and III. stage, the 3rd group (placebo) was composed of 14 patients in the initial stage, from the II. and III. stage suffered 13 persons. In the 1st group marked subjective improvement and improvement in psychic functions was noted in 13 persons, improvement in 40, no effect in 4, impairment in 3 and 5 patients did not finish therapy for intolerance. In the 2nd group subjective improvement was found in 21, no effect in 8, impairment in 2 patients. Minimum improvement was found in the 3rd group. Rheoencephalograms showed reduction of arterial tonus and improved circulation mainly in the occipital region. On EEG records in the 1st group normalisation of basal curves was found, marked reduction of beta/activities and symetrisation of curves from both hemispheres, higher response to light stimulation. Similar, however less pronounced changes were found in the 2nd group. No EEG response in the 3rd (placebo) group. In some patients from the 2nd group improvement of vestibular functions was observed.

Neretin et al. (N17,N18) used magnetotherapy in patients suffering from syringomyelia (60 persons) and posttraumatic cystic myelopathy (11 persons). Magnetic filed used - B=10-30mT, basic f=50Hz, interrupted regimen, impulse:pause ratio 2:10, repeated frequency 1 sec. 20 persons served as the control group. Except of magnetotherapy or blind exposure all the patients were treated by massages, vitamins and electrostimulation with a device STIMUL 1 was performed. In syringomyelia in 51 cases pains were reduced as well as paresthesiae, hyperhydrosis and cyanosis. Hand temperature increased by 2+0.28oC, muscular strength increased by 6.0+2.04 kg. On EMG at the beginning polyphasic potentials were present in 13% of cases, after the treatment in 32%. By means of luminescent capillaroscopy reduced perifocal oedema was found and increased number of opened capillaries in nail bed. IR radiation of the skin was amplified. The effect lasted 0.5-1 year. In the control group changes far less pronounced. No effect in cystic myelopathy. No adverse side effects found, it is recommended to apply magnetotherapy in the period 1-2 months.

Tab. 16.

Tab.16 - cont.

Tab.16. - cont.

Since 1980 pulsed magnetotherapy (PMT) has been used mainly in these branches because of increasing number of locomotor apparatus diseases. Jerabek (R8) published the first results with PMT in arthritides, spondylitides, "frozen shoulders", "tennis elbows" and ankylosing spondylitis. for mixed diagnoses only subjective improvements were evaluated without any statistics. Analgesic action of PMT was approved in 80% of the treated patients.

Thurzova et al. (R19) reported about 34 patients treated (JLM-1, 12.5 Hz, 20', 15 times) for vertebral algic syndromes of C and L spine. Significant reduction of pains, improvement of spinal functions, reduction of paravertebral spasms were proved. All the cases of L-spine were successful, while in CB and CC syndromes very good effects were in 6, good effects in 10 and no effects in 3 patients. Valentova et al. (R21) confirmed those results in 90 patients in spa treated except of common procedures also by PMT. 30 of them were treated with a combination of PMT and balneoprocedures, 30 patients served as a placebo group (PMT was applied with non-energised device), 30 patients were treated with classical spa therapy. It was shown that PMT did not exhibit any placebo effect and PMT was always well tolerated.

Vaclavik (R20) applied PMT in patients with vert.alg.syndromes, gonarthritides and epicondylitides. He compared efficacy of PMT with other types of electrotherapy. He did not find statistically significant differences among various therapies immediately after the cure. But duration of pain relief was markedly longer if PMT was applied. It is interesting, that if "trigger points" in vert.alg.syndromes were exposed, immediate effects were reached.

Kocian et al. (R11,R12) proved efficacy of PMT with JLM-1 in coxarthritides, mainly subjective improvement and Jezek (1990) reported good efficacy of JLM-2 in gonarthritides.

Kovarovicova (R13) used JLM-3 in vert.syndromes comparing PMT to peloid packs. She found significantly improved Lasagne manoeuvre and Thomayer distance. Subjective evaluation by patients favoured PMT. Optimal combination - peloid packs and PMT.

Gavlas et al. (R5) performed a large study in patients treated in spa Frantiskovy Lazne for arthritides of load-bearing joints. The patients were divided into 2 groups; one treated by current balneotherapy + pulsed magnetic field (PMF) (JLM-1, f=3.125 or 6.25 Hz, exposure 20' daily, number of exposures 12-19), and a control group that had the same balneological therapy, but PMT was performed with the device switched off.

The group balneo: 36 females (born 1900-1952; 15 hip and 22 knee joints); 20 males (born 1910-1949; 8 hip and 12 knee joints). Overweight: 31 females and 19 males.

The bal + PMF group: 92 females (born 1909-1953, 52 hip and 44 knee joints); 46 males (born 1911-1951, 22 hip and 25 knee joints). Overweight: 78 females and 43 males.

Evaluation: consumption of analgesic drugs (yes/no), subjective improvement, walking time at distance 2 x 30 m with 3 stairs 15 cm high (patients had to perform it twice), duration of pain relief was recorded by mail response - that's the reason why not all the patients were evaluated. Results were processed by commonly used statistical methods.

Tab. 17a. Consumption of analgesic drugs - males

Tab. 17b. Consumption of analgesic drugs - females

Tab. 18.

Improvement of walking time after the therapy

Balneo (performed in 8 males and 19 females)

Bal + PMT (performed in 28 males and 64 females)

X2 for trend between the groups - males=1.609, N.S.

- females=3.037, p=0.081

Tab. 19. Subjective improvement after the therapy

X2 for trend between the groups - males=2.479, p=0.115

- females=25.312, p=0.000

Tab. 20. Pain relief duration in months:

Jerabek & Zidekova (R9) treated 16 females (age 19-48) and 71 males (age 22-64) with ankylosing spondylitis (AS) in various stage of the disease. In addition to this basic diagnosis DM in 8, hypertension in 9, IHD in 11, anaemia in 5, hepatic lesion in 21, renal colic (in patient's history) in 6 and blindness caused by pharmacotherapy in 2 patients were present.

Therapy: all the patients were bed-ridden, received NSAIDs, analgesic and other drugs recommended by their GPs, PMT (JLM-1, local application, 10-15' daily, 10 exposures), no other rehabilitation procedures were performed.

Evaluation: spinal movability tests (measurements of Stibor, Schober, Thomayer and chin-sternum distance, lateroflexion of the body, rotation of the head and Forestiere-Fleche) were performed before and after the whole cure , urine and blood samples were taken for biochemical and haematological tests. In 48 patients analgesic effect was tested by means of pain scale. General examinations were performed daily.

The control group - 14 patients treated with non-energised device (10 exposures) served as control. Because no significant spine movability changes were found and only in 2 males and 2 females certain subjective improvement was reported, conditions before-after the therapy were compared and the result were processed statistically by means of non-parametrical tests.

Results: in all the mentioned movability tests high statistically significant differences were found (p<0.01). Particular data not shown here.

As successful therapy improvement in 5 or more out of the 9 spinal movability parameters tested was considered.

Tab. 20. Results in control group:

Tab. 21. Exposed group:

(Numbers in cells represent numbers of patients; underlined numbers - successful cases)

Comparison of successful cases against unsuccessful ones:

Tab. 23.

X2 = 31.052; p = 0.000

Considering as the most important parameters Thomayer distance and head rotations (these parameters reflect most important functional movements), and if in Thomayer distances 0-9 cm were accepted as normal values, then:

Tab. 24.

X2 = 4.330; p = 0.037.

Similarly, if in head rotations 60o were accepted as a limit of good results, then rotation to the right and left:

Tab. 25.