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We have chosen to operationally define alternative modalities as "technologies that have become popularized for treatment of conditions involving chronic pain and delayed tissue healing." There are a number of thoughts about why these techniques may be of interest to the therapist and patient. Our patients want to get better. We want our patients to get better. For a variety of reasons, previous interventions may have been unsuccessful— thus, the search for another option. In many cases of chronic pain and delayed tissue healing, attempts may be made to maximize recovery of function at any cost. In this chapter, we discuss the use of magnet therapy, monochromatic infrared therapy (MIRE), hyperbaric oxygen therapy (HBOT), and extracorporeal shock wave therapy (ESWT). The popularity of these interventions may not parallel their published effectiveness. Magnet therapy, MIRE, and HBOT are within the scope of practice of nonphysician practitioners; ESWT is used by physicians and surgeons.


Magnets have been used for therapeutic purposes for more than 2,000 years.1,2 Greek healers in AD 200 used magnetic rings as a treatment for arthritis. During the emergence of complementary/alternative medicine (CAM) in the late 20th and early 21st centuries, interest has been increasing regarding the use of magnets for therapeutic benefit.3 The use of pulsed electromagnetic fields (PEMF) for promotion of fracture healing and other orthopedic problems, such as osteoarthritis, has been commonplace during this time.4

Physical Principles of Magnets

Magnets are metals, such as iron, that exhibit an attractive or repulsive force. The force field around a magnet is represented in Figure 16-1. The number of lines per unit area representing the magnetic field is proportional to the magnitude of the field. The distance between two magnets will determine the amount of force exerted on each magnet. The shorter the distance between two magnets, the greater the force between them. The force one magnet exerts on another magnet can be described as the interaction between the magnetic fields of each magnet. This force can be either repulsive or attractive. When two north or two south poles are brought close together, the force is repulsive. When two opposite poles (one north and one south pole) are brought close together, the force is attractive. The direction of the magnetic field at a given point is defined as the direction that the north pole of a compass needle would point when placed at that point. The pole of a freely suspended magnet that points toward the north is the north pole. The other pole, which points toward the south, is called the south pole. The earth acts as a huge magnet with a magnetic field and north and south poles.5 For thousands of years, voyagers have used compasses for navigation that are attracted to the earth's north pole by the earth's magnetic field.


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