Provider Name & Treatment Location: Joseph Giacomo, PT — Hospital for Special Surgery, New York, NY.
Key Words: Idiopathic pulmonary fibrosis; interstitial lung disease; TECAR (Transfer of Energy Capacitive and Resistive); pulmonary rehabilitation; manual therapy
Summary (Abstract)
This case report describes an 8-week, 11-session course of multimodal physical therapy — combining manual TECAR therapy with active exercise performed concurrently with TECAR — in a 61-year-old female with idiopathic pulmonary fibrosis (IPF) and interstitial lung disease (ILD). At intake, the patient demonstrated reduced ambulation tolerance (under 5 minutes), inability to single-leg stand longer than 2 seconds or manage stairs without a handrail, hypomobile thoracic spine, and an apical (accessory) breathing pattern. Pulmonary function testing (PFT) showed a residual volume (RV) of 1.32 L and a diffusion capacity for carbon monoxide (DLCO) of 13 mL/min/mmHg, consistent with restrictive/obstructive lung disease.
Following 11 sessions of combined manual TECAR (soft tissue and joint mobilization using CET and RET modes over the upper thorax and lung apices) and active exercise performed with concurrent TECAR application, repeat PFT showed a 22% increase in DLCO (to 17.18 mL/min/mmHg) and a 39% increase in RV (to 2.19 L). The patient reported reduced dyspnea and fatigue, and was able to ambulate for over 20 minutes, navigate a flight of stairs independently, and single-leg stand for more than 5 seconds.
What is unique about this case is the application of TECAR therapy — a modality with little prior documentation in pulmonary rehabilitation — directly to the thoracic wall and lung apices in a patient with IPF/ILD, paired with concurrent active exercise. The take-away is that TECAR may have a role in reducing diaphragmatic and thoracic wall tension, improving tissue elasticity, and supporting functional and PFT gains in patients with fibrotic lung disease.
Key take-away lessons:
- TECAR therapy applied to the thoracic wall and lung apices, combined with manual therapy and active exercise, was associated with clinically meaningful PFT improvements (DLCO +22%, RV +39%) in a patient with IPF/ILD.
- Functional gains (ambulation tolerance, independent stair negotiation, single-leg stance) accompanied the objective pulmonary changes.
- TECAR may help reduce diaphragmatic tension, enhance diaphragmatic breathing mechanics, and improve tissue elasticity of the thoracic wall and lungs.
- Further research on TECAR therapy in IPF and other pulmonary conditions is warranted, given the current absence of a gold-standard rehabilitation protocol for this population.
Introduction
Idiopathic pulmonary fibrosis (IPF) is a debilitating, progressive lung disease in which lung tissue thickens and stiffens with scar tissue formation, causing increasing difficulty breathing and reduced quality of life. IPF is the most common interstitial lung disease (ILD); its prevalence is estimated at 32.6 per 100,000 with a mortality rate of 5.9 per 100,000, and a recent meta-analysis reports a five-year cumulative survival rate of 45.6%. Patients with fibrosing IPF demonstrate a restrictive ventilatory defect on pulmonary function testing and low DLCO, with a clinical presentation that is often nonspecific — dyspnea, cough, and constitutional symptoms are frequently reported.
Current treatment recommendations emphasize a personalized approach combining antifibrotic medications, pulmonary rehabilitation (including breathing techniques), oxygen therapy, symptom management, and, in advanced cases, lung transplantation. The antifibrotic agents nintedanib and pirfenidone have been shown to slow decline in forced vital capacity (FVC), though combination therapy carries a high burden of adverse effects (nausea, diarrhea, dyspepsia, vomiting, photosensitive rash) and superior efficacy of combination therapy over monotherapy has not been established; combination antifibrotic therapy is not currently recommended outside of clinical trials.
There remains a lack of evidence supporting specific rehabilitative interventions for IPF, with no gold-standard technique. Transfer of Energy Capacitive and Resistive (TECAR) therapy is an electrotherapy modality gaining attention across a wide array of rehabilitation applications. TECAR was originally conceived in the late 1800s by French physician and physicist Jacques Arsène d’Arsonval, based on high-frequency electrical currents and diathermy that enhance plasma membrane permeability and generate heat within biological tissue. TECAR operates in a radiofrequency range of 300 kHz to 1.2 MHz and produces thermotherapy effects, bioelectrical effects at the cellular level that facilitate ion exchange, facilitation of lymphatic drainage, and mechanical micro-vibration effects that support tissue healing.
Capacitive energy transfer (CET) uses an insulated electrode to create an electric field between the electrode and the patient’s skin, targeting tissues with high water content such as muscle and subcutaneous tissue; the resulting localized heating produces vasodilation, increased local blood flow, and enhanced metabolic activity, improving tissue elasticity, reducing muscle tension, and clearing metabolic waste. Resistive energy transfer (RET) uses a non-insulated electrode to target deeper, higher-resistance tissues such as bone, tendon, and ligament, generating heat in dense structures that facilitates collagen synthesis, tissue regeneration, and reduction of inflammation.
The purpose of this case report is to highlight how TECAR therapy affects rehabilitative outcomes for a patient with IPF, and to describe a rehabilitative protocol utilizing TECAR for the treatment of fibrotic lung disease — providing insight into the potential use of TECAR in pulmonary conditions more broadly.
Patient Information / Diagnosis
Demographics: 61-year-old female.
Diagnosis: Mild interstitial lung disease (ILD) with pulmonary fibrosis, diagnosed March 2021. Combined restrictive and obstructive pattern on pulmonary function testing, with ILD and small nodules on CT. Documented mold exposure with IgG precipitins positive for two molds. Reactive airways (triggered by odors such as cigarette smoke and perfumes) and mold sensitivity. Recently reported increased difficulty with balance, no consistent pattern.
Current Medications / Self-Management: Inhaled nebulized glutathione (minor, temporary symptom relief; risk of bronchospasm with continued use); Flovent 110 mcg inhaled orally twice daily; bronchodilators (subjective relief despite PFTs consistently showing irreversible obstruction); incentive spirometry and an Airofit device, with breathing exercises performed 4x/day every 3 hours.
Relevant Medical History: Narrow-angle glaucoma (followed by specialist at NYU); hearing deficit with reverse cookie-bite pattern loss; pancreatic cyst seen on MRI 9/2022 (follow-up in 2024 deemed unremarkable); mildly elevated liver enzymes; anxiety disorder; breast lump (followed every 6 months); hiatal hernia; history of kidney stones; bilateral hand osteoarthritis; right plantar fasciitis (2022).
Past Interventions and Outcomes: No prior rehabilitation-specific intervention for IPF/ILD documented prior to this episode of care; ongoing pulmonary medication management and self-directed breathing exercises with limited symptom control.
Clinical Findings
Subjective
- Decreased ambulation tolerance, unable to walk more than 5 minutes due to dyspnea and fatigue.
- Functional mobility impacted: unable to single-leg stand greater than 2 seconds, and unable to traverse stairs without use of a handrail.
Objective
- Thoracic spine hypomobile on active range of motion and accessory motion testing; apical (accessory-muscle-dominant) breathing pattern.
- Baseline PFT (performed by physician just prior to examination): residual volume (RV) 1.32 L; diffusion capacity of the lungs for carbon monoxide (DLCO) 13 mL/min/mmHg — both findings consistent with ILD and decreased lung capacity.
- Peak flow tracked throughout care using a peak flow meter; a change of more than 10% considered significant. Patient’s peak flow runs 300–350 when doing well, falling to the 200s when symptomatic.
Detailed Treatment, Timeline, and Outcome
1. Timeline
| Period | Detail |
| 9/4/2024 – 10/31/2024 | TECAR therapy 1–2x/week for 8 weeks; 11 total visits, each 30–45 minutes with TECAR utilized throughout the entire session. |
| Post-discharge (Nov–Dec 2024) | Patient traveled south for the winter; continued self-tracking of peak flow, DLCO, expiratory reserve volume (ERV), and inspiratory reserve volume (IRV). |
| January 2025 | Repeat PFT performed, compared against baseline (pre-treatment, taken in October) to determine final outcomes. |
2. Diagnostic Assessment
Diagnostic methods: physician-performed pulmonary function testing (PFT) immediately prior to the PT evaluation; clinical examination of ambulation tolerance, single-leg stance, stair negotiation, thoracic spine active and accessory motion, and breathing pattern; ongoing self-monitored peak flow.
Diagnosis: idiopathic pulmonary fibrosis with mild interstitial lung disease, combined restrictive/obstructive pattern, consistent with the baseline PFT findings (RV 1.32 L, DLCO 13 mL/min/mmHg) and CT findings of ILD with small nodules.
Prognostic characteristics: chronicity of disease (diagnosed March 2021) and irreversible obstructive component on PFT despite subjective bronchodilator relief; reactive airways and mold sensitivity as ongoing aggravating factors; motivated patient already engaged in self-directed respiratory exercise (incentive spirometry, Airofit, structured breathing 4x/day).
Therapeutic Intervention
1. Type of Intervention
Non-invasive multimodal physical therapy combining manual TECAR therapy (CET and RET modes) with active exercise performed concurrently with TECAR application.
Session Structure: 30-minute treatment sessions: 10 minutes of manual TECAR therapy followed by 20 minutes of active exercise performed in conjunction with TECAR therapy.
2. Protocol Steps
Manual TECAR (first 10 minutes):
- Soft tissue mobilization with bilateral deep CET at 30–40% intensity for 3 minutes over the bilateral upper trapezius region, to calm accessory respiratory musculature.
- Soft tissue mobilization with resistive energy transfer (RET): electrode head over the apex of the lung, ground adhesive pad electrode over the upper posterior thorax wall, patient in supine position; intensity 30% for 3 minutes.
- Joint mobilization by clinician using an RET bracelet; intensity 30% for 4 minutes.
Active exercise with concurrent TECAR (20 minutes): RET current at 30% intensity using a 3-channel adhesive pad setup (2 active adhesive pads over each lung anteriorly, 1 ground adhesive pad over the posterior upper thorax wall at the midline of both lungs). Exercises performed with coordinated breathing (inhale through the nose, exhale through the mouth):
- Seated trunk control with coordinated breathing and ball press-outs: 20 repetitions.
- Seated trunk rotation with ball press-out.
- Seated bilateral rows with tubing resistance: 3 sets of 12–15.
- Seated forward serratus punches with tubing resistance: 3 sets of 12–15.
- Seated horizontal abduction with thoracic spine rotation, tubing resistance: 2 sets of 10 each side.
- 30-second rest breaks were provided between all sets.
3. Changes in Therapeutic Intervention
The protocol structure (10 minutes manual TECAR followed by 20 minutes active exercise with concurrent TECAR) was maintained consistently across the 11-session course; no modifications were documented.
Treatment Protocol and Follow-Ups
Session Frequency: 1–2x/week for 8 weeks; 11 sessions total.
Techniques used in follow-up sessions: Manual techniques with TECAR therapy (CET and RET), and active exercise performed in conjunction with TECAR current, as described above.
Clinician- and patient-assessed outcomes: Pre- and post-session peak flow testing; pulmonary function testing values (DLCO, RV, ERV, IRV) tracked over the course of care and at follow-up.
Important follow-up diagnostic and other test results: Repeat PFT in January showed DLCO 17.18 mL/min/mmHg (+22%) and RV 2.19 L (+39%) compared to baseline.
Intervention adherence and tolerability: Assessed via peak flow testing before and after each session.
Adverse and unanticipated events: None reported.
Results after Treatment Completed
Physical therapy was discontinued after 11 sessions over 2 months. Repeat PFT, performed following discharge, revealed a 22% increase in DLCO (from 13 to 17.18 mL/min/mmHg) and a 39% increase in RV (from 1.32 L to 2.19 L).
| Measure | Baseline (Pre) | Post-Discharge (Jan) | Change |
| DLCO (mL/min/mmHg) | 13 | 17.18 | +22% |
| Residual Volume — RV (L) | 1.32 | 2.19 | +39% |
Subjective and functional reports: the patient reported subjective improvements in dyspnea and fatigue, and was able to ambulate for greater than 20 minutes (compared with under 5 minutes at intake), navigate a flight of stairs independently (compared with requiring a handrail at intake), and single-leg stand for greater than 5 seconds (compared with under 2 seconds at intake). No adverse or unanticipated events were reported; adherence and tolerability were assessed via pre/post-session peak flow testing throughout.
Discussion
Following a multimodal course of treatment combining manual TECAR therapy, manual therapy, and aerobic/active exercise, this patient demonstrated improvements in aerobic capacity, functional mobility, and pulmonary function test values. TECAR may help reduce diaphragmatic tension, enhance diaphragmatic breathing mechanics, and improve tissue elasticity of the thoracic wall and lungs — mechanisms that are biologically plausible given TECAR’s known effects on local tissue metabolism, vascularity, and connective tissue extensibility.
Strengths of this case include the use of objective pulmonary function testing (DLCO, RV) alongside functional outcome measures (ambulation tolerance, stair negotiation, single-leg stance) to track change over an 8-week, 11-session course — and the application of TECAR to a patient population (IPF/ILD) in which it has little prior documentation.
Limitations include the single-patient design, the absence of a comparison/control condition, and the concurrent use of manual therapy and active exercise alongside TECAR, which prevents isolation of TECAR’s independent contribution to the observed PFT and functional gains. The patient’s ongoing self-directed respiratory exercise program (incentive spirometry, Airofit, structured breathing) is an additional confound.
Take-away: a multimodal approach combining manual TECAR therapy (CET to accessory musculature, RET to the lung apices and thoracic wall) with active exercise performed under concurrent TECAR application was associated with meaningful gains in DLCO, RV, and functional mobility in a patient with IPF/ILD. Further research on the effectiveness of TECAR therapy in patients with IPF and other pulmonary conditions is warranted.
Patient Perspective
Not provided in the source documentation for this case.
Informed Consent
Patient consent for the use of de-identified clinical data and outcome measures in this case report is available on request.