Nerve and muscle stimulation using TENS and EMS

1. Methods of electrical stimulation
of Nerves and Muscles

2. Transcutaneous Electrical Nerve Stimulation
It is the application of low frequency current in the form of pulsed
rectangular currents through surface electrodes on the patient’s skin to
reduce pain. There are three types of TENS.
1. High transcutaneous electrical nerve stimulation.
2. Low transcutaneous electrical nerve stimulation
3. Burst transcutaneous electrical nerve stimulation

3. Methods of Treatment
Electrode Placement:
TENS electrode can be placed over:
Area of greater intensity of pain
Superficial nerve proximal to site of pain
To the appropriate dermatome
To the nerve trunk trigger point

4. How TENS is different from other electro
therapy methods?
• It can be used for a single daily treatment of 40 min duration
• Portable tens can be used continuously for 24 hours
• It can be used in night eg for the treatment of phantom limb pain.

5. High transcutaneous electrical nerve
stimulation
• In this high frequency and low intensity electrical stimulation is
applied. The stimulation will cause impulse to be carried along with
large diameter afferent fibres and produces presynaptic inhibitions of
transmission of nociceptive A delta and C fibres.
• Frequency:100-150Hz
• Intensity:12-30mA

6. Low transcutaneous electrical nerve
stimulation
• In this low frequency and high intensity electrical pulses are applied.
It gives a sharp stimulus and like a muscle twitch. As the nociceptive
stimulus is carried toward the cerebrum, its passage through the
midbrain will cause the peri aqueductal area of gray matter to interact
to release the opiate-like substances at cord level. The endorphins
released have the effect of blocking forward transmission in pain
circuit.
• Frequency:1-5Hz
• Intensity:30mA

7. Muscle Stimulation

8. Burst transcutaneous electrical nerve
stimulation
In this high frequency, short pulse, high intensity electrical current is used.
Burst TENS are a series of impulse repeated for 1-5 times per second. Each
burst lasts for about 70ms.The benefits are that it has both conventional and
acupuncture like TENS and thus provide pain relief by both routes.
Indications of use
It is used for the treatment of :
1. Chronic pain syndrome
2. Phantom limb pain
3. Reflex sympathetic dystrophy
4. Obstetric pain

9. Precautions /Contraindications
• Continuous application of high TENS may result in some electrolytic
reaction below the skin surfaces.
• It is contraindicated in patients having cardiac pacemakers.
• It should be avoided in first 3 months of pregnancy.
• It should be avoided in hemorrhagic conditions.
• It should be avoided in open wounds, carotid sinus, near eyes etc.

10. Microcurrent Electrical Neuromuscular
Stimulation
• These are extremely small pulsating currents used to relieve pain and to
heal soft tissues of the body. These currents are so small that the patient
rarely feels it. Typically less than 600microamperes, there is no patient
discomfort or even sensation felt during application. It is recommended in
cases of soft tissue inflammation or muscle spasm.
• The various effects used by MENS are:
• Reduce acute and chronic pain
• Increase local blood circulation
• Reduce swelling and inflammation
• Decrease muscle spasm
• Prevent atrophy of muscle tissue
• Re-educate nerves and muscles.

11. Nerves and muscle Stimulation.

12. Thank you.