Note: This post is the second in a series of posts about treatment options for sports and exercise injuries. In the first post, I introduced the debate about when athletes and patients should use heat and ice. In this post, we discuss (and include the thoughts of other sports medicine experts) the modality electrical stimulation, or e-stim. In future posts, we will address ultrasound, dry needling, kinesio taping, and more.

What is electrical stimulation? When would you use it on a patient? And does it work?

Steven Kleinman, PT, MPT, in Riverdale, New Jersey:
Electrical stimulation is a modality used in physical therapy. It is the use of an electrical current to cause an effect on the tissue being treated. The most commonly used applications for electrical stimulation include: pain, inflammation, muscle spasm; healing skin incisions, healing bone fractures, muscle atrophy, and enhancing delivery of medication through the skin.

Electrical stimulation will affect the body in many different ways including: stimulating muscles to contract; stimulating nerves to decrease pain; increasing blood flow to speed healing and reduce inflammation; stimulating cells to reproduce and speed healing; and improving the flow of medication through the skin.

Stephanie Davey, MEd, ATC, PES, Charleston, South Carolina:
A physical therapist uses e-stim on a patient’s shoulder.[/caption]“As an athletic trainer, access to electrical stimulation depends on the setting in which you are working. When I have access to it, I will use e-stim to control pain, decrease muscle spasm, and reduce edema. I always use it in conjunction with other therapeutic modalities, such as heat or ice, and with a rehab program. Athletes need to understand that e-stim alone may feel good, but will not be a long term fix to their injury.”

Vincent M. Burke, PT, DPT, MPT, BS, CSCS,CPT-NASM, Rochelle Park, New Jersey:
“Electrical stimulation has several applications in the clinic. Some is researched, some is evidence based, some is experience, some is “sales pitched”, and some is just because patients like it, but most does have a physiological affect (cellular), pain inhibition and muscle activation. The settings need to vary depending on the clinical pathology and what response you are looking for. We as clinicians see patients for two reasons loss of function and pain. Often, trauma or chronic pathologies will cause both muscle inhibition and pain. Electrical Stimulation is not my “cure all” but I use it as a “healer helper”, in conjunction with corrective exercises. Electrical Stimulation offers both a passive and/or active modality for tissue healing, muscle recruitment and pain modification. In the end you don’t want the patient to rely on any modality. Movement is how one typically gets injured and movement is how one often recovers, for this is the best modality.”

Eric Sampsell PT, ATC, Hagerstown, Maryland:
“Electrical stimulation is a modality/treatment often used in physical therapy and athletic training that serves multiple functions in order to get a patient or athlete back to their normal functional state or to athletics. It first can be used to treat pain and/or swelling, especially in the acute stage of healing when an injury is new and pain/swelling is inhibiting progress or function. It helps to treat pain by stimulating larger nerve fibers that can override the smaller nerve fibers that produce pain. It’s not unlike rubbing your elbow after bumping it into the corner of a wall at home to make it feel better. This treatment is sometimes referred to as TENS or Transcutaneous Electrical Neuromuscular Stimulation.

The other purpose that electrical stimulation serves is to stimulate weaker muscles to contract during exercise to improve strength more quickly. This is often used on the quadriceps after knee surgery or on a rotator cuff in the shoulder to stimulate strength gains. The electrodes are placed on the muscle that is weakened and the patient/athlete is instructed to exercise while the machine is delivering stimulation to the muscle externally. The research has shown that the use of neuromuscular electrical stimulation (NMES) can significantly improve recovery times.”

Renée Garrison, PT, MTC, CLT, Charleston, South Carolina:
“I LOVE using NMES for muscle re-education post-operatively. I think it works so well to get the quad working again after ACL reconstruction & I’ve also used it on shoulder external rotators and anterior tibialis as needed for shoulder or ankle problems. I use TENS only occasionally, but it is a great way to break the pain cycle when ice doesn’t do the job. If someone is very painful, you can use TENS while exercising to help decrease pain to allow proper movement patterns.”

And finally, a critical look at TENS:
Selena Horner, PT, Willimaston, Michigan (from her blog, Snippets from a Physical Therapist):
“In 1962 Melzack and Wall introduced the Gate Control Theory of Pain…The basic idea was flow of information to the brain could be shut off or opened up. It was believed that if someone had pain, a message had to be sent to the brain and a “gate” controlled if the person felt the pain or not. An open “gate” resulted in pain and a closed “gate” resulted in no pain.

As with all theories, they evolve over time. The Gate Control Theory of Pain has evolved. Clinicians who are current with literature realize the pain experience is quite complex.

TENS is based on an old, outdated theory of pain. If your treatment session includes TENS, you deserve more for your money than a feel good, short term treatment. TENS was created off the 1962 gate control theory of pain and it doesn’t consistently provide the desired results because the pain experience is far more complex than a “gate.” I’d suggest you find a clinician who understands pain and is familiar with pain research.”