Do I Need Electrical Stimulation To Heal?
Electrical Stimulation in Physical Therapy
Treatment Toolbox: Electrical Stimulation
If you have ever been in a physical therapy clinic or worked with a physical therapist before, you probably realize that physical therapists use a variety of tools in their practice. Some of these tools are meant to reduce symptoms, some to promote healing, some to help bodies learn. Amongst the various tools in a physical therapist’s toolbox, is electrical stimulation. Electrical stimulation is a modality that sends a carefully controlled electrical current into tissues to achieve a desired effect such as pain modulation or muscle activation. This modality is not always indicated but as you may see this during your treatment session, it is helpful to understand how it works and why your therapist might prescribe it.
HOW DOES ELECTRICAL STIMULATION WORK?
Though it may sound kind of scary, when used correctly, electrical stimulation is quite safe and is used by many rehabilitation professionals. Occupational therapists often use it to help re-educate muscles in the upper extremity, speech therapists may use it to activate the muscles for swallowing and physical therapists use it to achieve several therapeutic outcomes.
Most individuals are familiar with the type of electrical stimulation that is delivered through sticky electrodes which are placed on the skin. It can also be delivered through very thin, solid needles that are inserted into the target muscle or tissue. Unlike massage or myofascial work that is applied superficially across the skin, electrical stimulation allows the treatment to permeate through layers of tissue in order to target deeper layers more directly.
When electrodes or needles are utilized to deliver electrical stimulation, they are applied in pairs. Each pair creates a circuit for the electrical current to travel from the device through the tissues and back to the device. In the clinic you may see therapists use small, hand held devices that can travel easily as you move about or larger devices that tend to reside permanently on a cart. These devices can sometimes supply electrical stimulation to more than one person, individually.
While the devices might look fairly uniform, there are many different types of electrical stimulation and each one aims to affect the nerves or tissues in its own way. The wave form, amplitude, pulse width and duration of the electrical impulse is different in each type of electrical stimulation. This is why it is important to know what the goal of treatment is in order to select the correct type of electrical stimulation and therefore the right device.
HOW DOES Electrical Stimulation FEEL?
If you’ve heard someone describe electrical stimulation you may have heard them describe it as “ants crawling on the skin.” This is a pretty accurate description of many types of electrical stimulation. After your therapist applies the electrodes or needles (don’t worry, this type of electrical stimulation is only used if you have consented to dry needling treatment ahead of time and after a thorough discussion with your therapist), they will set the desired parameters on the electrical stimulation device. Next, they will slowly turn up the stimulation until you let them know you are beginning to feel the tingling. Depending on the type of electrical stimulation, a comfortable tingle may be the goal and at this point you get to rest and relax until the treatment is over. You will likely feel a pattern of slightly changing stimulation happening throughout the treatment but oftentimes it is continuous.
Other types of electrical stimulation are used to externally stimulate a muscle and your therapist will continue to turn up the stimulation until the muscle is contracting noticeably. Typically, this type of stimulation is used to activate muscles. The stimulation will turn on to contract the muscle for a short period and then turn off to allow the muscle to rest. You will likely be asked to try and actively contract the muscle each time the electrical stimulation turns on.
Electrical stimulation should not be painful. While it is true that the sensory-level stimulation that usually leads to a brief nap tends to be more comfortable that the motor-level stimulation that helps contract a muscle, there are ways your therapist can modify the parameters of the electrical stimulation to help make you more comfortable.
WHY IS IT USED?
Because there are different types of electrical stimulation there are several ways it can be utilized. Some patients benefit from the use of electrical stimulation to decrease sensations of pain. Interferential current or IFC is often used to manage acute, chronic pain, post-surgical and post-traumatic pain. TENS or transcutaneous electrical nerve stimulation is also used commonly in the management of pain and is often prescribed to those with chronic pain.
Several types of electrical stimulation are also utilized to activate muscles, promote neuromuscular re-education and neuroplasticity for motor recovery. The electrical stimulation used most commonly for these goals are Russian protocol stimulation, NMES (neuromuscular electrical stimulation) and FES (functional electrical stimulation). These forms of electrical stimulation bypass the brain and spinal cord and stimulate the muscle externally. This type of therapy is most effective when patients act as an active participant and try to actively contract the target muscle along with the stimulation. The goal here is to restore the brain to muscle connection so that the body can activate the muscle independently and effectively. This type of electrical stimulation may be used on a quadriceps muscle inhibited after an ACL repair or on the ankle muscles of a patient recovering from a stroke.
Iontophoresis is a less common and more specialized type of electrical current that helps transport medications through the skin. These medications are prescribed by your doctor and applied to specialized electrodes and placed over the affected area. The type of drug utilized will determine the effect of the treatment but iontophoresis may be used to decrease inflammation, decrease pain, manage scar tissue or reduce calcium deposits.
In addition to the benefits described above, electrical stimulation is sometimes used to promote healing, increase range of motion, improve circulation, decrease edema and inflammation, decrease spasticity and improve overall function.
SHOULD EVERY PATIENT HAVE ELECTRICAL STIMULATION?
While there may be a positive effect of electrical stimulation in many situations, it is not a magic bullet nor a stand-alone treatment. Electrical stimulation is not necessary or indicated for all patients and tends to be utilized earlier on in a patient’s treatment and then replaced by more active exercises and modalities that more closely mimic daily life.
Electrical stimulation is contraindicated in the presence of certain medical conditions, implants and devices and could pose a serious danger in these circumstances. Be sure to tell your physical therapist your entire medical history so that they can decide if electrical stimulation is a safe option for you.
At Evolve Physical Therapy we aim to heal. If you would like to discuss if electrical stimulation is a beneficial and appropriate adjunct to your treatment plan we would love to discuss this with you. To learn more about the full toolbox of treatments and interventions we have to help you feel better, call to schedule and evaluation today.
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Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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