As mentioned above, there are several different types of electrical stimulation. Each one is designed for a specific purpose. If your PT decides electrical stimulation is indicated in your care, they will select the type of stimulation based on their goals. Here is a list of some of the most common types of electrical stimulation used in physical therapy and how they can be used to treat many elbow conditions:

TENS (Transcutaneous Electrical Nerve Stimulation): Stimulates sensory nerves to decrease pain. TENS may be used to manage painful elbow conditions such as the ones listed below:

• Elbow arthritis
• Chronic elbow pain
• Tennis elbow
• Golfer’s elbow
• Sore, aching muscles

IFC (Interferential current): This type of electrical stimulation is also indicated for the management of acute, chronic, post-surgical or post-traumatic pain. IFC might be prescribed to manage the following elbow conditions:

• Elbow surgeries like an elbow replacement, ligament repair, tendon repair
• Elbow muscle strain
• Elbow ligament sprain
• Arthritis
• Tennis elbow
• Golfer’s elbow

NMES (Neuromuscular Electrical Stimulation): Primarily used for muscle re-education, NMES is typically used to stimulate a muscle to contract–though sometimes just targets the sensory nerves in the area–to help re-educate a weakened muscle. It can help to prevent muscle atrophy and improve circulation. Below are some examples of how NMES is used in elbow rehabilitation:

• Post-surgical muscle weakness or atrophy
• Muscle weakness or atrophy after immobilization
• Neurologic injury resulting in muscle weakness such as a stroke

In the case of a neurologic injury, stimulating a muscle externally aims to help restore the connection between the brain and the nerve controlling the muscle. By triggering the NMES to contract the muscle while the client tries to activate it themselves it can help restore the mind-muscle connection and strengthen the muscle.

FES (Functional Electrical Stimulation): Functional Electrical Stimulation refers to the use of NMES within a functional activity. Pairing an externally triggered muscle contraction around the elbow with a functional activity can help improve neuroplasticity and facilitate functional use of the elbow. A physical therapist may apply FES to the bicep muscle to help bend the elbow while a patient lifts a food item toward their mouth. Alternatively, they may apply the FES to the tricep muscle to straighten the elbow while bearing weight through the arms.

Iontophoresis: This is a 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 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. For instance, a steroid medication may be transmitted through iontophoresis to reduce inflammation in tennis or golfer’s elbow.

Dry Needling: Dry needling is a technique wherein very thin, solid needles are inserted into tissues like muscles, fascia, tendons or near bones to treat trigger points and alter the nervous system activity in the area. Electrical stimulation is sometimes applied through these needles to apply it to a very specific area. Dry needling is not allowed in every state and only therapists specially-trained in this technique will perform dry needling.

If you decide to work with a physical therapist to help correct your elbow issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

IS ELECTRICAL STIMULATION RIGHT FOR YOU?

As you can see, electrical stimulation has many applications but not all therapists choose to use this modality. This is because there are often many ways to address pain, inflammation and motor control, for example, besides electrical stimulation. Before applying electrical stimulation it is important that you share your medical history with your therapist. Electrical stimulation is contraindicated in the presence of certain medical conditions or devices. 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.

If your therapist chooses to use electrical stimulation, it is often a short-term treatment intervention. Though it can feel good to the body, most therapists will eventually transition you toward interventions that you can perform independently after discharge from physical therapy. In some cases, your therapist may recommend a home TENS unit for chronic pain, or NMES unit for muscle re-training.

Whether your therapist elects to use electrical stimulation or not, my team of therapists and I have a large toolbox of interventions ready to address your concerns. If you are experiencing uncomfortable symptoms in your elbow or recovering from an elbow injury, physical therapy is a great choice . Our team of physical therapists can help you improve your symptoms through our care and empower you to manage them longterm on your own.