How Electrical Stimulation Is Used in Physical Therapy

Electrical muscle stimulation, rebahilitation. Policlinica Gipuzkoa, San Sebastian, Donostia, Euskadi, Spain
Javier Larrea/Age Fotostock/Getty Images

So your doctor has ordered physical therapy for your injury, and he or she is recommending electrical stimulation. It sounds interesting (and a bit scary). So, what is electrical stimulation, or e-stim, and how is it used in physical therapy?

What Is Electrical Stimulation?

Electrical stimulation is a type of physical therapy modality used to accomplish various tasks in physical therapy. If you have an injury or illness that causes pain or limited functional mobility, your PT may use electrical stimulation, or E-stim, as one part of your rehabilitation program.

Conditions in which electrical stimulation is used may include:

  • Low back pain
  • Post-surgical pain
  • For muscle weakness or poor motor control
  • Tendonitis
  • Bursitis

If you are experiencing pain, spasm, inflammation, or muscular weakness, your PT may use this versatile modality as part of your treatment.

Why E-Stim Is Used

Electrical stimulation is used for many reasons in PT. It can be used to administer medication for inflammation. Electrical stimulation may be used to contract muscles that are weak or not functioning well. E-Stim may also be used to help decrease pain or spasm.

There are some evidence and cases where e-stim is used to help treat stubborn wounds. A PT who is a wound care specialist would be the professional who provides this treatment for you.

The big question in PT these days is: should electrical stimulation be used? Electrical stimulation is a relatively passive modality; you do nothing (or very little) while the treatment is being applied. Most successful rehab programs include active participation by the patient. Learning the right movements and exercises for your specific condition is key. For this reason, some professionals debate whether e-stim is something of value in PT. And some research shows that electrical stim offers very little in the way of improved functional outcomes. Other research indicates that some types of stimulation can be useful.

As the debate rages on, one thing is certain: you may encounter e-stim if you go to physical therapy, so knowing what it is and what to expect can be helpful.

What to Expect During E-Stim

If your PT chooses to use electrical stimulation during your rehab, he or she should explain to you the procedure and the expected risks and benefits. A typical application of e-stim goes something like this:

  1. Expose the area of your body being treated.
  2. Your PT will apply electrodes to your skin. These electrodes are connected via a wire to an e-stim machine.
  3. You will feel a slight tingling sensation.
  4. The sensation will be increased until it feels strong but comfortable.
  5. If the e-stim is used for muscle spasm or pain relief, you will relax during the treatment.
  6. If the electricity is used to improve muscular strength or function, you may be required to contract your muscle as the machine is working.

Application of electrical impulses may feel a bit uncomfortable, but they should never hurt. If you feel pain during electrical stimulation, tell your PT. He or she will adjust the treatment or discontinue its use.

Types of Electrical Stimulation

Your physical therapist will use different types of electrical stimulation to accomplish different tasks. These may include:

  • TENS: Transcutaneous electrical neuromuscular stimulation (TENS) is a physical therapy modality used to manage acute and chronic pain in physical therapy. Your PT will use TENS to decrease your pain by applying electrodes to your body over painful areas. The intensity of the electricity will be adjusted to block the pain signals traveling from your body to your brain.
  • Iontophoresis: Iontophoresis is a type of electrical stimulation that is used to help administer medication to you in physical therapy. The electrical current pushes various medication in through your skin and into your body. Your PT will likely use medicine to decrease inflammation or muscle spasm, or iontophoresis drugs can be used to break up calcium deposits that may occur in conditions like shoulder calcific tendonitis. Different medicines are used to accomplish different goals using iontophoresis.
  • Neuromuscular electrical stimulation (NMES): NMES uses an electrical current to cause a single muscle or a group of muscles to contract. By placing electrodes on the skin in various locations the physical therapist can recruit the appropriate muscle fibersContracting the muscle via electrical stimulation helps improve the way your affected muscle contracts. The physical therapist can change the current setting to allow for a forceful or gentle muscle contraction. Along with increasing muscle function, the contraction of the muscle also promotes blood flow to the area that assists in healing. NMES can also be used to help decrease muscular spasm by artificially tiring your muscle in spasm, allowing it to relax.
  • Russian stimulation: Russian stimulation is a form of electrical stimulation that can accomplish a similar task as NMES: to improve the way your muscles contract. Russian stim simply uses a different waveform that may be a little more comfortable for you to tolerate.
  • Interferential current: Interferential current (IFC) is often used by physical therapists to decrease pain, decrease muscular spasm, or improve localized blood flow to various muscles or tissues. It is often used to decrease low back pain and muscular spasm. Interferential current typically uses 4 electrodes in a crisscross pattern. This causes the currents running between the electrodes to "interfere" with one another, and allows your PT to use a higher intensity current while still maintaining maximum comfort for you.
  • High voltage galvanic current (HVGC): High volt galvanic stimulation uses high voltage and low-frequency electricity to penetrate deep into tissues. It is used to relieve pain, improve blood flow, relieve muscle spasm, and improve joint mobility.

    Keep in mind that many forms of electrical stimulation are a passive treatment; you are doing nothing while receiving the stimulation. Some forms of e-stim, like NMES and Russian stim, require that you are active while the E-stim is in use.

    Electrical stimulation should never be the only treatment you receive during physical therapy. Research indicates that active engagement in your physical therapy program with or without electrical stimulation yields the best results. E-stim should only be used to augment your active physical therapy program that includes specific motions and exercises to treat your condition.

    Risks

    If your PT wants to use electrical stimulation during your rehab treatments, he or she should explain to you the various benefits and risks associated with the treatment. Risks to using e-stim should be taken seriously, and working to avoid unfortunate problems with e-stim should be taken by your PT. Risks may include muscle tearing, tissue burn, or skin irritation.

    If You Experience a Muscle Tear

    If the electrical stimulation impulse is adjusted to an intensity that is too high, you may feel intense muscle pain. Is this happens, tearing of your muscle tissue may occur. In this case, the e-stim should be stopped immediately and treatment for an acute muscle injury should be started. This may include rest, ice, and elevation.

    If Skin Irritation Occurs

    Some forms of electrical stimulation may cause irritation of the skin underneath the electrode. Iontophoresis uses a direct current during application, and this has been known to be irritating to the skin. Sometimes, people with sensitive skin may be irritated by the electrode's adhesive or by the electrical stimulation. If irritation occurs, the procedure should be stopped and lotion may be applied to the affected area.

    If You Suffer a Tissue Burn

    If electrical stimulation is applied with an intensity that is too great, tissue burns may occur. While this is rare, it may happen, and the procedure should be stopped immediately and appropriate skin care should be provided.

    Your PT can ensure that the electrical stimulation is used properly to minimize the risks associated with e-stim use. Understanding these risks can help you decide if you want to include it in your rehab.

    Contraindications

    There are some conditions where you should never use electrical stimulation. These contraindications to e-stim use should be heeded by your physical therapist. Contraindications to electrical stimulation include:

    • Altered tissue sensation
    • Impaired mental status
    • Presence of an implanted electrical device (The e-stim could interfere with pacemakers or implanted pain stimulators .)
    • Over malignant tissue
    • Over wounds that are overly moist
    • Near the eyes, carotid sinus, anterior neck, or over reproductive organs

    Your physical therapist should have identified these contraindications during your initial evaluation, but it is important to remind him of any condition that you may have that may have a negative interaction with e-stim.

    Alternatives to Electrical Stimulation

    If you cannot have e-stim as a treatment, or if you wish not to have it, your PT may offer you alternatives.

    If you have pain or limited mobility, check in with your physical therapist and see if using electrical stimulation is the right treatment for you and your specific condition.

    A Word From Verywell

    If you have a condition that results in pain or limited functional mobility, you should check in with your doctor and see your physical therapist. He or she may use e-stim to help augment your rehab program. If so, knowing what electrical stim is and how it is used can help you fully understand your entire rehab program.

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    Article Sources
    • Carlo Ammendolia, D. C., Pierre Côté, D. C., Brian Budgell, D. C., Bombardier, C., & Hawker, G. (2016). Effect of TENS Versus Placebo on Walking Capacity in Patients With Lumbar Spinal Stenosis: A Protocol for a Randomized Controlled Trial.
    • Ward, Alex R. "Electrical stimulation using kilohertz-frequency alternating current." Physical therapy 89.2 (2016): 181-190.

    • Ennis WJ, Lee C, Gellada K, Corbiere TF, Koh TJ. Advanced Technologies to Improve Wound Healing. Plastic and Reconstructive Surgery. 2016;138. doi:10.1097/prs.0000000000002680.