Neuromuscular Re-education (E-Stim) and Ultrasound
What is Neuromuscular Re-Education?
Electrotherapy is a type of modality that utilizes mild electrical currents to treat a variety of issues. It is typically used in conjunction with other treatments as a method of pain management and muscular stimulation. There are multiple variations of electrotherapy that can be beneficial in relieving pain an recovering from an injury via small electrical currents; the two primary forms that we utilize in clinic are:
Neuromuscular Electrical Stimulation (NMES)
NMES, commonly referred to as Russian stim, is a form of electrotherapy that is used to assist in rebuilding muscle tissue through increased neuromuscular activation. Following surgery or injury, muscles can become significantly weakened and it may become difficult to get the muscle to “fire” voluntarily. With NMES, electrode pads are applied to the skin over the weakened muscle and an electrical current runs through the muscle causing a contraction. The goal is to help rebuild the neuromuscular pathway and allow the patient to once again contract and control the muscle. The length of a treatment varies but the typical protocol is 10 seconds on, 10 seconds off. While the current is on, the patient may be asked to perform an exercise such as a straight leg raise or simply to squeeze the muscle until the 10 second period is over.
Is Electrotherapy Safe?
YES! It is understandable for one to initially be fearful of having electrical currents flow through their body, however the treatment is completely safe when administered by a health professional. The currents used are mild and many patients find the treatment relaxing and therapeutic. The feeling is often described as a buzzing, vibrating or tingling similar to that of a pins and needles sensation. The most common side effect to the treatment is a small rash or skin irritation from the adhesive pad. It is very rare to experience any sort of side effect from the current.
As electrotherapy has become more popular, transcutaneous electrical nerve stimulation (TENS) units have become more readily available to the public. While these units are generally safe to use, not all have been FDA tested and approved. Therefore, it is best to consult your physician or physical therapist prior to using electrotherapy on your own. Many physicians advise the introduction of e-stim in a physical therapy setting before considering a home unit.
What is Ultrasound Therapy?
Ultrasound is another type of modality commonly used in physical therapy. Like electrotherapy, ultrasound is used in conjunction with other treatments for a variety of issues. The main difference is that sound waves are used to stimulate the tissues instead of electrical currents. Simply put, sound is a mechanical vibration and when the frequency is beyond the range of human hearing it is referred to as ultrasound. Much like an ultrasound used during pregnancy, the treatment involves the use of a probe or wand placed on the skin along with a gel or cream. However, therapeutic ultrasound uses a different frequency as the goal is the treatment of affected tissues rather than imaging. As sound waves move through the tissue, they cause vibration to occur at the molecular level. This produces a thermic effect (heat) that promotes increased blood flow and muscle relaxation. Varying frequencies are used to reach different tissues depths depending on the issue being treated.
During an ultrasound treatment, the frequency is at such a high level that no vibration will be felt. Occasionally, patients note a slight warming sensation but most say they do not feel anything during the treatment. The increased blood flow can promote accelerated healing of certain injuries such as muscle strains and ligament sprains. Ultrasound is used to a variety of issues but may not work for everyone. The most common uses are for chronic inflammation, tendonitis, joint swelling and muscle spasms. Some studies suggest using ultrasound can assist in the breakdown of scar tissue.
What is a Combo Treatment?
A combo treatment is a modality that uses electrotherapy and ultrasound together. A single electrode known as the dispersal pad is placed on the skin more than 8 inches from the affected area. The ultrasound wand is then used along with a gel or cream to complete the circuit on the treatment area. As the wand is moved across the skin, it causes the muscle to contract as a result of the electrical current and the tissue to heat up as a result of the ultrasound. The benefits from this treatment are similar to what you would expect from both of the modalities involved.
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