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Electrical stimulation: Does it serve a purpose, or does my physio just want to zap me?

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Electrical stimulation: Does it serve a purpose, or does my physio just want to zap me?

Electrical stimulation (e-stim), most people are familiar with the term. It has become a mainstay in many physiotherapy practices, but what actually is it? Did you know there are actually many different types?

What is e-stim?

E-stim is an umbrella term for various different electrotherapy devices with different intervention goals. Of the most commonly used are Neuromuscular Electrical Stimulation (NMES), Transcutaneous Electrical Nerve Stimulation (TENS) and Inferential Stimulation (IFT). Despite these devices conducting electrical currents through the body via electrodes on the skin, they are in fact used to treat different things and thus their practical application varies [1].

 

NMES

NMES is used with the primary outcome to maintain strength and flexibility in order to restore, maintain and improve function [1,2]. Normally our brain sends messages to our muscles to initiate contractions. After muscular injuries, our muscle’s ability to activate becomes inhibited due to pain, swelling and/or trauma [1,2]. This leads to muscle wastage and poorly controlled muscle activation patterns, limiting the individual’s ability to properly recover during the healing process and placing them at an increased risk of future injury [2]. To prevent this, NMES is used to send an electrical current into the muscle to cause it to contract. In doing so, the muscle is being used and thus minimises muscle wastage; whilst also aiding to regain strength and restore correct movement patterns [1,2]. NMES has a wide practical application with research supporting its efficacy in chronic disease management [3],  post ACL repairs [2] and even in neurological injuries such as stroke [4]. The small battery-operated device is portable and thus can be used on essentially any type of land-based exercise whether that be in laying down or during a functional movement.  

 

TENS

TENS is similar to NMES, however where NMES is used for muscle activation, TENS is used for pain management [5,6]. The pulsed currents are sent through the muscle to help stimulate the release of various chemicals [5]. These chemicals help assist in reducing the sensitivity of the muscles and surrounding tissue by inhibiting neural pain pathways to the brain [5,7]. Current research demonstrates proven efficacy for TENS in decreasing pain compared to both placebo and anti-inflammatories [5]. TENS is often used for a multitude of different conditions including arthritis (both osteo and rheumatoid) [5], neuropathic (nerve related) [8] and even post- surgical pain [5]. It is a small portable battery-operated device, making it easily portable and usable regardless of whether you are at home, in the clinic or at work.

 

IFT

IFT is a form of TENS where rather than sending one frequency current, it utilises two alternating currents simultaneously [1]. These two currents become superimposed on each other where they intersect, enabling the ability to stimulate deeper within the targerted tissue [1]. This results in a reduction in pain in a similar underlying mechanism to TENS [9]. Compared to placebo, IFT has been found to have a positive effect on pain reduction [5]. IFT also can have positive effects on improving circulation and decreasing oedema by assisting in the removal of fluid in both the circulatory and lymph systems [1]. Unfortunately, unlike NMES and TENS, IFT is a larger stationary device and thus does not provide the portable convenience like the others.

 

Take home message

There is a variety of different e-stim devices all used for different purposes. Current research supports their use as an adjunct to therapy, meaning they aren’t a complete cure within themselves [1]. The use of e-stim is relatively safe with the most common side effects reported including pain, discomfort and skin irritation [10]. Several contraindications and precautions do come with the use of these devices [1], but your physio will assess you to clear these risks before starting the treatment to ensure your safety.

 

If you have any questions regarding e-stim or think you may benefit from its application, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

REFERENCES

  1. Brukner P. Brukner and Kahn’s Clinical Sports Medicine. 4th Editio. McGraw-Hill Australia; 2012.

  2. Kim K-M, Croy T, Hertel J, Saliba S. Effects of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength, Function, and Patient-Oriented Outcomes: A Systematic Review. J Orthop Sport Phys Ther. 2010;40(7):383-391. doi:10.2519/jospt.2010.3184

  3. Jones S, Man WD-C, Gao W, Higginson IJ, Wilcock A, Maddocks M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev. 2016;(10). doi:10.1002/14651858.CD009419.pub3

  4. Pomeroy VM, King LM, Pollock A, Baily-Hallam A, Langhorne P. Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database Syst Rev. 2006;(2). doi:10.1002/14651858.CD003241.pub2

  5. Sluka KA (Kathleen A, International Association for the Study of Pain. Mechanisms and Management of Pain for the Physical Therapist. https://books.google.com.au/books?hl=en&lr=&id=ng2DCwAAQBAJ&oi=fnd&pg=PT22&dq=Mechanisms+and+management+of+Pain+for+Physical+therapists+&ots=QW8vap0AOC&sig=7v6EK-jAhIoZbjlXu--KnLykUvs#v=onepage&q=Mechanisms and management of Pain for Physical therapists&f=false. Accessed February 26, 2019.

  6. Gibson W, Wand BM, Meads C, Catley MJ, O’Connell NE. Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2019;2:CD011890. doi:10.1002/14651858.CD011890.pub2

  7. Ahmed S, Haddad C, Subramaniam S, Khattab S, Kumbhare D. The Effect of Electric Stimulation Techniques on Pain and Tenderness at the Myofascial Trigger Point: A Systematic Review. Pain Med. January 2019. doi:10.1093/pm/pny278

  8. Gibson W, Wand BM, O’Connell NE. Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;9:CD011976. doi:10.1002/14651858.CD011976.pub2

  9. Almeida CC de, Silva VZM da, Júnior GC, Liebano RE, Durigan JLQ. Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis. Brazilian J Phys Ther. 2018;22(5):347-354. doi:10.1016/j.bjpt.2017.12.005

  10. Samuel SR, Maiya GA. Application of low frequency and medium frequency currents in the management of acute and chronic pain-a narrative review. Indian J Palliat Care. 2015;21(1):116-120. doi:10.4103/0973-1075.150203

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Blood Flow Restriction Training

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Blood Flow Restriction Training

What is blood flow restriction training?

Blood flow restriction training (BFRT) refers to resistance training performed with a reduction of blood flow in the exercising muscles with the use of a compression device. The compression device used can either be a belt, an inflated air cuff (pneumatic cuff), a sleeve (elastic wrap) or a specific tape. Contrary to common resistance training routines, the intensity of BFRT is very low, performed with a load between 20 to 40% of an individual’s 1-RM [5].

The compression device reduces the level of oxygen circulating through the exercising muscles, and in doing so, muscle adaptation occurring after working at low intensity is greater than the benefits of low intensity with a normal level of oxygen in the working muscle [5]. However, it is unclear whether low load BFRT reaches the same benefits as high load training or not [1,3].

BFRT is a relatively new type of resistance training, inspired from KAATSU, a Japanese strengthening method invented in 1966. Over the last years, studies have been conducted to understand the benefits of BFRT, how it is best to be implemented for different conditions and its safety [4].

Benefits of BFRT

Most studies found that BFRT brings physiological and functional benefits for the general population as well as people with various conditions, such as knee osteoarthritis, tendon injuries and ACL reconstruction. Physiologically, BFRT has been found to increase muscle size (hypertrophy) and muscle strength in the general population. Functionally, the use of BFRT may reduce pain and recovery time in people with specific conditions [1,2,3].

The authors of a systematic review compared low load BFRT to low and high load training without BFR, for population presenting with various musculoskeletal conditions (ACL reconstruction, knee osteoarthritis, and older adults at risk of sarcopenia). Low load BFRT showed a greater increase in strength compared to low load training without BFR, whereas it was found to be less effective than heavy-load training [3]. However, another study focusing on women with knee osteoarthritis found that low load BFRT provided the same increase in lower limb strength than high load training [1]. This study also looked at muscle size, function and pain. The authors found that (1) low load BFRT and high load training provided a greater increase in lower limb muscle size compared to low load training; (2) low load BFRT and high load training led a greater improvement in function compared to low load training; (3) low load BFRT and low load training provided a greater reduction in pain compared to high load training [1].

People with patellofemoral pain may also benefit from BFRT. Compared to standard rehabilitation, the use of BFRT provided a greater increase in knee extensors strength and a greater reduction in pain in daily activities [2].

Safety, precautions, contra-indications

The safety of BFRT is a common and legitimate question as blood flow is voluntarily restricted within the exercising muscles. A study conducted in Japan in 2006 indicated that KAATSU training  (original name given to BFRT) is a safe method for training athletes and healthy persons, and it can also be applied to persons with various physical conditions [4]. The most common side effects are subcutaneous hemorrhage (13.1%) and temporary numbness (1.3%), while serious complications are rare (venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%)) [4].

Take home message

BFRT is an effective way to increase strength and muscle size while only working at low intensity. Thus, it appears to be a good clinical rehabilitation tool, especially for people suffering from knee osteoarthritis, tendon injuries, and ligament injuries (such as ACL reconstruction). During rehabilitation, the use of BFRT provides greater gain in muscle strength and muscle size than low load training, while avoiding pain caused by high load training.

Due to the potential side effects of BFRT, we recommend you to use this method in the presence of health professionals. They will set it up safely for you and will monitor throughout your training in order to minimise the risks of side effects.

If you have any questions regarding whether you think you could benefit from doing some supervised blood flow restricction training, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

References

1. Ferraz RB, Gualano B, Rodrigues R, et al. (2017). Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis. Medicine & Science in Sports & Exercise, 897-905. DOI: 10.1249/MSS.0000000000001530

2. Giles L, Webster KE, McClelland J, et al. (2017). Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med, 51, 1688–1694.

3. Hughes L, Paton B, Rosenblatt B, et al. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med, 51, 1003–1011.

4. Nakajima T, Kurano M, Iida H, et al. (2006). Use and safety of KAATSU training: Results of a national survey. Int. J. KAATSU Training Res., 2, 5-13

5. British Journal of Sport Medicine (blog) (2018). Bood flow restriction: miracle return to play adjunct or therapy fad? Retrieved on 18/01/2018 from https://blogs.bmj.com/bjsm/2018/11/07/blood-flow-restriction-miracle-return-to-play-adjunct-or-therapy-fad/?utm_source=hootsuite&utm_medium=social&utm_term=&utm_content=&utm_campaign=

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