II. The Science Behind Muscle Stimulation
How EMS Works Physiologically
Normal muscle contraction involves a complex physiological process. EMS works similarly to a voluntary muscle contraction. The EMS device delivers an electrical signal through the electrodes to the motor neurons in the muscle fibers. This electrical impulse, called an action potential, causes motor neurons to depolarize, leading to involuntary muscle contraction.
Involuntary and voluntary muscle contractions differ. The brain's motor cortex stimulates voluntary muscle contractions. Electrical muscle stimulation leads to muscle contraction through the peripheral nervous system, not the motor cortex. The electrodes on the skin deliver the electrical impulse that bypasses the brain.
The FDA classifies muscle stimulators as medical devices because:
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Their intent is to improve muscle strength.
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And they can be used in physical therapy and rehabilitation.
Types of Electrical Stimulation
Neuromuscular electrical stimulation and transcutaneous electrical nerve stimulation (TENS) are both E-stim forms but have different purposes.
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Electrical muscle stimulation (EMS) uses electrical impulses to stimulate muscle contraction and strengthen the muscles.
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Transcutaneous electrical nerve stimulation (TENS) reduces pain instead of stimulating muscle contraction.
EMS Settings and Parameters
Users can set various parameters on EMS devices, including waveforms, frequency, intensity, and pulse duration.
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Waveform: The waveform is the pattern of the electrical impulse used to stimulate muscle contraction. Waveforms have differing characteristics that affect muscle response and comfort level.
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Frequency: Frequency refers to how often the waveform repeats itself per second.
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Intensity: The intensity determines how many muscle fibers become recruited and how strongly they contract. Higher-intensity treatments generally lead to stronger contractions, but they also have the potential for discomfort.
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Pulse duration: This is the time that the electrical current flows during each pulse of electrical stimulation.
Selecting the best parameters to use varies depending on the goal of EMS and the individual. For example, a healthy person using EMS to strengthen muscles may need different settings than a patient with muscle atrophy.
Different studies and research also indicate differing parameters. For example, there is no exact consensus on which frequency is most beneficial. However, according to an article published in Medicine, high-frequency stimulation generates greater adaptations of the level of fast-twitch fibers. It also enhances strength better than lower frequency.
However, it should not exceed 75 Hz, which can lead to muscle fatigue. In general, acceptable parameters include:
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A frequency of 20-50 Hz
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Pulse duration of 150-200 microseconds for small muscles and 200-300 for large muscle
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A biphasic waveform is a versatile waveform for electrical muscle stimulation. It can be used to re-educate and strengthen muscles.
Scientific Studies and Research
Various studies and research have examined electrical muscle stimulation to improve strength, prevent atrophy, and improve rehabilitation outcomes. For example, the Journal of Orthopedic and Sports Physical Therapy examined eight studies. These studies compared electrical muscle stimulation with exercise to exercise alone in people recovering from ACL surgery.
Research reports did not indicate the combined number of study participants. Researchers theorized that EMS may help restore quadriceps strength by facilitating the recruitment of muscles inhibited by swelling or pain.
Post-ACL repair participants were assigned to a traditional physical therapy program or a combination of physical therapy and electrical muscle stimulation.
The studies varied widely in treatment time. They ranged from 30 minutes to over an hour of EMS daily or every other day. The treatment duration ranged from 3 to 11 weeks, with an average of 6 weeks. Research indicated the EMS with physical therapy group had greater quadricep strength improvement than the group receiving PT alone.
Another study in Brain Sciences looked at the effect of EMS on muscle mass and function in older sedentary adults with dementia. The study included 32 adults with dementia over the age of 80. The participants were randomly assigned to an intervention or control group.
The intervention group underwent general rehabilitation exercises and EMS for 23 minutes thrice a week for 23 weeks. The control group underwent rehabilitation alone for the same timeframe. Results indicated the intervention group receiving EMS had a significant increase in muscle mass. Muscle mass in the control group did not change.