Effectiveness of Electrical Stimulation in Physical Therapy yields mixed reviews despite favorable general consensus among experts

•  Electrical Stimulation is effective in increasing blood flow to injured areas through contractions and muscular re-education, but ineffective when it comes to permanently solving patients pain problems
• Most experts say they use electrical stimulation on their patients 
•  PhD student Shaun Edmonds says electrical stimulation is effective when used with other traditional methods
• More research needs to be conducted on electrical stimulation

Electrical stimulation (E-stim), also known as Transcutaneous electrical nerve stimulation (TENS), or Neuromuscular Electrical Stimulation (NMES), has been a topic of debate for years in the Physical Therapy industry. Some expert opinions and research have shown that electrical stimulation is an effective way of treating patients for pain relief and muscle re-education. Nevertheless, there are still many that find electrical stimulation to be ineffective in cases where severe injuries are involved.

Electrical Stimulation Broken Down

Electrical stimulation is a very simple process when broken down and is described throughly by Livestrong.com. The patient receives anywhere from two to four adhesive patches that are stuck on the area that is injured. The patches are attached to wires from the electrical stimulation machine that generates the electrical current. Depending on the situation, the physical therapist either delivers a high voltage or low voltage current to the patient in order to effectively treat the injury. The body responds to these currents via a sensory or motor response.

I talked to PhD student Shaun Edmonds about his experience and opinions on the use of electrical stimulation in physical therapy. Edmonds has a PhD in kinesiology and a strong background in sexuality, physical health, and organized physical activity. Edmonds has had a multitude of experience working with electrical stimulation throughout his undergraduate and graduate work. Edmonds breaks down his experience with electrical stimulation and finds it to be helpful for both re-education of muscles in athletes as well as use on patients with general muscular problems.

What Electrical Stimulation can be used for and how it works

Steven Kleinman, a physical therapist in Riverdale, New Jersey says that electrical stimulation can affect muscles in many different ways and can be used for many different purposes. Some of the uses for e-stim include pain relief, relieve muscle spasm, healing skin incisions, healing bone fractures, and enhancing delivery of medication through the skin. Kleinman says that the affects of e-stim on the human body can include “stimulating muscles to contract; stimulating nerves to decrease pain; increasing blood flow to speed healing and reduce inflammation; stimulating cells to reproduce and speed healing; and improving the flow of medication through the skin.”

Figure 1: Describes how Electrical Stimulation is used for muscular re-education

However, electrical stimulation is mainly used for two main purposes, one of which is muscular re-education. Livestrong.com says that Electrical stimulation can be used on muscles that have trouble contracting on their own. Through stimulation, the muscles will automatically contract without the help of the patient and can get the brain to re-learn how to contract the muscles.

The other use for electrical stimulation is for pain relieve. However, it is not completely certain how electrical stimulation helps with pain. The two main theories on how electrical stimulation works for pain relief are the Gate Theory and the Endorphin Theory.

Physical therapists Bob Schrupp and Brad Heineck explain how both of these theories work. Schrupp and Heineck say that the Gate Theory works by using the electrical stimulation to stimulate pain nerves and block the nerves that deliver the pain sensations to the brain. The Endorphin Theory is described as using the electrical stimulation to produce endorphins (natural pain relievers) in the brain, which help to decrease pain.

For pain relief and muscular re-education alike, Edmonds described his experience as using electrical stimulation in conjunction with other traditional methods of physical therapy for the best results. Edmonds also informed me that for pain relief he generally used a lower current of electrical stimulation while using a much higher current for muscular re-education in order to make the muscles contract.

Evidence of why Electrical Stimulation doesn’t work

Some doctors, such as Richard Dubinski, M.D., find electrical stimulation to be ineffective. Dubinski conducted research on how stimulation affected back pain, and found that two out of the five studies showed the stimulation to be ineffective, while the other three had mixed results.

Livestrong.com also acknowledges the multiple shortcomings of electrical stimulation. One of the drawbacks noted is the fact that while electrical stimulation can get rid of pain for a period of time, it does not fully solve the condition that is causing the pain in the patient. Electrical stimulation also does not always effectively re-educate the injured muscle(s) if the injury is too severe.

Expert Opinions on Electrical Stimulation

Despite the evidence against electrical stimulation, many experts and physical therapist alike believe that e-stim is beneficial for their patients.

Eric Sampsell, a physical therapist and certified athletic trainer from Hagerstown, Maryland, says that electrical stimulation can be used to stimulate weaker muscles during exercise in an effort to improve strength more quickly. Sampsell also says that e-stim can significantly improve recovery times.

Renée Garrison, a physical therapist and clinical laboratory technician from Charleston, South Carolina, says that she “LOVE(s)” using electrical stimulation to help re-educate muscles after a patient has gone under an operation. Garrison also says that using stimulation during exercising helps to decrease pain and allow the patient to use “proper movement patterns”.

Edmonds informed me that based on his research and experience he finds electrical stimulation to be almost 100 percent effective with very few cases of patients who found e-stim to be unhelpful. Edmonds also says that he likes to use electrical stimulation for muscular re-education and finds it to be very helpful for those
who have problems with general muscle functions.

The Future of Electrical Stimulation

In general, electrical stimulation has been found to be very helpful for patients in need of pain relief and muscular re-education with little evidence showing negative effects of e-stim. One possible reason for people to dismiss e-stim is the lack of research that has been put into it to better understand how it works. Andreas Binder, M.D., and Ralf Baron, M.D says, "Absence of evidence is not evidence of absence" and continued to say that "there seems to be considerable empirical evidence that, at least in some patients, TENS is useful." Nonetheless, it is still evident that electrical stimulation in physical therapy is an area that needs to be further researched to be able to fully understand the effectiveness of the treatment.

The differing perspectives on Dan Price of Gravity Payments decision to raise minimum wage to $70,000 in his company

Dan Price, founder and CEO of Gravity Payments made headlines when he made a life altering decision in order to help out his employees. He cut his $1 million dollar salary in order to raise the salary of those who made less than $70,000 in his payment processing company. Three articles posted by three different websites discuss very different perspectives on Price’s decision. The Huffington Post wrote an article on why he decided to help out his employees and the his plans by pulling this move, Buzzfeed gives straightforward information on Price’s pay cut, while a piece on Recruiting Blogs brings into question Prices decisions.

The Huffington Post

An article posted on the Huffington Post titled CEO Slashes $1 Million Salary To Give Lowest Paid Workers A Rase discusses Dan Prices’ decision to cut his $1 million dollar salary. It stated that it was growing income inequality and a 2010 Princeton University study that finally pushed the CEO to make this decision that not only changed his life, but the lives of his employees. The Princeton study stated that $75,000 is and ideal salary at which people can achieve happiness. Price’s $70,000 minimum salary is just below the study’s figure, which directly affected 70 of his 120 Gravity Payments employees. 

While many thought of Price’s decision to be charitable, the CEO saw this pay raise as more of an investment for the future. It is an incentive to build his company higher, also he believes that since his employees will have less money troubles than before, that they will be able to put in more time and focus and do better during the work day.

Buzzfeed

Buzzfeed posted an article titled This CEO Is Giving His Employees’ A $70,000 Minimum Wage giving the topic a straightforward run through of the facts and is perfect for someone who is on the go and looking to read an article which will at most take 1 minute to read. This article gives a reader the when, where, and why. When this happened, where it happened, and why Dan Price decided to do it, no more and no less. 

Recruiting Blog

Maren Hogan and Kerry Pivovar posted on a piece about the Gravity Payments CEO’s decision, titled What Gravity Payments’ $70,000 Salary Increase Really Means on Recruiting Blogs. They discuss the disadvantages of a risky business move such as the one Dan Price just pulled. The writers go in depth of how true the ‘happiness’ salary level really is, then they continued to bring into question Price’s motives and how his company could take a large hit in years to come. Hogan and Pivovar moved on to discuss how this radical decision could leave some employees dissatisfied, believing that some do not deserve that large of a salary for their amount work, while others deserve a higher salary. They move on to now that the employees have had this one time pay bump will they truly work harder for the money or will they relax since they know a fat paycheck is on the way to the bank. Maren and Kerry finished off the in depth article with raising many questions on how the future for this company will turn out when Price starts to earn a normal CEO’s salary again, will he continue this trend of raising his employees pay to close the pay gap, or will it be a one time thing.

Of all the articles on Dan Price, the Huffington Post did the best job at laying down the facts and covering the story. Where the blog and Buzzfeed failed at, the Huffington Post succeeded, it wasn't too short or too long, and gave the readers straightforward information and the facts behind the Gravity Payments CEO’s decision.

While Maren and Kerrys blog was wonderful, I thought it it did the worst job at covering the story due to the length and unencessity of some of the points. It was in very in depth, brought up many questions and very carefully written, but it was unfortunately too long. It felt as though the article kept going and while reading I found myself easily distracted. 

In order to provide a more complete story Maren and Kerry should have

• shortened each of the topics they covered
• eliminated the unnecessary sections 
• lay down the facts instead of assuming everyone has heard of Dan Price and Gravity Payments

While all three articles had very different view points on Dan Price’s decision, I thought they each had something different to offer. The Huffington Post did a great job at laying out the facts in an article that wasn't too lengthy. Buzzfeed was successful at giving the information for the type of person who wants to know what happened and fast. Maren Hogan and Kerry Pivovar wrote a wonderful and in depth article with many viewpoints on the various potential problems Price’s decision could cause.

Unemployment for Veterans is a massive problem that goes far beyond the battlefield

Veterans all over the nation continue to come home from the struggles of battle to face a whole new set of problems; one of those being the large unemployment rate for soldiers returning home.

Both pictures display troops returning home but with very different stories behind them. The picture on the right displays happy soldiers being greeted by other troops and a color guard. The sky is blue and the American flag is waving in the wind which produces a very happy and proud emotion.

However, the cartoon below displays troops walking off a plane and into some sort of pipe or possibly cannon with unemployment written on the side of it. The picture is dark and gloomy as if to represent that soldiers are leaving one war and coming home to another one.

The unemployment rate for veterans is has been a major problem in the post-9/11 time period. These are two examples of how very similar pictures can portray a very different story to the viewing audience. 

The Camera Angles Used in The Dark Knight Rises Make Bane Even More Menacing Than He Appears

2. Bane, from The Dark Knight Rises, can be thought of as an extremely menacing villain not only because of his physical stature, but also because of the different camera angles that are used to portray him in the movie.

Bane is often shot from below as if he is above others. This is often referred to as a low angle shot because the camera looks up at the character, making him look more powerful, while the audience feels weak. In the picture to the right Bane is standing on top of the tank while the camera is shooting from below him, therefor he is above everyone else both physically and mentally.

Throughout the movie, Bane is also filmed using an extreme close-up shot while being filmed from a low angle. The low angle shot makes the audience perceive Bane as powerful, while the close-up allows the audience to look at Banes face and into his eyes. This creates an extremely intense mood and environment because it allows the audience to get up close and personal with the villain of the movie, which can become frightening very quickly.

Unlike many other camera angles, almost all the camera angles of Bane in the Dark Knight Rises are used to portray his menacing features. Bane is never shot using a high angle shot because than the audience would be looking down upon Bane, and perceiving him as weak. The film is truly amazing when it comes to portraying certain characters through the use of different camera angles. 

I'm a Kinesiology and my interests include lacrosse, both college and professional football, professional baseball, and having a good time with friends.