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.