How Electrical Stimulation Is Used in Physical Therapy

Electrical stimulation involves sending electrical currents through the skin and into muscles. This may help reduce pain, stimulate tissue healing, and strengthen muscles.

If you have an injury, your healthcare provider may order physical therapy to help you on the road to recovery. Along with other forms of treatment, you may receive electrical stimulation as part of your therapy. Oxygen Hydra Dermabrasion

How Electrical Stimulation Is Used in Physical Therapy

Keep reading to learn more about electrical stimulation (e-stim) and how it's used in physical therapy.

Electrical stimulation is a type of physical therapy modality or treatment used to accomplish various tasks in physical therapy (PT). The idea is that applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.

If you have an injury or illness that causes pain or prevents you from easily moving around, your physical therapist may use electrical stimulation, or e-stim, as a part of your rehabilitation program.

This video has been medically reviewed by Oluseun Olufade, MD.

Electrical stimulation is used for many reasons in physical therapy. It can be used to:

If you are experiencing pain, spasms, inflammation, or muscle weakness, your physical therapist may use this treatment to help you.

Some of the medical conditions treated with e-stim include:

E-stim has also been used to help treat stubborn wounds. A physical therapist who is a wound care specialist would be the professional who provides this treatment for you.

The big question in physical therapy these days is should electrical stimulation be used? Electrical stimulation is a relatively passive form of treatment. You do nothing (or very little) while the treatment is being applied.

Most successful rehab programs include active participation by the patient. Learning the right movements and exercises for your specific condition is extremely important.

Some professionals debate whether e-stim is something of value in physical therapy. And some research shows that electrical stim doesn't help injured people very much. Other research indicates that some types of stimulation can be useful.

Despite the ongoing debate on whether e-stim truly helps, you may encounter it if you go to physical therapy. So knowing what it is and what to expect can be helpful.

If your physical therapist chooses to use electrical stimulation during your rehab, they should explain the procedure to you. Your physical therapist should also discuss the expected risks and benefits. A typical application of e-stim goes something like this:

The application of electrical impulses may feel a bit uncomfortable, but it should never hurt. If you feel pain during electrical stimulation, tell your physical therapist. They will adjust the treatment or stop using it.

Your physical therapist will use different types of electrical stimulation to accomplish different tasks. Learn about some of the types available.

Transcutaneous electrical neuromuscular stimulation (TENS) is a physical therapy treatment used to manage short- and long-term pain in physical therapy. Your physical therapist will use TENS to decrease your pain by applying electrodes to your body over painful areas. The intensity of the electricity will be adjusted to block the pain signals traveling from your body to your brain.

Iontophoresis is a type of electrical stimulation that is used to help provide medication to you during physical therapy. The electrical current pushes various medications through your skin and into your body.

Your physical therapist will likely use medicine to decrease inflammation or muscle spasms. Iontophoresis drugs can also be used to break up calcium deposits that may occur in conditions like shoulder calcific tendonitis. Different medicines are used to accomplish different goals using iontophoresis.

Neuromuscular electrical stimulation (NMES) uses an electrical current to cause a single muscle or a group of muscles to contract. By placing electrodes on the skin in various locations, the physical therapist can activate the appropriate muscle fibers. 

Contracting the muscle via electrical stimulation helps improve the way your affected muscle contracts. The physical therapist can change the current setting to allow for a forceful or gentle muscle contraction.

Along with increasing muscle function, the contraction of the muscle also promotes blood flow to the area. This helps the injury heal. NMES can also be used to help decrease muscular spasms by tiring out the muscle that is in spasm. This allows it to relax.

Russian stimulation is a form of electrical stimulation that can accomplish a similar task as NMES. It improves the way your muscles contract. Russian stim simply uses a different waveform that may be a little more comfortable for you to tolerate.

Interferential current (IFC) is often used by physical therapists to decrease pain, relieve muscle spasms, or improve blood flow to various muscles or tissues. It is often used for low back pain.

Interferential current typically uses four electrodes in a crisscross pattern. This causes the currents running between the electrodes to "interfere" with one another, and allows your physical therapist to use a higher-intensity current while still maintaining maximum comfort for you.

High-voltage galvanic stimulation (HVGC) uses high-voltage and low-frequency electricity to penetrate deep into tissues. It is used to relieve pain, improve blood flow, relieve muscle spasm, and improve joint mobility.

Keep in mind that many forms of electrical stimulation are a passive treatment. You do nothing while receiving the stimulation. Some forms of e-stim, like NMES and Russian stim, require that you are active while the e-stim is in use.

Active engagement in your physical therapy program with or without electrical stimulation gives you the best results. E-stim should only be used in addition to your active physical therapy program that includes specific motions and exercises to treat your condition.

Electrical stimulation should never be the only treatment you receive during physical therapy.

If your physical therapist wants to use electrical stimulation during your rehab treatments, they should explain to you the various benefits and risks associated with the treatment.

Risks of e-stim may include:

If the electrical impulse is too strong, you may feel intense muscle pain. If this happens, tearing of your muscle tissue may occur. In this case, the e-stim should be stopped immediately.

The healthcare provider should then begin treatment for an acute muscle injury. This may include rest, ice, and elevating the injured body part.

Some forms of electrical stimulation may cause irritation of the skin underneath the electrode. Iontophoresis uses a direct current during application. This has been known to irritate the skin.

Sometimes, people with sensitive skin may be irritated by the electrode's adhesive or by the electrical stimulation. If irritation occurs, the procedure should be stopped. Then a soothing lotion may be applied to the affected area.

If electrical stimulation is applied with an intensity that is too great, tissue burns may occur. This rarely happens. But when you get a tissue burn, the physical therapist should immediately stop the procedure. Appropriate skin care should be provided to treat the burn.

Your physical therapist can ensure that the electrical stimulation is used properly to minimize the risks associated with e-stim use. Understanding these risks can help you decide if you want to include it in your rehab.

There is moderate to strong evidence that e-stim is beneficial for the following conditions:

There are some conditions in which electrical stimulation should never be used. Your physical therapist should pay attention to these factors that make it necessary to avoid e-stim.

You should avoid electrical stimulation if you have:

E-stim should also be avoided if:

Your physical therapist should have identified these issues during your initial evaluation. But it is important to remind them of any medical condition that could negatively interact with e-stim.

The cost of e-stim will vary depending on your location, health insurance coverage, and the reason it is used.

Insurance may not pay for e-stim therapy as a stand-alone procedure, but if a physical therapist or other medical specialist uses e-stim therapy during the course of other approved services, it is likely to be covered.

Some insurance providers may also limit coverage to qualifying conditions. A healthcare provider may need to provide documentation of the condition and show evidence that other treatments were not successful.

It is best to check with your insurance provider to understand potential out-of-pocket expenses.

If you cannot have e-stim as a treatment or don't wish to have it, your physical therapist may offer you alternatives. Other forms of therapy may include:

And if you have pain or limited mobility, check in with your physical therapist. They will help you figure out if using electrical stimulation is the right treatment for you and your specific condition.

Electrical stimulation is a form of physical therapy used to help people who have experienced an injury. It's also used for people dealing with pain, spasms, or muscle weakness. There are various forms of electrical stimulation your physical therapist may choose to use.

In the procedure, the physical therapist places electrodes on the part of your body that requires treatment. You will experience a tingling sensation during the therapy. The treatment is not supposed to be painful. If you experience pain during the session, tell your physical therapist right away so they can adjust or stop the treatment.

EMS is used in physical therapy to treat muscle weakness and poor motor control. Medical conditions that respond well to e-stim include lower back pain, tendonitis, bursitis, and post-surgical pain. 

STIM, TENS, and EMS are all terms used somewhat interchangeably for electric muscle stimulation (EMS). TENS is a medical term, while STIM is often used in fitness.

TENS, or transcutaneous electrical nerve stimulation, refers to treatment given with a specific machine known as a TENS unit. Wires from the unit are attached to electrodes, which are adhesive pads that are put on the skin at the treatment site.

Sometimes known as e-stim, STIM machines are sold over the counter and use electrical pulses to strengthen and tone muscles.

Maybe, but not in the way it is often marketed. Research shows that EMS can increase muscle mass and improve functioning. However, the study was performed on people with a muscle injury or muscle atrophy. After six weeks of treatment three times a week, muscle mass increased by just 1%. Muscle function improved by 10% to 15%.  

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Ammendolia C, Côté P, Rampersaud YR, et al. Effect of TENS versus placebo on walking capacity in patients with lumbar spinal stenosis: a protocol for a randomized controlled trial. J Chiropr Med. 2016;15:197–203. doi:10.1016/j.jcm.2016.04.001

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By Laura Inverarity, DO  Laura Inverarity, PT, DO, is a current board-certified anesthesiologist and former physical therapist.

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How Electrical Stimulation Is Used in Physical Therapy

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