TENS AND EMS

Reference- Cameron
 Clinical application/ Indications-Electrically stimulated muscle
contraction
1. Orthopaedic conditions: e.g ACL reconstruction, TKA, RA, Patellofemoral pain syndrome
2. Neurological disorder : e.g SCI, stroke, Functional electrical stimulation (DF during swing phase of gait), TBI, MS
3. Strengthening
4. Promote blood flow in DVT
5. To prevent muscle atrophy
6. Muscle spasm
7. Muscle re-education
8. Spasticity management
Functional electrical stimulation (FES)/ Neuromuscular electrical stimulation (NMES)
• Can use AC current stimulate innervated muscles or DC for a denervated muscle.

Parameter Pulse Pulse duration On: off times Ramp time Tx time Times per day
frequency
Muscle 35-80 pps 150-200 us for small 6-10 secs on: 50-120 sec off 2 seconds 10 – 20 mins Every 2-3 hrs when
strengthening muscles, 200-350us ratio 1:5 awake
for large muscles (Can reduce the off time
with repeated treatment to
1:4 or 1:3)

Muscle re-education 35-50 pps 150-200 us for small Depends on functional 2 seconds Depends on functional activity NA
muscles, 200-350us activity
for large muscles

Muscle spasm 35-50 pps 150-200 us for small Equal times on: off 1 seconds 10-30 mins Every 2-3 hrs until spasm
reduction muscles, 200-350us 2-5 secs 2-4 secs off relieved
for large muscles ratio 1:1

Edema reduction 35-50 pps 150-200 us for small Equal times on: off 1 seconds 30 mins Twice a day
muscles, 200-350us 2-5 secs 2-4 secs off
for large muscles ratio 1:1
Electrical muscle stiulation (EMS) - When muscle is denervated by nerve injury it no longer contracts physiologically
nor can be contracted through NMES. However, if the electrical stimulus last longer than 10 milliseconds, the
denervated muscles will contract.

Type of current Direct current

Direct current Gradually increased to reach full amplitude

TENS- Transcutaneous electrical nerve stimulation

Parameter setting Pulse Frequency Pulse Duration Amplitude Treatment time Mechanism of
Action

Conventional (high 100-150 pps 50-80 us Produce Used for pain control Gating at spinal
rate) comfortable level Can be used for 24 hours cord
Short-duration, of sensation
High frequency

Acupuncture (low 2-10 pps 200-300 us Till visible Will control pain for 4 to 5 Endorphin
rate) contraction hours after 20-30 min release
Long pulse treatment. (Opioids)
duration, High Can be applied every 2 hours
amplitude *Should NOT be applied longer
than 45 min

Burst mode Delivered in 100-300 us Till visible 20 - 30 min Endorphin

burst/packages at contraction Can be applied every 2 hours release
10 bursts *Should NOT be used for (Opioids)
longer hours