Medicine:Electrical muscle stimulation

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Short description: Use of electricity to involuntarily contract muscle

Electrical muscle stimulation (EMS), also known as neuromuscular electrical stimulation (NMES) or electromyostimulation, is the elicitation of muscle contraction using electric impulses. EMS has received an increasing amount of attention in the last few years for many reasons: it can be utilized as a strength training tool for healthy subjects and athletes; it could be used as a rehabilitation and preventive tool for people who are partially or totally immobilized; it could be utilized as a testing tool for evaluating the neural and/or muscular function in vivo. EMS has been proven to be more beneficial before exercise and activity due to early muscle activation. Recent studies have found that electrostimulation has been proven to be ineffective during post exercise recovery and can even lead to an increase in Delayed onset muscle soreness (DOMS).[1]

The impulses are generated by the device and are delivered through electrodes on the skin near to the muscles being stimulated. The electrodes are generally pads that adhere to the skin. The impulses mimic the action potential that comes from the central nervous system, causing the muscles to contract. The use of EMS has been cited by sports scientists[2] as a complementary technique for sports training, and published research is available on the results obtained.[3] In the United States, EMS devices are regulated by the U.S. Food and Drug Administration (FDA).[4]

A number of reviews have looked at the devices.[5][6]

Uses

Active recovery session
Athlete recovering with four-channel, electrical muscle stimulation machine attached through self-adhesive pads to her hamstrings

Electrical muscle stimulation can be used as a training,[7][8][9] therapeutic,[10][11] or cosmetic tool.

Physical rehabilitation

In medicine, EMS is used for rehabilitation purposes, for instance in physical therapy in the prevention muscle atrophy due to inactivity or neuromuscular imbalance, which can occur for example after musculoskeletal injuries (damage to bones, joints, muscles, ligaments and tendons). This is distinct from transcutaneous electrical nerve stimulation (TENS), in which an electric current is used for pain therapy. "The main difference is the desired outcome. TENS unit is a medical device for pain relief. The desired outcome is to reduce pain by stimulating different nerve signals. EMS fitness is also an FDA-cleared medical device but meant for muscle development. EMS fitness is designed to stimulate all the major muscle groups to elicit strength and endurance adaptations."[12] In the case of TENS, the current is usually sub-threshold, meaning that a muscle contraction is not observed.[original research?]

For people who have progressive diseases such as cancer or chronic obstructive pulmonary disease, EMS is used to improve muscle weakness for those unable or unwilling to undertake whole-body exercise.[13] EMS may lead to statistically significant improvement in quadriceps muscle strength, however, further research is needed as this evidence is graded as low certainty.[14] The same study also indicates that EMS may lead to increased muscle mass.[13] Low certainty evidence indicates that adding EMS to an existing exercise programme may help people who are unwell spend fewer days confined to their beds.[15]

During EMS training, a set of complementary muscle groups (e.g., biceps and triceps) are often targeted in alternating fashion, for specific training goals,[16] such as improving the ability to reach for an item.

Weight loss

The FDA rejects certification of devices that claim weight reduction.[17] EMS devices cause a calorie burning that is marginal at best: calories are burnt in significant amount only when most of the body is involved in physical exercise: several muscles, the heart and the respiratory system are all engaged at once.[18] However, some authors imply that EMS can lead to exercise since people toning their muscles with electrical stimulation are more likely afterwards to participate in sporting activities as the body becomes ready, fit, willing and able to take on physical activity.[16]

Effects

"Strength training by NMES does promote neural and muscular adaptations that are complementary to the well-known effects of voluntary resistance training".[19] This statement is part of the editorial summary of a 2010 world congress of researchers on the subject. Additional studies on practical applications, which came after that congress, pointed out important factors that make the difference between effective and ineffective EMS.[20][21] This in retrospect explains why in the past some researchers and practitioners obtained results that others could not reproduce. Also, as published by reputable universities, EMS causes adaptation, i.e. training, of muscle fibers.[22] Because of the characteristics of skeletal muscle fibers, different types of fibers can be activated to differing degrees by different types of EMS, and the modifications induced depend on the pattern of EMS activity.[23] These patterns, referred to as protocols or programs, will cause a different response from contraction of different fiber types. Some programs will improve fatigue resistance, i.e. endurance, others will increase force production.[24]

History

Luigi Galvani (1761) provided the first scientific evidence that current can activate muscle. During the 19th and 20th centuries, researchers studied and documented the exact electrical properties that generate muscle movement.[25][26] It was discovered that the body functions induced by electrical stimulation caused long-term changes in the muscles.[27][28] In the 1960s, Soviet sport scientists applied EMS in the training of elite athletes, claiming 40% force gains.[29] In the 1970s, these studies were shared during conferences with the Western sport establishments. However, results were conflicting, perhaps because the mechanisms in which EMS acted were poorly understood.[30] Medical physiology research[31][23] pinpointed the mechanisms by which electrical stimulation causes adaptation of cells of muscles, blood vessels[32][33][34] and nerves.[24]

Society and culture

United States regulation

The U.S. Food and Drug Administration (FDA) certifies and releases EMS devices into two broad categories: over-the counter devices (OTC), and prescription devices. OTC devices are marketable only for muscle toning; prescription devices can be purchased only with a medical prescription for therapy. Prescription devices should be used under the supervision of an authorized practitioner, for the following uses:

  • Relaxation of muscle spasms;
  • Prevention or retardation of disuse atrophy;
  • Increasing local blood circulation;
  • Muscle re-education;
  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis;
  • Maintaining or increasing range of motion.

The FDA mandates that manuals prominently display contraindication, warnings, precautions and adverse reactions, including: no use for wearer of pacemaker; no use on vital parts, such as carotid sinus nerves, across the chest, or across the brain; caution in the use during pregnancy, menstruation, and other particular conditions that may be affected by muscle contractions; potential adverse effects include skin irritations and burns

Only FDA-certified devices can be lawfully sold in the US without medical prescription. These can be found at the corresponding FDA webpage for certified devices.[35] The FTC has cracked down on consumer EMS devices that made unsubstantiated claims;[36] many have been removed from the market, some have obtained FDA certification.

Devices

Relax Acizor

Non-professional devices target home-market consumers[37] with wearable units in which EMS circuitry is contained in belt-like garments (ab toning belts) or other clothing items.

The Relax-A-Cizor was one brand of device manufactured by the U.S. company Relaxacizor, Inc.[38][39][40][41][42][43]

From the 1950s, the company marketed the device for use in weight loss and fitness. Electrodes from the device were attached to the skin and caused muscle contractions by way of electrical currents.[38] The device caused 40 muscular contractions per minute in the muscles affected by the motor nerve points in the area of each pad. The directions for use recommended use of the device at least 30 minutes daily for each figure placement area, and suggested that the user might use it for longer periods if they wished. The device was offered in a number of different models which were powered either by battery or household current.[44]

Relax-A-Cizors had from 1 to 6 channels. Two pads (or electrodes) were connected by wires to each channel. The user applied from 2 to 12 pads to various parts of their body. For each channel there was a dial which purported to control the intensity of the electrical current flowing into the user's body between the two pads connected to that channel.[44]

As of 1970, the device was manufactured in Chicago, Illinois, by Eastwood Industries, Inc., a wholly owned subsidiary of Relaxacizor, Inc., and was then distributed throughout the country at the direction of Relaxacizor, Inc., or Relaxacizor Sales, Inc.[44]

The device was banned by the United States Food and Drug Administration in 1970 as it was deemed to be potentially unhealthy and dangerous to the users.[38][44] The case went to court, and the United States District Court for the Central District of California held that the Relax-A-Cizor was a "device" within the meaning of 21 U.S.C. § 321 (h) because it was intended to affect the structure and functions of the body as a girth reducer and exerciser, and upheld the FDA's assertions that the device was potentially hazardous to health.[44]

The FDA informed owners of Relax-A-Cizors that second-hand sale of Relax-A-Cizors was illegal, and recommended that they should destroy the devices or render them inoperable.[42]

Slendertone is another brand name.[45] (As of 2015) the company's Slendertone Flex product had been approved by the U.S. Food and Drug Administration for over-the-counter sale for toning, strengthening and firming abdominal muscles.[46]

See also

References

  1. ↑ Dupuy, Olivier; Douzi, Wafa; Theurot, Dimitri; Bosquet, Laurent; Dugué, Benoit (2018). "An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis". Frontiers in Physiology 9: 403. doi:10.3389/fphys.2018.00403. ISSN 1664-042X. PMID 29755363. 
  2. ↑ Zatsiorsky, Vladimir; Kraemer, William (2006). "Experimental Methods of Strength Training". Science and Practice of Strength Training. Human Kinetics. pp. 132–133. ISBN 978-0-7360-5628-1. 
  3. ↑ Examples of peer-reviewed research articles attesting increased muscular performance by utilizing EMS:[improper synthesis?]
    • Babault, Nicolas; Cometti, Gilles; Bernardin, Michel; Pousson, Michel; Chatard, Jean-Claude (2007). "Effects of Electromyostimulation Training on Muscle Strength and Power of Elite Rugby Players". The Journal of Strength and Conditioning Research 21 (2): 431–437. doi:10.1519/R-19365.1. PMID 17530954. 
    • Malatesta, D; Cattaneo, F; Dugnani, S; Maffiuletti, NA (2003). "Effects of electromyostimulation training and volleyball practice on jumping ability". Journal of Strength and Conditioning Research 17 (3): 573–579. doi:10.1519/00124278-200308000-00025. PMID 12930189. 
    • Willoughby, Darryn S.; Simpson, Steve (1998). "Supplemental EMS and Dynamic Weight Training: Effects on Knee Extensor Strength and Vertical Jump of Female College Track & Field Athletes". Journal of Strength and Conditioning Research 12 (3). 
    • Willoughby, Darryn S.; Simpson, Steve (1996). "The Effects of Combined Electromyostimulation and Dynamic Muscular Contractions on the Strength of College Basketball Players". Journal of Strength and Conditioning Research 10 (1). 
  4. ↑ FDA Guidance Document for Powered Muscle Stimulator, standard indications for use, page 4; contraindications, p. 7; warnings and precautions, p. 8. Product code: NGX
  5. ↑ Gondin, Julien; Cozzone, Patrick J.; Bendahan, David (2011). "Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes?". European Journal of Applied Physiology 111 (10): 2473–2487. doi:10.1007/s00421-011-2101-2. PMID 21909714. 
  6. ↑ Babault, Nicolas; Cometti, Carole; Maffiuletti, Nicola A.; Deley, Gaëlle (2011). "Does electrical stimulation enhance post-exercise performance recovery?". European Journal of Applied Physiology 111 (10): 2501–2507. doi:10.1007/s00421-011-2117-7. PMID 21847574. 
  7. ↑ Babault, Nicolas; Cometti, Gilles; Bernardin, Michel; Pousson, Michel; Chatard, Jean-Claude (2007). "Effects of Electromyostimulation Training on Muscle Strength and Power of Elite Rugby Players". The Journal of Strength and Conditioning Research 21 (2): 431–437. doi:10.1519/R-19365.1. PMID 17530954. 
  8. ↑ Banerjee, P.; Caulfield, B; Crowe, L; Clark, A (2005). "Prolonged electrical muscle stimulation exercise improves strength and aerobic capacity in healthy sedentary adults". Journal of Applied Physiology 99 (6): 2307–2311. doi:10.1152/japplphysiol.00891.2004. PMID 16081619. 
  9. ↑ Porcari, John P.; Miller, Jennifer; Cornwell, Kelly; Foster, Carl; Gibson, Mark; McLean, Karen; Kernozek, Tom (2005). "The effects of neuromuscular stimulation training on abdominal strength, endurance and selected anthropometric measure". Journal of Sports Science and Medicine 4: 66–75. 
  10. ↑ Lake, DA (1992). "Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries". Sports Medicine 13 (5): 320–336. doi:10.2165/00007256-199213050-00003. PMID 1565927. 
  11. ↑ Delitto, A; Rose, SJ; McKowen, JM; Lehman, RC; Thomas, JA; Shively, RA (1988). "Electrical stimulation versus voluntary exercise in strengthening thigh musculature after anterior cruciate ligament surgery". Physical Therapy 68 (5): 660–663. doi:10.1093/ptj/68.5.660. PMID 3258994. 
  12. ↑ Sanchez, Conrad (2022-08-05). "Tens Unit Vs. EMS Fitness - Bodybuzz" (in en-US). https://www.bodybuzzfit.com/tens-unit-vs-ems-fitness/. 
  13. ↑ 13.0 13.1 Jones, Sarah; Man, William D.-C.; Gao, Wei; Higginson, Irene J.; Wilcock, Andrew; Maddocks, Matthew (2016-10-17). "Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease". The Cochrane Database of Systematic Reviews 2016 (10): CD009419. doi:10.1002/14651858.CD009419.pub3. ISSN 1469-493X. PMID 27748503. 
  14. ↑ Jones, Sarah; Man, William D.-C.; Gao, Wei; Higginson, Irene J.; Wilcock, Andrew; Maddocks, Matthew (2016-10-17). "Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease". The Cochrane Database of Systematic Reviews 2016 (10): CD009419. doi:10.1002/14651858.CD009419.pub3. ISSN 1469-493X. PMID 27748503. 
  15. ↑ Hill, Kylie; Cavalheri, Vinicius; Mathur, Sunita; Roig, Marc; Janaudis-Ferreira, Tania; Robles, Priscila; Dolmage, Thomas E.; Goldstein, Roger (2018-05-29). "Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease". The Cochrane Database of Systematic Reviews 2018 (5): CD010821. doi:10.1002/14651858.CD010821.pub2. ISSN 1469-493X. PMID 29845600. 
  16. ↑ 16.0 16.1 Vrbova, Gerta; Olga Hudlicka; Kristin Schaefer Centofanti (2008). Application of Muscle-Nerve Stimulation in Health and Disease. Springer. pp. 70. 
  17. ↑ FDA Import Alert 10/02/2009 Electrical Muscle Stimulators and Iontophoresis Devices Muscle stimulators are misbranded when any of the following claims are made: girth reduction, loss of inches, weight reduction, cellulite removal, bust development, body shaping and contouring, and spot reducing.
  18. ↑ Maffiuletti, NA (2006). "The use of electrostimulation exercise in competitive sport". International Journal of Sports Physiology and Performance 1 (4): 406–407. doi:10.1123/ijspp.1.4.406. PMID 19124897. 
  19. ↑ Maffiuletti, Nicola A.; Minetto, Marco A.; Farina, Dario; Bottinelli, Roberto (2011). "Electrical stimulation for neuromuscular testing and training: State-of-the-art and unresolved issues". European Journal of Applied Physiology 111 (10): 2391–2397. doi:10.1007/s00421-011-2133-7. PMID 21866361. 
  20. ↑ Filipovic, Andre; Heinz Kleinöder; Ulrike Dörmann; Joachim Mester (September 2012). "Electromyostimulation--a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes". Journal of Strength and Conditioning Research 26 (9): 2600–2614. doi:10.1519/JSC.0b013e31823f2cd1. ISSN 1533-4287. PMID 22067247. 
  21. ↑ Filipovic, Andre; Heinz Kleinöder; Ulrike Dörmann; Joachim Mester (November 2011). "Electromyostimulation-a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters – part 2". Journal of Strength and Conditioning Research 25 (11): 3218–3238. doi:10.1519/JSC.0b013e318212e3ce. ISSN 1533-4287. PMID 21993042. 
  22. ↑ Quoted from National Skeletal Muscle Research Center; UCSD, Muscle Physiology Home Page – Electrical Stimulation
  23. ↑ 23.0 23.1 Salmons, S; Vrbová, G (1969). "The influence of activity on some contractile characteristics of mammalian fast and slow muscles". The Journal of Physiology 201 (3): 535–49. doi:10.1113/jphysiol.1969.sp008771. PMID 5767881. 
  24. ↑ 24.0 24.1 Pette, Dirk; Vrbová, Gerta (1999). "What does chronic electrical stimulation teach us about muscle plasticity?". Muscle & Nerve 22 (6): 666–677. doi:10.1002/(SICI)1097-4598(199906)22:6<666::AID-MUS3>3.0.CO;2-Z. PMID 10366220. 
  25. ↑ Ranvier, Louis-Antoine (1874). "De quelques faits relatifs à l'histologie et à la physiologie des muscles striés" (in fr). Archives de Physiologie Normale et Pathologique 6: 1–15. 
  26. ↑ Denny-Brown, D. (1929). "On the Nature of Postural Reflexes". Proceedings of the Royal Society B 104 (730): 252–301. doi:10.1098/rspb.1929.0010. Bibcode: 1929RSPSB.104..252D. 
  27. ↑ Buller, AJ; Eccles, JC; Eccles, RM (1960). "Interactions between motoneurones and muscles in respect of the characteristic speeds of their responses". The Journal of Physiology 150 (2): 417–39. doi:10.1113/jphysiol.1960.sp006395. PMID 13805874. 
  28. ↑ Pette, Dirk; Smith, Margaret E.; Staudte, Hans W.; Vrbová, Gerta (1973). "Effects of long-term electrical stimulation on some contractile and metabolic characteristics of fast rabbit muscles". Pflügers Archiv: European Journal of Physiology 338 (3): 257–272. doi:10.1007/BF00587391. PMID 4736724. 
  29. ↑ Ward, AR; Shkuratova, N (2002). "Russian electrical stimulation: The early experiments". Physical Therapy 82 (10): 1019–30. doi:10.1093/ptj/82.10.1019. PMID 12350217. 
  30. ↑ Siff, Mel (1990). "Applications of Electrostimulation in Physical Conditioning: A Review". Journal of Strength and Conditioning Research 4 (1). 
  31. ↑ Vrbová, Gerta; Gordon, Tessa; Jones, Rosemary (1995). Nerve-Muscle Interaction. London: Chapman & Hall. ISBN 978-0-412-40490-0. [page needed]
  32. ↑ Blomqvist, C G; Saltin, Bengt (1983). "Cardiovascular Adaptations to Physical Training". Annual Review of Physiology 45: 169–89. doi:10.1146/annurev.ph.45.030183.001125. PMID 6221687. 
  33. ↑ Cabric, M.; Appell, H.-J.; Resic, A. (2008). "Stereological Analysis of Capillaries in Electrostimulated Human Muscles". International Journal of Sports Medicine 08 (5): 327–330. doi:10.1055/s-2008-1025678. PMID 3679647. 
  34. ↑ Harris, B. A. (2005). "The influence of endurance and resistance exercise on muscle capillarization in the elderly: A review". Acta Physiologica Scandinavica 185 (2): 89–97. doi:10.1111/j.1365-201X.2005.01461.x. PMID 16168003. 
  35. ↑ FDA-Certified Devices
  36. ↑ FTC Charges Three Top-selling Electronic Abdominal Exercise Belts with Making False Claims
  37. ↑ Porcari, John P.; Miller, Jennifer; Cornwell, Kelly; Foster, Carl; Gibson, Mark; McLean, Karen; Kernozek, Tom (2005). "Effects of Neuromuscular Electrical Stimulation Training on Abdominal Strength, Endurance, and Selected Anthropometric Measures". Journal of Sports Science and Medicine 4 (1): 66–75. PMID 24431963. 
  38. ↑ 38.0 38.1 38.2 Kate Knibbs (14 July 2015). "The Fitness Wearable So Dangerous It Was Supposed to Be Destroyed". Gizmodo. Gawker Media. https://gizmodo.com/the-fitness-wearable-so-dangerous-it-was-supposed-to-be-1716877387. 
  39. ↑ "April 29, 1970 – 400,000 Buyers Can Be Wrong". Archives.chicagotribune.com. 29 April 1970. http://archives.chicagotribune.com/1970/04/29/page/33/article/400-000-buyers-can-be-wrong. 
  40. ↑ "That Was Then, This Is Now: How 72 Brands From 'Mad Men' Have Changed Since Don Draper Was in Charge". Consumerist. 15 May 2015. http://consumerist.com/2015/05/15/that-was-then-this-is-now-how-72-brands-from-mad-men-have-changed-since-don-draper-was-in-charge/#more-10204753. 
  41. ↑ Gourley, Catherine (2008). Ms. and the Material Girls. Twenty-First Century Books. p. 68. ISBN 9780822568063. https://archive.org/details/msmaterialgirlsp0000gour. Retrieved 29 July 2015. "Relax-a-cizor." 
  42. ↑ 42.0 42.1 "The Relaxacisor". MuseumOfQuackery.com. U.S. Department of Health Education and Welfare. http://www.museumofquackery.com/devices/relaxacisor.htm. 
  43. ↑ ""Cellulite" Removers". Quackwatch. 9 October 2000. http://www.quackwatch.com/01QuackeryRelatedTopics/cellulite.html. 
  44. ↑ 44.0 44.1 44.2 44.3 44.4 "United States v. Relaxacizor, Inc., 340 F. Supp. 943 – Dist. Court, CD California 1970". Google Scholar. https://scholar.google.com/scholar_case?case=3239332033316792191&hl=en&as_sdt=6&as_vis=1&oi=scholarr. 
  45. ↑ Johannes, Laura (25 November 2009). "Cinching Your Belt Without a Crunch". Wall Street Journal. ISSN 0099-9660. https://www.wsj.com/articles/SB10001424052748704779704574553790579199098. 
  46. ↑ "Electronic Muscle Stimulators". U.S. Food and Drug Administration. 25 March 2015. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ucm142478.htm. 

Further reading

  • Sila Fit. Electro Muscle Stimulation Training. Sila Fit. https://sila.fit/.  This compilation aims to function as a practical guide for comprehending electrical muscle stimulation in sports training. It is enriched with content conveyed by the author during workshops and supplemented by appendices authored by professional trainers.



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