Friday, January 9, 2009

EMS (electromagnetic stimulation/ electrotherapy) for rehab and active recovery

I recently have had the dubious pleasure of working with an electro magnetic stimulation (EMS) and TENS (transcutaneous electrical neural stimulation) unit, along with z mobility work, to rehab a shoulder strain. Gotta tell ya, the results in terms of (a) speed of rehab and (b) maintenance of muscle performance seem impressive.

For those who have strained a shoulder muscle, you know that, depending on the intensity of the injury, you can forget about normal training with that muscle for weeks. SLOOOOW build back of performance. It seems EMS and z can help accelerate the recovery process. This isn't new information. In looking at various web sites on the usual rehabing of shoulders, several techniques kept recurring depending on strain severity: ice it initially (check), and use ultrasound and/or electrical stimulation, and from there, get one into a program to build back strength.

My understanding of the role of ultrasound is to help move waste products away from the affected tissue. This is what normal range of motion movement generally does. If you can't move, stuff can accumulate. EMS also has this effect.

The recommendation for EMS is listed as something a sports medical professional provides. This can mean seeing a doctor to get to a physio who has EMS gear, and getting in for appointments frequently enough to have a benefit. Seemingly not as simple as ice. Unless you have access to a portable unit yourself. We'll come back to that.

It may help to describe a bit about EMS/TENS first.
Most of us have seem electro-magnetic stimulation devices if we've ever seen infomercials about building up abs without exercise - or seen the Dragon movie with Bruce Lee sitting hooked up to a machine that's causing his muscles to twitch rapidly.

It's electrical impulses in our body that cause our muscles to contract, and that's where the money is in muscle growth: the work of contraction. Thus, EMS devices pass varying (low) levels of current through the muscle in varying cycles and intensities to stimulate muscular contraction. Taken to extremes, the same principle applies to the use of electricity in torture: the current causes extreme and painful involuntary contraction of the muscles. At appropriate levels, this approach to muscle rehab, as a quick look though pubmed research shows, has been used for treating a range of conditions including renal failure, arthritis, and stroke rehabilitation especially.

TENS is more often used as an analgesic, to stimulate endorphin responses. It's been used for pain management in a range of conditions and researched over decades.

Here's an entire chapter in Physical Medicine and Rehabilitation on the use of EMS. Pretty well accepted techno for rehab/muscle building/performance protocols.

Rehabbing Tweaked Muscles
For sport rehab, which is where this story comes in, EMS has a long history of helping to build up muscle when voluntary contractions have not been as possible. In my case, pressing or snatching was not gonna happen, and i was loath to part with 2-3 weeks of training. So ok, i was fortunate enough to have access to a Compex Mi-Sport unit so thought i'd give it a go.

For the past week, each evening, i've been hooking up my arms to a rehab program of EMS - which feels like pulsing the muscles into forced fast contractions - bang bang bang - but not painful. For the past two days of this week, i've followed up rehab with strength building. The strength building is interesting: there's a sensor on the thing that detects muscle contractions. That is, you make muscle contractions while it's pulsing away - it stops if it senses you're not doing your contractions. Once your contractions kick in again, off it goes. There's timing built into this too according to research studies so, some programs have contractions for a set period and intensity, followed by an "active recovery" break. There's a pain program here too called "endorphic" - and it is. oh ya.

The results: accelerated recovery; maintenance of strength.
Within one week, the ROM without pain of my delt has improved dramatically. It's not 100%, but 85-90% yes. More than that, the other day i thought i'd see if i could press my 16 with the sore side. I could - nothing really pushing it - but yup, C&P'ing away - just for a test - wasn't really focusing on going for it; just if i could begin to work it again with weight.

Then i got a little cheeky and tried snatching - something that twinged considerably with an 8 the day after the strain happened and made me say "well that's it for swings, snatches and presses for awhile." Much to my surprise, it was ok. In fact, i was going back and forth non-stop for 10's a side with more ease than ever before. No pausing to put down the bell between tens. I wished i'd had a timer for my snatch test numbers.

Now, i'm not claiming that the EMS work made me stronger. Not at all. But having suffered through shoulder pulls in the past, i am impressed that within a week of easy therapy, not only am i able to get back to my training, but, it seems the EMS has kept the muscles from losing too much progress. The research wasn't kidding.

You may say that a week off is not going to kill anyone's progress - and may even be good for it. Ah! but i'd already had my back off week - this was an enforced second in a row. And maybe that's ok, too (though that's not really been my experience), but i do know i've not had such fast recovery from shoulder issues in the past. Based on the research, it also seems that this kind of repair is not unusual.

Indeed, the cool thing about the research is that it shows that combining weight training (or any training) with EMS is great for strength and power improvements as both approaches work the muscles somewhat differently. In some cases, EMS was able to improve torque over voluntary contraction (VC) alone, too, and likewise to improve muscle perfusion over VC alone, and help the CNS "to optimize the control to neuromuscular properties" when followed by sport-specific training. Chris Thibaudeau at T-Nation, in response to a question from John Berardi, goes into more detail about each of these benefits (citing older research than what i note above, showing this stuff has been around for awhile).

Active Recovery
While the unit has settings for various training programs, based on this past week's experience, i'm most interested in exploring it to support not only rehab, but active recovery. A quick glance at YouTube shows athletes using just such protocols - and claiming to get improved performance results. While one might be tempted to think that they're just saying this because the person has invested in a device, again, the research suggests that these things, in combination with regular training for enhancement, active recovery or rehab, have a strong benefit.

There's also some pretty weird looking applications being explored that the company has yet to put in their brochures - these are called Functional EMS - in other words, rather than sitting in a chair and being zapped, or simply flexing your muscles while being zapped, you do your activity in sync with the zapping. Back in 1998 this was done with the vertical jump; rehab protocols as well use this work *with* the stimulation.

There's a youTube vid of a swimmer claiming great improved results from active recovery with these (he has two on him. who's his sponsor??) And, since you'll find it anyway, perhaps the best "cult" video for EMS is this one, where the cyclist/reporter looks like he's in pain using it - and yes, you can ratchet the machine up to painful levels, but how clever is that? (i wrote the fellow in the vid about this protocol to get a copy of it. He said it's "experiemental" and has yet to be released to the public. uh huh). To quote zhealth, never move into pain.

Therapist in a Box
What is unusual is access to such a tool outside a clinical setting. Though that is changing. In the US, as Thibaudeau recommends, there's a product by compex, called the Sport.

In the EU, for some reason, there are a plethora of models. None of these is cheap gear. The Sale price in the US on the Sport is around 699 (from 899); in the uk, units range from just under £200 to over £600. And you thought a Beast kettlebell was expensive.

Is it worth the price? Well i guess that depends on what the "it" is and where that "it" fits into one's training sense. What i can say is that if i had had to pay 35 quid to go see a therapist for a session for 7 days of treatments, that's £245 right there - and usually a PT session is only 20 mins; the compex are 30-60. And would i have been able to schedule 7 appointments in a row? So, a week of treatments and one of the entry level units is more than paid for. That's almost scary - on demand rehab, recovery, strength support for the price of the therapy i would have needed this week, but wouldn't have gone to get, and i'm back training two weeks sooner than anticipated? and i'd still have the device?

This is a tool with some proven research chops for rehab, recovery and even strength/power enhancement. I'm very impressed with its rehab effect, pleased to see that that is backed up by research and not some fluke or me imagining an effect. While i have the opportunity, i will be checking out its active recovery effects further - and maybe the massage settings, too.

Anyway, this could be a device worth considering adding to your workout repertoire (by the way, full disclosure, i have no connexion with compex or any other ems manufacturer).

1 comment:

Mike T Nelson said...

Glad the shoulder is better!
Smart bodies heal faster.
Rock on
Mike N


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