E-Stim & Acupuncture: Alternative MS Treatment

You’ve heard of Acupuncture, but what is it exactly and how does combining it with E-Stim (ES) work exactly?

We all know how pain can be disabling, or if not disabling, still influential over our moods, our ability to sleep, our energy levels, even the decisions we make. Pain is distracting, specific, invisible to others, and always an obstacle to normal living.

Some of my pain is related to MS (migraines, leg cramps, and MS hugs). However, most of my pain comes from the Osteoarthritis I’ve had in my left knee for the past decade.  It’s there on a daily basis, affecting how I walk or if I can walk.  On top of having Osteoarthiritis, I have two miniscal tears. I get this tight sensation that encompasses my entire knee on top of burning sensation in the middle of my knee. It’s like having an MS hug in my knee.

E-Stim and Acupuncture has helped significantly cutting down on the pain, the tightness is a lot less and the burning has greatly reduced as well. I am able to sit/stand for longer periods of time than I could before starting this therapy. Sure beats taking drugs. I’m all about natural remedies. 

What is Acupuncture?

Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine in which thin needles are inserted into the body. Acupuncture is a pseudoscience because the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery. There is a range of acupuncture variants which originated in different philosophies, and techniques vary depending on the country in which it is performed. It is most often used to attempt pain relief, though it is also recommended by acupuncturists for a wide range of other conditions. Acupuncture is generally used only in combination with other forms of treatment.

From Wikipedia

What is E-Stim?

E-stim uses electrical pulses to mimic the action of signals coming from neurons (cells in your nervous system). These mild electrical currents target either muscles or nerves.

E-stim therapy for muscle recovery sends signals to targeted muscles to make them contract. (Flexing your biceps is a form of muscle contraction.) By causing repeated muscle contractions, blood flow improves, helping repair injured muscles.

Those muscles also improve their strength through repeated cycles of contraction and relaxation. E-stim can also “train” muscles to respond to the body’s natural signals to contract. This is an especially helpful benefit for stroke survivors who must essentially relearn basic motor functions.

The type of e-stim that focuses on pain relief sends signals on a different wavelength so they reach the nerves, rather than the muscles. Electrical stimulation can block pain receptors from being sent from nerves to the brain.

E-stim and Acupuncture

What are the main types of e-stim?

The two main types of e-stim are transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS).

TENS

TENS may be used for chronic (long-term) pain as well as for acute (short-term) pain. Electrodes are placed on the skin near the source of the pain. Signals are sent through nerve fibers to block or at least reduce the pain signals traveling to the brain.

EMS

EMS uses a slightly stronger current than TENS to get muscles to contract. The unit’s electrodes (also placed on the skin near the affected muscles) cause rhythmic contractions. This can improve muscle strength if the user attempts to contract the muscle simultaneously.

Other e-stim types

In addition to EMS and TENS, your doctor or physical therapist may recommend other e-stim treatments.

One of the following similar e-stim treatments may help you, depending on your condition:

  • Electrical stimulation for tissue repair (ESTR) helps reduce swelling, increase circulation, and speed up wound healing.
  • Interferential current (IFC) stimulates nerves to reduce pain.
  • Neuromuscular electrical stimulation (NMES) stimulates the nerves in muscles to restore function and strength, prevent muscle atrophy, and reduce muscle spasms.
  • Functional electrical stimulation (FES) involves a unit implanted in the body to provide long-term muscle stimulation aimed at preserving function and motor skills.
  • Spinal cord stimulation (SCS) uses an implantable device to relieve pain.
  • Iontophoresis helps deliver ionically charged medication to tissue to help speed up healing.

 

How does e-stim work?

E-stim uses small electrodes placed on the skin. The electrodes are small, sticky pads that should come off with little discomfort at the end of the session.

Several electrodes are placed around the area receiving treatment. Wires from the e-stim device are attached to the pads.

Steady streams of electrical pulses are delivered through the wires from the e-stim unit. The unit may be small enough to fit in your hand or larger, like a landline phone and answering machine.

For muscular stimulation, the pulses will reach the muscles, signaling them to contract.

Pulses aimed at the nervous system block the transmission of pain signals from reaching the spinal cord and brain. The pulses also stimulate the body to produce more natural pain-relieving chemicals called endorphins.

What to expect during e-stim

  • Electrodes are placed around the site receiving therapy.
  • The electrical current will begin on a low setting and increased gradually.
  • You’ll get a tingly, “pins and needles” feeling at the site.
  • Depending on the type of e-stim, you may feel a muscle twitch or contract repeatedly.
  • Each e-stim therapy session may last 5 to 15 minutes, depending on the condition being treated.

What does it treat?

E-stim may be appropriate for the following conditions:

  • pain associated with Multiple Sclerosis (MS)
  • back pain
  • cancer-related pain
  • dysphagia (trouble swallowing)
  • fibromyalgia
  • joint pain
  • arthritis
  • muscle conditioning (mostly for athletes, such as long-distance runners)
  • muscle injury from trauma or disease
  • nerve inflammation
  • poor muscle strength
  • urinary incontinence
  • spinal cord injury
  • stroke
  • surgery recovery

Researchers are also working on ways to use e-stim to help people with advanced Multiple Sclerosis walk again.

 

What’s the Result For People Who Use E-Stim?

E-stim targeting the nerves for pain relief can be effective in treating a range of conditions causing nerve and musculoskeletal pain as well as pain that doesn’t respond to traditional treatments, according to 2019 researchTrusted Source.

However, the researchers note e-stim isn’t always a first-line treatment. Rather, it’s part of a broader set of options available to physical therapists.

Depending on your condition, you could start to feel better after one e-stim session. You may need multiple sessions, depending on the severity of your condition and symptoms.

In a small 2019 studyTrusted Source, researchers found that 36 NMES sessions over a 16-week period improved muscle function in people with rheumatoid arthritis.

E-stim is still considered an alternative therapy. There are some health experts who are skeptical of its long-term effectiveness.

There’s also some disagreement about which conditions are best suited for e-stim treatment.

Generally speaking, e-stim is most effective at working weakened or atrophied muscles and healing muscles after an injury or surgery.

As a pain reliever, e-stim (especially TENS therapy) can be effective in treating many conditions, though typically as part of a broader pain-management program.

 

Are there alternatives to e-stim?

While e-stim can be an effective tool in physical therapy and rehabilitation, it’s just one of many strategies employed by Physical Therapists, Sports Medicine Physicians, Naturopaths and Orthopedists.

Other forms of therapy include:

  • muscle-strengthening exercises using weights, resistance bands, machines, and a person’s own body weight
  • massage
  • range-of-motion exercises
  • stretching and flexibility exercises
  • ice and heat treatments

Functional Electrical Stimulation In Multiple Sclerosis

The below article is a very good  summary article written by J. M. Campbell, Ph.D, P.T. explaining some of the electrical stimulation results for multiple sclerosis patients.

For clarity purposes the term “ES” or “Estim” is a generic declaration of an external device in most cases, that produces a flow of electrons from one electrode to the other of the same channel. The flow of the electrons produces an ionic reaction in the body in the areas between the electrodes, in most cases motor nerves and muscle tissue.  The most common use of a specific form of ES with multiple sclerosis patients is the term “Functional Electrical Stimulation”, or FES.   This is a form of estim where one stimulates motor nerves, at the same time as attempting to move mentally.   The breaching of the gap between movement and the brain’s message to move is preserved or restored.  The FES process is accomplished with voluntary repeated movement assisted by functional stimulation.

A quicker method of accomplishing functional electrical stimulation would be to use “medium frequency Infrex interferential stimulation” with volitional movement at the same time.   Typical FES applications involve multiple daily sessions ( 5 – 15), for 10 – 20 minutes whereas “functional stimulation” protocols are 1- 2x daily for 15 minutes at maximum output.   Functional stimulation is designed to also increase muscle bulk and strength.

The reference to “healing decubitus ulcers” ( bed sores ) is generally a form of estim known as “pulsed galvanic stimulation”, or “high voltage”.

The “reduce spasticity” can be accomplished by using FES to fatigue the muscle(s) however most studies fail to then continue to use estim for extended time periods to avoid future spasticity.   This accomplished by “interferential therapy” over night for 6 – 12 hours either sensory or subsensory.   The process of constant, low amperage stimulation of muscles stops spasticity.   Spasticity should be prevented, not treated.

From: http://ifess.org/sites/default/files/ALS.pdf

Because multiple sclerosis is a chronic disorder in which there may be intermittent periods of recovery or remission, the indications for and the application of electrical stimulation [ES] will vary with the symptoms and functional limitations. ES may be helpful in the management of spasticity, pain, respiratory dysfunction and urinary incontinence with resulting improvements in muscle strength, coordination, balance, walking ability and performance in daily activities.

Applications that involve the use of skin electrodes may be accomplished with a variety of commercially available electrical stimulation devices that are small, battery powered and inexpensive. Implantable electrical stimulation technology would be selected by the surgeon.

Management Of Spasticity:

ES has been demonstrated to reduce or eliminate interfering spasticity, or involuntary muscle activity, in multiple sclerosis. The involuntary muscle activity may take the form of spontaneous muscle contractions or it may occur when voluntary movement is initiated. A variety of ES protocols have been employed.   Some investigators and clinicians have used inexpensive portable stimulators and skin electrodes [placed on the spastic muscles, or over the muscles that work against the spastic muscles or on areas of skin that receive the same nerve supply as the spastic muscles].

The intensity of ES may be minimal, with only a tingling sensation felt by the user.  In other protocols, the intensity of ES is increased to assist with joint movement. The intensity of ES should never cause discomfort.  Other clinicians have surgically placed microelectrodes over the dorsal columns of the spinal cord. Stimulation protocols varied from one to two hours each day to intermittent use all day long, as needed.  As a result of ES, spasticity has been reduced, pain was less, bowel and bladder function improved and walking was more normal [with longer step lengths and greater walking velocity].

Maintaining Or Improving Joint Range Of Motion:

ES of muscle[s] can be used to move the joint to the end of the available range or it can be combined with the patient’s exercise to be sure the patient is going to the end of the range and stretching just a bit. Electrical stimulation for this purpose has advantages over vigorous manual range of motion including the use of the individual’s muscles to gain the range in a gentle manner without traumatizing the tissues and it can be done several times during the day as part of a home program.  When spasticity has contributed to the limitation of joint motion,  the movement may improve remarkably as ES helps to reduce the spasticity.  Among the advantages of improved joint range of motion are greater ease of positioning and reduced risk for development of pressure sores.

For the individual who has the ability to walk, improved range will reduce the energy expenditure of standing and walking which should translate into less fatigue for the person with multiple sclerosis.

 

Improving Muscle “Strength” Or Performance: 

When interfering spasticity is reduced or eliminated, muscles may appear to be stronger in the absence of actual change in the muscle properties. In addition, ES may improve the timing or recruitment of muscles so that muscles exert force in a more useful and coordinated manner.  Exercise home programs, with ES added to voluntary effort, can be designed to improve muscle force production and fatigue resistance.

 

Improving Bladder And Bowel Control:

Electrical stimulation has been reported to improve urge incontinence, urethral and anal sphincter control and constipation. Investigators and clinicians have used exercise of the abdominal and pelvic floor muscles in combination with ES of these muscles with skin electrodes.  Some protocols have employed special electrodes made to fit in the anus or vagina.  Surgical approaches have included placement of electrodes on the spinal cord in the thoracic, or upper back; on the sacral spinal nerves [in the low back]; as well as in the pelvic floor near the pudental nerve. The majority of patients [78 to 85%] reported improvements in their bowel and bladder function, but there is agreement that multiple sclerosis patients do need daily home ES treatments.

 

Reducing The Risk Of Respiratory Infection:

While most people with multiple sclerosis who can walk are not likely to have serious impairment of their respiratory muscle function, those in a wheelchair with decreased arm and trunk activity are at risk for respiratory compromise and infection. One of the most serious problems is the reduction in coughing ability and ES may be useful in contracting the abdominal muscles to assist in coughing and keeping the airway clean.  Reduction of spasticity by ES may improve breathing and coughing by allowing more coordination of the muscles of inspiration and expiration.

 

Minimizing The Risk Of Pressure Sores And Treating Skin Lesions:

Among the many factors that contribute to pressure sores are spasticity, joint contractures, muscle paralysis and poorly fitting wheelchairs. ES may reduce the risk by reducing the involuntary movements in spasticity, by improving joint range of motion, and by increasing the bulk of muscles that cushion the bony prominences and so distribute pressures more evenly over the skin.  Once a pressure sore has occurred, ES may be helpful in speeding the healing process.  While most of the research in this area has been done in spinal cord injury or diabetes, the findings are applicable to multiple sclerosis. Possible mechanisms include improving the oxygen supply to the skin and the muscle in the area of the sore, improving the rate of deposition of connective tissue, or scar, and minimizing the infection in the wound.

The chance of healing is, of course, better if the pressure sore is a partial thickness lesion, meaning that only the more superficial layers of the skin are missing. In this case, the skin can grow from the base or bed of the dermis, similar to the way grass grows after mowing. If the sore is deep enough to go through the skin, it must heal in from the sides and surgery is often needed. If there is infection underlying the skin and in the exposed bone, surgical intervention is required to clean the area and to graft skin and sometimes muscle over the bony prominences. After wound closure, the mechanical integrity of the skin will not return to normal and it will be necessary to continue routine skin checks and to use custom seating devices for pressure relief as needed.

Successful ES protocols have included daily stimulation for a total time of two or more hours. Some investigators have employed a very low intensity, direct current. Others have used a pulsatile current and created a muscle contraction in the area of the pressure sore. Electrodes may be placed adjacent to the wound or one of the electrodes may be placed in the wound. In the latter case, an electroconductive dressing is used as the electrode.

 

Improving The Mechanics And Energetics Of Walking:

ES has been discussed for the reduction of spasticity as well as improvement in joint range of motion and muscle performance. Maintenance of ankle dorsiflexion range of motion [to 10 degrees of ankle dorsiflexion] and modulation of ankle plantar flexor spasticity are critical to walking. It is necessary for the body weight to progress over the stance limb in order to take a step with the other leg. If the ankle does not have dorsiflexion range or if the calf muscles contract at the wrong time because they are stretched as the body moves forward, the stance leg will be pulled backward and the patient will have to use crutches and drag their entire lower extremity. These two problems prevent walking for many people with multiple sclerosis. ES can be employed to rectify these problems and result in much more normal walking.   There is evidence to show that people with multiple sclerosis who walk better with ES will continue to use the ES device at home for many years. For the MS patient who has a relapsing and remitting course, ES is only needed when ankle spasticity and/or range is a problem.

For those individuals who have more persistent symptoms, ES may continue to be needed on an everyday basis to maintain walking ability for as long as possible, and then indefinitely to control spasticity, joint range of motion and bladder function.  Careful selection of shoes will contribute further to the benefits of ES. Many people with multiple sclerosis have improved their walking ability by using rocker shoes, or clogs. Based upon the research assessment of the rocker shoes that have been most beneficial, there are specific shoe dimensions [in terms of heel bevel, forefoot rocker and heel height] that result in improvement for those patients who are candidates. It is necessary to have sufficient muscle control at the hip and knee in order to be able to walk at the increased velocity of joint motion afforded by the rocker shoes.

If you’ve used Acupuncture or E-stim, how has it worked for you? Drop your comments below……

 

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