What are the guidelines for using an Electronic Muscle Stimulator (EMS)?

Guidelines for Using Electronic Muscle Stimulation (EMS)

Electronic muscle stimulation (EMS) should be used for rehabilitation of both upper and lower extremity motor outcomes in patients with muscle weakness, particularly following stroke or critical illness, with specific protocols tailored to the clinical condition being treated. 1

Clinical Applications of EMS

Rehabilitation Settings

• Stroke Rehabilitation:

  • EMS is recommended for both upper and lower extremity motor outcomes 1
  • Functional electrical stimulation (FES), neuromuscular electrical stimulation (NMES), and transcutaneous electrical nerve stimulation (TENS) have shown benefits for improving activities of daily living (ADL) function 1
  • Particularly effective for patients with demonstrated impaired muscle contraction, including ankle/knee/wrist motor impairment 1
  • Recommended for patients with shoulder subluxation following stroke 1

• Critical Illness and ICU Settings:

  • EMS should be considered for early mobilization of critically ill patients 1
  • Helps preserve muscle mass in critically ill patients who cannot perform conventional exercise 2
  • Should be implemented early to prevent muscle atrophy during immobilization 2

• Musculoskeletal Surgery Recovery:

  • Strong recommendation for using NMES with standard treatment to improve function after musculoskeletal extremity/pelvis surgery 1
  • Should be incorporated into post-surgical rehabilitation protocols 1

Non-Rehabilitation Applications

• Athletic Performance Enhancement:

  • Can significantly improve maximal strength (isometric +58.8%; dynamic +79.5%), speed strength, and power (+67%) in trained and elite athletes after 3-6 weeks 3
  • May improve vertical jump height by up to 25% and sprint times by up to 4.8% 3

• Muscle Toning:

  • Recent evidence shows sustained increases in bicep strength (48.4%) and tricep strength (27.12%) 90 days after completing a 2-week EMS protocol 4
  • However, older studies have shown mixed results for body composition changes in healthy individuals 5

EMS Protocol Parameters

Stimulation Parameters

• Pulse Duration: 300-450 μs (large pulses) 6
• Frequency:
  • 50-100 Hz for younger individuals
  • Approximately 30 Hz for older individuals 6
• Intensity: As high as individually tolerated 6
• Session Duration: 30 minutes per session is common in clinical applications 4

Treatment Schedule

• Minimum Frequency: At least 3 sessions per week 6
• Treatment Duration: Minimum of 5-6 weeks for significant results 6
• Progression: Gradually increase intensity as tolerated

Safety Considerations and Contraindications

• Intracranial Pressure Monitoring:

  • Continuously monitor intracranial pressure in patients with established ICP monitoring when using NMES 1
  • EMS combined with other mobility interventions has shown increased ICP in some patients 1

• Initial Sessions:

  • May cause severe increase in circulating creatine kinase during first session 6
  • Start with lower intensity and gradually increase

• Patient Selection:

  • Assess patient tolerance before implementing full protocol
  • Consider individual patient characteristics and preferences 1

Clinical Efficacy

• EMS can increase muscle mass by approximately 1% and improve muscle function by 10-15% after 5-6 weeks of treatment 6
• In critically ill patients, EMS significantly reduces muscle mass loss compared to standard care 2
• For stroke patients, EMS improves ADL function but shows less clear evidence for improvement in functional motor ability 1

Important Caveats

• EMS should not replace conventional exercise when patients are capable of performing it 6
• The benefits of EMS are primarily related to muscle preservation/building rather than comprehensive fitness
• Results vary based on patient population, with better outcomes in rehabilitation settings than for cosmetic purposes in healthy individuals
• Stimulation protocols (pulse duration, frequency, intensity) should be adjusted based on the specific clinical application and patient characteristics