EMS and Rehabilitation

electro muscle stimulation training

How FITtec.® EMS helps pre-surgery, post-surgery, injuries, immobility, weak muscles, non-contributing muscles and an out of balance muscular system

In previous articles, we have discussed electrical muscle stimulation (EMS) in general, and specifically, Whole Body EMS (WB-EMS) for the general healthy population. For them, WB-EMS is a phenomenal way to ‘amp-up’ (pun intended) your workout. WB-EMS is an incredible bio-hack that shortens work-out time, recruits more muscle fiber contraction for deeper conditioning and provides for higher exercise intensity faster with less wear and tear on joints.

In those posts, I have only been speaking to the average healthy, non-injured person, but there is another beneficial side to WB-EMS. WB-EMS can also be beneficial to people who have health challenges, from mild sprain-strain injuries to surgical repair, or other conditions that limit their ability to exercise to maintain muscle tone – a requirement for health. Further, loss of muscle tone, strength and density is a secondary effect of injury, immobility or illness which leads to long-term disability complications. You may remember that initially, beginning about 70 years ago, locally applied EMS was important treatment in rehabilitation therapy. Thus, WB-EMS can be included in the rehabilitation conversation with certain provisions.

People with health challenges need to check with their health provider to see if WB-EMS is a viable option to assist them in speeding recovery or supporting them to be more functional and be referred by their health provider.

ems and rehabilitation

Here are several circumstances where WB-EMS may be effective:

Rehabilitation ‘Rehab’

Rehabilitation exercises are an important part of overall recovery. They help restore strength, range of motion, and endurance. The overall goal of rehab exercises is to restore someone to their former activity level and strength or as near normal as possible. Rehabilitation exercises are also crucial for preventing future injuries.

Injuries can be the garden variety sprains or strains that keep you out of the gym, away from your favorite hooby or your favorite training regimen. They can also be as serious as joint replacement surgeries that require a specialized protocol of just the right amount of range of motion plus exertion to heal and not hurt the repaired joint. For instance, decreased strength in the muscles around your knee is often a problem area after a total knee replacement. Strengthening exercises help improve your quadriceps and hamstrings stability but typical weight training can injure the repair. WB-EMS is a way to progressively increase the strength of surrounding muscle without any added training stress on the damaged joint prior to surgery. It is common knowledge and proven fact that strengthening those muscles that support a damaged joint prior to surgery can in fact reduce your recovery time. The same applies for post-surgery training, WB-EMS greatly reduces the time needed to recover due to it’s localization of treatment, depth of treatment, added increase of blood flow to the area all while not damaging or hindering the surgically repaired joint. Second to those points, you get a Whole-body workout at the same time, not only allowing your body to recover but start building again. A regular exercise program is a key part of recovery from an operation. Building up strength in the muscles around a new joint, will help the return to normal activities and increase the level of functional mobility.

Any possible type of exercise can be improved with WB-EMS. Typically, rehabilitation lasts 4 to 8 weeks. Remember that everyone heals at different rates, and your recovery time may be shorter or longer. EMS cannot shorten normal physiologic healing time but will shorten the time required to train to get the results needed.

Here is a study preformed on an elite level athlete with a shoulder injury where localized EMS was applied. Kevin E Wilk

rehabilitation exercises


“The active electrical muscle stimulation recovery with the Compex® Sport produced the highest reduction in blood lactate levels as compared to the other recovery methods (not EMS) which had no significant effect on blood lactate. Reduction of blood lactate allows for the recovery of the muscle, which should allow for better performance in the subsequent pitching activity. It was indeed measured that pitching speed following NMES recovery was higher compared to pitching speed after jogging recovery.” Warren et al.

WB-EMS is able to simultaneously stimulate up to 14–18 regions
or 8–12 different muscle groups

“Whole-body electromyostimulation (WB-EMS) is becoming increasingly popular as a novel training technology. While local electromyostimulation produces an external stimulation of single specific muscle groups, WB-EMS is able to simultaneously stimulate up to 14–18 regions or 8–12 different muscle groups with up to 2.800 cm2 electrode area (Filipovic et al., 2015). Positive effects of WB-EMS on health biomarker parameters have been shown. WB-EMS improves body composition in elderly women (60 years) with sarcopenic obesity or at risk of sarcopenia (Kemmler et al., 2014, 2016c), in postmenopausal (Kemmler et al., 2010) and in healthy untrained middle-aged men (Kemmler et al., 2016b).

Secondly, WB-EMS increases resting metabolic rate in postmenopausal women (Kemmler et al., 2010), and increases energy expenditure during exercise in moderately trained men (Kemmler et al., 2012).

WB-EMS also improves strength levels in elite football players (Filipovic et al., 2016), in postmenopausal women (Kemmler et al., 2010), and in healthy untrained middle-aged men (Kemmler et al., 2016b), as well as increases bone mineral density in osteopenic women (> 70 years) (Von Stengel et al., 2015). Finally, WB-EMS training seems to improve human red blood cell deformability in elite football players (Filipovic et al., 2015).” Kemmler2

WB-EMS is a “joint–friendly, and highly customized application. Further, by applying a minimum degree of common sense and the proper application of recently published WB-EMS guidelines, WB-EMS is a very safe exercise technology even eligible for multimorbid older people.” Kemmler1

Pre-hab

Most people are familiar with the term: ‘rehab’, short for rehabilitation. Rehabilitation is exercise and therapy designed to strengthen and support an injured area or tissue to reduce pain or regain function after an injury, illness, or surgery. But do you know about ‘Pre-hab’? Prehab is a proactive approach to avoiding pain and injury. You build strength and stability around your most vulnerable areas, while improving mobility, balance and joint function to decrease the potential for injuries. When the unfortunate meets the unavoidable and an injury occurs, it is far more beneficial to have healthy strong tissue. Strong tissue repairs better and faster than weak deconditioned tissue. It also minimizes the damage to the arears under stress.

Prehab is a proactive approach to avoiding pain and injury

You build strength and stability around your most vulnerable areas, while improving
mobility, balance and joint function to decrease the potential for injuries.

Pre-hab for Surgery

Getting in shape prior to surgery can make recovery easier.

“Fifty percent of outcome success is due to the surgeon, and the other 50 percent is due to the patient’s commitment to recovery – starting with pre-hab,” says Vonda Wright, MD, assistant professor of orthopedic surgery at the University of Pittsburgh’s Center for Sports Medicine.

Rehabilitation is an exercise and therapy program performed for up to three months after surgery, and most joint-replacement patients know to expect it. Pre-habilitation – “pre-hab” for short – is an exercise therapy program started at least six weeks (and preferably longer) before surgery. It’s a new concept to many.

“Pre-hab makes a huge difference in our patients’ outcomes,” says orthopedic surgeon Hal Crane, MD, founding medical director of the Rose Institute for Joint Replacement at the Rose Medical Center in Denver. “They get vertical sooner and recover faster.”

Effectiveness of Pre-hab

A study by researchers at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School, all based in Boston, found that knee and hip replacement surgery patients who had participated in water- and land-based strength training, and aerobic and flexibility exercises for six weeks prior to their surgeries reduced their odds of needing inpatient rehabilitation by 73 percent.

“Even in a fairly brief time period, the exercise paid off for the participants,” says lead study author Daniel Rooks, PHD, former clinical research investigator and professor of medicine at Harvard Medical School. “Their level of function and pain stabilized prior to surgery, whereas those who did not exercise got worse. The benefits of exercise before surgery are very clear.”

Patients who are more fit prior to surgery may have shorter hospital stays and may be discharged and sent to outpatient rehab, rather than to a rehab facility for inpatient therapy. They also have fewer outpatient rehab sessions, says physical therapist Steve Sylvester, PhD, assistant professor of health and human performance at Palm Beach Atlantic Univer­sity in West Palm Beach, Fla. “Patients can more quickly do recommended exercises at home, with follow-up on an as-needed basis, whereas those who haven’t had pre-hab need more hands-on sessions,” he says.

Injuries

Injuries to the musculoskeletal system may happen unexpectedly. injury to an active person is part of the risk of being active. When injuries do occur, the best strategy is to take care of the injured part or tissue type quickly and safely, so as not to perpetuate the injury and also not to lose conditioning in other non-injured parts.

If an ankle is injured, accepted protocol of treatment is rest, ice, compression and elevation. (the acronym RICE). What happens to the uninjured leg and torso and arms when you are resting the injured ankle? You lose conditioning, strength gains, body shape as it is difficult to exercise around the injury. With WB-EMS, you can continue to stimulate healthy muscle contractions without harming the recovery area and refuse to lose the hard-won conditioning in uninjured tissues.

Immobility

Conventional exercise a person must move their body; i.e. lift weights, run, perform strenuous activity. People with an immobility cannot do that. As long as the nerve to the muscle is intact, WB-EMS can help the muscles to contract, thus working out the muscle and increasing conditioning.

Exercise maintains bone mass. But do people maintain exercise? [1]. Indeed, the majority of elderly subjects in Germany [2] or the US [3] fall far short of the exercise doses recommended for consistently impacting Bone Mineral Density [4–6]. Our novel training technology, called FITtec.® whole-body electrical muscle stimulation will increase effects of moderate exercise on the musculoskeletal system and thus might be a time-saving and feasible option for subjects unable or unwilling to perform strenuous conventional exercise.

EMS technology primarily focuses on muscle by activating muscle contraction and directly stimulating muscle protein synthesis rate [7], there is evidence that this mode of muscle stimulation also impacts bone density [8].

Weak Muscles

Traditional training is used to work the big muscles. Sometimes it is difficult to design an exercise protocol for a hard to activate muscle. Trying to contract a certain muscle proves difficult when other muscles are recruited prior to it due to poor exercise form or poor posture habits. With WB-EMS, muscles in the entire motor unit are contracted with a larger and deeper area covered by the suit and the way that electrical stimulation works.

Non-Contributing Muscles

Very similar to weak muscles, or immobilization; as long as there is a working connection of the motor nerve to the muscle the EMS signal will assist the brain-muscle connection and supply the signal for muscle contraction, which is the work needed to build muscle physiology.

On the neural level, the authors found that EMS training enhanced the overall activity of the stimulated muscle: the motor nerves are able to activate more muscle fibers with EMS. On the muscle level, EMS training produced increased quadriceps muscle mass (measured by cross sectional area of the muscle) and changes towards a more efficient muscle architecture. Neural adaptations occurred mainly during the first 4 weeks of training, while muscle adaptations became significant between 4 and 8 weeks of training. It was concluded that the strength gains with electrical muscle stimulation training are associated with neural as well as muscular adaptations.

Balance Out the Muscular System

FITtec.® EMS enables the simultaneous activation of up to eight to ten muscle groups (upper legs, upper arm, bottom, abdomen, chest, lower back, upper back, latissimus dorsi, and two free options which can be used on the calves or shoulders; total stimulation area 2,800 cm2) with regionally dedicated intensity.

The significant changes of maximum isometric strength in the back (+14.6%} 18.6%; P=0.005) and abdomen (+15.3%}17.8%, P=0.003) were impressive.

FITtec.® EMS also significantly improved physical function and performance status (p < 0.05). No significant differences of changes in quality of life, fatigue and blood parameters were detected between the study groups after 12 weeks. Supervised WB-EMS training is a safe strength training method and combined with nutritional support it shows promising effects, against muscle wasting, on physical function, a muscles contribution to the entire system and muscle and joint mobility.

Detraining has been characterized as a partial loss of training-induced physiological and performance adaptations, as a consequence of various weeks of training cessation (Maldonado-Martín et al., 2016). However, detraining periods are frequent and, in many cases, uncontrollable in most sport disciplines (injuries, transition periods, discharge micro-cycle, etc.). It has been shown that detraining periods produce several decrements in VO2max after 3 and 8 weeks (7% and 16%, respectively) (Costill et al., 1985; Mujika and Padilla, 2001). Therefore, it is necessary to seek for other alternatives to prevent or reduce the large decreases in physiological and performance-related parameters induced by training cessation (Mujika and Padilla, 2001; Berryman et al., 2018).

Since musculoskeletal impairment increases with age, it is important to determine if exercise changes age-related muscle weakness. This study compared the training effects of electrical stimulation and voluntary isometric contraction, the traditional exercise, on the quadriceps femoris in males 65 years and older. Electrical stimulation has an increased potential versus traditional exercise to provide improved strength for aged males. Future research should examine electrical stimulation in older persons with compromised ability to exercise using traditional methods. Caggiano 1994.

References:

Pre-hab for Surgery Prehabilitation

Anja Weissenfels, “Effects of whole-body electromyostimulation on chronic nonspecific low back pain in adults: a randomized controlled study”, Journal of Pain Research, 2018:11 1949–1957, https://www.dovepress.com/

Kemmler W, von Stengel S., “Whole-body electromyostimulation as a means to impact muscle mass and abdominal body fat in lean, sedentary, older female adults: subanalysis of the TEST-III trial”, Clin Interv Aging. 2013;8:1353–1364.

Lüning BC, Lundberg M, Lindberg P, Elfving B., “Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain”, Disabil Rehabil. 2012;34(10):852–858.

Kemmler W, Weissenfels A, Bebenek M, et al., “Effects of whole-body electromyostimulation on low back pain in people with chronic unspecific dorsal pain: a meta-analysis of individual patient data from randomized controlled WB-EMS trials”, Evid Based Complement Alternat Med. 2017;2017:8480429.

Kristin Schink, Hans J. Herrmann, et al, “Effects of whole-body electromyostimulation combined with individualized nutritional support on body composition in patients with advanced cancer: a controlled pilot trial”, BMC Cancer (2018) 18:886.

Kevin E Wilk, “Surgical Repair and Rehabilitation of a Combined 330 Degree Capsulolabral Lesion and Partial Thickness Rotator Cuff Tear in a Professional Quarterback: A Case Report”, February 2013 DOI:  10.2519/jospt.2013.3726 Source PubMed.

Warren et al., “Effect of Three Different Between-Inning Recovery Methods on Baseball Pitching Performance”, Journal of Strength and Conditioning Research, March 2011, Volume 25(3), pp. 683-688.

Gondin et al., “Electromyostimulation Training Effects on Neural Drive and Muscle Architecture”, Medicine & Science in Sports & Exercise, 2005, Volume 37(8) pp. 1291-1299.

B. T.Wall,M. L.Dirks, L.B.Verdijk et al., “Neuromuscular electrical stimulation increases muscle protein synthesis in elderly type 2 diabetic men,” The American Journal of Physiology—Endocrinology and Metabolism, vol. 303, no. 5, pp. E614–E623, 2012.

Francisco J. Amaro-Gahete, Alejandro De-la-O, et al., “Whole-Body Electromyostimulation Improves Performance-Related Parameters in Runners”, Front. Physiol. 9:1576., doi: 10.3389/fphys.2018.01576

Kemmler, W., Schliffka, R., Mayhew, J. L., and von Stengel, S., “Effects of whole-body electromyostimulation on resting metabolic rate, body composition, and maximum strength in postmenopausal women: the training and electrostimulation trial”. (2010).

Edith Caggiano, MS, PT, “Effects of Electrical Stimulation or Voluntary Contraction for Strengthening the Quadriceps Femoris Muscles in an Aged Male Population”, Journal of Orthopaedic & Sports Physical Therapy. Volume 20 Number I July 1994

Elizabeth V. Menshikova, Vladimir B. Ritov, et al., “Effects of Exercise on Mitochondrial Content and Function in Aging Human Skeletal Muscle”, J Gerontol A Biol Sci Med Sci. 2006 June ; 61(6): 534–540.

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