Low back pain has become a common musculoskeletal pathology in our society and it is one of the most observed painful conditions. It is important that the physiotherapist has available different tools and options to the rehabilitation of this condition.
Your treatment includes a wide variety of analgesics, opioid and non-opioid, favoring the occurrence of side effects (gastropathy, neuropathies, etc.) potentially deleterious that affect the quality of the life of the patients.
In addition, the «myofascial» component (strength, resistance, flexibility, etc.) is only one piece of the puzzle that must be considered in the treatment, together with the joint and neurodynamic components, psychosocial factors, pain mechanisms, among others.
The role of electro-stimulation
On the other hand, electrical muscle stimulation (EMS) involves the stimulation of muscle groups through low intensity electrical current through electrodes applied on the body surface. These impulses stimulate the nerves to send signals to a muscle, which reacts shrinking, just as it would with a normal muscle activity, but unintentionally.
In the healthy population, its use is widespread in the improvement of the physical condition and muscle strength in people with sporting activity. It is also intended for the rehabilitation of diseases that affect the musculoskeletal system.
Its main advantages are based in various parameters of training, mainly those related to the muscle strength. Different studies and authors agree that these improvements are greater when performed simultaneously with voluntary exercise, and that they should be considered as complementary to training and not as an isolated or alternative method.
The stages of rehabilitation for low back pain
In the process of the physical rehabilitation for a low back pain or associated pathology, the exercises, aimed to awake the muscle (sensorimotor reprogramming) in patients who require them, may include several successive stages, among we highlight the following:
- Perception (to feel the contraction of the stabilizing muscles).
- Precision: stage which consists of the learning of a specific isometric muscle recruitment without compensation.
In these two stages is where the use of electrical muscle stimulation with imotion-ems.com appears, as it incorporates simultaneously electrodes in the abdominal zone and lumbar and dorsal paravertebral area and it also adds therapeutic exercises, which would assist in the activation of stabilizing muscles of the spine, thereby generating a feedback to the patient.
Generally, experts use light loads in the initial phase in order to work mobility and reduce fears and possible inhibitions; then, they use more and heavier loads mobilized by a number of repetitions that decrease progressively, to work on resistance and muscle strength.
Aspects to consider
Conductance: the facility that provides a mean to the passage of electric current. Some body tissues are more conductive than others and they are classified into:
- Little conductive tissue.
- Moderately conductive tissue.
- Good conductive tissue.
- Electricity generation tissue.
Pulse form: Here we can find the different forms of the pulse. They can mainly be the triangular and rectangular. This will determine whether the stimulus input is performed abruptly or more progressively. In the triangular pulses might appear what is known as accommodation.
Pulse ramp: The more you approach to the vertical, the less accommodation you will have. Therefore, the rectangular currents, by having a more vertical rise, will take less time to reach the maximum intensity.
Intensity: It measures the amplitude levels that cause muscle contraction.
Frequency: It allows us to regulate what kind of muscle fibers are going to be activated. The frequency tells us the number of times per second that an impulse will be produced.
It is important to control all aspects and use them appropriately for each objective.
In the case of low back pain, it is recommended to use frequencies between 20 and 80 Hz, with an impulse time of 3-5 seconds with pause periods between 4-20 seconds and a depth of 300-400 µs. The objective is to generate strength resistance and the development of it, along with voluntary muscular activation through rehabilitation.
- Liddle Dianne Sarah, Baxter G. David, Gracey Jacqueline H., Exercise and chronic low back pain: what works? Pain 2004; 107: 176-190.
- Ofelia Loani Elvir-Lazo, Lumbalgia y el Uso de la Estimulación Nerviosa Eléctrica Transcutanea (TENS); Rev. Fac. Cienc. Méd. 2008
- Kamper SJ, MaherCG, Hancock MJ, KoesBW,Croft PR, HayE. Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence. Best Pract Res Clin Rheumatol 2010;24:181–91
- Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, et al. Low back pain. J Orthop Sports Phys Ther 2012;42:A1–57.
- Herrero, J. A., Abadía, O., Morante, J. C., & García, J. (2007). Parámetros del entrenamiento con electroestimulación y efectos crónicos sobre la función muscular (II). Archivos de Medicina del Deporte, 24(117), 43-53