Electrotherapy – an overview of the various methods

Electrotherapy is an umbrella term. It includes every treatment that uses electrical current. The best-known are TENS, EMS, MENS, iontophoresis, interferential current, and the newest vagus stimulation (tVNS).

Although all apply electrical impulses, their mechanisms and effects differ. Just like a spoon, a knife, and a fork are all eating utensils but serve different purposes.

There are simpler and cheaper devices that provide only one current type, i.e., one treatment mode. For example: TENS only, muscle stimulation (EMS) only, or iontophoresis only.

Today most electrotherapy devices are multifunctional and offer more than one current type. Generally, the more treatment types a device contains, the more expensive it is, but it can treat a wider range of problems.

A more expensive device is not necessarily better for you, because it may include many treatment programs you don't need for your situation. Expensive devices often include modes that a physiotherapist treating many patients can exploit. For example, you would only need a Genesy 600 or 1500 with a program for denervated muscle treatment if you intend to treat peripheral muscle paralysis.

If you only want to relieve pain or strengthen your muscle, there's no point in buying the most capable device — the effect does not depend on having the most expensive unit!

Before you buy a device, check which treatment types and functions you need and decide based on that!

In this article I list which electrotherapy treatments may be available in a device and what you can use them for.

I only mention the methods offered by devices that can be purchased for home use. There are additional electrotherapy methods that require a professional and are therefore only available in clinic-grade machines.

Types of electrotherapy

TENS (nerve stimulation)

A pain-relieving method whose impulses "mask the pain signal", temporarily eliminating symptoms. This treatment type has little or no curative effect and does not act on muscles — it "only" reduces pain for a period. Its advantage compared to drugs is that you don't poison yourself and there are no side effects.

The pain-reducing effect of TENS is noticeable during the treatment and can last for several hours.

Watch my video about transcutaneous nerve stimulation. Click the play button.

EMS (muscle stimulation)

A method intended for treating muscles (an exception is muscles affected by so-called peripheral paralysis, which require selective denervated current treatment — see below).

There are treatment types that have their own names but in reality represent particular applications or forms of muscle stimulation.

• Threshold stimulation (TES). Very low current muscle stimulation applied for several hours that does not produce visible or perceptible muscle contraction, yet has beneficial effects on the overall condition of muscles.
• Functional stimulation (FES). Muscle stimulation aimed at restoring a lost function. For example, one of the best-known forms is treatment for urinary or fecal continence problems (incontinence). It also includes reducing muscle stiffness after cast removal following a bone fracture or regaining muscle strength weakened by serious illness.

EMS works depending on the device program settings. Different stimulation is required to relax muscles, improve muscle strength, or accelerate post-operative recovery (regaining muscle strength). By causing muscle contractions it can increase blood flow by up to 300%, thus improving circulation and promoting healing. Indirectly it relieves musculoskeletal pain — for muscle-origin pain it can be even stronger than TENS.

It is excellent for any condition where muscle strength, mass, posture, or function needs to be restored. This includes, among others, incontinence, muscle wasting, herniated discs, lumbago, sciatica, varicose complaints, peripheral arterial disease, muscle pain, neck/back/waist/knee and other muscle pains. It helps release muscle stiffness in central paralysis, Parkinson's disease, ALS, multiple sclerosis, etc. It speeds up motor relearning after stroke-induced paralysis.

Strengthening muscles takes time. If you could get stronger from a single stimulation, athletes would only use that: stimulate once tonight because the Olympics are tomorrow... It's not that simple. Muscles strengthen with regular contractions. Muscle stimulation should therefore be applied once or twice daily. Improvement is noticeable after 2–3 weeks and persistent treatment for at least 2–3 months is required. There are conditions (paralyses) where years of application may be needed.

Watch my video about which disease symptoms can be treated with muscle stimulation.

In this one I talk about what muscle stimulation is used for by athletes.

In this video I demonstrate how to perform muscle stimulation.

Selective denervated current (denervated muscle stimulation)

A method for treating muscles whose motor nerve is damaged — the so-called denervated, i.e. nerve-lost muscles. This condition occurs in peripheral paralysis, which can result from traumatic or surgical nerve injury, but also from herniated discs, spinal fractures, spinal canal narrowing, etc. Bell's palsy (facial nerve paralysis) — often following a cold — can also produce such a state. Denervated muscle does not respond to normal EMS! Therefore it requires impulses with special settings. Moreover, nerve healing is very slow — even in the best case it takes several months and more likely years. If the muscle does not receive electrotherapy during this time, it deteriorates. Even if the nerve regenerates, it may no longer find a functioning muscle. Therefore, in peripheral paralysis a stimulator must be used continuously (even 2–3 times a day).

The strengthening of denervated muscles takes a very long time. The first favorable signs are usually felt only after a few months; use may be needed for more than a year.

You need a device that provides selective denervated current only if you intend to treat muscles that are denervated — i.e., muscles suffering from peripheral paralysis.

Attention! If you treat a muscle with intact motor nerve using selective denervated current, you will strongly increase muscle stiffness (spasticity). A common mistake is applying selective denervated current after stroke or in multiple sclerosis (and wondering why the muscle gets progressively stiffer). After stroke or in MS, EMS (muscle stimulation) should be used.

Microcurrent (MENS)

Microcurrent is both a more effective pain-relieving modality than TENS and also has healing, regeneration-promoting effects. It should be used in all inflammations, muscle and ligament injuries. It is excellent for osteoarthritis, arthritis, carpal tunnel syndrome, tennis and golfer's elbow, frozen shoulder, rotator cuff inflammation, neck/back/waist pain, lumbago, sciatica, sciatic nerve inflammation, piriformis syndrome, hip pain, knee pain, Achilles tendon and plantar fascia inflammations, and heel spur pain.

It stimulates the processes that heal inflammation, so its effect develops slowly over weeks. The conditions above typically cause complaints that have lasted for years, so a few weeks of dedicated microcurrent treatment is relatively short compared to the duration of the disease.

Microcurrent stimulates the body's self-healing processes, so you cannot expect much from a single treatment. A minimum of 40–50 treatments is required. At least one treatment per day is recommended; if you skip several days you must restart the entire course.

Iontophoresis

Iontophoresis uses direct current, and the movement of charges during the treatment drives the active substance into the treatment site (avoiding the digestive system). Thus the drug reaches exactly where it is needed immediately, avoiding the "loss" typical of oral tablets (a taken tablet is digested, absorbed in the intestines, enters the bloodstream, and only a fraction reaches the injured ankle, for example).

Iontophoresis exploits the fact that electrical charges move between the positive and negative poles. During treatment the current flows between electrodes placed on the two sides of your joint, passes through the joint, and "carries" the medication into the joint cavity.

The treatment must be given as a course. A minimum of 10 treatments is required before effects appear.

Kotz (Russian)

Kotz stimulation, also known as Russian stimulation, is a high-frequency electrical muscle stimulation (EMS) technique originally developed by Soviet sports physician Yevgeny Kotz in the 1970s. Its aim is to increase muscle strength, aid rehabilitation, and improve sports performance.

Interferential

Interferential therapy (IF therapy) is an electrotherapy method primarily used for pain relief, muscle rehabilitation and improving circulation. The treatment uses two different medium-frequency currents that meet and interfere within your tissues to create a lower-frequency therapeutic current and effect. This method is especially effective at reaching deeper tissues while minimizing skin irritation.

Vagus stimulation (tVNS)

Transcutaneous electrical vagus nerve stimulation (tVNS) stimulates the vagus nerve through the skin. Electrical impulses are delivered to the tragus, the front part of the external ear.

This stimulation can modulate vagus nerve activity, thereby stimulating the parasympathetic nervous system and restoring optimal balance in the autonomic nervous system.

It has many positive effects on the body, for example regulating heart rate, reducing inflammation, and improving overall health.

Other applications of electrotherapy

So far I have listed the current forms that provide the treatments; now I mention other features that mainly contribute to the device's versatility.

Multifunction devices offer many features, but you may not need all of them. The important aspects differ for a private individual, a masseur or physiotherapist, and an amateur or professional athlete. Remember that electrotherapy can also be effectively used in beauty care!

A more serious electrostimulator can be used for about 8–10 years. It's worth considering which functions beyond the current types might be relevant to you and your close relatives. This can be a factor in choosing a device.

Muscle treatment (SPORT programs on Globus devices)

The SPORT programs on devices are useful for muscle-related injuries, diseases, loss of strength and muscle mass, etc. They are intended not only for patients but for athletes as well. The parameters of each muscle treatment program differ, so different programs promote muscle blood flow improvement (capillarization), relaxation of stiff muscles, enhancement of base or maximal strength, or increase in muscle mass.

Why do they differ? If you have trained in sports, you know a long-distance runner's muscles are prepared differently than a bodybuilder's. The runner has lean, enduring muscles; the bodybuilder wants large muscles. Different training — different results!

The muscle-treatment programs are identical across all Globus 4-channel muscle stimulator devices — they are all included!

Special muscle treatment (Special SPORT programs)

While the “regular” sport programs are useful for both patients and athletes, the special sport programs are intended primarily for enthusiasts of particular sports. The device name usually gives a clue. Runner Pro provides extras for running, Cycling Pro for cycling lovers. The Champion can be used for more than 10 sports. Genesy devices do not include special sport programs, so Genesy units are mainly recommended for those with disease-related symptoms.

Fitness and body-shaping programs

These programs help non-competitive but regularly active people develop muscles and shape their bodies. They assist in sculpting the abdominal muscles, buttocks, thighs and arms, and reducing small or stubborn fat pads.

Such programs are available on every Globus device.

Beauty care programs

These include muscle stimulation programs for the face, neck, décolleté and breast areas. Examples are restoring skin sagging after pregnancy, fading and reducing stretch marks and facial capillaries. Stimulating facial muscles helps reduce early wrinkles. Genesy devices do not include beauty programs, so Genesy units are mainly recommended for those with disease symptoms.

Electrical impulses accelerate the skin's collagen production processes, and regular repetition is needed to maintain this. Visible results are expected after 40–50 treatments.

G-Pulse beauty programs

G-Pulse is a group of special facial and cosmetic treatments developed by Globus. These programs can only be used with the G-Trode treatment head. A G-Trode is included as standard only with the Activa 700 device; for others it must be purchased separately. G-Pulse programs go far beyond the above-mentioned beauty treatments. Electrical stimulation enhances the skin's collagen production, so regular treatment improves skin elasticity, tone and smooths wrinkles.
These programs treat the face, neck, décolleté and breast areas. For example, they help restore skin loosened after pregnancy, fade stretch marks and facial capillaries. Stimulating the facial muscles helps reduce early wrinkles. G-Pulse programs are not available in Genesy devices, nor in the Premium 400 and The Champion models!

Electrical impulses accelerate the skin's collagen production processes, and regular repetition is needed to maintain this. Visible results are expected after 40–50 treatments.

Incontinence treatment — functional stimulation

This can be used to treat urine or stool leakage (incontinence). These are actually EMS — muscle stimulation — treatments. Because the pelvic floor muscles are very small and have a special placement, they require programs with special settings. You cannot treat the tiny anal sphincter with the same program used for a large thigh muscle. If you need such treatment, you must know whether you suffer from stress, urge, or mixed incontinence.

Some multifunction devices include incontinence programs, and there are devices specifically designed solely for incontinence treatment.

Functional stimulation causes pelvic floor muscles to adapt — depending on the program they either strengthen or relax. Regular repetition is necessary for the effect. Noticeable results are expected after 40–50 treatments, and maintenance sessions preserve the effect.

2+2 mode

The device can run two programs simultaneously, so you can treat your right knee and your left shoulder with different programs at the same time. You can also "share" the device: use channels 1–2 for your knee pain while your partner sitting next to you treats their shoulder muscles. TENS and EMS programs can be combined in this way.

Action NOW!

This mode can be used on the thigh muscles as well as the abdominal and trunk muscles. I recommend it primarily for post-operative regeneration and regaining muscle strength, and for athletes to maximize muscle development. It is more effective than physiotherapy or "regular" exercise! You can combine volitional exercise with electrostimulation.

For example, the best exercise to develop your thigh muscles is the squat. If you attach the device electrodes to your thigh muscles, a push of a button triggers a contraction of your thigh. Simultaneously perform the squat movement.

You can set how long the contraction and rest periods last (for example, 2 seconds contraction followed by 2 seconds rest). Time the sequence to match the exercise.

Hungarian language

Globus devices have a Hungarian-language menu. They also offer English, German, Italian, French and Spanish options. For users who do not speak other languages, a device that communicates in Hungarian makes safe operation easier.