Leg ulcer – supporting healing with muscle stimulation

What is a leg ulcer?

An ulcer is the death of the skin and the tissues beneath it, creating an open wound. A leg ulcer typically develops in the area between the ankle and the knee and is notoriously difficult to heal. While a normal cut closes within a few weeks, an ulcer may remain open for months or even years.

The cause is an underlying circulatory disorder: the tissues do not receive enough oxygen and nutrients, and waste products are not removed properly. The wound therefore becomes “stuck” in a persistent, non-healing state.

Types of leg ulcer

Based on their origin, ulcers are divided into three main types:

This article focuses primarily on home support with a muscle stimulator for the most common type, the venous leg ulcer. In diabetic and arterial ulcers, treatment of the underlying disease takes priority – seek medical guidance.

How does wound healing happen?

When you accidentally cut your finger, the wound closes within 2–3 days, and barely a week later there is hardly any trace of it. The body has a remarkable “self-healing” ability. The injury sends a signal to the defence system: first, the mechanism responsible for blood clotting becomes active and seals the small severed blood vessels. The bleeding stops.

Blood flow then increases in the injured area. It brings a large number of white blood cells, which destroy pathogens and foreign materials that have entered the wound. Fresh blood contains plenty of oxygen and nutrients – these are needed to produce the substances that close the wound. Healthy blood circulation is essential for wound closure.

Do you know what keeps your blood circulating?

You can read about every medicine, dressing and operation on many medical websites – but the most basic information is rarely discussed, or its importance is not explained.

Your blood circulates continuously throughout your body for your entire life. Your heart pumps it into the arteries, which carry it to every cell in your body. Your veins and lymphatic vessels collect it, while the pumping action of your muscles drives it back towards your heart.

Some of your muscle fibres (10–15%) are constantly contracted. Although you do not feel it, this muscle tone pumps your blood even while you sleep.

When you get up and start doing things, this is no longer enough. More blood enters your limbs, and in an upright position it is harder to return it to your heart. This is why you need movement.

As you go about your activities, your muscles contract and squeeze blood out of the veins – just as you squeeze toothpaste out of a tube. When the muscle relaxes, the veins fill again. The valves in the veins and lymphatic vessels allow blood to move only backwards, towards the heart.

Little exercise = poor blood circulation

You can now understand this: if you do not move your muscles thoroughly and regularly, you create the conditions for poor blood circulation – and therefore for ulcer formation.

By sitting at your desk or in an armchair in front of the TV all day, you are “choosing” to weaken your circulation.

The most effective way to prevent ulcers (and many other diseases) is regular physical activity. You do not need to be an athlete! Walk around your neighbourhood for 30–40 minutes each evening. Go hiking, try Nordic walking, jog, cycle, swim, do yoga, exercise or dance. It does not matter which. The important thing is to work your muscles thoroughly every day.

This “gets your circulation moving”. You may prevent ulcers, symptoms caused by arterial narrowing and many other problems.

What can you do to support healing of a leg ulcer?

If you were unable to prevent the ulcer and it has developed, you have a more difficult task. Move as much as you can without pain.

If you can no longer move, use a modern medical device: replace muscle movement with a muscle stimulator (EMS). This type of treatment makes your muscles contract rhythmically; its effect is similar to walking. It supports venous blood circulation and may therefore have a favourable effect on the chances of healing a leg ulcer.

Treating a leg ulcer with electrotherapy – protocol

The treatment is very simple to perform. Attach the muscle stimulator electrodes to the calf muscles, select the treatment programme, then set the current intensity so that you feel firm but not painful contractions in your muscles.

Basic treatment parameters

• Time: 20–30 minutes daily, repeated up to twice a day.
• Electrode placement: along the midline of the calf muscles (the requirements are described in the device instructions). Do not place the electrodes directly on the wound.
• Current intensity: a clearly noticeable, rhythmic contraction that is firm but not painful.
• Duration: continue until the wound has healed completely (often 2–4 months, or longer in more severe cases).

Electrode placement

I have prepared an illustration showing where to attach the electrodes. Place them on the calf muscles – not directly on the ulcer. Typically, two electrodes are placed on the upper part of the calf and two on the lower third, along the midline.

What should you expect?

The more severe the condition, the more often you need to exercise the muscles thoroughly. You can also treat a large ulcer – the important thing is not to place the electrodes directly in the wound.

During the first treatments, your pain may temporarily increase. This is because the faster circulation flushes accumulated toxins out of the ulcer (breakdown products formed by cell death), which causes pain. After a few days, the pain subsides – this is a sign that the healing process has begun.

Healing takes time – it does not happen within minutes, or even within a few days. But if you support your circulation, it will repay your patience.

Other home modalities alongside ulcer treatment

A muscle stimulator is not the only solution – successful leg-ulcer treatment is a team effort and combines several modalities:

• Medical supervision – diagnosis and treatment of the underlying disease.
• Compression therapy – the most important foundation for a venous ulcer (compression stocking or bandage, adjusted by a professional).
• Appropriate wound dressing – providing a moist wound-healing environment.
• Movement – operating the muscle pump supports venous return.
• Muscle stimulator (EMS/FES) – the main topic of this article.
• Soft laser therapy (photobiomodulation) – a parallel home modality that can be combined with EMS.
• Lymphatic massage device (pneumatic compression) – to support venous return in more severe venous circulation disorders.
• 3 tips for a daily leg-ulcer protocol – a practical daily routine combining soft laser, an ergometer and an elastic band.

When should you NOT expect a miracle?

Start with realistic expectations. A muscle stimulator will not heal an ulcer if:

• You do not treat the underlying disease – wearing compression stockings is essential in venous insufficiency, while blood-glucose control is indispensable in diabetes.
• Severe arterial insufficiency is present – if the blood supply is critically low, this must be addressed first, possibly with vascular surgery.
• The wound is infected – an active, pus-producing infection first requires antibiotic treatment.
• You do not follow hygiene rules – without regular dressing changes and wound cleaning, a stimulator cannot help either.

EMS is a valuable adjunctive device – but it does not replace medical care or treatment of the underlying disease.

Scientific background