What is multiple sclerosis?
Multiple sclerosis – or MS for short – is a chronic, inflammatory, autoimmune disease of the central nervous system (the brain and spinal cord). The extensions of nerve cells (axons) are covered by a protective sheath called the myelin sheath. Its role is similar to the insulation around electrical wires: it allows nerve impulses to travel quickly and smoothly along the nerve pathways.
In MS, the immune system becomes disturbed and starts attacking the myelin sheath. Because the “insulation” is damaged, nerve signals travel more slowly or do not reach their targets at all – this causes the characteristic, varied symptoms of the disease. MS is known as the “disease of a thousand faces” for good reason: symptoms differ from person to person and also change over time (becoming stronger or milder).
Key point
MS treatment has three basic pillars: drug therapy + regular exercise + electrical muscle stimulation (NMES). Because MS affects the central nervous system, muscle stimulation requires biphasic square-wave EMS/NMES – NEVER selective stimulation current, which could increase spasticity.
The most common MS symptoms – by group
MS symptoms can be divided into three main groups. Developing the right rehabilitation strategy starts with assessing these symptoms accurately:
- Muscle weakness and muscle stiffness (spasticity): the muscles become tense and stiff, making movement more difficult.
- Balance and coordination problems: walking becomes unsteady and dizziness is common.
- Reduced range of movement: spastic muscles prevent the joints from moving through their full range.
- Fatiguing walking: significant exhaustion even after covering short distances.
- Numbness, tingling: altered sensation in the limbs or trunk.
- Visual disturbances: blurred or double vision caused by inflammation of the optic nerve.
- Pain: muscle- and nerve-related pain, especially in spastic muscles.
- Fatigue: abnormal, unexplained tiredness that is not proportionate to the activity performed.
- Incontinence: difficulty controlling urine or bowel movements.
- Breathing problems: particularly in advanced stages, because of weakening respiratory muscles.
- Mood problems: depression and anxiety.
Why is regular exercise vital in MS?
MS cannot yet be treated by addressing its underlying cause, but its symptoms can be managed and its progression may be slowed. Alongside drug treatment, regular exercise is one of your most important tools. This is not merely a recommendation – it is a basic necessity.
Why? Because muscles quickly begin to waste when they are not used. MS already makes movement more difficult – if a sedentary lifestyle is added to this, a vicious circle develops: you move less → your muscles weaken → movement becomes even more difficult. Regular exercise breaks this cycle.
Key benefits of exercise in MS
| Benefit | Why is it important? |
|---|---|
| Maintaining muscle strength | Active muscles lose strength more slowly. |
| Reducing spasticity | Regular movement helps relax stiff muscles. |
| Improving balance | Targeted exercises develop your sense of balance. |
| Improving mood | Exercise releases endorphins, which reduces the risk of depression. |
| Reducing fatigue | Paradoxically, regular training reduces abnormal fatigue. |
Useful equipment for exercising at home
For people living with MS, it is especially important that exercise is gentle but effective:
- Elastic resistance bands and loops: they provide varied resistance, can be used sitting or lying down, and the resistance level is easy to adjust.
- Home exercise machines: an exercise bike or cross-trainer is ideal for maintaining endurance – it is safe because it can be used sitting down, reducing the risk of falls.
The limits of voluntary movement – this is where muscle stimulation comes in
You may understand how important movement is – but MS itself places limits on that movement. The disease damages the nerve pathways that start in the brain, so voluntary movement commands do not reach the muscles properly.
What does this mean in practice? You may want to move your leg, but the muscle does not respond properly to the command. Or even if it does respond, it becomes tired more quickly than in a healthy person. Spasticity – abnormal muscle stiffness – makes the situation even more difficult because it prevents the full range of movement.
Voluntary movement – however important it is – is not always enough on its own. This is where adjunctive therapy comes in, and one of the more favourable options is electrical muscle stimulation (NMES, EMS).
How does NMES work in MS?
Electrical muscle stimulation – EMS or NMES – is a treatment method that acts directly on the muscles, partly bypassing the damaged central nerve pathways. Through electrodes placed on the skin, the stimulator sends an electrical impulse to the motor nerve ending supplying the muscle – from there, the signal travels along the peripheral nerve pathway, which typically remains INTACT in MS.
Important: the muscle does not know where the impulse comes from. Whether the signal comes from your brain or a stimulator, the muscle contracts through exactly the same mechanism. The same metabolic processes take place in it; it develops, strengthens and becomes tired in the same way.
The three main types of NMES in MS rehabilitation
Short and gentle electrical impulses that mainly target the sensory nerves. They may be used to manage pain associated with MS. This is essentially the TENS protocol – detailed explanation in the TENS pillar article.
Repeated electrical impulses that trigger muscle contractions. They are effective for developing muscle strength and endurance. Regular, repeated impulses help strengthen the muscles gradually and increase their endurance. This is the classic NMES protocol – the Genesy 300 Pro is an ideal device for it.
The more advanced approach: EMG detects your muscles’ own electrical activity (the attempt) and times the stimulation accordingly. This “personalised” method is especially useful during movement rehabilitation because stimulation “reinforces” the active attempt. The ETS specialist device is the DuoBravo N. Detailed explanation in the biofeedback pillar article.
How can muscle stimulation help manage MS symptoms?
NMES may support people living with MS in several ways. It is worth reviewing the following overview according to your current symptoms:
In MS, muscles often become stiff and tense, which restricts movement and may cause pain. Traditionally, this stiffness is treated with forceful manual mobilisation, which can be uncomfortable and may traumatise the tissues.
Electrical stimulation is a considerably gentler solution. Stimulation increases blood circulation, relaxes the muscle and surrounding tissues, and reduces excessive activity in the motor nerve. By stimulating the antagonist muscles, NMES promotes reciprocal inhibition, which may bring further improvement.6
Muscles need contraction to remain healthy. If a muscle does not contract for a long time, it begins to waste. With muscle stimulation, your muscles work regularly even when you can no longer move them properly by choice. This helps preserve muscle mass and strength.
Research suggests that NMES may particularly improve lower-limb strength – which is essential for walking and general mobility. Increased muscle strength may lead to better performance in everyday activities.4,5
Because of spastic muscles, you often cannot use the full range of movement in your joints – for example, your elbow or knee may not straighten completely. Muscle stimulation may relax the muscles, which may increase the range of movement.
Incontinence – difficulty controlling urine or stool – can be a common consequence of MS. It is caused by weakening of the pelvic floor sphincters and impaired function of their motor nerves. Most people with MS treated with functional muscle stimulation report improvement in bladder and bowel function. Pelvic floor treatment can be performed with a special probe or surface electrode placement after consultation with a urologist or gastroenterologist.
In people with MS who use a wheelchair, activity in the arm and chest muscles decreases, which may lead to breathing difficulties and an increased risk of respiratory infections. Functional stimulation may help maintain the strength of the abdominal and trunk muscles, improving coughing ability and breathing.
Limited mobility increases the risk of pressure ulcers (bedsores). Maintaining muscle mass and tone distributes pressure across the skin more evenly, which may reduce this risk.
According to research, NMES may promote neuroplasticity – the process through which the brain reorganises itself by forming new neural connections. Central effects may lead to cortical reorganisation, which is essential for functional recovery in MS. This effect may be particularly relevant with the ETS protocol (DuoBravo N), because the timing of the voluntary attempt and stimulation together helps condition brain reorganisation.2,3
Technical information – which impulse is suitable for MS?
MS causes central paralysis – NOT selective stimulation current!
Multiple sclerosis affects the central nervous system, and the type of paralysis it causes is central paralysis. For this condition, NEVER use so-called selective stimulation current (denervated muscle) treatment!
Selective stimulation current treatment, such as the PeroBravo programme, increases muscle stiffness and spasticity. This may appear as clear deterioration from the patient’s point of view – and it may also be painful and unpleasant.
For MS, use EMS/NMES (classic muscle stimulation), with the appropriate waveform being a biphasic square wave. A detailed explanation of the difference between peripheral and central paralysis is available in the selective stimulation current article.
Which device is suitable for people living with MS?
In MS (central paralysis!), biphasic square-wave NMES is required – the ideal choice is either an ETS specialist (which “reinforces” the attempt), a classic NMES device, or a versatile Globus Genesy device (its selective programme must NOT be used for MS, but its NMES function can be used).
Primary recommendations for MS
DuoBravo N – ETS specialist (featured MS recommendation)
A specialist for central paralysis (stroke, MS): it uses ETS (EMG-Triggered Stimulation) technology, which starts stimulation in response to the patient’s own voluntary attempt. This is particularly valuable for people living with MS because it brings the active attempt and stimulation together in time, supporting the conditioning of neuroplasticity (brain reorganisation). The “assistive” system helps maintain muscle strength and coordination.
Genesy 300 Pro – classic NMES (rehabilitation)
A classic NMES device, specifically suitable for rehabilitation. It is the entry-to-mid-range model in the 4-channel Globus Genesy range. It offers extensive NMES functionality. Its value for money is excellent for home rehabilitation in people living with MS.
Versatile Globus Genesy range – these devices contain NMES programmes for MS treatment (do not use their selective stimulation current programme for MS!), while also being suitable for several other indications. They are ideal for patients who want to use one device for several purposes:
Genesy 600 – versatile entry-to-mid-range model
4-channel, with NMES programmes, also suitable for MS rehabilitation. A cost-effective choice if you need the device for other purposes in addition to NMES.
Genesy 1500 – top device for home use
4-channel, with extensive NMES functionality. An excellent value-for-money choice for home MS rehabilitation and other indications.
Genesy 3000 – professional-level versatile device
The top model in the Genesy range. With a professional-level NMES programme library, it is ideal for home MS rehabilitation when combined with physiotherapy.
What should you expect from treatment – and what should you not?
Realistic expectations
Electrical muscle stimulation does NOT treat the underlying cause of multiple sclerosis. It does not repair damaged nerve pathways and does not eliminate the fundamental cause of the disease.
What it may achieve: it may help you maintain movement for longer. This makes a huge difference to quality of life. In the early stages of MS, stimulation may even produce improvement for a while (muscles become stronger and spasticity may decrease). As the disease progresses, it increasingly helps slow the symptoms – and this is also an extremely valuable result: if NMES helps you preserve your ability to walk for years longer or delay becoming dependent on a wheelchair, that is a major gain.
Quality-of-life benefits
- Greater independence: improved muscle strength and functional mobility may directly contribute to greater independence in everyday activities.7
- Psychological wellbeing: taking part in physical activity – even to a limited extent – may increase self-esteem and reduce feelings of helplessness.7
- Reduced fatigue: in some cases, NMES may be associated with reduced fatigue and improved general physical fitness – paradoxically, the “more active” state of the stimulated muscle reduces chronic fatigue.7
Frequently asked questions
The sooner, the better – but always after consultation with a neurologist. In the early stages, NMES may help maintain muscle strength before significant wasting develops. Your doctor or physiotherapist will determine the precise treatment timing and protocol based on your current condition.
Selective stimulation current is intended for denervated muscles that have lost their nerve supply, where the nerve is damaged or severed, such as peripheral peroneal paralysis. In MS, the peripheral nerve is INTACT – the problem is in the brain. Selective stimulation current is unpleasant and painful on a normally innervated muscle and may increase spasticity. Therefore, MS requires biphasic square-wave EMS/NMES – the NMES functions of the DuoBravo N, Genesy 300 Pro or Genesy 600/1500/3000.
Classic NMES (Genesy 300 Pro and the Genesy range) works with automatic timing – the device alternates stimulation and rest at a steady rhythm. ETS (DuoBravo N), by contrast, monitors the muscle’s own electrical activity and starts stimulation when you actively try to move the muscle. This combination of active attempt and stimulation “reinforcement” may be particularly valuable in MS rehabilitation because it supports neuroplasticity (brain reorganisation). The ETS protocol is MORE EXPENSIVE, but functionally it is the more advanced option.
Your physiotherapist or doctor will determine the precise protocol based on your current condition. General guidance: 5–6 times a week, with treatments lasting 20–30 minutes. If several muscle groups are treated, these may be separate sessions. For reducing spasticity, regularity is much more important than making individual sessions longer.
Yes. In fact, clinical protocols specifically recommend NMES as an adjunctive therapy alongside drug treatment and physiotherapy. NMES does not interfere with the effect of MS medicines (interferon, glatiramer acetate, monoclonal antibodies), and it may also support physiotherapy exercises, for example, movement therapy after treatment may be more effective when the muscles are relaxed.
According to clinical experience, pelvic floor muscle stimulation may bring meaningful improvement in bladder and bowel function for people living with MS. Treatment uses a special probe or surface electrode placement and may begin ONLY after consultation with a urologist or gastroenterologist and training by a physiotherapist. Incontinence-specific devices and protocols belong to a different category – you can obtain detailed information about these during a medical consultation.
Before starting treatment
NMES is generally safe in MS, but there are conditions in which it must not be used. Always discuss treatment with your doctor or neurologist before starting!
When should you be cautious?
- Implanted cardiac pacemaker or defibrillator – the electrical impulses may interfere with the implanted device
- Selective stimulation current (denervated muscle) treatment is prohibited in MS – it increases spasticity and may be painful
- Active cancer in the treatment area – electrical stimulation should be avoided in the treatment area
- Pregnancy – consultation with a gynaecologist is required
- Epilepsy – electrical stimulation may provoke a seizure (relative contraindication; specialist consultation required)
- Skin inflammation or an open wound at the electrode site – electrodes must not be placed on damaged skin
- Thrombosis or thrombophlebitis in the treatment area – muscle contraction in the affected area may be dangerous
- Severe loss of sensation in the treatment area – increased caution is required
- Acute phase of an MS relapse – the neurologist should stabilise the relapse first; NMES may then be started or continued
Adjunctive treatment, not a standalone therapy
Home NMES is an adjunct to MS rehabilitation, not a replacement for specialist neurological treatment or physiotherapy. Diagnosis, treatment planning and monitoring must always be carried out by a healthcare professional. A detailed list of contraindications is available in the contraindications to electrotherapy article.
Summary – Quick overview
Sources
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- Xu Q, Guo F, Salem HMA, Chen H, Huang X. (2017). Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study. Clinical Rehabilitation, 31(12), 1583-1591. PubMed: 28459163
- Ou CH, Shiue CC, Kuan YC, Liou TH, Chen HC, Kuo TJ. (2023). Neuromuscular Electrical Stimulation of the Upper Limbs in Patients With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. American Journal of Physical Medicine & Rehabilitation, 102(2), 151-158. PubMed: 35687763
- Fornusek C, Hoang P. (2014). Neuromuscular electrical stimulation cycling exercise for persons with advanced multiple sclerosis. Journal of Rehabilitation Medicine, 46(7), 698-702. PubMed: 24763902
- Jones S, Man WD, Gao W, Higginson IJ, Wilcock A, Maddocks M. (2016). Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database of Systematic Reviews, 10(10), CD009419. PubMed: 27748503
- Khan F, Amatya B, Bensmail D, Yelnik A. (2019). Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews. Annals of Physical and Rehabilitation Medicine, 62(4), 265-273. PubMed: 29042299
- Alves IGN, da Silva E Silva CM, Martinez BP, de Queiroz RS, Gomes-Neto M. (2022). Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis. Clinical Rehabilitation, 36(4), 449-471. PubMed: 35014892
- Alenazy M, Daneshgar Asl S, Petrigna L, et al. (2021). Treatment with electrical stimulation of sensory nerves improves motor function and disability status in persons with multiple sclerosis: A pilot study. Journal of Electromyography and Kinesiology, 61, 102607. PubMed: 34710779
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- Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, et al. (2022). Can strength training modify voluntary activation, contractile properties and spasticity in Multiple Sclerosis?: A randomized controlled trial. Physiology & Behavior, 255, 113932. PubMed: 35905806
