Therapy can be provided from a variety of clinicians, including physical, occupational and massage therapists. Similar interventions are used by all of these professionals because these interventions yield positive results. While each clinician has particular areas of expertise, appropriately applied electrical stimulation or massage treatments can reduce pain and swelling, improve range of motion and restore function. Understanding the purpose, process and expected result of each intervention can guide you in making decisions with your care.
Electrical Stimulation for Pain
Electrical stimulation can be effective in reducing pain. A transcutaneous electrical nerve, or TENS, pattern is used frequently to confuse the pain nerves around your injury. By overstimulating the tissues, your brain no longer is able to distinguish the pain signals, and the pain can diminish significantly or even completely. TENS often feels like a moderate prickling sensation and may not be tolerated by some. This type of electrical stimulation usually results in approximately 24 hours of pain relief and often is used during a course of physical therapy or occupational therapy while your injury is rehabilitated. Your therapist may issue you a pocket-sized TENS unit to be used over the long term for occasional flare-ups.
Functional Electrical Stimulation
Functional electrical stimulation, also referred to as patterned electrical neuromuscular stimulation, or PENS, is different from all other electrical stimulation because it mirrors the patterns of movement that your muscles naturally use. By accessing these patterns, your therapist can rehabilitate your neurological system while increasing muscle fiber strength to help normalize muscle tone, improve coordination and increase range of motion. Set at a lower perceived setting compared to other electrical stimulation protocols, PENS is the most comfortable option, usually with only a slight tickle sensation felt.
Strengthening Electrical Stimulation
Often referred to as "Russian" stimulation, strengthening stimulation is the most uncomfortable stimulation and, thus, poorly tolerated. However, if you are able to receive this type of stimulation, you can strengthen your muscle fibers more quickly than using any other type of electrical stimulation. Because the treatments can focus on only one muscle group at a time, the functional results often are limited.
Massage therapy can provide significant pain relief and therapeutic benefits. Retrograde massage can be used in some cases to reduce the swelling in your arm or leg. Your therapist uses repetitive stroking motions to move fluid up to your armpits or hip joints, which allows your body to reabsorb the fluid. This massage generally is not prescribed for pregnant women or those with a history of congestive heart failure, as it can cause severe heart strain. Swedish and effleurage massage techniques also make use of stroking motions to reduce pain and release stored lactic acid from your muscles. Trigger point release also is beneficial to release lactic acid in muscle knots and reduce tension in your muscle fibers. Drink additional fluids for one day after any massage to reduce the feeling of soreness related to the release of lactic acid.
While massage and electrical stimulation are very different treatments, they can provide similar benefits, such as pain relief, swelling reduction and improved function. Because of the sensory impact, electrical stimulation may be less tolerable. Communicate with your therapist to help guide her in the setting of this treatment. Similarly, clearly communicate with the therapist providing massage to let him know what level of pressure is most comfortable for you. The combination of electrical stimulation with massage often is the most effective and is widely used by therapists.
Melissa Sabo is an occupational therapist who started writing professional guidebooks for all Flagship Rehabilitation employees in 2009. Specializing in applied therapy and exercise for non-medical readers, she also coauthored a manual on wheelchair positioning. She graduated from the University of Pittsburgh with a Bachelor of Science in occupational therapy.