Neuropathy

 

Absolute Physical Therapy offers state-of-the-art neuropathy treatment using electric muscle stimulation, otherwise known as EMS. Research shows that EMS improves symptoms such as paresthesias, pain, burning sensation, sleep disturbance, and numbness.

 

What We Do for Neuropathy:

Absolute Physical Therapy’s goal with using EMS for neuropathy is not just to decrease pain, but also to increase muscle mass to help with function, to elicit strong muscle contractions, and to pump blood into the area in an attempt to improve circulation.  While patients usually report immediate relief after their EMS session, ongoing treatment seems to continually lessen symptoms. One patient case, with regards to increased sensation, has been doing the electric stimulation at home every other day for three months, and we plan to retest going forward. The use of a home stimulator is ideal because they often pay for themselves quickly and can make it possible to get the ideal use of at least three times per week, if not daily, that is recommended by research and fine-tuned by experience.

Additionally, patients with lower extremity neuropathy often need an especially strong stimulator to get a good muscle contraction; so while treatment is provided in the clinic, a lot of what Chad Reilly PT, MPT and his technicians do is help patients decide what kind of EMS/TENS machine and accessories they need, help them program the machine, and teach them how to set up the electrodes for home use.

Check out Chad’s blog to read more about EMS for Neuropathy

 

Our Approach:

  1. Decrease pain
  2. To increase muscle mass to help with function
  3. Elicit strong muscle contractions
  4. Pump blood into the area in an attempt to improve circulation

 

Why We Use EMS Instead of TENS:

Studies that have compared EMS (parameters designed to increase muscle strength) with TENS (parameters designed to decrease pain), show that the EMS parameters do more to decrease pain.  TENS works by gate control theory and is more effective with increased intensity, EMS which by nature is more intense than most recommended TENS parameters, should work better. Additionally, these parameters allow for strengthening to occur simultaneously with pain relief.

I think the most intense core strength exercise is done with electric muscle stimulation, which if done properly not only increases muscle strength better than you can with curl ups or planks, but also does a real good job of acutely reducing back pain. I get a lot of results with short term pain reduction and strengthening of the core muscles by using EMS if it is too painful to do regular core exercises. Usually though, I have my patients do both EMS and exercises. Squats and deadlifts, if performed keeping the spine neutral, are two of my favorite spine stabilization exercises. If tolerated, I also think front and side planks/bridges are still a good exercise. Also, while I have not tried it yet, I suspect an ideal EMS program would not be just one set of parameters, but rather alternating between two or more; some settings directed at increasing strength, and others directed more towards improving circulation and cardiovascular benefits.

 

EMS Case Reports of Absolute Physical Therapy

EMS works exceptionally well for neuropathy/neuropathic pain, and I have seen it immediately eliminate arm tremors in a patient. This patient had gone through a bastion of tests at Barrow Neurological, been diagnosed with conversion disorder, then after a 12 minute EMS treatment the tremors were gone.

Another instance is when I was treating a 74 year old patient for poor balance, neuropathy, back pain, and neck pain all with a combination of exercise and EMS. She reported all of her other pain had resolved but she had elbow pain which I diagnosed as lateral epicondylitis/tennis elbow. I didn’t want to spend much time treating the elbow, as I thought it was the least of her worries. I wanted to continue to work on fall prevention with general strengthening, balance training, and agility training. The patient also had a history of dropping light objects, she calls it her “dropsies,” but over the course of her treatment she said it been reduced ~50%. Her muscle strength was much improved, so weakness was not a reason for her dropping objects. Long story short, I decided to add reverse wrist curls to her exercise program and did EMS to her biceps, triceps, and forearm muscles with a hope to further increase UE strength and lessen pain.  After one treatment, the following weekend she reported her dropsies had decreased another 30-40%, which is pretty big improvement over one intervention. The next day I applied EMS to her arm again, but also had her use my hand grip electrode to provide EMS through the palm of the hand.  So, on her next visit I will see what she has to say. Even though I treated the arm reluctantly, I maybe came up with a new understanding and breakthrough with her, which I can hopefully apply to other patients.

When you are using multiple interventions (which is generally the case in physical therapy) to treat a problem, it is sometimes impossible to say what does what and how much it does. Also, there is a lot of overlap between each intervention (strength exercise, balance exercise, coordination exercise, EMS) and what you are hoping to achieve. However, this patient’s rapid response was much faster than one would expect from a single day of exercise and I think it was most likely due to the EMS working on the muscles in the arm and hand and also increasing activation and blood flow in the brain. It’s also interesting that brain activity was seen in a dose response manner; in that more intense EMS causes more of a brain response. This perhaps strengthens neural connections and improves nerve conduction velocity, resulting in improved coordination. I am starting to see this in other studies as well. What’s also interesting is all the areas of the brain that are affected. Electric muscle stimulation applied to the study participants’ quadriceps increased blood flow to the primary sensory cortex, primary motor cortex, cingulate gyrus, thalamus, and cerebellum with blood flow always increasing more so in the brain as intensity levels of electrical stimulation was applied to the study subjects leg muscles.

 

Obtaining Your Own EMS Machine

I do think home use of a stimulator is ideal, because they often pay for themselves quickly. I would expect ideal use to be at least three times per week, if not daily. Contact Absolute Physical Therapy to purchase your own EMS machine today! Supplies are limited.

 

What We Don’t Do for Treating Neuropathy:

We Don’t Recommend Cold Laser Therapy (Anodyne)

Anodyne is a brand name for cold laser, low level laser, monochromatic infrared photo energy (MIRE), red beam, near infrared, far infrared, and probably a lot of new names to come out in the future to refresh an old idea. The purpose of this study was to determine the efficacy of anodyne monochromatic infrared photo energy (MIRE) in-home treatments over a 90-day period to improve peripheral sensation and self-reported quality of life in individuals with diabetes. In this double blind study, the manufacturers came up with a sham/placebo device that was so convincing, that neither the patients, nor the investigators could tell which device was which. At the end of the study, it  turned out that unlike in prior poorly controlled, or even fully uncontrolled studies, they found no treatment effect whatsoever that was greater than the sham treatment. In fact, the authors commented:

“Not only was there no clear benefit from the treatment, but there was also a large placebo effect in which the sham therapy showed double the number of improvements in the effect size compared with the anodyne treatment.”

These results make me feel bad for Anodyne, in that they went out of their way to construct a bomber sham device, and in doing so they scientifically sawed off the branch which they were sitting. Practicing science or evidence based medicine means that you may have to stop doing things you used to do when you find out, in fact, that they don’t really work. If you continue with the same practices because “it seems like it’s working,” well, you got placeboed too right along with your patient, and having that graduate degree means you should be beyond all that.

Check out Chad’s blog to read more about Cold Lasers and Neuropathy

 

Other:

Chad’s latest innovations for the treatment of neuropathy look at diet related changes. These diet related changes show very positive influences on risk factors for neuropathy, reducing insulin and improving insulin sensitivity, and lessening atherosclerotic plaque; all of which seems to be the causal factors behind neuropathy and are now being shown to actually improve peripheral nerve survival.

 

Calorie Restriction and Peripheral Nerves

A study that I commented on in my Neuropathy blog section conducted an  experiment to determine the extent of oxidative damage within myelinated peripheral nerves. They studied sciatic nerves from rats of four different ages (8, 18, 29, and 38 months) maintained on an ad libitum or a 40% calorie-restricted diet. It was seen that markers for lipid peroxidation, inflammation, and immune cell infiltration are all elevated in nerves of ad libitum-fed rats, whereas food restriction is able to attenuate such deleterious processes with age. Together, these results show that dietary restriction is an efficient means of defying age-related oxidative damage and maintaining a younger state in peripheral nerves.

A limitation of this study is that the rats used were on lifelong calorie restriction, whereas most people eat a lot of calories, for a long time, before they start worrying about peripheral nerve damage issues like carpal tunnel syndrome, neuropathy, or intermittent claudication. It also makes me wonder if there are benefits for those with sciatica.  I have had really, really good results treating my physical therapy patients with neuropathy from the outside with electric stimulation (based on what’s becoming a fair amount of research); ditto for intermittent claudication. So this study makes me wonder if, and how much, the improvements might be further enhanced by treating the body/nerves from the inside with caloric restriction or intermittent fasting diets. Though this study found caloric restriction effective, another I looked at suggests that intermittent fasting (which may or may not also entail caloric restriction) may be better still specifically for protecting neurons from insult. Based on piles of studies I have on caloric restriction and intermittent fasting, the big side effects are just that you stay healthier, age slower, and live longer. Like research on exercise, caloric restriction appears to be pretty much win win all the way around.

Check out Chad’s blog to read more about Calorie Restriction and Peripheral Nerves

 

Chad Reilly’s physical therapy practice is constantly evolving based on current empirical evidence combined with self-experimentation and clinical results. To follow the changes, simply look at “Chad’s Blog” and receive links to novel studies, as well as Chad’s impressions on quality and real world application.