There are two different clinical situations in which we use eStim with dry needling.
1) To reduce pain.
2) For muscle and fascia rehabilitation
Muscle and fascia rehab involves using electrical impulses delivered by tiny electrodes attached to your needles that help to unlock tight muscles and fascia, deactivate trigger points, and speed repair of collagen fibers damaged by chronic inflammation.
There are three ways to vary the intensity of the stimulation….
One, you can adjust the strength of the electrical pulse
Two you can adjust the speed of the pulse
Three, you can vary the amount of time the eStim is applied.
The strength, speed, and legnth of time the pulse is applied is a function of whether you are using your estim primarily to reduce pain, or primarily to rehab muscle..
When we use
1) To reduce pain, especially chronic pain, we keep the eStim at a low speed and low stregnth and leave it on for a longer time frame. Depending on the comfort level of the patient we may leave the eStim on for anywhere from 5 to 15 minutes.
The strength of the eStim (how strong the pulse is) is always going to be relative to the specific person and case. This is because some areas of the body may have greater impedience. But the key point is that low stregnth means that the patient only feels a gentle level of pulsation. Its very important that in all cases the eStim is adjusted to the tolerance and comfort level of the individual patient. Strong enough to feel, but never so much that the person can not relax.
The eStim needs to be comfortable so that the patient can relax during the process.
2) To unlock tight muscles and fascia that are the cause of acute trigger point pain, such as you see with athletes, we cause a stronger stimulation, that is faster and stronger, but kept on for a shorter length of time. Anotherwords, we use a relatively intense burst of stimulation for a short period.
The purpose here is to cause an alternating muscle contraction/relaxation over a short time frame. When the fascia and muscle contracts and relaxes repeatedly, this can dramatically release trigger points and stimulate motor points, helping your muscle and fascia to release and legnthen. New blood enters the interstices and muscle cells, flushing out lactic acid and other toxic by-products of anerobic respiration that tight poorly vasculated cells resort to….
Now that the muscles have relaxed, we then see reduced inflammation at the tendon attachments and insertions. This process also can help stimulate laying down of new collagen fibers in cases of tendonosis, speeding healing of tendons, muscles, and fascial sheaths.
Here I am treating an acute case of periostititis and tendonosis of the right elbow that developed after an intense burst of activity that involved cranking and uncranking the hitch to a trailer.
Also, as tendonosis involves both inflammation and damage to the collagen fibers, I want to stimulate healing of the tissues with a stronger stimulation that may speed up collagen repair. This patient is a strong, stoic type with super tight muscles and fascia that have led to his inflamation. After consulting with him, and assessing his typology, we together decided to. try an intense burst of strong stimulation, in part because he already enjoyed very strong deactivation of trigger points with 30 and 32 guage sterile dry needles.