Chad’s Continued Electric Stimulation Notes 2015-17 and Onward

This is a continuation of the “Notes From My Year Year of Electric Muscle Stimulation” which is becoming one of my more popular blog posts. Those notes were what I wrote down as I did EMS (electric muscle stimulation) for all major muscle groups instead of weight training for an entire year (October 2013 thru October 2014). I still think I’m the only person to ever do that and I learned a ton about how to make the most out of EMS for strengthening muscle, and while applying those same parameters to my patients I was happy to find out that the EMS parameters did a great job of decreasing pain (better than TENS in my observation, which turns out to be backed up by research as well.) Since that year ended I have continued to use EMS on myself for abdominal training, most frequently with my “core 2” electrode pattern, and I continue to use EMS for neck strength and hypertrophy, and I think somewhere below in the notes I did finally reach my goal of a 17” circumference neck (starting from 15 ⅞) and losing neck fat in the process per my next self experiment of intermittent fasting, which I have stuck with and been doing for over two years now. The neck stim is experimental, supposedly unsafe per every TENS and EMS manual ever written since 1970ish (however based on NO RESEARCH whatsoever that I have been able to locate). So I’m not telling anyone to do it, and I would even tell my readers not to do it. That said, I’m continuing to do it myself, and I don’t think it would be right not to talk about something that if shown safe for others, might be of considerable benefit. So these notes are about what I learned for myself, some of which info I use on my patients to optimize EMS and TENS treatments. For myself I’m not exclusively using EMS anymore for strengthening. I’ve returned to weight training for the bulk of my strengthening, but for abdominals and neck, EMS with Core-1 or Core-2 is just better, for abs I still think WAY better than any exercise ever created. So in the last few years I think I have learned a few things with regards to strengthening electrode placements, but I’m not trying out new things almost every day like I did in year one. However, I’ve continue to read research, especially on TENS (transcutaneous electric nerve stimulation) for applications where I might not want to use my go to EMS. So the results of all that is as follows. Also the format of my last set of notes was from oldest at the top to newer at the bottom, but on this one I’m just pasting in as I wrote it, new at the top. The other way only delays my sharing of the information for what’s been a couple years. New on top and I think it will be easy to just add things in a day at a time as I think I learn something important enough to write down with no planned schedule. The following is also just my raw notes, so if you chose to read them, don’t expect literary genius. The notes were 27 pages long when copied from my google documents, so if you are looking for something in particular “control-f” is your friend “command-f” if you are on a Mac. As always I’m interested in comments and questions so feel free to ask questions or tell me something if you think it will help in the “leave a reply box” at the bottom. Chad Reilly, Physical Therapist
[4-11-17] Just tried “trans cerebral” EMS, with the electrodes over the parietal/sphenopalatine ganglion region, which I just read about in a paper on surgically implanted electrodes for cluster headache. I’ve always been a bit afraid to try it, but I’m also thinking that if I start recommending EMS for headaches, with the advisement to keep the electrodes right next to each other, it’s only a matter of time until someone messes that up. I would think the big risk would be could you cause a seizure as with electroconvulsive therapy (ECT) at which point you might be less depressed, but maybe have some memory loss. I’ll have to look in ECT book to see exactly what parameters they used but my recollection was that the amount of stimulation used was WAY more than you get from a TENS/EMS machine. I did my 10-10-10 headache program and started with 13/14 mA and only worked up to 15/15 mA. My thoughts are that the farther away electrodes made the stim feel way stronger and the EMS was definitely hitting my masseter muscle. Contrast to supraorbital stimulation with the electrodes side by side, I can get to 30 mA. 15 mA was plenty uncomfortable at first and if my headache patient data holds true for transcerebral stimulation, nobody is going to go that high, nor do they need to go that high to eliminate a headache. I didn’t notice any brain stimulation effects, just muscular and tingling outside the head so maybe it’s no big deal. Afterwards I felt fine and I’m able to write this. I felt “alert” afterwards if that means anything. I still wouldn’t recommend it because keeping the electrodes closer together is supposed to keep the stimulation more superficial and superficial stimulation is what is supposed to best target the nerves and blood vessels involved in a migraine, though I’m not sure how this would relate to a cluster headache.
[4-2-17] Sacral stim attempt. Criss cross with posterior electrodes just to the side of the sacrum and brother electrodes on opposite side femoral triangle. 5-15-10 with 35/40 mA to start. Moved up to 45/60 and stim felt pretty strong. No pelvic floor stimulation but paresthesias and twitching in quads. Posterior stimulation doesn’t feel as strong probably because any nerves are way deeper. I couldn’t tell you if there is any detrusor muscle inhibition or not but I imagine the stimulation is going considerably deeper than if you just put one channel electrodes side by side the sacrum. That’s what I would do if I wanted to prevent deep stimulation, like in headaches. At 45/66 during the blast, quad contractions started to cause my knee to extend, but it was easy to overcome by flexing hamstring. 55/66 both knees extended uncontrollably. Not able to overcome with hamstrings. Feels like it might work, and the advantage being electrode placement is easy, uses one thick strap and non-”invasive.” Another try. One channel side by side of sacrum. No idea if there is any detrusor inhibition but I do feel glutes contracting without anything else getting in the way. Went to 55/70 within a couple blasts then 65/75, which I would have to think is more than just superficial stimulation, but don’t notice any stim or paresthesias going down legs. Did another just like above but moved the single channel of electrodes outward and down a little, right over where I think the sciatic nerve is and went to 55/70 mA and just notice glute flexion with just a hint of a paresthesia in my left ankle that might be my imagination. So I think that makes me think sciatic nerve stimulation is impractical. The nerve is probably too deep to reach in most people. I think my first choice for stim for my upcoming patent with overactive bladder/urge incontinence will be a criss cross pairing of the tibial nerve at the medial ankle with the brother electrodes on the opposite side of the sacrum. Though I’m thinking it might be tough to outdo my criss cross “hips-2” pattern I was using for general hip muscle strengthening. And core 2 I expect would really increase “reflexive” contractions of the pelvic floor. So far I’m not getting much in the way of direct EMS contractions of the pelvic floor without invasive electrodes that I expect most people are loath to do. One more idea, criss cross hip out with other side hip in (abductor-adductor). 40/45 to 45/45. Feels like adductors and abductors are working really hard but criss cross stim does feel like it’s hitting pelvic floor muscles much at all. Running core-2 now, just to work my abs as usual with 10-50-10. 45 mA first blast the stim does feel like my waist is being squeezed by a snake and I think my pelvic floor muscles do tense up significantly during the EMS blast, but it’s nothing near as hard as my core muscles are contracting with the direct stimulation. Still the pelvic floor contractions feel higher than with any of the leg stim patterns, but probably just in the range of doing kegel exercises. Giant 5-8” electrode, single channel, front and back, quickly to 80/100hz, put “rest” stim at 8 hz because of paper I am reading right now indicating that’s probably ideal for detrusor muscle inhibition. Still non-invasive, easy to set up, comfortable, maybe worth a try. To 90/110, you can comfortably get a lot of mA with the giant electrodes.
[4-1-17] Working on stim pattern for what might work for incoming patient diagnosed with overactive bladder / and urge incontinence. First try: Criss cross back of knees (tibial n) with parasacral stim. 5-15-10 program, 30/45 mA to start. Went to 33 mA on blast and had unbearable calf cramp so went back to 30 mA. Feels like a lot of deep tingling & but not much in the way of pelvic floor action. Moved distal electrodes to feet, 20/34 mA and it felt stronger but no floor action even up to 23/40 mA. Then did just soles of feet like my neuropathy stim at 25/40 mA and felt almost as good as combined with parasacral stimulation but don’t feel it at all in the hamstrings. Criss cross with single channel over tibial nerve 25/50 mA up to 36/55 mA and it felt like it might work, slightly more proximal stim feeling than with feet stim but no noticeable floor action. Tried tibial nerve stim with 2 electrodes (1 channel) per leg and not criss crossed and 30/45 mA up to 35/45 mA and I didn’t feel it would be as effective as criss crossed with a single channel as all tingling was distal, no proximal feeling at all. The ankle placement seemed to have the benefit of not cramping the calves, but afterwards my calves felt pretty pumped, with some DOMS the next day, particularly the calf that cramped.
[3-25-17] I’m preparing a review blog on RSD and TENS, and I’m reading about the various electrode placements and how they were putting the electrode on the femoral triangle, either with or without the paired electrode being on the dorsum of the foot. I had noticed really good and deep stimulation (that I expect would work better for TENS than EMS) by putting the distal electrode on the sole of the foot, and in theory the sole should feel better because it’s meatier and research as shown that electrode placement over muscle (for pain and certainly for EMS) works better because you can comfortably handle more current. However, even though the top of the foot is  bunch of bones, the dorsum placement felt just as good, probably because when combined with the other electrode being so far away at the hip, the current is running so deep through the leg that it doesn’t matter. Placing the proximal electrode over the sciatic nerve at the glute felt slightly less tingly than over the femoral triangle, but I bet if you have a fatter bottom then then it would work less still as the nerve would be further away from the electrode. Just having the electrode proximal (at the femoral triangle and sciatic notch) didn’t feel like it simulated very far distally either front or rear, so I think having the other electrode placed on the foot (top or bottom) is important if you want deep stim throughout the leg and foot. Then I tested a single channel, with one electrode over the sciatic notch on the left and femoral triangle on the right. At 50 mA, left side all I got were glute contractions and right side a mild quad contraction and tingling over the thigh only, maybe very slight in the ankle.
[3-20-17] All that pain, 120 mA with sticky electrodes and I didn’t get a stitch of DOMS. Pec stimulation sucks and I’m at a loss as to why. I still wonder if I can max out the TwinStim4 like I did the Globus. In theory it should be easier since both pulse width and maximum mA are less. So I tried it, got 81 mA on first blast, up to 100 on third blast and riding it out. Using the ___ sticky electrodes. Felt intense as hell, getting that high up with my muscles still that fresh. With the Globus last time I hit 120 mA, but only at the end and on my 2nd run of 10-50-10. Moderate pump after, felt better than worthless. So why is my tolerance to stim so much higher? Probably part is a manned up, and with the Globus it was a lot easier to move up the intensity to feel what I could take. Part is the research is clear that people get used to stim, and can take more over time. So I expect it’s some combination of those two factors.
[3-17-17] Going to try pec stimulation with my Globus Genesy 1100 cause the TwinStim4 is at work, so this won’t be an apples to apples comparison but pretty close. Those sticky electrodes in past weeks did give me a muscle contraction that’s marginally good, but man they hurt. So I just dug out my larger sticky electrodes that came with my Globus machines to give them a try. I’ve never used them before because by the time I upgraded to a Globus machine (still my favorite by far) I was already sold on the merits of rubber carbon electrodes over that of sticky. So if pecs are the only muscle group where sticky works better, I want to find the best sticky electrodes. So let’s start: First blast on 10-50-10 program went right to 50 mA, not too bad! Only minor stinging from on electrode at 35 mA on up. 55mA on 2nd blast and maybe spoke too soon, that electrode stings bad. Other 3 don’t. I’ll mark it and see if it’s the pad or placement next time I stim. 60 mA on the 3rd blast, 60 again (definitely getting higher than with the TwinStim4 & ____ combo). 70 mA next, only the one electrode hurts. Pushed left pec up higher independently since that side not stinging so bad, so at 80 and 75 mA with 2 min to go. 80 and 75. Finished with 92 and 85 mA. That was a lot higher, than I got with the TwinStim4 _____ combo. Come to think of it, those other electrodes are here. I’ll try them out with the Globus and see how high I get right now that I’m warmed up. Went right to 65 mA, these electrodes sting more, right from the start but still started higher with Globus than I finished with TwinStim4. 70 mA 2nd, then 75, 80mA (at 80 the stim is intense enough it’s starting to counter the sting with these electrodes) 85mA hurts again. 6 min to go and I’ll see if I can break the 92 I got on the left side with the other electrodes. 90 with 5 to go, if I don’t reach 100 now then I’m not a man. 95 (I have to say that the contraction doesn’t feel exceedingly hard, like my pecs have atrophied some from a decade of no bench press, post 3rd shoulder surgery) and after you get a smaller muscle to contract as hard as you can more stim doesn’t hit it harder. 100, 105, stings pretty bad, one to go. 120 mA MAXED IT! Booyaaah. More than double what I got with the TwinStim4 with the same pads. Will try to max the TwinStim4 and see if the extra 50 mA of the Globus makes that much difference, or if I just toughened up. If I don’t get some good DOMS after that, I don’t know what to say because I just maxed out a Globus Genesy with what are some smallish sticky electrodes. I definitely notice the ease of operation of the Globus and being able to push up the intensity of all the channels at once rather than down once followed by up, up, up one channel at a time with the TWINSTIM4. It’s got me thinking about something, those smallish sticky electrodes hurt real bad so I’m probably eliciting a fair number of _________ neurons, so maybe the reason why the larger rubber electrodes work so much better for pain is that with the better conductance and lesser current density, you are only activating the _________ fibers pushing the gait control wheel purely in the opposite direction as the chronic pain central sensitization wheel (the wheel is how I’m conceptualizing it and want to write up a complete description later). If you stim with a lot of pain you would activate both the _____ and _______ and might then jam the wheel. In theory you would want to reverse it I would think.
[3-4-17] Pec stim with TwinStim4 hurts like hell. Not because of the machine but those sticky electrodes just don’t cut it like the rubber ones do. Got to 50 mA, which I think is my highest and it felt effective with my muscles feeling pumped after, but it sure wasn’t a joy. Larger sticky electrodes than the 2×4” ovals will likely be more comfortable. I’m going to try core EMS today with two channels and of the TwinStim4 and the super large (5×8”) electrodes and see if the machine is strong enough to drive the giant pads. Was able to turn the machine up immediately to 100 mA (maxing it out) on the first blast. It’s not light and in fact seems pretty strong, but not as strong as the where for core I use twice the channels and smaller electrodes to get more current into my core. And not as strong as when I used the Globus, three channels, and the big pads and got to 120 mA, which evidently raised my blood pressure so much that I had petechiae the following day. As I’m going, I think the trick to not having your blood pressure elevate when the stim hits your core, is to breath out and empty your lungs so there isn’t much for the muscles to push against. I’m not sure if I can get a BP reading that fast to test but it sure feels like my BP is higher when the contraction comes and I’m full of air. The other downside of the giant pads is you have to be a bit of a contortionist to apply them around your core. I stopped doing so in my office as the smaller (3.5” circles) were faster and a lot less awkward to put on for both patent and employee.
[2-22-17] Three things: One: My pecs are mildly sore from last night’s EMS so maybe there are applications for sticky electrodes, though of all muscle groups tested, only pecs is the first place I have thought so and I still had to shave my chest to get it too work. For strength and hypertrophy I’m sure bench press would be better, but since I have had three shoulder surgeries, bench press is out. Two: I was able to get up to 80 mA on neck EMS with my TwinStim4. It felt strong and good with my 3.5” rubber carbon electrodes and my normal criss cross neck EMS electrode placement. It felt hella strong so I think it’s a legit stimulator. Three: I have a guy with severe sciatic hypersensitivity secondary to two herniated lumbar discs. So I’m stimming his core to increase core strength and decrease back pain, though his back isn’t bothering him near as much as his leg. So I have been doing FMTENS (my new name for Frequency Modulated TENS) with on pad on his femoral triangle and the other on the sole of his foot with an effort to decrease leg sensitivity per gate control theory. It’s hard to tell if it’s working, because I’m doing a lot of other things too, but anyway his pain is way down. But I was thinking. I’m doing the femoral triangle/foot pad placement for deep leg stimulation as tested once before in my notes after reading about it in some study (I’ll have to see if I cited it) and being duly impressed in real life when I tried it. However I was thinking, putting another channel over the piriformis muscle region to specifically target the sciatic nerve and its brother electrode on the top of the foot might be better. So I did just the femoral triangle/foot bottom on one leg and the same plus a piriformis/foot top placement on the other leg and to be honest I didn’t feel a lot of difference. So the two channels on one leg might be a little better, but not enough to write home about. However, if you have unused channels on your machine, they why not, as the strap use is the same. So next time I think I’ll try femoral nerve/foot bottom with one channel and sciatic nerve/foot bottom with the other and see if one feels better worse, or different. Update a couple hours later. My soleus on the right (the two channel leg) is sore like I worked it out real hard, while the left leg (single channel) feels pretty much normal. So I would say the two channels even if it didn’t feel that different during the TENS did get worked harder. Which is interesting because it was FMTENS at 30 mA rather than EMS. I think that’s the benefit of having the electrodes so far apart (hip to foot), the ES just goes real deep.
[2-21-17] Finally figuring out how to train pecs with EMS (maybe). The trick, use Uni-Patch (apparently from Medtronic now) sticky electrodes and you have to shave your chest. Yes I know I always say I hate sticky electrodes, but of the one’s I have tried the Uni-Patch brand are by far the best I have used to long term stick, conductivity and lasting ability (per my experience using them on an EMS bike for TBI and SCI patients. I still like rubber carbon better almost all the time, for all these reasons, but I think for pecs, trying to strap rubber carbon in place, the elastic just won’t hold them tight enough against your skin, so I was always using both hands to hold them in place in addition to some fairly high tension elastic straps. So today was day two using 2” x 4” oval electrodes, one over the upper inner pec and the other on the lower outer pec with channel 1 and the mirror image used on the other pec with channel two. It felt like a good hard contraction, not epic like core or neck, but hopefully better than a waste of time, so I’ll try it for a while and see if it’s worth the effort. I got to 45 mA today, starting at 30 mA, and I forget what I did two days ago but probably not that different. No DOMS on pecs from two days ago though, while my abs were plenty sore from the last time. My Uni-Patch electrodes have been in a box for years (maybe 10?) and seem to work just fine, but now I see are on the medtronic website, and I see they have several versions, so when I wear these out I’ll have to do some comparison testing. I should probably give the stock Globus electrodes a shot too. I do notice the sticky electrodes sting more even with low intensity (~15 mA) EMS, but if I just keep turning the machine up, the tingling outdoes the stinging. So I’ll see how that lasts if I work up to higher intensities.
[2-2-17] Trying out the two channel Twin Stim 4 machine. It’s actually pretty good. There are a few annoyances with it, like I can only turn up one channel at a time, I can’t upload my presets to it, I can’t rapidly increase the EMS like I can on the Globus or even EV, and it has pictures of body parts to coincide with EMS treatment protocols that defy logical sense. However, it’s an inexpensive ($70) biphasic symmetrical square wave two channel machine that’s programmable and I can save 6 different EMS programs (one for each picture) and 6 different TENS programs, though the TENS programmability seems limited to just changes in length of treatment, rate of impulse and width of impulse, but no individualization of frequency or _____ modulation. Pulse width is 400 uS is pretty stout, and almost as strong as my Globus. For an inexpensive two channel machine, it’s my current recommended machine as best for the money. I expect it work great for headaches, and other applications where one or two channels are all you need, and power needs are not extreme (for example advanced neuropathy). The battery is rechargeable, and I’m not sure how long it will last.
[8-11-16] Playing around with some foot intrinsic pad placements and parameters. What I would do if I were targeting/treating bunions. Pad placement on forefoot top and bottom, not criss crossed, seems the best. Criss cross makes the contractions not feel local enough. Did 10-50-10,5hz and started with 40 mA and 50 mA. Did about the same yesterday with 5-10-10,5hz and mA kept going up up up cause muscles fatigued so fast. So maybe Kotz is right. Also I’m changing over all my EMS machines to have a 5 hz pulse during the EMS rest period. My reasoning being that if you don’t like it (like I don’t like the 1 hz pulse anyway) you can turn it down to zero during your session, while if you do like it, you can turn it up during your session. Yesterday I did 10-50-10,5hz and both core and neck, didn’t like the 5hz twitch at all, but just turned it down to where I barely felt it, so it was no consequence. I still haven’t tried it on any patients yet to get much feedback.
[8-3-16] Some headache experiments. New employee has chronic headaches, tried my new freq mod TENS program that I was testing, with supraorbital and suboccipital stimulation, and she said her pain was more temporal (which had me a little worried it might not work, but I didn’t verbalize my doubts because I didn’t want to ruin any placebo effects, and because the combination of =SONS and ONS almost always works. She said pain went up a point (3/10 to 4/10) which is the first time in all my my tests that pain increased. So I was thinking about that, about how my Freq-Mod TENS program only went up to 80 hz, and if my idea was right about high frequency fatigue, the 120 hz I get with the 5-15-10 and 10-50-10 EMS programs. So the next headache she had on 7-26-16 was combined right side temporal and supraorbital stimulation. So my idea was to do one channel (2 electrodes) one over her supraorbital nerves and the other over her temporal region, which was close so I figured the two channels would target the EMS exactly where we wanted it, and since the electrodes were directly adjacent to each other there would be lower risk of “brain stimulation.” Initially I put FRQ-MOD TENS, and she didn’t like it, so I immediately switched it to my most proven program 5-15-10. The result, 6/10 pain of 3 hour duration was gone about 5 minutes into the 10 minute treatment, with 0/10 pain afterwards, with only 1 headache when at home since the 7-28-16 treatment (on in 9 days so far, not bad!). Yesterday we did some additional experiments, cause she said she had bilateral SON region headache. We weren’t sure if it was the different electrode placement or the different parameters that made the difference. I suspect it’s both. She also asked about the Cefaly device, so I wrote up another program using Cefaly parameters, so I programmed them (60 hz, 250 uS, up to 16 mA) but with otherwise equal parameters to what she did last (5-15-10 at 120 hz, 450 us, and mA as tolerated. She got to 6 mA on with the Cefaly parameters, and 4 mA on my preferred settings. She didn’t have a headache at the time, but I wanted to know what she thought of the differences. Also to better simulate the cefaly we used 1.25” square sticky electrodes both ways. She said with a headache she’d want my settings but maybe for prevention she would like the Cefaly ones since it felt less intense. So I decided to try it myself with the same sticky electrodes and with Cefaly vs my parameters. I got to 16 mA within the first minute the Cefaly parameters, which felt intense but not that intense, but I’m pretty EMS tolerant at this point. I was able to get to 16 mA, immediately and it felt more intense but not much less comfortable, and by the end of the 10 minute treatment I matched my prior record of 30 mA and could have gone higher, but it is my brain were talking about. It’s my second favorite organ. Today as a follow up experiment headache she says her headaches are typically temporal or supraorbital (never suboccipital) but the side is inconsistent. So I think for prevention, where you don’t know where the stim is going to go, and you still want the pads very close to each other we tried. Channel 1 on the right SON and TN, and channel 2 on the left SON and TN, SUCH THAT THE PADS OF EACH CHANNEL WERE DIRECTLY ADJACENT TO EACH OTHER NOT CRISS CROSSED WHICH WOULD PROBABLY CAUSE DEEP BRAIN STIMULATION. Deep brain stimulation might be great, or might make you forget your address and phone number, and near as I can tell isn’t at all necessary for the treatment of headaches. That’s just a warning, because, these are just my experimental notes and if I share them online, they are not prescriptions.
[7-13-16] Have a CVA patient who on her 3rd visit is making spectacular progress, drop foot when walking gone, and this seems better than we think she was prior to her first stroke in 2014, TIA in 2010, and her recent stroke 5-13-16. So in addition to exercise, I’m having her do 2-2-10 program which she is working up pretty high. She had neuropathy in her right foot so I tried the combined glove and sock on the right side, thinking that would be a fast and easy way to get real deep stimulation for someone with hemiparesis. The depth of stimulation being so deep because the electrodes were so far away. It didn’t go that well because her foot with the neuropathy was very sensitive to the stim, such that she could only get to 6 mA, while the hand stimulation was easy. I hooked it up to myself (left side sock and glove) and worked up to 40 mA in 3 minutes of 2-2-10 program. I stood up to prevent the foot cramping and once standing it was my left arm that was limiting me from going higher. I thought it maybe wasn’t the best combination because my arm felt like it was working a lot more than my leg. However, afterwards (just 3-4 min of stim) my calf muscle felt pumped for a few minutes and “worked” for at least an hour (thus far) and my left forearm feels worked, even into my triceps. So not bad for just one channel of EMS and the mesh gloves. Since my CVA patient didn’t anywhere as high as I did, I had her do stim again with the 4” rubber carbon electrodes strapped to her biceps/triceps, forearm (top and bottom) and calf/TA and she worked up the stim to ~25 to 35 mA, so in her case, this time, I think the latter was a better workout. I think continuing with the foot stim with the sock will have merit for the neuropathy going forward, so will likely try it again. Plus I want to see how long those electrodes last with frequent machine washing. Interestingly, my soleus (lower calf) had DOMS for 2 days after the experiment with the sock and glove. At the time I did it, I felt like my foot and calf muscles weren’t working nearly has hard as my arm. And it’s not like my muscle are untrained as I’m currently doing single leg DB calf raises for 3 sets of 20 reps (definite “T”) holding a 50 lb dumbbell.
[5-24-16] Did EMS to neck today, a couple days behind schedule and only got to 90 mA, so maybe the secret to getting high mA levels is hitting it more regular to build up a tolerance. Or maybe you don’t want that tolerance because a tolerance may or may not lead to harder muscle contractions. Today felt pretty hard!
[5-19-16] Got to 115 mA at 450 uS on neck this morning and it wasn’t that bad. I figure I might as well go for 120 mA coursing right through my carotid sinus. If that doesn’t kill me, nothing will. Did core 2 and just got to 85 mA. So neck EMS is now my highest tolerance, not counting the calf EMS I did a year ago at 120 mA braced into a leg press machine to prevent cramping.

What about aerobic (5 hz) EMS/TENS to the neck. The idea that it would improve aerobic conditioning of the swallowing/breathing muscles to treat sleep apnea. I think 5 hz for 10-30 minutes prior to or following 10-50-10 for muscle strengthening would improve the strength and fitness of the throat muscles for people with sleep apnea, and might also improve the brain/muscle link in those with central sleep apnea. I got the idea from a patient who had sleep apnea return and was going back on the C-Pap in spite of the fact that she had lost 40 lb with intermittent fasting. Also I thought the aerobic TENS would be a good test of the effects of stimulation to the carotid sinus because it’s continuous and thus I can repeatedly monitor my BP with my Omron cuff and fitbit. I predict, HR and BP to go up a bit not down just because of the exercise aspect. Not sure how tolerable it will be because the last time I tried aggressive aerobic EMS I didn’t like it too much, but maybe it won’t be so bad if I don’t do it too hard. I’ll know in a few minutes. So 30 min program HR at start
  • 136/86 & 47 (dig that resting heart rate!)
  • 1 min, 150/88&78 started at 80 mA and too bumpy so went down to 60, still hella bumpy.
  • 5 min 154/100&80
  • 10 min 140/90&75
  • Went up to 65 and couldn’t get cuff to read, came down to 60 and still had trouble
  • 18 min 114/69&120 fitbit HR 68 (I think the OMRON was wrong on this one)
  • 20 min 143/87&63
  • 25 min 124/85&85 fitbit HR 60
  • 29 min 127/78& 61 fitbit HR 58
  • Right after 127/80&53 fitbit HR 53
  • 5 min later 124/79&51 fitbit HR 51
How about that? Vitals performed about as I expected they would. As for the experience it was hella bouncy. Shoulders shrugging up and down so I couldn’t read hardly at all, gave up on the idea of reading a paper during the stim. Could barely type out the above responses. Otherwise it wasn’t really uncomfortable, EMS didn’t sting or hurt a log, just bouncy/bumpy the whole time and I think if you had neck pain or a headache it could either get irritating or cure both. I think I could have worked up higher where it would have been painful, but then the BP cuff wouldn’t work, and it was iffy as is, having to take a few different measurements. Most people probably won’t bounce as much as me just because they don’t have as much neck muscle. Fitbit seemed reliable throughout. Borderline hypertension at the start of treatment cured! Does make me wonder if what’s better for combined stim, strength or cardio first? Or does it matter.
[5-10-16] Last night I did 10-50-10 EMS on my neck and got to 85 mA on the last blast, which was just 5 mA shy of my prior record. I was pushing it up each time but not really trying for a record but maybe next time I’ll try for a record. I also tested out a “guts” program, where I had a 3 second ramp up, _____________ The ramp felt hella comfortable and I worked up to 60-70 mA as I recall and my abs are sore today, but no idea about viscera, but sure felt like it should work. I felt like I was about to start sweating by the end, like a real workout, and with the short rests it was fairly unpleasant, just because it was on so much, I couldn’t read during, it unlike 10-50-10, where you just have 10 blasts that take your attention, but during the rest periods you can actually read a paragraph.
[4-9-16] Experimented 100 hz instead of 120 hz on neck EMS with my typical 10-50-10 protocol. This was spurred by a email conversation I had with Giovanni probably over a year ago, when I said I had couldn’t find where Charlie Francis said he liked 120 hz with his EMS protocols and Giovanni confirmed that was the case per conversations he had with Charlie, but I still can’t find my cite. Giovanni said he still programmed his Globus machines at 100 hz and Charlie liked the programs and felt I was overkilling it with 120. I think I tried it at the time and stayed with 120 hz anyway, but thought I’d try again. 100 hz felt just fine, activated the muscles great, but I think 120 hz just feels slightly creamier, slightly less grainy a stim than 100. Not near as big a difference as I noticed when testing the 60 hz used with the Cefaly machines, but I put my machine back at 120 anyway. This was more spurred by my friend Grant’s professors saying my use of 120 hz was “non-standard”, well I guess if you want standard results, go to Baylor’s school of physical therapy and sign up to be in their dry needling experiment.
[3-6-16] Pecs not sore at all.
[3-5-16] Tried giant pads on pecs, one channel, one pad per pec (portrait) with new wetsuit vest. Started at 75 mA and got to 120 mA and it seemed to work pretty well. Even with the wetsuit though I had to use my hands to press the pads against my pecs for good enough contact to prevent stinging pain above 65 mA or so. Sticking out my chest and retracting my shoulders helped too but not as good as direct pressure with hands, so I had to grab the machine and hold it too my chest before the stim began so I could increase the intensity. Felt like a moderately intense workout, maybe it will get better if pecs hypertrophy, but machine already maxed. Will try other patterns. Will see if I get DOMS tomorrow. Pecs looked and felt a little pumped after.
[3-1-16] Abs pretty sore today, anterior, obliques not so much after core 6. Petechia going away but not gone.
[2-29-16] Haha, looked in the mirror today around lunch and had petechia in forehead, around eyes etc. Not extreme but definitely noticeable. The only time I’ve had it before was
[2-28-16] Weekend EMS. Did neck today cause I’m going to up neck EMS frequency to twice a week. Neck circumference has dropped down ¼ to ½ inch to 17.00, which might be due to fat loss from fasting and my no meals Mondays, or because I decreased my EMS frequency from twice a week to once a week. So neck by itself I got to 85 mA today, which was pretty close to my all time record of 90 mA. Also tried Core 6 Big Pads (6 big electrodes all criss cross diagonal, all portrait which fully encircled my core, even overlapping a smidge. I really wanted to test it so I started at 60 mA and worked up to 70, 80, 90, 100, 110, 120, 120, 120 and it was pretty immense. Felt like the valsalva you would get doing 20 rep squats all holding your breath. Like your heads about to pop. Just an immense squeeze. So it definitely works, likely is pushing the bounds of safety. Though I feel fine now. Makes me think with all that EMS coursing transabdominal that it might be ideal for functional abdominal pain/IBS, but you would definitely want to go to the bathroom first, and probably wouldn’t need to go near so high of intensity and my Freq-Mod TENS program might be better, or might not. But for a fact the big pads let you tolerate way more EMS without discomfort. While the stim felt immense it was the muscle contraction causing it. The tingling wasn’t that bad, with no real stinging/prickling that I recall. Also those big pads are a PITA to self apply if you are wearing a shirt and coming up from underneath. Shirtless with just the big strap they went on easy dropped in from on top. For core strengthening it might be overkill though and using 6 pads negates the advantage of having two free channels to train neck (or something else) with. Also my waist being 34” is probably the lower limit for how it would work, cause because smaller wasted people would run out of real estate. The electrodes being 5.25” wide when placed in “portrait” would allow another pair (4 channels 8 pads) if waist size were 42” or bigger, if they were so inclined.
[2-24-16] Did Core 4 big pads, all portrait except lumbar which was landscape as I think portrait on the lumbar spine will stim as much bone as muscle, combined with my neck EMS with regular pads.  Started at 50 mA neck and 70 mA core and worked up to 65 and 85 by the end of 10 minutes. As before it’s almost overwhelming. This mornings combined neck and back pain patient I treated got to 56 mA core and 11 mA neck and reported it brought her low back pain and neck pain that were both 3/10 to 0/10 immediately after. She thinks it feels great but isn’t going near as high on the neck, so I’m sure it’s more comfortable. The overwhelming feeling however, hitting both core and neck circumferentially I have to think would really power pain down via gait control theory and might be just the ticket for those with widespread central sensitization with conditions like fibromyalgia.
[2-19-16] My abs are pretty sore from two days ago. Even my lower ribs are sore, probably from large pads overlapping my intercostals. Becky tried “Core 4 Big Pads” all portrait today and wasn’t impressed. Said Core 2 feels like a better workout, plus getting Big Pads in place and keeping them wet was a PITA she says.
[2-16-16] Tried core 5 big pads diagonal, all portrait and combined it with neck stim since I had the two extra channels. Worked up to 65 mA on neck and 85 mA on core. Felt like one hell of a workout with all that stim going on at once. Almost overwhelming and with the neck stim going I don’t think I can give a fair assessment of how Core 5 diagonal vs Core 4 felt. I guess I’ll see if I’m sore tomorrow. Seemed hard to get either neck or abs as high as usual at first due to the overwhelming stimmage, but got reasonably high near the end of the 10 minutes. It was cool to get EMS workout done in 10 minutes instead of two times 10 minutes, however with all that EMS going on at once, the 10 minutes feels longer. To be continued.
[2-12-16] Courtney tried Core 5 Big Pads (60-80 mA, all portrait) “Not impressed” Says it wasn’t any better than before but there was more paresthesias going down her leg from one of the diagonal anterior electrodes. Says her back was maybe worked a little better but still likes Core 4 Big Pads more. Says Core 5 Big Pads, still feels better than 10 cm electrodes for both comfort (for sure) and workout intensity (maybe) but she says it’s hard to differentiate.
[2-11-16] DOMS in abs from yesterday and interestingly hip abductor muscles getting DOMS too, with portrait placement of large stim pads just barely going down below iliac crest, but seems to have hit hip abductors relatively hard anyway. Want to try with combined targeted hip abductor and adductor stimulation using all four channels.
[2-10-16] First EMS thing I learned this year. Core 4 Big Pads Trained core just using 2 channels but 4 electrodes that are huge 5”x8” putting one electrode sideways across low back and it’s pain sideways across abdominals while channel two was placed vertically on obliques (I put them vertical so they wouldn’t overlap but it might fit better horizontal so I’m not stimming my iliac crest, which didn’t feel that great. Otherwise it felt like a good workout and only used two channels. I’ll play around with vertical vs horizontal placement of the pads, which I expect will be something that should be mixed and matched in accordance with a person’s girth. Vertical for skinny folks and horizontal for fatter. Felt like a good workout. Started out with 75 mA and worked up to 90 mA, and I expect I’ll be able to do more. Also thought of a new idea to try, which would be the same 4 electrodes but instead of placed front back and side side, they would be placed diagonally on quadrants so will try that next time and have the girls all try both in the office to get their feedback. The big pads did seem a little more difficult to get placed well on my core by feel. One downside is if I got up to 105 once with the small pads doing core 2, if I keep with the big pads I might max out the Globus, buy maybe not as my stim tolerance seems to have decreased, this year, for which my guess as to shy is increased autophagy of my nervous system from the >9 months of intermittent fasting I have been doing. Definitely this is a Globus thing since I started at 75 mA and worked to 90 on first try, there is no way the EV-906 will be powerful enough to drive those big pads. I don’t think it’s better than using the smaller 4” circular electrodes, but it frees two additional channels so they could be placed on hip glute medius or maximus or quad/hams just so you can hit more muscle at once if so desired. I got the idea because I did so desire, for my patient who had both low back pain and trochanteric bursitis. So I tried it on her last week and she liked it, so I wanted to see what it felt like. Also tried it on a patient with sports hernia where his abdominal pain was more central so we wanted to use one pad over his central lower abdominal region paired with another big pad on the spine extensors and he said that felt pretty good. So anyway, not a lot of new comments on EMS pad placements and experiments in the last year because my treatments are more set and a lot less experimenting, at least on myself. I’m lifting weights now for general fitness, and doing EMS once a week for abs and neck (because that’s better than weights for those) for neck. I was doing twice a week on both but it seemed like overkill and my neck circumference increased substantially by eating more protein with my intermittent fasting, and exceeded my neck circumference goal of 17” hitting 17.25. Girls say any bigger and I’ll look freakish, so I figured I’d lessen my EMS frequency to once a week for maintenance. So the big pads seem cool for strength, something new to try out. I guess another thing I learned is people love the Frequency Modulated TENS program I wrote up on the Globus Genesy last year. Posterior neck, upper trap and middle trap placement done supine with 4” circle pads is something my neck pain patient LOVE, so I think it’s going to be my go to program for neck pain. I still think EMS to the neck (front and back) is going to be the best thing for pain and strength, but since I test everyone’s heart rate and blood pressure when trying it, I think that increases anxiety, which is something neck pain patients have too much of anyway. So I think I’ll keep up the freq mod TENS for the time being going forward, until I get my safety study completed and published so I can stop increasing people’s anxiety about EMS over the carotid sinus “maybe” being dangerous. About Core 4, Courtney said: Awesome, got it up way high and was way sore (DOMS). Says the velcro needs to be tighter. Says she noticed with the pads in “landscape” if felt like the charge was stronger on the side of the electrode where the wire was in and less so distal to it. Better than the small pads. She likes it in portrait all the way around and the current felt even. She says started on maybe 50 mA and worked up to 80 mA.
[9-30-15] EMS tolerance decreasing with increased use, or fasting? Just noticing lately that I have been doing EMS to neck and core on the reg, 2-3 days per week, but the mA I am working up to is way less than it was last year or earlier this year. So on neck I’m starting at ~40 mA lately and working to 50 mA, maybe 60 mA, but certainly not the 90 mA I got to several months ago. On core 2 I have been starting around 30-40 mA and working up to 50-70mA, which feels strong as hell- such that I have no idea how I ever got to 105 mA last year. If anything, I’m more fit, muscular and leaner now because I have been doing the intermittent fasting, combined with 4 scoops of whey protein per day over the last couple months. So I think the higher sensitivity to the current is because I’m leaner by a couple percent of body fat while my overall muscle mass has increased with my combination of weights and EMS (right now to different body parts). Charlie Francis talked about that in his book, how the leanest athletes with the most type II muscle fibers often required the least EMS because fat is an insulator and type II nerves and muscles contract with EMS particularly well. At this point it’s the only thing I can think of that would explain it
[7-30-15] TENS frequency vs amplitude modulation Thoughts on TENS modulation: I don’t like amplitude modulation, it feels boring just like stim getting stronger and lighter at a given frequency. It feels like EMS ramping up and down. If I’m going to do that, I would rather just do EMS. Frequency modulation feels novel however, and I think might be psychologically more interesting, distracting, and might thus decrease pain levels more so than regular TENS or intensity modulation. I think it feels better so I might have my employees try both and see which they subjectively like better. When playing around with different programming parameters on my Globus Genesy, I settled on the following as my favorite:
  • Name: tens fr mod
  • Type of stimulation: TENS
  • Number of phases: 1
  • Phase duration: 30’
  • Program name: Symmetric TENS
  • Type of modulation: Frequency Modulation
  • Start workout frequency: 2Hz
  • End workout frequency: 80Hz
  • Workout pulse width: 450 uS
  • Workout duration: 15s
Comparison amplitude modulation settings
  • Name: tens amp mod
  • Type of stimulation: TENS
  • Number of phases: 1
  • Phase duration: 30’
  • Program name: Symmetric TENS
  • Type of modulation: Amplitude Modulation
  • Workout frequency: 120Hz
  • Start workout amplitude: 100uS
  • End workout amplitude: 450 uS
  • Workout duration: 15s

[7-29-15] Plantar fasciitis and posterior tibial tendinopathy pad placements I tried out a slight adjustment for EMS pad placements for plantar fasciitis. I had been putting my posterior electrode on kind of medial attempting to target the tibialis posterior, but looking at the anatomy I think the muscle belly is more central-posterior than I thought so I’m moving that electrode more central, just below the gastrocnemius. I think I should be getting a lot flexor digitorum longus and flexor hallucis longus, for which I would bet money they both help support the foot arch, though as of yet I am unaware of any references saying as much. I was worried that a more central posterior pad placement might hit the soleus hard enough to raise me up on my toes during the EMS like what happens when I put the pads on my gastrocnemius, but in trying it on myself just now, that wasn’t a problem. So for plantar fasciitis, posterior tibial tendinopathy, or acquired flat foot deformity (for which I expect prevention is a lot better than treatment) my current go to pad placements is standing on the pads with channel one split between the heel and ball of the foot, and channel 2 split between tibialis anterior and tibialis posterior (pad placed centrally, just inferior to the heads of the of the gastrocnemius.) Also, today I only got to 70 mA on core 2, compared to Monday when I worked up to 90 mA. I was hoping today to advance higher, thinking that if I keep my frequency of EMS up I could max out the machine and hit 120 mA. So perhaps the lesser tolerance could be due to the fact that I only had 48 hours of rest between Monday and today, while, last time I had 72 hours as I rested over the weekend. So maybe EMS tolerance is greatest if you have that longer rest period. Or maybe I used a different machine and there is some variability in output. I’ll pay attention to both going forward.
[7-14-15] Core stim in prone position, continuous headache stimulation I’m doing neck and core stim (core 2-3) after working out on MWF pretty regularly. My neck circumference is up to 16.75” pretty solid now. Yesterday I tried core 2 laying prone, and my abs felt real strong on lower stim levels pushing me into a bridge. I think I started at 25 mA and working up to 60 mA, but at the higher mA ranges I got a lot more back extension. I’m not sure I liked that, as it was almost painful. I’ll think about it. My abs and low back muscles are pretty sore with DOMS today though from what was otherwise a typical core 2 workout, so there might be something to it. I just tried EMS, 120 Hz continuous to supraorbital region, working up to 25 mA. I’m curious if it affects my mood. I have been super high energy lately due to intermittent fasting and my testosterone levels are feeling higher from fasting combined with weightlifting being added back onto it.
[6-28-15] Forearm/hand stimulation with gloves vs rubber carbon electrodes It’s difficult to type because I just finished unilateral forearm workouts with glove electrodes 10-50-10. My left hand did glove and paired CR (carbon-rubber) electrode on my left forearm extensors. On the right I did glove and right forearm flexors. Both felt very effective and both got to ~40 mA. The flexor combination, for some reason, made my hand intrinsic muscles feel palpably harder contracted. Neither was particularly uncomfortable on my wrist and hands even without bracing or holding anything. Neither felt like they worked my forearms much harder than a glove on each hand with a split RL channel, but with split RL can’t palpate my hand intrinsics during stim, and it’s hard to control machine with both hands being stimmed. I think ideal forearm hand workout might be channel 1 (glove/flexors) channel 2 (both forearm extensors). Maybe I will try vice versa with my trigger finger brace to maybe hit the forearm flexors harder. I will try both to see what I like better. I read a case study about RSD in a 6 year old and they put one electrode on the bottom of the affected foot and the other on the femoral triangle and they ran 90 and 50 Hz continuous with 2.5 and 3.5 mA. I don’t feel anything until 8 mA, and it starts feeling strong around 19 mA. I did a frequency mod over 30 seconds of 5-120 Hz at 450 us and it felt pretty good. I thought the electrode placement was pretty clever as it got the electrodes pretty far apart and I felt the stim throughout my anterior thigh and everywhere from the knee down. 30 seconds to do the mod over felt boring so I changed it to 15 seconds, then 10. Ten felt most interesting, but was still maybe too long. I certainly feel biased towards the higher rates, which is maybe good since higher rates appear (per the research) to work better for chronic pain. I changed the rate to 1-120 Hz but settled on 2-120 Hz as feeling best. I’m still biased to the high rate it seems. I stretched out modulation over 15 seconds 2-20 Hz and liked it better. Still biased high but more interesting than continuous high.
[6-26-15] New core electrode placements, core 3 While doing core 3, I tried 4 pads on front and 4 on spine extensors, criss crossed, I thought it worked by back harder and my obliques less hard (because that’s where I got the extra back electrodes from) so it all stood to reason. I had a number of my employees try it, most liked it though maybe not as much as core 2. I missed the oblique contractions with core 2, so I would therefore still say core 2 is my favorite. However, the following day my abs had decent DOMS, which I didn’t expect, perhaps because the additional spine extension better braced my back so I could work my anterior abdominal better against it, while with core 2 recently I felt my abs were winning the war of cocontraction.  It could also just be the different electrode placements getting the electric currents moving through the nerve and muscle fibers in a different direction, thus activating and training different fibers, so as I have commented before, I think there is merit mixing it up sometimes with regard to electrode placement and/or joint positions to hit the muscles differently. The other thing I noticed was when the stim went off, it really felt like an anterior to posterior squeeze, like I was being squished front to back with a vice. With core 2, I felt the squeeze as well, (much more than core 1) but the squeeze with core 2 felt more circumferential. What it really makes me wish is that Globus came out with a 5 channel machine so I wouldn’t have to compromise obliques for extra pads on the back. In the meantime, I’m thinking a good compromise would be to alternate between core 1 and core 2 for my workouts. My abs are still pretty sore even 2 days after. So it’s weird that an extra channel on the back made abs more sore, but unlike last year where I wasn’t weight training at all, just doing EMS, this year I’m lifting again, and I had just done (earlier that day) front squats up to 110 kg for 6 and RDLs 130 kg for 10 reps. The latter worked my back pretty hard and I have been doing so for weeks, so my spine extensors may be pretty DOMS proof. Plus, historically with the EMS I think my abs get more sore than my back. I had been doing EMS (core 2) after my squats and RDLs for weeks also, so I would have thought abs were getting DOMS proof as well. So core 3 might be for real. I had 2 people with back pain try it and both said it eliminated their pain immediately after a 10-50-10 workout. One of them, before trying it said her pain was too high up for core 2 to work, and I said perfect because core 3 has 2 electrodes going higher, showed her my diagram and she said cool, with her pain of 3-4/10 immediately reduced to 0/10. Everyone agrees it’s WAY better than any abdominal exercise. I also did my neck again in supine and I think that is the ideal position. I usually do it in sitting, but supine takes the load off the head if the person has a weaker neck, and puts their neck in neutral. For a stronger neck like myself, where I worked up to 85-90 mA, the supine position lets me brace my neck better in that safer, more neutral position.
[6-21-15] Electric stimulation for menstrual cramps Reading some papers on EMS for dysmenorrhea and, imagining that I had it, I think 2 pads on the lower abs and 2 pads on the low low back feels like it would be ideal, but I think girls should adjust for comfort. Also, I thought criss-crossing the pads from front to rear felt like it might work a little better because it felt like the stimulation would be deeper and might actually get the uterus. Normal, non-criss-cross placement felt almost as good. I will test that on my people (female people) and see what they think. High frequency TENS >100 Hz seems to be what’s most supported in the literature, but I think the low rate TENS groups >10 Hz is getting a bad wrap by researchers sometimes putting the pads on ridiculous acupuncture points on the lower legs or whatever rather than on the source of pain. I think the low rate TENS might work well with better pad placement. If it were me, I would probably want to use some frequency modulated current, with as wide as possible a pulse rate (300-450 uS) since high is necessary to eliminate pain. I expect more to be better than less up to a point although you might not want to go too high, with such a long treatment time. Maybe an hour+ would be an ordeal and an EMS parameters might over fatigue the muscles.  I’ll test it out on some of my girls with dysmenorrhea as they seem pretty willing volunteers. JD, reported 6/10 pain was eliminated during Chad’s TENS for 10 minutes, but she said pain returned to 3-4 a few minutes after she stopped. She then did 5-15-10 and reported that it also eliminated pain, but that it still returned to 3-4/10 afterwards, so I want her to try a 2 channel machine belt clipped on to her with a 60 minute treatment time and gel electrodes, which I hope will fully eliminate pain and still be wearable while she works.
[5-29-15] Glove and sock mesh electrodes, pretty cool! I tried out my new sample gloves and socks yesterday, filmed it, and those things are no joke. I started with the gloves, one channel split, and just trying it a few times my forearms felt strained immediately. I did a 10-50-10 workout working up to 40 mA, and my forearms have DOMS today. It felt really good for just the gloves, I didn’t need anything to grip, I just put my hands into fists to brace myself. I felt really strong stim up to my elbows and lesser up to my shoulders. The experience was maybe not as intense as 2 pads on the forearms, but maybe it was because I stopped moving up due to mild wrist strain/pain. Gloves are certainly easier to apply. The socks got my legs twitching, which I would expect to pump blood and improve neuropathy. They felt a lot like the flip flop electrodes, but are easier to apply because you didn’t have to be weight bearing. I didn’t feel like foot intrinsic muscles were getting as intense a contraction, much like the flip flops, in comparison to standing on a single channel with 2 pads on ball and heel of foot.
[5-8-15] 5hz aerobic TENS/EMS still feels best I tried 4-5&6 Hz TENS/EMS on calves to see what felt like the best for circulation. I think 5 Hz was best, but probably my experience is colored by the results of my HR tests where 5 Hz won. On my left calf I put the 2, 4” pads on my gastroc in lateral position, and on my right up put one on my TA and the other on my center gastroc to see if it felt like it would squeeze my muscles better against my tibia and fibula for more of a blood pumping effect. I couldn’t tell that it did, and my left was more comfortable and probably got more, while the TA felt like it was working more on my right. I’m sure it was, but overall muscle activation vs 2 pads on the gastrocs felt maybe less. Also, the TA stim hurt more, I think because the anterior electrode was real close to my tibia bone, so it maybe handled 10 mA 65 vs 75 on the calves at about equal comfort. So in theory ,I like the calf/TA placement better but the 2 on the calves felt better so I could work higher. Verdict = a push. Try both, keep what you like. Unless there is a drop foot then probably you want that pad on the TA.
[5-6-15] More wetsuit trials for electrode placement I’m all motivated to stim again for two reasons. First being that I want to see how much muscle mass I can maintain, since I noticed I was losing weight on my Fast 5 diet. Second, I’m doing tests on my “Muscle-Stim-Power Suit” So here goes, first try on hips, the setup was easy without any cuts, but some cuts might made it easier still, particularly for hip adductors, but I was able to reach the pads in without much difficulty. Electrode contact is good without any velcro straps. Doing a regular stim pattern rather than criss-cross since I did criss-cross last time and I figured I’d mix it up. Doing 10-50-10. Verdict, it worked great. Even an unmodified wetsuit for legs seems better than straps but reaching pads down from the top was not as convenient as it should be. All of the pads work and the contact feels good. When standing ,upper hamstrings don’t seem that tight to the skin, but since I’m doing the treatment in sitting it’s not a problem. The distal vastus lateralis doesn’t seem that tight but works fine. Maybe I need a tighter wetsuit for pants. I already ordered a smaller jacket to try out. Verdict on thighs, wetsuit worked, but slits will make pad placement easier, hopefully without destroying the integrity of the suit.
[5-5-15] Wetsuit idea for holding EMS pads in place I’m trying out my wetsuit for the first time. 2 blasts with 6 pads on my left side is working great. Maybe next time I’ll buy a tighter one as it might hold the pads better. I wasn’t sure where to make cuts so I just stuck the pads in through the chest area and zipped it up. The only thing I felt like I couldn’t get is the forearms. I might play around with my spandex shirts to put cuts so I can test positioning before I cut my wetsuit since it’s more expensive. Contractions feel good though, even on the chest (well no, chest could be tighter, all else is good). No burning so chest contact not that bad, but EMS to pecs always lackluster. Put channel one on biceps and triceps, 2 criss-crossed on posterior RTC and anterior delt, with channel 3 criss-crossed on pec and posterior delt. Channel 4 was not used but would go well on the forearm/hand. The suit works though, pads staying in place and not sliding around. Next time, I’m going to skip putting the electrode on the front delt because it’s already hypertrophied and it looks like the pec thing might finally be worth doing. Some cuts I think will make it better but it’s already a lot easier and cleaner than trying to strap your own arms.
[5-3-15] Maybe hard EMS should be right before a meal I stimmed neck, abs, core, hips, right and left thighs today. And I’m sitting here thinking it might be good to carbo load afterwards (post workout nutrition and all that) but I missed my window because I’m doing IF and can’t eat for several more hours. So that got me thinking I really ought to be doing my EMS workouts right before I eat at night, or after, or between eating, but after 5-6 pm. Or maybe it don’t matter much, as I feel fine but I’m curious if I gain weight when I weigh myself tomorrow at work. My mood today, after stimming my forehead, better than average.
[5-3-15] Continuous stim for headaches Tried EMS continuous just to my supraorbital region but used 150 Hz and was only able to work up to 20 mA.  I forget what I started at but I think it was only 8-10 mA A few minutes later I’m doing it again but returning my rate to my normal 120 Hz to see what I get, since I got 30 mA with a different machine at my office 2 days ago.  Started right at 16 mA but only worked to 21 mA, so maybe the difference isn’t the rate, maybe it’s a difference between my Genesy 300 and 1100, or maybe the extra electrodes on the neck made me tolerate more on my head. 120 Hz felt better though, it felt like the frequency was more “in tune” with my body. That might be something to test with others to see what they say. I’m curious how my mood is today. Also I noticed if I pushed my fingers on the pads, that portion of the pad felt like it was delivering more current to my body than the rest. I imagine that might be because I am improving the connection there between pad and skin (but it was already tight) so maybe I’m flattening out my skin and sub-q region getting that electrode portion closer to the sensory nerves under the skin. I’m not sure there is much practical importance here, but I noticed it.
[5-2-15] Aerobic EMS/TENS 4 hz worse than 5 hz, 5 hz seems the sweet spot 4 hz cardio test, otherwise same as last time
  • t=0 mA 60 HR and BP 52 116/77
  • t=5 mA= HR=86
  • t=10 75, 98
  • t=15 80, 108 turned on fan
  • t=20 80, 105
  • t=25 85, 116
  • t=30 85, 119
4 hz felt a little more pleasant than 5 hz, but HR didn’t get quite as high even with 5 extra mA, so it’s probably a push. It felt like the muscles were just barely, but fully relaxed before the next pulse, while at 6 hz it felt like they weren’t, so probably 4-5 hz is the sweet spot and I would guess 5 hz is best for cardio/blood flow. I’m sure it could stand a lot more tests on more people to be sure. It is cool having the Globus Genesy where I can just program and test whatever I want.
[5-1-15] Globus Genesy vs EV-906 for HAs, better but way more than necessary I did HA test of EMS (or you could call it high intensity high rate TENS), basically my favorite EMS program without the rest periods to see how that affects headaches compared to the 10 on 50 off (for 12 minutes with the EV-906) and 5 on 15 off for 12 minutes with the EV-906 I had tried before. Also since the Globus Genesy is now my go to EMS unit in my office I wanted to start testing its use. The differences in parameters are that I generally use a 10 minute treatment time (as developed by Yakov Kots and used by Charlie Francis) with the Globus because with the single button to control all channels at once I don’t need the extra 2 minutes of fiddle time used with the individual channels with the EV-906. Other differences are that the Globus is a symmetrical biphasic square wave, which for practical purposes means both electrodes on a channel are and feel of identical strength. With the EV-906, the black wires feel full strength, while the electrode attached to the red end is noticeably weaker. Is the difference a big deal? I would say no. Do I prefer the symmetrical wave of the Globus? Yes. Is it worth the cost differential between units? I would say that depends on your needs and your discretionary income. Regarding headaches, nobody (thus far) turns the machine up high enough to max out the EV-906 and my pretty amazing results thus far have all been with that machine. So I want to see if the Globus works as well or better. I suspect it will work as well, and with the more even current perhaps marginally better. Also, I program in a pulse duration of 450 uS on the Globus (its highest setting) as opposed to the 300 us on the EV-906 (its highest setting), so I’m curious if this has any effect on outcomes. I expect that it won’t with regards to headache intensities, but I expect the max mA level (height of the wave) worked up to by patients will be proportionally lower with the Globus to offset the greater intensity imparted by the longer pulse duration (width of the wave). What I noticed afterwards was that I was in a particularly good mood. The best in months. I know there is a fair amount of research on TCDCS and depression, so I wonder if I got a bit of that.
[4-2-15] Aerobic EMS/TENS 5 hz worked even better than 6 hz 5 hz cardio test, otherwise same as last time
  • t=0, mA =0 HR 55
  • t=5 70, 105
  • t=10 70, 100
  • t=15 75, 116, turned on fan
  • t=20 80, hard to read, hurts a lot 7.5/10, 121
  • t=25 turned glutes down to 77, 120, thirsty
  • t=30 126
That was unpleasant! I had to turn glutes down 3 mA because it was intolerable for that many minutes on end. My calves are really sore from plantarflexing so hard due to EMS on calves but all of the joints felt fine. Just the stim at 80 mA, which I got to sooner this time made it sore. 5 hz felt better than 6 hz at the start and it felt like muscles relaxed a little more between each hit, while at 6 hz it felt like only partial relaxation before the next impulse. I already wrote a 4 hz workout to try next time and see how that is for comfort, and will then try the 3 hz pulsed TENS program to compare on heart rate, pain/comfort before changing any other variable, like electrode size or electrode position on the lower leg. I think maybe putting a real big pad over the TA would activate the TA better while still getting co-contraction of the calves so it might be more balanced forces across the ankle. 126/177 (my calculated max HR) is 71% so not bad for watching TV. Respiration was way up but I’m not sure how to calculate that, but I expect it correlates with HR much as it would on a treadmill. Felt about the same.
[3-28-15] Aerobic TENS/EMS, bingo, it worked Giving aerobic training another try. 6 Hz, Criss cross lateral on all channels, calves, quads, and hamstrings but only 1 BIG rectangle pad on each muscle so this might have a good chance. HR 51 at start, BP 132/88. Started off at 59 mA.
  • 2 min HR 80 BP 157/99
  • 5 min HR 75 BP 150/98
  • 7 min increased to 65 mA (hard to type)
  • 10 min HR 82 BP 157/97 (not exactly comfortable or pleasant feeling and I notice I’m breathing deeper so it seems to be working.
  • 11 min increased to 70 mA, twitches almost violent feeling, 6.5/10 pain
  • 17 min HR 87 BP 148/91 increased to 75 mA right after
  • 20 min HR 103, BP 151/89, feeling warm and starting to sweat, moved to 80 mA
  • 25 min HR 114 BP 163/96 definitely starting to breathe hard
  • 27 min HR 113 BP 171/94
  • 30 min HR 116…
my max HR at 43 is 177 BPM, 50% is low end of moderate aerobic workout,
  • 89 is 50%
  • 116 is 65%
  • 100 is 56%
So the last 10 min were getting to be a mild aerobic workout, at/near 65% of max HR. I think it worked. I had trouble getting blue dot on BP wrist cuff towards end but was able to with a few tries. I had to put a fan on myself after. I will have to check out the my % HR. It felt like a pretty good workout but wasn’t at all comfortable. It was probably not as bad as the step mill, and I think certainly a worthwhile option, maybe as good as the EMS bike for SCI, and a whole lot cheaper. Maybe lower HZ or pulsed HZ would work as good and feel better. 6 Hz felt really fast. Large and criss crossed electrodes certainly made it better. I think even larger electrodes might work better still since I only got to 80 mA, and the muscles not under the pads didn’t feel like they were contracting. I wasn’t dripping sweat or anything but the couch was damp where I sat. Kind of gross. I will have the fan on next time during the running of the program. TENS burst at 5 Hz, when turned up past 30 mA, just melded into a continuous/constant on. 3 Hz stayed separate and I programmed it in and it felt like it might work ,but the contractions felt harder. I’m not sure if that’s good or bad. I may try it for 30 minutes next time and see how it affects HR. I have neck and throat DOMS today from 90 mA yesterday. I actually feel some DOMS in my anterior throat when swallowing. Probably hitting the right muscle and then some for dysphagia.
[3-27-15] Brief detraining with time off from EMS, core and neck I did EMS on Monday for the first time in over a month and started stim on core 2 to only 30 mA or so, but today (Friday) I was able to start at 50 mA and work up to maybe 80 or so. With time off, you definitely need to work up again. The neck went easier on Monday getting me to 60 mA I think, and today I worked up to neck 90 mA, a new record. I didn’t even try to breath during the “on” phase because beyond 60-70, I knew I couldn’t. This isn’t such a big deal if you are just holding your breath and bracing yourself anyway, and not alarming if you know what to expect. I felt great afterwards. 60-70 mA on abs started to feel some stinging and I was thinking I was overwhelming my pad area, but neck went to 90 mA with no stinging discomfort so go figure. I felt tingling in my lower left molars above 55 or so mA.
[1-19-15] Criss-cross thigh placements with giant electrodes I tried criss-cross thighs with big pink and new grey pads and started right off at 65 mA with thighs extended. The contraction felt reasonably immense but comfortable. 70, 75, (real strong, contraction feels and looks complete in thighs), 80, 80 (it’s a lot of stim to take all at once), 80 (criss cross I feel like quads are too much and I need more hams but can’t individually add more hams because I have quads and hams criss crossed together. Maybe next time I will criss-cross but keep quads and hams separate) 80, (at 80 mA with the big pads it’s the forceful knee extension that’s stopping me from going higher, EMS under pads is fairly comfortable) 80, 85, 90. Breathing real deep and hard after. Will have to use my BP/HR cuff next time. Thighs feel super fatigued after. Contractions felt very deep.  I’ll bet I’m sore tomorrow. ~20 minutes later my legs still felt fatigued and I felt like I could take a nap. 10 minutes gave me 10 contractions even with time prolonged due to moving stim up so that’s cool. I wonder if the extra seconds are just taken out of final rest or if time is added onto the program, will have to time it in the future. It did take a long time to set up with changing the pads and all. Before I went, I thought the time change might not be worth it because training one leg only takes 10 minutes. The setup with pad changes felt near to 10 minutes. I should have timed it. I’m breathing really hard between sets. This might be getting aerobic with this much muscle going at once. If quads and hams are getting equal stim (and they are with my criss-cross pattern), it seems that the weaker muscle ,hams, needs more stim to help balance out the stronger quads and that in time might help lessen muscle imbalance
[12-30-14] Four mode TENS program, just to try everything out
  • Chad’s TENS
  • Type:TENS
  • Number of phases: 4
  • Phase 1 duration: 3’
  • Phase 1 Program Name: Symmetric TENS
  • Type of Modulation: Amplitude Modul.
  • Workout Frequency: 120 Hz
  • Start workout amplit.: 180 uS
  • End workout amplit: 450 uS
  • Workout duration: 3s
  • Phase 2 duration: 2’
  • Program Name: Symmetric TENS
  • Type of modulation: Frequency Modul
  • Start workout freq.: 10 Hz
  • End workout freq.: 120 Hz
  • Workout pulse width: 450 uS
  • Workout duration: 6s
  • Phase 3 duration: 3’
  • Program Name: Symmetric TENS
  • Type of Modulation: Continuous
  • Workout frequency: 10Hz
  • Workout pulse width: 450 uS
  • Phase 4 Phase duration: 2’
  • Program Name Symmetric TENS
  • Type of modulation: TENS Burst
  • Burst Frequency: 1 Hz
  • Workout pulse width: 450 uS

12 thoughts on “Chad’s Continued Electric Stimulation Notes 2015-17 and Onward

  1. Holy diary of a crazed therapist, Batman!

    Chad, this is quite impressive. Pushing the boundaries and assumptions of EMS treatment and recording it all, and then actually sharing it with us. Words fail me. Thank you!

  2. Hi Chad, nice to e-meet you.
    Thx for all the info and research, I’m learning so much!

    I’m suffering from a chronic back pain for the last couple of year and seeing physiotherapist for the last couple of month. Most of the treatment involved tens machine which is very helpful and I feel much better after. And the thing is I’m pretty much get to the to power limit of the machine :).

    I decided to purchase tens machine for my home use and I’m looking for the most powerful option there is in a budget friendly price.

    I came across 3 options and would like your knowledge and expertise to tell me which one is stronger and what’s better.

    First is this one –
    This one is very “nice looking” and seems very convenience. Is powerful enough?

    The second is
    It’s seems very professional but very pricey too

    And the third is –
    This one is the one that interest me the most, portable, nice , is it very powerful as I think? The same as the Genesy?

    Which one to get , if you

    Much appreciate


    • Hi Adam,

      Of those three, I’d go with the Globus 3000 for sure. The first one sounds way under powered. The third one sounds plenty strong but has only two channels so you would have to run it twice, to get it to do what the four channel Globus does. Also the third one does not sound programmable like the Globus 3000. However, if I were you and you are in the United States, I’d consider one of my Globus Genesy 300s over the 3000. It should cost way less, and has all the power and programmability (at least the programmability I think is useful, since I only use wide biphasic square waves) for strength and pain. I have the higher dollar Globus Genesy 1100 at home, and it’s great, but my 300s at the office are 100% as good, which is why they are the only model I sell. Regardless of what machine you choose, look to get some large rubber carbon electrodes and good straps to hold them in place. Here’s why. I hope that helps.

  3. As someone coming to this with no pain issues, just interest in recovery and any ancillary strength gains I can handle with regard to bench, squat and deadlifts, do you have an opinion regarding the Globus Premium 400 versus others in their line, or versus the Compex sport elite (I have seen some of your preference in reading on this blog so far)

    Money is not “no issue” but I’d rather buy something worthwhile, you know, not spend $200 less and discover I should have spent $300 more.

    Any feedback and insight is much appreciated.

    • Hi KJ, it might depend on where you are located. I know a guy who got a Globus Premium 400 from Europe and it was programmable. I just got a “USA model” Triathlon and while it was listed as programmable on the European Globus site, mine wasn’t. So thus far I’m sticking with my Genesy 300 models as the sweet spot for performance over price. Programmability means everything to me, as I didn’t like any of the preset programs, even on my Genesy 1100. I haven’t used a Compex, but on paper they are listed as weaker in both mA capacity and pulse width, in comparison to the Globus, and I don’t think the USA Compex models were programmable at all. It’s not that my programs best, but I’m real particular with what I like, and I like the ability to change my mind as I learn something new, or just want to try something new. I don’t know if my shop makes it all that clear, but I put all my current favorite programs into the Genesy 300s I sell in my shop. Also if you read through my notes you’ll probably see why I think electrodes are as important as the machines. I hope that helps.

  4. Hi Chad,
    I really appreciate the time you take to answer question and all of the material you have put together on your blog. I am a long time reader of Charlie Francis’ blog and materials, but you have certainly added a lot of clarity to making EMS more useful.

    Do you have any idea on how to tell which machines are programmable and which are not? From looking at the Globus Italy page it seems there is some confusion between machines that have the memo function to save favorite protocols used frequently in a list and programmability of the machine. I want to pick a Globus up. I want to use the same 10/50/10 duty cycle as described in the Francis’s training manual and extensively here by you. The Premium 400 is $100.00 to $200.00 cheaper though. It appears the only difference between the two machines is the number of programs built into the machine, from what I can tell.

    I am interested in trying your year long experiment,with weights where possible, but would like your opinion on a couple of issues.

    Would you avoid using the Core 1 or Core 2 on abs completely if there is a history of umbilical hernia repair, or just drive the mA as high?

    In your blog you talked about having 3 shoulder injuries and surgeries. I am avoiding surgery on a 3 to 12 slap tear if at all possible. Have you any experience working with people with a slap or other labral tear with EMS? Has using the EMS allowed you to sustain some upper body strength, where you are not benching at all? I can no longer bench and probably never will bench again, even if I get the repair done. It is sort of humbling to go from a 320 bench to struggling with 225 on a floor press.

    I am also curious if you have looked at NMES where these people are hooking up and working against the contraction. I don’t know if you have seen this so I posted a youtube link. Do you know what the mechanism of action is or what advantage there is to using the machine that way?

    Sorry for the length. I appreciate all of the information you have on here.

    All the best,

    • Hi Bill,

      Yeah I really like everything I have read from Charlie Francis. I read Speed Trap in college and I forget what got me to read his training principles because I hardly ever work with sprinters. I never thought it would change how I do my physical therapy. I guess that shows a benefit of broad reading.

      On the International Globus site it tells if the machines are programmable if you click under “strong points.” It should then be listed under “special features.” All the Globus Genesy models are supposed to be programmable, as well as a number of the European fitness and sport units. However, I think some of them sold in the USA have this feature disabled. That’s the reason I’m using and only selling the Genesy 300, because it’s the least expensive full power programmable EMS machine I can get in the USA at this time. Otherwise you are correct in that generally the higher dollar machines just have more preset routines, and for me that doesn’t matter because I’m picky and I write all my own programs.

      With a prior hernia repair I would probably start with core 1. That would let you go less intense in the area of the repair until it feels strong enough that it can take the same as other regions. I recommend core 1 to all my new to EMS patients because in general people can’t take as much anterior abdominal stimulation, at least at first. It’s possible you could injure something if you went to hard too fast, it’s also possible (and I think more likely) that the increased abdominal strength from EMS will decrease long term risk of hernias. So maybe follow your instincts there, as there is no research to guide us.

      I stim all my shoulder pain patients and I think it helps with both pain and strength, but it’s awkward to put the pads in place, and while it works, I don’t think it works as great as does for core, hips and thighs. If you aren’t using your shoulder too much you can get by without surgery, however your shoulder will likely always feel a little unstable. My shoulder did treat after labral repair number 1, then I crashed a skateboard and it was never the same after that. If you have read through all my notes you’ll see I never found a pad placement that I thought worked pecs that well, so for upper body strength training after my EMS experiment was over I started just doing dumbbell curls and rope pushdowns, neither of which irritate my shoulder, which after surgery 3 is now arthritic. So I think EMS works for upper body, but for the most part I think lifting weights is more practical. For abs I don’t think anything comes close to my EMS machines, my programs combined with my rubber carbon electrodes.

      I think the EMS combined with active exercise is bogus. If you can move when the EMS is on, then I don’t think the EMS is intense enough to be optimal. When I do EMS and the blast hits I just brace myself as best as I can for it. I read one paper where they said such “whole body stimulation” worked but they fudged the results. They used an experimental group that were detrained at the start relative to the control group, so it was easier to show improvement. I was thinking about doing a blog on that paper just to show the scientific sleight of hand. So for the most part I think light EMS on top of light exercise might be marginally more effective than either by itself, but less effective than either hard exercise or hard EMS done separately. I hope that helps!

  5. Hi Chad,
    Its my first time reading your blog and I must thank you for sharing all this information and knowledge with the community.
    I am a therapist and in my practice I see a variety of patients, from athletes with the common sprains and strains to patients with neurological conditions like muscle denervation, stroke, nerve lesions, etc. I have been wanting to incorporate electrotherapy to my practice because I think it will improve my results and in some cases speed up the healing process. Your research and experience with electrotherapy encourage me to do so. I had the opportunity to play a little bit with the Globus Sport Plus and I liked what I saw.
    I would like to ask for your opinion on which EMS unit I should get for my practice keeping in mind I see a wide variety of patients with many different conditions and I would like a unit that allows me to write or modify the programs.
    After some research I think I narrowed to these units:
    Cefar Compex 3
    Cefar Compex Physio 5
    Globus Genesy 3000
    Chattanooga Physio or Rehab

    Could you give your opinion please?

    And also, whats your opinion in wireless vs wired? (I am talking about the Chattanooga line of EMS) Is it worth the extra money? I like the fact wireless allows you to do more functional type of therapy but I have a hard time trusting the reliability of the wireless technology. Yes, you can call me old school.

    Chad, words can’t describe how helpful your blog is for somebody like me and how appreciative I am for your help.

    Thank you

    • Hi Oz,

      I can’t keep up on all the different models. Chattanooga has always seemed overpriced for what you get. Personally, I think for a clinic the Globus Genesey 300 Pro is the way to go. It’s “medical” and does everything I would want it to do. It’s programmable, like just like the Genesy 1100 I have a home, it just has less present programs and current types, but I don’t use any of those anyway. In fact for my office I have gone to the Globus Triathlon, because it does everything I want, and mine are programmable and I was able to get them preset with my programs, but since it’s a “sport” model it does not require a prescription for out of state sales. Same power, and actually more presets, but like I said I don’t use any of the presets.

      As for wireless I don’t trust them yet either. The wires are a PITA but sticky electrodes fall off and I bet sticky electrodes with a battery pod attached to them fall off even faster. I went to the Compex site a couple months ago and saw they were selling straps and sleeves to hold the battery pods on so I’m sure they know it’s a problem. Oh and looking through their manual on the wireless electrode model I wasn’t able to find anything on how many mA an uS it produces unlike the 100 mA and 400 uS they had out of their USA available sport models. I imagine if it were high power they would flaunt it, and since they aren’t flaunting it I suspect it’s weak.

      Definitely rubber carbon electrodes like the one’s I have in my shop make the ES way more comfortable and I think more effective because of that. And mine have been going strong for about 3 years now. I hope that helps.

  6. Hey Chad, was wondering if you could coach a EMS program for joint hypermobility syndrome via email. Lumbar-pelvic area is a mess and too unstable atm to get any proper lower limb work done. Cheers.

    • Hi Li,

      Wow, it’s very timely you are asking about hypermobility! I have been researching hypermobility and it’s relation to yoga/anxiety and have been putting some of my research findings on my new website I still have a lot more to add and I’m looking to add some narrative articles soon. Some of the research I’m putting on there now under “the science” section and I have a drop down specific for hypermobility.

      What I’m doing is coming up with a yoga sequence that does NOT stretch any of the joints, keeps the spine neutral, and builds strength and fitness everywhere. I designed it for neck and back pain for people who don’t have equipment and otherwise can’t come to my office, but when I learned about hypermobility I thought, “If you told me to design a program just for hypermobility, I wouldn’t change a thing. Unfortunately, the program is still not online yet but should be shortly. But maybe in the meantime you can email me at and I can give you some good EMS advice, which I agree could be a great tool to get you started.

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