Electric Muscle Stimulation for Strength, How to Make It Work.

”Electromyostimulation–a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters. J Strength Cond Res. 2011 Nov;25(11):3218-38. ”

Since I plan to discuss a number of studies on electric stimulation, I figured I should get this one out there. It gives some background as to which electric stimulation parameters work for increasing muscular performance so that people can judge if what they are doing (or plan to do) is anywhere close to the ballpark of what works. There are countless electric stim machines out there that range from less than $100 to many thousands of dollars, and this is a case where it’s not as simple as “you get what you pay for”. Rather, you have to know what works and if a given machine can do that or not. In that sense this review is incredibly useful. The abstract, which is a bit daunting, is as follows:

“Our first review from our 2-part series investigated the effects of percutaneous electromyostimulation (EMS) on maximal strength, speed strength, jumping and sprinting ability, and power, revealing the effectiveness of different EMS methods for the enhancement of strength parameters. On the basis of these results, this second study systematically reviews training regimens and stimulation parameters to determine their influence on the effectiveness of strength training with EMS. Out of about 200 studies, 89 trials were selected according to predefined criteria: subject age (7 days). To evaluate these trials, we first defined appropriate categories according to the type of EMS (local or whole-body) and type of muscle contraction (isometric, dynamic, isokinetic). Unlike former reviews, this study differentiates between 3 categories of subjects based on their level of fitness (untrained subjects, trained subjects, and elite athletes) and on the types of EMS methods used (local, whole-body, combination). Special focus was on trained and elite athletes. Untrained subjects were investigated for comparison purposes. The primary purpose of this study was to point out the preconditions for producing a stimulus above the training threshold with EMS that activates strength adaptations to give guidelines for implementing EMS effectively in strength training especially in high-performance sports. As a result, the analysis reveals a significant relationship (p < 0.05) between a stimulation intensity of ≥50% maximum voluntary contraction (MVC; 63.2 ± 19.8%) and significant strength gains. To generate this level of MVC, it was possible to identify guidelines for effectively combining training regimens (4.4 ± 1.5 weeks, 3.2 ± 0.9 sessions per week, 17.7 ± 10.9 minutes per session, 6.0 ± 2.4 seconds per contraction with 20.3 ± 9.0% duty cycle) with relevant stimulation parameters (impulse width 306.9 ± 105.1 microseconds, impulse frequency 76.4 ± 20.9 Hz, impulse intensity 63.7 ± 15.9 mA) to optimize training for systematically developing strength abilities (maximal strength, speed strength, jumping and sprinting ability, power).”

My comments:

In the text they look at all aspects of electric stimulation: the type of wave, the intensity, duration, rate, etc. The authors discuss how it performed with an emphasis on athletics, give a summary of the results with regards to what seemed most effective, and give some ballpark figures to work with. Though the paper attempts to focus more on the training of healthy athletes, I find that information invaluable in rehabilitation situations as well.  Unless I have reason not to, I tend to use similar (but not always the same) parameters with my patient population. Reading each section, what the authors note/recommend is as follows:

  • Impulse type/form: biphasic square wave is emerging as the current favorite
  • Training Frequency: 3 days per week
  • Contraction time: 3-10 seconds
  • Duty Cycle: 20-25%
  • Impulse Frequency: >60 Hz
  • Impulse Width: 200-400 uS
  • Impulse intensity: >50 mA

The guidelines are all a little rough, but this paper describes parameters that current research is pointing towards. It’s more current and usable than any electric stimulation book I have read. Unfortunately, while it is pretty well established that electric muscle stimulation works, there are still a lot of unknowns with regards to what works best.

Training 3 times per week sounds like a good place to start, however I think if a person’s muscles are particularly atrophied and difficult to activate, more frequent stimulation might be better. Some studies on post-op knee replacement have stimmed 2 times per day with beneficial effects. On the other hand if muscle is developed and the stimulation intensity is high, I think 3 times per week might be too much for adequate recovery between workouts. In my own training where I have worked up to a high intensity of stimulation, training each bodypart every 3rd day feels about right.

In terms of contraction time, 3-10 seconds sounds right. I usually use 10 seconds on and 50 off, but I do so largely by appealing to the authority of Kots (Russian stim) and Charlie Francis’ work with his sprinters. Duty cycle of 20-25% sounds good, but the famed “Russian stim” parameters is a 10 second on 50 second off, which equates to about 16% duty cycle. I liken this to lifting weights when people ask what number of reps is best. The answer is “it depends.” The idea of the long rest period of 10 on 50 off is that your muscles are able to recover more fully and thus contract harder during each upcoming contraction. I do notice however that if I shorten the rest period, upcoming contractions are not as hard, but I am then able to turn up the intensity of the machine and reach new muscle fibers. This makes me wonder which contraction time pattern is more effective in the long term.

Impulse frequency >60 Hz sounds right according to most research I have seen and is enough to give a tetanic contraction. I use 120 Hz because I first became interested in electric stimulation after reading sprint coach Charlie Francis’ book, and that’s what he used. I have yet to find any reason to change it. 120 Hz feels more smooth than 60 Hz for what that is worth.

In my experience impulse width is underappreciated and is as important as intensity. 200 uS seems a bit short to me. It will probably work fine for arms but won’t be enough for core or leg musculature. 300 uS is pretty stout, will adequately train most anyone, and can be found in inexpensive but quality stim machines (i.e. the EV-906). 300 uS is also strong enough that most people will not be able to max out. I do notice my patients with neuropathy in the calves and feet, 300 uS at 100 mA often isn’t enough to get a strong muscle contraction. However, in that case the Globus unit with the availability of 450 uS is enough to get good muscle activation out of all but those with full denervation.

Impulse intensity over 50 mA sounds reasonable. If the pulse width of the machine is just 50 uS,  then 50 mA isn’t going to feel very strong, but bring the pulse width up to 300+ and it’s another matter altogether. For optimal strength the research seems to suggest that more intensity is better. Work up to as much as you can take!

Not addressed in this paper but worth knowing: I find you can comfortably get more current into a large muscle by adding electrodes rather than just turning up the electrodes. Two electrodes (1 channel) for large muscles like the quadriceps and hamstrings does not feel like it works the muscle as completely as 4 electrodes (2 channels) on each. However, this depends on the size of the person, how many channels you have available, and how many muscles you want to work at once. Large electrodes are more comfortable than small ones because they lessen the current density going through your skin. Rubber carbon electrodes last a lot longer than sticky gel electrodes, but you do need straps to hold them in place. In my opinion stick on gel electrodes are more trouble than they are worth. Rubber carbon electrodes wet with water and held with good straps feel better, work better, and last a lot longer. I’ve tested all sizes and 4” round rubber carbon electrodes are my favorite type and size.  A 4” wide elastic-velcro strap is best to hold them in place.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

35 thoughts on “Electric Muscle Stimulation for Strength, How to Make It Work.

  1. Thank you for the info! I have been searching the internet for relevant parameters, and this was by far the most informative and user-friendly article I have read.

    • Thanks for the feedback. FYI, I wrote that blog over two years ago and I have experimented with a lot of parameters since. 10-50-10 with 120 hz and as wide a pulse width as possible (450 uS on my Globus) is still my favorite program.

  2. Hi Chad,

    I’m a cyclist and am adding in some strength workouts into my routine.

    I’ve seen some articles propose using EMS (I’m using a Compex Sport Elite) in a resistance or strength mode while performing the strength exercises and others that suggest to do them 6-8 hours after a lift to continue to tax the body without taxing the central nervous system or joints. A third option is for endurance athletes to use something like EMS entirely for their strength component. Do you have any thoughts on the three different approaches?

    thanks!

    • Hi Jon, I wish I had better answers, but you’re questions come down to experience and anecdote. How much of the gains in strength you might get to EMS that can be applied to cycling is speculative, but for that matter, the last time I checked the same was true for strength training. I still think both are worthwhile. EMS strength gains are real hard to test, you feel stronger, your muscles feel harder, but unlike lifting weights you don’t know you are stronger because you don’t have that measure of weights and reps objectively showing improvement. The research is pretty clear that EMS works, it’s just hard to test on yourself and know how much it’s working for you.

      As for 6-8 hours after lifting, I am unaware of any research that suggests that’s ideal. In therapy for my patients, who I am almost always trying to strengthen, I have them do EMS immediately after their strength exercises. That’s due to convenience because they are in my office, so it’s now or never. Charlie Francis said in his book “The Charlie Francis Training System” that 2 or more hours after strength training was best. Again, I don’t know of any data showing that’s the case but his anecdotes rate a lot higher than average in my book.

      Based on my experience, I think for legs, both strength training and EMS would be best, but that’s a lot of time to devote to strength training. So if you only have time for one or the other I think exercises like squats, lunges, and RDLs give you more bang per buck, hitting more muscles harder in a given time period than you can get with EMS. I think EMS with a good four channel machine and program can hit your abdominal muscles harder in 10 minutes than any conventional exercise can in 30 minutes. Arm training I would definitely rather just lift weights, as it’s a PITA to try and self strap electrodes onto your chest, shoulders, arms, etc. So contrary to what I did in my “year of electric stim” I only regularly EMS my core and neck muscles now. I do regular PRE for everything else. If I had an injury, I would do more EMS to train around it, if a strength training workout was aggravating it.

      I’m not sure that EMS doesn’t tax the central nervous system. A recent paper showed all sorts of increased blood flow in the brain in a dose response manner with EMS. Though I don’t know if it’s causing fatigue or if it’s potentiating the nervous system to make it stronger. I tend to think the latter.

      So if it were me I’d probably lift weights for my legs with multi-joint basic lifts, and use your EMS machine on your core regularly, also to train around an injury, or to maybe bring up a lagging body part. It depends how much time you have to devote to it. But mostly try different methods, and see what seems to work for you. Hope that helps. If you have any other questions let me know.

  3. Thanks so much for the very detailed insight I really appreciate it! Hitting the core makes sense to me as I really feel like I get a solid core workout with EMS.

  4. Correct me if I’m wrong, but what I’m absorbing from all of this is that if these parameters are met, the price/quality of the EMS unit isn’t of concern? Ive been searching everywhere lately, trying to see if I’m missing something. There doesn’t seem to be much information on this matter at all.

    I see these $250 plus compex units and its got me thinking I have to be missing something. There has to be a catch to the cheaper units. Assuringly these devices wouldn’t carry such an excessive price tag if I can simply buy a similar unit for $50? Ive reached out to compex themselves trying to get some answers with no response. At this point im convinced theres no reason for these prices other than the brand.

    What would your take be on a device such as the Intensity twin stim III?

    • Hi Ed, those are really good questions. I went through the exact same thought processes when I was getting my own EMS machines and choosing what I wanted for myself and my patients. I documented most of it in my “notes from my year of EMS.” On 3-24-14 I start talking about the differences between the Globus MyStim, and on 4-5-14 I got a Globus Genesy 1100, which is awesome but had a bunch of programs I never use, then I settled back on the the Globus Genesy 300 as the best bang per buck. So it kind of depends on what you want to use it for. If you don’t need that much power or channels the less expensive machines are pretty good. I used the EV-906 for several months before I thought I needed more power, and the better quality machines are better quality, but sometimes you end up paying a lot for a name and for programs you might not want. That’s why I want my machines to be programmable, so I’m not limited.

      I get a lot of questions about the Twin Stim III and I was hoping I could just look up the parameters and give you an opinion. However, it’s a uses a monophasic current, while what I’m used to is biphasic. So since it’s cheap I just ordered one so I can see what it feels like and give you a better opinion. So if you can wait a week, I can give you a more detailed response.

      • I got the Twin Stim III and was able to try it out (for $37.00 delivered from Amazon why not) and it’s a powerful little guy. However, here’s the reason I wanted to try it out before commenting just based on the parameters listed. The problem with the monophasic current is that you can get chemical burns with it if the parameters (amplitude, pulse width, rate) are set to high. The idea is that positive electrode attracts a lot of negative HCL to it, creating an acidic environment inside you and you get burned. So I got the Twin Stim III, programmed in my favorite 10-50-10 parameters that I would use with my EV-906 or Globus, turned up the stim and I got burned!
        Heres the pic of the burn:
        burn
        So the Twin Stim III is not recommended by me for muscle building. Too bad cause it was a handy, sturdy, and programmable little unit.

        The other downside which I expected is that it only has two channels so you can’t work as many muscles at once. But that can be a pro too, if you just want to work a small area. I am on the lookout for a good low priced 2 channel machine to use for headaches.

        So I think you want a machine that does the right parameters, but you really need to know what you are looking for. In my opinion that’s a machine with biphasic (preferably symmetric) square wave current, that’s programmable. Some of the lower price machines are biphasic asymmetric, which means the black wire feels stronger than the red wire when you are using it for EMS. The EV-906 that I sell in my shop is this way, and it’s not a big deal, and you save a lot of money on it, over my favorite machine the Globus Genesy (for which I think the 300 is the best price point), but the current is clearly more even between the pads, with the Globus. The Globus is clearly more powerful, durable and user friendly, with the colored, thicker wires being worth their weight in gold when you are trying to untangle them, and they hold up longer, as do the buttons on the machine. So if you are just going to stim something for a short time, or you just want to try it out, a lower cost machine like the EV-906 is enough. The EV-906 burns through batteries like crazy, but you can plug it into an outlet and not worry about it, while the Globus rechargeable battery lasts for weeks with regular use.

        I haven’t worked with the Compex units but I hear they are high quality. When I was looking for a top of the line unit I went with the Globus because it was a little more powerful (120 vs 100 mA, 450 vs 400 uS) and also because it was programmable. Oddly none of the Compex or Globus preset programs included my favorite 10-50-10 program, but with the Genesy line of Globus (and even with the EV-906) I could program in and save exactly what I wanted. The programmability is something that for me is mandatory, because I want to be able to mimic and test out any settings I read about in the research, or just think up, and the Globus Genesy EMS machines let me do that. I like (and thus sell) the Genesy 300 Pro because it’s the least expensive full power Globus machine that does everything I want.

  5. Hi Chad

    Been reading up on ems in the last 24hrs only trying to figure out if it could help me. I’ve had a complete tear of acl two weeks ago and waiting for brusing to go away. Was thinking this could help with muscle atrophy of the quad while I wait for swelling to go away and I can start rehab.
    Not asking for medical advise…just whether its a stupid idea? Just want to recover as quick as possible (and hopefully not have an op)

    Kareem
    ps I was going to buy the ev906 thats how I found your site.

    • Hi Kareem, I’m out of town right now so my internet access isn’t the best. So to keep it short EMS in your situation is not a stupid idea and the EV906 should be plenty strong for that application. If it were me, I’d put two channels (four pads) on the quads and two channels on the hamstrings all at the same time. I’d apply the channels in a criss cross fashion.

  6. Hi Chad,
    Thank you for your posts on EMS, I have now read this one and the one ‘a year with EMS’. I am writing from the Netherlands, I own a Compex Mi-Sport and have trained with Miha Bodytec as well.
    The Compex is not programmable and max. pulsewidth is 400 uS. That’s why i am looking for a Globus Genesy type unit. You mentioned in the article that Genesy 300 is the best bang for the buck, because you do not use other programs.
    My question is: do you actually have experience and/or heard good results on Globus Genesy microcurrent programs?
    It supposedly helps in recovery; injuries such as tendonitis; ankle sprain etc. as microcurrents seem to increase ATP-production?
    Apparently microcurrents are widely used in fysio/medical/clinical field? Would you maybe know something about APS-therapy
    and or Alpha stim. It’s all about microcurrents.
    And what about modern type Kotz current? Which is included in e.g. Globus Genesy 1500 or Genesy 3000? Thank you very much for a reply.
    Best regards, Thomas

  7. Hi Chad,

    Just a short check, if myprevious posts are actually received.
    (I am writing you from the Netherlands, I posted without checking the box “I am not a robot”. Will do that now).
    I own a Compex Mi-sport now, it is good machine with EMS/TENS, not programmable.

    I am considering a Globus Genesy 1500?/ 3000, maybe? It is more a medical/clinical device with programs such as Russian waves/Kotz current, but also micro current.
    Do you have any experience with microcurrents? It apparently is used in therapy and it is supposed to increase ATP levels, which promote protein synthesis and aiding recovery in muscle, muscle tear, fibromalgya etc.
    I hope my post will be received.
    Thank you in advance for a reply.
    Best regards,
    Thomas

    • Hi Thomas,

      I’m out of town right now so my internet access is limited. The short answer is I’ve tried microcurrent, but I don’t believe it does anything, so I never use it. I think biphasic symmetrical square wave is infinitely better. I think Russian currents on modern machines (to include the Globus) are too weak to be of use. So definitely try it before you buy it, but I expect you’ll be underwhelmed. So I do like the Russian duty cycle of 10-50-10 and I I’ve that all the time as my go-to duty cycle for strengthening, but I program those parameters in using biphasic symmetrical square wave currents for the best of both worlds. That’s why the Globus Genesy 300 Pro is my favorite machine. It’s fully programmable, so I can create any effect I want, but I’m not paying for extras I don’t think work very well anyway.

      If I can give you anymore detail, or you have additional questions let me know but I won’t be back in town for a few more days.

  8. Hi Chad,

    Thank you for all the great info. I’ve found the EMS 7500 which seems to a biphasic square wave machine for about $50. Do you have any experience with this machine?

    Also, what settings would you recommend for muscle recovery?

    Thank you in advance,
    David

    • Hi David,

      I haven’t used that exact machine, but I think it’s a two channel version of the EV-906 that I have used a lot. It’s two channels instead of four, so you won’t be able to stimulate a lot of things at once, but if two channels is all you need, then you are good. I’m not positive but I think it’s fully programmable, and it’s reasonably strong, both of which are cool. I’m pretty sure it’s biphasic “asymmetrical” rather than “symmetrical” like the Globus, which means the red wire will feel weaker than the black when you use it. It’s still probably worth getting and seeing if you like it, then you could upgrade to a more powerful machine later if you needed it. That’s how I did it.

  9. I developed a hematoma in my left groin area at my hip replacement from 4 years ago. It has knocked out my femoral nerve and muscles in the leg, effectively making my knee feel like a broken hinge. I can’t kick out or lift up very much, and my muscles are starting to atrophy. They say it will be 3 to 4 months for my hematoma to dissolve. Currently, I have almost no feeling in my kneecap + and – about 5 inches.
    Is there any recommendation for EMS to ward off some of the muscle problem? If so, which machine would you recommend, and what settings?
    Thank you for any suggestions.

    • Hi Ed,

      Peripheral nerve damage, like you describe is a tough one. If the nerves are completely killed off, then the EMS will not work and there won’t be any muscle contraction, at least not at first. If the nerves are just partially damaged then you have a chance and EMS will perhaps keep your muscles active while the nerve heals. Or it will strengthen the muscle fibers still activated from the part of the nerve that’s still alive, which might help it compensate for the fibers that may not work. Also with peripheral nerve damage, even if the nerve is gone, there is a chance for it to recover, often thought to be at a rate of a mm per day, so that can take some time and it’s far from a sure thing. The problem is that it’s hard to know where you are in all the above scenarios and if you should keep trying or give up. So it’s a gamble.

      Program wise 10-50-10 would be my program of choice for restoring muscle strength and size while 5 hz TENS would be what I would use for circulation and endurance. On my new machines I’m combining both my programs, a 5 hz aerobic TENS program during the “rest” period between the hard 10 second EMS blasts with the thought of increasing strength and endurance at the same time. All programs ‘might’ encourage nerve regrowth, which I have seen research on in animals but I’m not sure how well that translates to the real world. With nerve damage I would think you would want as long a pulse width as possible, thus the Genesy 300 Pro, with a pulse width of 450 microseconds would the best choice of any machines available in the USA. If you get it from my shop, it would have all my programs preset.

  10. I recently developed a hematoma in my artificial hip (inserted 4 years ago), which has knocked out my knee joint causing me to collapse if I use the wrong foot on stairs. As a result, I m using a walker. I’ve lost feeling in my knee cap area + and – about 5 inches. I was told it will take a few months for it to dissolve and hopefully take the pressure off the femoral nerve that’s causing the problem. A Dr. suggested that I obtain an electric stimulator to help avoid too much atrophy.
    Do you have an suggestions re a unit, as well as settings? Thanks.

    • No worries, and your welcome. I like talking about this stuff so if I can answer any other questions feel free to ask. If your doctor thinks you should try EMS, that’s a good sign that it’s not a complete injury and he thinks it might help. You might even ask him that follow up question. If it were me, I’d try it. Worse comes to worst EMS/TENS is good for a LOT of other things. I’m of the opinion that everyone should have one.

    • Hi Ed,

      If you get one of my Globus machines, it comes with all the factor programs, plus I preprogram mine with my favorite programs including what I described above. I’m currently writing up more thorough descriptions of each and how I use them, which I should have on my website shortly.

  11. Hey Chad, i was trying to post a message and something went wrong so i think it’s gone. Anyway, i’m an ex olympic lifter, and i have just been diagnosed with an upper limb disability due to an accident. As i cannot use my hands anymore, it will be almost impossible to keep my training regime going, so i turned towards EMS to at least protect for as long as i can the strength and mass i gained over all my training years. Do you recommend a programable EMS machine for my goal and some specific settings, or i could use the cheapest machine with a hypertrophy setting ? I would greatly appreciate your input as i have been following you for a long time and respect your work, but i never thought a day would come when i would need a machine to keep me in shape. Meanwhile i will start reading all the articles around here 🙂

  12. Right, so 10/50 still better due to strength>mass in joint protection, so i need a genesy 300.
    Also, do you go for 10/50 on all muscle groups ? Did you ever have any bad experiences with small muscle groups getting cramped or something from too much intensity or contraction time ? Also do you stimulate while going through the ROM with a light weight added to engage the CNS, or you just have couch sessions ? 🙂 Cheers !

    • Hi Dan,

      Do you mean to say you can’t move your hands at all, or are they just weak? If the nerve damage is complete then EMS probably won’t do any good. If the muscles are weak, and the nerves damaged, but not obliterated, then EMS might work to both prevent atrophy and restore strength.

      If you are in the USA the Globus Genesy 300 Pro is the best machine for the price I can get, it allows me to save and preset all my favorite programs. The EV-906 has only about half the strength, has poor battery life (but you can plug it in) and it’s less user friendly, but you can get one for ⅓ to ⅕ the the price of the Genesy 300. The EV-906 is programmable, and it’s what I used for the first 6 months of my year of EMS so it’s not junk. If you are just using EMS for arms, the EV-906 likely powerful enough, so could be a viable option. What pads and how you affix them is, in my experience, almost as important as your machine. Outside the USA, there are maybe more good options but since I can’t get them to try I can’t comment so well. The price on Compex machines have come down a lot, and I hear they are good, stronger than the EV-906, but not as strong or programmable like the Globus Genesy. I would imagine the compex strength or hypertrophy programs are decent, just not exactly what I would write. I definitely prefer my machines be programmable so I can update them as I learn more about EMS.

      Regarding your second set of questions:

      The Genesy 300 is the best machine but the EV-906 can still be programmed to do my 10-50-10 program. It won’t be as strong but might be strong enough, though the Globus has the benefit of the contraction under each electrode of a channel being equal strength. With the EV-906 the positive (red wire) electrode will feel weaker (maybe 30%) than the negative (black wire) electrode.

      I do 10-50-10 (10 second contraction, 50 second rest, 10 minutes) almost all the time and for every muscle if I am trying to increase muscle strength and hypertrophy. I don’t know that 10-50-10 is best but it was preferred by the Russian pioneer of EMS (Yakov Kots) and Charlie Francis for his sprinters and I have yet to find anything that works better. I had a theory that 5-15-10 might be better, but after trying it for a while on myself and a lot of my patients I went back to 10-50-10. I still have 5-15-10 preset on my machines if you wanted to try it. I also use a 5 hz program for circulation, and in my newer programs programmed 5 hz into the “rest” periods that you could turn up or down separate from the 5 or 10 second “on” period.

      I avoid most problems with smaller muscles cramping as long as I take certain precautions. If I’m stimulating the feet, I’ll have people stand on the electrodes with full bodyweight to prevent the feet from cramping up. For calve stimulation bodyweight might not be enough and I’ll brace my calves into a leg press machine to prevent movement. Which if I’m locked into a machine I figure I might as well do calf raises, so I prefer just weight training for my calves. If you are stimulating your forearms you are probably going to have big problems with your hand/fingers cramping, which is alleviated by gripping a round piece of PVC pipe, a handle or some sort, or a rolled up towel. To really hit the hand intrinsic muscles I got the hand grip electrodes which prevent painful cramping and are electrodes themselves to really get the stimulation into the hands. Mesh EMS gloves worked better than expected when I tried them but I’m not sure how well they hold up to frequent washing. With EMS of the forearms I still had to limit my intensity somewhat because wrist flexors would overpower my extensors and flex my wrist so hard that I felt like I would strain/injure my wrist ligaments if I went any harder. I was able to partially negate that by bracing my wrist against my thigh when the EMS blast came. If your muscles are atrophied due to nerve damage, that all might be less of a problem because they wouldn’t flex your muscles as hard. As you recover it would be more of a problem, but that’s a problem you want to have.

      I just do couch sessions, haha. I think if you are able to move your joints while the EMS is on, then the EMS is not on enough. If I’m stimulating my thigh, abs, or arms, when the blast hits I just brace myself and hold on as best I can. As Charlie Francis put it, “The contraction is massive, and it feels that way!” However, like I said above if the nerves are severed there will be no contraction at all no matter how much you turn it up, and if the nerves muscles are weaker, the contraction isn’t going to feel as strong as it would if you applied it to healthy nerve/muscle. I hope that helps and feel free to ask questions. I’m trying to make an EMS FAQ and you are giving me good ideas.

  13. I’ve been reading your year of EMS notes. Good reference.

    I wanted to say, I got the TwinStim IV for about $55. It does say it’s a biphasic square wave. The manual for the III also says it’s biphasic but only for EMS, not TENS.

    I’ve also switched the red and black end around keeping the pads in the same places and can’t tell any difference. It’s great that it’s programmable and can save 6 programs, but I am disappointed at the lack of 1hz during rest, I think that would be beneficial.

    Also, I don’t know how people are needing 100ma, is that something people eventually build up to? I start at 15ma and am able to move up to 22-30ma depending on the muscle group. I feel I’m getting very strong contractions and do get some intense DOMS for the next couple days. I’ve been using 6on/10off 2sec ramp, for 20min.

    • Hi Adam,

      Thanks for the info, it sounds like the TwinStim 4 is different from the TwinStim 3 I tried (which burned me). I just read the manual on the 4 and it says it’s biphasic symmetrical square wave so that would make sense that both the red and black wires feel the same. I think I’m going to get one to try.

      100 mA is something I worked up to in just a few weeks with my EV-906, but how many mA you can get up to is also a factor of what uS you set it at. On my Globus with 450 uS, instead of 300 on the EV-906 I can only get about half as high and rarely hit 100 mA. 22-30 mA shouldn’t be that hard to get to unless the electrodes are small. Small electrodes hurt more and contract the muscles under them just fine, but because they are smaller and more painful you don’t get as much surrounding muscle fibers. Also rubber carbon electrodes transmit current with less pain than do the sticky ones. I would think that 10 seconds rest after a 6 second contraction would be too little rest between contractions. What’s best isn’t known, but I like 10 seconds contraction, 50 seconds rest for 10 minutes. That’s the old Russian stimulation duty cycle. I use 120 hz all the time, but in theory 70 hz is enough. The splitter will let you stimulate more muscle groups but also cut in half the current delivered so you will have to turn the machine up twice as high to get the same amount of contraction.

      I max out my pulse duration with each machine I use. So 450 uS on my Globus, 300 uS on my EV-906. I’ve read about chronaxie and how based on it you should use a larger pulse width for legs compared to arms. However, I just use the widest pulse I can and I have never felt like it was too much for my arms. A shorter pulse duration might very well be too little to work your legs though. I hope that helps.

  14. Also, I usually use one channel on one muscle on the left and the other channel on the right. Though some groups seem like they really need 3 or 4 pads rather than just the two. Since I want to do both sides at the same time for time saving, I ordered a splitter. Not sure how well it’ll work, haven’t had a chance to try it yet.

    I’ve also been using 70hz, 300us for all the muscle, do you switch it up based on muscle group?

    I read some stuff about muscle chronaxie, but couldn’t find a chart that would give the number for each muscle. Have you looked into that?

    Thanks, Adam

    • Hi again Adam,

      I just wanted to reply back and let you know I got a Twin Stim IV to test out, and you are right. For a $70 stimulator it’s really good (I couldn’t find one for $55 like you did). From reading the manual and testing it, it seems both the EMS and TENS are biphasic symmetrical square wave. There are a couple annoying things about it, but they are pretty minor, so for an inexpensive two channel stimulator, it’s the best I know of. FYI, when I set mine up for EMS, I maxed out the pulse width at 400 uS and frequency at 100 hz. The current felt really good and even and didn’t burn me like the older model did.

  15. I have a question. My friend has been paralyzed from the waist down for over 40 years. His doctor recommended EMS. He now has legs like a body builder. How is that possible when he shouldn’t even have contractions? I personally have 2 AXION STIM-PRO X9+. I did have to order it from Germany came to under $200 USD delivered. It has up to 400 uS biphasic symmetrical square wave and 150 hz. along with 30 TENS & EMS programs. I don’t use too many EMS programs. I program my own. TENS are very handy as their are programs for different ailments. Has 4 channels also.I did suffer from severe atrophy due to lower back and neck injuries. I have used a 10-25-30. I do this opposed to applying a few times in a day. I use a variety of electrodes for different body parts. I also find that more muscle coverage works alot better. I am 5’6″ 125lbs 57 years old. I have managed to become well portioned and stronger but still have some muscle dysfunction in about 5 months. I did find the same problem that if I used the lower pulse width that I could handle full intensity but as soon as I up the pulse width to 400 thar was a different story. I did this before I read your article and against what I had read that said < 250 small muscle and large 300. I was happy too see that I had made the right decision. Any pointers? I do workouts 2 to 3 times a week. EMS is the reason I am still walking before dedicating time to it my doctor was recommending walker at the very least. Thanks

    • Hi Ray,

      About your friend, I wonder if his level of injury was at the thoracic level above where the spinal cord ends and divides into separate nerves in what’s called the caude equina. If so the spinal nerves to the cord would still be intact, even if the cord above them isn’t, and thus he would still have spasms and you would be able to stim the muscles with regular EMS. If his injury is below that level and regular EMS works on him, I wouldn’t be able to explain that, but I did blog on a stim machine in England that’s supposed to be powerful enough to stimulate muscle fibers directly so if he got one of those, that would be possible.

      With my machine I still mostly do 10-50-10 to hit the muscles hard and move on. I wrote about why I like the large rubber carbon electrodes with all machines and they should work well with yours if you haven’t tried them already. Have you read thru my notes where I stimmed myself for a year, and notes on what I’ve learned since? Almost all my tips are in there. I’m writing up a chapter on EMS, in relation to both neck and back pain for what’s going to be my Spinal Flow Yoga book and as soon as that’s done I’ll link it here. I’ve done a lot of work with EMS to the neck for neck pain and strengthening, and I talk about it in some detail in my notes, but in the book I’ll be much more specific and cite a lot of research since it’s controversial.

  16. Thanks Chad for the great article.

    Let say I want to go with the 10 sec on and 50 sec off cycle. How many “sets” do you suggest?
    I am using it on my quad looking to increase vertical jump

    • 10 sets, or 10 minutes. The “Russian” stimulation protocol for athletes was 10 seconds on, 50 off 10 times. That’s what Charlie Francis said he used for his sprinters too. When I was using my older stimulator I would program it for 12 minutes because I could only increase intensity on each channel one at a time, so I would use the extra minutes to get everything set right. But when I started using the Globus EMS machines they had a button where I could move them all up together, and it doesn’t start counting down until you stop increasing the intensity, so I was able to adjust everything on the first blast and go back to just 10 minutes.

      For vertical jump, I would consider applying the EMS to you hip extensors too.

      I hope that helps.

  17. Hello Chad,

    I am new to EMS and have been interested in using a system for some time. My wife recently got me a LG Tec Elite TENS/EMS unit from LG med supply. (http://www.lgmedsupply.com/lgelteunandm.html) After reading your blog and notes. I am happy to have some real guidance in the use of EMS. I am a little concerned that the unit is a mono-phase square pulse wave. I don’t want to get burned, so my question is what the amplitude, pulse width, and rate would you use with this unit. After reading your blog, I have changed my settings to 10-50-10 (PW 300us, PR 70hz). What are your thoughts, I have not been burned yet.

    Sonnyg

    • Hi Sonny,

      I’m sorry I don’t know if I can answer your question very well. When I tested out a monophasic unit with my favorite settings for muscle building, I did get burned. You are using 70 hz, which is less than the 100 or 120 I usually use so that might give you some margin for error, and you could try lowering it to 50 hz and see how that works. According to the prominent theory I’m overdoing my hz anyway, and I did do a blog about it.

      So you might be safe at your lower frequency, or you might just be safe “for now” until you work up to higher amplitude levels as you get used to your machine. It’s hard to say. I guess if you feel it stinging, you should look and see if it’s really burning. On the bright side my burns healed up in a couple weeks so it wasn’t the worst of experiences. Definitely, if you decide to upgrade your machine look for one thats biphasic symmetrical square wave, then you don’t have to worry about it.

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