Electric Stimulation and Peripheral Vascular Disease

Chronic muscle stimulation improves ischaemic muscle performance in patients with peripheral vascular disease. Eur J Vasc Surg. 1994 Jul;8(4):419-22. Tsang GM1, Green MA, Crow AJ, Smith FC, Beck S, Hudlicka O, Shearman CP.

Abstract
There is currently no established treatment for intermittent claudication with proven long term benefit. Exercise classes have been shown to improve walking distance. Chronic electromyostimulation (CEMS) a method of stimulating skeletal muscle has effects on normal muscle which may also benefit claudicants. We investigated the effects of one month of CEMS on claudicants in a single blind placebo controlled study. Patients were randomised to either CEMS (treatment) or transcutaneous nerve stimulation (TENS) placebo. The effects of the two modalities were assessed using the conventional measures of claudicating distance (CD), maximum walking distance (MWD), ankle-brachial pressure index (ABPI) and pressure recovery time (PRT). Muscle performance was assessed by the fatigue index (FI) a technique determining the decrease in ischaemic muscle response to repeated contraction. After 4 weeks treatment the CEMS group showed significant improvements in their median CD (88 to 111) and MWD (118 to 158); this was not seen in the control group. Muscle performance also increased significantly during the 4 weeks of treatment in the CEMS group but not in the control group. These changes were not maintained after CEMS was stopped. This pilot study suggests that CEMS may well have a role to play in the treatment of intermittent claudication though a number of further studies need to be undertaken.

My comments:
This is an older study that found benefit of electric stimulation for intermittent claudication. As I think about its capabilities for a potential application I often find decades old research showing considerable benefit that seems to get lost in time, which is almost funny as all on pubmed.com.

  • Electric stimulation parameters used in this study were:
  • Frequency: 8 Hz
  • Pulse duration: 350 uS
  • Amplitude: “maximum tolerable”
  • Two electrodes placed over the “anterior tibial” and “poplitial” nerves, which is a little vague (a photo would have been nice)
  • Frequency and duration: 20 minutes per day, 3 times per day for 4 weeks.

Walking performance was measured on a treadmill at 3.5 kpm (2.17 mph) with a 10 degree grade, with pain free walking distance (PFWD) increased 26% and maximal walking distance (MWD) improved 34%. While the results were better in the electric stimulation group than the control group, they weren’t a lot better, and by 4 weeks after treatment cessation the differences had largely disappeared. The latter I would expect and I think continued electric muscle stimulation and exercise is necessary for continued health. I also think the protocol used here is likely not optimal, though a similar protocol was used more recently (2004) with better results.  However the difference might be in electrode placement as in the 2004 study the electrodes were placed over the triceps surae motor point and muscle belly.

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.

4 thoughts on “Electric Stimulation and Peripheral Vascular Disease”

  1. Chad,

    Thanks for posting. Even though the improvement was marginal, any improvement is worth the effort.

    Best,
    Greg

  2. PAD with Intermittent Claudication severe in right leg, moderate in left leg:

    On an Amazon search there are many devices for EMS. I’m looking at one that seems interesting: Revitive-it’s a circular platform that you place your feet on and does not use electrodes to send the EMS signal into the calf.

    • Hi Sal,

      I just looked up what I could on the Revitive device. I’m semi-skeptical for the following reasons, particularly for you given you peripheral artery disease/intermittent claudication (PAD/IC). Everything the Revitive is FDA approved for is everything a regular TENS machine is FDA approved for, so nothing special there, and nothing specific to PAD/IC. Also I could not find any online material with regards to the settings. It says it’s strong enough to cause muscle contractions (which is good) but they are performed in sitting, such that I wouldn’t expect the muscle contractions to be that strong, or else your feet would be bouncing off the electrodes. If they listed the possible range of pulse durations, pulse amplitudes, rate, rest time, etc., I would be able to comment on whether I like it or not. Since they didn’t it makes me think it’s not all that versatile or powerful.

      With your PAD/IC I would expect your LE nerve conduction to be impaired, particularly on the bottom of your feet, such that you might not be able to get much in the way of muscle contractions, even if the machine is strong, such that you would want to have electrodes stuck or preferably strapped onto your calves, where nerve conduction is likely better and where the bulk of the muscles you are trying to make contract are. I do think there is something to be said for standing on the electrodes but there are differences to be had depending on electrode set-up. If a single channel is put on the front and back of the same foot the muscle contractions will be very localized and not reach your calves. If the channels are criss crossed so that one electrode is paired with it’s mate on the other leg, then the contractions, if the machine is powerful enough can go up the calves to the knees and I think would give you a pretty good contraction. However, when I do this in my office I have my patients stand on the pads so their full bodyweight prevents their feet/calf muscles from cramping too much. Prolonged standing might not be what you want to do, so again with PAD/IC I’d rather just strap the electrodes on the calves, lay back, put the feet up and watch TV. So if you want to try it I would order it on Amazon Prime so you can return it if it doesn’t work for you. If it works or doesn’t I’d love to hear what you think. FYI, I sell two machines in my office and my PAD and neuropathy patients generally have to go with the Globus Genesy, because the EV-906 isn’t strong enough (and it’s stronger than average) with the impaired nerve conduction velocity that often goes hand in hand with PAD/IC even if the electrodes are placed on the calves. At this point I think I would want the versatility of a machine that would let me program in a 5 hz program for circulation in addition to a 10-50-10 program for muscle strength (which also works really well for pain).

  3. Chad,

    I bought the Globus 300 Pro EMS machine from you some time ago. It was to be used to treat my PAD with Intermittent Claudication.

    Back in September of 2017, I broke the right leg femur bone which required surgery and a steel rod to repair. The recovery has been long and difficult. After one year, I’m starting to use the Globus 300 again to treat my claudication.

    I’m using your program: 10-50/5Hz-30 with the intensity levels set at 50mA and 25mA for one hour at least three times a week. My question: Have you made any changes to the program and do you have further recommendations?

    I’m 92 years old.

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