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.
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.
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.