EMS Decreases Back Pain, Increases Core Strength, Endurance

“Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial. Rheumatol Int. 2009 Jun;29(8):947-54.”

Right now this is my favorite electric muscle stimulation (EMS) study with regards to low back pain as I read it soon after I came up with my own protocol, which was fairly similar.

Abstract
The aim of this clinical trial was to evaluate the effects of electrical stimulation (ES) program on trunk muscle strength, functional performance, quality of life (QOL) in the patients with chronic low back pain (CLBP). A total of 41 patients with definite CLBP were included in this study. These patients were randomized into two groups. Group 1 (n = 21) was given an ES program and exercises. Group 2 (n = 20) was accepted as the control group and given only exercises. Both the programs were performed 3 days a week, for 8 weeks in the out-patient department. The patients were evaluated according to pain, disability, functional performance, endurance, quality of life, depression. The muscle strengths were measured with a hand-held dynamometer. There were significant improvements for all the parameters in two groups after the treatment. Except depression and social function, the improvements for all the parameters were better in the ES group than in the control group. We observed that ES program was very effective in improving QOL, functional performance and isometric strength. In conclusion, we can say that ES therapy provides comfortable life functions by improving muscle strength, functional performance and QOL.

stimpattern
Durmus et al. Low Back Pain set up.

They did 4 electrodes on the rectus abdominus region and partial on the obliques for 15 minutes using 50 Hz, 50 ms phase time, and 70-120 mA until “apparent muscle contraction was established”. They used a 10 second on 10 second off pattern, then flipped the patient over and did the same on the lumbar erector spinae muscles. This group of patients was compared to a control group 3 times a week for 8 weeks. The EMS group did exercises as well as electric muscle stimulation, while the       control group did only exercise. Researchers conclusions were as follows:

“Both the programs were performed 3 days a week, for 8 weeks in the out-patient department. The patients were evaluated according to pain, disability, functional performance, endurance, quality of life, depression. The muscle strengths were measured with a hand-held dynamometer. There were significant improvements for all the parameters in two groups after the treatment. Except depression and social function, the improvements for all the parameters were better in the ES group than in the control group. We observed that ES program was very effective in improving QOL, functional performance and isometric strength. In conclusion, we can say that ES therapy provides comfortable life functions by improving muscle strength, functional performance and QOL.”

Exercise & EMS start Exercise & EMS at 8 weeks Exercise only start Exercise only at 8 weeks
Pain VAS (out of 10) 8 1 7.7 4
Oswestry Disability Index(sec) 36.66 6.57 37.22 19.22
Extensor Endurance Test(sec) 35 150 59.9 83.5
Abdominal Endurance Test(sec) 98 236 104.5 144.88
50 meter walking time(sec) 40.71 23.42 39.22 32.16
Pain Disability Index 19 4 22 9.5
Back extensor strength(kg) 7 16 7 11
Back flexor strength(kg) 6 16 6.5 10.5

 

My comments:

As you can see from the above table, adding EMS to the core muscles of those with low back pain led to reductions in pain and the increases in strength, endurance, and function were substantial.  The electrode placement I do is nearly the same. I put 4 electrodes on the rectus abdominus (usually in a diagonal pattern), 2 electrodes more lateral than they do to better target obliques and transversus abdominis, and just 2 on the lumbar region, which feels plenty sufficient at high intensity (as much as is tolerable rather than just what is comfortable). I also use a 4 channel machine so I can stim all the muscles at once rather than having to do the front first and later the back. I do a 10 second on and 50 second off period, 120 Hz and 300 uS pulse width for 12 minutes. [Update to add on a Globus machine I set the pulse width to 450 uS] My combination of parameters closely approximates the “Russian Stim” duty cycle used on olympic athletes and recommended by Charlie Francis as what he used with his sprinters. While perhaps coming across a white noise to patients with low back pain, a therapist understanding the specific EMS parameters is critical to getting an adequate treatment response. EMS performed this way is in fact exercising the muscles very intensely, and the parameters need to be adjusted as you would adjust exercise sets, reps and resistance level when weight training.

My patients report this immediately decreases pain better than classic TENS patterns I used prior and does more to increase abdominal strength than any conventional exercise I have ever tried, all while the spine is kept in a neutral posture with no external load. I think combining the treatment with exercise for extremity strength and spine awareness is certainly ideal, but I find the EMS to significantly boost both pain reduction and strengthening. The best part is that high quality machines are very affordable, so the treatment can be done at home while watching TV. As such, therapy time in the clinic can be maximized with whole body strength, endurance and spine awareness/motor control exercises.

 

 

 

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.


Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.

28 thoughts on “EMS Decreases Back Pain, Increases Core Strength, Endurance”

  1. Hi Chad

    Great article. Im unsure about the electrode placements and was hoping for some clarification.

    >The diamond on the rectus abdominis – is that one electrode either side of the linea alba in a diagonal fashion or ……

    >Most setups for the back have 2 electrodes per erector spinae so Im a bit confused

    Any pictures would be great!

  2. I really appreciate the info on this website. I would like to know where you ordered the Globus Genesy PRO 300. I see them for sale in Italy. Do you have a rep in the USA. Can you change the language on the machine if not. I speak Spanish, so Italian is not that difficulty, but just curious. Thanks again.

  3. I’ve recently been having a bout of back pain and tingling from a bugling/herniated disc. I bought a dual EMS/TENS unit off Amazon. I was wondering if you could give me a simple protocol to start using to address my pain and muscle weakness in core/glutes.

    • Hi Drew,

      The easy answer, is to do Core 1 and/or Core 2 electrode placements. However, you’re machine being just two channels will mean that you have to run it twice. With just two channels, the same placement the authors used in the above study might be great too, but you would have to run the machine again to hit your oblique muscles. If you want to do hip strengthening where I like either of the following pad placements best:

      https://www.absolutept.com/wp-content/uploads/2016/05/Hip-ES-2.pdf

      https://www.absolutept.com/wp-content/uploads/2016/05/Hip-ES-3.pdf

      I read the manual on your machine and unfortunately I think you are going to run into a few problems. First it’s only has two channels, which is fine if you are treating a small area, but for back pain, especially if you want to strengthen your hip muscles too, you are going to have run change the pad placements so many times that you probably won’t stick with it. If you just do the machine right where it hurts, that should help with pain some, but it’s not going to strengthen the core musculature, which I think is responsible for the well above average results I get using my Globus machines, or even the EV-906.

      Also your machine isn’t programmable. That’s not to say it won’t work, but you won’t be able use the same settings, like the Russian Stimulation 10-50-10 duty cycle, I use on mine. EMS program “P6” on your machine looks closest and is what I would start with if I were you. Last, which isn’t so much a problem with your stimulator, but with all of them, is they all seem to come with those sticky 2” x 2” square electrodes. A) They don’t stick well for long and B) they hurt. The sticky electrodes only conduct electricity through the skin about half as well as the rubber carbon electrodes, and since they are so small the amount of current they do conduct goes through a small area of skin, lighting up pain receptors. That’s one of the things I learned by experience in my year long self experiment only before finding out there was research on it. So if I were you I’d try out your machine as is, see what you think. If it’s like I say maybe check out my shop and just get some of the green rubber carbon electrodes and straps. That will probably make your machine feel a lot better. Then later if it’s not strong enough for you, or if you want to stimulate more muscle at once, upgrade to an EV906 or Globus Genesy 300. The latter is in my opinion the best on the market and should last a lifetime, and is what I use in office for all my back pain patients, unless they have a pacemaker or something.

      Outside of stimulation it’s worth noting that TENS, and even EMS with a Globus, are only partial answers for low back pain. They do a LOT to strengthen muscle and eliminate pain, however if you don’t eliminate the source of injury (usually too much spine flexion or twisting) then you’ll just feel better in the short term, while your discs continue to degenerate in the long term. Eliminating the source of injury often comes first from awareness, using good lumbar supports when sitting, and lessening spine flexion, extension, and twisting when moving (spine/hip motor control). The latter is generally learned best with carefully selected exercise. I hope that helps, feel free to ask for clarification if you need it, and maybe let me know if your experience with your machine is different than I expect.

  4. I found your recommendation on Core 2 very helpful. I just one question. What are the polarity of the electrodes shown in your “Chad’s Core 2” picture? In order words where the negative and positive electrodes go?
    Thank you

    • Hi Hector,

      Good question. If you are using a “symmetrical” biphasic square wave current (my favorite) then, positive and negative distinctions are meaningless because they are alternating polarity equally such that each is equally positive and negative. For some reason even better stimulators like Globus and Compex (that ARE symmetrical biphasic square wave) show a positive and negative distinction in their electrode placement charts, which always makes me laugh. The Globus wires are even the same color, so I don’t even know how they would be able to tell what’s what even if you wanted to.

      If you are using a “asymmetrical” biphasic square wave (my second favorite) then there is still alternating current but the black (negative) wire will feel stronger because it’s wave is square and while the red one is rounded, so you could put the black wire where you want the stronger contraction. When I was using my EV-906 in my year of EMS experiment I would just randomly put the electrodes on, so on average each spot was getting equal current. So you could worry about what goes where, but when it was me I didn’t worry about it. I did prefer when I moved to the Globus in that all the electrodes felt equally powerful so I didn’t have to worry about it.

      If the machine is some form of direct current, uniphasic, monopolar, or high volt stimulation (all descriptions meaning one electrode is positive and the other really is negative) then I wouldn’t use the machine. I tried muscle stimulation with a TwinStim3 just to see what happened and I got a chemical burn in less than 3 minutes use when I turned it up enough to build muscle. FWIW, in the new TwinStim4 they fixed that problem and is biphasic symmetrical square wave, and pretty cool for an inexpensive two channel unit.

  5. Chad,
    I’m using the Twin Stim Plus 3rd Edition in EMS mode with a symmetrical biphasic square wave. Thank for the quick response.

  6. I find your blog a really comprehensive and thought provoking read. As a back sufferer of 30 years – your comments make so much sense to me. Could you possibly consider a temporary move to the uk…?! The more I read about EMS, the more I am convinced that it would offer so much help for my severely weakened and underused back / core. However, EMS is very misunderstood here; mostly physios think you are talking about TENS. A recent phonecall in a bid to find someone to advise me resulted in the comment, “I’ve never heard of that being used on the lower back.” Having just had another MRI showing no major damage – I’m back being referred for more physio….. One day!
    Great site though!

    • Hi Ruth,

      Thank you! If you are in the UK I would look around to see what EMS machines are available to you locally. My favorite Globus units come from Italy. And yes, EMS kind of a forgotten art in physical therapy where the science behind EMS has really advanced, while physios have lost interest. I think it’s something you can really teach yourself on by reading and trying. That’s how I got good at it, as even the modern physical therapy books on electric stimulation have dated information.

  7. Hi Chad.
    I live in Ireland and have been suffering with disc problems for about a year and a half (a bulging disc in L4-L5 that is moderate degenerative)
    I’m wondering if you still recommend the Globus and EMS? I’m very much considering a purchase to help alleviate some pain – I already exercise quite regularly with good posture and overall awareness. I’m wondering what core exercises you recommend ? Currently I stick to regular and side planks. Is there anything else ? I mostly exercise of my feet to engage my core. I’m by no means weak.
    I should mention there is a posture that alleviates pain for me. I guess it’s the cat in the cat cow yoga stretch (I never do the cow as to avoid flexion)

    • Hi David,

      I still think the Globus EMS machine is the best one. You want a 4 channel unit to do what I do and Globus is the only one available in the USA that I have found that has the channels I need, the power, and the programmability. In my experience it almost always helps with pain, chronic back pain especially. I wish they didn’t cost as much but the cheaper ones just don’t do it all. Any 4 channel Globus model that’s programmable should work as well as mine and being in Europe you might have better deal. Definitely, to get the results I think you need electrodes like mine. I still have some EV-906 units left that I sell for $150, plus another $100 for my pads and straps kit, and it’s strong enough to get you started and the same pads and straps kit would work on a Globus if you decided to upgrade. Some machines that look exactly like the EV-906 are very weak, even though the specs are identical, which is one of the reasons I stopped selling them. Plus the batteries go dead really fast so you have to use the wall outlet, and the wires tend to break if you aren’t really careful with them. All of which is why I only talk about the Globus now.

      I don’t think you want to just train core, but rather total body, minus that which is bad for the back. I have a video of a chronic back pain person doing my favorite exercises on my low back pain page. Unfortunately that’s not a lot of help if you don’t have a gym like mine. So I came up with a neutral spine/strength/endurance based yoga sequence that incorporates all my resistance training principles and is progressive without weights. It’s just really hard to describe it properly online, but my intention is to have it be very inexpensive at $20 per year or something like that. The website is up at SpinalFlowYoga.com but it’s still not ready for business yet. I’ll reply here as soon as it is tho. I should be working on it now, but I’m answering questions. Yes, the cow part has mild extension so might help with your tingling, but if you push it too far extension can be problematic too. I just summarized a paper on that with some newer thoughts in the Spinal Flow science section. It’s worth knowing that exercise with good posture is almost worthless if you still sit with bad posture. You’re tingles have a reason and it’s probably too much flexion somewhere, which hopefully you have already gotten rid of.

  8. Hi Chad,

    two things.
    1. I may have meant the cow part of the yoga pose:

    https://fthmb.tqn.com/QiWPkhAEY29l5kNeA5UWhqk_1eY=/768×0/filters:no_upscale()/young-woman-practicing-cow-face-pose-against-white-background-673162135-57f67e225f9b586c3509d6e6.jpg

    above with neutral spine, it’s good for relieving the tingling.

    2. The Globus on your website is very expensive. It’s not something I’d buy without trying first. I’d still like to hear your recommendation first though, and if there’s a cheaper product you’d recommend for testing

  9. Just purchased TEC Bean rechargeable TENS EMS combo to aid in chronic back pain. Do you have any recommendations? I went to your site, but I do not see a store there with the carbonized rubber electrodes you have recommended in comments above

    • Hi Heather,

      I don’t know anything about that your stim unit. I tried looking up a manual online to see what the setting were and I saw two different machines with the same name. If you can post a PDF of the manual I might be able to tell how powerful it is and what settings it can do. That’s still a little iffy because some machines say things they don’t actually deliver on. I would love to hear what you think as I’m always looking for low cost yet effective options.

      As for electrodes, I recently brought down my store because I’ll be moving to India largely to start teaching my yoga sequence for chronic spine pain that might be perfect for you to go along with EMS. My yoga sequence is minus all the stretches I think are bad for the spine, and levers up what neutral spine strength, endurance and awareness. I’m still working on the cite but the flow is up well enough for people to start at SpinalFlowYoga.com. Best of all, full access for a year is just $20. Spinal Flow by itself is working really well but a good stim machine really helps a lot, especially in the beginning. And honestly, if the machine is strong enough it’s still better core workout than any exercise I have tried.

      Unfortunately I recently took down my web store where I sell my electrodes and straps because I don’t have time to deal with that and getting Spinal Flow going, and I’m definitely not going to be able to ship product from India. However, I did just talk to my web guy about putting my store back up because I have a friend to partner up with who might be able to take it over while I’m away. I know it’s important because it’s hard to find good electrodes and for good straps I had to have them custom made. In the meantime if you email the the office we can probably figure out a way to help you.

  10. Hi, I was wondering if you could help? 15 years ago I had 2 micro-disectomies in my lower back. Ever since, I have had some back pain due to vertebrea coming out of position and relying on my chiropractor to pop them back in. I also help manage my back myself by laying on the floor, on my back , with my neck on a lumbar roll. When I completely relax, my lower vertebrae drop back into position and any discomfort that I had been feeling has gone. I feel the build-up of pressure, feel a crack and the tension pain has gone. I do this 2-3 times a day, sometimes it cracks but when my back feels completely OK, it doesn’t. I see the chiropractor when this doesn’t work.I assume that because they can drop back in position easily, they can pop out as well.I had degenerating discs when I had an MRI 15 years ago, so assume they haven’t improved. I recently came across your EMS article and wondered if it could help strengthen core muscles around my spine to keep my vertebrae in position, stimulate blood flow to heal and possible regenerate my discs and could this work better if my back was put into a little traction? I was originally thinking about having my spine fused but was to seek out alternatives first. How is Ruth (from the UK) getting on now? Sorry for the longwinded question!

    • Hi Richard,

      1: To directly answer your question I do think EMS can help you a lot if you get a good machine, which almost always requires aftermarket rubber carbon electrodes and good straps to hold them in place. Since you are in the UK, I any one of the Globus 4 channel machines that’s programmable would be best and it what I use. 3.5 to 4″ circular rubber carbon electrodes would be best and you can find them on the internet I’m sure. Straps are harder to find, I actually had to have mine special ordered from China. I have thousands of them but that doesn’t do you much good in England but you’ll be looking for something 8″ wide that can go around your waist, or two sets of straps 4″ wide. Something that fully covers the electrodes and holds them tight against you. EMS done right should both decrease pain and strengthen your core, both of which can be a big help but won’t do your discs any good at all if you don’t know how to use that strength, and you really want to have leg and hip strength too, so you can better rest your spine.

      2: Its unlikely that your discs are coming out of place and are being popped back by your chiropractor. That pop is thought to be just cavitation of your facet joints in your spine, the same as cracking your knuckles, but there is zero evidence that doing so puts a spine in any better position than it was prior. However there is a pretty good placebo effect with research (on many thousands of people) showing manipulation makes you feel better than if you were put on a waiting list, but it’s 0.0% better than if you are given an active sham treatment. The researcher compiling that data is a chiropractor. What you might be feeling, besides the endorphin rush thought to come with a good placebo, is you relaxing some muscle spasms, which might make you feel better. However those muscle spasms are your bodies attempts to keep you from further damaging your spine.

      3: When your discs herniate, they do become shorter, and the ligaments around them, that span their gap become more slack, which does result in instability and probably your feeling of tightness after you wrench it. Strengthening all the muscles should help stabilize this and lessen pain. Or else your body will stabilize your spine the old fashioned way, but building bone spurs and osteophytes, which will lessen range of motion, but unfortunately sometimes pinch nerves, so getting fit without further injuring your vertebra is your best bet. So if I were you I would stretch my spine NONE, and I wouldn’t twist and try and pop it either. It’s funny in the chiropractic community everyone feels they need a “pop to put things back in place,” while in the yoga world everyone wants to “stretch and feel release” yet in both cases you are likely lessening spine stability.

      4: EMS will increase blood flow to your spine and abdominal muscles but I expect that won’t improve circulation to your discs, which are largely avascular and too deep for the stim to reach. So I don’t think you will build much back. The only time I have heard of people increasing disc height was after bariatric surgery and the loss of a LOT of weight. But I do think you can, and should, do very much preserve what disc height you have by avoiding extremes of spine range of motion, particularly sustained and repetitive spine flexion, with extension and twisting not being very good either.

      5: Research on traction over the years shows it does’t help. Though it’s intuitive that it would help, we effectively unload our spines at night and the discs imbibe more water, however in doing so they are weaker, much in the way that full balloons are more likely to pop. Traction probably isn’t causing you to fully fill the discs but I imagine it’s keeping your loose ligaments stretched out, which might better off tighten up. I’ve given patients a fair amount of traction over the years thinking “this time it might work” but it never has in my experience. Research, that I’ve blogged on agrees it doesn’t work.

      6: I would avoid fusion too if I were you. Fusing one segment has been shown to accelerate degeneration at the levels above and/or below because stresses are just further concentrated higher/lower.

      7: Probably my best thoughts are in the comments following my McKenzie method blog. I completely understand your predicament where you have pain, and nobody around knows how to best help you with it. I’m mid way through building my new website spinalflowyoga.com. It’s still a ‘minimal viable product’ but the program is up and it’s progressable from Level-1 for people who are hurt (but not so hurt they are limping) to Level-2 (fit and probably pain free) to Level-3 (so fit nobody yet has finished it, including myself). However, unlike conventional yoga mine focuses on strength, stability and instead of stretching the spine, keeping it neutral. It’s only $31 per year and if you want to help me test out my new membership software this link…

      https://spinalflowyoga.com/?ref=chadreilly

      …and this code… RSiDQtV71S

      …should get you $10 off. As I said it still needs work so I allowed comments on all the pages so you can ask questions helping me explain things better. Sorry for the long winded answer, haha.

  11. Hi Chad. I am so impressed with your commitment to help people with LBP and other maladies.
    I read McKenzie, Chad Reilly and then McGill and now back to you. I hope you can offer me some guidance. I shall present this in three parts: my condition. What I am doing, and then what do you suggest that I do.

    I am a 75 year old male. I am in generally good health. Until I hurt my back last August, I played tennis and racquetball 3 or 4 times a week( singles and doubles.) I had hurt my back several times before while doing yard chores. But I got over the injuries in a couple of weeks. Last year, I had a couple of tweaks to the back while playing tennis, but last August, I had the killer injury to the back.
    Diagnosis:

    , 1. Mild to moderate degenerative disc disease with osteophytes
    laterally at the level of L5-S1. Foramen patent. Disc/osteophyte
    contiguous with the right 5th nerve. Also touches the left 5th nerve.
    Severely degenerated left facet..

    2. Mild to moderate degenerative disc disease at L4-5 is more advanced
    on the left laterally with osteophyte. Minor central disc bulge. Mild
    to moderate narrowing of the right lateral recess. 5th nerve interposed
    between disc margin and facet. Distally disc/osteophyte is in contact
    with the left 4th nerve.

    3. Mild degenerative disc disease L3-4. Annular tear. Minimal central
    disc bulge.

    Needless to say. At first I was in a lot of pain.
    finally got into a Back specialist, got a shot, some pills and got some relief. But I was on my own to solve my LBP problems.

    Since I had nothing but time to research, I found McKenzie. Read him and did exercises. More reading took me to your site. Also to McGill. I read two of his books.

    So now I do the Big Three. With a 6,4,2 set each day. I walk, swim and some Elliptical. I did buy an Ireliev 5050 wireless EMS set. I use the EMS program 6, but it does not do the 10/50 pulse. It does a 5/10. I have the 4 channel with 4×2 pads. However, I am confused because in your Charles Francis he states:When looking for a machine there are a few things to keep in mind. First, I’ve seen good ones for as little as $280 as well as over a thousand. Some of them only allow you to use two seconds on/two seconds off pulses and rest periods. You don’t want that (although that’s fine for abs since abs should be trained as endurance fibers for ten to fifteen minutes at a time). Instead, look for a machine that allows you to control the rest periods. You’ll want to be able to get ten second contractions with fifty second rest periods.

    It’s the OK for abs that has be puzzled.

    I also purchased a standing desk for my computer. An adjustable bed for adjusting head and feet height. And a Zero Gravity recliner that I watch TV in.

    Now What can I do to further heal my back< if anything.
    I have constant very low grade pain in my lower back, I do not take any pills to help me . I just try to watch what and how I do things. I would like to be able to return to tennis if possible, So I am asking your opinion as to whether you with your vast experience ,if you think it is possible, or will the twisting and running be to much at this stage of life.

    Would the Globus 300 be of use to me, knowing it is an additional $500+ over the Ireliev 5050 that I have.
    I have access to gym equipment.

    Also I am interested in joining your new Spinal flow yoga if would be good for me. Would I use it in conjunction with an EMS machine or would it be all I need.

    Looking forward to your recommendations.
    ,

    • Hi Benny,

      It’s hard for me to comment on your stim unit as the online spec says how high it goes with regards to milliamps but not the pulse width, so I can’t make a knowledgeable comparison. When it fires it should fire so strong that your muscles are going harder than you can make them go yourself, almost harder than you can bear. One problem is those sticky electrodes don’t transmit the current as well as the rubber carbon type, so they get painful before the muscle contraction is as hard as it should be. So I can’t say for sure if that the Globus will be a lot better, but very likely it will be. But even the Globus is hobbled by the cheap sticky electrodes it comes with. Unfortunately I’m only mid way between switching my store over to SpinalFlowYoga.com, and there are problems with the USA model Globus Machines not having all the capabilities (like custom programming) like the European models, so when friends ask me I tell them to just order them direct from Italy off Ebay right now. The Globus Triathlon being my preferred model now, being a sport model that doesn’t require a prescription but the Genesy 300 Pro is just as good. If you get one, message me about electrodes and straps. Electric stim is such a long complicated story. I’m planning on doing a blog or video on why it’s so hard to get good equipment and how just about every manufacturer is screwing you in some way and the FDA import requirements are making things worse rather than better.

      10-50-10 is still my favorite program for back pain (and most everything else) but 2-2-10 is a program I’m using. There’s no research to compare programs but 2-2-10 should help with pain and I would agree with you is more geared to muscle endurance. In theory you aren’t getting adequate rest time between contractions, but that theory is untested that I have seen. 2-2-10 is hella arduous though at high intensities, but it does decrease pain.

      If your gym equipment lets you copy the program I’m using in my low back pain page I would think that would help. SpinalFlowYoga.com should work too, probably working out with levels 1-2 to begin. I’d love to hear your thoughts if you tried it. I think the EMS works synergistic with either my weights program or Spinal Flow. My workouts do train the core, but the EMS hits the abdominals harder than any exercise, and helps decrease the pain so that you can progress on all the other exercises faster. Were hoping that one of your bone spurs isn’t perpetually hitting a nerve, in such case neither exercise or EMS will be able to fully alleviate your symptoms, but a “low grade constant pain” doesn’t sound like that’s the case.

      Whether you can or should get back to tennis? That’s hard to say, the stronger/more endurance/more coordination to twist through your hips and legs and less through your spine the better.

  12. Hi Chad

    Thanks for answering my questions. Again I appreciate how you take the time to help those with LBP.

    I’ll be interested in how the 2/2/10 works for you. I am still thinking about the Globus. I upped the intensity on my Ireliev of 5/10/10/to where I was very uncomfortable. I hope this helps but If as you stated “pain before muscle contraction”, is all I am getting then I need to change.

    I viewed your LBP video, I already do the Bid Three which is part of your program and now I shall add the other exercises that you demonstrate.

    I shall order the Spinal flow yoga as then I can do them without going to the gym

    Any other suggestions would be appreciated. Benny

    • Hello again!

      I won’t be able to give you too much first hand feedback on the 2-2-10 program. I’ve done it a few times, it’s super intense! Literally I was sweating afterwards, but my go to program is still 10-50-10. In theory the longer rest periods allow for a greater strengthening effect, with what you said about endurance of 2-2-10 sounding right. 2-2-10 is 10 full minutes of suffering at high intensity. It’s not “painful” but it’s just so much intensity that it tests your limits. That said I had some girls in my office that loved it. They might be tougher, haha. But it’s hard/impossible to measure one over the other on yourself, except to just try it and see what it feels like to you. 10-50-10 lets me read a couple paragraphs in the 50 second rest period, for which I endure the 10 times 10 second blasts. 2-2-10 at high intensity doesn’t let you multi-task at all. For decreasing pain, based on what my patients tell me, they are roughly equivalent.

      The cool part (one of them) about the Globus is you can writer programs for both and alternate and see what you like better. The price you quote from ebay sounds fair. They retail for $600 in the USA and that’s with considerably less programability. If it were my back, I would go for it, then hit me up for rubber carbon electrodes and straps if I still don’t have my store up.

      If you join Spinal Flow Yoga the flow is there, but not everything is explained as well as I want yet. So I opened up comments on all the flow pages so you can ask questions and I would encourage you to do so. It will help me come up with my FAQ and help me explain things better, both for you and others.

  13. I just looked on internet for Globus Triathalon and got storeforwellness.com > lt is from Italy and has the unit on special for 399 euro which is about $465= 41 shipping is this a good deal?

  14. Hi Chad

    OK. I purchased the Globus Triathlon. I purchased and received from you the straps and electrodes.
    It only took me 3 days to figure out how to program. Thanks for you video or I would never have figured it out.

    I do your Low Back Pain video exercises twice a week and Spinal yoga flow twice a week. ( level 1 all but balancing 60 seconds. Maybe 20 seconds

    I do the abs and back with the Globus 3 times a week. I use your settings. The intensity I use is from your video that shows the women using 38 and 43 . Is this what I should be using?

    I also have knee osteoarthritis and shoulder bone spur. Globus has a program for this and it is a TENS program for 20 minutes. I bump to a 60 intensity which is comfortable. Do you have a recommended program that I can set?

    Thanks Benny

    • Hi Benny,

      That sounds like a great schedule. The only thing I would add is if any of the individual Spinal Flow exercises seem easy enough, feel free to move up to level-2 on them. In other words don’t try and move up a level all at once, but on each exercise one at at time if you are able to get the max number of reps without increasing pain.

      As far as intensity goes, it’s very individual. Most people start out with less because they aren’t used to feeling that intense of a stimulation, but in time as you get used to it you can handle more. Part of it is your muscles have to get stronger too. The first time I tried EMS on my abs I thought to myself, “if I turn this up any higher, I’m going to get a hernia” and who knows I might have. Nobody that I know of actually has but the stim definitely felt like my muscles were contracting harder than they ever had, so it took some time for my muscles to strengthen up to be able to handle more too. Upper 30s to 40s is a good amount of stimulation that should build muscle, but I usually tell people to try and get into the 50s. Expect that to take some number of weeks though. I also work higher as the 10 minutes goes on. I did it this morning starting with 70 mA and working up to 85 mA taking 5 mA jumps whenever I felt like I could. My record on core-2 was 105 mA but it took me well over a year to work up that high. So it’s more based on feel, what you feel like you can take, but getting into the 50s is plenty solid and your core muscles should feel very much stronger by the time you get there. That much EMS usually does a great job of zapping out pain too.

      I don’t use any of the Globus preset programs. Just ones I write myself. Not that there is anything wrong with their programs but for the most part I want my programs done in 10 minutes so I can go on about my day. Also I want to know exactly what my parameters are. For the knee I would most likely still do a 10-50-10 or maybe 5-15-10 program with what I call a criss cross quads/hamstring electrode placement. For shoulder I’ll strap on electrode in front of the shoulder and one behind with the same programs, which should help strengthen muscle at the same time it lessens pain. It should work for both, but I think the EMS is less or a miracle than it is for chronic low back pain. For just pain reduction without worrying about muscle contractions I like my FMTENS program.

      Parameters of all my favorite programs are as follows. I hope that helps. Let me know what you think, or if you have any other questions.

      10-50-10
      Type of stimulation: EMS
      Number of phases: 1
      Phase duration: 10
      Type of stimulation: Intermittent
      Type of modulation: Constant
      Workout frequency: 120Hz
      Workout pulse width: 450 uS
      Ramp up duration: 2500 mS
      Workout duration: 10s
      Ramp down duration: 500mS
      Rest stimulation: type: Constant
      Rest frequency: 5Hz
      Rest duration: 50s

      5-15-10
      Type of stimulation: EMS
      Number of phases: 1
      Phase duration: 10
      Type of stimulation: Intermittent
      Type of modulation: Constant
      Workout frequency: 120Hz
      Workout pulse width: 450 uS
      Ramp up duration: 2500 mS
      Workout duration: 5s
      Ramp down duration: 500mS
      Rest stimulation: type: Constant
      Rest frequency: 5Hz
      Rest duration: 15s

      10-10-10 (headache favorite)
      Type of stimulation: EMS
      Number of phases: 1
      Phase duration: 10
      Type of stimulation: Intermittent
      Type of modulation: Constant
      Workout frequency: 120Hz
      Workout pulse width: 450 uS
      Ramp up duration: 2500 mS
      Workout duration: 10s
      Ramp down duration: 500mS
      Rest stimulation: type: Constant
      Rest frequency: 5Hz
      Rest duration: 10s

      2-2-10
      Type of stimulation: EMS
      Number of phases: 1
      Phase duration: 10
      Type of stimulation: Intermittent
      Type of modulation: Constant
      Workout frequency: 120Hz
      Workout pulse width: 450 uS
      Ramp up duration: 2500 mS
      Workout duration: 2s
      Ramp down duration: 500mS
      Rest stimulation: type: Constant
      Rest frequency: 5Hz
      Rest duration: 2s

      5hz-10
      Type of stimulation: TENS
      Number of phases: 1
      Phase Duration: 10’
      Program Name: Symmetric TENS
      Type of modulation: Continuous (START)
      Workout freq: 5Hz
      Workout pulse width: 450 uS

      5hz-30
      Type of stimulation: TENS
      Number of phases: 1
      Phase Duration: 30’
      Program Name: Symmetric TENS
      Type of modulation: Continuous (START)
      Workout freq: 5Hz
      Workout pulse width: 450 uS

      FMTENS-10
      Type of stimulation: TENS
      Number of phases: 1
      Phase Duration: 10’
      Program Name: Symmetric TENS
      Type of modulation: Frequency Modul.
      Start workout freq: 2Hz
      End workout freq: 80 Hz
      Workout pulse width: 450 uS
      Workout duration: 5s

      FMTENS-30
      Type of stimulation: TENS
      Number of phases: 1
      Phase Duration: 30’
      Program Name: Symmetric TENS
      Type of modulation: Frequency Modul.
      Start workout freq: 2Hz
      End workout freq: 80 Hz
      Workout pulse width: 450uS

  15. Thanks Chad. The 38 intensity is very strong on my ads. The back not so much. Maybe i’ll back off a little and increase weekly as you recommend. I use 4 electrodes on front and four on back. I did see somewhere that they used 2 in back. is there much of a difference?
    On my shoulder, I tried the straps but cannot find a way to attach to shoulder without getting the stinging because of the strap not being tight enough. So I used the original sticky electrode and it works well.
    I saw on your video that you used a program that increase your heart rate. My wife is a bit sedentary and I make her walk. But I would like her to increase her heart rate as if she were really exercising. I thought if you had increased your heart rate while watching TV, it might be of advantage to her. What program if any would you recommend?..Thanks again for all you do. Benny

    • It’s common (pretty much all the time) for the stim to feel harder on the abs than on the back. For that reason I usually start people off with “Core-1” electrode placement. That way each channel is on a different body part and you can turn the stim up higher on your low back, not being limited by the abdominals. Usually obliques take an intensity that is in the middle, between that of the back and the anterior abdominals. Over time (2-4 weeks) of regular use the abs should strengthen and be able to handle as, or near, much stimulation as the low back. At that point I’ll usually have people start doing the “Core-2″ electrode placement. With Core-2 all the electrodes are further apart, allowing for deeper stimulation, but if you do it too early because of the abdominal weakness the low back gets under stimulated.

      Two electrodes in the back seems good enough in my experience. I just turn them up higher. Four in the back would probably be a little better on the back but to do that you have to sacrifice stimulation of the obliques, and I think stimulating the obliques is more important. If I were to design my own stimulator it would be much the same as the Globus, but with 5 channels so I could have four electrodes in front, four in the back, and two on the sides. I already have it planned, it’s Core-5.

      The trick for stimulating the shoulder is to use either two of the 8″ wide or 4” wide straps put together for increased length, and have it go under one shoulder and over the sore one, then slip the electrodes underneath after the strap is in place. It’s still not as good as the core tho.

      Here’s my blog where I experimented with aerobic stimulation. It works. The 5hz-30 program worked best. I had to use different, extra large (5″x8″) electrodes to make it work. It wasn’t exactly pleasant but I suppose one wouldn’t have to turn it up as high as I did. It definitely increases blood flow!

      • Oh, I would add that it was because of my findings with aerobic stimulation that I set the “resting period” hz at 5 in all my strength programs. That way if you want to increase circulation more, in addition to strengthening with the other programs, you can turn up the rest period intensity. The Globus automatically sets the rest period (5 hz) stimulation at 1/2 the milliamps of what you start with for the EMS blast. However, you can turn that stimulation up or down, independent of the EMS blast, according to your preference.

  16. Chad, I’ am 75 so a little show on the uptake of new things. So I am having a little trouble with setting program FMtens-10

    Type of stimulation: TENS
    Number of phases: 1
    Phase Duration: 10’
    Program Name: Symmetric TENS
    Type of modulation: Frequency Modul.
    Start workout freq: 2Hz I start at 2 hz It prompts me to intensity which set at 50
    End workout freq: 80 Hz I don’t know how to to change from 2hz to 80
    Workout pulse width: 450 uS
    Workout duration: 5s How do I set 5s

    Thanks for your patience

    • Let me think, it should be like this:

      FMTENS-10
      Type of stimulation: TENS
      Number of phases: 1
      Phase Duration: 10’
      Program Name: Symmetric TENS
      Type of modulation: Frequency Modul.
      Start workout freq: 2Hz
      End workout freq: 80 Hz
      Workout pulse width: 450 uS
      Workout duration: 5s

      You should be setting the above parameters under the programming tab when you first set up the machine. There shouldn’t be any prompt for intensity while writing the program. The hz should be at 2 on the bottom (start frequency) and 80 on the top (end frequency), then go on to set pulse width, then duration of 5 seconds. The 5 seconds is how long it takes for the electric stimulation to vary between 5 and 80 hz so when you are running the machine it should feel like a faster and slower wave of stimulation. You then set the intensity in mA when you turn on the machine to run it. In the instruction booklet there should be more instructions on how to program the machine in case I’m not explaining it well, but the above parameters are the best I and my patients have ever felt as far as “comfortable” pain relief. As opposed to 10-50-10 which is an uncomfortable workout and pain relief.

      Feel free to ask more questions if that doesn’t cover it, and let me know how you like FMTENS!

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.