How to use a TENS units & EMS machines for tennis & golfer's elbow? Placement of electrode pads (UK)

The elbows are among the most important joints of the human body, since they are responsible for much of the mobility of the arm, in addition to carrying a large amount of stress, which can vary depending on the lifestyle of each person. Among the most common elbow joint injuries are lateral epicondylitis, popularly known as tennis elbow, and medial epicondylitis or golfer's elbow.

These almost exclusively sports injuries can be particularly painful, so an effective method of treating their symptoms is necessary. This is where TENS and EMS electrostimulation therapies come in. Below, we will teach you everything you need to know about this ailment, and how to use electrotherapy to treat its symptoms effectively.

How to use TENS machines to relieve elbow pain?

The electric shocks applied by TENS devices have the characteristics of being able to interact on the innervation of the treated area, so they are very effective when applied on a nerve-covered area such as the elbow.

Next, you will learn how to place the electrodes and the optimal intensity to apply to achieve an optimal TENS session:

How to place the electrodes?

For TENS therapy to be effective in treating elbow pain, it is necessary to take into account the positioning of the electrodes. It is important to emphasize that the point of pain should be located in the middle of both pads, so that the current passes through it correctly.

For pain in the external aspect of the elbow, a common symptom of tennis elbow, two electrodes should be placed, one in each of the following positions:

• Triceps brachii vastus externus
• Pronator teres muscle

For golfer's elbow, the positioning differs slightly, with the ideal locations being as follows:

• Medial head of triceps brachii
• Brachioradialis muscle, at the border with the pronator teres muscle.

What current intensity to use?

The optimal current for the treatment of symptoms caused by injuries such as tendonitis and epicondylitis will depend largely on two factors: the intensity of the pain and the duration of the pain.

For conditions lasting less than three months, known as acute pain, the ideal is to apply moderately high frequencies, between 90 and 120 Hz, to ensure maximum interaction with the radial, median and ulnar nerves, and to achieve a rapid and prolonged effect

In the case of chronic pain, the situation is different, since they are persistent ailments that afflict the patient for periods longer than three months. For these ailments, the ideal current is between 2 and 10 Hz for prolonged periods, in order to stimulate the release of endorphins and generate a feeling of relief in the patient.

Best TENS units to treat elbow injuries

The variety of TENS devices that have emerged thanks to their effectiveness and popularity for pain treatment gives us a wide selection of machines with their own programs for treating the symptoms of epicondylitis and other elbow ailments. Among the best devices you can use, we can highlight the following:

From EOSVAP comes this wonderful wireless electrostimulation device, effective for back pain, sciatica, arthritis and muscular ailments although its range of function is so wide that it can be used almost anywhere on the body portability and rechargeable battery make it an excellent investment when it comes to pain relief.

It has 7 intensity levels and 5 massage modes for instant pain relief in a natural and completely drug-free way. Its rechargeable lithium battery provides 24 hours of continuous use on a single charge, and can be charged via its USB connectors. Undoubtedly a complete revolution in the massage experience that you can keep in your pocket and take anywhere thanks to its small size.

The E3 model from OMRON is a TENS electrostimulator of compact size and great power, designed to be portable and used to relieve pain caused by exhaustion, injuries or diseases such as sciatica or neuropathy. This device uses TENS stimulation technology, proven and widely used by physiotherapists for its ability to relieve any type of pain.

It has a wide variety of pre-programmed modes of use designed to treat a wide range of ailments. Its compact size makes it incredibly convenient to carry wherever you want, and its specialized long-lasting electrodes can be washed and reused up to 150 times. The purchased package contains 1 OMRON E3 electrostimulator, 1 electrode cable and 1 long-lasting pad.

Dioche has available to the public one of the best TENS machines on the market, which stands out for its ease of use, versatility and portability. You can use it to relieve pain caused by various causes, from neuropathies and arthritis to injuries and muscle contractures.

One of its best features is the presence of a laser line for the nose that will allow you to treat rhinitis symptoms effectively, improving your health conditions considerably. The dual channel function of this rechargeable mini TENS machine allows you to treat multiple parts of the body simultaneously, bringing benefits such as improved circulation, reduced pain and accelerated metabolism.

The Moonssy electro-stimulator is one of the most versatile and widely used machines in the field of physiotherapy thanks to its innovative combination of TENS and EMS technologies, which give this electrotherapy unit a wide range of functions, from natural relief of ailments to stimulation of muscle growth.

It has 16 programmed modes and 20 intensity levels, ranging from acupuncture and shiatsu to vibration and tuina, among many other modalities designed to treat different types of pain, relieve stress and increase the production of endorphins to relieve pain in a completely natural way.

The physiotherapy brand Beurer offers its users one of the most versatile electrostimulation devices that can be found on the market. This is the Beurer EM49, which contains an incredible 3-in-1 function that allows you to apply therapeutic massage, muscle stimulation and nerve stimulation, providing a completely different level of relief to its users with its more than 70 programs and 50 levels of intensity.

This powerful electro-stimulator offers immediate relief for almost any type of ailment using stimulation methods that stimulate the production of natural analgesic agents within the body. It also works as an effective methods to accelerate muscle growth and regeneration, making it one of the most complete and versatile electrostimulation units on the market.

How to use EMS to strengthen muscles and prevent epicondylitis and epitrochleitis?

While EMS therapy is contraindicated for elbow injuries, it has great potential to condition the musculature surrounding and moving the elbow in order to reduce the chances of suffering any of these.

Where to place the electrodes?

Below, we will show you how to position the electrodes and what intensity of current to apply to the arm musculature to increase the stability of the elbow joint and prevent epicondylitis, epitrochleitis and other injuries.

To strengthen the muscles that surround and stabilize the elbow, it is necessary to position an electrode on the muscle belly of each muscle you want to work, so that the electrical impulse generates a complete contraction in the muscle or muscle group.

The ideal areas to position the EMS machine's electrodes are as follows:

• Long portion and short portion of biceps brachii
• Anterior brachioradialis muscle
• Triceps brachii
• Anterior and posterior part of the forearm

What intensity of current to use?

The use of electrical impulses on the muscles adjacent to the elbow is very useful when it comes to improving the stability and resistance of the joint, helping to prevent injuries and improve its capabilities, for which it is necessary to choose the frequency indicated for the muscles in question.

In the case of the triceps brachii, anterior brachialis and biceps brachii, the ideal frequency for training purposes ranges from 65 to 85 Hz, with variations in the duration of each session and the time of each shock, which depend on the user's objectives.

Best EMS machines to avoid elbow joint injuries

In the sports arena, muscle training and conditioning is vitally important, both to thrive in the competitive environment and to keep the body in optimal condition and avoid wear and tear, which is particularly important when it comes to maintaining joint stability.

The Compex Sport 4.0 is the ideal companion for competitive athletes, thanks to its application of EMS technology to increase physical performance in a natural way, while facilitating recovery. It also has the innovative MI technology, through which you can perform a scan of the muscle and know what frequency is appropriate for the treatment you want, greatly increasing the effectiveness of treatment.

The Compex Sport 4.0 has 10 conditioning programs, 5 recovery massage programs, 8 pain management programs, 2 rehabilitation programs and 5 fitness programs. All these features make it the perfect electrostimulator for athletes who practice their sport 3 to 4 times a week, for injury prevention and fast recovery from injuries.

Twenty intensity levels can be selected independently for each output to meet different massage needs, whether for leisure or sport. Two independent channels control the electrode pairs, so that two channels of the electric massager can be used simultaneously on different parts of the body. Includes high quality adhesive electrodes (replacement electrodes sold separately)

This combination device is ideal for pain relief and can also be used as a massager to relieve persistent tension. It is a non-pharmacological alternative to relieve pain and tension for people suffering from muscular, chronic, nerve and even some acute pain. For those who wish to tone and firm their muscles, the EMS mode of the device stimulates the muscles and improves their performance. For sedentary people, the device promotes local blood circulation.

The TechCare mini massager is one of the best and most practical tools to deal with acute and chronic ailments safely and without the use of medication. It is a device that combines TENS and EMS massage functions, applying low voltage electrical impulses to effectively block pain signals, as well as increase the natural production of endorphins, a natural painkiller.

It features 10 pre-programmed massage modes and 20 intensity levels that target different types of ailments and injuries. It has a session timer function that allows you to adjust the duration of the sessions and has a lithium battery that allows you to apply therapy for more than 20 consecutive hours.

The Smart Dot 2.0 is one of the best in a line of smart electro stimulators that automatically connect to your mobile phone and are controlled by an app. Its small size makes it completely portable, so you can use it to treat muscle recovery and ailment relief at any time, reducing recovery time and increasing your performance.

It has more than 10 preset programmes designed for muscle stimulation, improved recovery and pain relief, thanks to its revolutionary Smart TENS stimulation technology. The package includes a pre-loaded device, 2 sets of pads, 1 set of cables, 1 USB charger and a portable case.

A perfect combination of TENS and EMS massager. Massages a wide area of the body with a dual output design that sends electrical impulses through electrode pads placed on the skin. To relieve pain in back, knees, shoulders, ankles, neck, wrists and elbows, relieve fatigue and stimulate muscles, improve blood circulation, strengthen the immune system and improve sleep quality.

The 50-level intensity allows you to explore for another unique experience, while the preset timer can be easily adjusted from 5 to 60 minutes. Safe enough to relax at home or in the office. Hydrogel with multi-layer technology, reusable 70 to 110 times when used correctly. Built-in rechargeable lithium battery, 10 hours continuous use after a full charge with USB cable.

Video: How to place electrodes pads on the elbow?

Electrodes for elbow

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What types of elbow injury are there and what are the causes?

While it is a fairly resilient joint, the elbow is made up of soft tissues that can be injured if used excessively, with improper technique and without medical precautions, making the joint vulnerable to a variety of injuries from different causes.

Among the most common elbow injuries we can find the following:

Epicondylitis

It is an almost exclusively sports injury that causes pain in the external part of the elbow, and although it is not serious, it can have a significant impact on the patient's life if the appropriate treatment and rehabilitation methods are not applied.

Epicondylitis does not have a list of probable causes. It is caused by repetitive extension and supination of the arm, which causes micro-injuries to the tendons and muscles in the elbow joint, leading to tendonitis. These injuries accumulate until the initial tendonitis evolves into epicondylitis

Fracture

A fracture is a very painful injury caused by the breakage of one or more bones due to trauma. In the particular case of the elbow, the fracture can be of varying complexity and require different treatment depending on the severity of the injury and the bones involved.

Elbow fractures have the following causes:

• Falls
• Direct impacts
• Excessive twisting
• Osteoporosis
• Loss of bone mass

Olecranon bursitis

It is a very frequent disorder in the elbow that affects the synovial bags, or bursae, which are responsible for cushioning the movement of bones, tendons and muscles. This disorder causes inflammation of the olecranon bursa and is popularly known as "Popeye's elbow".

The main causes of this ailment are the following:

• Repetitive movements of the joint
• Exerting pressure on the elbow for prolonged periods of time
• Injuries, falls and trauma to the elbow
• Inflammatory arthritis

Tendonitis

Tendonitis is an injury caused by inflammation of the tendons that attach the muscles to the bone. While primarily a sports injury, tendonitis can occur when constant stress is placed on the joint through extension and supination movements.

Other common causes of tendonitis are described below:

• Sudden elbow injury
• Tendon overload
• Poor exercise technique

Differences between epicondylitis and epitrochleitis?

Both epicondylitis and epitrochleitis are diseases that affect the fibrous tissues of the elbow and generate pain sensation in the patient. However, they have crucial differences that cause them to be categorized as distinct diseases.

Epicondylitis has the following characteristics:

• Inflammation of the tendons responsible for wrist extension and arm supination
• Pain on the inside of the elbow
• Difficulty lifting the arm
• Pain when holding light objects
• Common among racquet sports athletes

Epicondylitis has similar origins, although it affects slightly different areas, in addition to being identified by means of other characteristics, among which we can highlight:

• Inflammation of the tendons that attach to the epitrochlea
• Weakness in the wrist joint
• Pain on the outside of the elbow
• Numbness, tingling and stiffness
• Pain when making a fist

Basically, the main difference between epicondylitis and epitrocleitis is the area in which the pain occurs. Since while the first one originates in the internal part of the elbow, the second one affects the external side.

In addition to this, both ailments share many similarities, as they both originate from microtrauma to the fibrous tissues of the elbow caused by repetitive, high-intensity activities involving use of the joint.

Differences between TENS and EMS: Which is better for treating tennis or golfer's elbow?

When it comes to electrotherapy treatment, sometimes there is confusion between transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) therapies, because in both cases electrical impulses are used for treatment. However, it is necessary to emphasize that each therapy is oriented to a different objective and works in a unique way.

In the case of TENS therapy, it is a means of physiotherapy focused on the treatment of pain produced by injuries, disorders and chronic diseases, which is distinguished by its own unique characteristics, among which we can mention:

• Its main focus is the treatment of symptoms of injuries and diseases that cause pain at specific points of the body.
• Its electrical impulses interact directly on the median, radial and ulnar nerve endings, numbing the nociceptors and mitigating the sensation of pain.
• It uses electric shocks of variable intensity (between 1 and 250 Hz) applied through electrodes placed on the skin at specific points of the body.
• It is used in the field of physiotherapy and treatment of chronic injuries to generate a sensation of relief in the patient.

On the other hand, EMS therapy is a method of training, rehabilitation and physical conditioning that focuses on the stimulation of muscle tissue. The most outstanding characteristics of this therapy are the following:

• The base intensity of its electrical impulses is higher, since it varies between 70 and 150 Hz.
• It interacts with the muscle tissue generating contractions that create physical activity in the muscle or muscle group being worked on.
• Applying the correct intensity, it can be used for the rehabilitation of low level pain injury, applying a gentle muscle massage.
• It is focused on physical conditioning and is widely used by medical teams in highly competitive sports.

With this in mind, we conclude that the optimal method for treating ailments caused by any of the forms of epicondylitis is transcutaneous electrical nerve stimulation, since its impulses interact with nociceptors in the median, radial and ulnar nerves, decreasing pain and generating a sensation of relief in the patient that can last up to several minutes after the session.

In contrast, EMS therapy is contraindicated for cases of epicondylitis, or any type of painful injury in the elbow, because the joint itself is composed of hard tissue and fibrous tissue (bones, ligaments, tendons and bursae), so its lack of muscle tissue, at best, will make ineffective the use of EMS impulses, and at worst, generate an adverse effect due to muscle contractions that their electrical impulses cause.

Contraindications in the use of electrodes and electrotherapy