Contraindications to Electrotherapy treatment (TENS, EMS, etc.)

There are several types of electrotherapy treatment. The most well-known is TENS treatment, also known as nerve stimulation, which is a pain-relieving method. These include EMS (muscle stimulation), iontophoresis, denervated (selective stimulation current), MENS and MCR (microcurrent). In most cases, they are completely harmless and free of side effects. Nevertheless, there are specific conditions where any form of electrical treatment is strictly prohibited. In other situations, it’s crucial to carefully consider whether it should be applied and, if so, on which part of the body. You should seek advice or seek the opinion of a physiotherapist before using electrotherapy. In this article, I will explain why and when you should consider NOT using electrotherapy treatments.

Never use pain relief (TENS, MENS) if you do not know what is causing the pain! The cause must be found out before starting pain relief!
This applies to any other pain relief procedure, including drugs! It can be dangerous to cover up symptoms of, for example, incipient appendicitis with treatment! Consult a doctor and start pain relief when the cause of the pain is known.

Contraindications to electrical treatment

Here are the most common scenarios where electrical treatment is not advisable:

In cases of severe trauma (e.g. accidental pain). In such cases, suppression of pain may distract attention from important symptoms
If a pacemaker is present – electrical impulses can stop or interfere with the pacemaker and are therefore risky to use.
Above the carotid sinus – electrical stimulation of this area may affect heart rhythm and blood pressure control.
Do not treat directly over tumour tissue in the case of cancer. This is because it is thought that the microcurrents generated by TENS may stimulate tumour growth. However, it may treat lower limb joint pain in lung tumours, for example.
Brain area stimulation (stimulation of the cranial area) – it follows that TENS is not recommended for headache relief. There are special stimulation devices that can be used for headaches, but not TENS.
Patients with epilepsy are not recommended to use the device because the impulses may trigger a seizure.
Fresh skin wound and dermatological inflammatory diseases.
In the immediate vicinity of a fresh surgical scar – muscle twitching from the pulses may impede fresh wound healing.
electrical treatment of the abdomen is prohibited during pregnancy.
Strictly forbidden to use electrostimulators on or near the eyes.
For patients with capillary fragility, use the device with extreme caution and at low intensity, as excessive stimulation may cause rupture of the capillaries.

Electric therapy and implants

In our country, the ban on TENS, EMS, FES, MENS treatment near or directly above implants has been in place for decades. But what is the truth?

There are two types of implants

One type of implant is the PASSIUM implant, employed for bone fixation like marrow pins, screws, plates, and even for joint replacements like knees and hips using metal materials.
Medical professionals categorize implants like pacemakers, defibrillators, insulin pumps, etc., as active implants because they operate on batteries.

Active implants and electrotherapy

Active implants operate on electrical power such as pacemakers and defibrillators, for example, monitor the electrical activity of the heart and intervene if they detect certain abnormal heart activity.

The presence of these devices is an absolute contraindication, no discretion! This is based on an assumption that an external electrical pulse can obviously interfere with the device. Thus, in active implant cases, domestic physicians REFUSE to use any electrotherapy treatment.

In international practice, the picture is more nuanced. This implies that if there is an active implant, one must assess the benefit-to-risk ratio and proceed with treatment if the expected benefits substantially surpass the risks.

For instance, the use of electrical treatment on the chest is still discouraged, but it is now considered to entail minimal risk when applied to the legs, feet, knees, hips, wrists, or elbows. To put it more plainly, you can use electrotherapy to treat severe knee pain or peroneal palsy, even if you have a pacemaker.

The pacemaker companies themselves recommend this. In their measurements, they found no evidence that TENS treatment caused any disturbance in pacemaker function.

I have compiled some notable publications on the subject.

Passive implants and electrotherapy

Suggestions have arisen regarding passive implants, indicating that the treatment current may induce “significant” heat in the metal implant, potentially causing harm to the cement securing the implant or the surrounding tissue.

This belief originated when predominantly iron and steel alloys were prevalent, and electrotherapy devices were relatively imperfect during that era. But in the meantime, the materials used for implants have changed completely and electrotherapy devices are much more precise.

Only low-frequency electrotherapy devices are currently available for home use. The vibrations of these, the current applied, cannot generate enough heat to cause heating even during prolonged treatments. On the other hand, the light metal alloys used in prostheses today react differently to electricity and magnetism than those of the past.

While you might come across a prohibition in your home electrotherapy device’s description advising against using it over implants, it’s essential to consider this advice as outdated.

Treatment methods that require a professional

But let’s look around a bit… there are some treatments whose main effect is heating and the resulting acceleration of blood circulation.

Shortwave, microwave, TECAR, diathermy, continuous ultrasound, medical laser treatments are such. Their careless use could even do harm.

Professionals can administer these treatments at an institute; they are not suitable for home use. Draper and colleagues have recently demonstrated that relatively high-power pulsed short-wave treatment had no harmful effects on metal implants in the treated area (Draper et al., 2004).

Summary

TENS, EMS, MENS, FES, interference treatments do not produce a heating effect that is harmful to the passive implant environment, even after prolonged use. This means that you can safely use these treatments with any passive implant.

If you still have doubts about the treatment, reach out to an experienced physiotherapist specializing in electrotherapy for guidance.