Electrical muscle stimulation

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Athlete squatting with four-channel, electrical muscle stimulation machine for training, attached through self-adhesive pads to her quadriceps.

Electrical muscle stimulation (EMS), also known as neuromuscular electrical stimulation (NMES) or electromyostimulation, is the elicitation of muscle contraction using electric impulses. EMS has received increasing attention in the last few years because of its potential to serve as a strength training tool for healthy subjects and athletes, a rehabilitation and preventive tool for partially or totally immobilized patients, a testing tool for evaluating the neural and/or muscular function in vivo, and a post-exercise recovery tool for athletes.[1] The impulses are generated by a device and delivered through electrodes on the skin in direct proximity to the muscles to be stimulated. The impulses mimic the action potential coming from the central nervous system, causing the muscles to contract. The electrodes are generally pads that adhere to the skin. The use of EMS has been cited by sports scientists[2] as a complementary technique for sports training and published research is available on the results obtained.[3] In the United States, EMS devices are regulated by the U.S. Food and Drug Administration (FDA).[4]

The XVIII Congress of the International Society of Electrophysiology and Kinesiology (ISEK 2010), which took place in Aalborg, Denmark on 16–19 June 2010, had a dedicated session on the subject: Electrical stimulation for testing and training in exercise and sports. As part of it, numerous research papers and reviews have been published.[5][6]


Luigi Galvani (1761) provided the first scientific evidence that current can activate muscle. During the 19th and 20th centuries, researchers studied and documented the exact electrical properties that generate muscle movement.[7][8] It was discovered that the body functions induced by electrical stimulation caused long-term changes in the muscles.[9][10] In the 1960s, Soviet sport scientists applied EMS in the training of elite athletes, claiming 40% force gains.[11] In the 1970s, these studies were shared during conferences with the Western sport establishments. However, results were conflicting, perhaps because the mechanisms in which EMS acted were poorly understood.[12] Recent medical physiology research[13][14] pinpointed the mechanisms by which electrical stimulation causes adaptation of cells of muscles, blood vessels[15][16][17] and nerves.[18]


"Strength training by NMES does promote neural and muscular adaptations that are complementary to the well-known effects of voluntary resistance training".[1] This statement is part of the editorial summary of a 2010 world congress of researchers on the subject. Additional studies on practical applications, which came after that congress, pointed out important factors that make the difference between effective and ineffective EMS.[19][20] This in retrospect explains why in the past some researchers and practitioners obtained results that others could not reproduce. Also, as published by reputable universities, EMS causes adaptation, i.e. training, of muscle fibers.[21] Because of the characteristics of skeletal muscle fibers, different types of fibers can be activated to differing degrees by different types of EMS, and the modifications induced depend on the pattern of EMS activity.[14] These patterns, referred to as protocols or programs, will cause a different response from contraction of different fiber types. Some programs will improve fatigue resistance, i.e. endurance, others will increase force production.[18]


Active recovery session
EMS for upper arms

EMS can be used as a training,[22][23][24] therapeutic,[25][26] and cosmetic tool. In medicine, EMS is used for rehabilitation purposes, for instance in physical therapy in the prevention of disuse muscle atrophy which can occur for example after musculoskeletal injuries, such as damage to bones, joints, muscles, ligaments and tendons. This is distinct from transcutaneous electrical nerve stimulation (TENS), in which an electric current is used for pain therapy.

Because of the effect that strengthened and Hypertrophied muscles have on appearance (a stronger muscle has larger cross-section[27]), EMS is also used by a niche of practitioners for aesthetics goals.[28][29][30] The FDA rejects certification of devices that claim weight reduction.[31] EMS devices cause a calorie burning that is marginal at best: calories are burnt in significant amount only when most of the body is involved in physical exercise: several muscles, the heart and the respiratory system are all engaged at once.[32] However, some authors imply that EMS can lead to exercise, since a person toning his/her muscles with electrical stimulation is more likely afterwards to participate in sporting activities as the body is ready, fit, willing and able to take on physical activity.[33] In EMS training few muscular groups are targeted at the same time, for specific training goals.[33] The effectiveness of the devices for sport training has been debated. A number of coaches regularly use professional EMS devices as an integral part of the training of their athletes; some of these are high profile coaches, such as track coach Charlie Francis, who used the technique to supplement the training of Olympic-level athletes.[34][35]

Non-professional devices target home-market consumers[36] with wearable units in which EMS circuitry is contained in belt-like garments (ab toning belts) or other clothing items.

FDA certification in the United States[edit]

The U.S. Food and Drug Administration (FDA) certifies and releases EMS devices into two broad categories: over-the counter devices (OTC), and prescription devices. OTC devices are marketable only for muscle toning; prescription devices can be purchased only with a medical prescription for therapy. Prescription devices should be used under supervision of an authorized practitioner, for the following uses:

  • Relaxation of muscle spasms;
  • Prevention or retardation of disuse atrophy;
  • Increasing local blood circulation;
  • Muscle re-education;
  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis;
  • Maintaining or increasing range of motion.

The FDA mandates that manuals prominently display contraindication, warnings, precautions and adverse reactions, including: no use for wearer of pacemaker; no use on vital parts, such as carotid sinus nerves, across the chest, or across the brain; caution in the use during pregnancy, menstruation, and other particular conditions that may be affected by muscle contractions; potential adverse effects include skin irritations and burns

Only FDA-certified devices can be lawfully sold in the US without medical prescription. These can be found at the corresponding FDA webpage for certified devices.[37] The FTC has cracked down on consumer EMS devices that made unsubstantiated claims;[38] many have been removed from the market, some have obtained FDA certification.

Popular culture[edit]

See also[edit]


  1. ^ a b Maffiuletti, Nicola A.; Minetto, Marco A.; Farina, Dario; Bottinelli, Roberto (2011). "Electrical stimulation for neuromuscular testing and training: State-of-the art and unresolved issues". European Journal of Applied Physiology. 111 (10): 2391–7. doi:10.1007/s00421-011-2133-7. PMID 21866361. 
  2. ^ Zatsiorsky, Vladimir; Kraemer, William (2006). "Experimental Methods of Strength Training". Science and Practice of Strength Training. Human Kinetics. pp. 132–133. ISBN 978-0-7360-5628-1. 
  3. ^ Examples of peer-reviewed research articles attesting increased muscular performance by utilizing EMS:[improper synthesis?]
    • Babault, Nicolas; Cometti, Gilles; Bernardin, Michel; Pousson, Michel; Chatard, Jean-Claude (2007). "Effects of Electromyostimulation Training on Muscle Strength and Power of Elite Rugby Players". The Journal of Strength and Conditioning Research. 21 (2): 431. doi:10.1519/R-19365.1. 
    • Malatesta, D; Cattaneo, F; Dugnani, S; Maffiuletti, NA (2003). "Effects of electromyostimulation training and volleyball practice on jumping ability". Journal of strength and conditioning research. 17 (3): 573–9. doi:10.1519/00124278-200308000-00025. PMID 12930189. 
    • Willoughby, Darryn S.; Simpson, Steve (1998). "Supplemental EMS and Dynamic Weight Training: Effects on Knee Extensor Strength and Vertical Jump of Female College Track & Field Athletes". Journal of Strength & Conditioning Research. 12 (3). 
    • Willoughby, Darryn S.; Simpson, Steve (1996). "The Effects of Combined Electromyostimulation and Dynamic Muscular Contractions on the Strength of College Basketball Players". Journal of Strength & Conditioning Research. 10 (1). 
  4. ^ FDA Guidance Document for Powered Muscle Stimulator, standard indications for use, page 4; contraindications, p. 7; warnings and precautions, p. 8. Product code: NGX
  5. ^ Gondin, Julien; Cozzone, Patrick J.; Bendahan, David (2011). "Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes?". European Journal of Applied Physiology. 111 (10): 2473–87. doi:10.1007/s00421-011-2101-2. PMID 21909714. 
  6. ^ Babault, Nicolas; Cometti, Carole; Maffiuletti, Nicola A.; Deley, Gaëlle (2011). "Does electrical stimulation enhance post-exercise performance recovery?". European Journal of Applied Physiology. 111 (10): 2501–7. doi:10.1007/s00421-011-2117-7. PMID 21847574. 
  7. ^ Ranvier, Louis-Antoine (1874). "De quelques faits relatifs à l'histologie et à la physiologie des muscles striés". Archives de Physiologie Normale et Pathologique (in French). 6: 1–15. 
  8. ^ Denny-Brown, D. (1929). "On the Nature of Postural Reflexes". Proceedings of the Royal Society B. 104 (730): 252–301. Bibcode:1929RSPSB.104..252D. doi:10.1098/rspb.1929.0010. JSTOR 81340. 
  9. ^ Buller, AJ; Eccles, JC; Eccles, RM (1960). "Interactions between motoneurones and muscles in respect of the characteristic speeds of their responses". The Journal of Physiology. 150: 417–39. doi:10.1113/jphysiol.1960.sp006395. PMC 1363172Freely accessible. PMID 13805874. 
  10. ^ Pette, Dirk; Smith, Margaret E.; Staudte, Hans W.; Vrbová, Gerta (1973). "Effects of long-term electrical stimulation on some contractile and metabolic characteristics of fast rabbit muscles". Pflügers Archiv European Journal of Physiology. 338 (3): 257–272. doi:10.1007/BF00587391. 
  11. ^ Ward, AR; Shkuratova, N (2002). "Russian electrical stimulation: The early experiments". Physical therapy. 82 (10): 1019–30. PMID 12350217. 
  12. ^ Siff, Mel (1990). "Applications of Electrostimulation in Physical Conditioning: A Review". Journal of Strength & Conditioning Research. 4 (1). 
  13. ^ Vrbová, Gerta; Gordon, Tessa; Jones, Rosemary (1995). Nerve-Muscle Interaction. London: Chapman & Hall. ISBN 978-0-412-40490-0. [page needed]
  14. ^ a b Salmons, S; Vrbová, G (1969). "The influence of activity on some contractile characteristics of mammalian fast and slow muscles". The Journal of Physiology. 201 (3): 535–49. doi:10.1113/jphysiol.1969.sp008771. PMC 1351409Freely accessible. PMID 5767881. 
  15. ^ Blomqvist, C G; Saltin, Bengt (1983). "Cardiovascular Adaptations to Physical Training". Annual Review of Physiology. 45: 169–89. doi:10.1146/annurev.ph.45.030183.001125. PMID 6221687. 
  16. ^ Cabric, M.; Appell, H.-J.; Resic, A. (2008). "Stereological Analysis of Capillaries in Electrostimulated Human Muscles". International Journal of Sports Medicine. 08 (5): 327–330. doi:10.1055/s-2008-1025678. 
  17. ^ Harris, B. A. (2005). "The influence of endurance and resistance exercise on muscle capillarization in the elderly: A review". Acta Physiologica Scandinavica. 185 (2): 89–97. doi:10.1111/j.1365-201X.2005.01461.x. PMID 16168003. 
  18. ^ a b Pette, Dirk; Vrbová, Gerta (1999). "What does chronic electrical stimulation teach us about muscle plasticity?". Muscle & Nerve. 22 (6): 666–677. doi:10.1002/(SICI)1097-4598(199906)22:6<666::AID-MUS3>3.0.CO;2-Z. 
  19. ^ Filipovic, Andre; Heinz Kleinöder; Ulrike Dörmann; Joachim Mester (September 2012). "Electromyostimulation--a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes". Journal of strength and conditioning research / National Strength & Conditioning Association. 26 (9): 2600–2614. doi:10.1519/JSC.0b013e31823f2cd1. ISSN 1533-4287. 
  20. ^ Filipovic, Andre; Heinz Kleinöder; Ulrike Dörmann; Joachim Mester (November 2011). "Electromyostimulation-a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters - part 2". Journal of Strength and Conditioning Research / National Strength & Conditioning Association. 25 (11): 3218–3238. doi:10.1519/JSC.0b013e318212e3ce. ISSN 1533-4287. PMID 21993042. Retrieved 2014-06-13. 
  21. ^ Quoted from National Skeletal Muscle Research Center; UCSD, Muscle Physiology Home Page - Electrical Stimulation
  22. ^ Babault, Nicolas; Cometti, Gilles; Bernardin, Michel; Pousson, Michel; Chatard, Jean-Claude (2007). "Effects of Electromyostimulation Training on Muscle Strength and Power of Elite Rugby Players". The Journal of Strength and Conditioning Research. 21 (2): 431. doi:10.1519/R-19365.1. 
  23. ^ Banerjee, P.; Caulfield, B; Crowe, L; Clark, A (2005). "Prolonged electrical muscle stimulation exercise improves strength and aerobic capacity in healthy sedentary adults". Journal of Applied Physiology. 99 (6): 2307–11. doi:10.1152/japplphysiol.00891.2004. PMID 16081619. 
  24. ^ Porcari, John P.; Miller, Jennifer; Cornwell, Kelly; Foster, Carl; Gibson, Mark; McLean, Karen; Kernozek, Tom (2005). "The effects of neuromuscular stimulation training on abdominal strength, endurance and selected anthropometric measure". Journal of Sports Science and Medicine. 4: 66–75. 
  25. ^ Lake, DA (1992). "Neuromuscular electrical stimulation. An overview and its application in the treatment of sports injuries". Sports medicine. 13 (5): 320–36. doi:10.2165/00007256-199213050-00003. PMID 1565927. 
  26. ^ Delitto, A; Rose, SJ; McKowen, JM; Lehman, RC; Thomas, JA; Shively, RA (1988). "Electrical stimulation versus voluntary exercise in strengthening thigh musculature after anterior cruciate ligament surgery". Physical therapy. 68 (5): 660–3. PMID 3258994. 
  27. ^ Muscle force is proportional to physiologic cross-sectional area (PCSA)...; quoted from National Skeletal Muscle Research Center; UCSD, Muscle Physiology Home Page - Skeletal Muscle Architecture, Effect of Muscle Architecture on Muscle Function
  28. ^ Currier, WD (1963). "Effects of electronic stimulation of the VII nerve. I. On senescent changes of the face". Annals of Otology, Rhinology, and Laryngology. 72: 289–306. PMID 14024328. 
  29. ^ Al-Majed, AA; Neumann, CM; Brushart, TM; Gordon, T (2000). "Brief electrical stimulation promotes the speed and accuracy of motor axonal regeneration". Journal of Neuroscience. 20 (7): 2602–8. PMID 10729340. 
  30. ^ Ågren, Magnus S.; Engel, Marc A.; Mertz, Patricia M. (1994). "Collagenase during Burn Wound Healing". Plastic and Reconstructive Surgery. 94 (3): 518–24. doi:10.1097/00006534-199409000-00015. PMID 8047605. 
  31. ^ FDA Import Alert 10/02/2009 Electrical Muscle Stimulators and Iontophoresis Devices Muscle stimulators are misbranded when any of the following claims are made: girth reduction, loss of inches, weight reduction, cellulite removal, bust development, body shaping and contouring, and spot reducing.
  32. ^ Maffiuletti, NA (2006). "The use of electrostimulation exercise in competitive sport". International journal of sports physiology and performance. 1 (4): 406–7. PMID 19124897. 
  33. ^ a b Vrbova, Gerta; Olga Hudlicka; Kristin Schaefer Centofanti (2008). Application of Muscle-Nerve Stimulation in Health and Disease. Springer. p. 70. 
  34. ^ Charlie Francis, The Truth About EMS -Electronic Muscle Stimulation: Facts and Fallacies T-Nation
  35. ^ "Notable Users of Globus EMS Machines - G Sport and Health Tech". Retrieved 2016-08-18. 
  36. ^ Porcari, John P.; Miller, Jennifer; Cornwell, Kelly; Foster, Carl; Gibson, Mark; McLean, Karen; Kernozek, Tom (2005). "Effects of Neuromuscular Electrical Stimulation Training on Abdominal Strength, Endurance, and Selected Anthropometric Measures". Journal of Sports Science and Medicine. 4: 66–75. 
  37. ^ FDA-Certified Devices
  38. ^ FTC Charges Three Top-selling Electronic Abdominal Exercise Belts with Making False Claims
  39. ^ "It's time to regulate the use of whole body electrical stimulation". BMJ: i1693. doi:10.1136/bmj.i1693. 
  40. ^ Guarascio, P.; Lusi, E. A.; Soccorsi, F. (1 August 2004). "Electronic muscular stimulators: a novel unsuspected cause of rhabdomyolysis". British Journal of Sports Medicine. 38 (4): 505–505. doi:10.1136/bjsm.2003.008540. ISSN 1473-0480. Retrieved 9 June 2016. 

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