Being confined to bed can be a challenging experience, often accompanied by the worry of losing muscle strength
and function. Prolonged bed rest, while sometimes medically necessary, can unfortunately lead to a significant
decline in muscle mass and strength. This loss, known as muscle atrophy, can significantly hinder rehabilitation
and extend recovery times. As physiotherapists, we are dedicated to helping our patients maintain their physical
well-being. Fortunately, Transcutaneous Electrical Nerve Stimulation (TENS) offers a promising physiotherapy
intervention to minimize muscle wasting during periods of inactivity. This article is designed to guide patients,
caregivers, and physiotherapists on how to effectively use TENS to combat muscle atrophy during bed rest, while
adhering to physiotherapy best practices.
Why do muscles waste away during bed rest? Muscle atrophy, or muscle wasting, is a common consequence
of prolonged inactivity. When muscles aren't used, the body begins to break down muscle tissue, leading to
a decrease in both muscle size and strength. This process is accelerated during bed rest because the body
slows down its muscle-building processes. Understanding the mechanisms behind muscle atrophy is crucial for
implementing effective interventions.
The physiological basis of muscle atrophy during bed rest involves a decrease in protein synthesis and an
increase in protein breakdown. Reduced muscle activity leads to decreased signaling pathways that promote
muscle growth and maintenance. This imbalance results in a net loss of muscle protein, contributing to muscle
wasting. Conditions like muscular dystrophy can exacerbate this process. Furthermore, it's important to note that
adequate nutrition, particularly sufficient protein intake, plays a vital role in mitigating muscle atrophy.
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive physiotherapy technique that uses
low-voltage electrical currents to stimulate nerves. A TENS unit delivers these electrical impulses through
electrodes placed on the skin, targeting specific nerves or muscle groups. While commonly known for pain relief,
TENS also has applications in muscle rehabilitation and preventing muscle atrophy.
The primary function of TENS is to stimulate sensory nerves, which can help to block pain signals from reaching
the brain. However, TENS can also stimulate motor nerves, causing muscle contractions. This muscle activation
is key to preventing muscle wasting during bed rest. By mimicking the effects of voluntary muscle contractions,
TENS helps maintain muscle mass and strength. The mechanism of action for pain relief by TENS is thought to
be central by blocking the pain pathway at the dorsal horn of the spinal cord and stimulating the endogenous
opioid system.
Applying TENS effectively for muscle atrophy requires careful consideration of electrode placement, stimulation
parameters, and individual patient needs. Physiotherapist will tailor these guidelines to your specific needs
and condition. It's crucial to remember that TENS should only be used under the guidance and supervision of a
qualified physiotherapist or other healthcare professional. Here are some practical guidelines for physiotherapists:
• Electrode Placement: Place electrodes on the skin over the target muscles. Ensure good contact between the
electrodes and the skin by using conductive gel. The placement should target the motor points of the muscles
to maximize muscle activation.
• Stimulation Parameters: Adjust the intensity and frequency of stimulation based on individual needs and
tolerance. Start with a low intensity and gradually increase it until the patient feels a comfortable tingling sensation
or mild muscle contraction. The frequency can be adjusted to optimize muscle activation while minimizing
discomfort. The specific parameters of TENS were burst mode, 2.0 Hz frequency, and 300 micro-seconds width.
• Treatment Duration and Frequency: The duration and frequency of TENS treatment will depend on the
severity of muscle atrophy and the patient's response to therapy. A typical session may last 30 minutes, and
treatments may be administered once a week. In the study, patients received one 30-minute session each week
for 12 weeks. The intensity of TENS was gradually increased from 0 mA until the subject felt a comfortable tingling
sensation beneath the electrode without any muscle contraction and pain. This approach can be adapted and
modified by a qualified physiotherapist based on individual patient needs.
From a physiotherapy perspective, TENS offers many benefits during bed rest. It can help reduce muscle loss
and improve muscle strength. By maintaining muscle mass and strength, TENS can improve functional outcomes
and reduce the risk of complications associated with muscle atrophy.
Moreover, TENS is a non-invasive and relatively safe intervention with minimal side effects. It can be easily
administered by a physiotherapist or even self-administered by patients under proper guidance. This makes TENS
a convenient and cost-effective option for preventing muscle atrophy during bed rest. While TENS is relatively
safe, proper training and understanding of contraindications are essential for safe and effective use. It's also a
safe treatment option. TENS is a cost-effective, safe, and non-invasive treatment option that does not require
much expertise unlike the percutaneous method.
Integrating technology into physiotherapy can significantly enhance patient care, especially for those on bed rest.
Devices like Axonease, can provide a more comprehensive approach muscle atrophy management. Axonease can
be used to monitor muscle activity and provide real-time feedback during sessions, allowing for more precise
adjustments to the stimulation parameters. This can lead to more effective muscle activation and better outcomes.
Furthermore, the use of remote physios can make TENS therapy more accessible and convenient for patients on
bed rest. Remote physiotherapy allows patients to receive guidance and support from a qualified physiotherapist
from the comfort of their own homes. This can be particularly beneficial for patients who have difficulty traveling
to a clinic or who live in remote areas. Remote physios can provide personalized treatment plans, monitor patient
progress, and make adjustments to the protocol as needed.
While TENS can be a valuable tool, it's essential to remember that it's an adjunct therapy and not a standalone
treatment for muscle wasting. The primary focus should always be on active and passive range of motion
exercises, and progressive resistance training (where appropriate). A physiotherapist can assess your specific
needs, develop a personalized treatment plan, and guide you on the proper use of TENS. They can also
incorporate other therapeutic exercises and modalities to optimize your recovery.
Physiotherapy plays a crucial role in addressing muscle atrophy by combining TENS with exercises, manual
therapy, and other interventions. A physiotherapist can help you regain strength, improve function, and prevent
further muscle loss. They can also provide education and support to help you manage your condition and achieve
your goals. For guidance and support, consider consulting with remote physios.
Consider a patient recovering from a hip fracture who is confined to bed for several weeks. Without intervention,
this patient is likely to experience significant muscle atrophy in their legs. By incorporating TENS into their
physiotherapy program, the patient can maintain muscle mass and strength, improving their ability to walk and
function independently after bed rest.
Another example is a patient with a spinal cord injury who has limited voluntary movement in their lower
extremities. TENS can be used to stimulate the muscles in their legs, helping to prevent muscle atrophy and
improve circulation. This can enhance their overall quality of life and reduce the risk of complications associated
with immobility.
While TENS is generally safe, there are some precautions and contraindications to consider. TENS should not be
used in individuals with pacemakers or other implanted electronic devices, over the carotid sinus, over areas of
active bleeding or infection, or over areas of skin with impaired sensation. It should also be avoided in pregnant
women (unless specifically prescribed by a healthcare professional), individuals with epilepsy, and those with
certain skin conditions.
It's essential to consult with a healthcare professional or physiotherapist before starting TENS therapy to ensure
that it is safe and appropriate for your individual needs. They can assess your medical history, evaluate your
condition, and provide guidance on the proper use of TENS.
TENS offers a promising physiotherapy intervention for minimizing muscle wasting during bed rest. By stimulating
muscle fibers, promoting blood flow, and potentially influencing protein synthesis pathways, TENS can help
maintain muscle mass and strength, improving functional outcomes and accelerating recovery. The mechanism
of action for pain relief by TENS is thought to be central by blocking the pain pathway at the dorsal horn of the
spinal cord and stimulating the endogenous opioid system. Remember, TENS is most effective when integrated
into a comprehensive physiotherapy program tailored to your specific needs.Don't let muscle atrophy
hinder your recovery – we're here to empower you and enhance your outcomes with personalized care, powered
by innovation.
If you or someone you know is experiencing bed rest or immobilization, take the first step towards preserving
your muscle health. Contact us today for a personalized consultation and to learn how TENS therapy can help
you.