Good evening, everybody! My name is Maryke. I'm the physiotherapist from sports-injury-physio.com,
where you can get online physiotherapy treatment. So, tonight's session is about neuromuscular
skeletal … neuromuscular stimulation … electrical stimulation. So, it's basically if you stick
electrodes on a muscle and you make it contract. I'm looking at: Can you use that for training? Is
it useful for rehab? And we're also going to see if it is useful for recovery, which is one of the
things that people tend promote it for or try to sell it to you for. The points that we're gonna
look at are: We're gonna first check, how does it actually work? What … Why can it strengthen
muscles, and does it actually strengthen muscles? Then we're gonna look at, if you use it in your
exercise regime or part of your training, say for instance you're a triathlete or a runner or you
just want to do strength training, is it useful? Can you get some useful results from that? We're
gonna look at why you should maybe be careful with it sometimes, whether it holds any dangers for
injury prevention or injury creation. Then we'll look at recovery: does it work for that? How to
use it if it is useful. And we're gonna look at how I use it for rehab and what I find it useful
for. But there's so many different ways to use it. Then, if you’re new to the livestreams, make sure,
if you've got any questions, ask them in the comments, I'll get to them as they come along. And
if you're watching this on replay, then feel free to ask them in the comments as well. And if you
tag me, I'll know it's there and I'll go have a look and answer them. The other thing is, I've got
a bit of laryngitis. So, I may go into a coughing fit, but I'm trying to keep my voice down compared
to normal, but I'm not sure whether I'll be able to do that all the time. So, do pardon me if I
start to cough. Very well! So, let's get going with: How does electrical stimulation actually
work? Now, there are a wide variety of machines and things that you can use for it. We tend to
use Compex machines in the clinic, basically, I think, because Compex was the one that was heavily
promoted to all the clinics in the UK a few years back. And to be honest, they do a really good
machine. You get a variety of different units. So, this is the slightly cheaper one – well, compared
to the rehab one we use in clinic – because it has fewer functions. The rehab one we have in clinic,
I think it can tell your future as well if you want, but if you're an athlete, or you're looking
for basic rehab functions, you do not need an expensive unit. And I will explain to you why not
as we go along. What I can tell from the Internet is that the price is pretty much defined according
to the programs that's on them. So, like for instance, if I can quickly switch this one on to
tell you what ... This one offers rehab specific things, so there's for disuse atrophy, if your
legs have not been used for a long time, there's a neuro rehab slow start, things like that. But
if you read up a little bit about the frequencies that's good for training different muscle fibres,
then you can actually use any of the cheap units by just adjusting that. But yes, more about that
in a minute. So basically, you'll have a machine. Then if you've got a cheaper version like I have,
you may have electrodes that you fasten via a cable. You'll always have a red and a black that
you put on the motor points of the muscle. Now, if you've got a slightly more expensive model,
you can get – although they're not that expensive anymore these days – you get the ones that
connect via Bluetooth. So, that's really useful, because then you can stick them on the muscles,
and you can just move freely without the cables getting in the way. Also, if you're doing
full-body stimulation, you may have a suit that you put on so that it stimulates nearly all or
as many muscles as possible, in your trunk, your arms, as well as your legs. And that's usually the
type of units that they use in the research that I've read about. But for rehab purposes, I often
prefer this because you can really target the specific muscles that you're after. So, how does
it actually work? Why can this really give you a six-pack by just sitting on the couch and sticking
this on? Now remember, our muscles contract in reaction to electrical currents from our nerves.
And depending on how many … how much the nerve is firing, it recruits different function ... muscle
fibres. Our bodies are all the time trying to preserve energy, that's their sole function is
to survive, and it's forever thinking that you will die if you use too much energy or too much,
because it doesn't realize that we've got loads of McDonald's available the whole time. So,
it's trying to preserve it. So, what that means is, if I pick something up, my brain is very good
at recruiting just enough muscle fibres to get the job done. Now, what the Compex machine or the
electrostimulation machine does is, you can decide how many fibres you stimulate. So for instance,
if I pick this up, I would only really recruit a few fibres, so I'm not gonna get a massive amount
of strength gains by lifting this up and down. If I want to get really strong muscles, as you know,
I've gotta lift heavy weights, because then my brain and my nervous system activate a lot of
muscle fibres, and we're getting the changes in the muscle that we need. With a Compex, because
you can set it to how high you want it to be or you can set the intensity, you can recruit to a
maximal contraction but without lifting any weights. So, that can be quite useful especially
for rehab purposes; if your joints, for instance, are injured and you can't lift heavy weights,
but you still can work your muscles hard. Another thing on that: Depending on the frequency that
you use, you can either recruit more of your slow-twitch muscle fibres, which is endurance
muscle fibres, or the higher frequencies recruits more of your fast twitch fibres, which is more
the strength based. So, whenever you look at the programs that's been added before on the machine,
you will notice that your endurance programs are more at the lower frequencies and your
strength-based programs will be on the higher frequencies. But for all of them, they usually
tell you to use it at the highest intensity that you can tolerate so that you recruit as
many fibres as possible. Sorry, just need a little sip of water. Okay, so … Hi Dominick,
I see you've joined us. So, does it actually work for training? Can you get any benefits by adding
this into your strength training regime? Now, yep, the research is quite clear on that it ... This is
one of the few electrotherapy things that you can use that actually gives you results with regards
to what they promise for strength gains. There's a load of research studies out there, anything from
explosive strength to maximum effort strength to even … to be honest, there's endurance gains
with regards to VO2 max and things like that. But you'll also notice, I gave up in the end today,
because the studies vary so much with regards to the results they get. And from what I can see,
it's down to the fact that these programs were extremely different that they used. So, when you
use the Compex machine for strength gains or for strength training, you're not meant to just sit on
your bottom and get it to work; you’re meant to do movements with it. So, for instance … sorry … if
you've got it on your legs, you'll do gentle squats, or your arms, you'll just move them up
and down. So, often they use combined movements like squatting down and doing bicycles, but not
with any weight. Remember, you get the training effect by putting the intensity on this machine
as high as you can tolerate; that's what gives you the results, because it recruits as many fibres as
you would when you're lifting heavy weights with it. So yes, for hypertrophy – so, muscle bulk – it
can give you that; strength gains, it can give you that; explosive strength, it can give you that,
depending on how you apply it. And also endurance gains, it can definitely give you that. But not
all of that is down to the muscle fibres changing. There's also research out there to show that
the other thing this does is, it stimulates and activates your nervous system on a spinal level as
well as cortical level in the brain, that it gets those neural pathways firing better. And remember,
if your nerves fire better, your muscles can contract better and it's better coordinated,
and more fibres can be recruited more easily. So, it works on the muscle level but as well as
the nerve level. Now, while we're on that subject. So, you'll notice that I'm not going into detail
about the movements you've got to do to get your gains and things. That would be very specific for
what sport you do and what type of things you're looking to improve with it. So, it's best to work
with somebody who's got some experience in this, or just search the Internet and see what type of
programs there are available. What I will say is, this little machine creates real muscle damage, as
you would get when you do strong strength training in the gym. So, don't think that you can suddenly
add this at high intensity into your regular program and you'll be fine, because you may end up
overtraining. There's also quite a few reports of people getting a condition called rhabdomyolysis,
which is basically that you get so much muscle damage from one session that it creates so much
waste product that it affects your kidneys, and you can possibly go into kidney failure and things
like that. So, to prevent … And there was an interesting study I read today, where they looked
at what happens if, at your first training session that you use this, you've never used this before,
your first session, you do exactly like the instructions tells you to do and you whack it up
as high as you can tolerate. What they found was that it creates so much muscle damage and DOMS and
things afterwards that it can actually potentially be dangerous for you, to give you rhabdomyolysis.
What they then found was, if they went on a more moderate intensity rather, once a week a session,
for ten weeks, and then tested it again, then it didn't have that same effect. So, your body gets
used to it, it gets trained just like with other strength training. So, be very careful. If you’re
new to this sort of training, don't just jump into really hard sessions and really all-out sessions
as you can. Be gentle with it. Ease into it. Get the muscles used to it. Just need a sip of water,
sorry, otherwise I'm gonna cough. Okay, so that takes care of the strength bit. Definitely works,
but be careful how you introduce it. Also think about it, if you’re new to it, it can give you a
lot of muscle soreness and things afterwards. So, schedule it into your training regime that you've
got enough time to recover after that, okay? Now, with regards to recovery – and these guys are
really being pushed with regards to recovery these days – the evidence is actually a bit dodgy. It
doesn't seem to show that this gives you any more benefit than what a passive or active recovery
would give you. So, let me talk you through this. When we look at recovery, we look at ... Now,
this counts as active recovery, by the way, if you use it on a setting where you get a gentle muscle
contraction. So, that counts as active recovery, not passive recovery. Now, in a review that I
found, where they looked at, if you do this versus an active and passive recovery, the following
results were found. They looked at three things: They looked at blood lactate levels, how quickly
you can get rid of your blood … your blood lactate back to normal levels, they looked at performance
recovery, and they looked at pain and perceived exert … perceived fatigue, basically, afterwards.
With regards to blood lactate, they found that it is possibly better than a passive recovery – so,
if you're just sitting down – this allows you to get rid of your blood lactate more quickly,
but it's no better than active recovery. So, if you're doing an active recovery, you don't need
this on top, it already gets rid of your blood lactate at the maximum rate that you can. Then,
performance recovery: there was no better effect from using this than … it had the same effect as
passive rest as well as active recovery. And to be honest, in one study, this one actually
created worse recovery rates. And I would say that you are at risk of actually not recovering that
well if you use this on a too high setting for recovery or you're not very fit. It's the same
as with active recovery; it works really well for somebody who's quite fit, but if you're somebody
who's just new to training, if you're going to do active recovery, because you're not that fit,
it counts towards your training. So, make sure you choose your recovery according to
your fitness level as well. So, this won't help you perform better more quickly than an active or
passive recovery. Then thirdly, with regards to pain and perceived rest or how rested you feel,
this gave better results than a passive recovery. So, if you choose between just sitting still after
you've exercised versus this, you will have less pain, likely, the next day if you've used this,
but it's no better than a normal active recovery. So, if you're doing a normal active recovery
already, you don't need this on top of that, okay? Good! Then the last bit is, how I use
the machine most often is for rehab purposes. I find it really, really useful for people who's
had their limbs immobilised in casts or in boots and things for a very long period. I don't know
if you've ever had that, but if you take, for instance, your ankle out of a cast or a boot,
the … It's amazing how dead your calf muscle is, and it just doesn't want to work. Or, if you've
had knee surgery, how the quads can sometimes just switch off. I've had a patient recently in
the clinic who's had a third reconstruction and an ACL, and that quad just did not know how to work
because they took part of the patellar tendon as well for that, and this can really get … because
it fires the nerve endings up, it can really get the muscle working much more quickly than if you
just did … try to get it working through regular exercise. Also, because you can protect the joint
while you work the muscle, you're able to work the muscle at a much harder level so you can get
strength gains much more quickly than if you just use your traditional exercise regime for it. So,
it's a definite useful tool for rehab, but be careful how you use it. If that muscle has
not been used for six weeks, you've got to go in quite gently. So, we're lucky, we've got a disuse
atrophy setting on this machine. But if you don't have that, don't worry. What I usually tell people
is, go for your endurance training session: If you can set how long you rest between contractions,
make the rest period double the contraction period. If not, that's okay, but just do
ten minutes of the programs; they usually run for about thirty minutes or so; just go and do a third
of the session the first time you do it. And treat it like normal exercise. See how you feel the next
day; if you don't have much muscle soreness or things, it feels fine, you can do it again. And
just don't put the intensity too high. You want to see a proper muscle contraction, but don't go
full-out the first few times; ease into it. So, see how you can adapt it. Think of it as normal
strength training and use the same principles. So, if it's an unused muscle: longer rest periods,
not such a long training session. So, you should cut the training sessions shorter, and maybe
not on consecutive days even. So, see how you can play with that. Very well! So, that's basically my
story for tonight. Remember, if you need any help with injuries, you're welcome to consult me via
a video call – the link to my website is in the description of this video. But to summarise this:
Compex definitely works to help you gain muscle strength and explosive strength, and endurance
even, in your muscles, and it can work just as well as regular exercise. That's the other
interesting thing, that not … It didn't always show that you had an enhanced effect using this
combined with normal strength training versus just doing strength training, whereas for other ones it
did. So, it depends on the program you follow and how you do it. With regards to recovery,
I wouldn't really waste my time with this; it may be useful if, like the football teams,
for instance: You play a match and you don't really have time to recover, you've got to get
on the bus and go home. So, if you’re forced to do a passive recovery, then it would be useful to
add this in. But if you're already doing an active recovery, don't spend your money on it. If you're
new to this, ease into it, because you can cause so much muscle damage that you cause yourself
damage to your kidneys. So, really take care that you don't ... you're not too aggressive at the
beginning. And as a rehab tool, and you've got a muscle that doesn't want to kick in, this is an
amazing tool to get it working quite quickly. Let me know if you've got any questions. Take care!