hey everybody it's doctor Jo and today I'm going to show you how to use a tens /
EMS unit for ankle pain. so let's get started.
so for the ankle pain I'm going to use the
tens / EMS unit sent by healthmate forever. this is their T24 and this is the one
that I'm going to use. if you're interested in purchasing any of their
tens EMS units, you can click on the link up there. so I like using a roll
underneath my ankle just so you can have some movement especially when you're
doing the EMS part where you're actually making the muscle contract. you want to
be able to have some movement in there so you can do it flat on the floor, but I
like having that roll it just allows you to get a little bit more movement in
there. so with a TENS versus an EMS or sometimes they call it a PMS you use
different electrodes and you can use different channels. for tens usually the
best way to use it is to use two channels and four electrodes. so each
channel has two electrodes. so the reason that four pads electrodes are the best
is because you can kind of encircle the pain area and when you're using four
electrode you want it to cross. so if my pain was maybe on the top of my foot
right here, I would take each channel and so there would be a pad here, one on the
opposite side, and one here, and then one here. so if I had you know a channel here
and a channel here, then they're talking to each other this way and it's not
really getting the spot in the middle. so you want to make sure that those
channels cross. otherwise you're not quite getting the benefit of the tens
unit. also with the tens you don't want to get a muscle contraction. this is tens,
stands for a transcutaneous electrical nerve stimulation. the transcutaneous
part just means those surface nerves. so this is to calm down the pain to help
increase the circulation which is really great for ankle pain because if you have
some swelling, a lot of times ankle sprains, strains, things like that, get a
lot of swelling because it just follows gravity and it ends up just hanging out
on the foot. so a tens unit does a great job of getting that increased
circulation to get the fluid back out of there
and decrease the pain at the same time. so when you're doing that with the four
electrodes or the two channels here, you can make sure, I'm gonna say that my
pains right here. some people might have the pain on the outside of their ankle,
on the inside ankle, especially if they have sprains or something like that,
so you can place them in a couple different places, and I'll show you if
you want to get a little bit more specific with the pain area - like if it
was just here, but if your whole ankle is kind of swollen and hurting, everything
in there is kind of hurting, I would say maybe do a placement here and here and
then one on each side, or again you can kind of cross the area just depending on
where you're feeling it the most. so this is one channel, together with these
electrodes. so what I'm going to do is just cross them over. so I'm going to
kind of place it a little bit almost in the arch area, and then over on the
lateral side up here. the further away the electrodes are, the more just kind of
general they get, and the closer you get them together, the more intense the area
is. so since it's a small area, sometimes I spread them out a little bit more just
so it's not quite as intense in the beginning, and you can easily move these
electrodes around as you go. you don't have to you know once you have them in
one spot, you have to keep it there. so again as you can see this one is here
and here, and this one's here and here. so they're crossing each other.
so with the tens, you should not have a muscle contraction. if you get the muscle
contraction, you're fatiguing out that muscle and that's not what the tens is
for, that's really what the EMS is for. so with this particular unit the t24, it's
pretty cool because it has the twelve channels but then it also has where you
can do shoulder, neck, back, elbow, hip, ankle, and foot, so if you just want to hit the
specific one for the ankle, you can, but if you want to go to the different
channels you can as well. so a lot of times people will say well which which
you know mode should I use. there's a whole bunch of them. with a TENS, for me I
think it really just matters about your comfort level.
tens is only supposed to really take away the pain and help increase the
circulation so all those settings are going to do that. so you just pick the
one that you like the most. some it's kind of a tingy, somes kind of a massage, some rev
up and then go down, so I would just try them all out and see which ones you like
the best. so I'm just going to start off with the first one. so you just press
that and then down at the bottom is the intensity level. so it gets pretty strong
quickly, so I wouldn't just sit there and start hitting right away, even if you
don't feel it, I would just kind of hit make sure it comes on, then you feel a
little bit and then you can just start going a little bit more as you go. so I
wouldn't go very fast because you might not feel a whole lot. now I can
start feeling a little bit, but I really shouldn't be getting any contractions or
movements, so as I go I'm just starting to feel a little bit more, and so you can
see there, now that started to make my big toe kind of move. so most likely it's
not necessarily super high, but it's probably because I have one of the
electrodes over the nerve and that's just pushing especially with the arches
it might be getting that tendon. and so you can see that it's pulling it down. so
what I would do is I would just take it back down, so you can start over and then
that one that was contracting it, just take it and move it slightly over
somewhere else. so it's not quite getting that spot. so maybe right there, and then
I would just go back into trying it. so if you are getting that muscle
contraction, I would either take it back down, but then if you don't feel like
it's very strong then I would move the electrodes around a little bit. so now I
can feel it again and I'm not getting that contraction. so that's really what
you want. and so you can change the time and it's automatic so you can set it for
10 - 20 all the way up to 80 and then it'll automatically shut off when you're
done. so that's really cool too. so with the tens you can also just do two
electrodes or one channel. so I'm going to go ahead and take that off and show
you. so let's say you have a lateral ankle sprain. so it's very specific
you're having a lot of pain on that outside area,
and so you just want to get it on that specific spot to get that pain taken
away. well you can you can definitely do that that's that's pretty easy to do, so
with just two electrodes or the one channel, if you're having the pain right
in here, you can either go one on top and then one on the bottom here, or if that
ends up catching some of those those nerves and tendons, you can do it going
this way. so you can go on the front here and then on the kind of back behind it
there. so again you might want to play around a little bit. with the tens it
doesn't specifically have to be exact, but you're just trying to get it. so now
it's just going back and forth into that place and when you have two electrodes
versus four, it's going to be stronger. so you might only have to hit one. I'm
already feeling it. it's not you know painful, but I'm feeling it more than I
was with the four. so you know again I would start off, so I wouldn't start
going crazy with it just kind of see how it feels and how it goes. so for the EMS
the electrical muscle stimulation, if you're having some ankle pain sometimes
it's from weakness and sometimes it's because the muscles aren't activating. if
you're having a hard time pulling your foot up, that's usually that anterior
tibialis muscle, that's the one that pulls it into dorsiflexion a little bit
of aversion. so if I wanted to strengthen the muscle to help get some of that pain
to get out of there because it might not be stable because of the weakness
causing pain, I would put the electrodes on that anterior tibialis muscle. so if
you're in the clinic they might take a probe and really get those trigger
points that they're going to do it, but again you can kind of move it around
until you get the spot that you want. but make sure when you're using this to talk
to your healthcare professional because there are some injuries where you
wouldn't want to use this EMS or tens unit, so make sure you're asking that
it's okay because there are certain things where you might not want to use
it, or it may be if you have something like a pacemaker that that's
contraindicated, or you're not supposed to use it for that. so the anterior
tibialis muscle right here I would then kind of put one up top here, the
the longer the peroneal nerve kind of goes around the head of the fibula here,
so sometimes if you get right on that that's really gonna activate it, but for
now I just want to get that muscle belly, so I'm gonna put one about right here
and then I'm gonna put one about right here so. on this unit the 10 and 11
settings are the ones for the the muscle stimulation, and I like it because the
picture kind of shows a person lifting weights which kind of indicates that
you're trying to strengthen the muscles. so I really like that. so I'm gonna click
on that one and then it starts moving so you know that it is clicked on it. so
same kind of things, start off pretty slow because sometimes it takes a while
to ramp up, so you might not feel it but you really want to kind of go slow until
you feel what's going on. and then try and get a contraction with it. so you
want it to be very strong, you're wanting to get that muscle contraction, so it's
this is not going to be a comfortable one though, electrical muscle stimulation
is strong, it's uncomfortable. you might even go like this a little bit, but
that's what you want because you want that contraction. so I'm just feeling it,
I'm not quite getting a contraction yet. as I go I'm gonna keep going a little
bit more and it usually comes on and then it drops off, so you want to wait
till you feel it come all the way up so you know how strong you're getting it. so
for this one I might not be quite on the right spot because... there we go, see how
it's starting is starting to go into that eversion a little bit, so if I
wanted to get some of that dorsiflexion to when it's activating when I feel it
pulling, I'm gonna come up and pull as well. so I probably have it a little bit
more on the everters than the anterior tibialis, so what I would do I'm actually
gonna take it all the way back down because you don't want to move it and
then it pop right back up, so I'm just gonna move it a little closer to the
front, and this is what you might have to do. you might just have to move around.
again it's not gonna be exact for everybody because everybody's muscles
are in different spots, and so it was pretty easy just to move it and then
start taking it back up. so once you start feeling that tingling, then keep
going until you start getting that contraction in there, and you know
depending on what muscle it is you might have to go
bit higher. so there we go. I'm starting to get it. you're starting to see my foot
go and then once it gets that contraction, then it's going to kind of
drop off. so I always say go as much as you can tolerate, that's you know pretty
high, and then if that's as much as you can tolerate, try and go one more because
that's what's really gonna kind of pull it up, and then relax. so you'll you'll
feel it be able to do that. sometimes people also say well you know how long
should I be doing this? I wouldn't do a whole lot in the beginning because it's
really going to work that muscle, especially if you haven't been able to
do it a whole lot on your own without the assistance. you're gonna fatigue that
muscle out really quickly. so I would just start with one to two minutes to
see how you feel, and you might be pretty sore afterwards. so again it might take a
little while for you to get to the right spot, but once you kind of know where it
is then you can get it to the right spot pretty quickly after that. so it's great
here to get that strengthening and then it's great with the tens to kind of
decrease that pain and increase the circulation which is good for the
healing in general. so if you're interested in purchasing the healthmate
forever TENS / EMS units, make sure and click on the link up there, and don't forget to
subscribe by clicking down there. and remember be safe (don't have to high), have
fun, and I hope you feel better soon.