PEMF and movement combine for results
I have had many epic treatment failures with patients, especially those with chronic pain.
Their pain is real, but chronic pain does not signify the presence of active harm that requires immediate intervention. It may be the by-product of a previous injury or an aspect of a longer-standing degenerative condition. With chronic pain patients, their body is trying to protect itself. Maybe the brain perceives an instability and then shuts down range of motion for protection. Or chronic lack of motion leads to tightness that leads to ischemia. Regardless, we should be open to all of the available tools to help treat chronic pain patients.
Manipulation and PEMF
I love manipulation and modalities, especially for chronic pain. Modalities can be blended with active care in rehab practices. As part of examinations you can observe patients’ range of motion and movement patterns, bring awareness to decreased range of motion, and then start the treatment process with figuring out how to regain lost motion. Patients become engaged and participate as we figure out ways to increase lost range of motion and then maintain these newly-found gains of motion.
An addition to modality menus for patients is Pulsed Electromagnetic Field (PEMF) treatment. I incorporate PEMF to nudge and push my patients while they are in the treatment experience to move through joint and muscle motion, increase lost range of motion, and figure out a less or non-painful movement pattern.
Education and an invitation
My treatment style is an invitation to patients. The goal is to stop doing harm to themselves in their daily life, as only they can be responsible for change. There are opportunities to teach a way out of chronic pain while sitting, walking, lying down, sleeping, standing, listening and eating. Patients can be guided through self-discovery or “inquiry” through range of movement, asking them what they are capable of doing without increasing pain, always moving slowly at first.
Together we seek effective ways of treatment to transform negative events or programming from the past. I simply tell patients, “Let’s regain as much lost motion as we can and then you never lose it again.” If you never lose range of motion, muscles and joint quality seem to remain stable as one ages. If range of motion becomes chronically subpar, patients’ capacity for flexibility and stability seems to suffer as they age.
I look for modalities that demonstrate improvements in pain and function. We may not fully understand the pathways for improving health and decreasing pain, but pulsed magnetic therapy (not to be confused with static magnets) appears to have positive health benefits. Therapeutic PEMF devices operate at various frequencies, and are non-ionizing and safe. PEMF does not treat or cure diseases or their symptoms. PEMF devices are designed for the delivery of varying pulse rates and strength under the user’s control for the purpose of supporting the circulatory system, immune system, relaxing muscles, supporting healthy lung function, supporting healthy joint and cartilage function, and supporting bone structure.
High-voltage PEMF does produce a sensation the patient can feel. If you ask me, “Does PEMF have an analgesic effect?” I will have to say “sometimes,” which is the same answer I’d give you for laser therapy or most other modalities. I can tell you that when it is turned up to a certain frequency it feels like “tapping,” and maybe that tapping sensation competes with the pain signal.
Applying PEMF therapy
I’ve compared my palpation skills for locating trigger points to the placement of PEMF over these trigger points, and the PEMF also seems to pick up trigger points. Common therapy for trigger points is ischemic compression, transverse friction, post-isometric relaxation, spray and stretch, and other modalities.
When I think I’ve located a trigger point, either with manual palpation or applying PEMF over these same areas, I suspect the nerve endings are sending amplified input into the cord. Trigger points seem to have all the following connections: present in chronic muscular pain, palpable as taut fibers, located in shortened muscles, and formed as a result of muscular strain. Scar tissue also tends to build up in trigger point areas that have been splinted.
Trigger points appear to be self-sustaining chain reactions causing continual contraction of sarcomeres. The cellular metabolism in a trigger point is abnormal in that ATP gets used up and cannot be renewed. The presence of ATP is necessary to provide energy for all the cell’s activities, including the return of calcium to its storage compartment, the sarcoplasmic reticulum, thus allowing the sarcomeres to resume a resting place.
Think about it — maybe PEMF acts in a similar way to manual pressure changing the blood flow to the trigger point. Disrupting the blood supply is something that nanosecond-long pulsed electric fields can do. Maybe PEMF ‘tapping’ on trigger points produces a parasympathetic effect that acts therapeutically to reduce the charge of tense tissues. Maybe it’s possible that the PEMF acts like pressure on the trigger point and may instigate the release of endorphins and enkephalin, two of the body’s natural pain fighters.
I’m sure there are many other things regarding PEMF we don’t know yet. What I am noticing is that the trigger points’ referred pain zone is decreased, and range of motion is increased.
Chronic muscle pain and joint inflammation
To diminish the trigger point and prevent it from becoming reactivated, it is important to keep the muscle fibers around it lengthened. During the PEMF treatment the patient is taught self-stretching, and the patient stretches the affected muscle during the treatment. Home instructions are for the patient to continue to stretch that area daily.
In an example of patients with trigger points in the hip flexors, the goal of stretching while being treated with magnet therapy (or any modality) is to reduce the active firing of trigger points to manage pain. I’ve seen vendors of magnet therapy suggest getting patients seated or lying as comfortably as possible to help reduce stress levels in the body. That is different than my form of therapy, which seems to work better to keep the muscles lengthened and relaxed.
I have tried PEMF with touch therapy (manipulation, soft tissue therapy), and without touch therapy, and PEMF solely with range of motion and stretching. Static stretching has been heavily criticized in recent years because it doesn’t do a lot of the things it’s supposed to. Most research shows that stretching has little effect on muscle soreness, and doesn’t appear to do much for injury prevention either. However, if you find that certain muscles feel a little “tight” (the hamstrings, hip flexors, quadriceps and adductors are the usual culprits), or there’s an “asymmetry” in flexibility (i.e. one leg feels substantially tighter than the other), then it’s worth experimenting with some static stretching to see if it makes you feel any better.
The PEMF therapy I have been using is combined with a simple flexibility stretch, aimed to stretch any “tight” muscle and decrease trigger points within the tight muscle. Patients hold the pose for a total of 60 seconds. They practice breathing and stretching for 60 seconds and then take the muscle through range of motion. One stretch lasting 60 seconds, or six stretches lasting 10 seconds, work equally well when it comes to increasing flexibility. Regardless of the length of a single stretch, the key to improvement seems to be that patients’ post check feels better and there is a decrease in trigger-point sensation. Patients get encouraged that range of motion increases and they don’t want to lose it. I understand flexibility may be influenced by genes, but active trigger points may not be.
Beneficial stretch + PEMF
It is easy to teach patients the Warrior 2 pose: Begin with your feet about four feet apart. Raise your arms parallel to the floor, with your palms facing down. Extend both arms out to either side so that your shoulder blades open.
Turn your right foot out 45 degrees and keep your left foot parallel to the back of your mat or floor space. Slightly bend your right knee. Feel your tailbone push down slightly as you keep your gaze focused on your fingers to your right.
Hold this pose for one minute, inhaling and exhaling deeply through the nose. Repeat on the other side. Either you or the patient can hold the PEMF paddle or loop around the tight hip flexors while it provides a tapping sensation. You can isolate any trigger point, check the sense of tightness in that muscle, use the PEMF over it and provide an isolated stretch. The retest is how the trigger point responds; have the patient notice if they feel increased pain-free range of motion in the body.
Positive outcomes
Chronic trigger points are a root cause or are associated with many musculoskeletal disorders.2 Trigger points are like inflammation in that they are the body’s natural response to injury and illnesses.
By combining the benefits of stretch poses and PEMF, patients are able to signal their brains that they can move further, and possibly regulate some inflammation or cell metabolism to diminish trigger points. This may have something to do with circulation, stress reduction, breathing, and more importantly, we’re teaching patients to expand range of motion and hold isometrics.
If you can help get one patient out of pain, to move better and regain some previously lost motion, you have improved their health. Positive long-term outcomes are caused when we make changes in the central nervous system.
Combining PEMF (or manual therapy or other modality techniques) improves change in the local tissue and produces change to the central nervous system, facilitating change in the local tissue. Change to the local tissue, while accessing peripheral windows to the brain with PEMF and range of motion, seems to facilitate the central changes that give positive effects to local tissue.
Jeffrey Tucker, DC, practices in Los Angeles, Calif. He is the current secretary/treasurer of the ACA Rehab Council. He can be contacted through DrJeffreyTucker.com.http://www.DrJeffreyTucker.com
