Help back pain patients develop a stronger muscular core for better stabilization, posture and gait with pulsed electromagnetic field therapy
The relationship between electricity and magnetism is well-known. By passing current through a coil of wire, we can generate a magnetic field perpendicular to the current flow in the coil. If a conducting medium such as soft tissue is adjacent to the magnetic field, then electric current will be generated in the tissue — the origins of pulsed electromagnetic field therapy and other magnetic therapies.
The HIFEM difference
Electromagnetic field therapy has long been of interest to chiropractors and has held out the promise of relief for back and neck pain, osteoarthritis and neuropathy. But numerous studies failed to find statistically significant improvement in the clinical setting. This was partly due to a lack of understanding of strength, pulse duration and frequency of electromagnetic field therapy to generate the desired physiological result.
We now understand that Highly Focused ElectroMagnetic (HIFEM) treatments are required to induce structural changes in human tissue and achieve therapeutic endpoints.
The first successful clinical application of HIFEM was demonstrated by a company that received FDA approval in 2000. This company developed the first non-invasive electromagnetic stimulation device which was used for the purposes of pelvic floor strengthening. Strengthening the pelvic musculature with this device was almost curative for patients, mainly female, with urinary incontinence.
The treatment was painless because the muscle was stimulated directly and not by causing the nerves to fire impulses to activate the neuromuscular junction. Patients were delighted with the clinical results, but due to commercial considerations, the device is not available currently in the United States, and resurgence of interest in electromagnetic field therapy has led other companies to introduce similar devices.
EMF therapy and the brain
The next use of electromagnetic field therapy came from a surprising field: neuropsychiatry. Pulses of between 100-200 microseconds at 2 tesla units (40,000 times the earth’s magnetic field or the same as in an MRI unit) have been shown to have about an 80% success rate in treating patients who were non-responsive to oral antidepressants and has been approved by the FDA for this purpose.
Initially it was thought that the benefits were related to depolarizing the brain neurons, similar to Electro Convulsive Therapy (ECT), but in a groundbreaking article in 2016, Lan and colleagues (1) showed with MRI imaging studies that this therapy, now christened Transcranial Magnetic Stimulation (TMS), caused morphological and structural changes in the brain. This was the first demonstration that electromagnetic fields can actually cause structural and morphological changes in biological tissue.
HIFEM, TEMS and changes in muscle and fat
This was followed up in 2018 by three presentations at the American Society of Laser Medicine and Surgery (2,3,4) that showed Highly Focused Electrical Magnetic (HIFEM) in the 7-tesla range caused structural changes in muscle and fat.
They demonstrated by MRI and ultrasound measurements a 16% increase in abdominal muscle and a 19% decrease in the overlying fat following four 30-minute treatment sessions administered over two weeks.
This application of electromagnetic field therapy is best understood by patients as TEMS (Transcutaneous Electromagnetic Muscle Strengthening) (4). The potential benefit of TEMS in chiropractic practice is immediately obvious.
Patients with back pain will benefit from having a strong core musculature. TEMS is a completely painless way to allow patients the opportunity to achieve a stronger, more muscular core without the strain that exercise poses on the body. Strengthening their midsection aids in an overall improved body posture.
Just as strengthening the pelvic musculature was an indirect route to treating urinary incontinence, strengthening the patient’s core abdominal musculature is an indirect route to treating back pain. TEMS therapy can also be utilized to strengthen gluteal, hamstring and quadriceps musculature, which will aid in posture and gaining mobility.
Questions that clinicians have about the effects of magnetic field therapy on muscle have recently been answered by Duncan et al., (5) who demonstrated that highly focused electromagnetic field therapy increased muscle mass density by 20.56% in a porcine model. Although there was an 8% increase in the number of muscle fibers, this did not reach statistical significance.
The average increase in diameter size of the individual muscle fibers by 12.15% however was statistically significant. This kind of structural and morphological change can only otherwise be achieved by the kind of intense weightlifting routines that competitive bodybuilders perform in the gym.
Studies documenting increased muscle mass
The longevity and durability of the muscle mass increase induced by electromagnetic field therapy was addressed in a recent paper from Busso and Denkova. They showed in treating the gluteal muscle and buttock areas that, not only was the increase in muscle mass persistent at two months, but at three months, the buttocks were measurably larger than when measured four weeks post-treatment.
Combining treatment of the gluteal muscles and abdominal musculature with TEMS therapy will provide back pain patients not only a stronger muscular core to stabilize their back, but also help in posture and walking. The results of TEMS therapy is likely to be very long-lasting. If patients do not experience complete relief of their back pain after an initial course of treatment, they are likely to request further therapy just as the urinary incontinence patients did. And since this is a painless, non-invasive treatment, administered in 30 minutes, there is no reason patients should not continue with this new treatment for back pain as long as they see the benefits.
BALDEV SANDHU, MD, is an attending plastic surgeon at Hoboken University Medical Center and a consultant to several nutraceutical companies and laser manufacturers. He can be reached at baldevsandhumd.com.
References
Lan, Martin J, Chhetry Binod Thapa, et al: Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis, Brain Stimulus July-August 2016: 9 (4)577-83
Kent, David E., & Jacob Carolyn I : Computed Tomography (CT) based evidence of simultaneous changes in human adipose tissue and muscle tissues following a high intensity focused electro-magnetic field a(HIFEM) application: A new method of body sculpting
Presented at the Annual Meeting of the American Society of Laser Medicine and Surgery 2018 Dallas, TX
Kinney, Brian M., & Lozanova, Paula: High Intensity Focused Electro-Magnetic Therapy evaluated by Magnetic Resonance Imaging(MRI): Safety and Efficacy of a Dual Tissue Effect based non-invasive Abdominal Body Shaping
Presented at the Annual Meeting of the American Society of Laser Medicine and Surgery 2018 Dallas, TX
Katz, Bruce et al: Changes in subcutaneous abdominal fat thickness following High intensity Focused Electro-Magnetic (HIFEM) Field Treatments: A Multi Center Ultra Sound Study
Presented at the Annual Meeting of the American Society of Laser Medicine and Surgery 2018 Dallas, TX
Sandhu, Baldev S: TEMS not TENS, Chiropractic Economics, 2020 18: 46-52
Duncan, Diane & Dinev Ivan: Noninvasive Induction of Muscle Fiber Hypertrophy and Hyperplasia: Effects High-Intensity Focused Electromagnetic Field Evaluated in an In-Vivo Porcine Model: A Pilot Study, Aesthetic Surgery Journal 2020, Vol 40(5) 568-574
Busso Mariano Denkova Radina: High-Intensity Focused Electromagnetic (HIFEM) Field Therapy Used for Non-Invasive Buttock Augmentation and Lifting: Feasibility Study, Journal of Aesthetic & Reconstructive Surgery 2019 Volume 5 No.1:2.
