Introduced two years ago in the U.S., TEMS is a one-two punch for both back pain and weight loss
Transcutaneous electromagnetic muscle stimulation (TEMS) is a new treatment modality that chiropractors may want to consider introducing to their practice, involving the use of focused electromagnetic resonance to cause supra-maximal contraction of the treated muscles.
Chiropractors are familiar with Magnetic Resonance Imaging (MRI) for soft-tissue imaging, which was a significant advancement over X-ray imaging. As in X-rays, the energy emitted in an MRI is collimated and a small portion of that energy is absorbed. The balance passes harmlessly through the body to record the images that are then provided to the physician.
By focusing and increasing the energy, X-ray beams can be used for a different purpose, namely to destroy cancer cells.
Magnetic resonance and muscle mass
Similarly, it was recently discovered that by focusing the energy beam and increasing energy levels, magnetic resonance increases muscle mass by causing supra-maximal muscle contractions.
These are unlike any muscle contractions that can be induced by using a TENS machine because these contractions are entirely painless and occur in rapid sequence.
It is estimated that one 30-minute session of TEMS therapy to the abdominal musculature is equivalent to 20,000 abdominal crunches. A 30-minute TEMS session to the gluteal muscles is equivalent to 20,000 squats. Repeated treatments cause a rapid increase in muscle mass which then utilizes fat as an energy source, so in addition to having stronger musculature, the patient loses fat.
In one study conducted by David E. Kent and Carolyn Jacob, muscle mass was documented by CT scanning to increase by 16% and the overlying fat layer was decreased by 19% at eight weeks following completion of four 30-minute treatments delivered over a 14-day period. These studies were replicated by Brian Kinney, MD, at the University of Southern California-Los Angeles.2
In these studies, the increase in muscle mass and decrease in fat was documented with MRI studies. Ultrasound was used to measure the reduction of fat, which again averaged 19%, in a third multi-center study conducted by Bruce Katz and associates.
In each of these studies the treatment was referred to as HIFEM for High Intensity Focused ElectroMagnetic Therapy, but Transcutaneous Electromagnetic Muscle Stimulation (TEMS) more accurately describes the treatment being performed and is better understood by patients.
Cosmetic treatment to back pain application
Cosmetic physicians could immediately see that this was the “holy grail” of non-invasive body contouring, and although it was expensive at $3,200 for the four-treatment session package, it is estimated that already over 200,000 patients have undergone TEMS treatment since it was introduced in the United States just under two years ago.
While this was essentially a cosmetic treatment, some patients started reporting that not only did they look better, with their firmer musculature and associated weight loss, but their back pain had also improved. A sufficient number of patients made this comment and I was intrigued to ask Jeffrey Massarone, DC, ND, about this finding. His take was that this was the missing piece in the chiropractic treatment of back pain.
“Most back pain occurs in the lumbo-sacral area and cervical area of the spine,” Massarone said. “Pain in the mid-back, namely the thoracic spine spanning the T1-T12 vertebral segments, is oftentimes attributed to dysfunction in the cervical and lumbar spine regions. This is most likely because these vertebrae are braced by the bony thoracic cage and significant vertebral movement requiring adjustment can therefore only occur in the cervical or lumbo-sacral area. While chiropractors have traditionally concentrated on the back, if you could strengthen the abdominal musculature there would automatically be less strain on the back. Strengthening the rectus abdominis and external oblique muscles by 16% would stabilize the back and account for the reported back pain relief.”
Patient pricing and benefits
Massarone’s feeling was that since insurance is unlikely to pay for TEMS, but it could be offered to patients as a cash add-on service, even insurance-based patients would see the value of strengthening their core musculature if it could be priced at $1,200 for a six-treatment package.
With his dual degrees in chiropractic and naturopathy, Massarone has consulted for a number of nutraceutical companies that sell weight-loss supplements. I personally was unaware that many chiropractors have expanded their practices to include weight loss, which only makes sense as weight loss is an important part of treating back pain. Massarone was excited about the possibility of introducing TEMS therapy as the cornerstone of a weight-loss practice.
“Realistically, while supplements play a role in weight loss, the only surefire way to lose weight is by a combination of calorie restriction and exercise,” Massarone said. “If chiropractors have a TEMS machine in their office, in addition to treating back pain they can utilize it to provide all the benefits of exercise that result in weight loss as a part of their weight loss program. In fact, more income may be generated by the use of the TEMS machine than in treating back patients, but one machine that provides two sources of incomes would be a godsend to most chiropractic practices.”
A small footprint with big results
The other thing chiropractors should be aware of is that a TEMS machine takes up less than two square feet of space and can be put in any treatment room that has an examining table. Treatments do not need to be supervised, as once the paddles that deliver the energy are placed on the patient and treatment has started, no further physician intervention is required.
The initial investment in the first generation of TEMS machines was quite expensive, but as with all new technology, prices are dropping rapidly and the newer machines are technologically more capable. Just as different exercise sets can be done to increase muscle mass and definition (think bodybuilders who compete in competitions) versus strength (think Olympic weight lifters), the newer TEMS machines have different programming to allow you to help patients achieve their goals, whether it be alleviation of back pain or weight loss, without going to a gym or breaking a sweat.
I foresee a TEMS machine in every chiropractic and weight loss clinic in the near future.
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.
1. 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
2. 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
3. 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