Article 008
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SHORTCOMINGS OF MODERN
ELECTRO-THERAPY, AND SOLUTIONS
by Darren Starwynn, O.M.D., Dipl. Ac.
Article for submission in CJOMThis article is based on a chapter of a book by the author entitled Microcurrent Electro-Acupuncture, to be published later this year.
Author’s note: While I have given as many references as possible for the factual and backround information presented in this article, most of the statements about the efficacy of the methods and principles of microcurrent electro-acupuncture herein are drawn from the combined anecdotal experiences of myself and hundreds of other acupuncturists and other health professionals with whom I have been in contact. To date, there has been very little formal, double-blind research on this subject.In this article we will examine the way electro-therapy is being taught and practiced in this country. You will learn why most practitioners are not having more consistent and positive clinical successes, and how your patients can enjoy far superior results. Until recent years, chiropractors and physical therapists were the main professionals utilizing electrical stimulation (ES) for clinical purposes. Many acupuncturists have started learning about and incorporating ES into their practices recently. This article, and the book it is excerpted from, are offered to help fill the need for clear information on this subject from the acupuncture point of view.
Before going into the specific shortcomings, it is helpful to briefly reflect on how electro-therapy has historically developed. The earliest recorded uses of electricity for pain relief were recorded by Scribonius Largus in ancient Rome. His narrative explains how Roman doctors fished the Mediterranean for torpedo fish, creatures that have electrical organs that can deliver a nasty 220 volt shock when in danger. These fish were put into buckets of water, and suffering gout victims placed their feet in the bucket to agitate the torpedo fish, and voila, instant electro-therapy! Apparently this technique was credited with the relief of a lot of pain, although this was far from a non-invasive approach.
Jumping ahead hundreds of years, Ben Franklin also left writings about healing his neighbor’s shoulder pain with shocks from a crude electrical battery he constructed.<1> We have all heard about Franklin’s experiments with electricity – remember the famous kite and key story?
In the landmark book The Body Electric <2>, Robert Becker goes through a fascinating account of the history of research into the electrical nature of life and healing over the last centuries. I highly recommend this book to anyone interested in being a practitioner of microcurrent electro-acupuncture.
In the United States of the 1800’s, the Industrial Revolution was booming, and this quest into new technologies also brought about the creation of scores of electro-therapy devices. <3> Many of these were fanciful and without any reputable scientific basis, while some were, no doubt, effective for some conditions. There are many health problems that do respond favorably to local stimulation to clear energetic obstruction, a common principle of Chinese acupuncture, and many of these devices worked on this basis. The devices of the 19th and early 20th century tended to create intense and sometimes burning stimulations, as modern electronics was not yet available to deliver precise or subtle stimulation. It appears that most or all of these devices applied electrical energy directly to painful or dysfunctional parts of the body, or bathed the whole body in electrostatic energy. Of course, these were also the days when anyone could order morphine or cocaine through the Sears and Roebucks catalogue!
In the year 1910 the infamous Flexner Report <4> delivered to Congress discredited many of the so-called alternative therapies in favor of allopathic/pharmaceutical medicine, and this led to creation of laws against practice of homeopathy and prejudice against electro-therapies. It was mainly chiropractors that kept the use of electro-therapy alive between the 1930’s and 1960’s. In the 1960’s chronic back pain research by Norman Shealy and others led to the creation of implantable spinal column stimulators. The invasive nature and irregular effectiveness of surgically implanted devices then led to the popularization of TENS <5> units that used surface patch electrodes.<6>
Since the 1960’s several improvements over the TENS units were developed. These include interferential, high volt galvanic, Russian stimulation, and microcurrent stimulators. <7> While each of these devices offer an improvement in some aspect of treatment, the style of treatment generally taught for most of them in health care schools and texts has not changed significantly since the freewheeling 1800’s. An examination of the training manuals or training courses offered with these devices will reveal directions for mostly local stimulation of the painful zone. While this may appear logical, this is actually not often the most effective way to apply therapeutic stimulation to the body.
Superior results with ES may be found through the marriage of the invaluable principles of acupuncture with modern electro-therapy, a topic that has not been adequately addressed until this time. It is most specifically the combination of gentle microcurrents with an energetic meridian-based approach that is responsible for so many of the surprisingly effective and rapid results we are frequently hearing about from colleagues and students. Now let’s examine the specific shortcomings of modern electro-therapy practice that need to be corrected to attain these kind of results, and the solutions to these shortcomings.
SHORTCOMING #1: Overemphasis on local stimulation
As mentioned above, most electro-therapy manuals and treatment formularies largely recommend placing electrodes over the local area of pain or injury. In my experience, this yields clearly positive results on an average of about 30 – 50% of the time at best. The reasons for this are several. First of all, pain is often perceived in areas of referral, that is, not in the actual area of injury. <8> Secondly, the area of pain is often is inflamed, which is associated with excess energy and concentration of electrons. Adding further stimulation to that area may be equivalent to pouring gasoline on a fire – not a good way to put it out. Appropriate distal acu-points in a sense are escape valves for this excess energy, and stimulating them is a far more reliable way to reduce the excess at the injury or pain site. It is true that release of ah-shi <9> or myofascial trigger points in the local area can also provide good relief, and so it is often a combination of local and distal treatment that yields the most balanced and effective results.<a>The solution to this shortcoming is more utilization of dermatome <b> treatments and distal acu-points and body zones for a balanced treatment approach.
SHORTCOMING #2: Use of “overkill” stimulation currents that inhibit healing and carry-over of relief
The innate electrical activity of the human body has been measured in the pico, nano and micro-current levels. Picoamps are measured in trillionths of an amp, nanoamps in billionths of an amp, and microamps in millionths of an amp. Therefore, even applying microcurrents to the skin surface is an introduction of currents generally far in excess of our innate biological electrical activity. Yet the resistive and capacitive qualities of bodily tissue greatly reduce and modify the actual current that penetrates to the target tissues, and so it is rare that the target tissues actually receive the level of stimulation set on your device <c>. Apparently one of the ways therapeutic currents benefits the body is by stimulating somewhat above the normal level, thus creating an intervention that can move “stuck” qi and tonify, or add energy, to areas lacking sufficient energetic charge to heal themselves. So, although microamps are rarely felt by patients, in fact they are much stronger than most of our innate currents. Research has shown that microcurrents in the 10 – several hundred uA levels can accelerate healing of wounds and fractures.<d>With this understanding that microcurrent stimulation is already stronger than our innate currents, it is easy to see why the milliamp currents <e> used in most modern stimulators are often way too much current for our bodies. Milliamps are measured in the thousandths of an amp range, 1000 times more intense than microamps. By the time our sensory nerves can clearly feel treatment currents, they are already at levels that can significantly disrupt our subtle bio-electrical systems, thus slowing down the healing process <f>. The common practice of running milliamp currents directly through acupuncture needles has several dangers in addition to its benefits. The first is electrolysis of the metal of the needles, which is the process of breaking down a substance with electrical currents. Potentially toxic metal ions can migrate from the needle into the tissues, an undesirable effect. This type of electro-acupuncture can also literally burn the tissues the needles are in contact with, and there is also a danger of needle breakage when the muscles it is inserted into are twitching. The practice of attaching leads from a milliamp stimulator directly to acupuncture needles is derived from surgical anesthesia practices developed in China. While often quite effective for surgery and acute pain, in my opinion this practice is likely to be way too intense for most modern sub-acute and chronic pain patients.
Because the body responds so well to gentle microcurrents, we can conclude that it is rarely necessary or desirable to use milliamp stimulation on your patients. I would suggest that you start to use microcurrent stimulation as your first and primary treatment, and only use milliamp if necessary after that if the patient’s pain is not relieved. You will be surprised to find how rarely milliamp currents are needed!
There are some exceptions, however. When a patient is presenting acute pain, inflammation, muscle spasm and edema these symptoms can greatly reduce blood and lymph circulation to the affected area. Because of this impaired circulation, it is hard for the body to eliminate waste products from the area, which is essential for reduction of inflammation and healing. <g> In cases like this, it may be appropriate to use milliamp stimulation to in effect force the body to relax its tension and to stimulate local muscles to pump out excess fluids. This can help restore proper circulation, which can carry off the toxic waste products, thereby promoting healing.
It is my practice to start almost all electro-therapy sessions with microcurrent stimulation through local and distal areas, and only use milliamp currents when this is not successful in reducing some acute pain cases. <h> In my practice, milliamp stimulation is necessary less than 20% of the time.
The solution to the overuse of overkill currents is simply much greater use of microcurrents as a first approach to pain, only using milliamps when necessary in some acute conditions.
SHORTCOMING #3: Simple treatment current patterns that cause adaptation
When a repetitive stimulation of any kind is applied to the body, it stops being effective very quickly as the body accommodates, or adapts, to the stimulation. <i> Most electro-stimulators deliver repetitive stimulation. There is greater clinical value in applying therapeutic currents that have variable frequency, intensity, and timing, as these will tend to create longer lasting pain control and other healing effects. Ask the manufacturer of a device you are considering buying what current modulations are available from it.The solution to the shortcoming of adaptation is use of modulated and multi-step protocols.
SHORTCOMING #4: Incorrect choice of polarities to the body leading to inappropriate treatment of extremities and radiculopathies
The Law of Polarity is an all-important, all-pervading reality of our physical and energetic existence. This is also totally applicable to electro-therapy. The healthy human body has an electrically positive orientation on the head and central spinal area, and a negative orientation at the extremities. <j> By following this pattern with electrode placements, we are working with the body, and it is much easier to bring about pain relief, healing and homeostasis. Unfortunately, most electro-therapeutic devices, including some microcurrent devices, offer most treatments only in biphasic, or alternating polarity, and this often is not what is needed. Biphasic currents are generally more successful for treatment of the neck and trunk of the body, but are rarely very effective for problems of the extremities and radicular <k> pain. In the realm of meridian balancing work, only properly polarized current will be effective, according to my experience.In seminars I teach, I often use a very dramatic illustration of this principle. I use kinesiology, or muscle testing, to determine the overall energetic response of the body, first testing the baseline strength of the indicator muscle before applying any stimulation. I then place a positive probe on a proximal acu-point and a negative probe on a distal point, and test the muscle. I then reverse the polarity on the same points, and test the muscle again. In 100% of the cases, the muscle will be strong with one polarity placement, and “blow out” or go weak in the opposite position. This procedure can be repeated over and over, and the same effect will keep happening.
In my experience, it is the misunderstanding of the Law of Polarity as it applies to electro-therapy that is the single most important factor in poor clinical results and aggravations of pain.
The solution is the use of properly polarized treatment currents for treatment of extremities, radiculopathies and meridian balancing.
SHORTCOMING #5: Passive electro-stimulation
Our experience has shown that during certain stages of treatment, electrical stimulation is much more effective if applied while the patient is in motion.This makes a lot of sense if you think about it. There are two main stages of pain and injury treatment – the acute phase and the rehabilitation phase. During the acute phase, it is not desirable or sometimes even possible for the patient to move or exercise – the first objective is relief of pain and inflammation so that suffering is reduced and healing can proceed. Once the acute pain has reduced, however, the most important objective besides continued pain relief is restoration of normal, healthy movement and function. Much of physical therapy consists of exercises and movements to re-educate the body to that end. By gradually increasing the pain-free range of motion and strengthening weakened muscles and tendons, the patient can gradually regain as much normal posture and movement as possible. Yet this process can often be painful and difficult as guarded and sore areas are exercised.
When microcurrent stimulation is applied during exercise, it makes the whole process easier. The patient feels less discomfort during movement, and the muscles and tendons often become more flexible and capable of re-education with less stress. There is also a strengthening effect on some weak muscles that assists in rehabilitation. I have seen several wheelchair bound patients find it easier to practice standing up and sitting down when microcurrent interferential pads were placed on their lower back during their exercise.
There is still no proven scientific explanation for this phenomenon (like most commonly accepted medical procedures), but here are some likely reasons:
Studies have shown that microcurrent stimulation increases ATPl concentrations in the cellsm, and this can promote muscle softening.
The meridian blockage clearing properties of microcurrent work in a similar way as acupuncture, increasing Qi flow in the area, freeing up available energy and promoting ease of movement.
Proprioception is the feedback system between peripheral muscles, tendons and sensory nerves and the central nervous system that adjusts muscle tone to allow smooth movement.<l> It is my theory that microcurrent stimulation during movement in some way augments proprioception, accelerating the re-education process of injured muscles and joints.
Because microcurrent stimulation often immediately reduces pain during exercise, patients can increase their range of motion with less resistance. This expanded movement helps the neuromuscular systems of the body to adapt to fuller and easier movement patterns.
There is one caution about this practice. Because it is easier for patients to extend their range of motion during stimulation, they may attempt so much increased movement that they have post-exercise soreness after underused muscles and tendons are activated. I have particularly seen this with rheumatoid arthritis patients. To avoid such pain rebound, ask the patient to extend their range of motion in gradual increments over a series of treatments using this technique. Massage, hot packs, analgesic plasters and hot baths may help alleviate soreness after therapy.Whatever the reasons, it is clear that “microcurrents with motion” is a far superior rehabilitative therapy than passive electro-stimulation, during which there is no movement. The solution to the limitation of passive electrotherapy is kinetic treatments – microcurrents in motion.
SUMMARY
The principles presented in this article are fairly simple and easy to apply, yet it is remarkable how little they are understood and practiced. It is this lack of understanding that is responsible for much of the mediocre reputation electric stimulation has had in the health care community, and is partially responsible for the cutbacks in reimbursement for this procedure we have seen in recent years. It is highly recommended for you to internalize these important principles. It is the combination of electro-therapies with knowledge of meridian energetics that yield the most positive results, far beyond that commonly experienced by practitioners using standard electro-therapy methods. An understanding and application of this information will certainly take a practitioner from “stone age” electro-therapy to highly effective holistic treatment with rapid, tangible results.
Questions or comments about this article can be directed to:
Darren Starwynn
3810 East Desert Cove Avenue
Phoenix, AZ 85028
(602) 494-5626
darren@neta.com
2 Principles and Practice of Electrotherapy by Joseph Kahn, page 1
3 The Body Electric by Robert Becker and Gary Selden
4 Clinical Electrotherapy by Nelson & Currier, Chapter 10
5 for more information, see website http://www.healthy.net/naturopathicjournal/vol4no1/rbpratn.htm
6 TENS – Transcutaneous Electric Nerve Stimulator
7 Clinical Electrotherapy, Chapter 10
8 ibid, various chapters
9 Principles of Anatomy and Physiology by Tortura and Anagnastokos, pages 361-362
a Ah Shi points are acu-points that spontaneously appear in painful and inflamed parts of the body. Acupuncture dispersal methods on these points is an important part of pain control through the tendino-muscular meridian system. Treating ah-shi points alone, however, is generally not a complete treatment.
b For a good book on acupuncture treatment of trigger points, see A New American Acupuncture by Mark Seem
c Dermatomes are regions of superficial tissues of the body that are each innervated by a specific spinal nerve. Dermatomes run down the arms and legs and circle the torso.
d Clinical Electrotherapy, Chapter 2
e for example, see Carley and Wainapel: Electrotherapy for Acceleration of Wound Healing: Low Intensity Direct Current Archives of Physical Medicine and Rehabilitation, Vol. 66, July 1985. Many other abstracts on electrical healing acceleration can be found at website www.eastwestmed.com/abstracts.htm
f As mentioned earlier, milliamps are currents graduated in the thousandths of an amp range, and can be clearly felt by the sensory nerves as tingling, prickling or throbbing sensations. Most electro-therapeutic devices in current use only deliver milliamp stimulation.
g See study Cheng, et Al: The Effects of Electric Current on ATP Generation, Protein Synthesis, and Membrane Transport in Rat Skin Clinical Orthopaedics and Related Research, #171, Nov/Dec. 1982
h Clinical Electrotherapy, Chapter 3
i ibid, Chapter 3
j The Body Electric, Chapter 4
k Pain or numbness that radiates, usually down the arms or legs.
l ATP- Adenosine triphosphate, the energy currency of the cell. See Cheng et al study cited earlier
m Principles of Anatomy and Physiology, pages 361-363
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