ANATOMY IN ACTION SERIES: Utilizing Landmarks for EMS Pad Placement
Educational Articles Designed to Help CAs Understand the Underlying Anatomy and Physiology of Conditions Presenting to the Chiropractic Office.
Laurie Mueller
Electric Muscle Stimulation
Electric muscle stimulation(EMS) is utilized in many offices via interferential current (IFC), premodulated current (premod), microcurrent, transcutaneous electrical nerve stimulation (TENS), Russian stimulation, and high-voltage pulsed current. No matter what current or pad types are being utilized, having a good understanding of the anatomy can help you more effectively place EMS pads and administer treatment.
A Review of Contraindications
Before we review the anatomy, a reminder of why we use EMS as a modality and when not to use it should be fully understood.
Contraindications include a pregnant uterus; local circulatory insufficiency (diabetes, ulcers, varicosities); epilepsy for EMS in the head or neck; malignancy; active epiphysis (bone growth plate/children); active implants like pacemakers or defibrillators; placing pads across the heart; tissue bleeding; over the eyes or testicles; and always use caution over areas of the skin that lack normal sensation, such as from diabetes, nerve injury, etc. Do not apply EMS transcerebrally or over the carotid sinus area. Nerve receptors in the carotid sinus can affect blood pressure and cause dizziness. Also, do not apply EMS to patients who cannot provide adequate feedback concerning the level of stimulation (infants, patients with mental disorders, seniors with dementia, etc.). Use caution near joint implants and scar tissue (which can transmit signals differently), bony prominence, the urinary bladder, and fatty tissue.
A Review of Indications
Safety definitely takes the primary role here, but let's not lose sight of why we use EMS. Depending on the type used on a patient, indications for use are great and it can have immense therapeutic benefit for things such as:
• Control of pain • Muscle stimulation
• Muscle relaxation
• Increased local blood flow
• Reduction of edema (swelling)
• For Russian stimulation, it helps to prevent disuse atrophy
• Muscle reeducation
• Increased range of motion
Patients tend to respond well to EMS, and it is generally a passive, relaxing modality to receive with very few ill effects.
Landmarks
Understanding palpation is important for optimizing pad placement to the affected muscles. We will go over just a few of the most common here.
The Trapezius
Our "traps" are huge muscles that span from the occipital region to the clavicle and scapula and all the way down through the thoracic region. They can be impacted by a variety of injuries as well as ergonomic position-
ing ^e.g., simng in a oaa posture at a computer all day). Women in particular tend to carry their "stress" in their traps, especially in the muscle belly at the top of the shoulders. By palpating Tl and moving across the shoulder posterior to anterior toward the acromion process, you can position EMS pads to maximize stress reduction and muscle spasm in that area.
Low Back
Think about spasm in the paraspinals versus spasm in the quadratus lumborum, and where you might place the EMS pads. To find the QL, find the iliac crest and move superior. It is more laterally located. Paraspinals/erector spinae run vertically/inferior
to superior, next to the spine—medially located. See the pad placement next to the spinous processes over the muscle bellies on the right of this diagram.
Always optimize your pad placement to the muscle that is spasmed.
The gluteal muscles often get tight. The gluteus maximus, medius and, minimus are all superficial when compared to the piriformis. They can all benefit from
some relaxation, but the piriformis is a huge culprit for low back pain, and even sciatic-type pain due to its position near the sciatic nerve.
Some doctors will prefer a deeper manual muscle technique to work the piriformis, while others may also try EMS to achieve relaxation. For ideal pad placement, palpate the lower lateral sacrum and the ischial tuberosity and place the pads in between.
As always, if in doubt, or if you have questions about placement or possible contraindications, ask your supervising doctor.
A Word about EMS Pads
There are different types of pads that may be used. These include reusable carbon electrodes, vacuum pads, and self-adhesive pads. There are pros and cons to each. The most popular by far are self-adhesive and disposable. A few things to remember when applying pads:
1. Size does matter! Pick the pads to fit the anatomy—too small will be ineffective and too large will overwhelm.
2. Make sure they are placed on skin that is clean and free of hair. Think of Austin Powers. Hair will block the current. You may need to ask the patient to go to the restroom and shave a patch or two. Show the patient where to clear the skin.
3. With disposable pads, you may be able to use them with the same patient several times before
they are thrown away (put them in a sealed bag with the patient's name for hygiene and don't intermix patients' pads). When the "sticky" part of the pad starts to deteriorate, make sure to throw them away or you will risk burning the patient. Pads are cheap; patient lawsuits are not. All areas of the pad should be securely adhered to the skin.
Education Fosters Understanding
An understanding of anatomy and clinical applicability helps all health-office employees better communicate with patients and provide care more safely. Online training programs in particular make high-quality training affordable and convenient and can be taken any time of day. At www.CCCAonline. com, learners can engage in a streamlined, 24-hour training program that meets or exceeds FCLB guidelines in every area of study and fulfill the training requirements needed for the national examination!
DCs will often pay for their employees' training. Full price for this training is an affordable $339 for the entire 24-hour program. Visit www.CCCAonline.com for a special discount just foryou! If you are receiving this article through The American Chiropractor magazine, use AMCHIRO as your discount code. Whenyou enterthiscode duringthe registration process, it will automatically provide a $15 discount off the regular price of the program. This is the program that gives back to the profession.
Learners can expect text, images/schematics, dynamic video lectures, and robust, customized, experiential interactivities in a thorough 19-module program. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an e-mail at [email protected].
practice graduate Laurie in director Mueller; San Diego, at BA, Palmer DC, California. College CFMP, She from served was 2000-2010; in the private postserved as the ACC postgraduate subcommittee chair for six years; peer-reviewed for the Research Agenda
Conference; and wrote the informal role determination study that aided in the development of FCLB ’s guidelines for chiropractic assistants. Dr Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, and the subsidiary, www.CCCAonline.com. She is a clinician, an educator, and an expert in online educational pedagogy.
