Some of these therapists, especially those with informal or self-awarded
‘credentials’, spend an inordinate amount of time applying an extensive
collage of muscle and other tests borrowed from physical therapy,
chiropractic and elsewhere. These tests are by no means universally accepted
or corroborated by science. They are often applied in static postures and
assessed by palpation, finger pressure or home-made combinations of string
and putty, but they seem to create an aura of thoroughness, scientific
precision and reproducibility that impresses clients into parting with tidy
sums of money. The fact that research has shown something like one third of
all such strategies to work because of a placebo effect ensures that there
will always be a significant number of satisfied clients to perpetuate some
healing myths.

At the opposite end of the scale, there are some therapists and even
individuals who never bother to rely on any therapists, who simply advocate a
rather generalised exercise, stretching and lifestyle regime in many cases of
musculoskeletal disorder. They apply few if any tests, advise clients to
work within sensible ranges of exercise intensity, modified by basic
perceptions of pain and effort – and lo and behold, they, too enjoy a very
significant degree of success!

This leads us to question if most functional tests, other than basic
palpatory assessments and those reported by the client in normal “functional’
activities, generally are a waste of time in the treatment of most
musculoskeletal disorders (excluding fractures, pathological disorders and
serious medical conditions). Are these static muscle tests for identifying
“weak”, “unfiring”, “imbalanced” and “lazy” transversus abdominis, rotator
cuff, multifidus, piriformis, psoas and other ‘key’ muscles generally
redundant or do they play an essential role in treating musculoskeletal
problems? Do exercises based upon such “muscle testing” methods definitely
enjoy a greater level of success than very general regimes based upon a
thorough classical medical ‘interrogation’ of the client?

Mel Siff
Denver, USA
Mel Siff Dot Com
Supertraining Twitter Feed

MACROCURRENT AND MICROCURRENT ELECTROSTIMULATION IN SPORT

Mel C Siff PhD

(Note: This article draws extensively on material from the textbook, Siff MC
Supertraining 2000. Anyone requiring further information on this topic
should consult Ch 4 of this book.)

The use of electric current on the human body largely has been restricted to
use by physiotherapists to facilitate the healing of musculoskeletal
injuries and control pain. It is fairly arbitrarily applied in two broad
categories:

* Macrocurrent Stimulation (currents over about 1 milliamp)
* Microcurrent Stimulation (currents below about 1 milliamp)

The former usually refers to Faradic, Interferential, Galvanic and TENS
(Transcutaneous Electrical Nerve Stimulation) devices, whereas the latter
refers to specialised microcurrent devices for application either to the
musculoskeletal system or as a non-invasive form of electroacupuncture via
the acupuncture points of the body or the auricular points of the ears. The
differences between these applications will be discussed later in this
article.

The concept of electrostimulation for physical conditioning is not new, and
for years has been used by physical therapists in clinical applications such
as muscle rehabilitation, relief of muscular spasm, reduction of swelling and
pain control. Its possible value in sports training is still considered
controversial. In strength conditioning, the potential applications of
electrostimulation fall into the following broad categories:

* Imposition of local physical stress to stimulate supercompensation
* Local restoration after exercise or injury
* General central nervous and endocrine restoration after exercise or injury
* Neuromuscular stimulation for pain control or movement patterning

Electrostimulation usually involves feeding the muscles low current
electrical impulses via moistened electrode pads placed firmly on the skin.
The effectiveness, comfort and depth of excitation depends on factors such as
pulse shape, frequency, duration, intensity and modulation pattern. The
resulting number of possible stimulation combinations immediately emphasizes
how difficult it is to determine the optimum balance of variables and compare
the results of different researchers.

The typical clinical machine supplies pulsating direct (galvanic) and/or
alternating (faradic) current in the form of brief pulses. The frequency of
faradic current is most commonly chosen in the range of about 50-100 Hz,
while pulse duration (width) ranges from about 100 mi–croseconds to several
hundred milliseconds. This brevity of pulse duration is important for
minimising skin irritation and tissue damage. However, the duration at any
particular intensity of faradic stimulation should not be too brief.
Although they may be suitable for decreasing pain, pulses that are too brief
will supply insufficient energy to cause full, tetanic muscle contraction.

Machines are designed to apply alternating currents directly at a preset or
selected frequency (conventional faradism), or in the form of low frequency
currents superimposed on a medium frequency (2000 to 5000 Hz) carrier wave. A
variation of the latter method, using two pairs of electrodes each supplying
medium frequency waves carrying low frequency waves dif–fering slightly in
frequency, forms the basis of what is called interferential stimulation. A
major advantage of using a higher frequency carrier wave is that impedance
between the electrodes and skin is lowered, enhancing comfort and
effectiveness.

American interest in electrostimulation as a training adjunct was aroused in
1971, when Kots in Russia reported increases of more than 20% in muscle
strength, speed and power produced by several weeks of electrotraining.
Unable to produce comparable results, the Canadians invited him to lecture at
Concordia University in 1977. Armed with the new information that Kots
employed a sinusoidally modulated 2500 Hz current source applied in a
sequence of 10 seconds of contraction followed by 50 seconds of relaxation,
they again tried to duplicate Russian claims.

Applications of Macrocurrent Stimulation

A literature review reveals the following major uses of macrocurrent
stimulation in the realm of therapy. A more detailed discussion or the
citations are not quoted here, but appear in my review on this topic [Siff M
C (1990) Applications of electrostimulation in physical conditioning: a
review J of Appl Sports Science Res 4 (1) : 20-26 ], as well as in the
textbook: Siff MC (2000) Supertraining, Ch 4.2

1. Increase in muscle strength
2. Re-education of muscle action
3. Facilitation of muscle contraction in dysfunctional or unused muscle
4. Increase of muscular and general endurance
5. Increase in speed of muscle contraction
6. Increase in local blood supply
7. Provision of massage
8. Relief of pain
9. Reduction of muscle spasm
10. Promotion of relaxation and recuperation
11. Increase in range of movement
12. Reduction of swelling
13. Reduction of musculoskeletal abnormalities
14. Preferential recruitment of specific muscle groups
15. Acute increase in strength
16. Improvement in metabolic efficiency

The Emergence of Microcurrent Stimulation

Recent research and clinical experience have revealed that electric currents
as much as 1000 times smaller than that of all the traditional physical
therapy modalities can be far more successful than the latter in achieving
many of the benefits outlined in the previous section.

Currents as low as 10 microamps (millionths of an amp) pulsating at between
0.1 to 400Hz are too weak to cause muscle contraction, block pain signals or
cause local heating, yet their effectiveness and safety is often superior in
many applications to that of faradism, interfer–entialism and conventional
TENS (Matteson & Eberhardt, 1985).

The steps to satisfactorily modify the existing paradigm for ES may be sought
in the research findings quoted earlier in the section: ‘Reasons for
conflicting research’. There, it was learned that cellular and subcellular
processes not involving cell discharge, propagated electrical impulses, or
muscle contraction, appear to be involved with cellular growth and repair.

Some studies have produced findings which offer partial answers to the
questions posed by microstimulation. For instance, work by Becker and others
suggests that small, steady or slowly varying currents can cause
sub-threshold modulation of the electric fields across nerve and glial cells,
thereby directly regulating cell growth and communication (Becker, 1974;
Becker & Marino, 1982). In this respect, some of Becker’s applications
included the acceleration of wound healing, partial regeneration of amphibian
and rat limbs, and induction of narcosis with transcranial currents.
Nordenström maintains that these electric currents can stimulate the flow of
ions along the blood vessels and through the cell membranes which constitute
the body’s closed electric circuits postulated by his theory (Nordenström,
1983).

Pilla (1974) has paid particular attention to electrochemical information
transfer across cell membranes. The model in this case hypothesizes that the
molecular structure of the cell membrane reflects its current genetic
activity. Here, the function of a cell at any instant is determined by
feedback between DNA in the cell nucleus and a macromolecule inducer
liberated from the membrane by means of a protein (enzyme) regulator derived
from messenger RNA activity within the cell. The activity of these
membrane-bound proteins is strongly modulated by changes in the concentration
of divalent ions (such as calcium Ca++) absorbed on the membrane. ES may
elicit these ionic changes and thereby modify cell function.

It has been shown that ES at 5Hz stimulates synthesis of DNA in chick
cartilage cells and rat bone by as much as 27%, but not in chick skin
fibroblasts or rat spleen lymphocytes (Rodan et al, 1978). Not only does the
effect of ES appear to be tissue-specific, but the increase in DNA synthesis
occurs 4-6 hours after 15 minutes of ES. The process of membrane
depolarisation carried by sodium ions seems to be followed by an increase in
intracellular Ca++ concentration, thereby triggering DNA synthesis in cells
susceptible to the particular stimulus. Further work by Pilla (1981) has
confirmed the existence of cellular ‘windows’ which open most ef–fectively to
certain frequencies, pulse widths and pulse amplitudes. To attune the ES
signal to these parameters, monitoring of tissue impedances is preferable, a
system employed by so-called ‘Intelligent TENS’ devices.

In addition, Cheng et al (1982) have shown that stimulation with currents
from 50-1000 microamps can increase tissue ATP concentrations in rats by
300-500%, and enhances amino acid transport through the cell membrane and
consequent protein synthesis by as much as 40%. Interestingly, the same study
reported that increasing the current above only one milliamp was sufficient
to depress tissue ATP and protein synthesis – and traditional ES most
commonly applies currents exceeding 20 milliamps, at which stage this
depression being nearly 50%.

An Integrated Theory of Electrostimulation

Therefore, it appears as if macrocurrent stimulation (MACS – currents
exceeding one milliamp) acts as a physiological stressor, which in the short
term causes the typical alarm response described by Selye (1975). This is
supported by the work of Eriksson et al (1981), who found that the acute
effects of traditional ES are similar to those found for intense voluntary
exercise. Furthermore, Gambke et al (1985) have found in animal studies that
long-term MACS causes some muscle fibres to degenerate and be replaced by
newly formed fibres from satellite cell proliferation. This fibre necrosis
occurs a few days after application of ES and seems to affect mainly the FT
fibres. The fact that the various muscle fibres do not transform at the same
time may be due to different thresholds of each fibre to the stimulus that
elicits the transformation. Possibly, the earlier changes might induce
subsequent ones.

Thus, if Selye’s General Adaptation Syndrome model is applied to MACS-type
stimulation, the body would have to draw on its superficial adaptation energy
stores and adapt to the ES-imposed stress by increasing strength or
endurance, or by initiating transformation of muscle fibre types. If the ES
is too intense, too prolonged or inappropriately used to augment a weight
training programme, adaptation might not occur or it might increase the
proportion of slow twitch fibres and thereby reduce strength. This could
explain some of the negative research findings discussed earlier.

Furthermore, excessively demanding MACS conceivably might cause the body to
draw on its deep adaptation energy and lead to permanent tissue damage.
Consequently, any athlete who may derive definite performance benefits from
MACS should not assume that increased dosage will lead to further
improvement. The contrary may well prove to be true.

Microcurrent stimulation (MICS – currents below one milliamp), on the other
hand, would not act as a stressor. Instead, the evidence implies that it
elicits biochemical changes associated with enhanced adaptation, growth and
repair. Since MICS appears to operate more on the basis of resonant
attunement of the stimulus to cellular and subcellular processes, the
specific therapeutic effects are determined by how efficiently the
stimulation parameters match the electrical characteristic of the different
cells, in particular, their impedance at different frequencies. MICS may be
applied in several ways to facilitate restoration:

* locally over specific soft tissues
* transcranially via electrodes on the earlobes or on sites on the surface
of the skull
* at acupuncture points on the body, hands or ears.

It is generally entirely safe to apply MICS anywhere on the body, because the
current and energy transmitted is too low to produce any thermal or
electrolytic effects on vital tissues. Under no circumstances should MACS be
applied across the brain, as it can cause serious harm. It is generally not
advisable to apply any form of ES to epileptics, pregnant women, cardiac
patients or persons with heart pacemakers.

The Validity of Microcurrent Application?

There has been considerable debate about the value of microcurrent (small
electrical currents of less than 1 ampere) in physical therapy, with its
supporters claiming consistently good results and its detractors claiming
that any benefits are probably due to a placebo effect. Some therapists
have stated that there is scant evidence of any research and practical
evidence of the value of microcurrent, so, for their interest and that of
others conducting research into microcurrent therapy, I have compiled a
lengthy, but incomplete, list of English language references that relate to
the theoretical foundations and clinical applications of microcurrent.

My own interest in this field was piqued while I was gathering research
information for my M.Sc into the mechanisms underlying the
electroencephalogram (EEG) in brain research. While browsing in the old
science library located in the physics building at the University of the
Witwatersrand, South Africa during 1971, I encountered a few fascinating
texts: one edited by Barnothy (1969) and another by Presman (1970), as well
as several articles by Robert Becker, with whom I later had periodic contact
over the years (these are all referenced below).

Microcurrent References

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Adey, RW. Electromagnetics in Biology and Medicine In: H. Matsumoto (ed)
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Adey, RW. Signal functions of brain electrical rhythms and their modulation
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Adey, RW. Some fundamental aspects of biological effects of extremely low
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Anderson, JC. & Eriksson, C. Piezoelectric properties of dry and wet bone.
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Barnothy MF (ed) Biological Effects of Magnetic Fields Plenum Press 1969

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Bassett CA, Pawluck R & Becker RO. Effects of electric current on bone in
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