Electrical Muscle Stimulation (EMS)

• A visibly shrunken muscle following injury or a period of reduced use
• A weak muscle that cannot move against gravity, or has just a flicker of activity following a nerve injury
• To rehab a nerve or tendon transfer.

• Help the training of your brain to using the targeted muscle during rehabilitation
• Increase the bulk of the targeted muscle and improve it’s strength
• Improve circulation

• Have an unstable fracture
• Are pregnant
• Have a pacemaker
• Have heart problems
• Have allergies to plasters or dressings as the electrodes use sticky pads
• Have hypersensitive skin  and are unable to tolerate electrical pulses
• A local infection.

Please discuss with your Doctor, or specialist practitioner,  before using EMS if you have:

• Tumours near to where the electrodes are placed
• Broken skin near to where the electrodes are placed
• A metal implant near to where the electrodes are placed

The electrodes are the sticky pads you stick to your body, they deliver the electrical impulses to your muscles.

Check the size of the electrode is the right size for the muscle you are targeting as it may affect other muscle groups if it is too large.

Electrodes are single person use, do not share them with others.

Stored correctly, the electrodes can be re-used for up to 6 weeks.

Cleanse and dry the skin before applying electrodes

Thick hair over the muscle may need to be clipped to allow the electrodes to be stuck down well.

The channel used will stimulate the muscle you are rehabbing.

Where there are two electrodes on one lead, there is a:

• Red electrode  (the “anode”)
• ​​​​Black electrode  (the “cathode” )

The anode should be placed closer to the centre of your body than the cathode.

There are different types of electrodes:

Monopolar – single electrode from one channel, one electrical lead and one pad.

Bipolar (what we typically use) – two electrodes from one channel, usually equal size and shape, one electrical lead split to two pads.

Quadpolar – electrodes from two or more channels, each electrical lead with two pads.

There is an additional lead with an electrode that is used to earth the electrical supply, this can be stuck anywhere on your body.

Frequency/ Pulse rate

This is the number of stimulation pulses delivered per second, it is measured in Hertz (Hz).

A weak frequency  is 1-10 Hz. This will cause a weak muscle twitch or flutter.

You will strengthen the contraction if you increase the frequency up to 60-70 Hz.

Increasing the frequency over 70 Hz will cause a sensory change, and the power of contraction reduces.

Pulse width

This is the length of time each group of pulses of stimulation is set to and is measured in microseconds (Us) or milliseconds (ms).

A short pulse width is around 200us. This should be comfortable to use.

A longer pulse width is around 300us. This will recruit more motor neurones.

Amplitude

This is the strength of the stimulation delivered and is measured in milliamps (mA).

The amplitude need to be high enough to produce a desired response whilst still being comfortable.

As the muscle gets stronger, less amplitude is required to produce the same response.

Balancing amplitude and pulse width can help to maximise both the muscle contraction produced and the comfort of using EMS.

For example, a wider pulse could mean a lower amplitude.

Our guidelines recommend daily use of low frequency stimulation.

Use for 10mins daily initially, with burst stimulation, and gradually build up to 1 hour daily if tolerated.

We recommend a rest day if the stimulation leads to extreme tiredness of the muscle you have been stimulating.

Settings we recommend:

• Frequency between 120 hz with continuous output, or
• Fixed frequency at 50 Hz with burst output.
• Pulse width over 200

Weak muscles will become tired quickly so keep sessions short to begin with.

Avoid sharp, sudden increases in intensity as this can increase sensitivity.

Only use the EMS when advised to do by your Physiotherapist.

Your therapist can practice pad placement with you in your session. Below are common areas we treat in PNI with EMS.

Tibialis anterior

-Front view

Peroneals

• Front view

-side view

Toe extensors

• Front view

-side view

Deltoid

Infraspinatus

Trapezius

Bodyclock NHS Discount Use code F57 for £10 off your order. With the discount the machine is roughly £50  www.bodyclock.co.uk

On Amazon you can find similar for roughly £25, always check they say they are EMS and not just TENS,  as TENS is a different treatment.

Whatever device you choose to purchase, always read the instructions carefully as they may differ from the information in this leaflet.

The products and retailers referred to in this booklet are provided as suggestions for informational purposes only. Readers are encouraged to conduct their own research before making any purchases related to their health.

EMS Unit - 1st Choice Electronic Muscle Stimulator - Body Clock
https://bodyclock.co.uk/3-in-1-combo-electrotherapy-machine-with-22-programs/

Kirsten Hart MSc & Matt White MSc (2017) 

A guide to the use of electrical stimulation in paediatric neurodisability (no date) Association of Paediatric Chartered Physiotherapists. Available at: https://apcp.csp.org.uk/content/guide-use-electrical-stimulation-paediatric-neurodisability (Accessed: 31 October 2025).

Alon Gad (2013)

Functional Electrical Stimulation (FES): Transforming Clinical Trials to Neuro-Rehabilitation Clinical Practice- A Forward Perspective. J Nov Physiother 3:176. doi:10.4172/2165-7025.1000176

Fu SY, Gordon T (1995b)

Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation. (J Neurosci 15:3886–3895.)

Young, W (2015) Electrical Stimulation and Motor Recovery: Article in Cell Transplantation 24(3) pp 429 - 446 · DOI: 10.3727/096368915X686904 ·