Jan 29, 2015
Stimulating Discussion

By Danielle Catalano

Recently, the State University of New York at Buffalo and the National Football League partnered to study the effectiveness of electrical stimulation in the acute care management of orthopedic injuries and edema formation. Here are some of the findings.

Mike Dolan, MA, ATC, is the Director of Canisius College’s Sports Medicine Research Laboratory, and for the last 15 years, his research has centered on electrical stimulation and athlete health. The purpose of his research projects has been to find an effective way in which electrical stimulation (e-stim) may be used to return athletes to competition as fast and safely as possible.

“We are primarily interested in using electrical stimulation to retard edema,” Dolan says. “But it also involves reconditioning muscles after surgery to prevent atrophy and a wide variety of applications that involve rehabilitative care.”

Dolan’s latest research included a joint effort with the State University of New York at Buffalo and the National Football League to study the effectiveness of electrical stimulation in the acute care management of orthopedic injuries and edema formation. The research team focused on Grade I and Grade II ankle sprains because they are the most common injuries sustained in sports.

“One thing we know about edema formation is that it is an important clinical goal to curb it or not let it form after an injury,” he says. “The primary reason for doing this study was that we are unaware of research that uses well-controlled human subjects to support the use or disuse of e-stim.” The research team’s double-blind, 18-month clinical trial ended in December 2006 and comprised 50 athletes from 12 colleges (ranging from NCAA Division I to Division III) and one NFL team. All participants were healthy at the start of the study.

After spraining their ankles, subjects received traditional RICE (rest, ice, compression, elevation) treatment and were fitted with a specially designed sock featuring electrodes and silver woven into the fabric for better conductivity. A small, portable, battery-operated stimulator was attached to the outside of the sock. Participants wore the sock for three days and took it off only when showering. Participants were trained individually for 20 minutes on how to work the stimulator, given instructions on how long and how often to keep the stimulator turned on, and how and when to adjust the intensity of the stimulation. Some instructions called for stimulators to be on three times a day for an hour each session while others had stimulators turned on for 22 hours. Participants were also directed to continue the RICE treatment and maintain a journal log. Unbeknown to the 25 participants in the control group, the electrical stimulation ramped off after four minutes, Dolan says, allowing enough time for placebo effect to occur. For the experimental group, the stimulators remained on and also measured the subjects’ limb volumes over the three-day period. The modalities of the electrical stimulator were cathodal (negative polarity) high-voltage pulse currents at 120 pulses per second at 90 percent of visible contraction mobility. “We’ve used these measurements throughout our animal studies and smaller clinical trials,” Dolan says. “Other studies have indicated these measurements as well, so it’s not just us creating the numbers. Now, whether or not these measurements provide a great enough treatment effect on humans is our next question to answer.” The data are still being compiled, Dolan says, but the preliminary results are promising. “We found e-stim did curb swelling when compared to the control group, but a more important finding was the effect the treatment duration periods had on the injured area,” he says.

“Typically, athletic trainers and physical therapists use electrical stimulation for up to 30 minutes, once or twice a day. In our model, electrical stimulation was shown only to be effective when the generator was on–once you turn the machine off, the treatment effect essentially disappears,” Dolan says. “Instead of using intermittent treatments, our research suggests that e-stim has to be applied for longer periods of time, and continuously if possible.” Eighty percent of participants maintained “quality” journaling, says Dolan, which increased the study’s external validity. “This study places a lot of responsibility on the athlete,” Dolan says. “But that’s why we designed the study this way. It has to be practical, so athletes can continue the other activities of their lives.” With all this new research, Dolan cautions sports medicine professionals against jumping to conclusions. “It is a very attractive option to clinicians, but this is really just one piece of the puzzle,” he says. “We still use RICE–electrical stimulation is just one treatment we can use.”

Danielle Catalano is the Marketing and Sales Assistant at MomentumMedia.

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