By Lin Duffyhill, L.Ac., CFST2, MAT, LM3

HOW TO START USING IT IN YOUR PRACTICE 

Using an electrical stimulation device can be really intimidating, especially with all of the different devices out there. The first step would be assessing what kind of ailments you are treating and if the application of electrical stimulation is applicable. In my practice, I use electrical stimulation for the treatment of pain, pain syndromes and the management of injuries. If this is something you see in your practice a lot, I would definitely consider using electrical stimulation. I completed the Whitfield Reaves Sports Medicine seminar for acupuncturists (https://www.whitfieldreaves.com/seminars/). It helps you understand where to needle and how to implement the electrical stimulation into your practice with different protocols. 

There are also so many devices out there and it can be hard to know which one is best for your practice. For me personally, the E-STIM II device is simple and does exactly what I need. In my practice, I primarily treat inhibition and over activation of muscles. For this, I like to set my machine to the Milli setting with the frequency between 5-10Hz. This lower frequency gives me fewer pulses delivered per second which results in a slower, pronounced muscle twitch. Occasionally I will treat issues involving neural pathways and associated dysfunctions. When treating these, I will typically switch my machine to Micro with the frequency around 25Hz.

The most common things I treat in my practice with electrical stimulation include, but are not limited to:

• Back pain: including acute back spasm, SI joint pain, chronic back pain
• Shoulder pain:
• AC (acromioclavicular) & SC (sternoclavicular) joint sprain
• Achilles tendinitis
• Patellar tendinitis 
• MCL sprain
• Lateral ankle sprain
• Hip pain
• IT band syndrome
• Neck pain 

CASE STUDIES

37 y.o. Male

Chief Complaint: Neuropathy of the right foot and pain & numbness down the lateral leg all the way to the foot with decreased sensation, strength & blood flow to the right foot & big toe. 

History: Came into the clinic 8 weeks post spinal fusion of L4/L5 and L5/S1. Decided to go the spinal fusion route as a result of low back pain and the inability to use his right foot. Originally had a foot drop, and the surgery helped with the foot drop, but he was still having the radiculopathy, weakness, and notable coldness of the right foot. He was going to physical therapy but hadn’t felt any relief or change since the surgery. Patient had a notable weakness of the big toe and decreased sensation of the entire foot. 

Treatment 1: Treated the motor point of the Quadratus Lumborum, Jian Kua and the motor point of the Peroneus Longus. Each point had 2 SEIRIN G-Type Needles in it and hooked it up to electrical stimulation. The setting on the E-STIM II was Milli, the frequency at 5Hz, and the intensity turned up until the patient felt the tapping of the e-stim and/or when there was a visible twitch of the muscle. E-stim ran for 25 minutes with an infrared lamp on the lower back. 

• After one treatment, the patient was able to sleep more comfortably, ROM of the hip and back increased and was able to have some sensation in the foot (could feel the water in the shower and a slight sensation of the sheets on his foot). 

Treatment 2: Repeated the QL and Jian Kua treatment from treatment 1. Added a protocol to treat the nerve bundles that supplied the foot. For this, I switched the machine to Micro at 25Hz for 25 minutes.  

• Deep peroneal neuropuncture point (about LR 2.5) connected to the common peroneal neuropuncture point (anterior GB 34)
• Sural neuropuncture point (BL 57) connected to tibial neuropuncture point (SP 6)
• After treatment 2, the patient felt like he was able to have more control over his big toe and had increased sensation along the lateral leg. 

Repeated treatment 2 in the next 4 sessions over 2 weeks and the patient was able to fully move their toe and felt like their sensation was about 95% returned. 

TECHNIQUES

The simplest way to start using e-stim to help treat pain would be a surround the dragon approach, using at least 4 needles. If using this technique, I will cross the leads so it makes an ‘x’ and run it for 15-20 minutes. However, the bulk of the techniques I use are from Whitfield Reaves in his Acupuncture Sports Medicine seminar. It is a 3-day weekend course where you go over the most common ailments and how he assesses and treats the most common injuries and sources of pain that have come through his clinic. 

Whitfield uses e-stim in 90% of his treatments. The majority of his treatments target the motor points of muscles, which are almost all found in common acupuncture points that we all know and love – i.e. SI 11 is the motor point for the muscle in the shoulder called the Infraspinatus. In addition to needling muscles, we learn how to needle joint spaces. Connective tissue permeates electricity very well, so being able to get needles into a joint space, which is filled with connective tissue, can be a very effective way to treat an inflamed, irritated and injured joint (think ankle sprain, MCL sprain, achilles tendinitis, SI joint, etc). 

PRACTICAL TIPS AND TRICKS

• Untangling wires is one thing I spend WAY too much time doing. To help prevent this, I like to hang the wires on a hook on the wall. That way it is a lot easier to grab them and get tangled up a lot less.
• When hooking the leads up to the needles, I like to make sure that I wrap the excess wire around the machine so that it isn’t hanging and therefore tugging on the needle.
  • If you have metal handles on your needles, make sure they aren’t touching because it can disrupt the connection of the circuit.
  • Don’t let the handles on the leads touch for the same reason stated above. 
• When using the Pointer Excel II, make sure that the hand on the device is in contact with the two metal plates and that your other hand is touching the skin of the patient. I like to place my thumb and index finger on either side of the needle, touching the skin of the patient. 
  • If you are in the right spot, it will be a good twitch and you won’t get much feedback on your hand on the patient’s skin. Sometimes I have found that if my needle placement isn’t quite accurate, I will get some feedback on my contact hand (or even on the hand on the device) and it feels like you feel a bit of a shock. If this happens, I will first try moving my contact hand to a different spot on the skin and/or adjusting the connection of my hand on the device and the metal plates. 
    • If this doesn’t change the feedback, I will try inserting the needle in a slightly different spot and as long as I am in the correct spot, I won’t get the feedback.
• Learning orthopedic diagnosis and muscle tests are a great way to help narrow down the diagnosis of the potential cause of the pain the patient is experiencing. I recommend Derrick McBride’s Acupuncture and Movement Project (www.acumovement.com). Derrick is my mentor and he has a wonderful systematic approach to investigating the cause of pain, which allows you to be more specific with treatment so you can do more with less needles. 

TESTIMONIALS

 “I was dealing with significant neck and hip pain, tightness, and tension—so much that it was impacting my sleep and daily life. I’d wake up with kinks in my neck, and my posture from working long hours as a lawyer left me with persistent, throbbing neck pain and headaches throughout the workday. On a scale of 1 to 10, my pain often hovered around a 6 or 7, leaving me exhausted, irritable, and desperate for relief.

I had never experienced anything like e-stim before seeing Lin, and now I’m hooked! It’s been the most effective solution I’ve ever found for targeting deep knots and sore areas. The way it grabs the muscle and releases tension is indescribable—it forces your body to relax in a way that feels both powerful and soothing. I’ve joked with Lin that if I could, I’d have her follow me around all day holding e-stim to my neck!

After each session, my pain is almost completely gone for several days, often dropping from a 6 or 7 down to a 0. Over time, with consistent treatment, I’ve noticed a lasting improvement in my pain and posture. Even when the discomfort does return, it’s significantly reduced—usually just a 2 or 3 at most. I’m sleeping better, feeling more energized, and able to focus at work without constant discomfort.”

“I have dealt with hip pain for years. I spent 3-4 years in various physical therapist offices who used dry needling, really painful deep tissue work and exercises that just never quite worked the way I wanted. As soon as I went to see Lin and she used her e-stim device in conjunction with the acupuncture, I saw immediate results that I never saw with any of the physical therapists. The deep muscle twitch that happened with whatever settings she had on her machine, felt so therapeutic and as soon as I would get off the table I felt instantly less pain and more range.”

“I love getting acupuncture, but as a professional football player, I am constantly wearing down my body. I feel like being able to add the electrical stimulation to the acupuncture allows the treatment to be extended longer than if I was treated with just the acupuncture. Acupuncture with electrical stimulation has been a game changer to my weekly recovery routine and I wouldn’t be able to make it through the entire season without it!”

Images courtesy of Becky Duffyhill https://beckyduffyhill.com