Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method for managing pain using a small, battery-powered device to deliver low-voltage electrical current through electrodes placed on the skin. TENS therapy is commonly used for various musculoskeletal conditions, including persistent elbow discomfort. Understanding the correct application and settings of a TENS unit is necessary to maximize its effectiveness for targeted elbow pain relief. This guide provides instructions on where to place the electrode pads and how to adjust the device for conditions like tennis elbow and golfer’s elbow.
How TENS Therapy Works
TENS works primarily through two physiological mechanisms to reduce pain perception. The first is the Gate Control Theory, where electrical impulses activate non-pain-carrying nerves. These activated nerves travel faster than pain signals, effectively closing a “gate” in the spinal cord and preventing the pain message from reaching the brain. This mechanism provides immediate, short-term relief while the unit is operating.
The second mechanism is the Endorphin Release Theory, involving the stimulation of the body’s natural opioid system. Applying a lower frequency current over a longer period prompts the release of endorphins and enkephalins, which are natural pain-relieving chemicals. These chemicals interact with receptors in the nervous system, producing an analgesic effect that can last after the TENS unit is turned off. Different settings target either the Gate Control mechanism for rapid relief or the Endorphin Release mechanism for sustained pain management.
Specific Pad Placement for Elbow Pain
Proper placement of the electrode pads ensures the electrical current targets the nerves and muscle tissue surrounding the source of pain, not the bone or joint itself. Position the pads so the current passes through the painful area, avoiding placement directly over the joint crease. Pads should be placed a minimum of one inch apart to ensure the current flows correctly through the tissue.
The location of the pain dictates the specific placement needed for effective treatment. Lateral epicondylitis, often called tennis elbow, causes discomfort on the outer side of the elbow and forearm. For this condition, place one pad one to two inches above the most tender spot on the outer elbow and the second pad one to two inches below that spot on the forearm muscle belly. This configuration targets the inflamed common extensor tendon and the muscle group responsible for wrist extension.
Medial epicondylitis, known as golfer’s elbow, presents with pain on the inner side of the elbow. Position one electrode pad slightly above the tender point on the inner elbow and the second pad one to two inches below it on the forearm flexor muscle belly. This placement aims stimulation at the common flexor tendon and the muscles that control wrist flexion. For broader or diffuse pain, a four-pad setup using two channels can create a cross-current pattern, surrounding the entire painful region.
Recommended Settings and Treatment Duration
Selecting the appropriate TENS settings depends on whether you seek immediate relief from acute pain or sustained management of chronic discomfort. For immediate pain blocking via the Gate Control Theory, a high-frequency setting is recommended, typically between 80 and 120 Hertz (Hz). This stimulation should be set to an intensity that creates a strong, comfortable tingling or buzzing sensation without causing muscle contraction.
When addressing chronic elbow pain for a longer-lasting effect, use a low-frequency setting, usually between 2 and 10 Hz. This lower rate encourages the release of endorphins and may be accompanied by a sensation of gentle tapping or pulsing. The intensity must be adjusted to the highest level that remains comfortable, often described as a strong tingle just below the point of discomfort.
A standard treatment duration is typically 20 to 40 minutes per session, repeatable several times daily for pain management. For acute flare-ups, sessions can be extended up to 60 minutes. Monitor the skin underneath the pads for any signs of irritation and allow the skin to rest between applications to prevent soreness or burns.
Safety Guidelines and Contraindications
Before beginning TENS therapy, understand the safety guidelines and conditions where the device should not be used. TENS is considered a safe, non-drug pain relief option, but certain circumstances present absolute contraindications. Never use a TENS unit if you have an implanted electronic medical device, such as a cardiac pacemaker or an implantable defibrillator, as the electrical currents can interfere with its function.
Electrode pads should never be placed over the front or sides of the neck, specifically the carotid sinus, as this can cause a rapid drop in blood pressure or laryngeal spasms. The device should also be avoided on areas of the body with reduced sensation, over open wounds, or on irritated or damaged skin. The safety of TENS has not been established during pregnancy, so treatment should be avoided. Individuals with epilepsy or heart disease should consult a healthcare professional before using the device.