Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method used to manage pain. The device delivers mild electrical impulses through electrodes placed on the skin, which help block pain signals from reaching the brain and may promote the release of natural pain-reducing chemicals. Golfer’s elbow, formally known as Medial Epicondylitis, involves pain and inflammation on the inside (medial side) of the elbow and forearm. The condition is caused by damage to the tendons that bend the wrist toward the palm due to repetitive strain or overuse. Using a TENS unit can provide temporary relief, but effectiveness relies heavily on proper electrode placement and correct settings. Before beginning TENS therapy, consult with a physical therapist or physician for an accurate diagnosis and a personalized treatment plan.
Identifying the Pain Target (Medial Epicondyle)
The first step in effective TENS application is accurately locating the source of the pain, which for Golfer’s Elbow is centered at the medial epicondyle. This anatomical landmark is the bony prominence found on the inside of the elbow. Tendons from the forearm muscles, specifically the wrist flexors, attach directly to the medial epicondyle.
When the tendons are strained or damaged, the pain often begins at this bony attachment site and can radiate down the forearm along the path of the wrist flexor muscles. This pain may be noticeable when flexing the wrist against resistance or when gripping objects. Identifying the most tender spot, typically over or immediately adjacent to the medial epicondyle, is necessary for positioning the TENS pads effectively.
Optimal Pad Placement for Golfer’s Elbow
Correct TENS pad placement utilizes the principle of surrounding the area of discomfort to intercept pain signals. The most common and effective strategy involves a cross-fire or bracketing technique using two electrodes. One electrode should be placed directly over or slightly above the most tender spot on the medial epicondyle.
The second electrode is then positioned one to two inches down the forearm, aligned with the muscle belly of the wrist flexors that run toward the wrist. This setup ensures the electrical current passes through the affected tendon attachment site and the irritated muscle tissue.
A secondary placement strategy, useful for more diffuse pain, involves placing the pads along the muscle pathway. For this approach, one pad can be placed near the inner elbow region and the second pad closer to the wrist over the bulk of the forearm flexor muscles. Small to medium-sized electrodes (approximately 2×2 inches) are recommended for the elbow area to ensure proper contact without overlapping. Always ensure the skin is clean and dry before application to facilitate good electrical conductivity and secure adhesion.
Recommended TENS Unit Settings and Treatment Duration
Appropriate TENS unit settings are crucial for maximizing pain relief from chronic tendon issues. For tendon pain like Medial Epicondylitis, two main frequency ranges are employed. High-frequency TENS (Conventional TENS) uses 80 to 120 Hertz (Hz) and is intended for immediate pain blocking through the Pain Gate Theory. This setting provides a strong, comfortable tingling sensation that overrides the pain signals traveling to the brain.
For longer-lasting relief, a low-frequency setting (Acupuncture-like TENS) uses 1 to 10 Hz. This lower frequency stimulates the body’s natural opioid system, promoting the release of endorphins for more sustained analgesic effects. A narrow pulse width, such as 50 to 100 microseconds (µs), is commonly used with the high-frequency setting to target the sensory nerves effectively.
Intensity should be adjusted gradually until the user feels a strong but non-painful tingling or buzzing sensation beneath the pads. The intensity must be kept below the level that causes a visible muscle contraction, as the goal is nerve stimulation for pain relief, not muscle activation. A typical session duration ranges from 20 to 45 minutes, and treatment can be repeated two to three times per day as needed.
Safety Guidelines and When to Avoid TENS Therapy
While TENS therapy is generally considered safe, certain conditions and placement areas require caution or complete avoidance. Individuals with implanted electronic devices, such as pacemakers or defibrillators, must not use TENS due to the risk of device interference. Pregnant individuals should also avoid using TENS, especially over the abdominal or pelvic regions, unless advised by a physician.
TENS provides symptomatic relief by masking pain, but it is not a curative treatment. If the elbow pain worsens, persists, or is accompanied by new symptoms, seek professional medical evaluation immediately to address the underlying cause.
Placement Restrictions
- Never use TENS over the front of the neck, specifically near the carotid artery.
- Do not place electrodes across the chest, as the electrical current could interfere with heart rhythm.
- Do not place electrodes over areas of broken, irritated, or numb skin.
- Check the skin for redness or irritation after each use.