Transcutaneous Electrical Nerve Stimulation (TENS) offers a non-invasive method for managing localized musculoskeletal discomfort. The device delivers low-voltage electrical current through electrodes placed on the skin, targeting underlying nerves to provide temporary relief. Golfer’s elbow, medically known as medial epicondylitis, involves discomfort originating from the medial epicondyle, the bony bump on the inner side of the elbow. This condition is caused by stress or damage to the wrist flexor and forearm pronator tendons that anchor at this point. Understanding the correct TENS pad placement and device settings is necessary for managing the symptoms of medial epicondylitis at home.
How TENS Therapy Targets Golfer’s Elbow Pain
TENS works by engaging the body’s neurological systems to disrupt the perception of discomfort. The immediate mechanism is the Gate Control Theory, where non-painful electrical input activates sensory nerve fibers, effectively closing a “gate” in the spinal cord. This action prevents pain signals from reaching the brain, resulting in an immediate reduction of perceived pain while the stimulation is active.
A second, more prolonged effect involves stimulating natural pain-relieving compounds. TENS prompts the release of endogenous opioids, such as endorphins, which bind to receptors in the nervous system to produce an analgesic effect.
Golfer’s elbow pain stems from the common flexor tendon group (including the pronator teres and flexor carpi radialis) attached to the medial epicondyle. The electrical current must be directed through the skin to stimulate the nerves supplying this area of the inner elbow and forearm. Proper pad positioning ensures the current modulates pain signals originating from these strained flexor-pronator tendons.
Precise Pad Placement Techniques
Effective placement is the most important factor for achieving pain relief for medial epicondylitis. The goal is to position the electrodes so the electrical current flows across the region of maximal tenderness on the inner elbow. Before beginning, the skin must be clean, dry, and free of oils to ensure proper pad adhesion and current conduction.
Technique 1: Centering the Field
One effective technique involves centering the electrical field directly over the affected area. One electrode pad is placed over the most painful spot, usually near the medial epicondyle on the inside of the elbow. The second pad is positioned 1 to 2 inches away, tracing the path of the flexor muscle group down the inner forearm.
Technique 2: Surrounding the Pain
Alternatively, the “surrounding the pain” method ensures the electrical current bathes the entire site of discomfort. In this approach, the two pads are placed on either side of the point of maximum tenderness on the inner elbow. For example, one pad is placed slightly above the elbow joint on the inner arm, and the second pad is placed just below the joint on the upper forearm.
Maintain a minimum distance of at least one inch between the two electrode pads to prevent short-circuiting or an uncomfortable stinging sensation. Pads must never be placed directly onto the elbow joint crease or over any bony prominence, as this causes discomfort and poor current distribution. If using a four-pad unit, position the pairs so the currents cross paths directly over the pain site, maximizing coverage of the injured tendons.
Operational Settings for Pain Relief
Once electrodes are placed, selecting the appropriate operational settings determines the type of pain relief achieved. Two primary protocols target different pain modulation mechanisms. The first is high-frequency TENS, used for immediate, short-term relief through the Gate Control Theory.
High-Frequency TENS (Conventional)
For this approach, the pulse rate (frequency) should be set between 80 to 120 Hertz (Hz), with a narrow pulse width (50 to 200 microseconds [µs]). The resulting sensation should be a strong, steady, comfortable tingling or buzzing feeling (paresthesia). Intensity must be gradually increased until the sensation is felt strongly without causing muscle contraction or discomfort.
Low-Frequency TENS (Endorphin Release)
The second protocol is low-frequency TENS, designed to stimulate endorphin release for longer-lasting pain relief. This mode uses a lower pulse rate (2 to 10 Hz) and a wider pulse width (200 to 500 µs). The sensation is distinctly different, characterized by a visible, rhythmic muscle twitch or tapping sensation.
The intensity level in the low-frequency mode should produce a visible muscle contraction that remains tolerable and not painful. Treatment sessions usually last between 20 to 45 minutes. Intensity may need slight adjustment upward during the session as the nerves accommodate the stimulation. It is advisable to start with the high-frequency setting for immediate relief, then switch to the low-frequency setting for a post-treatment analgesic effect.
Safety Guidelines and Contraindications
TENS therapy requires caution or complete avoidance in certain medical conditions and placement areas. The use of a TENS unit is strictly contraindicated for individuals with implanted electronic devices, such as a cardiac pacemaker or defibrillator, as the electrical current can interfere with function. TENS should also not be used over an area of malignancy, active deep vein thrombosis (DVT), or if the user has epilepsy.
Electrode placement must avoid several sensitive anatomical regions: the front of the neck over the carotid sinus, the eyes, and areas where sensation is impaired. TENS safety during pregnancy has not been established, so it should be avoided, especially over the abdominal or pelvic region. If the skin at the application site is broken, infected, or has a rash, electrodes should not be applied there to prevent irritation or infection.
Users should monitor their skin under the pads after each session for signs of irritation or redness, which may indicate a need to adjust pad placement or reduce intensity. If the pain worsens during treatment, or if the user experiences systemic symptoms such as dizziness or nausea, the device should be turned off immediately and use discontinued. Always consult a healthcare professional before starting TENS therapy, particularly if you have pre-existing health concerns or undiagnosed pain.