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Elite SII
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Globus Elite SII User Guide

Rev. 11.2014
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GLOBUS
ELECTROSTIMULATION
User guide
Rev. 11.2014
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THE ELECTROSTIMULATION...................................................................................................................................5
CLASSIFICATION OF THE DIFFERENT TYPES OF MUSCLE FIBERS....................................................... 6
Stimulation intensity ....................................................................................................................................................10
Stimulation type ........................................................................................................................................................... 12
PROGRAMMING............................................................................................................................................ 14
Diagram of the programming of the EMS currents......................................................................................................15
Diagram of the programming of the TENS currents....................................................................................................15
Diagram of the programming of the DENERVATED currents ...................................................................................16
Diagram of the programming of the KOTZ currents....................................................................................................16
Diagram of the programming of the INTERFERENTIAL currents.............................................................................16
Diagram of the programming of the MICROCURRENT currents............................................................................... 16
PRACTICAL APPLICATIONS ....................................................................................................................... 17
Use in sport field .......................................................................................................................................................... 17
Use in beauty field........................................................................................................................................................17
Localized loss of weight...................................................................................................................... 17
Anti-cellulite treatment ....................................................................................................................... 18
The lymphatic drainage....................................................................................................................... 19
Firming/Toning.................................................................................................................................. 19
Specific breast cleavage and arm firming treatment ....................................................................................... 19
Specific face treatment........................................................................................................................ 20
Applications in rehabilitation........................................................................................................................... 20
The TENS ......................................................................................................................................... 20
The MENS Microcurrents............................................................................................................................... 21
IONOPHORESIS............................................................................................................................... 23
Currents for denervated or partially denervated muscles................................................................................23
Interferential currents.......................................................................................................................... 25
Russian currents (kotz) ....................................................................................................................... 25
PROGRAM LIST“SPORT”......................................................................................................................................... 27
PROGRAM LIST ”MICROCURRENTS” ..................................................................................................................38
PROGRAM LIST REHAB .......................................................................................................................................... 41
PROGRAM LIST PREVENTION (available on Genesy SII-Elite SII) ...................................................................... 45
PROGRAM LIST SPECIAL SPORTS ........................................................................................................................46
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G-PULSE TREATMENTS (only in Activa, Fit&Beauty and Swing) .........................................................................51
Operating mode:...........................................................................................................................................................52
The recommended accessories to carry out the 3S sequential drainage programs ....................................................... 53
Conductive bands................................................................................................................................... 53
“Fast band”............................................................................................................................................ 54
“Fast pad”.............................................................................................................................................. 54
Splitted cables........................................................................................................................................ 54
Electrode placement for the sequential drainage..........................................................................................................54
THE ACTION NOW PROGRAMS..................................................................................................................... 56
PERSONAL TRAINER...................................................................................................................................... 58
Use suggestions for the main programs........................................................................................................................ 58
ELECTRODE PLACEMENT ............................................................................................................................. 71
The body position during the stimulation.....................................................................................................................71
Electrode placement for Tens and Microcurrent programs .......................................................................................... 71
Bibliography...................................................................................................................................................... 84
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THE ELECTROSTIMULATION
The electrostimulation does not want to replace physical activity but it must be considered as an additional treatment to it. According to the aims, it will be useful:
- To sportspeople, in order to complete the normal training and to increase performances
- To those who want to treat some imperfections
- To those who suffer from some pathologies
- To those who have suffered from a trauma or in the rehabilitation. The electrostimulation is a technique that provokes a muscle contraction completely similar to the voluntary one, by using electrical impulses that act on motor points (motoneurons) or on nerve endings (TENS impulses). There are two different ways of use:
- muscle stimulation (ideal for strength development and for aesthetic treatments)
- stimulation to nerve endings (ideal for the treatments against pain)
Types of muscle
The muscle can be divided in three different types: streaked or voluntary muscle; cardiac muscle and smooth or involuntary muscle. The voluntary muscle (streaked) includes the skeletal muscles and the musculature of organs such as the eyeball and the tongue. It permits the movement and the maintenance of the posture and contributes to shape the body. It responds very quickly to nerve impulses, by contracting in a rapid and intense way. The voluntary muscle cannot be contracted for long time with high intensity because it is subject to fatigue. Generally, streaked muscles are connected to the skeleton by means of tendons. The involuntary muscle (smooth) covers the internal walls of our organs, it is in the wall of the blood vessels, in the wall of the hollow organs (stomach, intestine), inside the eyeball, in the erector muscles of the hairs. Its main function is to push materials inside and outside the body. Smooth muscles have very slow, but prolonged and more effective contractions (requiring less ATP). They are not easy to fatigue and are often intrinsic and, therefore, they do not adhere to skeletal structures. The cardiac muscle is responsible for the continuous and rhythmic contractility of the heart and it has some functional and structural features of the other two types of muscle tissues. The cardiac and the smooth muscle are not voluntarily controlled. The most part of the human body muscles belongs to the category of streaked or voluntary muscles, with approximately 200 muscles for each side of the body (approximately 400 totally). Skeletal muscles are the target of the EMS (Electrical muscle stimulation).
The mechanism of the muscle contraction
The skeletal muscle exercises its functions through the mechanism of the contraction. When the muscle contraction happens, the movement of the articulations is produced and, consequently, the movement of the skeleton, too.
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The muscle contracts in the following way: when a person decides to make a movement, his/her brain automatically elaborates the information needed and it creates a signal that, through the nervous system, transmits an electric impulse to the muscle that has to move. After the reception of the impulse, the anatomic structures of the muscle contract causing the desired movement. The energy demanded for the contraction is provided by the supply of sugars and fats stored in the human body. In other words, the electrical stimulation is not a direct energy resource but it works as an instrument that triggers the muscle contraction. The same type of mechanism is activated when the muscle contraction is produced by the electrostimulator. EMS (the electrostimulation produced by the electrostimulator) assume, in other words, the same role of a natural impulse transmitted by the motor nervous system. Normally the muscle relaxes and returns to its original state at the end of the contraction.
Isotonic and isometric contractions
The isotonic contraction occurs when the interested muscles produce a state of constant tension producing the displacement of the joint heads and therefore the movement. Instead, when the musculature produces a tension and the joint heads of a physical segment are blocked (without moving), we talk about an isometric contraction. In the event of the electrostimulation, an isometric contraction is preferred because it fosters to obtain an even maximum contraction without creating sudden and uncontrolled movements of the joint heads. Despite this, for specific applications, especially in sport field, the electrostimulation can be used together with an isotonic contraction (with overloads, too).
CLASSIFICATION OF THE DIFFERENT TYPES OF MUSCLE FIBERS
The skeletal muscles are composed by a combination of muscle fibers that have different shapes according to the mechanical functions they have to carry out.
I type FIBERS
This type of fibers are also called ST fibers (slow contraction fibers) or SO fibers (oxidative metabolism slow fibers). The motoneuron that innervates them is tonic and with slow conduction speed. They are red fibers (the color is due to the presence of the myoglobin molecule) that have a slow contraction speed and a mainly oxidative energetic metabolism (oxygen consumption). I type muscle fiber is very resistant to fatigue as it is responsible for every kind of activity with a tonic, slow nature, that is connected to the maintenance of the posture. These fibers are surrounded by a thick capillary net that enables the optimal execution of the aerobic metabolism in a prolonged activity that has moderate strength expressions. I type fibers are very important in all endurance sports: running, cycling, swimming, cross-country skiing, etc.
IIa type FIBERS
They are also called FTa fibers (rapid contraction fibers) o FOG fibers (oxidative-glycolytic metabolism rapid fibers).
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These fibers are to be considered intermediate between the I type fibers and the IIb type fibers; they are innervated by a phasic motoneuron that has a faster speed than the one of the tonic motoneuron. Thanks to their features, they can specialize by addressing them towards more aerobic or anaerobic metabolic properties. Therefore, the IIa type fiber is able to carry out rapid contractions with a modest strength development, that are extended during the time due to their relative endurance to fatigue.
IIb type fibers
They are also called FTb fibers (rapid contraction fibers) or FG (glycolytic metabolism rapid fibers). This kind of fiber is innervated by a phasic motoneuron that transmits the impulses to the muscle at a very high speed. These fibers are white and have a high content in glycogen and glycolytic enzymes to develop a powerful energetic anaerobic activity. The contraction is very rapid and develops high strength values; the almost complete lack of mitochondria makes these fibers not able to support an extended activity and, thus, easy to fatigue. IIb type fibers are very important in all human activities that have explosive strength expressions and, naturally, in all power sports: sprints, throws, jumps, etc.
The limits of the actual classifications
The actual classification of muscle fibers is due more to the need of establishing a series of categories to use for practical aims than to the biological-functional reality of the human muscular system. It is certain that the fibers are in a continuous range of different metabolic organization levels that correspond to the different types of human activity, generally, and sport performance, specifically.
The distribution of the different types of fibers in the muscle
The relation between the two main categories (type I and the type II) can vary in a sensitive way. There are muscular groups that are typically constituted by fibers of I type, like the soleus, and there are muscles that have only fibers of II type like the orbicular muscle. However, in the most of the cases we have a simultaneous presence of various types of fibers. The studies lead on the distribution of fibers in the muscle have put in evidence the strait relationship that exists between the motoneuron (tonic or phasic) and the functional features of fibers from it innervate. They have also shown as a specific motor activity (and sports in particular) can determine a functional adaptation of the fibers and a modification of their metabolic features. In the same way, also the training with the electrostimulation enables the training to focus on some types of fibers rather than on other types, by modifying the parameters of frequency and duration of the impulse, according to the results achieved.
Motor unit type
Contraction type
Contraction frequencies
I type fibers
Slow contraction I
0 - 50 Hz
II a type fibers
Fast contraction II
50 - 70 Hz
II b type fibers
Fast contraction II b
80 - 120 Hz
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In order to make a tissue pass from the phase of rest to the one of excitation by means of an induced electrical stimulus (impulse of the electrostimulator), some factors have to be considered:
- the stimulation intensity
- the duration of the stimulation that must be adapted to the body district that is wanted to be stimulated. Indeed, to excite a tissue, not only the pick intensity value is particularly important, but also the relationship between the duration and the intensity of the stimulus. This relationship varies according to the muscular districts.
Chronaxy and reobase
The graphical course that represents the relationship between the intensity of a stimulus (l) and its duration (t) is not linear, as the studies carried out by Lapique demonstrate. Observing img. 1, which shows the relationship between intensity and duration of an electrical stimulus provoked to excite a target tissue, it turns out to be obvious that, an increase in the duration of the stimulus corresponds to a decrease in its intensity.
Image 1
However, it does not spoil its effectiveness. On the other hand, when a stimulus of short duration is wanted to be used, its intensity will have to increase for being able to reach the excitation threshold. Lapique's important discover consists in having understood that for being able to obtain an electrical stimulus, qualitatively valid, it is not sufficient to establish a parameter and consequently derive the other. That depends on the intrinsic features of the organic tissues, which try to get accustomed to a constantly repeated stimulus. This phenomenon, called "tissue accommodation", involves the realization of a stimulus that does not depend on it. The two parameters individuated by Lapique, necessary in order to obviate the problem, are: REOBASE and CHRONAXY. REOBASE: it is the value of minimum intensity in order to excite the tissue independently from its duration. CHRONAXY: it is the duration of the stimulus, with a double intensity compared to the reobase, it is necessary in order to excite correctly the target tissue. Once the chronaxy has been identified, a suitable stimulus is automatically produced to excite correctly the target muscle group. In this way it is also possible to avoid all those typical annoyances of an extended electrical stimulation such as a burning sensation and formication. During the researches to define the electrostimulation programs, therefore, it is indispensable to consider the chronaxy, which varies according to the muscular group that you want to stimulate.
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Body Part
Chronaxy
Leg
400 μs
Thigh
350 μs
Lower trunk
300 μs
Upper trunk
250 μs
Arm
150 μs
Forearm
200 μs
Table of the values of chronaxy of the different body parts
Impulse parameters
Recent researches have explained that the muscle contracts in various ways according to the type of stimulation it has received and according to the parameters that characterize it: intensity, frequency, amplitude of the impulse, duration and recovery time. The parameters that characterizes an electrical impulse are:
- frequency
- amplitude
- intensity
The frequency suggests how many impulse cycles occur in a second. It is expressed in Hertz. This value affects the fibers that will be stimulated: the higher the frequency is, the more the stimulation aims to fast fibers. At low frequencies, slow fibers are stimulated.
Image 2. In the first graphic the frequency is 10 Hz, in the second one it is 4 Hz.
EXAMPLE:
frequency fiber type (work)
10/50 Hz Slow fibers – Endurance 50/70 Hz Intermediate fibers 70/100 Hz Fast fibers - Strength 100/120 Hz Fast fibers
Impulse cycles in 1”
Impulse cycles in 1”
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The amplitude is the duration value of the impulse. It is measured in microseconds and represents the chronaxy value of the motor nerve that innervates the muscle to be treated.
EXAMPLE: 150-250 ms Upper limbs 350-450 ms Lower limbs 250-350 ms Trunk
The intensity is the value of the electrical current that can be set by the user and it is measured in mA (microampere). Higher the intensity, greater the number of the fibers recruited.
Stimulation intensity
The intensity of current necessary to obtain muscular contraction is personal and depends on the position of the electrodes, the underlying adipose tissue, sweating, the presence of hair on the area to be treated, etc.. For these reasons, the same intensity of current can generate different feelings from person to person, from day to day, and from the right side to the left side of the body. During the same working session, it will be necessary to regulate the intensity in order to obtain the same level of contraction because of the accommodation phenomena. The intensities of current recommended in the different phases are proposed as indicative values, and each person should modify these levels according to his/her personal needs.
- Moderate intensity. The muscle does not tire, not even during prolonged treatments. The contraction induced is tolerable and pleasant. This is the first level on the graphic representation of intensity.
- Intermediate intensity. The muscle is visibly contracted but the stimulation does not cause the joints to move. This is the second level on the graphic representation of intensity.
- Elevated intensity. The muscle is contracted substantially. The muscular contraction will cause the extension or bending of the limb if this is not blocked. This is the third level on the graphic representation of intensity.
- Maximum intensity. The muscle is contracted maximally. This is an intense treatment that should be performed only after having executed different applications at lower intensity.
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In the descriptions of the treatments, the best levels of intensities are recommended. NOTE: The recommended levels of current are only indicative. NOTE: For Microcurrents programs, it is not necessary to set an intensity value (in mA) because this is preset and automatically activated for all phases.
Moderate
Maximum
Elevated
Intermediate
From 10 mA to 20 mA
At the maximum level of tolerance, but below the pain threshold
From 30 mA to 40 mA
Above 30 mA
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Stimulation type
Globus electrostimulators offer different stimulation modes: continuous, intermittent, frequency modulation, amplitude modulation and BIO-PULSE®.
Continuous stimulation
It consists in a continuous stimulation without times of recovery all the phase long.
This type of stimulation is generally used, in order to execute treatments of warm up and cool-down at low frequency (with TENS currents) or for antalgic treatments.
Intermittent stimulation
During this type of stimulation there is an alternation between working time and rest time (active and passive); there can be, for example, 6 seconds of contraction and 10 of recovery, after that the contraction starts up again for 6 seconds and so on for all the duration of the phase. During the time of recovery, there is also the possibility to raise the intensity of current in order to execute a cool-down active recovery during the rest.
Frequency modulation stimulation
In this type of stimulation, during the working phase, the frequency of the stimulus varies between the predefined values in order to involve the greater number of muscular fibers. They are used for aesthetic treatments and also for specific programs, such as programs of explosive strength.
Amplitude modulation stimulation
Ramp-Down
Rest
Ramp-Up
Stimulation
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In this type of stimulation the frequency remains constant while the amplitude of the impulse varies progressively between the predefined values. It is indicated mainly for aesthetic and fitness treatments.
BIO PULSE stimulation
It must be considered a true and proper Globus innovation (studied in collaboration with some Italian and foreign Universities). It consists in a particular type of modulation of the amplitude of the impulse and of the stimulation frequency, too. The Bio Pulse stimulation is particularly indicated for beauty and wellness programs such as some kinds of lipolysis and drainage and, above all, programs of relaxing, deep and anti-stress massage.
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PROGRAMMING
In the most of Globus electrostimulators there is a function that enables the user to set the programs in a very specific way and according to the current needs. The personalized work can create a very specific training and a rapid achievement of the proposed results inn sport field and rehabilitation, fitness and in beauty field. It is clear that the use of this special function of the principal Globus electrostimulators needs a deep knowledge of the electrostimulation field and especially an optimal experience in the field, firstly made with the preset programs to be personalized further. The currents that can be programmed vary from device to device and are:
- EMS;
- TENS;
- Interferential;
- Microcurrents;
- Denervated;
- Kotz.
Here we just want to offer some general notions on the parameters that can be set to create a new program. To program the electrostimulator correctly it is important to consider three different factors that characterize the impulse: the ramp up, the stimulation time and the ramp down. With the term “Ramp-up” we mean the time that the stimulation intensity needs to pass from the value of 0 to the preset value during the working phase. Therefore, it represents the time that the muscle needs to reach the maximum contraction set. The ramp up varies according to the features of the program chosen. The choice of the ramp up is in a strait relationship with the physical and muscular features of the athlete, of the sport practiced and of the goal you want to reach. It is important to consider that too brief ramps reduce considerably the comfort of the stimulation and they are difficult to manage by the person that is carrying out the treatment, as he has not enough time to prepare to the contraction. In the same way, too long ramp time can fatigue the muscle even before the contraction ends. With the term “Ramp-down” we mean the time needed for the intensity to return to 0 after the end of the contraction. Even in this case it should be considered that too rapid ramp down times can be less comfortable because the subject does not have the time needed to support the voltage drop, while too long ramp down times can anticipate the feeling of localized fatigue. With the term “stimulation time” we mean the time the musculature keeps the maximum contraction reached. The duration of the working phase does not have a fix value but is has to be established according to the muscle qualities you want to train.
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Diagram of the programming of the EMS currents
Diagram of the programming of the TENS currents
* With the term “Tens burst” in the
stimulation during the rest, we mean a burst constant, that is a constant current in the form of brief impulse packages.
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Diagram of the programming of the DENERVATED currents
Diagram of the programming of the KOTZ currents
Diagram of the programming of the INTERFERENTIAL currents
Diagram of the programming of the MICROCURRENT currents
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PRACTICAL APPLICATIONS
Use in sport field
Different kinds of strength exist and they are measured in different ways. The maximum
development of strength is the absolute strength, without considering the body weight; instead when the body weight is considered, we are talking about the relative strength.
Here’s an example. We know that an ant is able to move an object that weights six
times more than it does, therefore it has a relative strength greater than any other
weight lifter, even if its absolute strength can be considered paltry. Another element to be considered is the kind of effort made. For example, the running of a one hundred meters runner is a performance very different from the one of a marathon runner and it develops different strengths. When the stimulation that our muscle bear is brief, intense and immediate, then we are measuring the rapid strength. When it is extended during the time (and it requires the organism countering certain fatigue), we are measuring the endurance strength. Obviously, every kind of strength will have a training and a specific load to increase it.
Use in beauty field
The electrostimulation treatments in beauty field can be distinguished in two big areas:
- specific programs to treat skin flaws: improvement of the capillary microcirculation, toning and tissue firming, liquid drainage, increase in metabolism and cellular activities, reduction and mobilization of the fat in the localized
deposits (e.g. cellulite, water retention, localized fat, …);
- toning or firming programs: for those who want to firm and tone their muscles but do not have enough time to practice motor activity. For long-lasting results, it should be used together with motor activities, as soon as possible. As you will see, these programs contribute to reduce skin flaws through the general and localized increase in the metabolism. Among the innumerable applications in beauty field, we briefly summarize some of the main aims.
- Loss of weight/ Localized lipolysis
- Anti-cellulite treatment
- Lymphatic drainage
- Firming/Toning
Localized loss of weight
It is known that, when a person goes on diet, he/she loses fat more quickly in the areas where he/she is already slim. For instance, when going on a diet, a woman, who does not have a voluminous breast and wants to lose weight because of her large hips, is going to lose weight in the breast and not in the hips. To obviate the problem, it is necessary to resort to the so-called “localized loss of weight”, that is the losing weight process that, through the increase in the muscle activity, enhances the mobilization of the fat from the adipose tissue (lipolysis) in the areas next to the activated muscles.
Love handles
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If the cellulite on hips is a feminine problem, love handles are instead almost exclusively a man problem. Both are difficult to tackle; gym, diet, aerobic work, and more, often permit to obtain only mediocre results. Electrostimulation can contribute in an effective way to treat this skin flaw because, being a localized treatment, it acts directly on the problem. In this case it is necessary to have the maximum perseverance and especially the possibility to act more times per day, or at least every day, with specific electrostimulation programs localized on the areas to be treated.
Anti-cellulite treatment
The cellulite is a sworn enemy of woman body. Its elimination is not only an aesthetic caprice, as it
is a real “ILLNESS” to tackle and treat from its first symptoms.
The causes that can lead to the appearance of cellulite are different (they often act together to make it difficult to treat): bad alimentation behaviors, lack of exercise, changes in body weight, bad circulation, ineffective lymphatic drainage, deposit of excess fat, water retention, family genetic predisposition, teen-age overweight, little elastic skin or not healthy skin, stress. The cellulite, which usually appears on feminine body rather than on masculine body, can be of different types:
EDEMATOUS cellulite: it is the first the stage of the cellulite and it is possible to recognize it because the skin, in the critical points, is doughy and when pinching, it presents bumps and it presents the orange peel skin effect. The edematous cellulite is caused by a loss of elasticity of the blood vessels that supply blood to the adipose tissue by causing the liquid stagnation. The cells, that are inflamed, strain blood circulation, by causing firstly swallowing and secondly anti-aesthetic tires.
FIBROUS cellulite: it is the second stage of cellulite. The continuous liquid stagnation makes the adipose tissue suffer and it becomes fibrotic. The skin begins to harden and to become dull. The orange peel effect is evident even without pinching the skin.
SCLEROTIC cellulite: it is the final result of the process of tissue degeneration. At this stage, the hardened nodules are very evident so that the skin looks like a “mattress”. In this third stage, the cellulite cause a considerable suffering to the tissues and the adipose cells increase in number and volume and the fibrous septa that separate them tend to stiffen and to shrink. This makes the nerve endings compress and even just touching the critical points causes pain. To tackle cellulite it is important the use of electrostimulation; indeed, like in an aerobic training, it produces an improvement in the lymphatic drainage and in blood microcirculation, that physiologically are the mechanisms intended to eliminate the excess fat. With the electrostimulation the treatment can be aimed at delimited areas and therefore it has a greater possibility of success.
The treatment must be always used together with other means that we have at our disposal today. Firstly, it is necessary to try to improve the skin health, at least because with healthy skin, cellulite is less evident. Then it is better to eliminate or at least to limit smoke, alcohol and fat assumptions (especially saturated fats of animal origin). Moreover, it will be useful to drink a lot of water poor of sodium, to eat a lot of vegetables and fresh fruits (especially fruits with more water and antioxidants, or with A, C, E vitamins and zinc and selenium).and to massage the areas in order to improve the circulation and the lymphatic drainage and to limit stress.
To sum up: the anti-cellulite strategy must base on five main factors that are diet, exercises, massages, natural integration and electrostimulation.
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The lymphatic drainage
Together with the blood, the lymph represents the means by which the interstitial liquid give and receive nutrients, refusal and regulation substances (hormones) that are needed to maintain the integrity and the cell functionality. Compared with blood, lymph is not pushed by the cardiac activity, but it flows in the vessels because of the muscle action. These tissues, by contracting and relaxing, act like a real pump. When this action does not occur, for example due to immobilization, the lymph tends to stagnate, amassing in the tissues. This is the reason why feet and ankles swallow when standing for a long time in a static position.
The “drainage” concept refers to the starting of the liquid from the area where it has been amassed
towards an outfall point. The lymph drainage supports not only this flow, by moving the liquids in the body, but it also acts to unblock the obstructed channels. It is an effective technique also to prevent and reduce the unaesthetic orange-peel aspect of cellulite. It is indicated in the treatment of pathologies (post-surgical edema, scars), but in this case we suggest that the medical prescription must be specific and personalized. The programs of drainage and lymphatic massage, carried out with the electrostimulator, can be used daily and are indicated especially for those who suffer from limb swelling or show, at the end of the day, a sense of muscle fatigue. Thanks to the rhythmic contractions induced by the electrostimulator (programs that link the stimulation in frequency modulation to the amplitude modulation), the so-called “pump effect” is obtained and it permits a reabsorption both of the water component and of the protein component inside the lymphatic ducts.
Firming/Toning
Some factors, such as sudden loss of weight, pre- and post-cellulite status or pregnancy, often affect in a negative way elasticity and the tone of skin and muscle tissue, making some body parts flabby and less tonic.
The “Firming” programs of our electrostimulators are specific and indicated for this kind of
problem, as they permit to act locally on the muscle tone involved. Muscle tone activities are instead intended to increase the percentage of lean mass and therefore to give more consistence and shape to the muscle tone.
Specific breast cleavage and arm firming treatment
Breast, cleavage and arms are the first areas in the feminine body that show symptoms of muscle relaxation. As for the breast, among the factors that determine its relaxation, reduction and the appearance of stretch marks, it is to mention especially pregnancy and lactation and too drastic and rapid loss of weight and hormone disorders. The only support musculature of the breast consists in the pectoral muscles situated in the area above. The mammary area, therefore, is one of the parts of the feminine body more exposed to the problem of muscle-skin relaxation. The cleavage is instead one of the areas more exposed to the damages of sun exposure; the consequent skin degeneration prematurely arises with the appearance of spots, keratosis and dehydration. As for the internal part of the arms, we can notice how the skin flaws most spread are cellulite, loss of volume, skin relaxation and stretch marks. The electrostimulation can be useful in tackling these problems by using specific firming programs for women daily.
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Specific face treatment
The electrostimulation is effective to recover and maintain the skin elasticity as it reactivates the local circulation bringing new nourishments to the tissues. The microlifting programs, specific for face, need specific electrodes of reduced dimensions in order to involve only the interested musculature
Applications in rehabilitation
After a force immobilization due to a musculoskeletal trauma, it is very important to recover the tone and the muscle trophism. Electrostimulation permits to recover the muscle tone quickly and to drain the liquids stored because of the immobility. Please, bear in mind that the electrostimulation should not completely replace the reeducation sessions made by a physiotherapist, who could decide to carry out also proprioceptive and mobility exercises. The presence of ostheosynthesis devices, such as screws and plates, is not a contraindication in the
use of the electrostimulator as it has been conceived not to damage that devices. Before starting any rehabilitation cycle, we suggest seeking your physician’s advice.
The TENS
The transcutaneous electrostimulation (TENS) is widely used to reduce most of the articular or muscle pains but also to treat pain of endogenous origin as they have little side effects compared with traditional pharmacotherapy and therefore they are considered an important alternative therapy. The TENS consist in the selective stimulation of big fibers of peripheral nerves favoring the closing of the gate for pain receptors and increasing the release of endorphin substances with a consequent considerable reduction of the intensity of different kinds of pain. With the TENS programs of our electrostimulators, therefore, we intend to treat acute and chronic pain due to the main musculoskeletal disorders. The pain decrease following the TENS currents application is connected to these factors: a. Gate control theory b. Endorphin secretion c. Different sedative effects in relation to the frequency
Gate theory
If the electric signals that lead to the brain information about pain are stopped, also the pain perception is eliminated. If, for instance, we hit our head into an object the first thing we do is massaging the area affected by the trauma. In this way, we stimulate the receptors relative to touch and pressure. TENS in continuous mode and in frequency modulation can be used to generate signals similar to the ones of touch and pressure. If their intensity is enough, their priority is so high that it prevails on the pain signals. Once the priority is gained, the gate related to the sensory signals is opened and the pain one is closed, impeding in this way the passage of these signals to the brain.
Endorphin secretion
When a nervous signal proceeds from the pain area to the brain, it spreads through a chain of connections joined together called synapse. The synapse can be seen as the space between the end
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of a nerve and the start of another. When an electric signal reaches the end of a nerve, it produces some substances called neurotransmitters that pass through the synapse and activate the start of the next nerve. This process repeats for all the way needed to the signal to reach the brain. The drugs (opioids) involved in the pain reduction have the task to insinuate in the synapse space and to impede the neurotransmitter propagation. In this way a chemical block of the pain signals occurs. The endorphins are opioids naturally produced by the body to tackle the pain and they can act both on the marrow and on the brain, in this way they are effective analgesics. The Tens can increase the natural production of endorphins and, thereby, they act decreasing the pain perception.
Different effects in relation with the frequency
Depending on the frequency used, it can occur antalgic effects of immediate effect but with no long duration (higher frequencies), or more progressive effects but also longer in time (low frequencies).
The MENS Microcurrents
The microcurrent stimulation is being increasingly used. In USA and other countries such as Japan, Canada etc., the MCR also called MENS is considered one of the more used current in physiotherapy and clinical applications (differing from TENS which, as well known, is particularly indicated for pain relief). A number of studies have demonstrated excellent results in therapy and various protocols and parameters have been defined (protocols and parameters that we have included in our stimulators). For particular pathologies and situations, we suggest referring to your physician. Compared with conventional electrostimulation therapy, which utilizes electrical current at the milliampere (mA) level, microcurrent utilizes a less intense microampere current for therapy (microampere μA). This slight electrical current is below the human threshold of perception and it is not therefore felt by the patient. MENS therapy offers patient the following advantages:
-Safe
-Comfort
-Acute and chronic pain relief
-Accelerated regeneration of damaged tissues and rapid healing of wound, cicatrix, and bone fractures.
-Collagen fiber production, promoting elasticity of the skin
-Total absence of side effects and complications.
Brief history of MENS electrostimulation therapy
The neuromuscular electrostimulation therapy with microcurrent (MENS) was developed approximately 20 years ago. Lynn Wallace treated more than 600 patients with MENS and examined its clinical effects on pain caused by various disorders of the feet, lower limbs, femur, lumbar area, shoulders, elbows, and neck, and found a remarkable sedative effect. According to Wallace, the initial treatment of 15-20 minutes provided some element of pain relief in more than 95% of patients. The extent of pain reduction was an average 55% after the first treatment, 61% after the second treatment, and 77% after the third treatment. The pain was completely disappeared in 82% of patients after less than 10 treatments (four treatments on average).
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Many studies are possible with MENS as its stimulation is not discernible by the patient. Lerner and Kirsch conducted experiments on 40 patients with chronic low back pain in which patients were randomly allocated to a MENS treatment group and a placebo group that was hooked up to dummy MENS units that provided no electrostimulation. Stimulation was conducted three times a week for eight weeks. Results showed pain reduction of an average 75% in the MENS treatment group and only 6% in the placebo group. A number of studies have also found that MENS promotes the healing of wounds and ulcers. Gault and Gatens reported a positive effect of MENS in 106 patients with ischemia skin ulcers. In their study, the group treated with MENS using an intensity of 200 μA - 800 μA current recovered approximately twice as fast as the non-treated control group. It has also been reported by a number of clinicians that the healing of bone fractures is greatly facilitated by low-level electrical current. The above-mentioned results demonstrate that MENS is markedly effective in treating acute and chronic pain, promotes regeneration of damaged tissues, and heals wounds, cicatrix, and bone fractures. (Gault WR, Gatens PF Jr : Use of low intensity direct current in management of ischemic skin ulcers. Phys Ther 56~265, 1976.)
Functional mechanism of the MENS currents, “Injury current” and the MENS functions
The functional mechanism of MENS is complicated and has to be fully analyzed yet. Although a variety of conflicting theories exists, sufficient research findings have been accumulated that the following conclusion seem justified.
Image 3
It has been clear for over a century that an electrical potential of about -5OmV is present in the cell membrane. This potential is known as the resting membrane potential. The outer surface carries a positive charge, while the inner surface has a negative charge [Img.3]. When a cell is damaged, the potential of the injured part becomes negative, and the electric current flows from the normal area to the injured area This phenomenon was accurately measured by Matteucci (1938) and Bois-Reymond (1843), this
current is commonly known as "injury current”. Injury current is generated not only when
individual cells are injured but also when the tissue is damaged. The intensity of the injury current
ranges from 10 μA to 30 μA, as demonstrated by experiments. In other words, injury current is a
microcurrent. Injury current is considered to promote the recovery of damaged cells and tissues in the living body. Stimulation by this current is thought to generate ATP and to synthesize protein for the restoration of damaged tissue. Therefore, it can be affirmed that artificially generated microcurrent would complement and further promote the natural functions of the injury current.
Phases and duration of Mens therapy
MENS therapy is ordinarily executed in the following two phases. Phase 1 is mainly intended to reduce pain, while phase 2 is designed to solve the trauma and to repair the damaged tissue.
Membrane
Nucleus
Damaged part
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Whereas phase 1 offers rapid pain relief, phase 2 promotes ATP production and protein synthesis to accelerate tissue recovery, providing basic healing. These two phases are executed in succession with phase 2 following immediately after phase 1. Treatment duration ranges from 15 to 30 minutes in phase 1 and from 5 to 10 minutes in phase 2 (5 minutes standard). Treatment sessions vary according to the condition being treated. Generally, once a day or once every other day is sufficient. To achieve satisfactory results, the therapy period can vary from 10 to 45 days. Five to ten follow-up sessions are recommended after satisfactory results have been achieved.
Combined use with TENS
MENS and TENS may be combined for therapy. This combination can produce great effects in cases of acute pain or symptoms of muscle stiffness.
IONOPHORESIS
The ionophoresis is a therapeutic technique that uses the continuous electric current that permits the displacement of charged particles through the tissues. If the charged particles are medicines, then the continuous current acts as a vector permitting the introduction and the penetration of medical substances. It has been shown that by means of the continuous current, there can be a ion migration that, according to the polarity law (negative ions that migrate towards the positive pole and vice versa), enter in the flow of current by penetrating the organism through the sebaceous ad sweat ducts and the hair channels. The application fields of ionophoresis are all the treatments that act positively on local inflammatory states.
IONOPHORESIS medications
Before performing ionophoresis, always consult your physician. Read the instructions provided with the medications prior to use. Before carrying out any treatment, consult with your physician or physical therapist to choice an appropriate medication and identify the correct polarity. DO NOT APPLY THE MEDICATION DIRECTLY TO THE SKIN. Apply the medication to the absorbent surface of the electrode corresponding to the medication's polarity; the absorbent surface of the other electrode should be dampened with slightly salted water, to promote circulation.
Preventive measures
If the treatment is not performed correctly or the intensity is too high, ionophoresis may cause skin irritation and burns. The recommended current density for an electrode is 0.2 mA/cm2. The skin must be free of lesions and injuries; do not shave the skin before treatment because razors may cause microcuts. Ionophoresis should not be used on persons with metallic implants or in contact with metallic items, e.g. tables and chairs.
Currents for denervated or partially denervated muscles
The stimulation of a denervated muscle differs from the one of a healthy muscle for the fact that the activation of muscular fibers needs particular currents.
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In presence of a traumatic lesion of the peripheral nerves, the measure of the chronaxy fosters to establish whether the denervation is insufficient, partial or total. The aim of an excitomotor treatment is the preservation of the trophism and the limitation of the muscular sclerosis in order to foster the muscle to be as functional as possible by the end of the reinnervation process that can sometimes last some months. The effectiveness of this type of treatment depends on the correct setting of the stimulation parameters; these must be defined in a specific way for every patient and must evolve with time. In the programs for denervated muscles three types of currents are mainly used.
Rectangular currents
The rectangular current is characterized by single rectangular impulses, than varies quickly from the null value to the maximum value of the set up intensity. The duration of the impulse causes a selective contraction of the denervated fibers and the null medium value of the impulses (alternated polarity) avoids whichever phenomenon of ionization of the dermis. The rectangular impulses are mainly use on totally denervated muscles.
Triangular currents
The triangular current reaches the maximum value of the set intensity through a linear ramp up, bound together to impulses of pretty long duration, it determines a valid contractile answer of denervated fibers (controlled by damaged nerves) without stimulating the adjacent and normally innervate ones (healthy ones). Naturally, being this stimulating current (the triangular impulse) in charge of the contraction of denervated fibers, it will be followed by a period of pause in which the current has a null value. The polarity of the impulses is alternated in order to avoid the phenomenon of ionization of the dermis. Because of the adaptation ability of the nervous fibers to the slow increase of intensity of the stimulus and the absence of annoyances to the patient, the triangular current is used to stimulate totally and partially denervated muscles. The selective stimulation of fibers happens without involving the already normal innervated fibers, a problematic sometimes found with the alternated rectangular one because of the fast rise of the impulse.
Trapezoidal current
Trapezoidal impulses are mainly used on partially denervated muscles.
I
T
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Stimulation time
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Interferential currents
The interferential current is a sinusoidal current alternated to medium frequencies (2500 Hz, 4000 Hz, or 10000 Hz), modulated in amplitude, characterized by a high ability to penetrate tissues and by an optimal tolerability, even in particularly sensitive patients. The analgesic action of bipolar interferential currents, with frequency of modulation included between 0 and 200 Hz, is connected to the mechanism of the gate control (peripheral block of the pain transmission) and to the stimulation of the inhibitory mechanism. Furthermore, also the removal of the substances that cause pain of the affected region is involved, as it happens for TENS current. By varying the frequency of employed modulation, also an effect of motor stimulation can be exploited, that contributes to the
return of the venous flow activating the “muscle pump”. They are called interferential currents
because they originate and interfere with the tissues in points in which two intermediate frequency currents meet.
Clinical Applications
The interferential current is particularly indicated for arthrosis of the deep articulations (hip, lumbar rachides), deep tendinopathies and for the muscular hypotrophy of normally innervated and deep muscles. The interferential current is basically used in physiotherapy for antalgic and excitomotor aims.
Therapeutic effects
Excitomotor effect: it may provokes the contraction of normally innervated and deep muscles. Analgesia: it could provoke vasodilatation, which, through the increase of the local blood flow, would remove the algogenic substances from the tissues. The guide lines for the applications of the electrodes are identical to those supplied for the TENS.
Russian currents (kotz)
Russian currents consist of a sine wave of intermediate frequency (2500 Hz), modulated in packages of work and rest each of 10 ms duration. To avoid early muscle fatigue, occurring after about 12/15 s of continuous stimulation, Kotz established that the maximum duration of the working phase should be of 10 seconds (with a duty cycle of 1:5). Like other currents of intermediate frequency, Russian currents programs facilitate penetration into deeper muscles and may be preferred to low frequency currents (e.g. rectangular biphasic and faradic).
Electrode application and placement
Electrodes for Russian currents are applied in the same manner as for EMS and TENS treatments. The current should be increased gradually until it provokes muscle contraction.
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Clinical applications
Muscular electrostimulation with Russian currents is mainly indicated for treatment of muscular hypertrophy, for increasing muscle mass programs and to treat idiopathic scoliosis. Compared to other low frequency excitomotor programs (e.g. rectangular biphasic and faradic), Russian currents programs offer better muscle recruitment and a deep action, since the skin offers less resistance to these frequencies. The disadvantage of these programs is that it is difficult to stimulate selected muscle fibers with the biphasic rectangular current, instead this is possible with lower frequencies.
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PROGRAM DESCRIPTION
In this chapter we offer a brief description of the main programs in our electrostimulators. NOTE. The program list is different for every model. To verify the programs in your
electrostimulators please refer to the user manual or to the device.
PROGRAM LIST“SPORT”
Capillarization
Program effects
Indications for use
Time and intensity
It increases the blood flow to the muscle and improves endurance and recovery abilities. This increase allows the primary and secondary capillary network to be active in order to improve the oxygenation system of the tissues, reducing fatigue during a quite intense work.
Capillarization programs are especially recommended during the first weeks of physical preparation. For sports requiring resistance and endurance strength, the program can be used during the whole season.
1 PHASE: 20' Recommended intensity: intermediate Electrode placement: 1-2-3-4­5-6-7-9-10-11-12-21-22-23­24-25-26-45-46
Warm-up
Program effects
Indications for use
Time and intensity
It increases muscle temperature to best prepare for training. It increases the blood flow and the muscle metabolism by producing the best physiological conditions to face the effort.
Recommended before a physical training. Use before executing SPECIAL SPORTS.
1 PHASE: 10' Recommended intensity: intermediate Electrode placement: 1-2-3-4­5-6-7-9-10-11-21-23-28-31
Pre-competition warm-up
Program effects
Indications for use
Time and intensity
It increases muscle temperature to best prepare for competition. It increases the blood flow and the muscle metabolism.
Use some minutes before competition on the muscles most involved in the sport activity. Especially useful in all sports that need an intense effort already from the first minutes. It does not replace the usual active warm-up of the athlete.
1 PHASE: 20' Recommended intensity: intermediate Electrode placement: 1-2-3-4­5-6-7-9-10-11-21-23-28-31
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