Use sEMG for visual confirmation of your diagnosis and progress of the treatment

Diagnosis was little more than a guessing game before the advent of X-rays, magnetic resonance imaging (MRI), and computerized axial tomography (CAT) scans. These technologies enable us to pinpoint the problem and treat the patient before it is too late or irreparable damage is done—sometimes we can even treat them before they start having symptoms. Surface electromyography (sEMG) is a technology that I find effective, efficient, and reliable in caring for my patients.

SEMG is a device that indirectly measures muscle tension or force generated during movement by measuring the amount of electrical activity in muscles. Similar to an electrocardiogram (EKG), the device has sensors or electrodes that are placed on the skin surface to conduct these measurements. The procedure is painless, convenient, and quick.

The Learning Process
As with any diagnostic equipment, education and care must be taken. Just as you do not plug a computer in and start using it right away before leaning how to operate it, the same goes for sEMG equipment. And, as with a computer, once you learn to handle it properly, you will wonder how you ever got along without it. SEMG can help in your practice in these ways:

• Serves as an adjunct component to your overall clinical exam; sEMG is not a stand-alone tool.
• Offers a painless tool for measuring muscle tension. Unlike the needle EMG, sEMG is non-invasive.
• Provides information about groups of muscles working together.
• Visually illustrates the areas that need treatment.
• Illustrates the results of the treatment and tracks the progress of adjustments.

And, as with any new technological product, there are reports of difficulties, just as there are reports that praise its benefits. It is your job, as a medical professional to study and weigh the reports to ultimately determine the tools that best fit your practice. Through personal experience and research, I have learned some important aspects about sEMG.

The Pullman study¹ of the clinical utility found that “sEMG is considered an acceptable tool for kinesiologic analysis of movement disorders; differentiating types of tremors, myoclonus, and dystonia; evaluating gait and posture disturbances; and evaluating psychophysical measures of reaction and movement time.”

There have been studies to determine and corroborate the reliability of sEMG; the results show that when used correctly, sEMG exhibits very good to excellent test-retest reliability.

The caveat is “when used correctly.” Preparation is necessary for most medical testing, and sEMG is no different. It is important to take advantage of the training offered with your equipment. In most cases, you received some training and/or coursework in sEMG while attending college, but you also need to attend any seminars or workshops offered by the equipment manufacturer. If the manufacturer does not offer this service, save your money. You will only be disappointed, frustrated, and upset with the technology. Do not make the mistake of blaming manufacturing or instructional inadequacies on the technology. As with any product and service, there is a wide range of qualities—do your homework before making this investment.

The most important factors to ensure reliability in the sEMG reading are to properly prepare the room and the patient. Make certain that the patient has time to adjust to the room temperature. Special care should be taken in climates or during seasons with large variations in temperature. To prepare the patient, be sure that the area of skin where the electrodes are attached is clean and free of oil.

Visual Validation
Ultimately, this technology can enhance your practice and strengthen the impact of your diagnosis and treatment. For example, on some equipment, the dynamic sEMG scan tracks up to four channels of muscle activity while the patient goes through various ranges-of-motion. The static sEMG scan charts deviations of paraspinal tension and muscle tone. The comparison of the results versus a normal scan is then indicated on a color-coded segmental analysis graph, making it easy to see any muscle asymmetries. The scanner assesses autonomic function by measuring skin temperature differentials (thus the reason for special attention and care with room temperature).

With this tool, I have visual confirmation of my diagnosis to educate my patients with these reports. And, as an added benefit, the sEMG measures the progress of chiropractic care to show patients exactly what effect my treatment has on their system.

The resultant scans are then available to patients as visual corroboration of your analysis. Your patients can see exactly where the areas of concern are located. They also receive a hard copy of personal data along with educational information about their specific diagnosis. They can chart their progress with visual data that affirms the physical outcome of their treatment.

This technology offers another positive benefit to your practice. As word spreads of this objective diagnostic tool, many DCs are reporting that they have had more success in retaining their current patient base because patients can now view, review, and validate the positive results of their treatment. Since my ultimate goal is to educate my patients and offer preventative health care, the sEMG takes the focus of my care from treating symptoms to chiropractic health care that leads to overall wellness.

It is prudent for all of us to remember that change and the introduction of new technologies are not absolutes. They are best approached with knowledge and forethought—not so much deliberation to prevent you from making that first step, but enough to give you the ability to make an informed decision. When the decision to change or add new technology will affect your practice and the well-being of your patients, you must make an educated choice.

Without change and the acceptance of technology, we would be living without modern conveniences such as electricity and heat, and our medical practice might still include such innovative techniques, such as bloodletting and surgery without anesthesia.

Use the technologies that exist to better treat your patients, and investigate new technologies and techniques to determine what fits with your practice and chiropractic philosophy. With wise choices and an eye on your ultimate goal, change and technology can work to benefit both you and your patients.

Mark N. Charrette, DC, writes and lectures on a wide scope of chiropractic topics. He has taught more than 140 seminars during the past 15 years. Charrette currently practices in Las Vegas. He can be reached via email: mndc@aol.com.

Reference
1. Pullman SL, Goodin DS, Marquinez AI, Tabbal S, Rubin M. Clinical utility of surface EMG. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. 2000; 55;171–177.