As we all know, chiropractic is intended to help facilitate the natural healing processes of the body. But when patients are in acute pain, even a simple chiropractic adjustment can become more challenging. One very effective adjunctive therapy that can provide temporary relief of pain is TENS therapy, which is short for transcutaneous electrical nerve stimulation. TENS is a natural way to deal with acute pain symptoms to start treatment.

Electrical muscle stimulation and electrical neural stimulation are two common forms of electrical therapy. The various forms of muscle stimulation are designed to cause muscle contraction for purposes of preventing or stopping disuse atrophy, re-educating muscle function, reducing spasms, and strengthening muscles.

TENS, on the other hand, stimulates the sensory nerves to reduce pain symptoms. The concept behind TENS is relatively simple. When someone experiences pain, the sensory nerves are being bombarded with stimulation. Fortunately for us, the nerves need to send impulses ultimately to the cortex of the brain for the cycle to be completed and for the person to perceive pain.

TENS reduces the perception of pain in two ways. One, it acts by introducing another form of stimulation, through electrical impulses. Those impulses act as a distraction, and, because the nerves are in sensory overload, the patient’s pain goes away temporarily. It functions on the same principles as described in the gait control theory of pain management. The second way that TENS works is by causing the body to produce endorphins and enkephalins, which are natural pain-relieving chemicals produced by the body. They act in different areas of the brain in response to painful stimuli.

It is important to explain to the patient that the relief is not permanent in nature, and symptoms will likely return upon completion of a session of TENS therapy. However, this momentary decrease in pain symptoms allows you to adjust the patient without the need for medication.

In the world of managed care that we live in, justification for the use of TENS therapy is not difficult. It can be a great adjunct to the ASR concept—adjust, support, and rehab—which easily follows treatment schedules that are directed by patient results. TENS is most effective as part of the adjustment phase for patients with acute pain. Minor pain does not require the use of TENS, because an adjustment can still be made without causing more pain for the patient. TENS helps facilitate the ASR concept, but it does not stimulate healing. It is simply a method used to facilitate the adjustment of a patient who has a great deal of pain. It is a passive therapy, and it should be treated accordingly as part of a larger course of treatment.

The Adjustment Phase
The adjustment phase is the first step for many patients on their road to recovery. It may be their first introduction to chiropractic as a whole. It would not help the patients’ perceptions of chiropractic if their first few adjustments were painful. That is why using TENS therapy is a great adjunct to use for a new patient in acute pain.

It is imperative that we do all we can as chiropractors to give our patients the best conditions to encourage healing. Chiropractic is a health care discipline that is centered on finding and eliminating the true cause of a patient’s problem.

The Support Phase
The support phase of the ASR concept is the next logical step in helping a patient heal. Chiropractic views the body as a structural entity of connected parts. That is why it is so important to ensure that your patients have the proper support to maintain their adjustments. Engineering is a science that tells us that the structure of a mass in weight-bearing position dictates its function, whether you are talking about a building, a bridge, or the human body. These principles are of extreme importance when you consider the dynamic nature of the human body and the small contact point it has with the world—the foot.

The human foot is designed to have three arches that absorb shock, distribute weight, and allow proper movement throughout the gait cycle. If these arches are not properly supported, detrimental effects can be seen throughout the kinetic chain. These effects can undermine chiropractic treatment by placing unnecessary stresses and postural imbalances on the knees, ankles, pelvis, and spine.

The Rehab Phase
Rehabilitation is the final phase of the ASR concept. This phase often includes continued spinal adjustments and exercises designed to strengthen the patient. When giving patients an exercise routine to use at their home, it is best to provide them with equipment that is similar to what they are using in your office. Patients are much more likely to comply with your recommendations about exercise if they are already familiar with the types of exercises and the equipment they will have to use at home. Although no rehabilitation program should cause pain, it is not uncommon for patients to experience some discomfort following therapeutic exercise. TENS can help to reduce this postrehab discomfort.

The TENS method of pain management can become a crucial part of the chiropractic practice for you. It is not necessary for everyone who comes into your office, but it is very helpful to those in acute pain prior to or following treatment or rehabilitative exercise.

Mark N. Charrette, DC, is a 1980 summa cum laude graduate of Palmer College of Chiropractic. He has lectured extensively on spinal and extremity adjusting throughout the United States, Europe, the Far East, and Australia. Charrette received a bachelor’s degree from Illinois State University (summa cum laude) in 1976, where he was an NCAA All-American in 1974.

For an article on interferential therapy, visit our Web site at www.chiropub.com/article.php?s=CHR/2006/01&p=10 .