Clinically reviewed by Dr. Zahra Fatima, DPT TREATMENT TECHNIQUES
TENS Therapy
TENS therapy explained in plain words: how the pain gate works, what a session feels like, buying a home unit, and when TENS must not be used.
Al-Shama Physiotherapy Clinic · Khanpur · English & Urdu
What is tens therapy?
TENS stands for transcutaneous electrical nerve stimulation. It is a small battery unit with wires running to sticky pads placed on the skin near the painful area. It sends a mild current that you feel as tingling or buzzing.
What it does is the part people get wrong. TENS does not treat the cause. A disc or a worn joint is the same after a session as before. What changes is how much pain reaches you while it is on, and for a while after.
The reason is the pain gate. Nerves carrying touch and tingling reach the spinal cord faster than nerves carrying ache, and when the cord is busy with tingling, less pain gets through. It is why rubbing a knock helps, and TENS does it more strongly and for longer.
What it can help with
- Nerve pain, including sciatica and nerve pain down the arm, where it is one of the more useful options
- Low back and neck pain, particularly when pain is stopping you sleeping or moving
- Knee and hip osteoarthritis pain, used before a walk or an exercise session
- Pain after an injury, once the skin is intact and a serious injury has been ruled out
- Pain where you want to rely less on painkillers, since TENS does not affect the stomach, kidneys or liver
- Muscle pain and spasm, where an hour or two of comfort makes gentle movement possible
- Some people get good relief, some get none at all, and you usually know within a week or two
What happens in a session
The first time, it is set up with you rather than handed over. Dr. Zahra checks the skin, then places two or four pads around or either side of the painful area, not on bony points and not on broken skin. For nerve pain down a leg, the pads follow the path of the pain.
The intensity is turned up slowly while you describe what you feel. The target is a strong but comfortable tingling, never pain and never a hard clench. If the feeling fades after a few minutes, which it does, turn it up slightly.
A session runs thirty to sixty minutes and you can sit, read or move around with it on. Nothing dramatic happens: the tingling continues and the ache becomes less noticeable.
At the end the skin is checked, and you are shown where the pads go, which settings suit you and how often to use it, so you can do it at home.
Does it hurt?
No. It should feel like comfortable tingling, buzzing or light tapping. The right intensity is strong enough to feel clearly and still easy to sit with. More is not better. If it stings sharply under one pad, burns, or makes the muscle clench painfully, turn it down.
Mild pinkness under the pads afterwards is normal and fades within an hour. Slight itching from the pad gel is common, and is usually solved by cleaning the skin first and moving the pads a centimetre or two next time.
Not normal: a blister, a red patch lasting into the next day, a rash spreading beyond the pad, or pain that is worse after using it. Stop and have it looked at.
Who should avoid it
TENS is one of the safest things in physiotherapy, but a few of these limits are absolute.
- A pacemaker or implanted defibrillator. TENS is not used unless your cardiologist has specifically agreed
- Pregnancy. Pads are not placed on the abdomen, lower back or pelvis
- Never on the front of the neck, over the eyes, across the head, or with one pad on the chest and one on the back, which sends current across the heart
- Broken, infected or inflamed skin, and numb areas, which cannot warn you that the current is too strong
- Over a known or suspected tumour, or any undiagnosed lump
- Over a swollen painful calf, or a known clot in a vein
- Epilepsy, which should be discussed with your doctor first, and anyone who cannot understand or control the unit. Never while driving or sleeping
How many sessions?
TENS is not really a course of appointments. One or two sessions are enough to find the pad placement and settings that suit you and to check you can use the unit safely. After that it is yours.
At home it can be used two or three times a day, thirty to sixty minutes at a time. Relief typically lasts from switching on to a few hours afterwards, and it works best used before the thing that hurts, such as a walk or your exercises.
Give it a fair trial of one to two weeks of proper use. If it does nothing in that time it will not start working later. A unit bought without anybody showing you where the pads go is the commonest reason people say TENS did not help.
Urdu
TENS ek chhoti battery wali machine hai. Iske pads jild par dard wali jagah ke qareeb lagte hain aur halka current chalta hai, jo jhunjhuni mehsoos hota hai.
Ye dard ki wajah theek nahi karti, sirf dard ka ehsas kam karti hai jab tak chal rahi ho aur kuch der baad tak. Jaise chot lagne par jagah malne se dard kam lagta hai, TENS wohi kaam zyada der tak karti hai.
Current itna rakhen ke saaf mehsoos ho lekin takleef na de. Zyada tez karne se faida nahi barhta, jild jal sakti hai.
Gale ke agle hisse, sir, aankhon ke qareeb, seene ke aage peeche, hamla hone par pet aur kamar, aur sun jild par pads nahi lagte. Pacemaker ho to TENS bilkul nahi.
Questions people ask
Does TENS cure the problem?
No, and it is not meant to. TENS reduces how much pain you feel while it is on and for a while after. The cause, whether that is a disc, a worn joint or a tendon, needs assessment, hands-on treatment and exercise. TENS is a way of coping better while that work is being done.
Should I buy my own TENS machine?
If it helps you, yes. Basic units are inexpensive and widely available, and using one at home is better than paying a clinic for the same current. Get shown the pad placement and the settings for your particular problem first, because that is what decides whether it works.
How long and how often can I use TENS?
Thirty to sixty minutes at a time, two or three times a day, is a reasonable pattern, and more is allowed if you need it. Move the pads slightly each time to avoid skin irritation. Do not use it while driving or sleeping, and take it off if the skin is red.
Can I use TENS with a pacemaker?
Not unless your cardiologist has specifically agreed to it. The current can interfere with the device. The same applies to an implanted defibrillator. Tell Dr. Zahra before anything is tried, and heat, manual therapy and exercise will be used instead.
Why did TENS stop working after a few minutes?
Your nerves get used to a steady signal, which is normal. Turning the intensity up slightly, or using a unit that varies the setting, usually solves it. If the relief is getting shorter over weeks rather than minutes, it is worth reviewing the whole plan rather than the machine.
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