Question: I had polio in May 1951 at the age of eleven months. I used long leg braces and crutches to ambulate. I started experiencing fatigue and muscle pain in my shoulders and lower back when I was about 50 years old. I started using a scooter occasionally and gradually transitioned to a power wheelchair full-time when I started having frequent falls when using my braces and crutches. I have a close friend who is an internal medicine doctor. She strongly recommends that I start using e-stim on my legs. She believes that I need to do this to get the physiological benefit of muscle contractions. I recently talked with a physical therapist who doubted that e-stim would be beneficial. I respect my physician friend very much and want to let her know that I have asked
physicians with experience in treating polio survivors about her recommendation. Thank you for sharing your thoughts on this matter.
Answer:
Marny Eulberg, MD: Electrical stimulation (e-stim) can get the muscle to contract because it basically does what the missing motor nerves would normally do by telling the muscle to contract. That
can help with circulation while the e-stim is doing its thing. However, e-stim will only enable the muscle to work better when you are hooked up to it. Since e-stim is usually first used in the physical therapist’s office, it obviously will only have an effect on the muscle(s) during the 20-60 minutes it is being applied. I think you can get e-stim units to use at home, but again, it is unlikely that you will want to sit or lie in one place while the electrodes are on for more than an hour or so a day. It is uncertain how much benefit you would get from something that only has an effect for a small portion of the day.
Most polio survivors and many physicians think of polio as being a problem with the muscle and don’t recognize that the reason the muscle is weak and/or atrophied is that the poliovirus killed or sickened the motor nerve coming out of the spinal cord and going to the involved muscle(s). Unless some way is found to restore that electrical connection, the
muscle is not going to contract and be useful when you want it to work for you.
I have to admit that I am biased because I personally find any kind of electrical stimulation very unpleasant. I had more than enough encounters with an “electric fence” when I was growing up on a farm, and any form of electrical stimulation reminds me of those uncomfortable experiences.
Frederick Maynard, MD: I agree with Dr. Eulberg’s comments and do not know of any benefits that are likely to result from using e-stim on your leg muscles. In fact, I think it unlikely that e-stim would result in a stronger contraction in your severely weakened muscles than you can obtain by your own voluntary efforts (assuming you can still initiate a weak but non-functional movement when you try to contract the involved muscles). When muscles suddenly lose their nerve supply, e-stim will cause the denervated muscle to contract; but when a muscle atrophies from chronic denervation (loss of its nerve supply), there is no longer muscle tissue to contract. This latter case is what one expects in an older polio survivor with a gradual and progressive loss of
strength in involved muscles.
Please reassure your friend, the internist, that you are regularly using your body’s muscles that still work, up to their safe limits of strength, endurance
and useful function, to give you the general “physiologic benefit of muscle contractions.”
Post-Polio Health (Vol. 39, No. 4, Fall 2013)