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TENS Unit Electrode Placement Guide

tens unit placement guide

Transcutaneous Electric Stimulators provide a path towards pain relief for some individuals. TENS units can decrease reliance on NSAIDs or other pain medicines people use to quash muscular and joint discomfort.

You may be thinking “Transcutaneous what?!” Put simply, TENS Units are relatively small, lightweight battery packs with attached electrodes that conduct gentle electric impulses through your skin to potentially help relieve pain and discomfort.

They can be purchased over the counter at a fraction of the cost of what continual trips to a physical therapist or chiropractor might cost you. TENS units can be used at home or discreetly in other locations like your office or while riding a commuter train. As such, they might give individuals dealing with pain an additional non-pharmaceutical, non-appointment based way to promote healing, health, and happiness.

Lots of people appreciate both the convenience and the results associated with using TENS units. However, they don’t work for everyone. For some individuals, introducing electric current, even extremely mild voltage, to one’s system can be detrimental. Indeed, individuals with electric medical devices like pacemakers or insulin pumps should avoid them.

Some medical conditions like certain cancers, heart problems, and epilepsy, for example, might contraindicate the use of a TENS unit. However, if a medical professional or doctor determines that TENS might be part of your pain management path, you might want to give it a try.

Before you decide to independently use a TENS unit, or if your chiropractor or physical therapist has used one on you already, it’s useful to understand how TENS units are designed to work. That way if you want to purchase one, you can choose and use one with confidence.

TENS Unit Basics

There are three parts of a TENS unit: the battery pack, the wires, and the unassuming (but mighty) sticky pads. The adhesive pads are electrodes that you place around a painful body part to create a field of healing electric energy. When the pads are in place and the pack is turned on, it starts delivering a mild impulse through your skin to the area between the electrodes.

The mild current, which is felt by most users as tingling, is thought to disrupt nerve patterns that cause pain. As a result, some users report relief while using the unit. Other users claim the pain-relief lasts longer. It’s theorized that the subcutaneous electric stimulation helps the body release endorphins that continue to circulate after the TENS unit is turned off. Circulating endorphins might help continue to mitigate pain.

Discuss with a medical professional how long and how often TENS Unit use might benefit you. Times and frequencies will vary according to what’s causing the offending pain and the individual’s response to subcutaneous electric stimulation. The ability to individualize use is a big benefit of TENS. The freedom to be able to use a unit alone on demand is potentially priceless.                                                                                                               

When You Open the Box…

Don’t be intimidated by the jumble of wires (leads) and voltage switches when you come face-to-face with a TENS Unit. Rest assured, despite the warnings and the suggestion that you get medical clearance before plugging in, TENS units are fairly easy to use if you understand some fundamentals.

Note the Pads

It is important to note, first, that the electrodes that come with a TENS unit are replaceable. This is good, because the adhesiveness of the pads eventually wears away with use. Plus, the more you use a TENS unit, it’s likely you’ll want different pads for different body parts.

The good news is that replacement pads come in many different shapes and sizes. If the starter pack included in your TENS unit does not have the shape you need, poke around a little. You are sure to find electrode pads in all shapes and sizes available for purchase from small squares, rectangles, and long strips to butterfly-shaped, ovals and circles.

Most users tolerate the adhesive pads well. But, if you end up having an allergic reaction to either the pad or the adhesive on the pad, don’t fret. There are several non-allergenic options out there when it comes to pads.

Pay Attention to Placement

There are few hard-fast rules regarding the placement of electrodes. But, for your safety, always keep these Eight Fundamentals in mind:

  1. Before starting, make sure your body is dry to avoid unintended shock. Never use the unit while in a tub or in water.
  2. To ensure pads stick, it is best to remove any lotion or oil from the site you are going to treat.
  3. If you experience burning or skin irritation, stop.
  4. Focus on addressing just one painful muscle or joint at a time. Explore the various ways you might place electrodes to encompass that area.
  5. Always use an even number of electrodes. Units usually come with at least two pads (two wires), though many come with four (plus four-wire channels). You always need to use an even number of pads in order to create a field.
  6. Avoid placing pads on your eyes, mouth, temples, front of your neck, and on wet body parts.
  7. Don’t place pads on both the front of your chest and your back at the same time. That positioning mimics a defibrillator and could harm your heart
  8. Place pads at least one inch apart. You might think that setting the pads close together will focus the current and be more effective. However, that’s not so. The electrodes provide better stimulation if they are placed further apart.

That’s about it when it comes to hard-and-fast rules when using a TENS unit. Otherwise, when placing the electrodes on your skin, you should seek to encompass the area giving you grief by determining where you hurt and placing the pads on either side of the pain.

Pads can be oriented horizontally, vertically, or at an angle. If it isn’t positioned quite right, try again. There is an element of exploration and experimentation when it comes to TENS.

You might want to avoid placing the pads directly on a joint. It’s not a matter of danger. It’s just that the pads tend not to stick well on joints. You’ll get better adhesion, and thus consistent electric impulse delivery, if you avoid joints and place pads on soft tissue.

TENS Unit Pad Placement for Common Pain Sites

Upper Back Pain: For pain on one side of your upper back, you can place a pad right on the pain (not on the spine, but on soft tissue) and one at least an inch away. You might want to move the second pad around to determine where you find the most relief. If you can’t reach the spot, ask someone for help.

You can also try moving off of the spot itself and sandwiching the troubled spot between electrodes. The same principle applies if you have four pads available.

Lower Back Pain : Use the same experimental approach to find relief for lower back pain that you would for upper back pain. Place two electrodes, small to large, on each side of the lower spine where pain is originating.

If you have four electrodes, place one pair on either side of your spine slightly above the focus area. Place the other pair of pads at least an inch below those two. Strip-shaped pads can come in handy for back pain. Try attaching long pads along the length of either side of your spine vertically.                                      

Sciatica: Sciatic pain manifests in the low back. You have some choices when it comes to pad placement to try. Start with an equal number of pads on either side of the spine near the low-to-mid back. Depending on your frame, you might be able to use larger pads on your back. You can also try placing two electrodes on your lower back with the other two below your buttock on the same side.

If you have four pads, try similar configurations with two pads on top and two below on one side or one on each side of your spine. You can even try placing one on each side of the spine and two more on the troubled side. There are many ways to place pads back there that can be effective. If one configuration fails to hit the mark, try again.

Knee Pain: Knee pain often subsides when electrodes are placed on the front of the leg surrounding the knee joint. Try putting two pads above your knee on the low part of your thigh and two electrodes just below your knee. Or, try circling the knee with pads.

Since leg size can vary and you might be working with a small parcel of real estate at the top of the shin below your knee, make sure the electrodes are spaced at least an inch apart before turning on the current.

Carpal Tunnel: This is one area of the body where it helps to sandwich the pain front to back. Place one electrode of a pair on your palm and another below on the inner part of your wrist/forearm. Flip your hand over and place an electrode on the back of your hand with the other one on the top of your forearm, opposite the one on your inner forearm. Small pads work well for this configuration.

Neck/Cervical Back: While it’s not advised to place electrodes on the front or side of your neck, it’s ok to attach them to the back of your neck to address cervical back pain. Remember to keep one inch between all electrodes at a minimum. Place two small electrodes below the nape of your neck. Place another pair at least an inch below the first pair.   

what is a TENS unit

The Bottom Line

TENS units can provide options and increased freedom for many people dealing with muscular and joint pain. Whether it’s self-administered or performed by a medical provider, transcutaneous electrical stimulation is a promising way to address muscular and joint pain throughout the body.

If you seek more information and are cleared by a medical professional to try TENS, there are additional videos and charts available on-line that can help you learn to optimize your own unit. Feel the freedom to experiment with pad placement,  size and shape. Figure out what level of electrical impulse feels good where. Explore.

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