Review Article

Effect of High-Tone External Muscle Stimulation (High-Tone Therapy) in Neuro-Musculoskeletal Disorders: A Narrative Review


High-tone external muscle stimulation (HTEMS) or high-tone therapy is a new type of electrotherapy. Unlike the conventional electrotherapy that uses a fixed frequency, in HTEMS, the frequency and amplitude are simultaneously modulated, delivering much higher energy into the tissues. Recently, considerable attention has been paid to applying high-tone therapy in managing different disorders. This systematic study, therefore, was set out to assess the effect of high-tone therapy in various neuro-musculoskeletal disorders. After an exclusive search in databases of PubMed, Scopus, and Google Scholar, seven relevant studies were selected, including 3 studies for low back pain, 2 studies for peripheral neuropathy, 1 study in multiple sclerosis patients, and 1 preprint study on the subjects with anterior cruciate ligament reconstruction. PEDro (the physiotherapy evidence database) scale was used to assess the quality of the included articles. Although the studies reported that high-tone therapy significantly improved signs and symptoms, the low number and poor methodological quality of included studies do not allow determining certain effectiveness of HTEMS, and it could be an important reason for performing more research in the future.

1. Zeng C, Yang T, Deng Z-h, Yang Y, Zhang Y, Lei G-h. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis and cartilage. 2015;23(2):189-202.
2. Negm A, Lorbergs A, Macintyre N. Efficacy of low frequency pulsed subsensory threshold electrical stimulation vs placebo on pain and physical function in people with knee osteoarthritis: systematic review with meta-analysis. Osteoarthritis and cartilage. 2013;21(9):1281-9.
3. Khadilkar A, Milne S, Brosseau L, Wells G, Tugwell P, Robinson V, et al. Transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a systematic review. Spine. 2005;30(23):2657-66.
4. Maher CG. Effective physical treatment for chronic low back pain. Orthopedic Clinics. 2004;35(1):57-64.
5. Robertson V, Ward A, Low J, Reed A, MCSP D. Electrotherapy explained: principles and practice: Elsevier Health Sciences; 2006.
6. Melzack R, Wall PD. The challenge of pain: Penguin London; 1988.
7. Howlett OA, Lannin NA, Ada L, McKinstry C. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis. Archives of physical medicine and rehabilitation. 2015;96(5):934-43.
8. Fuentes JP, Armijo Olivo S, Magee DJ, Gross DP. Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Physical therapy. 2010;90(9):1219-38.
9. Jung B-O, Bang H-S. Effect of russian current stimulation on muscular performance and muscle activity of quadriceps femoris muscle of convalescent patient after leg fracture. Journal of Digital Convergence. 2014;12(7):365-70.
10. Vaz MA, Aragão FA, Boschi ÉS, Fortuna R, Melo MdO. Effects of Russian current and low-frequency pulsed current on discomfort level and current amplitude at 10% maximal knee extensor torque. Physiotherapy theory and practice. 2012;28(8):617-23.
11. Ward AR, Shkuratova N. Russian electrical stimulation: the early experiments. Physical therapy. 2002;82(10):1019-30.
12. Nowakowska I, Szymanska J, Witkos J, Wodarska M, Kucharzewski M, Dembkowski M. The influence of high tone power therapy on the peripheral microcirculation in the lower limbs. Physiotherapy Quarterly. 2009;17(4):10.
13. Strempska B, Bilinska M, Weyde W, Koszewicz M, Madziarska K, Golebiowski T, et al. The effect of high-tone external muscle stimulation on symptoms and electrophysiological parameters of uremic peripheral neuropathy. Clin Nephrol. 2013;79(Suppl 1):S24-7.
14. Darwish Mohamed E. High-tone external muscle stimulation (HTEMS) for radicular leg pain compared to transcutaneous electrical nerve stimulation (TENS) 2017.
15. Kempf K, Röhling M, Darwish E, Martin S, Jander S, Herdmann J, et al. High-Tone External Muscle Stimulation for the Treatment of Chronic Sciatica–A Randomized Controlled Crossover Trial. The Open Pain Journal. 2018;11(1).
16. Kempf K, Martin S. High-frequency external muscle stimulation in the relief of symptomatic diabetic neuropathy. Diabetes Stoffw Herz. 2010;19:3-9.
17. Bhogal SK, Teasell RW, Foley NC, Speechley MR. The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature. Journal of clinical epidemiology. 2005;58(7):668-73.
18. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy. 2009;55(2):129-33.
19. Yamato TP, Maher C, Koes B, Moseley A. The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials. Journal of clinical epidemiology. 2017;86:176-81.
20. Szymańska J, Nowotny J, Nowakowska I, Brzęk A, Nowotny-Czupryna O. The effect of high tone power therapy on gait range in patients with chronic lower limb ischaemia. Ortopedia, traumatologia, rehabilitacja. 2011;13(3):279-92.
21. Reichstein L, Labrenz S, Ziegler D, Martin S. Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation. Diabetologia. 2005;48(5):824-8.
22. Kubsik A, Klimkiewicz P, Klimkiewicz R, Jankowska K, Jankowska A, Woldańska-Okońska M. The influence of high-tone power therapy on the functional status of patients with multiple sclerosis. Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego. 2014;37(217):24-9.
23. Ogrodzka-Ciechanowicz K, Głąb G, Ślusarski J, Gądek A. Quadriceps Muscle Strength Recovery With the Use of High Tone Power Therapy After ACL Reconstruction: a Randomized Controlled Trial. 2020.
IssueVol 16 No 3 (2022) QRcode
SectionReview Article(s)
High-tone therapy Electrical stimulation Pain

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Namvar H, Olyaie G, Bagheri H, Naiemi E, Hoseinifar M, Sargolzehi M. Effect of High-Tone External Muscle Stimulation (High-Tone Therapy) in Neuro-Musculoskeletal Disorders: A Narrative Review. jmr. 2022;16(3):208-213.