Percutaneous musculoskeletal electrolysis (EPM)

Invasive Techniques 15 August 2022 Hits: 1038

Percutaneous musculoskeletal electrolysis (EPM) is a technique that belongs to the invasive physiotherapy. It is very precise because of the ultrasound guidance and involves the targeted application of a galvanic current through an acupuncture needle at the site to be treated, which evokes an acute, controlled, local inflammatory process, which in turn allows phagocytosis of the damaged tissue and repair of the affected soft tissue. The EPM technique, compared with the EPTE technique (low-voltage current), uses high amperage currents, leading to excellent results in terms of modifying and improving the quality of the damaged tissue. Compared with the EPI® brand, the EPM methodology has generated treatment protocols supported by scientific basis.

It is very effective and greatly increases the therapy effectiveness, especially in cases of chronic pain. Usually, the results of EPM are seen already after one or two treatments; the technique is applied once a week and the treatment lasts 45 to 60 minutes.

Other physiotherapeutic forms are used as a complement to this technique, such as muscle strengthening and stimulation of neuromuscular control through active exercises and other conventional physiotherapeutic treatments (myofascial treatments, diathermy...).

This technique is practiced by a therapist specialized in musculoskeletal invasive physiotherapy (MIP), who, in order to practice it, must first take a course in musculoskeletal ultrasound (minimum 30 hours) and then the EPM course (60 hours). This training is also included in a university master's course that takes place in Spain, at the University San Pablo – Madrid (60 ECTS). During the training all the techniques of invasive physiotherapy are learned, which aim to treat soft tissues such as tendons, muscles, capsules, bursae, nerves and ligaments.

The technique is relatively new: it has been applied in Spain since 2008. The inventor of the technique is Jose Manuel Sánchez-Ibáñez, who registered the trademark EPI®. Later, Francisco Minaya-Munõz and Fermín Valera-Garrido developed the EPM application methodology, which today is the most scientifically validated approach. Francisco Minaya-Munõz and Fermín Valera-Garrido formed the MVClinic, who, in collaboration with the University San Pablo – Madrid, developed protocols for the treatment of each individual structure based on clinical and laboratory studies. In ten years, they trained many Spanish physiotherapists and thus greatly increased the chances of recovery for patients, especially where other physiotherapy techniques had previously failed.

The EPM technique is indicated for:

Chronic tendinopathies (patellar tendon, Achille’s tendon, pubalgia, lateral/medial epicondylitis, rotator cuff, supraspinatus tendon...)
Bursitis (retrocalcaneal, deltoid bursitis, Achilles bursitis...)
Acute and chronic muscle injuries
Peripheral nerve entrapment syndromes
Joint impingements
Tenosynovitis (De Quervain's syndrome, tenosynovitis of tibialis posterior...)
Tibial Periostitis
Plantar fasciitis
Acute and chronic muscle rupture (fibrosis)
Myofascial trigger points
Ligament sprain (medial collateral ligament of the knee, talofibular anterior ligament of the ankle…)
Knee’s flexum (posterior joint capsule)
Carpal and tarsal tunnel syndrome
Anterolateral and posterior ankle impingement
Adherent and painful scars

The advantages of the technique are:

It is a precise and local treatment that, with the help of an ultrasound, is performed directly on the altered and/or degenerated tissue. The precision of this technique is also ensured through the use of Power Doppler and elastography.
When the rapier of connective tissue of a tendon or muscle is difficult, the EPM technique initiates a new process of collagen fiber proliferation, which in turn allows the repair process to resume in a physiological manner.
The structural changes and mechano-biological behavior of soft tissue are immediate and in real time.
The efficiency of EPM is high (about 70%) compared with both conventional physiotherapy (ultrasound, laser, Cyriax technique, diathermy therapy, shock waves, etc.) and other medical treatments (infiltrations or sometimes even surgery) in cases of neuro-musculoskeletal problems.
The frequency of relapse is low.

In more chronic cases, electrolysis can also be combined with other invasive physiotherapeutic techniques:

Neuromodulation (NMP_e)
Microcurrents
Bioregulation
Intramuscular modulation (IMS)
High-voltage currents

Contraindications:

Belonephobia
Acute systemic infections with or without fever
Written permission for the invasive treatment is not granted by the patient
All cases of acute emergency
Osteosynthesis, prostheses, and implants (local contraindication)
Pace Makers
Heart disease where electric field charges could alter heart rhythm
Skin problems (local contraindication)
Thrombophlebitis
Tumors
Sensitivity disorders (relative contraindication)
Lymph edema or situation of removal of lymph nodes (local contraindication)
High risk of infection (relative contraindication)
Metabolic alterations (relative contraindication)
Fibromyalgia (relative contraindication)
Pregnancy (absolute contraindication in the first trimester and in the subsequent months relative to areas that could affect the fetus)
Children (parental permission required)
Contagious diseases (relative contraindication)
Allergies to the material used (relative contraindication, special measures required)
Epilepsy (relative contraindication)
Mucous membranes, eyes, genitals, nipples, and endocrine glands

Although it is a relatively new technique, there are already several studies showing its positive effect:

Studies conducted in Spain have shown that damaged tissue can potentially be treated through the EPM procedure rather than surgery. This implies that the affected tendon or area is able to heal without the need for invasive surgery.

Percutaneous musculoskeletal electrolysis (EPM)

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