When we introduce providers and our own patients to the NeuFit® Method and the Neubie® neuromuscular stimulation device, one of the topics we always discuss is safety. We understand that providers and patients alike want to fully understand the implications of any effective medical device and the methods for using it. In this week’s blog, we are going to discuss the use of the Neubie device as part of a client’s training and/or rehabilitation regimen.
Even if a client is just embarking on a training program, the Neubie device is safe to use. It has been rigorously tested and utilized with great success for a variety of conditions and training. To ensure safe use of the Neubie device, it should be used either by a licensed clinician, or by someone who’s completed our certification process and is working in the office of a clinician or under their supervision.
As a neuromuscular electrical stimulation (NMES) device, the Neubie device utilizes electrical impulses to communicate with the body. Incorporating NMES into training and therapeutic programs has been shown to improve overall fitness and health (1-6) and enhances long-term outcomes by supporting adaptation of cells in muscles, blood vessels, and nerves. (7)
Because the Neubie device does intensify training to maximize efficiency, it essentially makes your body think that it is doing more reps than it is. For this reason, it is important to work with a professional who has been trained in the proper use of the Neubie device who will help a client work at a safe level and appropriately increase the training intensity over time. This provides your body with ample time to adjust and recover from the training.
It is also extremely important to make sure the client is providing their body with enough fuel to recover properly because of the intensity of the stimulation that the NEUBIE creates. Hydration and electrolyte supplementation are important and will help a patient’s training to be as safe and effective as possible.
On occasion we get asked about rhabdomyolysis – also commonly referred to as “Rhabdo”. Rhabdo is a very rare (only about 26,000 cases occur every year in the US) but serious syndrome caused by direct or indirect muscle injury.18 It happens when dead muscle fibers release their contents into the bloodstream. This can lead to serious complications such as renal (kidney) failure when the kidneys cannot remove waste and concentrated urine.19
During exercise, muscle fibers are broken down and metabolites are released. White blood cells are dispatched to begin the repair process, then the remnants of those cells make their way into the lymphatic system, through the kidneys, and are eventually excreted. Various cells are preferentially given any hydration that we drink, so if we are at all dehydrated, the waste products from the muscle breakdown will move much slower, causing the lymph to move much slower, and putting a greater strain on the organs required for healing and excretion of waste.
Rhabdo is most commonly caused by a combination of several factors, including intense muscular exercise and/or overtraining, electrolyte imbalances, metabolic and hereditary disorders and stroke (8-11). It’s important to note that rhabdo is almost always the case of the “straw that broke the camel’s back”. When examined, there are typically other powerful contributing factors to the kidney’s inability to process the metabolites released during the muscle breakdown process. This can include overall health issues or underlying conditions, alcohol consumption, dehydration, slow lymphatic movement, and poor nutritional support. This is another reason we are big proponents of supplementing water intake with electrolytes, like LMNT packets.
Does electrical stimulation with the Neubie device cause rhabdo?
There is no empirical evidence that NMES devices or electrical impulses alone cause Rhabdo. As with any training program, proper nutrient support (including minerals used by nerves and muscles like calcium, sodium, and potassium) can reduce the risk of adverse effects of intense training (including training with the Neubie device). (8)
Persons engaging in highly restrictive diets (keto, high fat low carb, etc.) may require additional nutrition supplementation to support their training with the Neubie device. Though there is evidence that training can be performed safely while on highly restrictive diets (12-13) , it is highly recommended to consider supplementation to prevent dehydration or electrolyte imbalances.
There are few reported cases of Rhabdo occurring in athletes who have utilized electrical stimulation in their training (14-17). None of these studies conclude that the electrical stimulation itself is the sole cause, but rather other factors including dehydration, hereditary conditions, acute injury, and overtraining without previous physical conditioning.
Perhaps most notable is one case report in which a woman who had not previously been engaging in physical training overexerted herself by beginning a workout regimen with an electrical stimulation device and no conditioning period. (15)
These studies support and demonstrate the importance of proper regulation, training techniques, and preparation for training when using electrical stimulation devices – they are powerful tools and should only be used under trained supervision.
So, could you get rhabdo from using the Neubie device?
If you’re hydrated, offering appropriate nutritional support to your body, and not overconsuming alcohol, there’s virtually no chance you would get rhabdomyolysis from exercise or treatment with the Neubie device. Simply put, when used safely and as described here, the Neubie device will not break down muscle fibers enough to cause rhabdomyolysis in an otherwise healthy individual.
Let’s charge forward safely to better outcomes together!
Gondin J, Cozzone PJ, Bendahan D. Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes? Eur J Appl Physiol. 2011 Oct;111(10):2473-87. doi: 10.1007/s00421-011-2101-2. Epub 2011 Sep 10. PMID: 21909714.
Gondin J, Brocca L, Bellinzona E, D’Antona G, Maffiuletti NA, Miotti D, Pellegrino MA, Bottinelli R. Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J Appl Physiol (1985). 2011 Feb;110(2):433-50. doi: 10.1152/japplphysiol.00914.2010. Epub 2010 Dec 2. PMID: 21127206.
Jandova T, Narici MV, Steffl M, Bondi D, D’Amico M, Pavlu D, Verratti V, Fulle S, Pietrangelo T. Muscle Hypertrophy and Architectural Changes in Response to Eight-Week Neuromuscular Electrical Stimulation Training in Healthy Older People. Life (Basel). 2020 Sep 8;10(9):184. doi: 10.3390/life10090184. PMID: 32911678; PMCID: PMC7554879.
Mancinelli R, Toniolo L, Di Filippo ES, Doria C, Marrone M, Maroni CR, Verratti V, Bondi D, Maccatrozzo L, Pietrangelo T, Fulle S. Neuromuscular Electrical Stimulation Induces Skeletal Muscle Fiber Remodeling and Specific Gene Expression Profile in Healthy Elderly. Front Physiol. 2019 Nov 27;10:1459. doi: 10.3389/fphys.2019.01459. PMID: 31827446; PMCID: PMC6890722.
Di Filippo ES, Mancinelli R, Marrone M, Doria C, Verratti V, Toniolo L, Dantas JL, Fulle S, Pietrangelo T. Neuromuscular electrical stimulation improves skeletal muscle regeneration through satellite cell fusion with myofibers in healthy elderly subjects. J Appl Physiol (1985). 2017 Sep 1;123(3):501-512. doi: 10.1152/japplphysiol.00855.2016. Epub 2017 Jun 1. PMID: 28572500.
Pigarev IN, Pigareva ML. Therapeutic Effects of Electrical Stimulation: Interpretations and Predictions Based on the Visceral Theory of Sleep. Front Neurosci. 2018 Feb 12;12:65. doi: 10.3389/fnins.2018.00065. PMID: 29483861; PMCID: PMC5816067.
Vanderthommen M, Duchateau J. Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev. 2007 Oct;35(4):180-5. doi: 10.1097/jes.0b013e318156e785. PMID: 17921786.
Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J. 2015 Spring;15(1):58-69. PMID: 25829882; PMCID: PMC4365849.
Tietze DC, Borchers J. Exertional rhabdomyolysis in the athlete: a clinical review. Sports Health. 2014 Jul;6(4):336-9. doi: 10.1177/1941738114523544. PMID: 24982707; PMCID: PMC4065559.
El Ghoch M, Calugi S, Dalle Grave R. Management of Severe Rhabdomyolysis and Exercise-Associated Hyponatremia in a Female with Anorexia Nervosa and Excessive Compulsive Exercising. Case Rep Med. 2016;2016:8194160. doi: 10.1155/2016/8194160. Epub 2016 Sep 19. PMID: 27721832; PMCID: PMC5046051.
Kim J, Lee J, Kim S, Ryu HY, Cha KS, Sung DJ. Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review. J Sport Health Sci. 2016 Sep;5(3):324-333. doi: 10.1016/j.jshs.2015.01.012. Epub 2015 Jun 3. PMID: 30356493; PMCID: PMC6188610.
Durkalec-Michalski K, Nowaczyk PM, Główka N, Ziobrowska A, Podgórski T. Is a Four-Week Ketogenic Diet an Effective Nutritional Strategy in CrossFit-Trained Female and Male Athletes? Nutrients. 2021 Mar 6;13(3):864. doi: 10.3390/nu13030864. PMID: 33800770; PMCID: PMC8001376.
Kephart WC, Pledge CD, Roberson PA, Mumford PW, Romero MA, Mobley CB, Martin JS, Young KC, Lowery RP, Wilson JM, Huggins KW, Roberts MD. The Three-Month Effects of a Ketogenic Diet on Body Composition, Blood Parameters, and Performance Metrics in CrossFit Trainees: A Pilot Study. Sports (Basel). 2018 Jan 9;6(1):1. doi: 10.3390/sports6010001. PMID: 29910305; PMCID: PMC5969192.
Johannsen, A. D., and Krogh, T. P. (2019). Rhabdomyolysis in an elite dancer after training with electromyostimulation: a case report. Transl. Sports Med. 2, 294–297. doi: 10.1002/tsm2.91
Estes MEZ. Rhabdomyolysis after exercise with an electrical muscle stimulator. Nurse Pract. 2018 Sep;43(9):8-12. doi: 10.1097/01.NPR.0000544286.79459.19. PMID: 30134431.
Kästner A, Braun M, Meyer T. Two Cases of Rhabdomyolysis After Training With Electromyostimulation by 2 Young Male Professional Soccer Players. Clin J Sport Med. 2015 Nov;25(6):e71-3. doi: 10.1097/JSM.0000000000000153. PMID: 25353720.
Finsterer J, Stöllberger C. Severe rhabdomyolysis after MIHA-bodytec® electrostimulation with previous mild hyper-CK-emia and noncompaction. Int J Cardiol. 2015 Feb 1;180:100-2. doi: 10.1016/j.ijcard.2014.11.148. Epub 2014 Nov 26. PMID: 25438227.
What is the prevalence of rhabdomyolysis is the US? https://www.medscape.com/answers/1007814-156076/what-is-the-prevalence-of-rhabdomyolysis-is-the-us