TENS stimulation near a femoral/tibial growth plate

Steve, Please allow me to emphasize something that I like to remind people of; biophysical agents are used to complement other skilled interventions as part of the comprehensive plan of care. There are just too many other unknowns about this patient to simply recommend use of one BPA or another. "What is the cause of the pain and what tissue/structures are involved" resonates in my mind when considering use of BPAs. A biomechanical exam and bone scan come to mind for this patient. Perhaps findings from those may shed better light on the underlying cause of this patient's symptoms.

You guys are great, thank you!

May I ask a follow-up question? This patient's pain issues are very troubling. He's visited multiple sports medicine orthopedists and PT's. He does recommended strengthening exercises for an hour each day. I have rarely seen someone so motivated. He's even had PRP injections. We are at a loss. It's been going on for over a year in an otherwise health kid.

We had thought to try ultrasound, but as I've read reports about growth plate disruption in animal models, we had ruled that out.

Prof Watson, I got the impression that you were implying that you might not consider this to be clinically significant. Is that true and would you others agree?

Steve, I agree 100% with Tim and will add that in one of the most comprehensive resources for contraindications and precautions for biophysical agents, TENS over an epiphyseal line is only listed as a precaution.

Contraindications and precautions: an evidence-based approach to clinical decision making in physical therapy. Physiotherapy Canada 62(5) Special Issue 2010 ISSN-0300-0508 E-ISSN-1708-8313

Hi Steve No reason why it should. Tim is the man with all the studies but I am not aware of ANY that suggested TENS will have an adverse effect on a growth plate. TENS, after all, is targeting Neural tissue Cliff

Steve. When we reviewed the evidence for contraindications + precautions for the 2020 edition of the textbook, we suggested that all E Stim (including TENS) would be attributed a precaution when employed near an active growth plate - in fact this is the same as we attributed to Ultrasound - so effectively that means that it is not contraindicated - but that it can be used, if on the basis of your clinical reasoning, the (potential) benefits outweigh the (potential) risks. The chapter also includes a discussion of this rationale and a range of relevant references. Tim