What Is The Difference Between EMS And TENS?

'Nerve Relief vs Muscular Relief - The Debate Begins....'

The Short Answer –

The fundamental similarity between EMS and TENS systems lies in their mode of delivery – that of electrical pulses through electrical pads to the skin.

As a result, both EMS and TENS treatments can now be delivered from a single unit. Why? But just how similar are EMS and TENS Machines?

Which one should you use and for what? What is the difference between EMS and TENS? We answer all of this below.

The Fundamental Difference Between EMS and TENS

EMS (or ‘Electrical Muscle Stimulator’) machines work by transmitting lower level electrical pulses into the nerves around muscles. This has the effect of causing the muscles to make micro contractions and theoretically improving muscle tone.

They are primarily similar to a TENS (Transcutaneous Electrical Nerve Stimulation) machine through their mode of action. That being that they both pass small electrical currents into the body through electrodes attached to the skin.

The principle difference is that the electrical impulses from a TENS machine targets nerve that deliver pain responses, rather than muscles to increase muscle tone.

What Is An EMS Machine and What Evidence Is They Work?

EMS machines are commonly used for –

  • Rehabilitation after injury
  • Increasing blood circulation
  • Relaxation of muscles
  • Muscle strengthening
  • Muscle Toning

Not so long ago, EMS machines were very popular for cosmetic purposes – placed on peoples stomach’s to allegedly give them a ‘6-pack stomach’.

Unfortunately, the case in favour of using an EMS machine is, at best, unproven. Hayter et al conducted a trial on oxygen consumption by the body (as an indicator of muscle workload) and found no difference between users with their EMS machine turned off and when they were running for 20 minutes.

As with the research into TENS machines, the results of different trials varied greatly.

What was noticed however was a strong correlation between the intensity of current and the effects on your body (Filipovic et al). 

What has been proven is the ability of EMS to lead to functional improvement in the elderly (Langeard et al). 

However, when it comes to building larger, stronger and more defined muscles, the improvements noted were modest and the potential for deviation (outcome affected by other factors) was large.

EMS used in combination with aerobic exercise was found to increase the reduction of fat tissue faster than with exercise alone (Noites et al), but again there were substantial concerns raised about the way that fat loss was measured (by way of loose skin). 

Anyway, the point is EMS does seem to cause changes in muscles and can help with everything from rehabilitation in people with limited movement to increased mobility in the elderly, although to what extent, has yet to be properly quantified.

As EMS/ TENS technology has developed a new treatment has emerged known as WB-EMS or ‘Whole Body Electrical Muscle Stimulation’.

Basically, advances in device capacity have led to multiple electronic pads from one machine.

This means that applying up to 6 or 8 sets of pads can cover almost your entire muscular system. This has been shown to have a much more concentrated effect than just working on one isolated area.

It uses exactly the same EMS machine, but with more electrodes at work at the same time.

The perfect combination for a healthy individual or one with non-debilitating pain would seem to be exercise combined with several sets of pads on multiple areas for approximately 20 minutes.

Where your injury has caused muscle loss or lack of range of movement, then you should be extra careful about not using the machine at too high an intensity. Filipovic concluded that an intensity of 50hz was sufficient for rehabilitation and that higher intensities greatly increased the level of muscle fatigue.

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TENS Machines – And How They Achieve Pain Relief

TENS Machines however, focus on disrupting pain signals to the brain. A similar electrical current is passed in to your body and floods your brain with lots of tiny messages.

Using what is known as ‘Gate Control Theory’ this stops your brain from properly reading the normal pain signals from your central nervous system – thus reducing pain.

The electrical output from a TENS machine passed through electrode pads is also said to stimulate the production of endorphins that are natural pain relievers.

I wont go in to detail on this page around it’s clinical effectiveness (please see ‘DO TENS machines really work) as this is an area I’ve been involved with research around in the past.

That is except to say that there does exist numerous studies that demonstrate some level of effectiveness. This could be in treating osteoarthritic knee pain (Adedoyin et al) or Fibromyalgia (Lauretti et al) or many other diseases.

How effective TENS units are again relies on how you interpret the results of various trials and how many flaws you are willing to forgive (trials that didn’t have enough entrants to be considered ‘significant’ or poor settings on the TENS machines etc).

However, as concluded previously, if you forgive the flaws in the clinical trials, there is a body of evidence that suggest TENS machines do work for reducing pain in the short term.

The other big vote of confidence for TENS machines, as discussed in other articles, is the number of family doctors that now use them as a valid treatment for a variety of pains.

Achieving The Best Of Both Worlds?

In todays’ market most devices come with multiple pairs of electrodes (pads) and have both a TENS and an EMS setting.

However, they also vary greatly in quality and have a large number of other settings.

Having many settings has both advantages and disadvantages.

The extra options are great from the perspective of finding the best combination for you (this will vary from person to person) and changing settings is a great way to prevent a tolerance being built up.

However, having so many options also means you need to know how to operate you TENS machine and what it does. Please do read ‘how to use a TENS machine for advice on the sort of things you need to know before operating a TENS machine.

The Final Word –

The difference between EMS and TENS lies in the different areas targeted for improvement. EMS focuses on the muscles, delivering strengthening of muscles and blood circulation.

The focus of EMS machines is around rehabilitation, achieving better range of movement or the cosmetic purpose of muscle strengthening.

TENS machines on the other hand focus on short-term pain relief and target the nerve messages travelling to the brain.

Both have been researched and show various improvements, while both also suffer from a lack of clinically conclusive evidence to back up their claims.

If you have any questions, please leave them below – or check out or other articles for recommendations on what to look for in a TENS/ EMS unit and guidance on how to use one.

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References –


1. HAYTER TINA L.; COOMBES, JEFF S.; KNEZ, WADE L.; BRANCATO, TANIA L. (2005). Effects of electrical muscle stimulation on oxygen.

2. Filipovic A, Kleinoder H, Mester J, Dormann U. (2011). Electromyostimulation—a systematic review of the influence of training regimens and stimulation parameters on effectiveness in Electromyostimulation training of selected strength parameters. J strength Cond Res. 2011;25:3218–38.

3. Langeard A, Bigot L, Chastan N, Gauthier A. Does neuromuscular electrical stimulation training of the lower limb have functional effects on the elderly?: a systematic review. Exp Gerontol. 2017;91:88–98. https://doi.org/10.1016/j.exger.2017.02.070.

4. Noites A, Nunes R, Gouveia AI, Mota A, Melo C, Viera A, et al. Effects of aerobic exercise associated with abdominal microcurrent: a preliminary study. J Altern Complement Med. 2015;21:229–36.

5. Filipovic A, Kleinoder H, Dormann U, Mester J, Klein Der H, Rmann UD, et al. Electromyostimulation—a systematic review of the effects of different Electromyostimulation methods on selected strength parameters in trained and elite athletes. J strength Cond Res. 2012;26:2600–14.

6. Adedoyin RA, Olaogun MO, Fagbeja OO. (2002) Effect of interferential current stimulation in management of osteo-arthritic knee pain. Physiotherapy 88, 493–499 (2002).

7. Lauretti GR, Chubaci EF, Mattos AL. (2013). Efficacy of the use of two simultaneously TENS devices for fibromyalgia pain. Rheumatol. Int. 33, 2117–2122 (2013)

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