The physiological effects can last several hours, and rewarming of the extremity tissues takes at least 20 minutes.

Monitor the patient’s skin closely to ensure that there are no adverse reactions.

Numbness indicates analgesia. The patient’s protective sensation is removed and patient cautioned.

Side effects include itching, hives, sweating, and wheal areas with reddened borders, blanched centers.

Never apply gel packs or ice packs directly to the skin surface and never longer than 20 minutes.

Subacute and chronic inflammation

Subacute or chronic pain

Subacute edema removal

Decreased ROM

Resolution of swelling

Myofascial trigger points

Muscle guarding

Muscle spasm

Subacute muscle strain

Subacute ligament sprain

Subacute contusion

Impaired sensation (superficial, skin graft, scar, or inability to determine temperature changes)

Poor thermal regulation

Tumors/cancer

Acute inflammation, including acute edema

Deep vein thrombophlebitis

Pregnancy—full immersion (the systemic effects of circulating blood on a fetus are unclear, superficial application over an extremity can be used)

Bleeding tendencies

Infection

Primary repair of tendon or ligament

Advanced cardiac disease

Semicomatose or impaired mental status (or patients with speech and language difficulties, they may not be able to inform or understand the therapists directions)

Rheumatoid arthritis (vigorous dosages of heat may facilitate proteins that act as catalysts to increase enzyme activity, exacerbating joint inflammation; Schmidt et al., 1979)

Acute musculoskeletal conditions

Compromised circulation

Peripheral vascular disease

Skin anesthesia

Open wounds or skin conditions

Monitor blood pressure, respiration, and skin color.

Discontinue if increased redness, petechiae, and blistering are observed.

Patients with vascular disease, deep vein thrombosis, emboli, atherosclerosis

Patients with hemophilia not covered by factor replacement

Over the eye, sex organs, over the uterus during pregnancy

Over stellate ganglions

Over the spinal cord following laminectomy

Directly over external metal implants

Over pacemakers, the heart, or implanted electronic devices

Cancer, areas of malignancy

Over rash, eczema, areas of skin irritation

Carotid sinus

Over anesthetic areas

Over areas that have been irradiated

Over metal implants

Over epiphyseal growth plates or immature bone

Areas with sensory loss or decreased sensation

Over plastic or cemented implants

Subcutaneous or bony prominences

Care should be used in the vicinity of a cardiac pacemaker and implanted devices

Patients with decreased mentation, cognition, or unable to communicate

Avoid stationary transducer

Over the thoracic region as it may interfere with heart activity

Patients with demand-type pacemakers, defibrillator or deep brain stimulator, or implanted electrical device

Do not place over phrenic nerve or bladder stimulators

Do not place over the anterior neck or carotid sinus as this may cause cardiac arrhythmias; where placement of electrodes could adversely affect a reflex center (e.g., the heart, parasympathetic nerves, ganglion, laryngeal muscles)

Transcerebral or individuals with epilepsy

Peripheral vascular disease, venous thrombosis, or thrombophlebitis

Over the eyes or reproductive organs

Over or near superficial metal pins, plates, or hardware

Active cancer, malignancy, infection, tuberculosis, or active hemorrhage

Pregnant people, over a pregnant uterus during the first trimester

Over areas with pathology within the muscle (i.e., Duchenne’s muscular dystrophy)

Over areas where movement is contraindicated or to be avoided

Near diathermy devices

Over areas with pathology of the cell body (polio)

Patients with hypertension or hypotension

Patients with obesity with excessive adipose tissue (may require higher levels of electrical current, which may cause skin irritation or burning)

Patients unable to provide clear feedback regarding the level of stimulation, such as infants or young children, patients with dementia or cognitive disorders, or individuals with mental disorders

Over areas with pathology of the myelin sheath (e.g., diabetic neuropathy, multiple sclerosis, peripheral neuropathy)

Over areas with pathology of the synapse points between muscle and nerve (e.g., myasthenia gravis)

Caution should be used in areas of absent or diminished sensation

Patients with skin conditions such as eczema, psoriasis, dermatitis

Patients with autonomic dysreflexia

Muscle Retraining: After an injury or stroke, sEMG biofeedback can help people relearn how to activate weakened muscles and improve their coordination.

Pain Management: It teaches individuals to reduce muscle tension associated with chronic pain conditions like back pain, tension headaches, etc.

Relaxation Training: sEMG biofeedback can help people learn deep relaxation techniques to manage stress and anxiety.

Improved Posture: sEMG biofeedback can assist in developing awareness of muscle imbalances and promote better postural habits.

Pelvic Floor Dysfunction: It helps individuals with incontinence or pelvic pain by improving their awareness and control of their pelvic floor muscles.

Sports Performance: Athletes can use sEMG biofeedback to optimize movement patterns and muscle recruitment for improved efficiency and reduce injury risk.

Skin sensitivity or allergies: Some people might experience mild skin irritation from the adhesive on the sensors. Testing a small area first and using hypoallergenic options can help.

Cognitive limitations: Individuals with significant cognitive impairments may have difficulty understanding and responding to the feedback provided during sEMG biofeedback.

Severe muscle weakness: In cases of extreme muscle weakness, the sEMG signal might be too faint to detect reliably, limiting its usefulness as a feedback tool.

Certain medications: Some medications could affect muscle activity and potentially influence sEMG biofeedback readings.

Open wounds or skin lesions: Placing sensors directly over broken skin can cause irritation and increase the risk of infection.

Implanted electrical devices: The electrical signals from sEMG could potentially interfere with the functioning of devices such as pacemakers or implantable cardioverter-defibrillators (ICDs). Consult with the patient's doctor in these cases.

Unstable Fractures or Recent Surgeries: sEMG might not be recommended immediately after a fracture or surgery until there's been sufficient healing.