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=Why use EMS?=
The main reasons to use EMS are around injury treatment and rehabilitation. EMS may be able to directly help with knee pain (see above), as well as reducing the loss of muscle strength (atrophy) that can occur while injured. EMS may be a beneficial supplement to regular training, but I have not found sufficient guidelines or studies that would define the optimal usage pattern.
=EMS and TENS=EMS is similar to TENS ([http://en.wikipedia.org/wiki/Transcutaneous_electrical_nerve_stimulation Transcutaneous Electrical Nerve Stimulation]), and many devices, such as the one recommended below, a capable of both EMS and TENS. The difference between the two is that EMS is intended to activate muscle fibers, where TENS is used at a lower intensity with the goal of reducing pain.
=Choosing an EMS device=
EMS devices vary wildly in price, from less than $50 to over $800. All devices sold in the US must be FDA certified<ref name="EMSFda"/>, so to avoid any device sold in the US without this certification. EMS devices for muscle stimulation can be sold in the US without a prescription, but devices to treat specific medical conditions require a doctor's prescription<ref name="EMSFda"/>. In looking at the specifications for a number of devices, it appears that they have generally similar capabilities:
[[File:IntensityEMS3.jpg|none|thumb|300px|The [http://go.fellrnr.com?id=35454X937677&xs=1&url=http%3A%2F%2Fwww.overstock.com%2FHealth-Beauty%2FInTENSity-Twin-Stim-III-TENS-and-EMS-Combo%2F6017593%2Fproduct.html InTENSity Twin Stim III].]]
=Replacement Pads=The sticky electrode pads are reusable and last for 5-20 uses. The sticky on the pads degrades quite slowly, so how many times you use them may depend on the location you're trying to stick them to. Flat, smooth locations like the quad are easy to stick to, where attaching them to the end of the [[VMO]] requires a little more adhesion. I ordered these [http://go.fellrnr.com?id=35454X937677&xs=1&url=http%3A%2F%2Fwww.amazon.com%2Fdp%2FB001TZJYXE replacement pads from amazon.com] and they were $25 for 40 pads, so the running costs are quite low. =Important Cautions=Though EMS is generally safe, you should be aware of these critical restrictions<ref name="EMSContra"/>:* Do not apply to the chest area if you have any heart conditions.* If you have a pacemaker, do not use EMS anywhere on your body.* Do not apply EMS to the [http://en.wikipedia.org/wiki/Carotid_sinus Carotid sinus] area of the neck, as this could affect heart rate or blood pressure.* Do not apply through your head.* Do not apply through cancerous tissue.* Applying to EMS through broken or irritated skin will cause discomfort.* Do not apply to protruding metal such as surgical staples or pins.Other cautions:* Be careful applying high intensity EMS directly over superficial bones, as this can be painful.* Applying EMS over thick areas of fat may require painfully high intensity to reach the underlying muscle.* Avoid applying EMS near the uterus if you are pregnant.If you have any doubts or concerns contact a healthcare professional.
=EMS and Intermittent Hypoxic Exposure=
There has been little research on combining EMS and [[Intermittent Hypoxic Exposure]] (IHE), but there is a suggestion that the two may be synergistic in some way<ref name="EMSIHE"/>.
=References=
<references>
http://www.translational-medicine.com/content/7/1/91/ </ref>
<ref name="PFClinical"> Clinical classification of patellofemoral pain syndrome- guidelines for non-operative treatment, Erik Witvrouw, S. Werner, C. Mikkelsen, D. Van Tiggelen, L. Vanden Berghe, G. Cerulli </ref>
<ref name="EMSContra"> Contraindications and Precautions to Electrical Stimulation http://faculty.uca.edu/fletcher/electro/unit1_TENS/Contraindications%20&%20Precautions%20to%20E-Stim.pdf </ref>
</references>