How electrical muscle stimulation (EMS) & transcutaneous electrical nerve stimulation (TENS) affect recovery and performance for running, OCR, and endurance sports
Thomas Solomon, PhD.
Updated onReading time approx 6 minutes (1500 words).
What you’ll learn:
Electrical muscle stimulation (EMS) uses low-voltage electrical pulses through the skin to make a muscle contract.
In sedentary older adults (including people with muscle loss or obesity), regular EMS is likely to help preserve muscle and improve strength.
Some evidence also suggests EMS can help preserve muscle during periods of forced inactivity, such as immobilisation or hospitalisation.
But, in trained athletes, EMS is unlikely to improve post-exercise soreness, speed up recovery, or boost real-world performance.
Curious about the how and why? Scroll down for the details, the nuances, and the nerdy bits.
The information I provide is not medical advice. Before making any changes to your habits of daily living based on any information I provide, always ensure it is safe for you to do so and consult your doctor if you are unsure.
What are electrical muscle stimulation (EMS) and transcutaneous electrical nerve stimulation (TENS)?
Humans have been zapping themselves on purpose for centuries — apparently ancient Egyptians, Greeks, and Romans used electric fish to treat all sorts of problems. And yes, Emperor Palpatine also used electricity to “encourage” cooperation. Today, electrical muscle stimulation (EMS, also known as neuromuscular electrical stimulation [NMES], electromyostimulation, or transcutaneous electrical nerve stimulation [TENS], which targets afferent nerves to blunt pain), is typically used by physiotherapists in rehabilitation. For example, meta-analysisA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment. conclude that electrical stimulation can improve motor recovery and increase gait speed in people who have had a stroke (see here, here, & here).
But, here’s the key: helping someone regain muscle function after illness or injury doesn’t automatically mean the same trick will improve recovery or performance in a healthy, trained athlete. Athletes’ brains already have an extremely well-tuned ability to send nerve signals to muscles. So, it’s possible that the extra “push” you get from electricity might be kinda redundant.
In physiology labs, EMS is also used as a “test-tube biology” method to study muscle contraction in cell culture experiments. PhD students and postdocs in my lab group used this “exercise in a dish” approach to test how muscle cell contraction affects glucose metabolism. In a dish, electrodes deliver pulses at different voltages, frequencies, and durations to mimic nerve impulses. In real humans, you do the same basic thing by sticking electrodes on the skin and running a current through to the muscle, creating involuntary contractions.
Consumer EMS devices like Compex and Powerdot are all over glossy social media videos, usually promising to “increase blood flow” and “flush out metabolic waste products”. They’re also relatively cheap and easy to buy. And, this is not new tech: vigorous EMS showed up in East German training camps in the 1970s. With the growing popularity of consumer devices (including whole-body EMS systems), it’s worth asking a very boring but important question: does EMS actually help athletic recovery and performance?
We’ve known for decades that muscle contraction increases muscle blood flow, which helps deliver nutrients and remove metabolites and hormones. So the “blood flow” claim is basically true. And using electrical stimulation to innervate afferent nerves to dull pain could, in theory, reduce soreness sensations after exercise. But here’s the practical snag: low-intensity exercise (i.e., active recovery) can do the same “move stuff in and out” job across lots of muscles, plus you get a gentle cardio stimulus as a bonus.
A 2011 narrative reviewA narrative review describes an entire body of evidence to summarise what is known on a topic. However, instead of using a systematic approach, a narrative review takes a subjective approach that allows the author(s) to express their opinion on the topic., “Does electrical stimulation enhance post-exercise performance recovery?”, suggested EMS may help lactate removal and reduce creatine kinase activity, but that evidence for restoring (or improving) performance was lacking. More research has emerged since 2011. And we can do better than opinion-based summaries. So…
What is the scientific evidence on the effect of electrical muscle stimulation (EMS) and transcutaneous electrical nerve stimulation (TENS) on recovery and athletic performance?
Quick note: this summary is specific to recovery and performance. It is not about pain management, and it’s not about rehab after injury or illness.
Electrical muscle stimulation is probably safe for most people, but if you have heart problems, epilepsy, wear a pacemaker, or are pregnant, EMS is not advised.
After a workout, EMS might lower blood lactate more than complete rest—but it does not beat active recovery (light movement), which is still superior (see Malone et al. 2014).
After a workout, EMS does not appear to reduce delayed onset muscle soreness (DOMS), and it doesn’t improve the recovery of performance after exercise (see Menezes et al. 2024 and Menezes et al. 2022; and also Malone et al. 2014).
In untrained older adults, EMS shows potential for maintaining muscle mass and improving strength—including in people with sarcopenia (muscle atrophy) or obesity (see de Oliveira et al. 2022 & Kemmler et al. 2022). But we still need further high-quality randomised controlled trialsThe “gold standard” approach for determining whether a treatment has a causal effect on an outcome of interest. In such a study, a sample of people representing the population of interest is randomised to receive the treatment or a no-treatment placebo (control), and the outcome of interest is measured before and after exposure to the treatment and control. to confirm these effects.
Strength training might be comparable to EMS in some untrained older adults (see Šarabon et al. 2022), but high-quality head-to-head comparisons are limited. And because we already have strong evidence that resistance training preserves muscle mass and increases strength in older adults (see Liu et al. 2009, Borde et al. 2015, and Chen et al. 2021), older adults should choose strength training over EMS unless injuries or physical limitations make that hard.
Some evidence also suggests EMS may help preserve muscle mass in chronic conditions that force inactivity (e.g. hospitalisation or prolonged leg immobilisation). So yes, EMS might help reduce muscle atrophy during rehab if you’re forced to be inactive—but that hypothesis still needs stronger tests.
These “muscle-saving” effects are genuinely interesting, but they mostly show up in people who are losing (or have already lost) muscle and strength. That doesn’t automatically translate into a recovery or performance boost for healthy people or trained athletes.
So what’s the story for athletes…?
A 2011 systematic review by Filipovic et al. suggested that an intensity of at least 50% of a maximal voluntary contraction (MVC) may be sufficient to drive strength adaptations—even in trained athletes—and estimated this could be achieved with 3 EMS sessions per week for 4 to 6 weeks, using an impulse width of roughly 200 to 400 microseconds (µs), a frequency of 50 to 100 hertz (Hz), and an impulse intensity of at least 50 milliamps (mA). A follow-up systematic review by Filipovic et al. also suggested EMS can improve strength, rate of force development, power, and functional outcomes like jump height and sprint time, even in trained athletes. However, neither review included a meta-analysisA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment. (so there were no pooled effect sizesA standardised measure of the magnitude of an effect of an intervention. Unlike p-values, effect sizes show the size of the effect and how meaningful it might be. Common effect size measures include standardised mean difference (SMD), Cohen’s d, Hedges’ g, eta-squared, and correlation coefficients. or confidence intervalsA measure of uncertainty used in Frequentist statistics. The 95% confidence interval is a plausible range of values within which the true value (e.g., the true treatment effect) would be found 95% of the time if the data were repeatedly collected in different samples of people. If this range of values (the confidence interval) crosses zero, there is little confidence that the average value is the true effect. If the confidence interval does not cross zero, we can be confident that the average value is the true effect.).
More recent systematic reviews with meta-analyses (see Wirtz et al. 2019 and Pano-Rodriguez et al. 2019) conclude that EMS has trivial, non-meaningful effects on strength performance in trained athletes. But there still aren’t enough high-quality studies to lock in firm conclusions about EMS training and performance.
A 2022 network meta-analysisNetwork meta-analysis is a statistical method that allows for the comparison of multiple treatments simultaneously by integrating data from various studies. It uses complex statistical models to assess the effectiveness of different interventions, even when some treatments have not been directly compared in head-to-head trials. (see Micke et al. 2022) suggested EMS might improve strength, jump, and sprint outcomes in trained athletes, but the effects seem heavily dependent on the protocol—especially combined sport-specific training plus low-volume, high-intensity EMS. Again though, the authors noted the lack of high-quality studies.
A 2022 systematic review on endurance outcomes reported potential effects on V̇O2maxV̇O2max is the maximal rate of oxygen consumption your body can achieve during exercise. It is a measure of cardiorespiratory fitness and indicates the size of your engine, i.e., your maximal aerobic power, which contributes to endurance performance., running economyThe rate of energy expenditure (measured in kiloJoules [KJ], kilocalories [kcal] or oxygen consumption [V̇O2]) per kilogram body mass (kg) per unit of distance, i.e. per 1 kilometre travelled. A runner with a lower energy cost per kilometre has a higher economy than a runner with a higher energy cost., and time trial performance (see da Mota Moreira et al. 2022). But only 3 included studies involved athletes (2 in recreational runners and 1 in soccer players), while the rest were in untrained middle-to-older adults. So we still need better direct comparisons between EMS and endurance training in athletes, ideally in a high-quality trial.
Overall, the current systematic reviewsA systematic review answers a specific research question by systematically collating all known experimental evidence, which is collected according to pre-specified eligibility criteria. A systematic review helps inform decisions, guidelines, and policy. and meta-analysesA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all studies of that treatment. describe a medium to high risk of biasRisk of bias in a meta-analysis refers to the potential for systematic errors in the studies included in the analysis. Such errors can lead to misleading/invalid results and unreliable conclusions. This can arise because of issues with the way participants are selected (randomisation), how data is collected and analysed, and how the results are reported. in the underlying studies. In plain English: the study designs often aren’t strong enough to trust the exact size of the effects.
There’s also no real consensus on the “best” EMS protocol. Researchers have used a huge range of currents, frequencies, impulse widths, and total treatment times. More standardisation is needed, and proper dose-response studies are still lacking.
Can electrical muscle stimulation (EMS) and transcutaneous electrical nerve stimulation (TENS) enhance recovery and athletic performance?
In sedentary older adults (including people with sarcopenia/muscle loss or obesity), regular EMS (including NMES and TENS) is likely to help preserve muscle mass and increase strength. The effect sizeA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment. is medium.
Some evidence also suggests EMS can help preserve muscle mass during forced inactivity—so it might be useful during recovery from an injury that stops you training normally.
For trained athletes, EMS after exercise is unlikely to reduce soreness or improve the recovery of performance.
Some evidence suggests TENS applied during endurance exercise can reduce perceived pain and produce small improvements in lab endurance tests. But there isn’t enough research to know if that translates into meaningful performance gains in trained athletes.
It’s also unclear how these effects compare between trained and untrained people, and between males and females, because the research base is thin.
Keep in mind: there are not many studies, sample sizes are often small, and study designs vary a lot. There is also high heterogeneity (variability)Heterogeneity shows how much the results in different studies in a meta-analysis vary from each other. It is measured as the percentage of variation (the I2 value). A rule of thumb: if I2 is roughly 25%, that indicates low heterogeneity (good), 50% is moderate, and 75% indicates high heterogeneity (bad). High heterogeneity means there’s more variability in effects between studies and, therefore, a less precise overall effect estimate. in effects between studies , a moderate to high risk of biasRisk of bias in a meta-analysis refers to the potential for systematic errors in the studies included in the analysis. Such errors can lead to misleading/invalid results and unreliable conclusions. This can arise because of issues with the way participants are selected (randomisation), how data is collected and analysed, and how the results are reported. (especially because blindingBlinding is when people in a study don’t know which treatment they’re getting. It stops expectations or beliefs (from patients or researchers) from skewing the results. “Single-blind” means participants don’t know; “double-blind” means participants and researchers don’t know; “triple-blind” means that the participants, researchers, and data analysts are kept in the dark. The goal is simple: fair tests and trustworthy findings. is impossible), and possible publication biasPublication bias in meta-analysis occurs when studies with significant results are more likely to be published than those with non-significant findings, leading to distorted conclusions. This bias can inflate effect sizes and misrepresent the true effectiveness of interventions, making it crucial to identify and correct for it in research.. So, the overall certainty of evidenceCertainty of evidence tells us how confident we are that the published results accurately reflect the true effect. It’s based on factors like study design, risk of bias, consistency, directness, precision, and publication bias. High certainty means that the current evidence is so strong and consistent that future studies are unlikely to change conclusions. Whereas, low certainty means more doubt and less confidence, and that future studies could easily change current conclusions. is low. Therefore, additional high-quality randomised controlled trialsThe “gold standard” approach for determining whether a treatment has a causal effect on an outcome of interest. In such a study, a sample of people representing the population of interest is randomised to receive the treatment or a no-treatment placebo (control), and the outcome of interest is measured before and after the exposure to treatment/control. are needed to increase confidence in the overall effects reported in meta-analysesA meta-analysis quantifies the overall effect size of a treatment by compiling effect sizes from all known studies of that treatment..
The nice part: EMS doesn’t appear to harm recovery or performance—unless you crank it so hard you cause extra muscle damage (in which case… yeah, don’t do that). If you like it and it feels good, fine, go for it. Just remember: time and money spent chasing a recovery “hack” with no clear benefit might be better spent sitting down, sleeping, eating something decent, and doing something calm.
How to use this: If you’re a trained runner/OCR/endurance athlete, treat EMS as an optional comfort tool, not a performance tool. If your goal is recovery, prioritise the boring winners (rest, sleep, food, light movement). If you’re forced into inactivity (e.g., immobilisation) and want to experiment with EMS, do it cautiously and don’t let it replace rehab guidance or (when possible) progressive strength training.
Information you can trust. All content on Veohtu is meticulously researched and written by Thomas Solomon, PhD. He does not sell supplements, recovery products, or ad space, and he has no sponsorships, brand affiliations, or ambassador roles. Everything you read reflects his independent views, shaped solely by peer-reviewed scientific evidence — and that will never change.
Full list of meta-analyses examining electrical muscle stimulation for recovery
Here are the meta-analyses I've summarised above:
Effects of photobiomodulation, intermittent pneumatic compression and neuromuscular electrical stimulation on muscle recovery: Systematic review with meta-analysis. Canez et al. (2025) J Bodyw Mov Ther.
Electrical Stimulation and Muscle Strength Gains in Healthy Adults: A Systematic Review. Swarup Mukherjee, Jeryn Ruiwen Fok, Willem van Mechelen. J Strength Cond Res. 2023
Is Electrical Stimulation Effective in Preventing or Treating Delayed-onset Muscle Soreness (DOMS) in Athletes and Untrained Adults? A Systematic Review With Meta-Analysis. Mayara Alves Menezes, Danielle Alves Menezes, Lucas Lima Vasconcelos, Josimari Melo DeSantana. J Pain. 2022
Effects of electromyostimulation on physiological determinants of endurance-performance in healthy subjects: a systematic review. Ivo da Mota Moreira, Anne Krause, Daniel Memmert. J Sports Med Phys Fitness. 2022
Effects of electromyostimulation on performance parameters in sportive and trained athletes: A systematic review and network meta-analysis. Florian Micke, Steffen Held, Jessica Lindenthal, Lars Donath. Eur J Sport Sci. 2022
Efficacy of Whole-Body Electromyostimulation (WB-EMS) on Body Composition and Muscle Strength in Non-athletic Adults. A Systematic Review and Meta-Analysis. Wolfgang Kemmler, Mahdieh Shojaa, James Steele, Joshua Berger, Michael Fröhlich, Daniel Schoene, Simon von Stengel, Heinz Kleinöder, Matthias Kohl. Front Physiol. 2021
Effects of whole-body electromyostimulation on health indicators of older people: Systematic review and meta-analysis of randomized trials. Túlio M D de Oliveira, Diogo C Felício, José E Filho, Diogo S Fonseca, João Luiz Q Durigan, Carla Malaguti. J Bodyw Mov Ther. 2022
Resistance Exercise, Electrical Muscle Stimulation, and Whole-Body Vibration in Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Šarabon N, Kozinc Ž, Löfler S, Hofer C. J Clin Med. 2020
Effects of Whole-Body Electromyostimulation on Strength-, Sprint-, and Jump Performance in Moderately Trained Young Adults: A Mini-Meta-Analysis of Five Homogenous RCTs of Our Work Group. Nicolas Wirtz, Ulrike Dörmann, Florian Micke, André Filipovic, Heinz Kleinöder, Lars Donath. Front Physiol. 2019
Effects of whole-body electromyostimulation on health and performance: a systematic review. Alvaro Pano-Rodriguez, Jose Vicente Beltran-Garrido, Vicenç Hernández-González, Joaquim Reverter-Masia. BMC Complement Altern Med. 2019
Neuromuscular electrical stimulation during recovery from exercise: a systematic review. Malone JK, Blake C, Caulfield BM. J Strength Cond Res. 2014
Electromyostimulation--a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes. Filipovic A, Kleinöder H, Dörmann U, Mester J. J Strength Cond Res. 2012
Electromyostimulation--a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters. Filipovic A, Kleinöder H, Dörmann U, Mester J. J Strength Cond Res. 2011
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Who is Thomas Solomon?
My knowledge has been honed following 20+ years of running, cycling, hiking, cross-country skiing, lifting, and climbing, 15+ years of academic research at world-leading universities and hospitals, and 10+ years advising and coaching in athletic performance and lifestyle change.
I have a BSc in Biochemistry, a PhD in Exercise Science, and over 90 peer-reviewed publications in medical journals.
I'm also an ACSM-certified Exercise Physiologist (ACSM-EP), an ACSM-certified Personal Trainer (ACSM-CPT), a VDOT-certified Distance Running Coach, and a UKVRN Registered Nutritionist (RNutr).
Since 2002, I’ve conducted biomedical research in exercise and nutrition and have taught and led university courses in exercise physiology, active recovery, biochemistry, and molecular medicine.
And, with my personal experience of competing on the track (800m to 10,000m), the road (5 k to marathon), on the trails, and in the mountains, by foot, bicycle, cross-country ski, and during obstacle course races (OCR), I deeply understand what it's like to train and compete — I've been there, done it, and gotten sweat, mud, and tears on my t-shirt.
Disclaimer: I occasionally mention brands and products, but it is important to know that I don't sell recovery products, supplements, or ad space, and I'm not affiliated with / sponsored by / an ambassador for / receiving advertisement royalties from any brands. I have conducted biomedical research for which I’ve received research money from publicly-funded national research councils and medical charities, and also from private companies, including Novo Nordisk Foundation, AstraZeneca, Amylin, the A.P. Møller Foundation, and the Augustinus Foundation. I’ve also consulted for Boost Treadmills and Gu Energy on R&D grant applications, and I provide research and scientific writing services for Examine.com. Some of my articles contain links to information provided by Examine.com but I do not receive any royalties or bonuses from those links. Importantly, none of the companies described above have had any control over the research design, data analysis, or publication outcomes of my work. I research and write my content using state-of-the-art, consensus, peer reviewed, and published scientific evidence combined with my empirical evidence observed in practice and feedback from athletes. My advice is, and always will be, based on my own views and opinions shaped by the scientific evidence available. The information I provide is not medical advice. Before making any changes to your habits of daily living based on any information I provide, always ensure it is safe for you to do so and consult your doctor if you are unsure.