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Anja Weissenfels,1 Marc Teschler,1 Sebastian Willert,1 Michael Hettchen,1 Michael Fröhlich,2 Heinz Kleinöder,3 Matthias Kohl,4 Simon von Stengel,1 Wolfgang Kemmler1 1Institute of Medical Physics, Friedrich-Alexander University of Erlangen, Erlangen, Germany; 2Department of Sports Science, University of Kaiserslautern, Kaiserslautern, Germany; 3Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany; 4Department of Medical and Life Sciences University of Furtwangen, Villingen-Schwenningen, Germany Purpose: Low back pain (LBP) is one of the most frequent chronic conditions worldwide. Data from a recent meta-analysis indicated that whole-body electromyostimulation (WB-EMS), a time-effective, joint–friendly, and highly individualized training technology, demonstrated promising effects on LBP; however, methodologic limitations prevent definitive evidence for this result. Thus, the aim of this study was to conduct a randomized controlled WB-EMS trial to determine the corresponding effect on chronic, nonspecific LBP in people with chronic LBP. Patients and methods: Thirty LBP patients, 40–70 years old, were randomly assigned into two groups (WB-EMS: 15; control [CG]: 15). While the nonactive CG maintained their lifestyle, the WB-EMS group completed a 12-week WB-EMS protocol (1×20 min/week) with slight movements, specifically dedicated to LBP. Pain intensity and frequency were determined by a 4-week pain diary before and during the last 4 weeks of intervention. Primary study endpoint was average pain intensity at the lumbar spine. Results: At baseline, no group differences apart from nonregular exercise were observed. Mean intensity of LBP decreased significantly in the WB-EMS group (P=0.002) and remained unchanged in the CG (P=0.730), with a significant difference between both groups (P=0.027). Maximum isometric trunk extensors improved significantly in the WB-EMS group (P=0.005), while no significant difference was seen in the CG (P=0.683). In contrast to the significant difference between WB-EMS group and CG for the latter parameter (P=0.038), no intergroup difference was determined for maximum isometric trunk flexors (P=0.091). The WB-EMS group showed a significant increase of this parameter (P=0.003), while no significant change was determined in the CG (P=0.563). Conclusion: WB-EMS is a time-effective training method for reducing chronic nonspecific LBP and increasing maximum trunk strength in people with such complaints. After this promising comparison with a nonactive CG, research needs to be extended to include comparisons with active groups (WB-Vibration, conventional back strengthening). Keywords: electrical stimulation, electrical muscle stimulation, EMS, LBP, pain intensity, muscle strength

Rare but regularly recurring complications are leading to ongoing regulation of the commercial, non-medical whole-body electromyostimulation (WB-EMS) market. In addition to the revised German Radiation Protection Statutes (NiSV), the Deutsche Industrie Norm (DIN) 33961-5 was recently published with safety policies for WB-EMS application, anchoring both relative and absolute contraindications for WB-EMS for the first time. The purpose of this article is to justify the rationale of contraindications in a commercial setting and to support their consistent application.While the relative contraindicationsappear plausible and uncritical, absolute contraindications for WB-EMS are much more debatable. In fact, some absolute contraindications (e.g. diabetes mellitus) could be safely addressed by WB-EMS at least after careful medical anamnesis and competent, close supervision. However, this requires sound knowledge of WB-EMS on the part of physicians and instructors, low user-trainer ratios and prompt medical care in an emergency.However, considering the multitude of different settings of commercial WB-EMS, in extreme cases with hardly supervised, only video-guided WB-EMS sessions, the necessary accurateness and expertise for safe WB-EMS is not always guaranteed. That there is no mandatory licensing of WB-EMS instructors, the key players in WB-EMS, underscores the concern. Whilst acknowledging the multitude of high-quality suppliers, it is advised thatthe commercial, non-medical WB-EMS sector as a whole to be wary of indications with significantly increased complication potential. Lastly, the mandatory acceptance of the contraindications listed in DIN 33961-5 might be considered as an inevitable step towards preventing overregulation by official authorities.KEY WORDS: Whole-Body Electromyostimulation, DIN 33961-5, Commercial Application, Guideline

Hepatic tumors appear as stiff inclusions within the surrounding soft, healthy tissue. In open surgery they are searched for by manual palpation with the gloved fingertip. However, to exploit the benefits of MIS it is mandatory to implement a substitution for the human sense of touch. Therefore, a tactile instrument has been developed with the aim of enlarging the sensing area at the tool tip once it enters the abdominal cavity through the trocar. The provision of a large sensitive surface enables the detection of nearly all sizes of tumors and decreases the time needed for the performance of this task. A prototype was manufactured by laser sintering in PA serving as a carrier for an existing flexible silicone sensor. Automated as well as manual subject palpation tests have shown that a prototypical instrument with a laterally opening lid would be a suitable device for tumor detection in laparoscopic liver surgery.

The article discusses the safety aspects and contraindications related to whole-body electromyostimulation (WB-EMS) in commercial and medical settings. It addresses the controversy surrounding the classification of tumor and cancer as relative contraindications for WB-EMS application. The authors emphasize the importance of evidence-based and consensus-driven approaches to ensure the safety of vulnerable clients and the need for medical supervision in WB-EMS facilities. The article highlights the differences in risk assessments between commercial and medical settings and the role of medical gatekeepers in determining the eligibility of patients for WB-EMS. [Extracted from the article]