The Pelvic Floor Chair: A Pelvic Floor Therapist’s Thoughts on the Emsella Chair.
What is the Emsella Chair?
The Emsella Chair is a medical device that has been approved by the FDA as a safe treatment for urinary leakage. Essentially patients sit in the chair and the chair sends electrical impulses to stimulate the pelvic floor muscles to contract. The Emsella advertises that in a 20-ish minute session, it can mimic 10,000+ pelvic floor contractions.
That sounds great, but kegels are not always the answer.
If we look at how the pelvic floor functions, it rarely functions in isolation. Instead, our pelvic floor co-contracts with the muscles of our core, hips, back, and even our feet. Saying that the Emsella is all you need is similar to saying kegels are all that you need to help with your symptoms, and that is simply not true.
Research is now heading to the direction of pairing pelvic floor strengthening in combination with other functional movement, breath coordination, ensuring good mobility of the hips, back and legs. (3)
Isolated pelvic floor strengthening is one piece of the puzzle and by only doing isolated pelvic floor strengthening, you are only looking at one aspect of how the pelvic floor functions.
Also, in some situations, kegels can make symptoms worse- if you are dealing with any degree of tension in the pelvic floor (and remember tight muscles aren’t strong muscles so tight muscles will feel weak with a vaginal exam), the Emsella can exacerbate your symptoms. We have had patients with prolapse feel more irritated after using the Emsella and all our patients with painful intercourse that have tried it felt pain, and worsening of symptoms.
What is the research?
To be honest, we aren’t impressed with the research. Much of the research is focused on the effectiveness of Emsella at reducing symptoms of stress incontinence, yet the chair is recommended by medspas to patients that have symptoms other than stress incontinence (such as prolapse, sexual dissatisfaction, and fecal incontinence). There are a lot of inferences made by these studies assuming that Emsella is effective at helping populations other than patients dealing with stress incontinence, however there isn’t research to support it.
There is some research that compares the effectiveness of the chair compared to electrical stimulation treatment.(1) However electrical stimulation treatment is an “old school” treatment of pelvic floor conditions.
Muscle physiology research shows that active contractions are always better than passive contractions (via a machine like E-stim). If you remember the ab belt craze from the late 90’s, early 2000’s, people realized that there is no substitution for hard work at the gym and that you cannot just get a six pack by wear a machine that will contract your abs.
Proper resistance exercise prescription involves manipulation of resistance used, total number of sets and repetitions, exercises selected and workout structure, the sequence of exercise performance, rest intervals between sets, repetition velocity, and training frequency specific to the targeted goals. (2)
Also, 10,000 submaximal contractions doesn’t fit within typical strength training parameters and we think it’s unnecessary and excessive. In addition, many of the studies only site the short term effectiveness of the Emsella chair, and that maintenance sessions are recommended every 3-6 months.
Unfortunately there are no good studies comparing the Emsella chair to good pelvic floor physical therapy, meaning an active, whole body, functional approach to pelvic floor training.
What is the cost?
The cost of treatment ranges from $300-$500 per 20-ish minute treatment. Most patients need 5-6 sessions, so the cost can definitely be a factor. Having said that, some people are willing to try it, but understandably others are not. On top of the initial investment, it is costly to have to continue to pay for maintenance sessions every 3-6 months.
Our recommendation.
All of that to say, research is questionable and quality studies comparing the Emsella chair to quality pelvic floor physical therapy are non-existent. The device costs medspas a lot of money, and we think crafty marketing and playing with data from research is very biased and misleading.
The chair goes against much of the strength training, muscle physiology research that is well known and well established. It doesn’t address all of the functions of the pelvic floor (it’s ability to coordinate with other muscles, or it’s ability to lengthen)
We tell our patients that if it’s something you are willing to try, you can, but please know that the cost may be a huge factor and your symptoms may not actually improve. In fact, for that cost, you could get quality pelvic floor physical therapy that can give you significant long term relief of your symptoms. To learn more about how good pelvic floor physical therapy can help you, click here.
Having said that, it is totally up to you, whether or not you want to try it, but please make sure you partner with a quality pelvic floor physical therapist and try quality, evidence based pelvic floor physical therapy prior to trying the Emsella chair.