Quick Overview

Scientists in Berlin asked a simple question. Can EMS-style FES help people whose legs are paralysed swim better?

They studied two men with complete paraplegia after spinal cord injury. Both could already do front crawl with their arms. For 10 weeks they swam in a 16 m pool. Staff timed laps with no help, with FES on the thighs, and with FES plus extra back stimulation.

FES made average laps about 15.4% and 8.7% quicker. Both together made them about 19.3% and 20.9% quicker. Water-proof sensors showed the knees straighter by up to 60 degrees. After 30–45 minutes, both men said tight spasms stayed away for up to four hours.

The work was checked by other experts and printed in a trusted science journal. Read the full post for the full story.

We always provide direct links to the original research at the end of every article so you can review the evidence yourself.

When Paralysed Legs Joined the Swim: What a Berlin Study Measured With Electrical Stimulation

This is a research story.
It is not medical advice.
It does not sell a device.

A small feasibility study asked a simple question.
Could electrical stimulation help people with paraplegia swim faster and feel more comfortable in the water?

The answer, in two experienced swimmers, was encouraging.

Where this came from

The paper was published on 16 April 2020.
The journal is the Journal of NeuroEngineering and Rehabilitation.
That journal is peer reviewed and open access.
It is published by BMC, part of Springer Nature.
The work is also listed on PubMed.

Lead authors worked at Technische Universität Berlin.
Swimming sessions ran at the Treatment Centre for Spinal Cord Injuries.
That centre sits inside ukb Unfallkrankenhaus Berlin, a major German trauma hospital.
Neurology support came from Charité – Universitätsmedizin Berlin.
An ethics committee of the Berlin Chamber of Physicians approved the protocol.
The approval code was Eth-28/17.
Both people gave written consent.

Germany has a long record in engineering and medical research.
This study sits in that tradition.
It is a pilot.
It is not a large trial.

Who took part

Two men joined.
Both had complete spinal cord injury.
Doctors graded both as ASIA A.
The injury level was T5/6 in each case.
That means the legs had no voluntary movement.

Subject A was 40.
His injury was 10 years old.
Subject B was 58.
His injury was 36 years old.
Both already knew front crawl.
Both reported some lower-limb spasticity.
Subject B also had a stiff hip.

They were not beginners in the pool.
They were people whose legs could not kick on their own.

What the team wanted to learn

After spinal cord injury, sport is hard.
Legs do not move.
Muscle fatigue comes early.
Spasticity can interrupt a session.

Water takes some of the body weight.
Swim training can still build fitness.
The purpose of this study was to test a hybrid idea.

Use the arms as usual.
Use functional electrical stimulation, or FES, to make the thighs work.
FES is a research form of electrical muscle stimulation, often called EMS.
Add transcutaneous spinal cord stimulation, or tSCS, over the lower back.
Ask whether swim time, leg position, comfort, and spasticity change.

That was the purpose.
Help a defined group: people with complete paraplegia who can already swim front crawl.

How the sessions worked

First came four weeks of FES cycling at home.
That built a baseline of thigh strength.

Then came 10 weeks of pool work.
Each swim session lasted 30 to 45 minutes.
A trained pool guard was always present.
The pool was 16 metres long.

Waterproof electrodes sat on both quadriceps.
A stimulator rode in a sealed bag on the back.
Floats at the ankles helped the knees bend when the pulse stopped.
The pulse then straightened the knee again.
That made a simple flutter kick.

FES ran at 25 Hz.
The on-off rate was 1 Hz for Subject A.
It was 2 Hz for Subject B.
Thigh intensity started near 30 to 40 mA.
It rose to 50 to 60 mA as muscles tired.
tSCS used 40 mA for both men.

Researchers timed the first laps of each visit.
They swam as fast as they could.
They compared three set-ups.
No stimulation.
FES alone.
FES plus tSCS.

They used that order on purpose.
The supported laps came later.
Fatigue would work against the extra support.
That made any gain harder to fake.

What the stopwatch showed

Both men got a little quicker over the weeks.
That happened with and without stimulation.
They were not regular swimmers before the trial.

The bigger change was the support itself.

For Subject A, FES cut average 16 m time by 15.4%.
FES plus tSCS cut it by 19.3%.
His no-support average was 32.5 seconds.
With FES it was 27.4 seconds.
With both forms of stimulation it was 24.6 seconds.

For Subject B, FES cut average time by 8.7%.
FES plus tSCS cut it by 20.9%.
His no-support average was 31.0 seconds.
With FES it was 29.2 seconds.
With both forms it was 24.2 seconds.

In this tiny sample, adding the second stimulation layer sat with a larger average gain.
The authors said the mix gave the greatest speed change they measured.
That is the bright reading of their numbers.
It is not proof that “more gadgets” help everyone.

Subject A completed six sessions.
Subject B completed seven.
Life and pool closures got in the way.
After the first combined session, both men chose FES plus tSCS as their preferred training mode.

What the sensors showed

Nine months later the team ran one extra session.
Waterproof motion sensors sat on thighs, shanks, and the back.
These IMUs tracked knee, hip, and trunk roll.

FES, and FES with tSCS, improved knee extension in both men.
The gain reached about 60 degrees versus no stimulation.
tSCS alone did not change the knee range.
Hip extension rose a little in Subject A.
It did not rise in Subject B.
He already had a hip contracture.
Trunk roll looked similar in every condition.

So the speed story lined up best with a straighter knee kick.
The extra spinal stimulation did not show a clear extra joint-angle change in that later test.
The authors said they still do not fully know why the combined mode looked faster in training.

What the two swimmers reported

After 30 to 45 minutes with tSCS and FES, both men said lower-limb spasticity dropped.
They said the quiet period lasted up to four hours.
In that window they could not trigger a clonus or extensor spasm by changing posture.
Subject A did not notice that effect after his first session.
That first session used FES only.

Both men fully agreed the supported swim felt more comfortable.
They fully agreed it felt more enjoyable.
They fully agreed it felt more efficient than swimming with quiet legs.
They said they would use such a set-up for recreation and rehab if it existed.

Reusable silicone electrodes cut set-up time to about five minutes.
Adhesive waterproof electrodes had taken about ten.

What this does — and does not — mean

This was two people.
The authors say so.
There was no sham spinal stimulation.
Lap times in a short pool can swing with the start.
One man was very tired in the late test.
FES cycling happened in the same period.
Nobody measured oxygen use.

So this is early evidence, not a finished rule for sport.

The group it speaks to is clear.
People with complete paraplegia after spinal cord injury.
People who can already swim front crawl.
In that group, FES during swimming was linked to faster timed laps.
Adding tSCS was linked to still larger average time cuts in training.
The same sessions were followed by hours of quieter legs, by self-report.
Comfort scores were high.

That is the purpose made plain.
Electrical stimulation was used to bring paralysed legs into a real sport skill.
The measured progress was time, knee angle, and how the two men felt after.

Keep it honest

This blog is explaining a published paper.
It is not a product ad.
It does not claim a cure.
It does not claim EMS restores walking.
It does not say any shop device is approved for these uses.

FES and tSCS in this study were clinic-style research tools.
They were used under ethics approval, with a pool guard, in people already able to swim.
Anyone living with spinal cord injury should talk to their own clinical team before changing exercise.

The paper is free to read.
Search the title: “Supporting front crawl swimming in paraplegics using electrical stimulation.”
The authors are Wiesener, Spieker, Axelgaard, Horton, Niedeggen, Wenger, Seel, and Schauer.
The citation is J NeuroEngineering Rehabil 17:51 (2020).

Two swimmers.
Ten weeks.
A stopwatch.
Waterproof sensors.
A peer-reviewed German hospital and university study.
That is the record.
And in that record, supported swimming looked faster, kinder on spasticity, and worth doing again.

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