TENS therapy for back pain: benefits and how it works

Back pain can turn everyday activities — like working, exercising, or just relaxing at home — into a challenge. While medication may offer relief, many people are seeking drug-free ways to manage persistent pain. One option, available both at home and in providers’ offices, is transcutaneous electrical nerve stimulation (TENS). TENS therapy uses a device to deliver gentle electrical impulses through the skin to help reduce back pain.

These impulses target the nerves and muscles in your back, which can quiet your pain response and make it easier to move comfortably. TENS is easy to use and is often recommended alongside other treatments for back pain, such as exercise therapy.

Here, learn more about how TENS therapy works to relieve back pain — and learn about Enso, a wearable pain relief device from Hinge Health that is a type of TENS device. 

What does a TENS unit do for back pain? 

A TENS (transcutaneous electrical nerve stimulation) unit is designed to help quiet your body’s pain response. A traditional TENS unit is a battery-operated device with leads (wires) that connect to sticky pads with electrodes, which are placed on your skin. The device sends electrical pulses through these pads.

These pulses affect the nerves in your back to help reduce your body's pain response. You may feel some relief from symptoms during the session. The relief may or may not last after you stop using the TENS device.

TENS may also stimulate the release of natural painkillers like endorphins, providing further relief.

TENS therapy may help reduce back pain associated with conditions like sciatica, spinal stenosis, arthritis, degenerative disc disease, fibromyalgia, and more. TENS may provide relief from back pain related to injuries such as muscle strains and herniated discs. 

Can a TENS unit help relax back muscles?

If you have tension in your back, a TENS unit may help back muscles relax by targeting a key cause of tension: pain. When your back hurts, the surrounding muscles often tighten up, which can actually make the pain worse, explains Dominica Sourial, PT, DPT, a physical therapist at Hinge Health. TENS therapy uses gentle electrical impulses to stimulate nerves and reduce pain signals. 

As your pain decreases, those tight muscles may begin to relax. This helps interrupt the pain-contraction cycle, making it easier for your body to let go of tension — especially in cases of muscle spasms related to back pain. 

How to use a TENS unit for back pain 

When using a TENS machine for back pain, make sure to read the instruction manual for your device carefully. Some general tips include:

1. Prepare the area. Clean and dry the skin where you’ll place the electrodes to prevent irritation and help the pads stick. Dr. Sourial notes that shaving any excess hair can improve contact and make the electrical stimulation work better.

2. Position the electrodes. Your device instruction manual should provide direction about where to position the electrodes. Bony surfaces like the spine can make it difficult for the pads to stick well and may reduce the effectiveness of the therapy. If you have pain in the middle of your back, try putting the electrodes on either side of your spine. 

3. Adjust the intensity. Turn the unit on and start at the lowest intensity. Gradually increase the level until you feel a gentle tingling or pulsing. “Ramp up the intensity slowly until it feels strong but comfortable,” says Dr. Sourial.

4. Choose a session length. There is no single recommended session length for using a TENS device for back pain — duration can vary based on your individual needs and the specific device you’re using. Many people use TENS for anywhere from 10 to 60 minutes per session. Some find it helpful to use a TENS unit multiple times a day for back pain relief. Always follow the instructions provided by your TENS unit’s manufacturer, including any guidance on how long and how often to use the device. Be sure to give your skin periodic breaks from the electrode pads to minimize irritation. If you’re unsure about what’s right for you, consult your healthcare provider or physical therapist for personalized recommendations. 

5. Monitor your back pain. Monitor your back pain by noting how your back feels during and after each TENS session. The sensation from the device should be focused on the area where you typically experience pain. Mild discomfort is okay, but the treatment should not be overly painful. If needed, adjust the electrode placement or intensity. Listen to your body’s feedback and make changes to the settings as necessary for effective relief.

When to use a TENS unit for back pain

You can use a TENS unit much like you would use ice or heat — to temporarily relieve pain and support your ability to stay active.

Many people use TENS if their back pain starts to get in the way of their daily routines or activities. For example, you might use it to ease stiffness and discomfort during long stretches of sitting, like working at a desk. TENS can also be helpful after any physical activities that trigger back pain, including lifting, doing household chores, carrying groceries, or exercising. Some people find relief by using a TENS unit before bed to reduce muscle tension, or in the morning to ease stiffness after waking up. 

Who shouldn’t use a TENS unit? 

While TENS therapy is considered very safe, it’s best to avoid it under certain conditions. Make sure to read the instruction manual for any TENS device and review the contraindications, warnings, and precautions. 

For instance, TENS devices may be contraindicated for those who are pregnant or have implanted electronic devices, such as a cardiac pacemaker or implanted defibrillator. TENS may not be recommended for people with heart disease or who have epilepsy or another seizure disorder. TENS may cause skin reactions, such as a rash or irritation where electrodes are placed on the body. This isn’t a complete list, so be sure to read the instruction manual for your device.

TENS unit side effects

Most people tolerate TENS therapy well, but some side effects can occur. Here are some common side effects to watch for: 

• Skin irritation. Redness, itching, or skin reactions may occur at electrode sites, especially with prolonged use. To help prevent this, always clean and dry your skin before applying the electrodes, vary pad placement on your back, and replace electrode pads regularly as recommended by the manufacturer.

• Unpleasant sensations. If the electrical settings are too high, you might feel some discomfort. Always start with the lowest intensity and gradually increase until you reach a gentle tingling or slight discomfort — never a painful or burning feeling.

• Muscle twitching. Occasionally, the electrical impulses can cause minor muscle contractions. For some people, this sensation may feel therapeutic. For others, it might be too intense, in which case you should lower the intensity or move the electrodes to a less sensitive area.

Back pain relief: TENS plus movement 

TENS therapy works best when combined with other treatments — especially movement and exercise therapy, which help strengthen muscles, improve flexibility, and keep your spine and joints healthy. While TENS doesn't directly address the source of your pain, it can be a useful tool to make exercise and everyday movement more tolerable.

Many physical therapists recommend using TENS before exercise sessions to reduce pain and help you perform movements with less discomfort. By taking the edge off your pain, TENS can help you stick with stretching and strengthening routines, and other recommended exercises. 

Hybrid-form impulse therapy (HFIT) for back pain

Hybrid-form impulse therapy (HFIT) is an advanced form of nerve stimulation that is different from traditional TENS (transcutaneous electrical nerve stimulation). HFIT uses unique waveforms — patterns of electrical pulses that change in speed and strength — that can deliver more tailored pain relief. 

Hinge Health offers a wearable pain relief device called Enso as part of its programs. Enso uses HFIT waveforms and lets users control the strength (intensity) of the pulses. This makes it easy for people to adjust the treatment to fit their needs.

Enso has key differences from other TENS devices:

• Small, lightweight, and wireless, making it convenient to wear throughout the day.

• Patented waveforms that can provide personalized pain relief. 

• Proven effectiveness. A clinical study of 325 participants with chronic pain showed that those who paired Hinge Health’s exercise therapy programs with consistent Enso use were 2.3x more likely to experience reduced pain after four weeks compared to users of another TENS device.

PT tip: Use TENS along with exercise therapy  

“TENS can be a helpful tool for managing back pain, especially if pain is making movement tough,” says Dr. Sourial. “Using TENS before or after activity can relieve symptoms enough to help you stay mobile. Remember — real progress comes from movement and strengthening, not from TENS alone. TENS is best used as part of a broader pain management plan that includes exercise, stretching, and other therapies.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Hong, M., Krauss, J., Wang, G., Cohen, K., Chaisson, C. E., & Gulati, A. (2024). Effectiveness of Hybrid Form Impulse Therapy (HFIT) Compared to Traditional Transcutaneous Electronic Nerve Stimulation (TENS) in Patients with Chronic Low Back and Knee Pain: A Randomized Controlled Trial. Journal of Pain Research, 17, 2417–2430. https://doi.org/10.2147/JPR.S461343

2. World Health Organization. (2023, June 19). Low back pain. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/low-back-pain

3. Elsevier – Clinical Skills │ Transcutaneous Electrical Nerve Stimulation Unit: Pain Treatment (Rehabilitation Therapy). (2024, September 26). Elsevier Health. Retrieved from https://elsevier.health/en-US/preview/transcutaneous-electrical-nerve-stimulation-unit-pain-treatment

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6. Vance, C. G. T., Dailey, D. L., Chimenti, R. L., Van Gorp, B. J., Crofford, L. J., & Sluka, K. A. (2022). Using TENS for Pain Control: Update on the State of the Evidence. Medicina (Kaunas), 58(10), 1332. doi:10.3390/medicina58101332