Dr. Armin Fischer has been one of the leading specialists in the field of pelvic floor training and modulated medium-frequency stimulation for many years.
As the author of the book “Pelvic Floor Training with Modulated Medium-Frequency Therapy”, he combines scientific understanding of pelvic floor musculature with extensive practical therapeutic experience. His expertise includes the functional anatomy of the pelvic floor, the causes and mechanisms of pelvic floor weakness, and the targeted use of modern technologies for deep-acting muscle activation.
Through his work, Dr. Fischer contributes significantly to raising awareness of the importance of the pelvic floor for posture, stability, well-being, and prevention. In the following questionnaire, he shares his knowledge on physiological relationships, the role of breathing, the use of medium-frequency stimulation, and practical recommendations for various target groups.
myostyle: What motivated you to engage so intensively with the pelvic floor and ultimately write a specialist book on it?
Dr. med. Armin Fischer: For more than 35 years, I have been working in the field of urogynecology. In addition to surgical treatment, conservative (i.e., non-surgical) therapy is an essential pillar in the effort to treat the suffering of women affected by pelvic organ prolapse and pelvic floor dysfunction. We have many different treatment methods available. Prior to the use of modulated medium-frequency electrotherapy in the form of external application of current, low-frequency applications often required intravaginal probes to deliver the current to the location where it needed to act. In connection with my own EMS training, we then developed, together with electrophysiotherapists, the concept of EEMA training, external electrical muscular activation. Initially, this was done using a full-body suit. Development then moved toward adhesive electrodes in the area of the anterior abdominal wall, inner thighs, or gluteal region. The results achieved then needed to be scientifically evaluated to make statements regarding effectiveness. Through numerous publications, including in book form, we attempted to spread this therapeutic concept and teach it in professional courses.
myostyle: How would you describe the structure and function of the pelvic floor in simple, understandable terms?
Dr. med. Armin Fischer: The pelvic floor is a very complex combination of organs (bladder, internal genital organs, rectum), layers of connective tissue, and musculature, which in women is designed to allow a vaginal birth. The connective tissue provides shaping, positional support, and force transmission. The musculature provides the required stability and the necessary forces to ensure the function of the organs. The musculature is arranged three-dimensionally in layered, curtain-like structures to allow opening and closing.
myostyle: What typical complaints or functional disorders arise when the pelvic floor is weakened? And which early warning signs are often overlooked?
Dr. med. Armin Fischer: Genetic disposition (“weak connective tissue”), physical stresses throughout life (work, childbirth, sports, incorrect loading due to illnesses such as asthma/COPD), but especially pregnancies and births place a heavy burden on the pelvic floor. The symptoms resulting from changes in the pelvic floor, whether functional and/or structural, are manifold. A feeling of downward pressure, a foreign-body sensation, chafing, soreness, and prolapse of vaginal segments up to uterine prolapse are considered prolapse disorders. Stress incontinence (urine loss during coughing, jumping, running, standing up) often results from laxity of the connective tissue surrounding the urethra, which ensures force transmission of the musculature to the closure mechanism. Prolapse-associated bladder symptoms include imperative urgency (having to go to the toilet immediately when the urge arises), increased frequency of urination (compared to earlier), which is often accompanied by an inability to hold urine on the way to the toilet due to insufficient force transmission. Symptoms often arise especially in the perimenopausal period because reduced estrogen production of the ovaries adds additional unfavorable factors.
Thus, early symptoms are more frequent urinary urgency (without a urinary tract infection), a feeling of downward pressure (especially in the afternoon/evening and after physical exertion), and stress incontinence.
myostyle: In your book, you describe the advantages of modulated medium-frequency. What fundamentally distinguishes this current form from low-frequency stimulation or classic EMS?
Dr. med. Armin Fischer:
- Simple and external application – no vaginal probes.
- Volume effect of modulated medium-frequency current (larger volumes are reached).
- Direct effect on muscle cells, neural impulse transmission is not required – very helpful in cases of pelvic floor muscle damage due to trauma.
- With localized application, daily 20-minute training is possible.
- Often 3 months are sufficient until training can continue independently without current.
myostyle: Why is medium-frequency particularly suitable for deep muscle groups such as the pelvic floor?
Dr. med. Armin Fischer: Due to the volume effect of modulated medium-frequency current, deep musculature can be effectively reached with appropriate electrode placement without having to apply current vaginally and without depending on the intact neural supply of still metabolically active muscle cells. The effect can be further improved through corresponding simple physiotherapeutic accompanying exercises.
myostyle: What physiological effects occur in the musculature with medium-frequency that are not achieved with other current forms?
Dr. med. Armin Fischer: What is particularly pleasant for users is that with this form of EEMA training, whether full-body or localized, no muscle soreness occurs, even though the muscle cells are effectively stimulated and thus encouraged to grow. The current penetrates deeply into the tissue by painlessly overcoming skin resistance. Through muscle stimulation, the user gains a sense of where muscle activity takes place and can thus be transferred from more or less purely passive training into active (possibly biofeedback-supported) training (proprioceptive feedback). Improvement of blood circulation and regeneration (from 6 weeks postpartum or postoperatively) due to a positive influence on tissue metabolism is also suggested. Medium-frequency current is also used for reducing pain and muscular hypertonus, although this is not the focus of EEMA treatment.
myostyle: What experiences have you gathered in practice – what do users typically feel first when working with electrical stimulation?
Dr. med. Armin Fischer: Essentially, it is the “aha” moment that is repeatedly mentioned first – “so this is where my pelvic floor is.” This realization—where strength originates and where I can generate force—is a key experience in connection with muscle training. The second thing reported, especially by women who have already undergone low-frequency training, is that it is absolutely not unpleasant, painful, or irritating and that it does not cause muscle soreness.
Interestingly, regarding women’s perception of the effectiveness of the application, it is similar to the often lacking perception of insufficiency of pelvic floor musculature and activity before therapy: around 30% of women have no ability to sense whether the pelvic floor musculature is contracting/relaxing or whether a hypertrophy effect has occurred during treatment. This makes it all the more important that an assessment is carried out during the 6-week check-up and, if necessary, electrophysiotherapy-supported early rehabilitation is initiated.
myostyle: For which target groups is pelvic floor training with medium-frequency particularly suitable – therapeutically and preventively?
Dr. med. Armin Fischer:
Postpartum (preventive or therapeutic):
- Multiple births
- Infant weight > 3800 g
- Head circumference > 37 cm
- Long dilation period
- Long pushing period
- Vacuum or forceps extraction
- Secondary cesarean section due to labor arrest
- Pelvic floor functional disorders in multiparity prior to the current birth
- Significant pelvic floor damage during birth
- Pronounced prolapse of the vagina/uterus during the discharge examination after birth
Third- to fourth-degree perineal tears
Therapeutically:
- Patients with stress incontinence
- Patients with prolapse-associated urge problems
- Patients with prolapse and simultaneously hypocontractile pelvic floor
- Generally as part of multimodal treatment (local estriol, pessaries, …)
myostyle: How often should training take place in your view to achieve noticeable and lasting results?
Dr. med. Armin Fischer: With the development of practical home devices, the following treatment regimen can generally be recommended:
1. Instruction in device use and in the physiotherapeutic exercises corresponding to the stimulation sequences by an appropriately trained physiotherapist/midwife (45–60 minutes).
2. Daily application for 20 minutes with regional current; for full-body training (2-) 3 applications/week.
3. Re-evaluation of treatment success after.
- 3 months for home use with regional current application.
- 18 sessions (2/week) for full-body application as part of a statutory health insurance prescription with 2 × weekly physiotherapy on equipment over 3 × 6 prescribed sessions (this is the only way possible for insurance).
- Another 3 months for home use.
- Possibly consider long-term prescription through statutory health insurance over a certain period.
myostyle: Are there differences between men and women in training or the approach that you generally recommend?
Dr. med. Armin Fischer: As a urogynecologist, I (almost) exclusively treat female patients. In urology, the use of EEMA would fundamentally be useful and important particularly in the aftercare of prostate surgeries. For external application, however, I do not see any fundamental differences regarding the type and duration of the application. The effect is then assessed by the attending urologist.
myostyle: What contraindications or precautions should users be aware of before starting EMS or pelvic floor training?
Dr. med. Armin Fischer: There are several that must be carefully asked beforehand:
1. Pacemakers/defibrillators
2. Pregnancy
3. Malignant diseases
4. Pelvic vein thrombosis (including history)
5. Possible neurological diseases (e.g., MS, parkinsonism, although differing experiences are sometimes reported, especially in connection with MS), spasticity.
6. Acute inflammations (in the pelvic region)
7. Relative:
- Skin diseases (in the application area)
- Severe cardiovascular diseases
- Epilepsy
- Neuropathy
- Anticoagulation
- Joint prostheses (?)
- Up to 6 weeks postoperative (for full-body training or surgery in the pelvic area)
- Endometriosis (especially in acute flare)
- Unclear lower abdominal pain
myostyle: Do you have general recommendations on how to prevent muscle weakness in old age and associated pelvic floor problems?
Dr. med. Armin Fischer: The age-related process of reduction in body muscle mass (sarcopenia) is certainly a broad field of application for external electrical muscular activation with modulated medium-frequency current, especially in connection with osteoarthritis-related comorbidities that limit mobility.
In my field, I can only advocate seeking urogynecological care early when signs of pelvic floor dysfunction appear. It would be desirable if this expertise were available as part of the often-utilized preventive examinations, which unfortunately is not the case because most gynecologists are not sufficiently experienced in the specialty of urogynecology. Seeing a specialist in this area is often necessary and important in addition to “normal” gynecological care, even if it means traveling some distance.
This also includes not turning a blind eye to emerging symptoms and choosing to remain silent about this still-taboo topic rather than seeking early and timely help and support from a competent specialist. The demands placed on many women in old age through additional physical burdens such as caring for relatives must not be underestimated regarding their negative influence on pelvic floor health. The same applies, for example, to heavy gardening and agricultural work or continued involvement in farming. Early use of aids (e.g., pessaries, Contam tampons), possibly in combination with EEMA, often prevents more severe outcomes. Good for the women, bad for the hospitals if surgery numbers decrease as a result.