Beurer EM 49 - Digital EMS/TENS Unit Manual

Signs and symbols

Read these instructions for use carefully and keep them for later use, be sure to make them accessible to other users and observe the information they contain.

	Warning instruction indicating a risk of injury or damage to health
	Safety note indicating possible damage to the device/ accessory
	Note Note on important information
	Observe the instructions for use
IP22	Protected against ingress of solid foreign objects greater than 12.5 mm in diameter. Protected against drops of water falling at up to 15° from vertical.
	Serial number
	Application part, type BF
	Manufacturer
	The device can emit effective output values above 10 mA, averaged over every five-second interval
	Authorized representative in the European Community

• Back pain, particularly in the lumbar/cervical spine area
• Sore joints (e.g. knee, hip and shoulder joints)
• Neuralgia
• Menstrual cramps in women
• Pain resulting from injury to the musculoskeletal system
• Pain caused by circulatory disorders
• Chronic pain with various causes.

Electrical muscle stimulation (EMS) is a widespread and generally recognised method and has been used in sports medicine and rehabilitation for years. In sports and fitness, EMS is used to complement conventional muscle training, to increase the performance of muscle groups and to adjust physical proportions to achieve the desired aesthetic results. There are two different types of EMS application: one is for targeted strengthening of the muscles (activating application), and the other is to achieve a relaxing, restful effect (relaxing application).
The activating application involves:

• Muscle training to increase endurance and/or
• Muscle training to support the strengthening of specific muscles or muscle groups, and to achieve the desired changes to physical proportions

The relaxing application involves:

• Muscle relaxation for easing muscle tension
• Improving symptoms of muscular fatigue

Acceleration of muscle regeneration after high muscle performance (e.g. after a marathon)
Thanks to integrated massage technology, digital EMS/TENS units are also able to relieve muscle tension and combat fatigue with a program based on the sensation and effects of a real massage. The positioning suggestions and program tables in these instructions for use allow you to quickly and simply determine the corresponding application (depending on the affected area of the body) and set the unit to achieve the desired effects.
Thanks to the two separately adjustable channels, the digital EMS/ TENS unit offers you the advantage of being able to set the intensity of the impulses independently from each other for two treatment areas on the body, for example to cover both sides of your body or to evenly stimulate larger areas of tissue. The option to individually set the intensity of each channel also enables you to treat two separate areas of the body simultaneously instead of having to treat the individual areas in turn, which saves you time.

Device description

Buttons:

1. ON/OFF button
2. ENTER button
3. Setting buttons
   ( left, right)
4. MENU button
5. Keylock

Initial use

1. Remove the belt clip from the unit (if attached).
2. Press the battery compartment cover on the rear of the device and slide it downwards.
3. Insert the three alkaline AAA 1.5 V batteries. Make sure that the batteries are inserted the correct way round.
4. Close the battery compartment lid again carefully (Fig. 1).
   
5. Reattach the belt clip, if required.
6. Connect the connection cables with the electrodes (Fig. 2).
   The electrodes feature clip closures to make connection particularly easy.
   
7. Guide the connection cable plugs into the socket on the top of the device (Fig. 3).
   
8. Do not pull, twist or make sharp bends in the cables (Fig. 4).
   Please note that when the battery is replaced or removed, all settings are restored to the factory default settings.
   

Use

Notes on use

• The device switches itself off automatically if it is not used for one minute (automatic switch-off). When the unit is switched on again, the LCD screen displays the menu selection and the most recently used menu flashes.
• A brief acoustic signal is output when a valid button is pressed. Two brief acoustic signals are output when an invalid button is pressed.
• You can pause the stimulation at any time by briefly pressing the ON/OFF button . To continue the stimulation, briefly press the ON/OFF button again and set the desired impulse intensity again.

Starting application

1. Look for a suitable program from the program tables (see "Program overview").
2. Place the electrodes on the desired area for treatment (for positioning suggestions see section „Information regarding the positioning of electrodes") and connect them to the device.
3. Press the ON/OFF button to switch on the device.
4. Press the MENU button to navigate through the / menus and press the ENTER button to confirm your selection.
5. Use the ˄/˅ setting buttons to select the program number you want and press the ENTER button to confirm your selection.
   At the start of the stimulation treatment, the impulse intensity of and is set to 00 by default. No impulses are sent to the electrodes yet.
6. Use the left and right setting buttons for and to select the impulse intensity you want. The indicator for impulse intensity in the display changes accordingly. If the program is in a pause phase, the intensity cannot be increased.

General information
If you wish to return to the previous selection menu, press the MENU button. By holding down the ENTER button, you can skip individual setting steps and start directly with the stimulation treatment.

Keylock
Locks the buttons to avoid them being pressed unintentionally.

1. To activate the keylock, hold down the button until the symbol is visible in the display (approx. 3 seconds).

2. To deactivate the keylock, hold down the button until the symbol disappears from the display (approx. 3 seconds).

Pausing application
You can pause the stimulation at any time by briefly pressing the ON/OFF button . To continue the stimulation, briefly press the ON/OFF button again and set the desired impulse intensity again.

Program overview

The digital EMS/TENS unit features a total of over 70 programs:

• 15 TENS programs
• 35 EMS programs
• 20 MASSAGE programs

In all programs you can set the impulse intensity of both channels individually.
You can also set various parameters in the TENS programs 13 – 15 and the EMS programs 33 – 35 to adjust the stimulating effect to the application area.

TENS program table

TENS programs 13 - 15 can be set individually (see section „Customisable programs").
Note: See the correct electrode position.

EMS program table

EMS programs 33 - 35 can be set individually (see section „Customisable programs").
Note: See the correct electrode position.

MASSAGE program table

Note: See the correct electrode position.

Do not apply the electrodes to the front wall of the chest, i.e. do not massage the large left and right pectoral muscles.

Information regarding the positioning of electrodes

It is fundamental to the intended success of electrostimulation applications that electrodes are positioned sensibly. We recommend that you consult your doctor to establish the ideal electrode positions for your intended application area. The figure on the display is intended as an initial aid to help you position the electrodes.
The following applies to the selection of electrode positions:

Electrode distance
The larger the distance between electrodes, the larger the stimulated tissue volume. This applies to the area and depth of the tissue volume. At the same time, however, the stimulation intensity of the tissue falls the further the electrodes are apart. As a result, greater distances between electrodes mean a larger tissue volume is stimulated, but less intensively. Consequently, you must increase the impulse intensity to boost stimulation.
The following guideline applies to selection of the electrode distance:

• Sensible distance: approx. 5 – 15 cm
• At distances below 5 cm, the unit primarily stimulates surface structures intensively
• At distances in excess of 15 cm, large areas and deep structures are stimulated very weakly

Relationship between electrodes and muscle fibre structures

Adapt the current flow direction to the fibre structure of the muscle according to the muscle layer you would like to treat. If you are targeting superficial muscles, position the electrodes in parallel to the fibre structure (A – B / C – D) and if you are targeting deeper layers of tissue, position the electrodes across the fibre structure. You can do this by positioning electrodes as crosses (i.e. diagonally), such as A – D / B – C.
As part of pain relief treatment (TENS) using the digital EMS/ TENS unit and its 2 separately adjustable channels and 2 adhesive electrodes each, it is advisable either to position the electrodes of a channel so that the area affected by the pain is between the electrodes or to position one electrode directly on the area affected by the pain and the other electrode at a minimum distance of 2 – 3 cm.
You may use the electrodes of the second channel to simultaneously treat additional areas affected by pain or use them in conjunction with the electrodes of the first channel to restrict the area affected by pain (position electrodes opposite).
In this case, we once again recommend positioning electrodes as crosses.
Tip for the massage function: always use all four electrodes for optimum treatment.
Use the electrodes on skin that is clean and preferably free from hair and grease in order to prolong the life of the electrodes. If required, clean the skin with water and remove hair prior to treatment.
If an electrode should come loose during use, the impulse intensity of both channels is reduced to the lowest level. Apply the electrode again and reset the desired impulse intensity.

Customisable programs

(Applies for TENS 13-15, EMS 33-35)
The programs TENS 13-15 and EMS 33-35 can be customised according to your needs.

TENS 13 program
TENS 13 is a program that you can also customise. In this program, you can set the impulse frequency to between 1 and 150 Hz and the impulse width to between 80 and 250 µs.

1. Place the electrodes on the desired area for treatment (for positioning suggestions see section "Information regarding the positioning of electrodes") and connect them to the device.
2. Select the TENS 13 program as described in section "Starting application" (step 3 to step 5).
3. Use the setting buttons to select the impulse frequency you want and use the ENTER button to confirm.
4. Use the setting buttons to select the impulse width you want and use the ENTER button to confirm.
5. Use the setting buttons to select the treatment time you want and use the ENTER button to confirm.
6. Use the left and right setting buttons for and to select the impulse intensity you want.

TENS 14 program
The TENS 14 program is a burst program that you can also customise. Various impulse sequences run in this program. Burst programs are suitable for all areas of application to be treated with changing signal patterns (to minimise the level of accustoming to the treatment). In this program you can set an impulse width of between 80 and 250 µs.

1. Place the electrodes on the desired area for treatment (for positioning suggestions see electrode positions) and connect them to the device.
2. Select the TENS 14 program as described in section "Starting application" (step 3 to step 5).
3. Use the setting buttons to select the impulse width you want and use the ENTER button to confirm.
4. Use the setting buttons to select the treatment time you want and use the ENTER button to confirm.
5. Use the left and right setting buttons for and to select the impulse intensity you want.

TENS 15 program
TENS 15 is a program that you can also customise. In this program, you can set the impulse frequency to between 1 and 150 Hz. The impulse width changes automatically during the stimulation treatment.

1. Place the electrodes on the desired area for treatment (for positioning suggestions see electrode positions) and connect them to the device.
2. Select the TENS 15 program as described in section "Starting application" (step 3 to step 5).
3. Use the setting buttons to select the impulse frequency you want and use the ENTER button to confirm.
4. Use the setting buttons to select the treatment time you want and use the ENTER button to confirm.
5. Use the left and right setting buttons for and to select the impulse intensity you want.

EMS 33 program
EMS 33 is a program that you can also customise. In this program, you can set the impulse frequency to between 1 and 150 Hz and the impulse width to between 80 and 320 µs.

1. Place the electrodes on the desired area for treatment (for positioning suggestions see electrode positions) and connect them to the device.
2. Select the EMS 33 program as described in section "Starting application" (step 3 to step 5).
3. Use the setting buttons to select the impulse frequency you want and use the ENTER button to confirm.
4. Use the setting buttons to select the impulse width you want and use the ENTER button to confirm.
5. Use the setting buttons to select the treatment time you want and use the ENTER button to confirm.
6. Use the left and right setting buttons for and to select the impulse intensity you want.

EMS 34 program
EMS 34 is a program that you can also customise. In this program, you can set the impulse frequency to between 1 and 150 Hz and the impulse width to between 80 and 450 μs. You can also set the working time and pause time for this program to between 1 and 30 seconds each.

1. Place the electrodes on the desired area for treatment (for positioning suggestions see electrode positions) and connect them to the device.
2. Select the EMS 34 program as described in section "Starting application" (step 3 to step 5).
3. Use the setting buttons to select the working time ("on time") you want and use the ENTER button to confirm.
4. Use the setting buttons to select the pause time ("off time") you want and use the ENTER button to confirm.
5. Use the setting buttons to select the impulse frequency you want and use the ENTER button to confirm.
6. Use the setting buttons to select the impulse width you want and use the ENTER button to confirm.
7. Use the setting buttons to select the treatment time you want and use the ENTER button to confirm.
8. Use the left and right setting buttons for and to select the impulse intensity you want.

EMS 35 program
EMS 35 is a burst program that you can also customise. Various impulse sequences run in this program. Burst programs are suitable for all areas of application to be treated with changing signal patterns (to minimise the level of accustoming to the treatment). In this program, you can set the impulse frequency to between 1 and 150 Hz and the impulse width to between 80 and 450 μs. You can also set the working time and pause time for this program to between 1 and 30 seconds each.

1. Place the electrodes on the desired area for treatment (for positioning suggestions see electrode positions) and connect them to the device.
2. Select the EMS 35 program as described in section "Starting application" (step 3 to step 5).
3. Use the setting buttons to select the working time ("on time") you want and use the ENTER button to confirm.
4. Use the setting buttons to select the pause time ("off time") you want and use the ENTER button to confirm.
5. Use the setting buttons to select the impulse frequency you want and use the ENTER button to confirm.
6. Use the setting buttons to select the impulse width you want and use the ENTER button to confirm.
7. Use the setting buttons to select the treatment time you want and use the ENTER button to confirm.
8. Use the left and right setting buttons for and to select the impulse intensity you want.

Doctor's function

The Doctor's function is a special setting to allow you to access your personal program even more easily and directly. Your individual program settings are instantly recalled and activated when the device is switched on.
You may wish to adjust this individual program following advice from your doctor.

Setting the Doctor's function

• Select your program and the corresponding settings as described in section "Starting application".
• At the start of the stimulation treatment, the impulse intensity of and is set to 00 by default. No impulses are sent to the electrodes yet. Before setting the desired impulse intensity using the intensity setting buttons, press and hold the -button for 5 seconds. Storage in the Doctor's function is confirmed with a long acoustic signal.
  If you switch on the device again, the program you saved using the Doctor's function is automatically opened directly.

Deleting the Doctor's function
To clear the device again and to re-allow access to other programs, press and hold the -button again for approx. 5 seconds. To do this, the impulse intensity of and must be set to 00.
Deletion of the Doctor's function is confirmed with a long acoustic signal.

Therapy memory
The EM49 records the treatment time. To reach the therapy memory, switch the device on using the ON/OFF button and press and hold the button for 5 seconds. The treatment time lapsed appears in the display. The top two numbers stand for minutes; the hours are shown below. To reset the treatment time, press and hold the button for 5 seconds. When replacing the battery, the therapy memory is automatically reset. Press the „Menu" button to return to selecting a program, or switch the device off. Info: Therapy memory cannot be accessed if the Doctor's function is activated.

Current parameters

Electrostimulation units operate with the following current settings, which may affect stimulation effects differently, depending on the setting:

Impulse shape

This describes the time function of the electrical impulse.
It distinguishes between monophasic and biphasic pulse currents. In monophasic pulse currents, the current flows in one direction and in biphasic pulse currents the electrical impulse alternates its direction.
The digital EMS/TENS unit only provides biphasic pulse currents as these relieve muscles, cause little muscle fatigue and provide safer application.

Impulse frequency

The frequency indicates the number of individual impulses each second and is given in Hz (Hertz). It can be calculated by determining the cyclic value for the time period. The relevant frequency determines which types of muscle fibres react favourably. Slow-reacting fibres react more easily to lower impulse frequencies up to 15 Hz, whereas fastreacting fibres only respond from approximately 35 Hz onwards. Impulses of approx. 45 – 70 Hz are linked with constant tension in the muscles and quicker fatigue. Higher impulse frequencies are therefore favourable in strength and maximum power training.

Impulse width

This indicates the duration of an individual impulse in microseconds. The impulse width therefore determines, among other things, the penetration of the electricity, where usually: larger muscle masses require larger impulse widths.

Impulse intensity

Setting the intensity levels depends on the individual sensitivity of each user and is determined by a variety of variables, such as site of application, blood circulation to the skin, skin thickness and the quality of the electrode contact. The setting used should be effective but should never cause an unpleasant sensation, such as pain, at the site of application. While a gentle tingling indicates sufficient stimulation energy levels, any setting that causes pain should be avoided.
During longer applications it may be necessary to make readjustments due to the adjustment processes over time at the site of application.

Cycled impulse parameter variation

In many cases it is necessary to cover the overall tissue structure at the site of application by applying several impulse parameters. In the digital EMS/TENS unit, this is achieved by the provided programs, which automatically make a cyclical impulse parameter change. This also prevents individual muscle groups at the site of application being affected by fatigue.
The digital EMS/TENS unit provides sensible default current parameter settings. With this, you can change the impulse intensity at any time during use. For 6 programs you can also set various parameters for stimulation yourself.

Cleaning and storage

Adhesive electrodes

• To ensure that the adhesive electrodes remain adhesive for as long as possible, clean them carefully with a damp, lint-free cloth or clean the underside of the electrodes under lukewarm, running water and pat dry with a lint-free cloth.
  Before cleaning with water, remove the connection cables from the electrodes.
• Reapply the electrodes to the carrier foil following treatment.

Cleaning the device

• Remove the batteries from the device before cleaning.
• Clean the device after use with a soft, slightly damp cloth. If it is very dirty, you can also moisten the cloth with a mild soapy solution.
• Do not use any chemical or abrasive cleaning agents.
  Ensure that no water enters the device.

Reuse of the device
Once it has been properly prepared, the device can be used again. Preparation includes replacement of the treatment electrodes as well as cleaning of the surface of the device using a cloth moistened with a mild soapy solution.

Storage

• Remove the batteries from the device if you will not be using it for a prolonged period of time. Leaking batteries may damage the device.
• Do not make sharp bends in the connection cables and electrodes.
• Disconnect the connection cables from the electrodes.
• Reapply the electrodes to the carrier foil after use.
• Store the device and accessories in a cool, well-ventilated space.
• Never place any heavy objects on the device.

Problems/solutions

The device does not switch when the ON/OFF button is pressed. How to proceed:

1. Ensure batteries have been inserted correctly and are in contact with the terminals.
2. Replace batteries, if applicable.
3. Contact Customer Services.

Electrodes do not adhere to the body

How to proceed:

1. Clean the adhesive surface of the electrodes using a damp, lint-free cloth. Replace the electrodes if they still do not adhere securely.
2. Clean the skin prior to any application; do not use skincare lotions or oils prior to treatment. Shaving may increase the life of electrodes.

There is no noticeable stimulation

How to proceed:

1. Press the ON/OFF button to interrupt the program. Check the connection cables are correctly connected to the electrodes. Ensure the electrodes are in firm contact with the treatment area.
2. Ensure the connection plug is firmly connected to the device.
3. Press the ON/OFF button to restart the program.
4. Check electrode positions and ensure that adhesive electrodes do not overlap.
5. Gradually increase the impulse intensity.
6. The batteries are almost empty. Replace the batteries.

The battery symbol is shown

How to proceed: Replace all batteries.

You have an unpleasant sensation at the electrodes

How to proceed:

1. The electrodes are not positioned correctly. Check their positions and re-position, if necessary.
2. The electrodes are worn. This may cause irritated skin as even distribution of the current across the entire area is no longer guaranteed. For this reason, replace the electrodes.

Skin in the treatment area turns red

How to proceed: Immediately stop treatment and wait until your skin has returned to its normal condition. If the redness is under the electrode and disappears quickly, there is no risk – this is caused by the locally stimulated, increased blood flow.
However, consult your doctor before you continue treatment if the skin irritation persists and this is accompanied by an itchy sensation or inflammation. This may be caused by an allergic reaction to the adhesive surface.

Replacement parts and wearing parts

You can obtain the following replacement parts directly from Customer Services:

Technical specifications

The serial number is located on the device or in the battery compartment.
Note: If the device is not used acording to the instructions specified, perfect functionality cannot be guaranteed!
We reserve the right to make technical changes to improve and develop the product.
This device complies with European standards EN60601-1 and EN60601-1-2 (In accordance with IEC 61000-4-2, IEC 61000-4-3, IEC 61000-4-4, IEC 61000-4-5, IEC 61000-4-6, IEC 610004-8 and IEC 610004-11) and is subject to special precautionary measures with regard to electromagnetic compatibility. Please note that portable and mobile HF communication systems may interfere with this unit.
More details can be requested from the stated Customer Services address or found at the end of the instructions for use.
This device meets the requirements of European Directive 93/42/EEC for medical products, as well as those of the Medizinproduktegesetz (German Medical Devices Act).

Notes on electromagnetic compatibility

• The device is suitable for use in all environments listed in these ins-tructions for use, including domestic environments.
• The use of the device may be limited in the presence of electroma-gnetic disturbances. This could result in issues such as error messages or the failure of the display/device.
• Avoid using this device directly next to other devices or stacked on top of other devices, as this could lead to faulty operation. If, however, it is necessary to use the device in the manner stated, this device as well as the other devices must be monitored to ensure they are working properly.
• The use of accessories other than those specified or provided by the manufacturer of this device can lead to an increase in electromagnetic emissions or a decrease in the device's electromagnetic immunity; this can result in faulty operation.
• Keep portable RF communication devices (including peripheral equipment, such as antenna cables or external antennas) at least 30 cm away from all device parts, including all cables included in delivery. Failure to comply with the above can impair the performance of the device.
• Failure to comply with the above can impair the performance of the device.

• Use identical or equivalent battery types only.
• Always replace all batteries at the same time.
• Do not use rechargeable batteries.
• Do not disassemble, open or crush the batteries.