After trauma or repetitive strain, pain and numbness may persist even when imaging looks normal. Is it nerve damage, muscle tension, or something else?
Electromyography (EMG) and nerve conduction studies (NCS)âcollectively called electrodiagnosticsâhelp pinpoint the cause, guide treatment, and often provide reassurance during recovery.
Think of the needle as a microphone. I am like an investigative reporter at the scene of the crime (the injury), interviewing the bystanders (your muscles) to learn what is happening with the nerves that control them.
What They Measure
Nerve Conduction Studies (NCV): Assess how quickly and effectively nerves transmit signals. Slowed or blocked transmission can indicate compression, stretch injury, or demyelination.
Electromyography (EMG): Uses a fine sterile needle to record electrical activity in muscles. It identifies whether a problem originates from the nerve root, peripheral nerve, or muscle itself.
Clarifying Complex Symptoms
In many injuriesâsuch as whiplash, shoulder traction, or repetitive wrist strainâpain and numbness may overlap. EMG/NCV helps distinguish:
Carpal Tunnel
Slowed median nerve conduction across the wrist, often from repetitive or crash-related hand strain.
Cervical Radiculopathy
Changes in muscles supplied by a specific nerve root, showing the issue is in the neck, not the shoulder.
Myofascial Pain
Normal nerve findings with localized muscle irritability, pointing toward tissue-level recovery strategies.
Plexus Injury
Multi-level nerve involvement patterns that differentiate spinal from peripheral injury.
How I Use EMG in My Practice
1. Diagnostic Precision
EMG helps identify whether symptoms stem from the spine, plexus, or a localized entrapmentâshaping targeted rehabilitation.
2. Patient Education
I engage patients directly, showing live muscle activity. Seeing how a trigger point behaves differently from normal muscle reduces fear and reinforces the mindâbody connection.
3. Therapeutic Value
Fine-needle stimulation during EMG often provides relief by gently activating or releasing myofascial trigger sites, similar to precise dry needling.
4. Integrated Pacing
Results inform a graduated care planâbeginning with reassurance before progressing to strengthening. This helps avoid over-treatment.
Integrating Into Recovery
Whether the injury occurred from an auto collision, workplace strain, or athletic stress, EMG/NCV testing complements a biopsychosocial recovery model. It combines diagnostic clarity with reassurance, education, and graduated reactivation.
Key Takeaway: EMG and NCV testing are not only diagnosticâthey are interactive tools that clarify, educate, and often calm the nervous system. By showing patients what's happening (and what isn't), these studies help reduce uncertainty and guide appropriate treatment.
References
- Willaert W, et al. Combining Stress Management With Pain Neuroscience Education... Phys Ther. 2021.
- Brambilla C, et al. Combined Use of EMG and EEG Techniques... Sensors (Basel). 2021.
- Hegmann KT, et al. Diagnostic Tests for Low Back Disorders. J Occup Environ Med. 2019.
- Malfliet A, et al. Effect of Pain Neuroscience Education... JAMA Neurol. 2018.
- Nijs J, et al. Integrating Motivational Interviewing... Phys Ther. 2020.
- Malfliet A, et al. Pain Science Education... in Chronic Whiplash Disorders. JAMA Netw Open. 2025.
- Rytter HM, et al. Nonpharmacological Treatment of Persistent Postconcussion Symptoms... JAMA Netw Open. 2021.
- Silverberg ND, et al. Action Collaborative on Traumatic Brain Injury Care... J Neurotrauma. 2025.