Non-Invasive Neuromodulation in Pelvic Rehabilitation: Clinical Observations in Patients with Urinary Incontinence with Dr. Tami Recesso

Transcript

Dr. Freddy Garcia:
Hello everybody, and welcome to another Algiamed webinar. My name is Dr. Freddy Garcia, and today we are welcoming Dr. Tammy Recesso.

Dr. Tammy is a licensed physical therapist and a multiple private-practice owner with more than 24 years of experience. She is also a global speaker and educator, having taught in London and Saudi Arabia, and with upcoming speaking engagements in Cape Cod, Budapest, Switzerland, and Thailand.

This is not her first time presenting at a high level. She is passionate about treating the root cause of conditions naturally, and she is also an expert manual practitioner and manual therapist. She is very talented, very gifted, and a great presenter, so I am excited about this.

Today’s webinar topic is “Non-Invasive Neuromodulation in Pelvic Rehabilitation: Clinical Observations in Patients with Urinary Incontinence.”

Dr. Tammy, I have to tell you, I am intrigued by this topic. For those who know my story, I missed the boat on pulsed radiofrequency delivered transcutaneously with the Stimpod years ago. I did not understand it. I did not even know how to use it. Now I understand it very well. I teach people about it, how to get successful in their clinics, and they know that it is amazing for chronic, intractable pain and for pain control during rehabilitation.

But then there are innovative clinicians like you who find new ways to apply this technology based on experience and science. I am very excited to learn more today. With almost 200 people registered for this webinar, either attending live or waiting for the recording, I think there are a lot of people who want to learn more about this. I think you are going to blow everybody’s mind today.

Dr. Tammy, are you ready to do this?

Dr. Tammy Recesso:
I am ready. Thank you.

Dr. Freddy Garcia:
Great. I am going to turn off my camera and microphone. I will be watching in the background. If I have a burning question, I may interrupt you, but I am going to let you take the stage and I will be back at the end with some follow-up questions. Does that sound like the plan?

Dr. Tammy Recesso:
Sounds great. Thank you.

Dr. Freddy Garcia:
All right. Have a great presentation.

Dr. Tammy Recesso:
Thank you.

Hello everyone, and thank you for joining me. As Freddy said, I am Dr. Tammy Recesso. I am a licensed physical therapist in Massachusetts and New Hampshire, a multi-private-practice owner, and a global educator.

Today I am going to share some really exciting findings based on patient reports and clinical observations. After even one to two sessions using the Stimpod at the femoral nerve, patients have reported significant improvement and reduction in urge and stress incontinence. For many of these patients, it has been life-changing. The response was so meaningful that we were inspired to share the observations more widely and create a study around them, which we plan to publish. Today I get to present this information to you for the first time.

The study is titled “Non-Invasive Neuromodulation in Pelvic Rehabilitation,” and it is based on clinical observations in patients who reported urinary incontinence prior to treatment.

By way of background, I have more than 30 years of clinical experience, 24 years as a self-employed private-practice owner, and I own several private practices in Massachusetts and New Hampshire. I also teach globally.

I developed the Doc Tammy Method, which is a method or protocol for treating each body part naturally. It includes how to rule in or rule out a neurological component versus a musculoskeletal component, and how to treat naturally without unnecessary opioids, pain injections, or surgeries. I am very passionate about that, and I teach it globally.

When I was in London last year teaching, I came across the Stimpod. Dr. Collins was at the conference, and I was able to trial it for myself. I will be honest: I was skeptical at first. Once I tried it, I realized that it really did activate the motor response, and I felt a little better afterward.

What really struck me was a conversation with a physical therapist in London. She told me that after one session, she was able to go for a run the next day without any urinary leakage. At that moment, I knew this was something important, potentially life-changing, and worth exploring further.

When I returned to my clinic, I started using it immediately. I first used it with a couple of friends who had suffered from urinary incontinence for many years. They were wearing pads every day and leaking constantly. After one session, they reported about 85% improvement. At that point I knew I needed to bring this into the clinic, treat more people, and understand how effective it could be in a broader population.

I also served on the Olympic and Paralympic medical team at the 2000 Sydney Summer Games, and I published my book, The Art of Manual Therapy, which is also offered as an e-course. It teaches methods and protocols to address conditions such as sciatica and pelvic asymmetry naturally, using osteopathic techniques.

Now, to get to the core topic: the current understanding of neuromodulation for urinary incontinence.

What we already know is that neuromodulation, including PTNS, carries Grade A evidence from the American Urological Association for overactive bladder and urinary incontinence. Recent systematic reviews show that tibial nerve stimulation can produce about a 70% responder rate.

A 2024 review in Nature Reviews Urology discussed the modulation of the pelvic reflex arc through three primary pathways: suppressing hypersensitive afferent signals, which reduces urgency; promoting spinal guarding reflexes, which helps maintain sphincter tone; and modulating supraspinal regulatory circuits, which helps restore central nervous system control.

The traditional anatomical target in many studies is the tibial nerve, originating from the L4 to S3 spinal segments, which shares nerve-root connections with the bladder and pelvic floor. In my patients, I was instructed to trial either the tibial nerve or the more proximal femoral nerve. Based on my experience, I preferred to work closer to the femoral nerve, right at the underwear line, where the pelvis meets the front of the leg.

The setup is very simple. Patients remain dressed. They lower their pants slightly, keep their underwear on, and the probe is placed on the femoral nerve at the underwear line. The dispersive pad is placed over S3 on the lower back. This creates a much shorter and more concentrated treatment path than treating from the tibial nerve near the ankle all the way to S3.

The way I have treated is femoral nerve to S3, with the probe at the underwear line and the dispersive pad at S3. Based on patient reports, it appears to be very effective.

The comprehensive review in Nature Reviews Urology concluded that neuromodulation modulates the pelvic reflex arc through three primary pathways. First, it suppresses bladder signaling, meaning that sensory information from the bladder to the brain is reduced, which can reduce urgency. Second, it promotes spinal guarding reflexes, which help maintain sphincter tone. Third, it modulates supraspinal regulatory circuits, which helps restore overall function.

We will also talk about how the Stimpod may help influence nerve function through pulsed radiofrequency and its anti-inflammatory effects.

In short, we are leveraging the body’s own neural pathways to help restore coordinated bladder function. Based on my clinical observations and patient reports, it is working, and it is working quickly. Often after one to three sessions, patients are reporting immediate changes. I have had patients in tears because they cannot believe they are not leaking anymore, that they do not feel the same urgency, or that they can get to the toilet in time. They are no longer planning their entire day around the nearest bathroom.

The clinical gap is that traditional PTNS often relies on a 12-week protocol with multiple sessions per week. With the Stimpod NMS460, we are observing changes in one to three sessions. It is not a 12-week protocol, and we appear to be getting better carryover. Traditional protocols can also be more invasive when they involve a needle near the tibial nerve. By contrast, treatment with the Stimpod is non-invasive and pain-free.

When the probe is placed on the femoral nerve at the underwear line, it elicits a quadriceps contraction. We are finding that the 0.2 ms setting, which is the deeper setting, is producing the best results. We often reach approximately 28 to 30 mA to achieve a quadriceps contraction, while keeping the treatment comfortable. If it becomes painful, we lower the intensity. The best results so far have been seen at 0.2 ms, which is consistent with what we are seeing clinically.

Case Study 1

The first case was a woman over 70 years old. She was leaking three to four times per day and waking two to three times per night. She wore pads 24/7.

She had one 10-minute session at the femoral nerve, with the intensity around 28 to 30 mA at 0.2 ms. She texted me the next day and said that she had sat at lunch with her girlfriends for three hours and did not have to get up to go to the bathroom. Normally, she would have expected to go to the bathroom about three times in that same period.

The response was very quick and very significant. She later came in for another session about a month later and found additional improvement. She has now come in for a third session. We are seeing that treatment helps right away, and in some patients, relief appears to last around three months, sometimes longer and sometimes shorter depending on the person and their history.

In this case, she noticed improvement 10 minutes after the session. At five-day follow-up, her urgency was completely gone. Long term, she reported approximately 95% overall improvement.

Case Study 2

The second case was also a woman over 70 years old. She had extreme hourly urgency and relied on deep breathing and crossing her legs to stop the flow. She had seen a pelvic health specialist about 10 years earlier and had learned breathing techniques and pelvic-health strategies.

After one Stimpod session, she was much better. After two sessions, she reported being almost 100% improved. She and her husband decided to purchase a unit so that she could self-treat long term.

Her IIQ-7 score went from 57.14 to 0 after one session, which is a very significant change. She reported approximately 80% overall improvement and said, “I have lost the urgency when I am walking to the bathroom. I have not had any episodes where I have to cross my legs.”

She did not require as much stimulation as some other patients. She was treated at 13 mA at 0.2 ms. Some patients tolerate up to 30 mA comfortably. The key is that treatment remains pain-free, at 0.2 ms, and strong enough to produce a quadriceps contraction.

Case Study 3

The third case was a woman over 70 years old who had suffered a spinal cord stroke approximately two years earlier. She had significant foot drop, some hemiparesis, and was walking with a rollator walker. She also had recurrent urinary tract infections, extreme urgency, and a UDI-6 score of 50.00.

We treated the bilateral femoral nerves at the underwear line. We also treated her for foot drop, lack of plantar-flexion strength, and numbness using the Stimpod.

She reported approximately 75% overall recovery over the course of treatment, with a meaningful improvement in quality of life. She was no longer actively planning her day around the bathroom. She also went a month and a half without a single UTI, after previously being on continuous antibiotics because of recurrent UTIs following the spinal cord stroke.

The Stimpod has significantly affected her urinary incontinence, overall health in terms of infection frequency, and her ability to walk. She is now using a straight cane with a small quad adapter rather than a walker. She is travelling again and returning to normal activities that had previously been difficult for her.

Case Study 4

The fourth case was a 60-year-old woman who wore a Poise mini pad daily. She reported leakage specifically triggered by laughing, coughing, or sneezing. Her initial UDI score was 27.78, and her IIQ-7 score was 14.29.

She had three sessions along the bilateral femoral nerves. She was also treated at the gluteus medius because she was experiencing hip pain, and the Stimpod is indicated for pain control. She had good results with that as well.

She noticed specific relief with laughing and coughing and described the change as better than a constant leak. She reported approximately 75% overall long-term improvement. Her UDI dropped to 16.67, and her IIQ-7 dropped to 9.52.

I have also worked with other women who are not included in this study, and I continue to receive feedback about how helpful the Stimpod has been for them. Many are surprised by how quickly the outcomes shift.

One patient texted me the day after her first Stimpod treatment. She said she had been on the phone with a girlfriend for about three hours, laughing so hard they were crying. Her friend said, “Oh my gosh, I peed my pants,” and my patient said, “Oh my gosh, I didn’t.” That kind of feedback has been remarkable to hear.

Combined Clinical Observations

In the combined figure of the seven cases, we looked at self-reported urinary incontinence severity as a percentage over time from baseline. We followed patients up to 120 days after the first session.

We saw variation in urinary incontinence triggers across the patients, ranging from stress incontinence with laughing and coughing to a 24-year history of post-hysterectomy leakage, as well as symptoms following spinal cord stroke. Across the cases, patients reported substantial improvements in symptoms, often after just one to three sessions.

This is significant and much faster than the 12-session protocol that is commonly known.

Key Takeaways

Based on these clinical observations, unlike the traditional 12-week protocol, most of the clinical benefit was observed within the first one to three treatments, with sessions lasting approximately 10 to 15 minutes.

The rapid results are consistent with hypothesized mechanisms of neural pathway engagement, including suppression of bladder afferent signals and promotion of spinal guarding reflexes, as described in the current literature.

Overall, we are seeing a positive subjective response. Patients are reporting an average subjective improvement ranging from approximately 65% to 90% reduction in urinary leakage after one to three Stimpod treatments.

The next step is that these preliminary observational findings warrant formal prospective randomized controlled trials to establish standardized protocols and validate efficacy in a larger sample.

Those are my references.

Q&A

Dr. Freddy Garcia:
Perfect. If anybody wants to snap a picture of those references, now is the time. Dr. Tammy, I turned my camera and mic back on. Can you hear me?

Dr. Tammy Recesso:
Yes, I can. Thank you.

Dr. Freddy Garcia:
Dr. Tammy, we have a flurry of questions. Can I rapid-fire some questions at you?

Dr. Tammy Recesso:
Sure.

Dr. Freddy Garcia:
Awesome. This is going to be good. I did my best to jot them all down. I answered a few. First, what is the reason for using the Stimpod on both sides? Everyone is trying to understand your exact protocol. It seems like you favor the femoral nerve. Do you treat bilaterally? Some people noticed the session was 10 minutes. Are you doing five minutes on one nerve and five minutes on the other, or 10 minutes on each nerve? Also, it seems like you prefer the 0.2 ms setting over 0.1 ms. Can you confirm that?

Dr. Tammy Recesso:
Yes, definitely 0.2 ms. We did have one woman who did not report improvement, and she was treated at 0.1 ms. I think that is consistent with the research and clinical findings that 0.2 ms reaches deeper.

So definitely 0.2 ms, and then five minutes on each femoral nerve: five minutes on one side and five minutes on the other.

The way I was taught to use the Stimpod was to cover both sides if a patient had bilateral symptoms. For example, if someone had neuropathy in both feet, we would treat the nerves on both limbs. It made sense to me to treat both femoral nerves. I have not trialed treating just one side at this point.

Dr. Freddy Garcia:
Perfect. What treatment position do you use? Are patients seated, or do you put them supine?

Dr. Tammy Recesso:
I prefer them supine, sometimes in a slight beach-chair position depending on the size of the individual, so we can access the superficial femoral nerve. Most patients are supine or in a slight beach-chair position, maybe around 20 degrees of trunk flexion.

Dr. Freddy Garcia:
What types of incontinence have you seen this help with in your population? Stress, urge, or mixed?

Dr. Tammy Recesso:
Everything. We have seen all three.

Dr. Freddy Garcia:
As soon as we announced this webinar, we started getting this next question. People are asking about different patient populations. We are theorizing here based on anatomy and physiology, but is there a chance this may help children with nocturnal enuresis?

Dr. Tammy Recesso:
Definitely.

Dr. Freddy Garcia:
That is interesting from a physiological perspective. I have heard of protocols with other neuromodulation devices to help children with delayed nocturnal enuresis, but the way you are applying it makes sense to me. I would venture to say that we may see some success. I am glad to see you agree.

Another question: could this help men with incontinence issues? Have you tested that yet?

Dr. Tammy Recesso:
I have not had any men sign up yet. It is not that I have been discouraging it; they just have not signed up for treatment. I do have one gentleman with prostate cancer who had prostate surgery, but he has not had treatment yet. That will be something we trial in the future.

Dr. Freddy Garcia:
Excellent. I want to see what you come up with there. I also like the way you are keeping the data and using outcome assessment questionnaires.

Another question I am getting from men is about prostate issues, other pelvic conditions, and erectile dysfunction. Again, this would be off-label and theoretical, but from a physiological perspective, could you theorize that it may be helpful based on what you have seen?

Dr. Tammy Recesso:
Yes. Especially when you understand the science behind pulsed radiofrequency and its anti-inflammatory component. It appears to get in there and almost reboot the nerve. If the nerve is interrupted because of inflammation or reduced conductivity, then as long as the nerve is viable, it is worth a try.

Dr. Freddy Garcia:
I agree. One last question: why the femoral nerve versus the tibial nerve? What I have seen previously is the tibial nerve with that longer loop. You seem to prefer the femoral nerve. Can you remind us why?

Dr. Tammy Recesso:
To be more concentrated. We are delivering from the probe to the dispersive pad, and with the femoral nerve it is right there. It is much closer and more concentrated, so you can directly affect that area.

It was also the nerve that was recommended to me when I spoke with the clinician in London. I believe she had used the tibial nerve, but I was told you could use either one. I thought, why not go closer to the root?

Dr. Freddy Garcia:
Awesome. I love that. You are going off your clinical experience, which is valuable as well.

Dr. Tammy Recesso:
Exactly.

Dr. Freddy Garcia:
Thank you so much for answering all those rapid-fire questions, and thank you to everyone who joined us.