Kim (00:00.461)
again.
All right, hello, Dr. Dufour, Sinead, thanks to have you here. Thank you so much for joining me. I'm excited about today's topic. We're gonna be talking about the M. cella chair, which I get asked about all the time. And I know that you have done some work in the space of understanding this technology. And I feel like you're always my go-to with regards to research. So before we jump into that topic, I would love for you to just give a quick...
introduction in terms of how you became a pelvic floor physical therapist and what led you down the path of research as well.
sinead (00:35.47)
Yeah, great, thank you so much Kim for having me. I'm excited to talk about this. But yeah, so I'm an academic clinician. My name's Shanae Dufour. I share my time between really McMaster University teaching and doing research and then my clinical practice which is the world of my baby. And I mentor a lot of physios. I run my own pelvic health practice out of that perinatal care center.
But actually my PhD and postdoctoral fellowship research really didn't have anything to do with pelvic health. I've been a PT for about two decades now and I was very much in the world of orthopedics and primary healthcare, but then getting pregnant myself with twins and navigating kind of postpartum care and sort of some major gaps in that care. That's what led me to what I'm doing today. So sort of for the last decade, my research teaching.
clinical practice has all focused on this area, and I am often kind of sort of consulted as an expert in these areas.
Kim (01:36.989)
Amazing. Okay, so let's jump into the M.cela chair. So I've seen this. It's talked about a lot on social media all of a sudden. So it was sort of a novel thing for a while and there was, you know, very few of them. But it seems like there's clinics popping up all over the place with an M.cela chair and I get asked about it all the time. It's also called the Kegel throne. Some people refer to it as. So can you tell us what is the M.cela chair?
sinead (02:05.034)
Yes, so it's essentially an electro therapeutic modality, right? So essentially it's a chair, so it's set up like a chair, but really it's a medium to put energy into the body, right? So in this case, it's high intensity electromagnetic stimulation that kind of there's some coils that are within the chair, and that's what transduces this energy up into the body. So in this case, the individual is sitting
with their perineum situated on the chair and this energy is transferred through the chair up into the perineum to have the intended rehabilitative effect. So in ways it's not different than other therapeutic, you know, modalities that we've used, electro-therapeutic modalities. You know, historically in physiotherapy, even in the world of orthopedics, I mean, we've used this type of therapy often.
And sometimes it's in forms of using sort of electrodes that are sticky, that paste right on to the muscular tissue. In the case of pelvic health, the more traditional forms of electro, of electric stimulation actually is delivered through probes that are inserted intravaginally or interactually. So in ways this is just, you know, a cousin of that type of care.
Kim (03:27.325)
Okay. And that was a question I had was like, how similar or different is it compared to the more traditional e-stim electrical stimulation? And you've just clarified that. And, and for the, one big difference is that this is fully clothed. So you sit on the chair, you don't, you're not disrobed in any way. You have all your clothing on, correct?
sinead (03:49.998)
right. So I would say there's probably two main differences. One is what you just said. You're sitting fully clothed on the chair. The other is that it is a high intensity, high frequency form of energy. Whereas a lot of the more standard probes only are able to produce a lower frequency, lower intensity.
So, you know, when you look across the trials, which is something I've done in a research group, we've actually just submitted this systematic scoping review for publication, you see that in the trials that use the more traditional lower frequency EMS, on average, the time of intervention for this type of energy to have the intended effect is about 700 minutes. Whereas when you look at the higher intensity,
types of electrical stimulation and the EMCELLA, which is referred to as HIFEM technology, fits within that umbrella. It's about 180 minutes of intervention. So you can appreciate you're getting a much stronger intervention, so you can kind of get the same effect over a dramatically less amount of time.
Kim (05:03.061)
Right, okay. And who would, I mean, there's a lot of people in my world who have incontinence and who have prolapse. I would say those are the two main categories of people who are drawn to the marketing of anything to do with vaginal rejuvenation, pelvic health, exercise, anything. And so they're looking for help and is there...
another population or who else would benefit from this? Or is it limited, is it restricted or most beneficial for that incontinence and prolapse group?
sinead (05:41.378)
Yeah, so great question. So, you know, looking across the studies, I mean, in our scoping review, and we included 40 studies, you know, we have trials that look at this type of stimulation, primarily for sort of developing different parameters of fitness capacity in the pelvic floor. But also there are studies that highlight and almost sort of found some of these findings, honestly, by accident, because most of the target populations for this type of care
is sort of for primarily for incontinence, but there's also some for prolapse and there's some for fecal incontinence too. But many of the studies used outcome measures that also tracked symptoms around sexual pain or overactive bladder urgency frequency. And actually we see improvements on those outcomes as well. So I would really be saying that for anyone, like always in my care, I'm very much focusing my care on the level 1A evidence strategies.
Right, which for the most part is individualized pelvic floor muscle training, lifestyle interventions, bladder retraining, and then in the case of incontinence with exercise, the use of intervaginal continence supports like URESTA. Those are all our level 1A strategies from our most recent clinical practice guidelines. So that is always where I start with people. But in fairness,
You know, we also know that those strategies just don't work for everyone for a whole variety of reasons. Even if we look at individualized pelvic floor muscle training and we see that it's eight times more effective than control for urinary incontinence, right? That's what our most recent Cochrane reviews say. We also know from Dr. Linda McLean's research that still that strategy only actually really helps about 50% of people. And people who have more severe incontinence.
are less likely to be really cured by just that strategy alone. So it tells us we really need to be well aware and educated of the whole menu of options available because probably different things are going to work for different people. And so anyone who I'm working with, who is having any of those issues that have, you know, a potential indication for this. So as you said, you know, pelvic floor, any type of issue with
sinead (08:09.006)
pelvic floor fitness capacity, right? Issues may be with urgency or frequency, issues with sexual pain. And they have not really met their goals with the level 1A strategies. That's when I start to introduce them to their options in level two strategies, level three strategies, et cetera. And so we know that kind of standard EMS, you know, has been long understood to sort of be level two be evidence.
The scoping review that we just did shows, as I said, kind of higher intensity, higher frequency forms of EMS actually seem to be better because you can get a better effect in a short amount of time and have more acceptability because people can kind of keep their clothes on, right? So I will introduce that as one of many options as like a level two care option. So again, people who just aren't meeting their goals, particularly from my perspective,
Kim (08:55.446)
Right.
Kim (09:02.911)
Okay.
sinead (09:08.638)
if they're just not able to reestablish that fitness capacity of their pelvic floor, they just seem to kind of need help rebooting their system. Electrical therapy seems to be quite helpful. And a recent 2023 review just on electrical therapy across the board kind of shows that we always thought the mechanism was like hypertrophy and strengthening.
But more data is kind of showing the mechanism actually might be around kind of improving an inflammatory sort of profile. So we don't really fully understand the exact mechanisms behind electrical therapy. We just don't. And so it's probably for reasons different than what we actually think, why it's helping. But I certainly will make sure people are well aware of it as an option and where it stands in terms of the level of evidence.
if they are not reaching their goals with the level 1A strategies.
Kim (10:08.765)
I've always sort of, I've said an answer similar to yours that, you know, look at what the, the evidence is for first line therapy. And if those aren't working, then this is something to consider. But I wouldn't, I wouldn't suggest the M. cella chair as somebody's first line of defense per se. Um, so, okay. So I'm, I'm with you so far, which is good, but what, what is it? What does it feel like if when you're sitting on that chair?
sinead (10:18.199)
Mm-hmm.
sinead (10:31.66)
Yeah.
Kim (10:37.493)
What would somebody feel? What sort of sensations would there be?
sinead (10:44.474)
Yeah, so this is a great question. And just before I answer the question, I very briefly will say, one of my big issues, to be honest with you about the M. Cellicare, is not what it actually does, it's actually with how it's marketed. And even unfortunately, the manufacturer of this product, which in my opinion actually holds really wonderful rehabilitation capacity, it's just that how it's sold and how it's marketed and my...
opinion is for one not correct and for two almost comes across as predatory. So I think that's honestly why even a lot of my own colleagues in pelvic health physiotherapy really have their backup about it. But what it feels like is it really feels like not unlike honestly even what like an interferential current machine might feel like which a lot of people have used in physiotherapy.
or even like a tens unit, if you can imagine, like a tens unit on and kind of that electrical type of stimulation, but it kind of moves on a varied pattern. So, you know, while you're sitting there and the protocols that have been studied are 28 minutes, you'll kind of feel this kind of variation of different types of tapping and vibration and stimulation kind of going through your body.
Which, and again, kind of highlights to you that the way it's sold, like this does 11,000 Kegels in 28 minutes. Well, a Kegel, by correct definition, Dr. Arnold Kegel really made the assumption that doing this type of exercise was all about strength and creating stiffness, and that's why it worked. And we understand now that actually isn't quite right. And so a Kegel, from his perspective, was ramping up these muscles to their.
absolute max and holding them. Right? And so that's what a kegel is. And really, when you're sitting on this chair, that isn't what it's doing. It's putting through energy in a varied, almost taking you through a really varied workout. Right? So, you know, it isn't really doing, you know, what it's kind of claiming to do. And it isn't necessarily just like making things stiffer and stiffer and
sinead (13:02.074)
repeated Kegels might do. So yeah, it really feels similar honestly to other forms of electrical modalities that people might have experienced. Just the difference is really you're sitting fully clothed and it goes through kind of more of variation than what standard models would do, I would say.
Kim (13:22.701)
Got it. And you've talked about 28 minutes being what you've seen in some of the research or that's what the general protocols are. And then I think you said 120 minutes total, was that the amount of time? And so how many treatments and how far apart would people need these is the first part of the question for there to be a potential resolution of symptoms. And then how often would it need to be repeated?
sinead (13:48.686)
Right, so most of the trials have used a protocol of six sessions that are spread across three weeks. So two 28 minute sessions with this energy over three weeks. So six sessions. There's a couple trials that actually have looked at 10 sessions, but really when you look at the outcomes, the outcomes really are no better with 10 sessions versus six.
So, you know, it stands to reason why it makes sense that therefore, you know, the recommendation at this point in time with the data we have is six. And, you know, as far as like, well, how long does it last? I mean, because I kind of consider this one of many rehabilitation tools, how long it lasts is all dependent on, you know, what the beholder is actually doing. Right. So if I, for example,
working with someone and I'm saying hey so like these are the bladder behaviors you need to do these are the bowel behaviors you do this is like your sleeping program that would optimize your biology and they were good with that for a few months but then they kind of derailed from that and they were putting totally just different inputs into their system well I would expect that then their health state would change and probably their symptoms would come back right so with something like this
Again, if someone is kind of using it really just to help sort of reboot their system and establish maybe a more optimal fitness capacity in their pelvic floor, which is generally how I suggest it's used, my hope always is that people don't ever need it again. That if people have kind of rebooted their system, they've kind of got things on track, they've become more motivated that they can actually kind of overcome some of the issues they've been having.
and alongside they're doing all the lifestyle things and all the other things that are actually contributing to their symptoms and they're doing all that. And then they're starting to engage more in lower extremity exercise more generally. Well, I mean, the pelvic floor is a postural muscle. So once it's rebooted and automated, really as long as we're doing lower extremity exercise and we're not sitting and we're getting that kind of force of gravity that comes with standing and walking on a regular basis.
sinead (16:05.142)
We should be able to maintain that, right? We should be good. But also, I mean, life happens, right? You might end up with a bout of bronchitis and that you've been coughing for two weeks and you've kind of gone backwards and people might find, okay, I feel like I need a reboot. My bias is that if someone sort of needs a reboot, I would still rather them have a reboot with sort of a PT or some knowledge about this area.
and then maybe also have a modality like emcella as an adjunct. Right. So your effects on treatment, whether it's emcella or you doing your own exercise program or following, you know, your own walking program. I mean, your effects are only as good as what you're putting in. And I see all modalities, you know, as really hopefully trying to give people like a boost at the beginning.
But in my mind, I don't love those types of strategies to be kind of used as a bandaid and over and over and over again. I'd really rather people kind of doing the level 1A behavioral things that they're really getting to the root of creating health. That's always my perspective.
Kim (17:16.009)
Yeah, yeah, and I agree 100%. I also talk a lot about this being suitable or a really amazing option for people that may have mobility challenges, that may have potentially spinal cord injuries or something that is prohibiting them from being able to connect with their pelvic floor, do that lower extremity work. Has there been any, like would you agree, I guess, but then has there been any research using populations that may have limitations?
sinead (17:46.018)
So I would agree conceptually, I would agree with that, because we do have lots of data that more traditional pelvic floor muscle training is actually appropriate for those populations. You know, any of those neural populations other than like a complete spinal cord injury, but incomplete, MS, any of those other ones we see like good effect of, you know, are more standard pelvic floor muscle training. So in theory, if this is a...
tool to help sort of stimulate fitness capacity, I would agree with you. Given that I consult with a company called Eurospot that uses this technology in conjunction with really amazing physiotherapy care, you know, I know anecdotally that, you know, people who would fall in that basket have gotten improvement from combined physiotherapy and the hyphen technology.
But as far as the research goes, like even as I'm thinking of our scoping review, not a single study, not even the ones in our study that was the more traditional form of EMS actually, you know, was looking at those populations.
Kim (18:55.181)
Okay. And what about protocols specific to the challenge a person has? So is there a different protocol for stress urinary incontinence? Is there a different protocol for prolapse? Is there a different for overactive bladder urgency and frequency? Is there is it just all standard that 28 minutes at the proposed frequency twice a week for three weeks?
sinead (19:18.914)
So there are two different established protocols for this tool. One is called protocol one, one is called protocol two. In the scoping review that we did, the only populations that ever looked at protocol two were for men with erectile dysfunction. And there's very good data of efficacy for this tool for that. For the myriad of issues among women that we've talked about,
all of what's been studied so far as protocol one. Other than, you know, you have the six sessions for the 28 minutes, there is a dial in terms of sort of intensity. And so most of the studies were actually using an intensity of at least 80% of like the max capacity of these machines to sort of get the desired results. So my advice is always, you know,
make sure like as you're sitting there you know it's not feeling so sensitive that the individual who's turned it on for you is saying oh well you're like you're only at 40 percent because we don't have good data that's successions at 40 percent are helpful right and really we want to make sure you're getting at least over 80 percent and this is why like you know in the collaboration between like the physiotherapist that work with your spot.
Kim (20:29.709)
Right, right.
sinead (20:39.746)
The physiotherapists are screening everyone for central sensitization. They're looking at all of these things because they don't want someone who's really highly ramped up and sensitized sitting on this. They can't really tolerate it. Then they're not really gonna get the proper treatment effect, right? So it's again why I really see this tool to be used integrated as a modality. I don't really see it as a great tool.
to be situated in every cosmetic medical clinic on the corner with the message of, oh, just sit down and this will fix all your problems. Like, I really have no patience for that type of an approach. Because, you know, to your point, what you just said is a lot of people are ramped up and sensitized. And you know, they are gonna be kind of sitting on there and then they probably won't be able to tolerate the proper treatment effect. And they don't know the research and the person administering that to them.
you know, has no training. And so it can be a really powerful rehabilitative tool when it is used properly.
Kim (21:46.581)
Yeah, fair enough. I agree. Um, a couple more questions before we leave, but one thing that comes to mind also is the, the people who have been told they have a hypertonic or overactive or my pelvic floor is too tight and therefore I can't do kegels or standard pelvic floor exercise. I need to work on relaxation. If we look at this, when you were talking about, there's a variety of sort of sensations and pulses or.
frequencies that may happen over that period of time, one of which I would assume would be a relaxation component. So is there a place for the overactive population, the hyper tone population with the mcella as well?
sinead (22:31.306)
Yes, absolutely. And this comes back to my whole point around when I first started learning about this chair, and this was actually in 2019 at the Iyuga conference. There was a number of the big trials were presenting their interim results. And what really caught my attention and actually the attention of the urogynecologist I worked very closely with here in Oakville named Dr. Carolyn Best, was even though the protocol was targeting incontinence, actually you could see
the outcome measures people with painful intercourse and overactive bladder all improved on those outcomes and so really as a physio I was thinking but we would never prescribe repeated Kegels for people with dysphoronia we would never prescribe repeated Kegels for someone with overactive bladder so it really got me thinking around so probably it's not doing
these Kegels and anytime I've talked to the engineering team from BTL they've never been able to explain to me where they've kind of gotten that. I really think they are you know counting every different little blip of energy that kind of pulses through. They're just counting that as a Kegel and then they're using that as their marketing.
So we absolutely do see that yes, people with those symptoms, or even if I was actually to physically assess someone and someone that is kind of more in that slightly protective state could benefit, but I'm always making sure those people also were doing all the other things, really from a central factor approach or a peripheral factor approach to address that tissue. So yes, absolutely. I really see them more in
thing to be thinking about isn't sort of, oh, am I high tone or low tone? Because we kind of understand now that really trying to think of it that way doesn't necessarily make a lot of sense. I like to kind of get a sense of where these people really centrally upregulated or centrally sensitized.
Kim (24:40.941)
Mm-hmm. And then what about people from a postpartum note that's a lot of the population that you work within the clinic and when you think of this statistic of, at least what I've seen in the research is 30% of vaginal childbirths may have levator avulsion tear or complete avulsion, I guess. But some of them will start to.
not the complete, but the partial ones may subside, may ease and sort of heal on their own over time. But is this a population that, you know, some people will say they can't feel their Kegels or no matter how much pelvic floor exercise and physio they do, they just can't get past a certain level. They can't, they don't seem to improve their strength. Is a modality like this or even the internal probes that we were talking about earlier, is this something that could come in and factor into some potential improvements or support for that population?
Kim (27:03.51)
And would it be more beneficial, like I'm so specific to this population again, is there any, and there may not be evidence or research on this yet, but is there any indication of how soon after injury we would wanna intervene with high FEM for there to be maximal effectiveness? Do we have any data on that yet?
Kim (27:31.891)
Mm-hmm.
Kim (28:39.981)
Got it, yeah. And then just final question, I know that this will be dependent on different clinics, but what is the average cost per session or average cost per sort of bundle of sessions?
Kim (30:06.977)
Okay, cool.
Kim (30:28.105)
Yeah, yeah. Okay, that's awesome. That's a perfect place to end off. Where can people find you to learn more about your work and potentially come in and have therapies with you at the womb?
Kim (31:05.213)
Amazing and we'll have all those links in the show notes for people as well for easy access. So Sinead, Dr. Dufour, thank you so much for your time and for your knowledge and expertise. This was super interesting and I know that it'll benefit everybody who was listening as well. Thank you.
