8+ Best TENS Machines for Carpal Tunnel Relief 2023


8+ Best TENS Machines for Carpal Tunnel Relief 2023

Carpal tunnel syndrome is a situation that causes numbness, tingling, and ache within the hand and forearm. It happens when the median nerve, which runs by means of a slender passageway within the wrist referred to as the carpal tunnel, is compressed. Transcutaneous electrical nerve stimulation (TENS) remedy makes use of low-voltage electrical currents to alleviate ache. A small, battery-powered machine delivers these currents by means of electrodes positioned on the pores and skin close to the affected space. TENS is commonly used as a non-invasive technique for managing ache related to this syndrome.

Managing this hand and forearm situation is essential for sustaining high quality of life and stopping long-term problems. Electrotherapy can play a big function in ache administration, providing a possible various or complement to different remedies similar to treatment, splinting, or surgical procedure. The applying of managed electrical pulses may help cut back ache indicators, enhance blood stream, and promote muscle leisure within the affected space. This non-invasive strategy has gained reputation attributable to its potential to supply reduction with out the unintended effects related to sure medicines. The historic growth of electrotherapy for ache administration spans a number of many years, with ongoing analysis persevering with to refine and optimize its effectiveness.

Additional exploration of this subject will cowl the underlying mechanisms of this hand and forearm situation, the rules behind electrotherapy, and sensible concerns for utilizing any such remedy for ache administration. This can embody discussions on the advantages, dangers, and potential limitations of the remedy, in addition to steerage on correct utilization and integration with different remedy modalities.

1. Carpal Tunnel Syndrome

Carpal tunnel syndrome is the central focus when contemplating using TENS remedy. The syndrome arises from compression of the median nerve inside the carpal tunnel, a slender passageway within the wrist. This compression can result in a variety of signs, together with numbness, tingling, ache, and weak point within the hand and forearm. The severity and frequency of those signs affect the potential advantages and limitations of utilizing a TENS machine. For instance, people experiencing gentle to average intermittent signs may discover substantial reduction from TENS remedy, whereas these with extreme, continual compression may expertise restricted profit. Understanding the underlying trigger and the particular manifestation of carpal tunnel syndrome in every particular person is essential for figuring out the appropriateness and potential efficacy of TENS remedy.

TENS remedy goals to modulate ache indicators and promote therapeutic within the affected space. {The electrical} pulses generated by the TENS machine can interrupt ache indicators touring to the mind, offering non permanent ache reduction. Moreover, TENS could stimulate the discharge of endorphins, the physique’s pure ache relievers. In some circumstances, TENS may enhance blood circulation to the affected space, doubtlessly aiding within the therapeutic course of. The effectiveness of TENS can range based mostly on components like the person’s particular situation, the frequency and length of TENS utilization, and the correct placement of the electrodes. Whereas quite a few anecdotal stories counsel the advantages of TENS for carpal tunnel syndrome, additional analysis is required to completely perceive its mechanisms and long-term results.

The sensible significance of understanding the connection between carpal tunnel syndrome and TENS remedy lies within the potential for improved symptom administration and high quality of life. TENS provides a non-invasive, drug-free strategy to ache reduction that may be significantly helpful for people looking for alternate options to treatment or surgical procedure. Nevertheless, it’s important to strategy TENS remedy with reasonable expectations and in session with a healthcare skilled. TENS must be considered as a possible part of a complete remedy plan, which can additionally embody different therapies like wrist splinting, ergonomic modifications, bodily remedy, and in some circumstances, surgical intervention. A radical evaluation of the person’s situation and a tailor-made remedy technique are important for maximizing the potential advantages of TENS and addressing the underlying causes of carpal tunnel syndrome.

2. Median Nerve Compression

Median nerve compression inside the carpal tunnel is the defining attribute of carpal tunnel syndrome. This compression, usually attributable to repetitive hand actions, irritation, or anatomical variations, triggers the cascade of signs related to the situation. The median nerve, answerable for sensation and motor perform in components of the hand and forearm, turns into irritated and infected, resulting in numbness, tingling, ache, and weak point. The situation of the compression, inside the inflexible carpal tunnel shaped by bones and ligaments, exacerbates the nerve’s vulnerability. Understanding this anatomical foundation is key to appreciating the function of TENS remedy. TENS goals to alleviate signs by modulating nerve exercise and lowering ache indicators originating from the compressed median nerve.

For example, people performing repetitive duties like typing or meeting line work usually expertise median nerve compression attributable to extended wrist flexion and extension. Equally, situations like rheumatoid arthritis could cause irritation inside the carpal tunnel, resulting in nerve compression. In these eventualities, TENS can provide a non-invasive technique for managing ache and bettering perform. By putting electrodes close to the affected space, TENS delivers electrical pulses that may interrupt ache indicators and doubtlessly cut back irritation. The strategic placement of electrodes, usually close to the wrist or alongside the median nerve pathway, goals to focus on the supply of the ache and discomfort attributable to the compressed nerve.

Comprehending the hyperlink between median nerve compression and the appliance of TENS supplies a sensible framework for efficient symptom administration. Addressing the underlying reason behind the compression stays essential for long-term reduction. TENS remedy must be thought of as a part of a complete strategy which will contain ergonomic modifications, splinting, bodily remedy, and, in some circumstances, surgical intervention. Whereas TENS can provide vital ache reduction and enhance perform, it doesn’t handle the underlying anatomical points inflicting the compression. Subsequently, integrating TENS with different therapies and life-style changes usually yields probably the most favorable outcomes for people experiencing median nerve compression and carpal tunnel syndrome.

3. TENS remedy

TENS remedy stands as a key part within the administration of carpal tunnel syndrome. This non-invasive strategy makes use of low-voltage electrical currents to stimulate nerves and provides a possible various to medicines or surgical procedure for ache reduction. Exploring the aspects of TENS remedy illuminates its function in addressing the signs of carpal tunnel syndrome.

  • Mechanism of Motion

    TENS operates by means of two main mechanisms: the gate management idea and endorphin launch. The gate management idea means that TENS interrupts ache indicators touring to the mind, successfully closing the “gate” to ache notion. Endorphin launch, triggered by TENS stimulation, supplies pure ache reduction. In carpal tunnel syndrome, these mechanisms can provide vital reduction from ache, tingling, and numbness.

  • Software and Utilization

    Making use of TENS includes putting electrodes on the pores and skin close to the affected space, sometimes across the wrist and hand for carpal tunnel syndrome. The TENS machine delivers managed electrical pulses, the depth and frequency of which could be adjusted based mostly on particular person wants and luxury ranges. Correct electrode placement and parameter adjustment are important for optimum outcomes. For instance, electrodes may be positioned close to the median nerve on the wrist or alongside the forearm, relying on the particular location and nature of the signs.

  • Advantages and Limitations

    TENS provides a number of benefits for carpal tunnel administration, together with drug-free ache reduction, non-invasiveness, and potential enchancment in hand perform. Nevertheless, it’s important to acknowledge limitations. TENS doesn’t handle the underlying reason behind carpal tunnel syndrome and may not be efficient for all people. Moreover, sure people, similar to these with pacemakers, ought to keep away from TENS remedy.

  • Integration with Different Therapies

    TENS is commonly simplest when used together with different therapies for carpal tunnel syndrome. Splinting, ergonomic modifications, bodily remedy, and medicine can complement the pain-relieving results of TENS and handle the underlying causes of the situation. This built-in strategy can result in extra complete and sustainable symptom administration. For instance, utilizing a wrist splint at evening may help keep a impartial wrist place, lowering stress on the median nerve, whereas TENS remedy can present ache reduction in the course of the day.

The interaction of those aspects highlights the worth of TENS remedy in managing carpal tunnel syndrome. By understanding the mechanisms, software, advantages, and limitations, people and healthcare suppliers could make knowledgeable selections relating to its incorporation right into a complete remedy plan. TENS remedy, as a part of a multimodal strategy, can contribute considerably to improved high quality of life for these experiencing the debilitating results of carpal tunnel syndrome.

4. Ache Administration

Ache administration constitutes a important facet of addressing carpal tunnel syndrome, and TENS remedy provides a worthwhile non-invasive strategy. Carpal tunnel syndrome, characterised by median nerve compression, usually results in vital ache, impacting each day actions and high quality of life. Efficient ache administration is crucial not just for assuaging discomfort but in addition for facilitating engagement in remedy and bettering total practical outcomes. TENS models, by means of the appliance of managed electrical pulses, can interrupt ache indicators, cut back irritation, and supply non permanent reduction, enabling people to take part extra absolutely in therapeutic workouts and actions. This may be significantly helpful in the course of the preliminary levels of remedy or when ache flares happen.

Contemplate a person experiencing ache that limits their means to carry out hand workouts essential for rehabilitation. TENS remedy can present enough ache reduction to allow participation in these workouts, selling energy, flexibility, and finally, long-term restoration. Equally, people whose ache interferes with sleep can make the most of TENS to scale back discomfort and enhance sleep high quality, which is crucial for total well-being and therapeutic. The applying of TENS previous to or throughout actions that exacerbate signs may assist people handle ache and keep engagement in each day routines. By modulating ache notion, TENS facilitates participation in therapeutic actions and enhances the effectiveness of different remedy modalities.

Understanding the function of TENS remedy in ache administration inside the context of carpal tunnel syndrome supplies a sensible framework for optimizing remedy methods. Whereas TENS provides a worthwhile software for symptom administration, addressing the underlying causes of carpal tunnel syndrome stays essential. Integrating TENS remedy with different approaches, similar to splinting, ergonomic modifications, and bodily remedy, usually yields probably the most favorable long-term outcomes. TENS can successfully mitigate ache, enhance perform, and contribute to a better high quality of life for people experiencing carpal tunnel syndrome. Nevertheless, acceptable software, reasonable expectations, and ongoing analysis of remedy efficacy are important for maximizing its advantages inside a complete care plan.

5. Electrical Stimulation

Electrical stimulation, the core mechanism of TENS remedy, performs a pivotal function in managing carpal tunnel syndrome. This system employs low-voltage electrical currents delivered by means of electrodes positioned on the pores and skin close to the affected median nerve. The pulses generated by the TENS machine work together with nerve fibers, modulating ache indicators and doubtlessly influencing physiological processes that contribute to symptom reduction. This interplay varieties the crux of the connection between electrical stimulation and using TENS machines for carpal tunnel syndrome. The particular parameters {of electrical} stimulation, together with pulse frequency, depth, and length, affect the therapeutic results. Understanding these parameters is essential for optimizing remedy outcomes.

Contemplate the state of affairs of a person experiencing nocturnal hand numbness and ache attributable to carpal tunnel syndrome. Software of TENS remedy earlier than sleep, utilizing particular electrical stimulation parameters concentrating on ache discount, might doubtlessly alleviate these signs, bettering sleep high quality. One other instance includes utilizing TENS in the course of the day to handle ache flares triggered by repetitive hand actions. By modulating ache indicators by means of exactly focused electrical stimulation, the person could expertise improved hand perform and a discount in discomfort, enabling participation in each day actions. The effectiveness {of electrical} stimulation hinges on components similar to correct electrode placement, acceptable parameter choice, and the person’s particular situation.

The sensible significance of understanding the hyperlink between electrical stimulation and carpal tunnel administration lies within the potential for tailor-made and efficient symptom reduction. Electrical stimulation, delivered by means of TENS, provides a non-invasive, drug-free strategy to managing ache and bettering hand perform. Whereas not a treatment for carpal tunnel syndrome, it may be a worthwhile part of a complete remedy plan. Challenges stay in optimizing electrical stimulation protocols for particular person wants and long-term symptom administration. Integrating TENS remedy with different established remedies like splinting, ergonomic modifications, and bodily remedy can additional improve its efficacy and handle the underlying causes of carpal tunnel syndrome. Continued analysis and medical apply will contribute to refining electrical stimulation parameters and optimizing outcomes for people looking for reduction from this prevalent situation.

6. Non-invasive Therapy

Non-invasive remedy modalities play a vital function in managing carpal tunnel syndrome, providing alternate options to surgical intervention. These approaches purpose to alleviate signs and enhance perform with out incisions or vital tissue disruption. Transcutaneous electrical nerve stimulation (TENS) remedy exemplifies such a non-invasive strategy, using electrical stimulation to deal with ache and different signs related to carpal tunnel syndrome. Exploring the aspects of non-invasive remedy inside this context illuminates their significance in managing this prevalent situation.

  • Minimally Disruptive Strategy

    Non-invasive remedies prioritize minimizing disruption to the physique’s pure buildings. In contrast to surgical procedure, which includes incisions and potential tissue trauma, strategies like TENS remedy depend on exterior software {of electrical} pulses, bypassing the necessity for bodily penetration. This minimally disruptive nature reduces the danger of problems related to invasive procedures, similar to an infection or nerve injury. For people experiencing gentle to average carpal tunnel signs, non-invasive remedies provide a worthwhile preliminary strategy, usually delaying or eliminating the necessity for extra aggressive interventions.

  • Accessibility and Comfort

    Non-invasive remedies usually exhibit better accessibility and comfort in comparison with surgical choices. TENS models, as an example, are transportable and can be utilized at dwelling, permitting people to combine remedy into their each day routines. This flexibility reduces the necessity for frequent clinic visits and minimizes disruption to work or private schedules. Elevated accessibility empowers people to actively take part in their very own care, enhancing compliance and doubtlessly bettering long-term outcomes. Moreover, the relative simplicity of software reduces the burden on healthcare methods and doubtlessly lowers total healthcare prices.

  • Symptom Administration Focus

    Non-invasive remedies primarily give attention to symptom administration, aiming to scale back ache, numbness, and tingling related to carpal tunnel syndrome. TENS remedy, for instance, targets ache indicators, providing non permanent reduction and doubtlessly bettering hand perform. Whereas not addressing the underlying anatomical causes of carpal tunnel syndrome, similar to anatomical variations or irritation, symptom administration improves high quality of life, permitting people to have interaction in each day actions with decreased discomfort. This give attention to symptom reduction enhances different non-invasive interventions like splinting and ergonomic modifications, contributing to a complete administration technique.

  • Complementary Function in Complete Care

    Non-invasive remedies steadily function a complementary part inside a broader remedy plan for carpal tunnel syndrome. Whereas surgical procedure may be crucial in extreme circumstances, non-invasive approaches like TENS remedy, splinting, and bodily remedy could be utilized earlier than or after surgical intervention to optimize outcomes. Pre-operatively, these remedies can handle signs and enhance hand perform, doubtlessly delaying the necessity for surgical procedure. Put up-operatively, they will support in restoration, cut back ache, and facilitate rehabilitation. This integrative strategy acknowledges the worth of non-invasive remedies in managing carpal tunnel syndrome throughout numerous levels of the situation.

The emphasis on non-invasive remedy for carpal tunnel syndrome displays a shift in the direction of patient-centered care, prioritizing minimally disruptive interventions and particular person wants. TENS remedy, as a first-rate instance, provides a secure, accessible, and handy strategy to symptom administration, usually delaying or eliminating the necessity for surgical procedure. When built-in inside a complete care plan that features different non-invasive modalities and, when crucial, surgical intervention, TENS remedy contributes considerably to bettering the standard of life for people experiencing carpal tunnel syndrome.

7. Symptom Aid

Symptom reduction represents a main goal in managing carpal tunnel syndrome, and transcutaneous electrical nerve stimulation (TENS) provides a non-invasive pathway towards attaining this purpose. Carpal tunnel syndrome, arising from median nerve compression, manifests as a constellation of signs, together with numbness, tingling, ache, and weak point within the hand and wrist. These signs can considerably affect each day actions, work productiveness, and total high quality of life. TENS remedy, by modulating nerve exercise and ache indicators, goals to alleviate these signs, bettering hand perform and lowering discomfort. The connection between symptom reduction and TENS utilization lies within the remedy’s means to interrupt ache transmission and doubtlessly cut back irritation, providing non permanent respite from the debilitating results of carpal tunnel syndrome.

Contemplate a person experiencing nocturnal numbness and tingling, stopping restful sleep. Software of TENS remedy earlier than mattress could cut back these signs, selling higher sleep high quality and total well-being. In one other state of affairs, an workplace employee experiencing hand ache and weak point throughout extended typing may discover reduction by means of TENS software throughout work breaks. This enables for continued work engagement with decreased discomfort. These examples underscore the sensible significance of symptom reduction inside the context of carpal tunnel administration. Whereas TENS doesn’t handle the underlying reason behind the syndrome, its means to alleviate signs enhances high quality of life and facilitates participation in each day actions and therapeutic workouts.

Symptom reduction achieved by means of TENS remedy must be considered as a part of a complete administration technique for carpal tunnel syndrome. Whereas TENS supplies worthwhile short-term reduction, addressing the foundation reason behind median nerve compression stays important for long-term decision. Ergonomic modifications, splinting, bodily remedy, and, in some circumstances, surgical intervention could also be crucial to deal with the underlying anatomical points. Integrating TENS remedy with these approaches provides a multi-faceted strategy to managing carpal tunnel syndrome. Challenges stay in optimizing TENS parameters for particular person wants and guaranteeing acceptable integration with different remedy modalities. Nonetheless, the potential of TENS to offer symptom reduction positions it as a worthwhile software in enhancing the standard of life for people experiencing the often-debilitating results of carpal tunnel syndrome.

8. Improved Perform

Improved hand and wrist perform represents a central purpose in carpal tunnel syndrome administration. This situation, stemming from median nerve compression, usually results in impaired dexterity, grip energy, and total hand perform, considerably impacting each day actions and occupational duties. Transcutaneous electrical nerve stimulation (TENS) remedy can contribute to improved perform by assuaging ache, lowering irritation, and doubtlessly bettering nerve conduction. The hyperlink between TENS and improved perform lies within the remedy’s means to modulate nerve exercise and cut back ache indicators, facilitating extra snug and efficient hand actions. By lowering ache, TENS allows elevated participation in therapeutic workouts and actions, additional selling practical restoration.

Contemplate a person struggling to button clothes or grip utensils attributable to carpal tunnel syndrome. TENS remedy, utilized earlier than or throughout these actions, can cut back ache and enhance hand management, enabling extra profitable process completion. Equally, a musician experiencing issue taking part in an instrument attributable to hand weak point and numbness may discover that TENS facilitates improved dexterity and management, permitting for continued musical apply. These examples illustrate the sensible significance of improved hand perform in restoring independence and enhancing high quality of life. The affect extends past easy duties, encompassing skilled actions, hobbies, and social interactions. Improved perform permits people to re-engage with actions they take pleasure in and keep their independence in each day routines.

Improved hand and wrist perform ensuing from TENS remedy have to be considered inside the context of a complete administration strategy for carpal tunnel syndrome. Whereas TENS provides a worthwhile software for symptom reduction and practical enchancment, addressing the underlying reason behind median nerve compression stays paramount. Ergonomic changes, splinting, bodily remedy, and, in extreme circumstances, surgical intervention play important roles in long-term decision. Integrating TENS remedy with these approaches provides a multi-faceted technique for managing carpal tunnel syndrome and optimizing practical outcomes. Challenges stay in quantifying practical enhancements and tailoring TENS parameters for particular person wants. Ongoing analysis and medical apply will additional elucidate the function of TENS in enhancing hand perform and its integration inside complete carpal tunnel administration.

Steadily Requested Questions

This part addresses widespread inquiries relating to using transcutaneous electrical nerve stimulation (TENS) remedy for carpal tunnel syndrome.

Query 1: How does TENS remedy alleviate carpal tunnel ache?

TENS remedy makes use of low-voltage electrical currents to stimulate nerves, doubtlessly interrupting ache indicators and selling the discharge of endorphins, the physique’s pure ache relievers. This will result in a discount in ache and different signs related to carpal tunnel syndrome.

Query 2: Is TENS remedy a treatment for carpal tunnel syndrome?

TENS remedy doesn’t handle the underlying reason behind carpal tunnel syndrome. It primarily focuses on symptom administration, offering non permanent reduction from ache, numbness, and tingling. It doesn’t treatment the situation or resolve the underlying nerve compression.

Query 3: Who ought to keep away from utilizing a TENS machine for carpal tunnel?

People with pacemakers, pregnant girls, and people with epilepsy ought to usually keep away from TENS remedy. Consulting a doctor is essential earlier than utilizing TENS if one has any underlying well being situations.

Query 4: How usually can one use a TENS machine for carpal tunnel?

TENS utilization frequency depends upon particular person wants and the severity of signs. Following a doctor’s suggestions is crucial. Typical utilization may contain a number of periods per day, every lasting 15-Half-hour.

Query 5: Can TENS remedy change different carpal tunnel remedies?

TENS remedy must be thought of a complementary remedy, not a substitute for different established therapies like splinting, ergonomic modifications, or bodily remedy. A complete strategy usually yields the most effective outcomes.

Query 6: Are there any unintended effects related to utilizing a TENS machine?

Whereas usually secure, some people may expertise gentle pores and skin irritation or discomfort on the electrode websites. Correct electrode placement and following utilization pointers can decrease these dangers.

Understanding the advantages and limitations of TENS remedy contributes to knowledgeable decision-making and acceptable integration inside a complete carpal tunnel administration plan. Consulting a healthcare skilled is all the time really useful for personalised steerage.

The next sections will additional discover sensible concerns for utilizing TENS remedy and integrating it with different remedy modalities.

Suggestions for Efficient Administration

Efficient administration of carpal tunnel syndrome usually includes a multi-faceted strategy, incorporating numerous methods to alleviate signs and enhance hand perform. The following tips present sensible steerage for integrating transcutaneous electrical nerve stimulation (TENS) remedy and different helpful practices right into a complete administration plan.

Tip 1: Seek the advice of a Healthcare Skilled

Searching for steerage from a professional healthcare skilled is paramount earlier than initiating any remedy for carpal tunnel syndrome. A correct prognosis is essential to rule out different situations and guarantee acceptable remedy choice. Skilled steerage ensures secure and efficient TENS software, tailor-made to particular person wants.

Tip 2: Correct Electrode Placement

Appropriate electrode placement is crucial for optimizing TENS remedy effectiveness. Electrodes must be positioned close to the affected median nerve, sometimes across the wrist and palm. Consulting a healthcare skilled or referring to machine directions ensures correct placement for focused stimulation.

Tip 3: Gradual Depth Adjustment

Beginning with a low depth setting and progressively growing it to a cushty stage is essential for secure and efficient TENS utilization. Extreme depth could cause discomfort or pores and skin irritation. Gradual adjustment permits the person to acclimate to the feeling and decide probably the most helpful stimulation stage.

Tip 4: Constant TENS Software

Constant TENS remedy software, adhering to a prescribed schedule, can improve symptom reduction and practical enchancment. Common use, as directed by a healthcare skilled, maximizes the therapeutic advantages {of electrical} stimulation.

Tip 5: Combine with Different Therapies

Integrating TENS remedy with different established remedies like wrist splinting, ergonomic modifications, and bodily remedy can optimize outcomes. A mixed strategy addresses each symptom administration and the underlying causes of carpal tunnel syndrome.

Tip 6: Ergonomic Concerns

Evaluating and modifying office ergonomics can considerably cut back pressure on the wrists and palms, mitigating carpal tunnel syndrome signs. Adjusting keyboard top, mouse placement, and workstation format can decrease repetitive actions and promote impartial wrist positioning.

Tip 7: Common Breaks and Stretching

Incorporating common breaks and hand and wrist stretches into each day routines may help alleviate signs and stop additional pressure. Transient relaxation intervals and focused stretches can cut back muscle pressure and enhance circulation within the affected areas.

The following tips spotlight the significance of a complete strategy to managing carpal tunnel syndrome. Combining TENS remedy with different acceptable methods can considerably enhance symptom reduction, hand perform, and total high quality of life. Constant software, correct method, {and professional} steerage are important for maximizing the advantages of those administration methods.

The next conclusion will summarize the important thing takeaways and emphasize the significance of proactive administration in mitigating the affect of carpal tunnel syndrome.

Conclusion

Exploration of carpal tunnel syndrome and transcutaneous electrical nerve stimulation (TENS) remedy reveals a worthwhile, non-invasive strategy to symptom administration. TENS, by modulating nerve exercise and ache indicators, provides potential reduction from numbness, tingling, and ache related to carpal tunnel syndrome. Whereas not a treatment for the underlying nerve compression, TENS can considerably enhance hand perform and high quality of life. Efficient administration requires a complete strategy, integrating TENS remedy with different established remedies like splinting, ergonomic modifications, and bodily remedy. Correct electrode placement, acceptable parameter adjustment, and constant software are essential for optimizing TENS efficacy.

The importance of understanding the connection between carpal tunnel syndrome and TENS remedy lies within the potential for empowering people to actively take part in their very own care. Proactive administration, incorporating each non-invasive and, when crucial, surgical interventions, can decrease the affect of this prevalent situation. Continued analysis and medical apply maintain promise for refining TENS protocols and additional enhancing its efficacy inside a complete carpal tunnel administration technique.