Nerve Conduction Studies (NCS) / Electromyography (EMG)

Nerve conduction studies (NCS) and electromyography (EMG) are tests used to assess how well your nerves and muscles are working.

These tests may be recommended if you have numbness, tingling, weakness, burning pain, muscle wasting, falls or unexplained imbalance. In a balance clinic setting, NCS and EMG can be helpful when unsteadiness may be partly related to nerve problems in the feet, legs or spine.

At Melbourne Balance Clinic, NCS and EMG may be used as part of a broader assessment of dizziness, imbalance, walking difficulty, neuropathy and complex neurological symptoms. The aim is to understand whether nerve or muscle dysfunction is contributing to your symptoms and to guide the most appropriate treatment plan.

Nerve conduction studies assess how well electrical signals travel through your nerves.

During the test, small recording pads are placed on the skin. An electrical impulse is then used to stimulate the nerve. The test measures how quickly and strongly the nerve responds.

This can help identify whether a nerve is damaged, compressed or not conducting normally. It can assess sensory nerves, which carry feeling from the body to the brain, and motor nerves, which help control muscle movement.

Electromyography, or EMG, assesses the electrical activity of muscles.

During EMG, a very fine needle electrode is placed into selected muscles. The muscle activity is recorded while the muscle is relaxed and while it is gently activated.

EMG can help determine whether weakness or abnormal muscle activity is due to a problem in the muscle itself, the nerve supplying the muscle, or the nerve root coming from the spine.

Not every patient needs EMG. Some patients only need nerve conduction studies. The testing plan depends on your symptoms and the clinical question being asked.

You may be referred for NCS or EMG if your symptoms suggest nerve or muscle involvement.

These symptoms may include:

• Numbness, tingling or burning in the feet or hands

• Weakness in the legs, feet, arms or hands

• Foot drop or difficulty lifting the foot

• Unsteadiness when walking

• Falls or near-falls

• Poor balance in the dark

• Muscle wasting, twitching or cramping

• Pain travelling from the neck or back into the arms or legs

• Suspected peripheral neuropathy

• Suspected nerve compression or nerve root irritation

For balance problems, NCS and EMG can be especially useful when the brain may not be receiving reliable information from the feet and legs.

Balance is not controlled by the inner ear alone. The brain also relies on information from the feet, legs, joints, eyes and muscles.

The nerves in the feet and legs help tell the brain where the body is in space. If these nerves are not working properly, balance can become less reliable, especially in the dark or on uneven ground.

Some people describe needing to look at their feet when walking. Others feel worse when showering, walking at night, stepping onto grass, or moving across uneven surfaces.

Nerve problems can also overlap with vestibular disorders. A person with both inner ear balance loss and peripheral neuropathy may feel much more unsteady than someone with only one of these issues.

NCS and EMG can help assess a range of nerve and muscle conditions, including peripheral neuropathy, diabetic neuropathy, carpal tunnel syndrome, ulnar nerve compression, nerve root irritation from the neck or lower back, muscle disorders and inherited nerve conditions.

In a balance clinic, the most relevant findings often relate to peripheral neuropathy, sensory nerve dysfunction, motor weakness or nerve root problems affecting walking and stability.

The results are interpreted alongside your symptoms, examination findings and other tests. A test result alone does not always explain the whole balance problem.

During nerve conduction studies, small electrical impulses are applied to the skin over selected nerves. These impulses may feel like a quick tap, flick or brief shock. They can be uncomfortable, but they are very short.

If EMG is required, a fine needle electrode is placed into selected muscles. You may be asked to relax the muscle and then gently contract it.

The number of nerves and muscles tested depends on your symptoms. For example, if you have numbness in the feet and balance problems, the test may focus on the legs. If you have hand numbness, the arms and wrists may be assessed.

NCS and EMG can be uncomfortable, but most people tolerate them well.

NCS involves brief electrical stimulation. EMG involves a fine needle placed into muscle. The clinician performing the test will explain each step and can pause if needed.

Any discomfort is usually temporary and limited to the testing period.

Preparation is usually simple.

You may be asked to avoid moisturiser, oils or lotions on the day of testing, as these can interfere with the recording pads.

Wear comfortable clothing that allows access to the area being tested. Shorts or loose pants may be helpful for leg testing, and short sleeves may be useful for arm testing.

Please bring your referral, medication list, relevant blood test results, imaging reports and any previous NCS or EMG results.

Tell us before testing if you take blood-thinning medication, have a bleeding disorder, have a pacemaker or implanted device, have lymphoedema, or have had recent surgery in the area being tested.

NCS and EMG results can help clarify whether symptoms are due to peripheral neuropathy, nerve compression, nerve root irritation, muscle disease or another neurological issue.

• If peripheral neuropathy is found, your doctor may recommend further investigation, medication review, diabetes assessment, vitamin level testing or strategies to reduce falls risk.

• If nerve compression or nerve root irritation is found, treatment may involve physiotherapy, splinting, medication, injections, surgical referral or monitoring, depending on the severity and location.

If the tests are normal, this can also be useful. It may shift attention towards vestibular, migraine-related, medication-related, cardiovascular or other causes of imbalance.

Melbourne Balance Clinic provides NCS and EMG within a broader balance and neurological assessment pathway.

This is important because unsteadiness is often multifactorial. A person may have an inner ear balance disorder, peripheral neuropathy, reduced vision, migraine, medication effects or muscle weakness contributing at the same time.

Our aim is to connect the test result with your real-world symptoms and provide a practical plan for what to do next.

Nerve conduction studies and electromyography can provide valuable information when numbness, weakness, neuropathy or nerve dysfunction may be contributing to balance problems.

Contact Melbourne Balance Clinic to arrange an appointment and take the next step towards understanding your symptoms.