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      The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction

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          Abstract

          The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741.

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          Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort.

          Ryan Mizner, K Stevens, Lynn Snyder-Mackler … (2009)
          To determine the effectiveness of progressive quadriceps strengthening with or without neuromuscular electrical stimulation (NMES) on quadriceps strength, activation, and functional recovery after total knee arthroplasty (TKA), and to compare progressive strengthening with conventional rehabilitation. A randomized controlled trial was conducted between July 2000 and November 2005 in an academic outpatient physical therapy clinic. Two hundred patients who had undergone primary, unilateral TKA for knee osteoarthritis were randomized to 1 of 2 interventions 4 weeks after surgery, and 41 patients eligible for enrollment who did not participate in the intervention were tested 12 months after surgery (standard of care group). All randomized patients received 6 weeks of outpatient physical therapy 2 or 3 times per week through 1 of 2 intervention protocols: an exercise group (volitional strength training) or an exercise-NMES group (volitional strength training and NMES). Treatment effects were evaluated by a burst superimposition test to assess quadriceps strength and volitional activation 3 and 12 months postoperatively. The Medical Outcomes Study Short Form 36 and Knee Outcome Survey were completed. Knee range of motion, Timed Up and Go, Stair-Climbing Test, and 6-Minute Walk were also measured. Strength, activation, and function were similar between the exercise and exercise-NMES groups at 3 and 12 months. The standard of care group was weaker and exhibited worse function at 12 months compared with both treatment groups. Progressive quadriceps strengthening with or without NMES enhances clinical improvement after TKA, achieving similar short- and long-term functional recovery and approaching the functional level of healthy older adults. Conventional rehabilitation does not yield similar outcomes.
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            Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial.

            Pamela Wolfe, W M Kohrt, D Eckhoff … (2012)
            The recovery of quadriceps muscle force and function after total knee arthroplasty (TKA) is suboptimal, which predisposes patients to disability with increasing age. The purpose of this investigation was to evaluate the efficacy of quadriceps muscle neuromuscular electrical stimulation (NMES), initiated 48 hours after TKA, as an adjunct to standard rehabilitation. This was a prospective, longitudinal randomized controlled trial. Sixty-six patients, aged 50 to 85 years and planning a primary unilateral TKA, were randomly assigned to receive either standard rehabilitation (control) or standard rehabilitation plus NMES applied to the quadriceps muscle (initiated 48 hours after surgery). The NMES was applied twice per day at the maximum tolerable intensity for 15 contractions. Data for muscle strength, functional performance, and self-report measures were obtained before surgery and 3.5, 6.5, 13, 26, and 52 weeks after TKA. At 3.5 weeks after TKA, significant improvements with NMES were found for quadriceps and hamstring muscle strength, functional performance, and knee extension active range of motion. At 52 weeks, the differences between groups were attenuated, but improvements with NMES were still significant for quadriceps and hamstring muscle strength, functional performance, and some self-report measures. Treatment volume was not matched for both study arms; NMES was added to the standard of care treatment. Furthermore, testers were not blinded during testing, but used standardized scripts to avoid bias. Finally, some patients reached the maximum stimulator output during at least one treatment session and may have tolerated more stimulation. The early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.
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              Spinal cord stimulation-induced analgesia: electrical stimulation of dorsal column and dorsal roots attenuates dorsal horn neuronal excitability in neuropathic rats.

              Fei Yang, Yun Guan, Charles Meyer … (2010)
              The sites of action and cellular mechanisms by which spinal cord stimulation reduces neuropathic pain remain unclear. We examined the effect of bipolar electrical-conditioning stimulation (50 Hz, 0.2 ms, 5 min) of the dorsal column and lumbar dorsal roots on the response properties of spinal wide dynamic range (WDR) neurons in rats after L5 spinal nerve injury. The conditioning stimulation intensity was set at the lowest current that evoked a peak antidromic sciatic Aα/β-compound action potential without inducing an Aδ- or C-compound action potential. Within 15 min of the dorsal column or root conditioning stimulation, the spontaneous activity rate of WDR neurons was significantly reduced in nerve-injured rats. Conditioning stimulation also significantly attenuated WDR neuronal responses to mechanical stimuli in nerve-injured rats and inhibited the C-component of the neuronal response to graded intracutaneous electrical stimuli applied to the receptive field in nerve-injured and sham-operated rats. It is noteworthy that dorsal column stimulation blocked windup of WDR neuronal response to repetitive intracutaneous electrical stimulation (0.5 Hz) in nerve-injured and sham-operated rats, whereas dorsal root stimulation inhibited windup only in sham-operated rats. Therefore, stimulation of putative spinal substrates at A-fiber intensities with parameters similar to those used by patients with spinal cord stimulators attenuated established WDR neuronal hyperexcitability in the neuropathic condition and counteracted activity-dependent increase in neuronal excitability (i.e., windup). These results suggest a potential cellular mechanism underlying spinal cord stimulation-induced pain relief. This in vivo model allows the neurophysiologic basis for spinal cord stimulation-induced analgesia to be studied.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biomed Res Int
                Journal ID (iso-abbrev): Biomed Res Int
                Journal ID (publisher-id): BMRI
                Title: BioMed Research International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2314-6133
                ISSN (Electronic): 2314-6141
                Publication date (Print): 2013
                Publication date (Electronic): 5 December 2013
                Volume: 2013
                Electronic Location Identifier: 802534
                Affiliations
                1Department of Physiotherapy Basics, Academy of Physical Education in Katowice, Mikolowska Street 72, 40-065 Katowice, Poland
                2Department of Medical Biophysics, Medical University of Silesia in Katowice, Medykow Street 18, 40-752 Katowice, Poland
                3Department of Physiotherapy, Public Higher Professional Medical School in Opole, Katowicka Street 68, 40-060 Opole, Poland
                4Department of Descriptive and Topographic Anatomy, Medical University of Silesia in Zabrze, Jordana Street 19, 41-808 Zabrze, Poland
                5Department of Physiotherapy, University of Medicine in Wroclaw, Grunwaldzka Street 2, 50-355 Wrocław, Poland
                6Department of Nervous System Diseases, University of Medicine in Wroclaw, Bartla Street 5, 51-618 Wrocław, Poland
                7Department of Gynecology and Obstetrics, University of Medicine in Wroclaw, Bartla Street 5, 51-618 Wrocław, Poland
                Author notes

                Academic Editor: Brad J. Schoenfeld

                Article
                DOI: 10.1155/2013/802534
                PMC ID: 3870113
                PubMed ID: 24381943
                SO-VID: 7ee92312-1e7f-41d8-a2fe-b4f7867eea6b
                Copyright © Copyright © 2013 J. Taradaj et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 8 September 2013
                Date revision received : 9 October 2013
                Date accepted : 13 November 2013
                Categories
                Subject: Clinical Study

                Data availability:

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