The surface mechanomyogram (MMG) (detectable at the muscle surface as MMG by accelerometers, piezoelectric contact sensors or other transducers) is the summation of the activity of single motor units (MUs). Each MU contribution is related to the pressure waves generated by the active muscle fibres. The first part of this article will review briefly the results obtained by our group studying the possible role of motor unit recruitment and firing rate in determining the characteristics of the MMG during stimulated and voluntary contractions. The second part of this article will study the MMG and EMG during a short isometric force ramp from 0 to 90% of the maximal voluntary contraction (MVC) in fresh and fatigued biceps brachii. The aim is to verify whether changes in motor unit activation strategy in voluntarily fatigued muscle could be specifically reflected in the time and frequency domain parameters of the MMG. MMG-RMS vs. %MVC: at fatigue the MMG-RMS did not present the well known increment, when effort level increases, followed by a clear decrement at near-maximal contraction levels. MMG-MF vs. %MVC: compared to fresh muscle the fatigued biceps brachii showed an MF trend significantly shifted towards lower values and the steeper MF increment, from 65 to 85% MVC, was not present. The alteration in the MMG and EMG parameters vs. %MVC relationships at fatigue seems to be related to the impossibility of recruiting fast, but more fatigable MUs, and to the lowering of the global MUs firing during the short isometric force ramp investigated.

Transcutaneous neuromuscular electrical stimulation applied in clinical settings is currently characterized by a wide heterogeneity of stimulation protocols and modalities. Practitioners usually refer to anatomic charts (often provided with the user manuals of commercially available stimulators) for electrode positioning, which may lead to inconsistent outcomes, poor tolerance by the patients, and adverse reactions. Recent evidence has highlighted the crucial importance of stimulating over the muscle motor points to improve the effectiveness of neuromuscular electrical stimulation. Nevertheless, the correct electrophysiological definition of muscle motor point and its practical significance are not always fully comprehended by therapists and researchers in the field. The commentary describes a straightforward and quick electrophysiological procedure for muscle motor point identification. It consists in muscle surface mapping by using a stimulation pen-electrode and it is aimed at identifying the skin area above the muscle where the motor threshold is the lowest for a given electrical input, that is the skin area most responsive to electrical stimulation. After the motor point mapping procedure, a proper placement of the stimulation electrode(s) allows neuromuscular electrical stimulation to maximize the evoked tension, while minimizing the dose of the injected current and the level of discomfort. If routinely applied, we expect this procedure to improve both stimulation effectiveness and patient adherence to the treatment.The aims of this clinical commentary are to present an optimized procedure for the application of neuromuscular electrical stimulation and to highlight the clinical implications related to its use.

To understand better the features of the mechanomyogram (MMG) with different force levels and muscle architectures, the MMG signals detected at many points along three muscles were analysed by the application of a linear array of MMG sensors (up to eight) over the skin. MMG signals were recorded from the biceps brachii, tibialis anterior and upper trapezius muscles of the dominant side of ten healthy male subjects. The accelerometers were aligned along the direction of the muscle fibres. One accelerometer was located over the distal muscle innervation zone, and the other six or seven accelerometers were placed over the muscle, forming an array of sensors with fixed distances between them. The array covered almost the entire muscle length in all cases. MMG signals detected from adjacent accelerometers had similar shapes, with correlation coefficients ranging from about 0.5 to about 0.9. MMG amplitude and characteristic spectral frequencies significantly depended on accelerometer location. The MMG amplitude was maximum at the muscle belly for the biceps brachii and the tibialis anterior. Higher MMG characteristic spectral frequencies were associated with higher amplitudes in the case of the biceps brachii, whereas the opposite was observed for the tibialis anterior muscle. In the upper trapezius, the relationship between characteristic spectral frequencies, MMG amplitude and contraction force depended on the accelerometer location. This suggested that MMG spectral features do not only reflect the mechanical properties of the recruited muscle fibres but depend on muscle architecture and motor unit territorial distribution. It was concluded that the location of the accelerometer can have an influence on both amplitude and spectral MMG features, and this dependence should be considered when MMG signals are used for muscle assessment.

The purpose of the study was to verify, by means of torque and mechanomyogram (MMG) compared analysis, the validity of MMG as a tool to investigate the contractile changes due to localized muscular fatigue induced by stimulation protocols usually employed for sport training and rehabilitation programs. Ten healthy sedentary subjects participated in the study. Torque produced by the dominant biceps brachii (BB) and vastus lateralis (VL) during transcutaneous stimulated contractions has been recorded by a load cell strapped to the subjects' wrist and distal one-third of the tibia, respectively. MMG was detected over the muscle bellies during a monopolar supramaximal stimulation of the main motor point. After potentiation, the fatiguing stimulation was administered. It consisted of 50 cycles, with 2 s of 50 Hz and 25 s of 2 Hz. Averaged normalized values of peak torque (pT) and MMG peak-to-peak (MMG-pp) of the subjects group decreased from their initial 100% values to 55% (pT) and 60% (MMG-pp) for BB and to 43% (pT) and 47% (MMG-pp) for VL. The pT% and MMG-pp% changes throughout the stimulation protocol presented high correlation (BB: R=0.95, P<0.001; VL: R=0.94, P<0.001). This correlation suggests that MMG could be used to follow muscle mechanical fatigue development when torque output is not or hardly detectable such as during electrical stimulation programs employed for sport training or rehabilitation protocols.

The aim of the study was to investigate the influence of two different transcutaneous neuromuscular electrical stimulation procedures on evoked muscle torque and local tissue oxygenation. In the first one (MP mode), the cathode was facing the muscle main motor point and stimulus amplitude was set to the level eliciting the maximal myoelectrical activation according to the amplitude of the evoked electromyogram (EMG); in the second one (RC mode), the electrodes were positioned following common reference charts for electrode placement while stimulus amplitude was set according to subject tolerance. Tibialis Anterior (TA) and Vastus Lateralis (VL) muscles of 10 subjects (28.4 ± 8.2 years) were tested in specific dynamometers to measure the evoked isometric torque. The EMG and near-infrared spectroscopy probes were placed on muscle belly to detect the electrical activity and local metabolic modifications of the stimulated muscle, respectively. The stimulation protocol consisted of a gradually increasing frequency ramp from 2 to 50 Hz in 7.5 s. Compared to RC mode, in MP mode the contractile parameters (peak twitch, tetanic torque, area under the torque build-up) and the metabolic solicitation (oxygen consumption and hyperemia due to metabolites accumulation) resulted significantly higher for both TA and VL muscles. MP mode resulted also to be more comfortable for the subjects. Based on the assumption that proper mechanical and metabolic stimuli are necessary to induce muscle strengthening, our results witness the importance of an optimized, i.e., comfortable and effective, stimulation to promote the aforementioned muscle adaptive modifications.