Neuromuscular Electrical Stimulation for Quadriceps Muscle Strengthening After Bilateral Total Knee Arthroplasty: A Case Series

Abstract

Study Design: A case series. Objectives: The purpose of this case series was to assess the effect of high-intensity neuromuscular electrical stimulation (NMES) on quadriceps strength and voluntary activation following total knee arthroplasty (TKA). Background: Following TKA, patients exhibit long-term weakness of the quadriceps and diminished functional capacity compared to age-matched healthy controls. The pain and swelling that results from surgery may contribute to quadriceps weakness. The use of high-intensity NMES has previously been shown to be effective in quickly restoring quadriceps strength in patients with weakness after surgery. Methods and Measures: All patients were treated for 6 weeks, 2 to 3 visits per week, in outpatient rehabilitation. Five patients (NMES group) participated in a voluntary exercise program for both knees and NMES for the weaker knee. Three patients (exercise group) participated in a voluntary exercise program for both knees without NMES. For each treatment session, 10 isometric electrically elicited muscle contractions were administered at maximally tolerated doses to the initially weaker leg of the NMES group. Quadriceps strength and muscle activation were repeatedly assessed up to 6 months after surgery using burst superimposition techniques. Results: At 6 months, the weak NMES-treated legs of 4 of 5 patients in the NMES group had surpassed the strength of the contralateral leg. In contrast, none of the weak legs in the exercise group were stronger than the contralateral leg at 6 months. Changes in quadriceps muscle activation mirrored the changes exhibited in strength. Conclusion: When NMES was added to a voluntary exercise program, deficits in quadriceps muscle strength and activation resolved quickly after TKA.

Late neural adaptations to electrostimulation resistance training of the plantar flexor muscles

“…Although the mechanisms mediating the improvement in muscle function parameters induced by NMES training have not been fully elucidated, researchers have mainly documented the occurrence of neural adaptations. For example, surface electromyographic (EMG) activity and activation of the plantar Xexor (MaYuletti et al 2002a) and knee extensor (Stevens et al 2004;Gondin et al 2005) muscles have been shown to increase signiWcantly after multiple sessions of NMES. In the same way, signiWcant cross-education eVect (Hortobagyi et al 1999), acute facilitative eVects (Howard and Enoka 1991) and observations on the speciWcity of NMES training eVects (e.g.…”

Torque and surface mechanomyogram parallel reduction during fatiguing stimulation in human muscles

“…Transcutaneous muscle electrical stimulation (ES) has gained an important role in rehabilitation and physical therapy as an adjunct tool for restoration of muscle functionality (Snyder-Mackler et al 1994;Stevens et al 2004), treatment of patello-femoral pain syndrome (Callaghan and Oldham 2004) or strengthening of limb muscles in elderly subjects with joint osteoarthritis (Talbot et al 2003) and may find a clear application in all those conditions that require the selective training of a specific muscle, such as vastus medialis during the treatment of patellar malalignment.…”

The Effect of Burst-Duty-Cycle Parameters of Medium-Frequency Alternating Current on Maximum Electrically Induced Torque of the Quadriceps Femoris, Discomfort, and Tolerated Current Amplitude in Professional Soccer Players

“…Recent research has demonstrated that lower burst duty cycles (10%-20%) are optimal for generation of maximum electrically induced torque in the biceps brachii, 4 finger flexors, 35 and wrist extensors 55 and produce less discomfort. 35,55 Despite the common use of NMES in clinical practice to increase the strength of knee extensor musculature, 6,29,38,[45][46][47]50 only 2 studies in the literature have assessed the effect of burst-duty-cycle duration on torque production of the quadriceps in healthy, untrained individuals. 33,37 The first study 33 compared 5 burst-duty-cycle durations (10%, 30%, 50%, 70%, and 90%) and found that a burst duty cycle of 10% elicited the strongest muscle contraction.…”

“…28,30 To minimize fatigue, a 5-minute interval was provided between each repetition. 43,45 Verbal encouragement was given by the investigator for each trial. The average of the peak torque values obtained for the 3 trials was calculated and used for subsequent analysis.…”

“…49 Application of the electrode over the motor point of the muscle was chosen to standardize electrode positioning and to reduce the required current intensity. 46 NMES was performed using the Endophasys-R (KLD Biosistemas Equipamentos Eletrônicos Ltda, Amparo, Brazil) within the following current parameters: 2500-Hz carrier frequency, 50-Hz modulated frequency, 200-microsecond phase duration of 9-second stimulation time (with a 3-second ramp-up), 29,40,42,45,46,49 and 5-minute rest between repetitions.…”