Transcutaneous electrical nerve stimulation improves fatigue performance of the treated and contralateral knee extensors

  • D. G. BehmEmail author
  • E. M. Colwell
  • G. M. J. Power
  • H. Ahmadi
  • A. S. M. Behm
  • A. Bishop
  • C. Murph
  • J. Pike
  • B. McAssey
  • K. Fraser
  • S. Kearley
  • M. Ryan
Original Article



Transcutaneous electrical nerve stimulation (TENS) can reduce acute and chronic pain. Unilateral fatigue can produce discomfort in the affected limb and force and activation deficits in contralateral non-exercised muscles. TENS-induced local pain analgesia effects on non-local fatigue performance are unknown. Hence, the aim of the study was to determine if TENS-induced pain suppression would augment force output during a fatiguing protocol in the treated and contralateral muscles.


Three experiments were integrated for this article. Following pre-tests, each experiment involved 20 min of TENS, sham, or a control condition on the dominant quadriceps. Then either the TENS-treated quadriceps (TENS_Treated) or the contralateral quadriceps (TENS_Contra) was tested. In a third experiment, the TENS and sham conditions involved two\; 100-s isometric maximal voluntary contractions (MVC) (30-s recovery) followed by testing of the contralateral quadriceps (TENS_Contra-Fatigue). Testing involved single knee extensors (KE) MVCs (pre- and post-test) and a post-test 30% MVC to task failure.


The TENS-treated study induced greater (p = 0.03; 11.0%) time to KE (treated leg) failure versus control. The TENS_Contra-Fatigue induced significant (p = 0.04; 11.7%) and near-significant (p = 0.1; 7.1%) greater time to contralateral KE failure versus sham and control, respectively. There was a 14.5% (p = 0.02) higher fatigue index with the TENS (36.2 ± 10.1%) versus sham (31.6 ± 10.6%) conditions in the second fatigue intervention set (treated leg). There was no significant post-fatigue KE fatigue interaction with the TENS_Contra.


Unilateral TENS application to the dominant KE prolonged time to failure in the treated and contralateral KE suggesting a global pain modulatory response.


Crossover Endurance Pain Strength Isometric 



Diffuse noxious inhibitory control




Knee extensors


Maximal voluntary contractions


Non-local muscle fatigue


Root mean square of the electromyography signal


Transcutaneous electrical nerve stimulation


TENS-treated dominant quadriceps with testing of treated dominant quadriceps


TENS-treated dominant quadriceps with testing of contralateral non-dominant quadriceps


TENS-treated dominant quadriceps subjected to a fatigue protocol (2 × 100 s MVCs) with testing of treated dominant and untreated non-dominant quadriceps



The study was funded by Natural Sciences and Engineering Research Council of Canada (Grant number 2017-03728).

Authors contributions

BDG: data interpretation and writing of manuscript. CEM, PGMJ, AH, BASM, BA, MC, PJ, MB, FK, KS, RM: data collection, analysis, and review of manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest with the contents of this manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Human Kinetics and RecreationMemorial University of NewfoundlandSt. John’sCanada

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