Neuromuscular Electrical Stimulation
- First Online:
- 167 Downloads
In sports medicine, neuromuscular electrical stimulation (NMES) has been used for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of immobilisation, selective muscle retraining, and the control of oedema. A wide variety of stimulators, including the burst-modulated alternating current (‘Russian stimulator’), twin-spiked monophasic pulsed current and biphasic pulsed current stimulators, have been used to produce these effects.
Several investigators have reported increased isometric muscle strength in both NMES-stimulated and exercise-trained healthy, young adults when compared to unexercised controls, and also no significant differences between the NMES and voluntary exercise groups. It appears that when NMES and voluntary exercise are combined there is no significant difference in muscle strength after training when compared to either NMES or voluntary exercise alone. There is also evidence that NMES can improve functional performance in a variety of strength tasks. Two mechanisms have been suggested to explain the training effects seen with NMES. The first mechanism proposes that augmentation of muscle strength with NMES occurs in a similar manner to augmentation of muscle strength with voluntary exercise. This mechanism would require NMES strengthening protocols to follow standard strengthening protocols which call for a low number of repetitions with high external loads and a high intensity of muscle contraction. The second mechanism proposes that the muscle strengthening seen following NMES training results from a reversal of voluntary recruitment order with a selective augmentation of type II muscle fibres. Because type II fibres have a higher specific force than type I fibres, selective augmentation of type II muscle fibres will increase the overall strength of the muscle.
The use of neuromuscular electrical stimulation to prevent muscle atrophy associated with prolonged knee immobilisation following ligament reconstruction surgery or injury has been extensively studied. NMES has been shown to be effective in preventing the decreases in muscle strength, muscle mass and the oxidative capacity of thigh muscles following knee immobilisation. In all but one of the studies, NMES was shown to be superior in preventing the atrophic changes of knee immobilisation when compared to no exercise, isometric exercise of the quadriceps femoris muscle group, isometric co-contraction of both the hamstrings and quadriceps femoris muscle groups, and combined NMES-isometric exercise. It has also been reported that NMES applied to the thigh musculature during knee immobilisation improves the performance on functional tasks.
There is some evidence to suggest that NMES is effective in selective strengthening of individual muscles within muscle groups or parts of muscles. Evidence for selective strengthening of the abdominal muscles, back muscles, triceps brachii and the vastus medialis obliquus has been presented. It is unclear whether this selective strengthening is due to local changes in the muscle or muscle area stimulated or to a change in the relative magnitude of recruitment of the different muscles within a muscle group or of the different portions of a muscle.
NMES has been suggested to be a useful adjunctive treatment in oedema. Several investigators have shown some effect of monophasic pulsed stimulation in the treatment of acute oedema when applied to produce muscle pumping. One investigator has demonstrated an effect of monophasic pulsed stimulation on acute oedema but only when applied at amplitude levels below those needed to produce muscle contraction.
Unable to display preview. Download preview PDF.
- Alon G. Principles of electrical stimulation. In Nelson RM & Currier DP (Eds) Clinical electrotherapy, pp. 35–103, Appleton & Lange, Norwalk, CT, 1991Google Scholar
- Alon G, McCombe SA, Koutsantonis S, Stumphauzer LJ, Burgwin KC, et al. Comparison of the effects of electrical stimulation and exercise on abdominal musculature. Journal of Orthopedic Sports Physical Therapy 8: 567–573, 1987Google Scholar
- Atha J. Strengthening muscles. In Hutton RS & Miller DI (Eds) Exercise and sport sciences review, Vol. 8, pp. 1–73, The Franklin Institute, Philadelphia, 1981Google Scholar
- Brooks ME, Smith EM, Currier DP. Effect of longitudinal versus transverse electrode placement on torque production by the quadriceps femoris muscle during neuromuscular electrical stimulation. Journal of Orthopedic Sports Physical Therapy 11: 530–534, 1990Google Scholar
- Burke RE. Motor units: anatomy, physiology, and functional organization. In Brooks VB (Ed.) Handbook of physiology, Sect. 1, Vol. 2, Part 1, pp. 345–422, American Physiological Society, Bethesda, MD, 1981Google Scholar
- Cosgrove KS, Bell SF, Fisher SR, Fowler NR, Jones TL, et al. The electrical effect of two commonly used clinical stimulators on traumatic edema. Abstract no. R289. Physical Therapy 71 (Suppl.): S117, 1991Google Scholar
- Currier DP. Neuromuscular electrical stimulation for improving strength and blood flow, and influencing changes. In Nelson RM et al. & Currier DP (Eds) Clinical electrotherapy, pp. 35–103, Appleton & Lange, Norwalk, CT, 1991Google Scholar
- Currier DP, Mann R. Pain complaint: comparison of electrical stimulation with conventional isometric exercise. Journal of Orthopedic Sports Physical Therapy 5: 318–323, 1984Google Scholar
- Delitto A, Robinson AJ. Electrical stimulation of muscle: techniques and applications. Snyder-Mackler L & Robinson AJ (Eds) Clinical electrophysiology: electrophysiology and electrophysiological testing, pp. 95–138, Williams & Wilkins, Baltimore, 1989Google Scholar
- Eriksson E, Haggmark T. Comparison of isometric muscle training and electrical stimulation supplementing isometric muscle training in the recovery after major knee ligament surgery. American Journal of Sports Medicine 17: 169–171, 1979Google Scholar
- Ferguson JP, Blackley MW, Knight RD, Sutlive TG, Underwood FB, et al. Effects of varying electrode site placements on the torque output of an electrically stimulated involuntary quadriceps femoris muscle contraction. Journal of Orthopedic Sports Physical Therapy 11: 24–29, 1989Google Scholar
- Fish DR, Mendel FC, Schultz AM, Gottstein-Yerke LM. Effectiveness of anodal high voltage pulsed current on edema formation. Abstract R289. Physical Therapy 71 (Suppl.): S117, 1991Google Scholar
- Godfrey CM, Jayawardena H, Quance TA, Welch P. Comparison of electro-stimulation and isometric exercise in strengthening the quadriceps muscle. Physiotherapy Canada 31: 265–267, 1979Google Scholar
- Gould N, Donnermeyer D, Gammon GG, Pope M, Ashikaga T. Transcutaneous muscle stimulation to retard disuse atrophy after open menisectomy. Clinical Orthopedics and Related Research 178: 190–197, 1983Google Scholar
- Grove-Lainey C, Walmsley RP, Andrew GM. Effectiveness of exercise alone versus exercise plus electrical stimulation in strengthening the quadriceps muscle. Physiotherapy Canada 35: 5–11, 1983Google Scholar
- Halbach JW, Straus D. Comparison of electro-myo stimulation to isokinetic power of the knee extensor mechanism. Journal of Orthopedic Sports Physical Therapy 2: 20–24, 1980Google Scholar
- Kahanovitz N, Nordin M, Verderame R, Yabut S, Parnianpour M, et al. Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation, part 2: comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance. Spine 12: 112–118, 1987PubMedCrossRefGoogle Scholar
- Kloth L. Interference current. In Nelson RM & Currier DP (Eds) Clinical electrotherapy, pp. 221–260, Appleton & Lange, Norwalk, CT, 1991Google Scholar
- Kloth LC, Cummings JP (co-chairs). Electrotherapeutic terminology in physical therapy, Section on Clinical Electrophysiology of the American Physical Therapy Association, Alexandria, VA, 1991Google Scholar
- Kramer JF, Semple JE. Comparison of selected strengthening techniques for normal quadriceps. Physiotherapy Canada 35: 300–304, 1983Google Scholar
- Kramer J, Lindsay D, Magee D, Mendryk S, Wall T. Comparison of voluntary and electrical stimulation contraction torques. Journal of Orthopedic Sports Physical Therapy 5: 324–331, 1984Google Scholar
- Kubiak RJ, Whitman KM, Johnston RM. Changes in quadriceps femoris muscle strength using isometric exercise versus electrical stimulation. Journal of Orthopedic Sports Physical Therapy 8: 537–541, 1987Google Scholar
- Lai DH, DeDomenico G, Strauss GR. The effect of different electro-motor stimulation training intensities on strength improvement. Australian Journal of Physiotherapy 34: 151–164, 1988Google Scholar
- Lake DA. The effects of neuromuscular electrical stimulation as applied by ‘toning salons’ on muscle strength and body shape. Abstract RO77. Physical Therapy 68: 789, 1988Google Scholar
- Lake DA. Increases in range of motion of the edematous hand with the use of electromesh glove. Physical Therapy Forum 8: 6, 1989Google Scholar
- Lake DA, Gillepsie WJ. Electrical stimulation (NMES) does not decrease body fat. Abstract 131. Medicine and Science in Sports and Exercise 20 (Suppl.): S22, 1988Google Scholar
- LeDoux J, Quinones MA. An investigation of the use of percutaneous electrical stimulation in muscle reeducation. Abstract R183. Physical Therapy 61: 737, 1981Google Scholar
- Miller CR, Webers RL. The effects of ice massage on an individual’s pain tolerance level to electrical stimulation. Journal of Orthopedic Sports Physical Therapy 12: 105–110, 1990Google Scholar
- Robinson AJ. Basic concepts and terminology in electrotherapy. In Snyder-Mackler L & Robinson AJ (Eds) Clinical electrophysiology: electrophysiology and electrophysiological testing, pp. 1–19, Williams & Wilkins, Baltimore, 1989Google Scholar
- Snyder-Mackler L. Electrically-elicited cocontraction of the quadriceps femoris and hamstring muscles: effects on gait and thigh muscle strength after anterior cruciate ligament reconstruction. Doctoral dissertation, Boston University, 1990Google Scholar
- ai]Snyder-Mackler L, Campbell L, Gardiner D, Kenney MB, et al. Effects of duty cycle of portable neuromuscular electrical stimulation on fatigue of the non-dominant triceps brachii. Abstract no. R283. Physical Therapy 68: 833, 1988a Snyder-Mackler L, Celluci MB, Lyons J, Magno J, et al. Effects of duty cycle of portable nueromuscular electrical stimulation on strength of the non-dominant triceps brachii. Journal of Orthopedic and Sports Physical Therapy 68: 833–839, 1988bGoogle Scholar
- Snyder-Mackler L, Garrett M, Roberts M. A comparison of torque-generating capabilities of three different electrical stimulation currents. Journal of Orthopedic Sports Physical Therapy 11: 297–301, 1989Google Scholar
- Taylor K, Fish DR, Mendel FC, Burton HW. Effect of a single 30 minute treatment of high voltage pulsed direct current on edema formation. Abstract R291. Physical Therapy 71 (Suppl.): S117, 1991aGoogle Scholar
- Taylor K, Fish DR, Mendel FC, Burton HW. Effects of electrically induced muscle contractions on postraumatic edema formation. Abstract R292. Physical Therapy 71 (Suppl.): S118, 1991bGoogle Scholar
- Underwood FB, Kremser GL, Finstuen K, Greathouse DG. Increasing involuntary torque production by using TENS. Journal of Orthopedic Sports Physical Therapy 12: 101–104, 1990Google Scholar
- Walmsley RP, Letts G, Vooys J. A comparison of torque generated by knee extension with a maximal voluntary muscle contraction vis-a-vis electrical stimulation. Journal of Orthopedic Sports Physical Therapy 6: 10–17, 1984Google Scholar