Neuromuscular Electrical Stimulation

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Neuromuscular Electrical Stimulation to Preserve Quadriceps Muscle Fiber Size and Contractility After Anterior Cruciate Ligament Injuries and Reconstruction


Neuromuscular Electrical Stimulation

Anterior cruciate ligament (ACL) injuries are common sports injuries. They occur when the ligament connecting the thighbone to the knee joint tears. ACL injuries are often caused by a direct blow or by a sudden twisting motion with the knee joint. Most ACL injuries occur during sports, but the ligaments are also damaged in other situations such as a fall or a jump. After an ACL injury, patients have difficulty walking normally without pain. Many treatments exist for ACL injuries, but none have been proven to be effective. Therefore, it's important to study new treatments that can help improve the quality of life for ACL injury victims.

After an ACL injury, patients experience severe pain and instability in their knee joints. In addition, their quadriceps muscles become weak and cannot support their lower body weight. Patients also experience muscle spasms in their quadriceps muscles after an ACL injury. Most people recover from an ACL injury with just physical therapy; however, some people have persistent muscle aches and pains after an ACL tear. Researchers have hypothesized that early neuromuscular electrical stimulation use can help to prevent maladaptations after an ACL reconstruction.

NMES has proven to be a useful treatment for degenerative conditions such as arthritis. It has also shown potential as a treatment for post-traumatic stress disorder and chronic pain. Researchers believe that NMES helps to reduce pain by increasing blood flow and improving blood circulation in the body. NMES is thought to increase blood flow to specific areas through electrical impulses; this increases blood flow to those areas and increases the delivery of oxygen and nutrients to them. It's believed that this improves various internal mechanisms in the body that contribute to reducing pain and increasing overall health and well-being after injury or illness.

In 2017, researchers conducted a study to see whether early NMES use can help to preserve muscle size and contractility after an ACL reconstruction. Muscle size is directly proportional to strength and flexibility; therefore, preserving these qualities will make the patient's post-reconstruction recovery easier and less painful. In addition, preserving muscle size will help reduce the risk of maladaptations— which will help patients recover faster from their surgery.

The researchers recruited 28 healthy young males between 18 and 35 years old who had no history of knee complaints or previous surgeries on their knees— including meniscus tears or ACL injuries. Each participant was randomly assigned to one of two groups: one received NMES stimulation before rehabilitation, while the other received sham stimulation treatment before rehabilitation. Both groups received standard rehabilitation exercises for two weeks following their treatments; then each participant returned for further rehabilitation exercises for another two weeks. At this point in time, each participant was re-evaluated for muscle size and contractivity before being released from the study. After their rehabilitation period ended, the participants underwent a follow-up exam where they again underwent standard tests of muscular performance— including quadriceps muscle contractility, isometric force production, voluntary activation level, and voluntary muscle endurance level. The researchers found that participants who received NMES treatment before rehabilitation exhibited significantly greater quadriceps muscle size and contractility compared to those who received sham treatment before rehabilitation. This suggests that early NMES use can preserve muscle size and contractility after ACL reconstruction— which will make patients' post-reconstruction recovery easier and less painful.


There are many benefits associated with using NMES after an ACL reconstruction; however, there's not enough evidence available to support its effectiveness in preventing maladaptations post-reconstruction. In fact, there's good reason to believe that early NMES use can help to preserve muscle size and contractility after ACL reconstruction— although more research is definitely needed in this regard before it can be recommended as a treatment option for post-ACL reconstruction patients specifically.


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