Neuromuscular electrical stimulation in rehabilitation and sport

Neuromuscular electrical stimulation in stroke rehabilitation

The effectiveness of NMES in stroke rehabilitation is well documented.

For example, Lee and colleagues showed that combining NMES with robot-assisted therapy significantly reduced muscle spasticity in patients with chronic stroke, suggesting that neuromuscular electrical stimulation can effectively complement conventional rehabilitation methods by addressing specific motor impairments (Lee et al., 2015).

Chen and Mei further detailed the benefits of NMES, highlighting its ability to improve limb function, enhance circulation in paralyzed limbs, and promote functional recovery through repeated limb movements (Chen & Mei, 2017). These findings underscore the role of neuromuscular electrical stimulation in promoting neuroplasticity and functional recovery, which are key in stroke rehabilitation.

NMES in chronic obstructive pulmonary disease (COPD)

In COPD, neuromuscular electrical stimulation has been shown to improve exercise tolerance and muscle strength, particularly in patients suffering from significant muscle weakness.

Studies indicate that NMES can prevent deterioration of muscle function and improve strength in COPD patients, even in those with low metabolic responses (Giavedoni et al., 2012).

For example, Akar and colleagues reported that muscle stimulation significantly increased muscle strength in COPD patients, emphasizing its potential value as an adjunct to pulmonary rehabilitation (Akar et al., 2015).

Moreover, combining NMES with endurance and resistance training has been shown to yield better outcomes in exercise capacity and balance in patients with chronic diseases (Acheche et al., 2020).

This synergistic effect suggests that NMES may be especially beneficial for patients who cannot participate in conventional exercise programs due to their health condition.

Physiological effects of neuromuscular electrical stimulation

The physiological effects of NMES go beyond simple muscle contraction.

Research shows that muscle stimulation is capable of inducing changes in muscle fiber composition, converting type II fibers to type I fibers, which are more resistant to fatigue (Xu et al., 2017). This transformation is crucial for improving endurance and overall muscle performance.

Additionally, neuromuscular electrical stimulation has been associated with increased muscle mass and improved contractile strength, which are essential for functional mobility and independence in patients recovering from various conditions (Xu et al., 2017).

Central mechanisms involved in NMES also promote cortical reorganization, further supporting motor recovery in stroke patients (Xu et al., 2017).

NMES in musculoskeletal disorders

The application of NMES is not limited to stroke and COPD; it has also shown promise in treating knee osteoarthritis and other musculoskeletal disorders.

A systematic review by Giggins and colleagues found significant improvements in quadriceps strength following NMES interventions, highlighting its role in addressing muscle weakness associated with osteoarthritis (Giggins et al., 2012).

This is particularly important in rehabilitation settings where maintaining muscle strength is key to joint stability and function.

The role of NMES in prevention

Beyond rehabilitation applications, NMES has been investigated for its potential role in preventing complications such as venous thromboembolism, particularly in immobilized patients (Ravikumar et al., 2017).

Activation of the lower limb muscle pumps by neuromuscular electrical stimulation has been shown to increase venous blood flow, thereby reducing the risk of thrombus formation. This preventive aspect of muscle stimulation adds another layer to its clinical usefulness, especially in intensive care settings.

Integration with other therapeutic methods

Furthermore, neuromuscular electrical stimulation can be integrated with other therapeutic methods to enhance its effects.

For example, combining NMES with mirror therapy has been shown to improve motor recovery in stroke patients by providing visual feedback that reinforces motor learning (Xu et al., 2017).

Similarly, the integration of NMES with transcranial direct current stimulation has been explored as a means to further improve upper limb function in stroke rehabilitation (Wei et al., 2021).

These combinations highlight the versatility of NMES as part of comprehensive rehabilitation strategies.

Muscle stimulation in sports applications

Increasing muscle strength and performance

In sports, NMES is increasingly recognized for its potential to enhance muscle strength and athletic performance.

Taradaj and colleagues, in a study on professional footballers recovering from anterior cruciate ligament (ACL) reconstruction, found that NMES effectively increased quadriceps strength and improved knee function (Taradaj et al., 2013).

This suggests that NMES can play a key role in athletes' rehabilitation, helping them return to sport faster while minimizing muscle atrophy.

Similarly, Oliveira and colleagues demonstrated that NMES training can significantly improve quadriceps strength in athletes, underlining its usefulness in enhancing athletic performance (Oliveira et al., 2018).

The ability of NMES to evoke muscle contractions without voluntary effort makes it a valuable tool for athletes who want to maintain or improve muscle strength during periods of reduced activity or injury.

Recovery and rehabilitation

NMES is also used in recovery protocols following intense training.

Malone and colleagues reviewed the effectiveness of NMES in aiding recovery from exercise-induced muscle fatigue, noting that it can help reduce markers of muscle damage and speed up recovery (Malone et al., 2014).

This is particularly relevant for athletes undergoing rigorous training programs, as NMES can be incorporated into recovery strategies to mitigate fatigue effects and promote faster recovery times.

Additionally, Sharma and colleagues compared the effects of NMES and intermittent pneumatic compression on recovery following anaerobic exercise in basketball players, concluding that NMES is an effective method to support recovery (Sharma et al., 2016).

This highlights the versatility of NMES as a recovery intervention applicable across different sports.

Combining NMES with other techniques

The effectiveness of NMES can be further enhanced when combined with other therapeutic interventions.

Mazloum's study showed that NMES combined with Kinesio taping was effective in reducing ankle swelling in athletes with lateral ankle sprain, suggesting that NMES can complement other rehabilitation techniques (Mazloum, 2023).

This integrative approach can optimize recovery outcomes and improve overall athletic performance.

Recommendation

In summary, neuromuscular electrical stimulation represents a versatile therapeutic approach with significant implications for rehabilitation across various medical conditions and for sports applications.

Its ability to promote muscle contraction, enhance functional recovery, and prevent complications makes it a valuable tool in clinical practice and athletic training.

However, ongoing research is needed to refine NMES protocols and fully understand its mechanisms of action, ensuring optimal use for different patient populations and athletes alike.

Click here to find therapeutic devices that provide neuromuscular electrical stimulation.

Sources

1. Lee et al. “Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial” Journal of Neuroengineering and Rehabilitation (2015) doi:10.1186/s12984-015-0088-3.

2. Chen and Mei “The Effects of Neuromuscular Electrical Stimulation in the Treatment of Stroke” (2017) doi:10.2991/icadme-17.2017.10.

3. Giavedoni et al. “Neuromuscular electrical stimulation prevents muscle function deterioration in exacerbated COPD: A pilot study” Respiratory Medicine (2012) doi:10.1016/j.rmed.2012.05.005.

4. Akar et al. “Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit” The Clinical Respiratory Journal (2015) doi:10.1111/crj.12411.

5. Acheche et al. “The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial” Canadian Respiratory Journal (2020) doi:10.1155/2020/9826084.

6. Xu et al. “Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study” Clinical Rehabilitation (2017) doi:10.1177/0269215517705689.

7. Giggins et al. “Neuromuscular electrical stimulation in the treatment of knee osteoarthritis: a systematic review and meta-analysis” Clinical Rehabilitation (2012) doi:10.1177/0269215511431902.

8. Pan et al. “Lack of efficacy of neuromuscular electrical stimulation of the lower limbs in chronic obstructive pulmonary disease patients: A meta‐analysis” Respirology (2013) doi:10.1111/resp.12200.

9. Kucio et al. “Evaluation of the Effects of Neuromuscular Electrical Stimulation of The Lower Limbs Combined with Pulmonary Rehabilitation on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease” Journal of Human Kinetics (2016) doi:10.1515/hukin-2016-0054.

10. Ravikumar et al. “Neuromuscular electrical stimulation for the prevention of venous thromboembolism” Phlebology the Journal of Venous Disease (2017) doi:10.1177/0268355517710130.

11. Wei et al. “Effects of Transcranial Direct Current Stimulation Combined With Neuromuscular Electrical Stimulation on Upper Extremity Motor Function in Patients With Stroke” American Journal of Physical Medicine & Rehabilitation (2021) doi:10.1097/phm.0000000000001759.

12. Taradaj et al. “The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction” Biomed research international (2013) doi:10.1155/2013/802534.

13. Oliveira et al. “Training Effects of Alternated and Pulsed Currents on the Quadriceps Muscles of Athletes” International journal of sports medicine (2018) doi:10.1055/a-0601-6742.

14. Malone et al. “Neuromuscular Electrical Stimulation During Recovery From Exercise” The journal of strength and conditioning research (2014) doi:10.1519/jsc.0000000000000426.

15. Sharma et al. “Effects of intermittent pneumatic compression vs. neuromuscular electrical stimulation on recovery following anaerobic exercise in male basketball players” International journal of biomedical and advance research (2016) doi:10.7439/ijbar.v7i10.3655.

16. Mazloum “The comparison of the effects of neuromuscular electrical stimulation and Kinesio Taping on ankle swelling in athletes with lateral ankle sprain” Journal of experimental orthopaedics (2023) doi:10.1186/s40634-023-00624-w.