Skip to main content
Top
Published in: European Journal of Applied Physiology 6/2014

01-06-2014 | Original Article

A new paradigm of neuromuscular electrical stimulation for the quadriceps femoris muscle

Authors: Nicola A. Maffiuletti, Isabelle Vivodtzev, Marco A. Minetto, Nicolas Place

Published in: European Journal of Applied Physiology | Issue 6/2014

Login to get access

Abstract

Purpose

Neuromuscular electrical stimulation (NMES) with large electrodes and multiple current pathways (m-NMES) has recently been proposed as a valid alternative to conventional NMES (c-NMES) for quadriceps muscle (re)training. The main aim of this study was to compare discomfort, evoked force and fatigue between m-NMES and c-NMES of the quadriceps femoris muscle in healthy subjects.

Methods

Ten healthy subjects completed two experimental sessions (c-NMES and m-NMES), that were randomly presented in a cross-over design. Maximal electrically evoked force at pain threshold, self-reported discomfort at different levels of evoked force, and fatigue-induced force declines during and following a series of 20 NMES contractions were compared between c-NMES and m-NMES.

Results

m-NMES resulted in greater evoked force (P < 0.05) and lower discomfort in comparison to c-NMES (P < 0.05–0.001), but fatigue time course and magnitude did not differ between the two conditions.

Conclusions

The use of quadriceps m-NMES appears legitimate for (re)training purposes because it generated stronger contractions and was less discomfortable than c-NMES (due to multiple current pathways and/or lower current density with larger electrodes).
Literature
go back to reference Adams GR, Harris RT, Woodard D, Dudley GA (1993) Mapping of electrical muscle stimulation using MRI. J Appl Physiol 74:532–537PubMed Adams GR, Harris RT, Woodard D, Dudley GA (1993) Mapping of electrical muscle stimulation using MRI. J Appl Physiol 74:532–537PubMed
go back to reference Alon G (1985) High voltage stimulation. Effects of electrode size on basic excitatory responses. Phys Ther 65:890–895PubMed Alon G (1985) High voltage stimulation. Effects of electrode size on basic excitatory responses. Phys Ther 65:890–895PubMed
go back to reference Bax L, Staes F, Verhagen A (2005) Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med 35:191–212PubMedCrossRef Bax L, Staes F, Verhagen A (2005) Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med 35:191–212PubMedCrossRef
go back to reference Bennie SD, Petrofsky JS, Nisperos J, Tsurudome M, Laymon M (2002) Toward the optimal waveform for electrical stimulation of human muscle. Eur J Appl Physiol 88:13–19PubMedCrossRef Bennie SD, Petrofsky JS, Nisperos J, Tsurudome M, Laymon M (2002) Toward the optimal waveform for electrical stimulation of human muscle. Eur J Appl Physiol 88:13–19PubMedCrossRef
go back to reference Bickel CS, Gregory CM, Dean JC (2011) Motor unit recruitment during neuromuscular electrical stimulation: a critical appraisal. Eur J Appl Physiol 111:2399–2407PubMedCrossRef Bickel CS, Gregory CM, Dean JC (2011) Motor unit recruitment during neuromuscular electrical stimulation: a critical appraisal. Eur J Appl Physiol 111:2399–2407PubMedCrossRef
go back to reference Botter A, Merletti R, Minetto MA (2009) Pulse charge and not waveform affects M-wave properties during progressive motor unit activation. J Electromyogr Kinesiol 19:564–573PubMedCrossRef Botter A, Merletti R, Minetto MA (2009) Pulse charge and not waveform affects M-wave properties during progressive motor unit activation. J Electromyogr Kinesiol 19:564–573PubMedCrossRef
go back to reference Bowman BR, Baker LL (1985) Effects of waveform parameters on comfort during transcutaneous neuromuscular electrical stimulation. Ann Biomed Eng 13:59–74PubMedCrossRef Bowman BR, Baker LL (1985) Effects of waveform parameters on comfort during transcutaneous neuromuscular electrical stimulation. Ann Biomed Eng 13:59–74PubMedCrossRef
go back to reference Burke D, Mackenzie RA, Skuse NF, Lethlean AK (1975) Cutaneous afferent activity in median and radial nerve fascicles: a microelectrode study. J Neurol Neurosurg Psychiatry 38:855–864PubMedCentralPubMedCrossRef Burke D, Mackenzie RA, Skuse NF, Lethlean AK (1975) Cutaneous afferent activity in median and radial nerve fascicles: a microelectrode study. J Neurol Neurosurg Psychiatry 38:855–864PubMedCentralPubMedCrossRef
go back to reference Delitto A, Strube MJ, Shulman AD, Minor SD (1992) A study of discomfort with electrical stimulation. Phys Ther 72:410–421PubMed Delitto A, Strube MJ, Shulman AD, Minor SD (1992) A study of discomfort with electrical stimulation. Phys Ther 72:410–421PubMed
go back to reference Doheny EP, Caulfield BM, Minogue CM, Lowery MM (2010) Effect of subcutaneous fat thickness and surface electrode configuration during neuromuscular electrical stimulation. Med Eng Phys 32:468–474PubMedCrossRef Doheny EP, Caulfield BM, Minogue CM, Lowery MM (2010) Effect of subcutaneous fat thickness and surface electrode configuration during neuromuscular electrical stimulation. Med Eng Phys 32:468–474PubMedCrossRef
go back to reference Feil S, Newell J, Minogue C, Paessler HH (2011) The effectiveness of supplementing a standard rehabilitation program with superimposed neuromuscular electrical stimulation after anterior cruciate ligament reconstruction: a prospective, randomized, single-blind study. Am J Sports Med 39:1238–1247PubMedCrossRef Feil S, Newell J, Minogue C, Paessler HH (2011) The effectiveness of supplementing a standard rehabilitation program with superimposed neuromuscular electrical stimulation after anterior cruciate ligament reconstruction: a prospective, randomized, single-blind study. Am J Sports Med 39:1238–1247PubMedCrossRef
go back to reference Gandevia SC (2001) Spinal and supraspinal factors in human muscle fatigue. Physiol Rev 81:1725–1789PubMed Gandevia SC (2001) Spinal and supraspinal factors in human muscle fatigue. Physiol Rev 81:1725–1789PubMed
go back to reference Gobbo M, Gaffurini P, Bissolotti L, Esposito F, Orizio C (2011) Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response. Eur J Appl Physiol 111:2451–2459PubMedCrossRef Gobbo M, Gaffurini P, Bissolotti L, Esposito F, Orizio C (2011) Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response. Eur J Appl Physiol 111:2451–2459PubMedCrossRef
go back to reference Gondin J, Cozzone PJ, Bendahan D (2011) Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes? Eur J Appl Physiol 111:2473–2487PubMedCrossRef Gondin J, Cozzone PJ, Bendahan D (2011) Is high-frequency neuromuscular electrical stimulation a suitable tool for muscle performance improvement in both healthy humans and athletes? Eur J Appl Physiol 111:2473–2487PubMedCrossRef
go back to reference Gorgey AS, Dudley GA (2008) The role of pulse duration and stimulation duration in maximizing the normalized torque during neuromuscular electrical stimulation. J Orthop Sports Phys Ther 38:508–516PubMedCentralPubMedCrossRef Gorgey AS, Dudley GA (2008) The role of pulse duration and stimulation duration in maximizing the normalized torque during neuromuscular electrical stimulation. J Orthop Sports Phys Ther 38:508–516PubMedCentralPubMedCrossRef
go back to reference Gregory CM, Bickel CS (2005) Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther 85:358–364PubMed Gregory CM, Bickel CS (2005) Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther 85:358–364PubMed
go back to reference Gregory CM, Dixon W, Bickel CS (2007) Impact of varying pulse frequency and duration on muscle torque production and fatigue. Muscle Nerve 35:504–509PubMedCrossRef Gregory CM, Dixon W, Bickel CS (2007) Impact of varying pulse frequency and duration on muscle torque production and fatigue. Muscle Nerve 35:504–509PubMedCrossRef
go back to reference Kebaetse MB, Lee SC, Binder-Macleod SA (2001) A novel stimulation pattern improves performance during repetitive dynamic contractions. Muscle Nerve 24:744–752PubMedCrossRef Kebaetse MB, Lee SC, Binder-Macleod SA (2001) A novel stimulation pattern improves performance during repetitive dynamic contractions. Muscle Nerve 24:744–752PubMedCrossRef
go back to reference Kesar T, Chou LW, Binder-Macleod SA (2008) Effects of stimulation frequency versus pulse duration modulation on muscle fatigue. J Electromyogr Kinesiol 18:662–671PubMedCentralPubMedCrossRef Kesar T, Chou LW, Binder-Macleod SA (2008) Effects of stimulation frequency versus pulse duration modulation on muscle fatigue. J Electromyogr Kinesiol 18:662–671PubMedCentralPubMedCrossRef
go back to reference Lai H, De Domenico G, Strauss G (1988) The effect of different electro-motor stimulation training intensities on strength improvement. Aust J Physiother 34:151–164CrossRef Lai H, De Domenico G, Strauss G (1988) The effect of different electro-motor stimulation training intensities on strength improvement. Aust J Physiother 34:151–164CrossRef
go back to reference Laufer Y, Snyder-Mackler L (2010) Response of male and female subjects after total knee arthroplasty to repeated neuromuscular electrical stimulation of the quadriceps femoris muscle. Am J Phys Med Rehabil 89:464–472PubMedCrossRef Laufer Y, Snyder-Mackler L (2010) Response of male and female subjects after total knee arthroplasty to repeated neuromuscular electrical stimulation of the quadriceps femoris muscle. Am J Phys Med Rehabil 89:464–472PubMedCrossRef
go back to reference Laufer Y, Ries JD, Leininger PM, Alon G (2001) Quadriceps femoris muscle torques and fatigue generated by neuromuscular electrical stimulation with three different waveforms. Phys Ther 81:1307–1316PubMed Laufer Y, Ries JD, Leininger PM, Alon G (2001) Quadriceps femoris muscle torques and fatigue generated by neuromuscular electrical stimulation with three different waveforms. Phys Ther 81:1307–1316PubMed
go back to reference Lexell J, Henriksson-Larsen K, Sjostrom M (1983) Distribution of different fibre types in human skeletal muscles. 2. A study of cross-sections of whole m. vastus lateralis. Acta Physiol Scand 117:115–122PubMedCrossRef Lexell J, Henriksson-Larsen K, Sjostrom M (1983) Distribution of different fibre types in human skeletal muscles. 2. A study of cross-sections of whole m. vastus lateralis. Acta Physiol Scand 117:115–122PubMedCrossRef
go back to reference Lieber RL, Kelly MJ (1991) Factors influencing quadriceps femoris muscle torque using transcutaneous neuromuscular electrical stimulation. Phys Ther 71:715–721PubMed Lieber RL, Kelly MJ (1991) Factors influencing quadriceps femoris muscle torque using transcutaneous neuromuscular electrical stimulation. Phys Ther 71:715–721PubMed
go back to reference Lyons GM, Leane GE, Clarke-Moloney M, O’Brien JV, Grace PA (2004) An investigation of the effect of electrode size and electrode location on comfort during stimulation of the gastrocnemius muscle. Med Eng Phys 26:873–878PubMedCrossRef Lyons GM, Leane GE, Clarke-Moloney M, O’Brien JV, Grace PA (2004) An investigation of the effect of electrode size and electrode location on comfort during stimulation of the gastrocnemius muscle. Med Eng Phys 26:873–878PubMedCrossRef
go back to reference Maffiuletti NA (2010) Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol 110:223–234PubMedCrossRef Maffiuletti NA (2010) Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol 110:223–234PubMedCrossRef
go back to reference Maffiuletti NA, Minetto MA, Farina D, Bottinelli R (2011) Electrical stimulation for neuromuscular testing and training: state-of-the art and unresolved issues. Eur J Appl Physiol 111:2391–2397PubMedCrossRef Maffiuletti NA, Minetto MA, Farina D, Bottinelli R (2011) Electrical stimulation for neuromuscular testing and training: state-of-the art and unresolved issues. Eur J Appl Physiol 111:2391–2397PubMedCrossRef
go back to reference Maffiuletti NA, Roig M, Karatzanos E, Nanas S (2013) Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med 11:137PubMedCentralPubMedCrossRef Maffiuletti NA, Roig M, Karatzanos E, Nanas S (2013) Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med 11:137PubMedCentralPubMedCrossRef
go back to reference Malesevic NM, Popovic LZ, Schwirtlich L, Popovic DB (2010) Distributed low-frequency functional electrical stimulation delays muscle fatigue compared to conventional stimulation. Muscle Nerve 42:556–562PubMedCrossRef Malesevic NM, Popovic LZ, Schwirtlich L, Popovic DB (2010) Distributed low-frequency functional electrical stimulation delays muscle fatigue compared to conventional stimulation. Muscle Nerve 42:556–562PubMedCrossRef
go back to reference Morch CD, Hennings K, Andersen OK (2011) Estimating nerve excitation thresholds to cutaneous electrical stimulation by finite element modeling combined with a stochastic branching nerve fiber model. Med Biol Eng Comput 49:385–395PubMedCrossRef Morch CD, Hennings K, Andersen OK (2011) Estimating nerve excitation thresholds to cutaneous electrical stimulation by finite element modeling combined with a stochastic branching nerve fiber model. Med Biol Eng Comput 49:385–395PubMedCrossRef
go back to reference Naaman SC, Stein RB, Thomas C (2000) Minimizing discomfort with surface neuromuscular stimulation. Neurorehabil Neural Repair 14:223–228PubMed Naaman SC, Stein RB, Thomas C (2000) Minimizing discomfort with surface neuromuscular stimulation. Neurorehabil Neural Repair 14:223–228PubMed
go back to reference Neyroud D, Maffiuletti NA, Kayser B, Place N (2012) Mechanisms of fatigue and task failure induced by sustained submaximal contractions. Med Sci Sports Exerc 44:1243–1251PubMedCrossRef Neyroud D, Maffiuletti NA, Kayser B, Place N (2012) Mechanisms of fatigue and task failure induced by sustained submaximal contractions. Med Sci Sports Exerc 44:1243–1251PubMedCrossRef
go back to reference Paessler HH (2012) Emerging techniques in orthopedics: advances in neuromuscular electrical stimulation. Am J Orthop 41:1–8 Paessler HH (2012) Emerging techniques in orthopedics: advances in neuromuscular electrical stimulation. Am J Orthop 41:1–8
go back to reference Parker MG, Berhold M, Brown R, Hunter S, Smith MR, Runhling RO (1986) Fatigue response in human quadriceps femoris muscle during high frequency electrical stimulation. J Orthop Sports Phys Ther 7:145–153PubMedCrossRef Parker MG, Berhold M, Brown R, Hunter S, Smith MR, Runhling RO (1986) Fatigue response in human quadriceps femoris muscle during high frequency electrical stimulation. J Orthop Sports Phys Ther 7:145–153PubMedCrossRef
go back to reference Place N, Maffiuletti NA, Martin A, Lepers R (2007) Assessment of the reliability of central and peripheral fatigue after sustained maximal voluntary contraction of the quadriceps muscle. Muscle Nerve 35:486–495PubMedCrossRef Place N, Maffiuletti NA, Martin A, Lepers R (2007) Assessment of the reliability of central and peripheral fatigue after sustained maximal voluntary contraction of the quadriceps muscle. Muscle Nerve 35:486–495PubMedCrossRef
go back to reference Snyder-Mackler L, Delitto A, Stralka SW, Bailey SL (1994) Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction. Phys Ther 74:901–907PubMed Snyder-Mackler L, Delitto A, Stralka SW, Bailey SL (1994) Use of electrical stimulation to enhance recovery of quadriceps femoris muscle force production in patients following anterior cruciate ligament reconstruction. Phys Ther 74:901–907PubMed
go back to reference Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM (2012) Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther 92:210–226PubMedCentralPubMedCrossRef Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM (2012) Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther 92:210–226PubMedCentralPubMedCrossRef
go back to reference Theurel J, Lepers R, Pardon L, Maffiuletti NA (2007) Differences in cardiorespiratory and neuromuscular responses between voluntary and stimulated contractions of the quadriceps femoris muscle. Respir Physiol Neurobiol 157:341–347 Theurel J, Lepers R, Pardon L, Maffiuletti NA (2007) Differences in cardiorespiratory and neuromuscular responses between voluntary and stimulated contractions of the quadriceps femoris muscle. Respir Physiol Neurobiol 157:341–347
go back to reference Vanderthommen M, Duchateau J (2007) Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev 35:180–185PubMedCrossRef Vanderthommen M, Duchateau J (2007) Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev 35:180–185PubMedCrossRef
go back to reference Vanderthommen M, Duteil S, Wary C, Raynaud JS, Leroy-Willig A, Crielaard JM, Carlier PG (2003) A comparison of voluntary and electrically induced contractions by interleaved 1H- and 31P-NMRS in humans. J Appl Physiol 94:1012–1024PubMed Vanderthommen M, Duteil S, Wary C, Raynaud JS, Leroy-Willig A, Crielaard JM, Carlier PG (2003) A comparison of voluntary and electrically induced contractions by interleaved 1H- and 31P-NMRS in humans. J Appl Physiol 94:1012–1024PubMed
go back to reference Vivodtzev I, Debigare R, Gagnon P, Mainguy V, Saey D, Dube A, Pare ME, Belanger M, Maltais F (2012) Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD: a randomized clinical trial. Chest 141:716–725PubMedCrossRef Vivodtzev I, Debigare R, Gagnon P, Mainguy V, Saey D, Dube A, Pare ME, Belanger M, Maltais F (2012) Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD: a randomized clinical trial. Chest 141:716–725PubMedCrossRef
go back to reference Walls RJ, McHugh G, O’Gorman DJ, Moyna NM, O’Byrne JM (2010) Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study. BMC Musculoskelet Disord 11:119PubMedCentralPubMedCrossRef Walls RJ, McHugh G, O’Gorman DJ, Moyna NM, O’Byrne JM (2010) Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study. BMC Musculoskelet Disord 11:119PubMedCentralPubMedCrossRef
go back to reference Zory R, Boerio D, Jubeau M, Maffiuletti NA (2005) Central and peripheral fatigue of the knee extensor muscles induced by electromyostimulation. Int J Sports Med 26:847–853PubMedCrossRef Zory R, Boerio D, Jubeau M, Maffiuletti NA (2005) Central and peripheral fatigue of the knee extensor muscles induced by electromyostimulation. Int J Sports Med 26:847–853PubMedCrossRef
Metadata
Title
A new paradigm of neuromuscular electrical stimulation for the quadriceps femoris muscle
Authors
Nicola A. Maffiuletti
Isabelle Vivodtzev
Marco A. Minetto
Nicolas Place
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Applied Physiology / Issue 6/2014
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI
https://doi.org/10.1007/s00421-014-2849-2

Other articles of this Issue 6/2014

European Journal of Applied Physiology 6/2014 Go to the issue