Lack of effect of superficial heat to the knee on quadriceps function in individuals with quadriceps inhibition (original) (raw)
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TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION’S EFFECT ON QUADRICEPS ARTHROGENIC MUSCLE INHIBITION: A SYSTEMATIC REVIEW, 2018
Background Arthrogenic muscle inhibition (AMI) is a multifactorial condition which results in the inability to fully voluntarily activate musculature surrounding an affected joint, in absence of a structural lesion to the muscle or innervating nerve. Despite the frequent presence of AMI following knee joint injury, the current evidence-base regarding treatments to directly address AMI is limited. Transcutaneous electrical nerve stimulation (TENS) is a promising disinhibitory intervention that warrants further investigation concerning its effectiveness in counteracting the detrimental influences of quadriceps AMI. Objectives The primary aim of this systematic review was to critically analyse and evaluate the current evidence-base relating to the effectiveness of TENS as a disinhibitory intervention to improve neuromuscular function of the quadriceps in pathological knee joints. Search strategy A comprehensive search of online databases including CINAHL, Medline, Embase, Scopus, Cochrane Library, and SPORTDiscus, was conducted using pre-determined keywords to identify relevant publications in April 2018. Eligibility criteria All relevant studies identified using the search strategy that investigated the use of TENS as a disinhibitory modality for quadriceps AMI and that satisfied the strict pre-determined inclusion and exclusion criteria were accepted. Data collection and analysis Risk of bias and methodological quality of included studies were assessed using the 11- point Physiotherapy Evidence Database Scale and were scored as excellent, good, fair, or poor quality. Main results Five studies, graded as either good or poor quality, satisfied the eligibility criteria for this systematic review. Three outcome measures were used to quantify changes in AMI following intervention. Three included studies evaluated the disinhibitory effects of TENS within a single treatment session with the patient at rest, while the other two included studies observed the effects of TENS in conjunction with exercise through multiple treatment sessions over a multi-week intervention period. All three studies examining the effects of TENS within a single treatment session observed significant improvements in voluntary quadriceps activation or excitability, but not for quadriceps strength. Significant improvements were observed in voluntary quadriceps activation and strength for participants with tibiofemoral osteoarthritis exercising with TENS. However, only large effect sizes were found for participants with acute anterior cruciate ligament injuries exercising with TENS and no significant improvements were observed between groups. Conclusions Based on the results from the systematic review, good quality evidence indicates TENS is effective as a disinhibitory intervention for quadriceps AMI immediately upon application, and when used as an adjunct therapy to therapeutic exercise for short-term benefits in voluntary quadriceps activation and strength. Greater clinical effects may be observed in participants with chronic knee pathologies who demonstrate persistent quadriceps weakness compared to severe acute knee injuries. Further research is required to determine the precise neural pathways by which the disinhibitory mechanisms of TENS operates, as well as optimal TENS dosage to produce the greatest clinical effects
Clinical Rheumatology, 2007
The aim of this study was to evaluate the effects of electrical stimulation program on pain, disability, and quadriceps strength in the patients with knee osteoarthritis. Fifty women diagnosed as knee osteoarthritis were randomized into two groups as electrical stimulation and biofeedback-assisted isometric exercises. Both of the programs were performed 5 days a week, for a duration of 4 weeks. Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index (WOMAC) pain score. Disability and stiffness were assessed with WOMAC physical function and stiffness score. One repetition maximum (RM) and 10 RM were used for measuring quadriceps strength. In addition, 50 m walking time and 10 steps stairs climbing up-down time were evaluated. Both groups showed significant improvements in pain, physical function, and stiffness scores after the therapy. There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength. In addition, there were no significant differences between the groups after the therapy. We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program.
Journal of athletic training, 2002
OBJECTIVE: Arthrogenic muscle inhibition (AMI) is a presynaptic, ongoing reflex inhibition of joint musculature after distension or damage to the joint. The extent to which therapeutic interventions affect AMI is unknown. The purpose of this study was to verify that the vastus medialis (VM) is inhibited using the knee joint effusion model and to investigate the effects of cryotherapy and transcutaneous electric nerve stimulation (TENS) on AMI using this model. DESIGN AND SETTING: A 3 x 6 analysis of variance was used to compare Hoffmann-reflex data for treatment groups (cryotherapy, TENS, and control) across time (preinjection, postinjection, and 15, 30, 45, and 60 minutes after injection). SUBJECTS: Thirty neurologically sound volunteers (age = 21.8 +/- 2.4 years; height = 175.6 +/- 9.6 cm; mass = 71.5 +/- 13.3 kg) participated in this study. MEASUREMENTS: Hoffmann-reflex measurements were collected using a percutaneous stimulus to the femoral nerve and surface electromyography of ...
Journal of Orthopaedic & Sports Physical Therapy, 2007
Case report. Following total knee arthroplasty (TKA), restoration of normal quadriceps muscle function is rare. One month after surgery, quadriceps torque (force) is only 40% of preoperative values and quadriceps activation is only 82% of preoperative levels, despite initiating postoperative rehabilitation the day after surgery. Early application of neuromuscular electrical stimulation (NMES) offers a possible approach to minimize loss of quadriceps torque more effectively than traditional rehabilitation exercises alone. A 65-year-old female underwent a right, cemented TKA. Isometric quadriceps and hamstrings muscle torque were measured preoperatively and at 3, 6, and 12 weeks after TKA. Quadriceps muscle activation was measured using a doublet interpolation technique at the same time points. The patient participated in a traditional TKA rehabilitation program augmented by NMES, which was initiated 48 hours after surgery and continued twice a day for the first 3 weeks, and once daily for 3 additional weeks. Preoperatively, the involved quadriceps produced 75% of the torque of the uninvolved side and demonstrated only 72.9% activation. At 3, 6, and 12 weeks after TKA, quadriceps torque was greater than the preoperative values of the involved side by 16%, 29%, and 56%, respectively. Similarly, activation improved to 93.4%, 94.6%, and 93.5% at 3, 6, and 12 weeks after TKA. Mitigating quadriceps muscle weakness immediately after TKA using early NMES may improve functional outcomes, because quadriceps weakness has been associated with numerous functional limitations and an increased risk for falls. Despite presenting preoperatively with substantial quadriceps torque and activation deficits, the patient in this case demonstrated improvements in quadriceps function at all the times measured, all of which were superior to those reported in the literature. The patient also made substantial improvements in functional outcomes, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), 6-minute walk test, timed up and go (TUG) test, stair-climbing test, and the SF-36 Physical Component Score. Appropriately controlled clinical trials will be necessary to determine whether such favorable outcomes following TKA are specifically attributable to the addition of NMES to the rehabilitation program.