Contralateral effects of disinhibitory tens on quadriceps function in people with knee osteoarthritis following unilateral treatment (original) (raw)
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Disinhibitory Interventions and Voluntary Quadriceps Activation: A Systematic Review
Journal of Athletic Training, 2014
Objective: To determine the effects of various therapeutic interventions on increasing voluntary quadriceps muscle activation. Background: Decreased voluntary quadriceps activation is commonly associated with knee injury. Recently, research has focused on developing specific disinhibitory interventions to improve voluntary quadriceps activation; yet, it remains unknown which interventions are most effective in promoting this improvement. Data Sources: We searched Web of Science from January 1, 1965 through September 27, 2012, using the key words quadriceps activation and transcutaneous electrical nerve stimulation, transcranial magnetic stimulation, cryotherapy, focal joint cooling, joint mobilization, joint mobilisation, joint manipulation, manual therapy, and neuromuscular electrical stimulation. Study Selection: Studies evaluating the effect of disinhibitory interventions on volitional quadriceps activation were used in our review. Standardized effect sizes (Cohen d) and 95% conf...
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
American Journal of Physical Medicine & Rehabilitation, 2010
To determine the relationship between quadriceps central activation ratios (CARs) derived from a percutaneous electrical stimulation (CAR(SIB)) and a transcranial magnetic stimulation (CAR(TMS)) in healthy participants. Nineteen healthy participants (5 men, 14 women, 23.7 ± 4.8 yrs, 66.8 ± 10.0 kg, and 170.1 ± 7.0 cm) qualified for this descriptive study. Muscle activation, using both methods (CAR(SIB) and CAR(TMS)), was measured at days 1, 14, and 28. All participants performed both methods in a counterbalanced order. Correlation coefficients and Bland-Altman plots were used to assess relationships and agreement between the two methods. For both methods, reliability was assessed at 14 and 28 days using Bland-Altman plots and intraclass correlation coefficients. CAR(TMS) scores were higher than CAR(SIB) scores for all three sessions, with mean differences between CAR scores of -0.06 (95% confidence interval, -0.19-0.07), -0.03 (95% confidence interval, -0.14-0.08), and -0.03 (95% confidence interval, -0.11-0.05). There was a significant moderate positive correlation between CAR(SIB) and CAR(TMS) at 14 days from baseline (ρ = 0.45, P = 0.05). Intersession reliability was strong for CAR(SIB) at 14 and 28 days from baseline (intraclass correlation coefficients = 0.80 [P = 0.001] and 0.85 [P < 0.001], respectively). Intersession reliability for CAR(TMS) was moderate from baseline to 14 days (intraclass correlation coefficients = 0.68 [P = 0.01]). It does not seem that the CAR(TMS) and CAR(SIB) methods are interchangeable measurements for evaluating volitional quadriceps activation; however, both measurements seem to have acceptable agreement at 14 and 28 days compared with day 1.