Electrotherapy

There are several types of electrotherapy treatments including ultrasound, interferential, laser and shortwave diathermy. There has been a move away from some of these techniques following further research, not because they do not work in their way, but because we have found other methods more effective. You may still have some form of electrotherapy as part of your treatment session as there are well reasearched and proven benefits in them at certain points of the healing process.

Neuromuscular electrical stimulation (NMES)

 

Neuromuscular electrical stimulation (NMES) can be

a beneficial supplement to traditional forms of therapy in the patient who finds a muscle function is reduced either by inhibition [post injury] or even

the period post-surgery [e.g Knee]. This inhibition may demonstrate itself as either weakness, with or without loss of bulk [atrophy], or even the lack of ability to “switch” the muscle on despite the patients best efforts!

 

We can use a simple non-invasive, no painful, neuromuscular stimulator such as “Compex” or Neuro Trac [Nuerotec] devices to override the patients inhibitions and produce a muscle contraction. A specific muscle or group of muscles can be targeted by placing simple “sticky” electrodes at certain points over a muscle to gain a variety of different muscle effects by “exciting “ that muscle. See below:

 

 

The patient can “passively” let the muscle contract through the stimulus or later on in the rehab process can actively join in with the contraction.

A great example is the rehabilitation of most knee conditions where one of the quadriceps muscles, the Vastu Medialis, can atrophy very quickly indeed. You will recognise this muscle as the “tear drop” shaped muscle on the inside of the knee. By stimulating this muscle very soon post injury or post operatively you can not only keep the muscle firing but can maintain some of its bulk. Later on in the rehab you can perform simple exercises such as step ups or squats along with the muscle stimulation to make quicker and better gains in muscle strength and function.

 

The evidence

There are lots of studies out there but a couple of interest can be found below:

 

It has been reported that after knee joint replacement, a patient group

who engaged in highly intensive activation of the quadriceps

muscle using electrical stimulation produced better

results for strength and muscle activation compared with

a control group.29 Comparable studies conducted after

anterior cruciate ligament (ACL) reconstruction produced

The American Journal of Sports Medicine, Vol. XX, No. X

 

 

The primary objectives of rehabilitation after ACL

reconstruction are to reduce inflammation, regain neuromuscular

strength and functional performance, recover

normal range of motion, and reintegrate the patient to

everyday activities. Studies have shown that the activation

pattern of the quadriceps and hamstring muscles as well as

restoration of proprioception play an important role in

rehabilitation after ACL surgery. A recent review concluded

that rehabilitation training with NMES superimposed

on voluntary contraction was better than either

NMES or voluntary contraction practiced separately.

Sports Med. 2008;38:161-177.