Lindsey K Lepley1, Edward M Wojtys2, Riann M Palmieri-Smith3. 1. Department of Rehabilitation, University of Kentucky, Lexington, KY, United States; School of Kinesiology, University of Michigan, Ann Arbor, MI, United States. 2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States. 3. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States; School of Kinesiology, University of Michigan, Ann Arbor, MI, United States. Electronic address: riannp@umich.edu.
Abstract
BACKGROUND: Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown to lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-reconstruction. Thus, the aim of this study was to evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. METHODS: Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; and STND, standard of care) and ten healthy controls participated. N&E and N-only received the NMES protocol 2× per week for the first 6 weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2× per week beginning 6 weeks post-reconstruction. Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. RESULTS: No differences in pre-operative measures existed (P>0.05). E-only recovered quadriceps activation better than N-only or STND (P<0.05). N&E and E-only recovered strength better than N-only or the STND (P<0.05) and had strength values that were similar to healthy at return-to-play (P>0.05). CONCLUSION: Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. LEVEL OF EVIDENCE: Level 3, Parallel longitudinal study.
BACKGROUND: Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown to lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-reconstruction. Thus, the aim of this study was to evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. METHODS: Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; and STND, standard of care) and ten healthy controls participated. N&E and N-only received the NMES protocol 2× per week for the first 6 weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2× per week beginning 6 weeks post-reconstruction. Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. RESULTS: No differences in pre-operative measures existed (P>0.05). E-only recovered quadriceps activation better than N-only or STND (P<0.05). N&E and E-only recovered strength better than N-only or the STND (P<0.05) and had strength values that were similar to healthy at return-to-play (P>0.05). CONCLUSION: Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. LEVEL OF EVIDENCE: Level 3, Parallel longitudinal study.
Authors: J Parry Gerber; Robin L Marcus; Leland E Dibble; Patrick E Greis; Robert T Burks; Paul C Lastayo Journal: J Orthop Sports Phys Ther Date: 2007-01 Impact factor: 4.751
Authors: Christopher L Mendias; Evan B Lynch; Max E Davis; Elizabeth R Sibilsky Enselman; Julie A Harning; Paul D Dewolf; Tarek A Makki; Asheesh Bedi Journal: Am J Sports Med Date: 2013-06-05 Impact factor: 6.202
Authors: Ethne L Nussbaum; Pamela Houghton; Joseph Anthony; Sandy Rennie; Barbara L Shay; Alison M Hoens Journal: Physiother Can Date: 2017 Impact factor: 1.037
Authors: Claudia Ferreira Gomes da Silva; Felipe Xavier de Lima E Silva; Karoline Baptista Vianna; Gabriel Dos Santos Oliveira; Marco Aurélio Vaz; Bruno Manfredini Baroni Journal: Braz J Phys Ther Date: 2018-03-28 Impact factor: 3.377
Authors: Annette V Hauger; M P Reiman; J M Bjordal; C Sheets; L Ledbetter; A P Goode Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-08-17 Impact factor: 4.342
Authors: Julie P Burland; Adam S Lepley; Marc Cormier; Lindsay J DiStefano; Robert Arciero; Lindsey K Lepley Journal: Sports Med Date: 2019-05 Impact factor: 11.136
Authors: Lindsey K Lepley; Steven M Davi; Emily R Hunt; Julie P Burland; McKenzie S White; Grace Y McCormick; Timothy A Butterfield Journal: J Athl Train Date: 2020-03-20 Impact factor: 2.860