DOI QR코드

DOI QR Code

Neuromuscular electrical stimulation improves strength, pain and weight distribution on patients with knee instability post surgery

  • Asakawa, Yasuyoshi (Graduate School of Health Sciences, Guma University) ;
  • Jung, Ji-Hye (Physical Therapy Team, Hangeoleum Rehabilitation Hospital) ;
  • Koh, Si-Eun (Physical Therapy Team, Ilsan High Hospital)
  • Received : 2014.10.23
  • Accepted : 2014.11.30
  • Published : 2014.10.26

Abstract

Objective: The purpose of this study was to investigate the effects of an exercise with and without neuromuscular electrical stimulation (NMES) of the quadriceps femoris muscle, on strength, pain, and weight distribution in patients with knee instability post surgery. Design: Randomized controlled trial. Methods: Twenty patients in the early stage of rehabilitation after knee surgery were recruited as subjects and were randomly divided into either experimental group (exercise combined with NMES) (n=10) or control group (n=10). Both groups received strength training of the lower limb for 20 min/day, 5 days/week for 4 weeks. The experimental group used NMES for unilateral quadriceps femoris training with incremental increases in the intensity of isometric contraction over 4 weeks. Outcome measurements were assessed using the digital manual muscle testing, 30-chair stand test (30CST), numeric pain rating scale (NPRS) and weight distribution using the foot analyzer before and after 4 weeks of training. Results: After the 4-week intervention, knee extensor strength increased significantly in the experimental group post intervention (p<0.05), and there was a significant improvement in the experimental group compared with the control group (p<0.05). The 30CST and NPRS scores improved significantly in the experimental group compared to the control group (p<0.05), and there was a significant difference between the two groups (p<0.05). Weight distribution was significantly improved in the experimental group compared with the control group, (p<0.05), but there was no significant difference in improvement between the two groups. Conclusions: This study showed that NMES combined with strengthening exercises of the lower limbs is effective in improving lower limb pain and strength in patients with instability after knee surgery.

References

  1. Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res 2003;21:775-9. https://doi.org/10.1016/S0736-0266(03)00052-4
  2. Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L. Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 2008;40:422-7. https://doi.org/10.1249/MSS.0b013e31815ef285
  3. Mizner RL, Snyder-Mackler L. Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res 2005;23:1083-90. https://doi.org/10.1016/j.orthres.2005.01.021
  4. Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff DG. Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res 2010;468:2460-8. https://doi.org/10.1007/s11999-009-1219-6
  5. Frost H, Lamb SE, Robertson S. A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties. Clin Rehabil 2002;16:200-9. https://doi.org/10.1191/0269215502cr483oa
  6. Lewek M, Stevens J, Snyder-Mackler L. The use of electrical stimulation to increase quadriceps femoris muscle force in an elderly patient following a total knee arthroplasty. Phys Ther 2001;81:1565-71. https://doi.org/10.1093/ptj/81.9.1565
  7. Petterson S, Snyder-Mackler L. The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty. J Orthop Sports Phys Ther 2006;36:678-85. https://doi.org/10.2519/jospt.2006.2305
  8. Paillard T. Combined application of neuromuscular electrical stimulation and voluntary muscular contractions. Sports Med 2008;38:161-77. https://doi.org/10.2165/00007256-200838020-00005
  9. Doucet BM, Lam A, Griffin L. Neuromuscular electrical stimulation for skeletal muscle function. Yale J Biol Med 2012;85:201-15.
  10. Talbot LA, Gaines JM, Huynh TN, Metter EJ. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc 2003;51:387-92. https://doi.org/10.1046/j.1532-5415.2003.51113.x
  11. Thomas AC, Stevens-Lapsley JE. Importance of attenuating quadriceps activation deficits after total knee arthroplasty. Exerc Sport Sci Rev 2012;40:95-101. https://doi.org/10.1097/JES.0b013e31824a732b
  12. Topp R, Swank AM, Quesada PM, Nyland J, Malkani A. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R 2009;1:729-35. https://doi.org/10.1016/j.pmrj.2009.06.003
  13. Li RC, Jasiewicz JM, Middleton J, Condie P, Barriskill A, Hebnes H, et al. The development, validity, and reliability of a manual muscle testing device with integrated limb position sensors. Arch Phys Med Rehabil 2006;87:411-7. https://doi.org/10.1016/j.apmr.2005.11.011
  14. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999;70:113-9. https://doi.org/10.1080/02701367.1999.10608028
  15. Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain 1994;58:387-92. https://doi.org/10.1016/0304-3959(94)90133-3
  16. Stevens JE, Mizner RL, Snyder-Mackler L. Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series. J Orthop Sports Phys Ther 2004;34:21-9. https://doi.org/10.2519/jospt.2004.34.1.21
  17. Avramidis K, Karachalios T, Popotonasios K, Sacorafas D, Papathanasiades AA, Malizos KN. Does electric stimulation of the vastus medialis muscle influence rehabilitation after total knee replacement? Orthopedics 2011;34:175. https://doi.org/10.3928/01477447-20110124-06
  18. Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther 2012;92:210-26. https://doi.org/10.2522/ptj.20110124
  19. McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993;52:258-62. https://doi.org/10.1136/ard.52.4.258
  20. O'Reilly SC, Jones A, Muir KR, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998;57:588-94. https://doi.org/10.1136/ard.57.10.588
  21. Hall MC, Mockett SP, Doherty M. Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function. Ann Rheum Dis 2006;65:865-70.
  22. Madsen OR, Bliddal H, Egsmose C, Sylvest J. Isometric and isokinetic quadriceps strength in gonarthrosis; inter-relations between quadriceps strength, walking ability, radiology, subchondral bone density and pain. Clin Rheumatol 1995;14:308-14. https://doi.org/10.1007/BF02208344
  23. Jung JH, Ko SE, Lee SW. Immediate effects of single-leg stance exercise on dynamic balance, weight bearing and gait cycle in stroke patients. Phys Ther Rehabil Sci 2014;3:49-54. https://doi.org/10.14474/ptrs.2014.3.1.49
  24. Glass NA, Torner JC, Frey Law LA, Wang K, Yang T, Nevitt MC, et al. The relationship between quadriceps muscle weakness and worsening of knee pain in the MOST cohort: a 5-year longitudinal study. Osteoarthritis Cartilage 2013;21:1154-9. https://doi.org/10.1016/j.joca.2013.05.016
  25. Stratford PW, Kennedy DM, Woodhouse LJ. Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Phys Ther 2006;86:1489-96. https://doi.org/10.2522/ptj.20060002
  26. Wright AA, Cook CE, Baxter GD, Dockerty JD, Abbott JH. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J Orthop Sports Phys Ther 2011;41:319-27. https://doi.org/10.2519/jospt.2011.3515
  27. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005;35:424-36. https://doi.org/10.2519/jospt.2005.35.7.424
  28. Boonstra MC, Schwering PJ, De Waal Malefijt MC, Verdonschot N. Sit-to-stand movement as a performance-based measure for patients with total knee arthroplasty. Phys Ther 2010;90:149-56. https://doi.org/10.2522/ptj.20090119
  29. Parent E, Moffet H. Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Arthritis Rheum 2003;49:36-50. https://doi.org/10.1002/art.10906
  30. Asay JL, Mundermann A, Andriacchi TP. Adaptive patterns of movement during stair climbing in patients with knee osteoarthritis. J Orthop Res 2009;27:325-9. https://doi.org/10.1002/jor.20751
  31. Harato K, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty 2010;25:225-9. https://doi.org/10.1016/j.arth.2009.02.003

Cited by

  1. Ultrasound imaging for age-related differences of lower extremity muscle architecture vol.4, pp.1, 2015, https://doi.org/10.14474/ptrs.2015.4.1.38
  2. Neuromuscular electrical stimulation therapy after knee surgery: a systematic review vol.60, pp.7, 2017, https://doi.org/10.5124/jkma.2017.60.7.579
  3. A Comparison of Multipath and Conventional Neuromuscular Electrical Stimulation pp.1942-5864, 2018, https://doi.org/10.3928/19425864-20180802-03