The combined effectiveness of therapeutic ultrasound, electrical stimulations, and blood flow restriction to treat symptoms of muscle damage.

This study assessed whether symptoms of muscle damage could be reduced by a combination of therapeutic ultrasound and electrical stimulations, and whether this could be enhanced by blood flow restriction. Before and 48 h after performing eccentric elbow flexion exercises, individuals completed assessments of muscle damage. A 10-min therapeutic ultrasound and electrical stimulation treatment was then applied with and without blood flow restriction to assess short (5 min) and long-term (24 h) improvements. Twenty-three individuals completed the study (11 females). Data were analysed using Bayesian repeated measures ANOVAs. The damaging exercise increased discomfort (BF10 = 2.93e14) and relaxed joint angle (BF10 = 2425.90) while decreasing pain pressure threshold (BF10 = 289.71). Each of these variables was acutely improved with the combination treatment protocol (all BF10 ≥ 74) with no added effect of blood flow restriction. A combination of therapeutic ultrasound and interferential electrical stimulations appeared effective at acutely alleviating symptoms of muscle damage with no additive effect of blood flow restriction.

Effects of neuromuscular electrical stimulation on glycemic control: a systematic review and meta-analysis.

Background: Physical inactivity increases the risk for metabolic diseases such as obesity and type 2 diabetes. Neuromuscular electrical stimulation (NMES) is an effective method to induce muscle contraction, particularly for populations with physical impairments and/or metabolic diseases. However, its effectiveness to improve glycemic control is unclear. This review aimed to determine the effectiveness of NMES on glycemic control. Methods: Electronic search consisted of MEDLINE (PubMed), EMBASE, Cochrane Library, Google Scholar, and Web of Science to identify studies that investigated the effects of NMES on glycemic control for this systematic review. The meta-analysis consists of the studies designed as randomized controlled trials. Effect sizes were calculated as the standardized mean difference (SMD) and meta-analysis was conducted using a random-effects model. Results: Thirty-five studies met the inclusion criteria for systematic review and of those, nine qualified for the meta-analysis. Existing evidence suggested that NMES effectively improves glycemic control predominantly in middle-aged and elderly population with type 2 diabetes, obesity, and spinal cord injury. The meta-analysis is comprised of 180 participants and reported that NMES intervention lowered fasting blood glucose (SMD: 0.48; 95% CI: 0.17 to 0.78; p=0.002; I²=0%). Additional analysis using the primary measures reported by each study to indicate glycemic control (i.e., OGTT, HOMA-IR, and fasting glucose) also confirmed a significant effect of NMES on improving glycemic control (SMD: 0.41; 95% CI, 0.09 to 0.72; p=0.01; I²=11%). NMES protocol varied across studies and requires standardization. Conclusion: NMES could be considered as a therapeutic strategy to improve glycemic control in populations with physical impairments and/or metabolic disorders. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020192491.

Analysis of electrical stimulation and voluntary muscle contraction on skeletal muscle oxygen uptake and mitochondrial recovery using near-infrared spectroscopy.

PURPOSE: This investigation was to compare differences in skeletal muscle oxygen consumption ([Formula: see text]) and mitochondrial recovery between voluntary (VOL) and electrically stimulated (ES) plantarflexion contractions. METHODS: Twelve men and women (26 ± 4.0 years; 171.8 ± 5.1 cm; 74.0 ± 13.7 kg) were seated in a chair with their right knee fully extended and right foot secured to a force transducer. ES electrodes and a near-infrared spectroscopy device were placed on the gastrocnemius. Participants performed ES plantarflexion contractions across a range of stimulation intensities at frequencies of 1 and 2 Hz and similar VOL contractions. Cuff occlusion occurred immediately following each series of contractions to measure [Formula: see text]. A standardized mitochondrial function assessment protocol was also performed to calculate K-constants between work-matched ES and VOL contractions. RESULTS: For mitochondrial assessments, there were no significant differences between ES and VOL rate constants (2.03 ± 0.98 vs. 1.25 ± 1.35 min-1, p = 0.266). ES resulted in a significantly greater workrate-[Formula: see text] slope at 1 Hz (0.007 ± 0.007 vs. 0.001 ± 0.002% [Formula: see text]/s/N, p = 0.014) and 2 Hz (0.010 ± 0.010 vs. 0.001 ± 0.001% [Formula: see text]/s/N, p = 0.012), as well as a significantly greater workrate-[Formula: see text] Y-intercept at 2 Hz (1.603 ± 1.513 vs. 0.556 ± 0.564% [Formula: see text]/s, p = 0.035) but not 1 Hz (0.579 ± 0.448 vs. 0.442 ± 0.357% mV̇O2/s, p = 0.535) when compared to VOL. CONCLUSION: ES results in a significantly greater [Formula: see text] at similar work rates compared to VOL, however, the mitochondrial recovery rate constants were similar. The greater mVO2 with ES may partially contribute to the increased rate of fatigue during ES exercise in individuals with muscle paralysis.

The impact of blood flow restricted electrical stimulations on recovery from muscle damage.

BACKGROUND: Both electrical stimulations (E-STIM) and blood flow restriction (BFR) have been shown to treat symptoms of exercise-induced muscle damage, but little is known about their combined effects which was the purpose of this study. METHODS: Individuals completed one set of eccentric elbow flexion exercises to induce muscle damage. Forty-eight hours later, E-STIM was applied using an interferential current administered to both arms for 20 min; however, only one arm completed the E-STIM protocol while also undergoing repeated bouts of BFR (full occlusion for 2 min separated by a 1-min rest intervals). Discomfort and isometric strength were assessed immediately before the damaging exercise, immediately before the treatments, and 0, 10, and 30 min posttreatment. RESULTS: A total of 22 individuals (11 females) completed the study. There were no interactions with respect to discomfort (BF10 = 0.008) or isometric strength (BF10 = 0.009) indicating that the addition of BFR did not alter the effectiveness of E-STIM. There was a main effect of time indicating that the damaging exercise was successful at depressing torque (pre: 284 N, post: 199 N; BF10 = 2.70e9) and inducing discomfort (pre: 0 au, post: 6.4 au; BF10 = 3.21e17). While isometric strength did not recover with the E-STIM treatments, discomfort was reduced at each the immediate post (5.3 au; BF10 = 56 294) 10-min post (5.0 au; BF10 = 46 163), and 30-min post (4.9 au; BF10 = 707 600) time points. CONCLUSION: E-STIM may be useful for treating discomfort, but does not appear capable of recovering strength associated with muscle damage. The efficacy of E-STIM would not appear to be enhanced if performed under BFR.

Blood Flow Restricted Electrical Stimulations to Prevent or Attenuate Symptoms of Muscle Damage.

The objective of this study was to determine if performing electrical stimulations (E-STIM) under blood flow restriction (BFR) would result in a greater protective effect against symptoms of muscle damage. 18 individuals (9 females) completed a damaging bout of exercise followed by a low frequency E-STIM treatment protocol on both arms, one of which was completed under BFR. The treatment protocol was then repeated 24-hours post-exercise. There were main effects of time for muscle thickness (pre: 3.5 cm; 48 h post: 3.8 cm; BF10 = 88.476), discomfort (pre: 0.0 au; 48 h post: 4.2 au; BF10 = 241.996), and isometric strength (pre: 278 N; 48 h post: 232 N; BF10 = 10,289.894) which all changed as a result of the damaging exercise protocol, but there were no differences between conditions [all Bayes Factors (BF10) < 0.28]. The effectiveness of low frequency E-STIM for preventing the onset of exercise-induced muscle damage would not appear to be enhanced if performed under BFR.

Cryoneurotomy as a Percutaneous Mini-invasive Therapy for the Treatment of the Spastic Limb: Case Presentation, Review of the Literature, and Proposed Approach for Use.

OBJECTIVE: To provide a proof-of-concept study demonstrating that the decades old procedure of cryoneurotomy, used traditionally for analgesia, is a safe adjunctive and effective treatment for limb spasticity. DESIGN: Case series. SETTING: Publicly funded outpatient hospital spasticity clinic and community interventional anesthesia clinic. PARTICIPANTS: Patients (N=3) who had plateaued with standard of care spasticity treatments including botulinum toxin. Two hemiplegic stroke patients with elbow spasticity and 1 pregnant patient with multiple sclerosis and a spastic equinovarus foot for whom botulinum toxin was now contraindicated. INTERVENTIONS: Selective anesthetic diagnostic motor nerve blocks with ultrasound and e-stimulation with 1cc of 1% lidocaine to the motor nerve to the targeted spastic muscle were performed to either the musculocutaneous nerve to brachialis, radial nerve to the brachioradialis or the tibial nerve. If the benefits included improved active and passive range motion and or decreased clonus, a percutaneous cryoneurotomy was performed. MAIN OUTCOME MEASURES: Active and passive range of motion were measured using the Modified Tardieu Scale. The change in resistance to passive stretch was measured using the Modified Ashworth Scale (MAS). Videos of the before and after treatment were collected. RESULTS: Both elbows' treatments resulted in MAS improving from a 3 to a 1+. Greatly improved active range of motion was noted at 94 and 64 degrees, respectively, as well as improvements in passive range on the Modified Tardieu Scale. The tibial nerve cryoneurotomy resulted in improvements in all parameters with a much improved gait. Results were maintained up to 17 months of follow-up. CONCLUSION: Cryoneurotomy as a treatment for spasticity is a novel safe adjuvant treatment. Our initial results suggest patients can achieve significantly increased active and passive range of motion in the upper extremity and decreased clonus, and improved gait after tibial nerve cryoneurotomy.