Motorpoint Heatmap of the Hamstring Muscles to Facilitate Neuromuscular Electrical Stimulation

The effectiveness of neuromuscular electrical stimulation (NMES) depends on electrode placement, with placement over the motor points (MPs) being the most effective. This study aimed to determine the MP-distribution and establish a heatmap indicating the probability of finding a MP in different areas of the hamstring (H) muscles. Additionally, inter-individual variations in the number of MPs were investigated. Thirty-one healthy participants (15 females, 16 males), aged 18-65 years, were included. The individual anatomy of the H-muscles, including the biceps femoris (BF), semitendinosus (ST), and semimembranosus (SM), was determined using ultrasound. MPs were located using a MP-search pen. The thigh anatomy was divided into 70 3x3cm areas, and the probability of finding a MP in each area was calculated using the Clopper-Pearson test to create a heatmap. Regression analysis was employed to determine if patient characteristics were associated with the number of MPs. The two best areas, found over BF and ST, exhibited a 39% probability of containing a MP and were significantly more likely to contain a MP compared to 85% of the remaining areas (p < 0.05). Two areas over SM had a 29% probability of containing a MP. BF exhibited a significantly higher number of MPs compared to SM and ST (p < 0.001). Male sex and higher physical activity were independent explanatory factors positively correlated with the number of MPs over BF in the multiple linear regression (R² = 0.38, p = 0.001). The MP-heatmap of the H-muscles can effectively facilitate NMES application by highlighting areas with a higher probability of finding a MP. Large inter-individual variations in location and number of MPs were demonstrated.