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Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation
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Neuromuscular Electrical Stimulation for Patellar and Achilles Tendon Loading: A Scoping Review With Practical

João Luiz Quaglioti Durigan, Naoaki Ito, Sarah E Katz

    The Journal of Orthopaedic and Sports Physical Therapy
    |July 1, 2025
    PubMed
    Summary

    Neuromuscular electrical stimulation (NMES) can improve tendon strength and reduce pain after injuries. Further research is needed to optimize NMES dosage for effective tendon rehabilitation and clinical application.

    Keywords:
    Achilles tendonelectrical stimulationpatellar tendonphysical therapyrehabilitation

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    Area of Science:

    • Orthopedics and Sports Physical Therapy
    • Rehabilitation Medicine
    • Biomedical Engineering

    Background:

    • Tendon injuries, including ruptures and tendinopathies, significantly impact strength and function.
    • Neuromuscular electrical stimulation (NMES) is a therapeutic modality with potential benefits for muscle strengthening and tissue repair.
    • Optimizing NMES parameters is crucial for effective clinical application in tendon rehabilitation.

    Purpose of the Study:

    • To conduct a scoping review summarizing the effects of NMES interventions on strength outcomes following tendon injuries.
    • To analyze NMES parameters and dosages used in studies investigating tendon loading and rehabilitation.
    • To identify areas for improvement in reporting NMES protocols for clinical implementation.

    Main Methods:

    • A comprehensive literature search was conducted across major databases (PubMed, Web of Science, CINAHL, PEDro, Cochrane Library).
    • Ten studies (RCTs, crossovers, cohorts) involving 166 participants were included in the scoping review.
    • Data extracted included participant demographics, study characteristics, NMES parameters, tendon outcomes, and study quality (PEDro scale).

    Main Results:

    • NMES, alone or superimposed (NMES+), effectively altered tendon loading by increasing force, strain, and stress.
    • NMES demonstrated both short-term and long-term effects on tendon mechanical properties.
    • Long-term NMES+ application reduced tendinopathy symptoms and pain during loading activities.

    Conclusions:

    • Existing studies on NMES for tendon loading are generally well-documented regarding parameters.
    • There is a need for more detailed reporting of NMES dosage and evoked torque to guide clinical practice.
    • Standardized reporting of NMES protocols will enhance its effective implementation in tendon rehabilitation.