Intramuscular Contributions to Low-Frequency Force Potentiation Induced by a High-Frequency Conditioning Stimulation

Protocols Targeting Afferent Pathways via Neuromuscular Electrical Stimulation for the Plantar Flexors: A Systematic Review

This systematic review documents the protocol characteristics of studies that used neuromuscular electrical stimulation protocols (NMES) on the plantar flexors [through triceps surae (TS) or tibial nerve (TN) stimulation] to stimulate afferent pathways. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, was registered to PROSPERO (ID: CRD42022345194) and was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020). Included were original research articles on healthy adults, with NMES interventions applied on TN or TS or both. Four databases (Cochrane Library, PubMed, Scopus, and Web of Science) were systematically searched, in addition to a manual search using the citations of included studies. Quality assessment was conducted on 32 eligible studies by estimating the risk of bias with the checklist of the Effective Public Health Practice Project Quality Assessment Tool. Eighty-seven protocols were analyzed, with descriptive statistics. Compared to TS, TN stimulation has been reported in a wider range of frequencies (5-100, vs. 20-200 Hz) and normalization methods for the contraction intensity. The pulse duration ranged from 0.2 to 1 ms for both TS and TN protocols. It is concluded that with increasing popularity of NMES protocols in intervention and rehabilitation, future studies may use a wider range of stimulation attributes, to stimulate motor neurons via afferent pathways, but, on the other hand, additional studies may explore new protocols, targeting for more optimal effectiveness. Furthermore, future studies should consider methodological issues, such as stimulation efficacy (e.g., positioning over the motor point) and reporting of level of discomfort during the application of NMES protocols to reduce the inherent variability of the results.

Functional Impact of Post-exercise Cooling and Heating on Recovery and Training Adaptations: Application to Resistance, Endurance, and Sprint Exercise

The application of post-exercise cooling (e.g., cold water immersion) and post-exercise heating has become a popular intervention which is assumed to increase functional recovery and may improve chronic training adaptations. However, the effectiveness of such post-exercise temperature manipulations remains uncertain. The aim of this comprehensive review was to analyze the effects of post-exercise cooling and post-exercise heating on neuromuscular function (maximal strength and power), fatigue resistance, exercise performance, and training adaptations. We focused on three exercise types (resistance, endurance and sprint exercises) and included studies investigating (1) the early recovery phase, (2) the late recovery phase, and (3) repeated application of the treatment. We identified that the primary benefit of cooling was in the early recovery phase (< 1 h post-exercise) in improving fatigue resistance in hot ambient conditions following endurance exercise and possibly enhancing the recovery of maximal strength following resistance exercise. The primary negative impact of cooling was with chronic exposure which impaired strength adaptations and decreased fatigue resistance following resistance training intervention (12 weeks and 4–12 weeks, respectively). In the early recovery phase, cooling could also impair sprint performance following sprint exercise and could possibly reduce neuromuscular function immediately after endurance exercise. Generally, no benefits of acute cooling were observed during the 24–72-h recovery period following resistance and endurance exercises, while it could have some benefits on the recovery of neuromuscular function during the 24–48-h recovery period following sprint exercise. Most studies indicated that chronic cooling does not affect endurance training adaptations following 4–6 week training intervention. We identified limited data employing heating as a recovery intervention, but some indications suggest promise in its application to endurance and sprint exercise.

Increasing the resting time between drop jumps lessens delayed-onset muscle soreness and limits the extent of prolonged low-frequency force depression in human knee extensor muscles

PURPOSE

Unaccustomed eccentric contractions generally result in a long-lasting contractile impairment, referred to as prolonged low-frequency force depression (PLFFD), and delayed-onset muscle soreness (DOMS). We here used repeated drop jumps (DJs) as an eccentric contraction model and studied the effects of increasing the time between DJs from 20 s to 5 min. We hypothesized that both PLFFD and DOMS would be less marked at the longer DJ interval due to the longer time to restore structural elements between DJs.

METHODS

Young men (n = 12) randomly performed 50 DJs with either 20-s (DJ-20 s) or 5-min (DJ-5 min) rest between DJs. Voluntary, 20 Hz and 100 Hz electrically stimulated isometric knee extension torques and muscle soreness were monitored before and for 7 days after DJs; serum CK activity was measured to assess muscle fibre protein leakage. In additional experiments, changes in mRNA levels were assessed in muscle biopsies collected before and 1 h after exercise.

RESULTS

A marked PLFFD was observed with both protocols and the extent of 20 Hz torque depression was smaller immediately and 1 day after DJ-5 min than after DJ-20 s (p < 0.05), whereas the MVC and 100 Hz torques were similarly decreased with the two protocols. Markedly larger differences between the two protocols were observed for the muscle soreness score, which 1-4 days after exercise was about two times larger with DJ-20 s than with DJ-5 min (p < 0.01).

CONCLUSIONS

The larger protective effect of the longer DJ interval against DOMS than against PLFFD indicates that their underlying mechanisms involve different structural elements.

Modulation of torque evoked by wide-pulse, high-frequency neuromuscular electrical stimulation and the potential implications for rehabilitation and training

The effectiveness of neuromuscular electrical stimulation (NMES) for rehabilitation is proportional to the evoked torque. The progressive increase in torque (extra torque) that may develop in response to low intensity wide-pulse high-frequency (WPHF) NMES holds great promise for rehabilitation as it overcomes the main limitation of NMES, namely discomfort. WPHF NMES extra torque is thought to result from reflexively recruited motor units at the spinal level. However, whether WPHF NMES evoked force can be modulated is unknown. Therefore, we examined the effect of two interventions known to change the state of spinal circuitry in opposite ways on evoked torque and motor unit recruitment by WPHF NMES. The interventions were high-frequency transcutaneous electrical nerve stimulation (TENS) and anodal transcutaneous spinal direct current stimulation (tsDCS). We show that TENS performed before a bout of WPHF NMES results in lower evoked torque (median change in torque time-integral: - 56%) indicating that WPHF NMES-evoked torque might be modulated. In contrast, the anodal tsDCS protocol used had no effect on any measured parameter. Our results demonstrate that WPHF NMES extra torque can be modulated and although the TENS intervention blunted extra torque production, the finding that central contribution to WPHF NMES-evoked torques can be modulated opens new avenues for designing interventions to enhance WPHF NMES.

A reduction in compliance or activation level reduces residual force depression in human tibialis anterior

AIM

We investigated if residual force depression (rFD) is present during voluntary fixed-end contractions of human tibialis anterior (TA) and whether reducing TA's activation level after active shortening could reduce rFD.

METHODS

Ten participants performed fixed-end dorsiflexion contractions to a low, moderate or high level while electromyography (EMG), dorsiflexion force and TA ultrasound images were recorded. Contractions were force- or EMG-matched and after the low or high contraction level was attained, participants respectively increased or decreased their force/EMG to a moderate level. Participants also performed moderate level contractions while the TA muscle-tendon unit (MTU) was lengthened during the force/EMG rise to the reference MTU length.

RESULTS

Equivalent fascicle shortening over moderate and low to moderate level contractions did not alter EMG (P = 0.45) or dorsiflexion force (P = 0.47) at the moderate level. Greater initial fascicle shortening magnitudes (1.7 mm; P ≤ 0.01) to the high contraction level did not alter EMG (P = 0.45) or dorsiflexion force (P = 0.30) at the subsequent moderate level compared with moderate level contractions. TA MTU lengthening during the initial force/EMG rise reduced TA fascicle shortening (-2.5 mm; P ≤ 0.01), which reduced EMG (-3.9% MVC; P < 0.01) and increased dorsiflexion force (3.7% MVC; P < 0.01) at the moderate level compared with fixed-end moderate level contractions.

CONCLUSION

rFD is present during fixed-end dorsiflexion contractions because fascicles actively shorten as force/EMG increases and rFD can be reduced by reducing the effective MTU compliance. A reduction in muscle activation level also reduces rFD by potentially triggering residual force enhancement-related mechanisms as force drops and some fascicles actively lengthen.

What are the best isometric exercises of muscle potentiation?

PURPOSE

The aim of this study was to follow post-activation potentiation (PAP), low-frequency fatigue (LFF), metabolic-induced fatigue and post-contractile depression (PCD) in response to different isometric muscle contraction modalities.

METHODS

Young healthy men (N = 120) were randomly assigned to one of ten exercise modality groups which differed in contraction duration (5-60 s), activation pattern (intermittent or continuous contractions), activation mode (voluntary or stimulated), and intensity [maximal or submaximal (50%)]. Isometric maximal voluntary contraction (MVC), and electrically induced knee extension torque were measured at baseline and at regular intervals for 60 min after exercise.

RESULTS

Muscle contraction modalities involving 5 s MVC were the most effective for PAP, whereas the lowest PAP effectiveness was found after the 12 × 5-MVC modality. After all of the 5-15 s MVC and 6 × 5-MVC protocols, the potentiation of the twitch rate was significantly higher than that recorded after continuous 30-60 s protocols (P < 0.001). Tetanic maximal torque (100 Hz) potentiation occurred 5 min after 15-30 s repetitive MVC modalities and after modality involving 15 electrical stimuli (P < 0.05).

CONCLUSIONS

The findings demonstrate that post-activation potentiation was most effective after brief duration continuous and repetitive MVC protocols. To understand the resultant warm-up of motor performance, it is necessary to recognize the coexistence of muscle PAP, tetanic maximal force potentiation, rapid recovery of metabolic muscle, and central muscle activation processes, as well as prolonged LFF and prolonged PCD.