Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series

Abstract

Introduction For those individuals who have suffered an injury to the knee or undergone a surgical intervention, the early recovery of the muscle strength contraction properties of the quadriceps is essential for a favorable recovery and for a return to the activities of daily living and other work- or sports-related activities. Objectives To evaluate the changes in maximal isometric strength (MIS) of the quadriceps muscle after the application of ultrasound-guided percutaneous neuromodulation (US-guided PNM) on the femoral nerve. Materials and Methods A case series involving subjects who had previously presented unilateral knee pathology and were in the stage of recovery of quadriceps strength. The subjects were pain-free at the time of the dynamometry measurements, which were performed before and after the application of the US-guided PNM technique. The isometric measurement was performed using the KINEO dynamometry system, performing a preintervention measurement of the mean maximal isometric strength (mMIS) based on 3 repetitions (3 seconds contraction and 6 seconds relaxation). The US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva CE0120 device (Prim Physio, Madrid, Spain) and a GE Logiq e R7 ultrasound (GE Healthcare, Chicago, IL, USA). Results In total, 13 subjects participated in the present study. Significant changes were obtained (p < 0.001) in the mMIS of the quadriceps of the affected knee, which progressed from a mean strength of 25.91 kg (standard deviation [SD]: 7.17 kg) to a mean strength of 29.98 kg (SD: 9.06 kg). Discussion In subjects with knee pathology, the quadriceps muscle is inhibited despite being pain-free during the strength measurements. This process of inhibition can improve with the application of low frequency percutaneous electrical stimulation on the femoral nerve. This technique represents a complementary strategy for the recovery of the normal strength values in pathological knees with or without prior surgery. Conclusions Ultrasound-guided PNM is an effective technique for the reestablishment of quadriceps strength in inhibited muscles.

Effect of ultrasound-guided percutaneous neuromodulation applied to the femoral nerve on pain and range of motion in patients with anterior knee pain: A case study

“…También, Ilfeld y col., 23 encontraron una disminución del dolor tras un tratamiento de NMP-e sobre el nervio femoral en pacientes con reconstrucción de ligamento cruzado anterior. Por otro lado, Álvarez-Prats y col., 27 demostraron un aumento inmediato de la fuerza isométrica del cuádriceps tras la estimulación del nervio femoral en pacientes con dolor de rodilla. Los resultados de este estudio añaden que, respecto a los efectos obtenidos, el porcentaje de cambio es mayor a las 24 horas de una única intervención.…”

Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial

“…However, most of the studies assessing the effects of PENS have been conducted in chronic pain populations. A recent study found that PENS could be a potentially effective technique for increasing isometric strength of the quadriceps in inhibited musculature in subjects with unilateral knee pathology [ 16 ]. Since therapeutic interventions focusing on the voluntary quadriceps muscle activation could improve the efficacy of exercise for strength improvement [ 32 ], PENS could be a useful procedure to improve physical performance to be used combined with exercise.…”

“…The procedure evoked pain-free maximal muscle contractions in 10 sequences of 10 s, each one with 10 s rest period between series according to Álvarez-Prats et al [ 16 ] protocol.…”

“…Although most previous studies have focused on pain management, others have investigated the effects of PENS in other outcomes. For instance, Álvarez-Prats et al have recently reported an increase in maximal quadriceps muscle strength after applying low-frequency PENS in the femoral nerve [ 16 ]. Similarly, de-la-Cruz-Torres et al have also shown that applying PENS is able to increase hamstring flexibility in healthy people [ 17 ].…”

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial

“…To date, there is limited literature on US-guided PNM. It has been applied to treat lateral elbow pain [ 14 ], short hamstring syndrome [ 23 ], anterior knee pain [ 24 , 25 ], or lower back pain [ 26 ]; to improve the activity of the hallucis flexor longus [ 27 , 28 ] or quadriceps strength [ 29 ]; and to improve sport performance [ 30 ]. Regarding LE, Arias-Buría et al [ 14 ] described a case-report and they only treated a patient with LE by applying PNM to analyze its effect on pain.…”