title: Physiological and methodological considerations for the use of neuromuscular electrical stimulation.
abstract: The main aim of this review is to discuss some evidence-based physiological and methodological considerations for optimal use of neuromuscular electrical stimulation (NMES) in healthy and impaired skeletal muscles. After a quick overview of the main applications, interests and limits of NMES use, the first section concentrates on two crucial aspects of NMES physiology: the differences in motor unit recruitment pattern between NMES and voluntary contractions, and the involvement of the nervous system during peripheral NMES. The second section of the article focuses on the most common NMES parameters, which entail the characteristics of both the electrical current (the input) and the evoked contraction (the output).
authors.affiliation: Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland. nicola.maffiuletti@kws.ch
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Maffiuletti
mesh_terms: D004558:Electric Stimulation / Q000009:adverse effects / Q000379:methods*; D019054:Evoked Potentials, Motor; D006801:Humans; D009046:Motor Neurons / Q000502:physiology*; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000294:innervation*; D009469:Neuromuscular Junction / Q000502:physiology* / Q000503:physiopathology; D011999:Recruitment, Neurophysiological
references.citation: Scand J Rehabil Med. 1985;17(3):141-6
references.pmid: 4059886
references.citation: J Physiol. 1981 Feb;311:463-73
references.pmid: 7264979
references.citation: Am J Clin Nutr. 2002 Jul;76(1):113-9
references.pmid: 12081824
references.citation: Int J Sports Physiol Perform. 2006 Dec;1(4):406-7
references.pmid: 19124897
references.citation: Phys Ther. 1983 Jun;63(6):915-21
references.pmid: 6856678
references.citation: Med Sci Sports Exerc. 1988 Oct;20(5 Suppl):S135-45
references.pmid: 3057313
references.citation: Phys Ther. 2005 Apr;85(4):358-64
references.pmid: 15794706
references.citation: Med Sci Sports Exerc. 1995 Dec;27(12):1671-6
references.pmid: 8614324
references.citation: J Appl Physiol (1985). 1990 Apr;68(4):1657-67
references.pmid: 2347805
references.citation: Phys Ther. 2007 Aug;87(8):1064-77
references.pmid: 17553920
references.citation: Int J Sports Med. 2007 Nov;28(11):901-4
references.pmid: 17525881
references.citation: Med Sci Sports Exerc. 1992 Jun;24(6):702-7
references.pmid: 1602943
references.citation: Haemophilia. 2006 Nov;12(6):629-32
references.pmid: 17083514
references.citation: Int J Sports Med. 1993 Jan;14(1):20-8
references.pmid: 8440541
references.citation: Exp Physiol. 2008 Jul;93(7):843-50
references.pmid: 18296492
references.citation: Aust J Physiother. 1988;34(3):151-64
references.pmid: 25026069
references.citation: J Bone Joint Surg Am. 1995 Aug;77(8):1166-73
references.pmid: 7642660
references.citation: Phys Ther. 1985 Feb;65(2):186-96
references.pmid: 3871529
references.citation: Clin Rehabil. 2001 Dec;15(6):637-46
references.pmid: 11777094
references.citation: J Appl Physiol (1985). 2007 Jul;103(1):170-6
references.pmid: 17463296
references.citation: Med Sci Sports Exerc. 2005 Aug;37(8):1291-9
references.pmid: 16118574
references.citation: J Appl Physiol (1985). 2003 Mar;94(3):1012-24
references.pmid: 12571132
references.citation: J Neurophysiol. 2006 Jun;95(6):3328-35
references.pmid: 16481458
references.citation: Med Sci Sports Exerc. 2005 Mar;37(3):455-60
references.pmid: 15741845
references.citation: Phys Ther. 1991 Oct;71(10):715-21; discussion 722-3
references.pmid: 1946610
references.citation: J Appl Physiol (1985). 2008 Jan;104(1):75-81
references.pmid: 17975128
references.citation: Aust J Physiother. 1986;32(1):18-30
references.pmid: 25026318
references.citation: Eur J Appl Physiol. 2000 Nov;83(4 -5):409-15
references.pmid: 11138583
references.citation: Motor Control. 1999 Apr;3(2):205-19
references.pmid: 10198150
references.citation: Sports Med. 1988 Jul;6(1):29-41
references.pmid: 3051257
references.citation: Eur J Appl Physiol Occup Physiol. 1999 Sep;80(4):394-6
references.pmid: 10483812
references.citation: J Orthop Res. 1993 Jan;11(1):131-41
references.pmid: 8423515
references.citation: Physiother Res Int. 2007 Sep;12(3):175-94
references.pmid: 17624871
references.citation: Muscle Nerve. 2005 Apr;31(4):475-80
references.pmid: 15617094
references.citation: Arch Phys Med Rehabil. 2000 Aug;81(8):1090-8
references.pmid: 10943761
references.citation: Am J Phys Med Rehabil. 2001 Mar;80(3):206-14; quiz 215-6, 224
references.pmid: 11237275
references.citation: Exerc Sport Sci Rev. 2007 Jul;35(3):102-9
references.pmid: 17620928
references.citation: J Appl Physiol (1985). 2004 Nov;97(5):1923-9
references.pmid: 15258127
references.citation: J Orthop Sports Phys Ther. 2004 Jan;34(1):21-9
references.pmid: 14964588
references.citation: J Orthop Sports Phys Ther. 1994 Jul;20(1):22-8
references.pmid: 8081406
references.citation: Sports Med. 1992 May;13(5):320-36
references.pmid: 1565927
references.citation: Can J Appl Physiol. 1994 Dec;19(4):451-61
references.pmid: 7849661
references.citation: Dev Med Child Neurol. 1986 Oct;28(5):662-70
references.pmid: 3536642
references.citation: Eur Heart J. 2003 May;24(9):871-8
references.pmid: 12727155
references.citation: J Strength Cond Res. 2003 Aug;17(3):573-9
references.pmid: 12930189
references.citation: Artif Organs. 1999 May;23(5):428-31
references.pmid: 10378935
references.citation: Muscle Nerve. 2010 Jan;41(1):54-62
references.pmid: 19882645
references.citation: J Appl Physiol (1985). 1991 Jan;70(1):306-16
references.pmid: 2010386
references.citation: J Neurophysiol. 1965 May;28:560-80
references.pmid: 14328454
references.citation: Muscle Nerve. 2000 Apr;23(4):482-9
references.pmid: 10716757
references.citation: J Appl Physiol (1985). 2002 Apr;92(4):1383-92
references.pmid: 11896001
references.citation: Respir Physiol Neurobiol. 2007 Aug 1;157(2-3):341-7
references.pmid: 17210271
references.citation: Spine (Phila Pa 1976). 1987 Mar;12(2):112-8
references.pmid: 2954215
references.citation: Phys Ther. 1991 Apr;71(4):273-80; discussion 280-2
references.pmid: 2008451
references.citation: Int J Sports Med. 2006 Jun;27(6):475-82
references.pmid: 16767612
references.citation: Clin Physiol Funct Imaging. 2008 Jul;28(4):251-61
references.pmid: 18355344
references.citation: Med Sci Sports Exerc. 1995 Apr;27(4):556-65
references.pmid: 7791587
references.citation: J Strength Cond Res. 2009 Mar;23(2):677-82
references.pmid: 19209077
references.citation: Am J Phys Med Rehabil. 2006 Feb;85(2):167-75
references.pmid: 16428910
references.citation: Med Sci Sports Exerc. 2002 Oct;34(10):1638-44
references.pmid: 12370566
references.citation: Int J Sports Med. 1989 Jun;10(3):187-91
references.pmid: 2674035
references.citation: Support Care Cancer. 2006 Sep;14(9):970-3
references.pmid: 16523264
references.citation: J Bone Joint Surg Am. 1991 Aug;73(7):1025-36
references.pmid: 1874764
references.citation: Med Sci Sports Exerc. 1996 Aug;28(8):999-1014
references.pmid: 8871910
references.citation: J Orthop Sports Phys Ther. 2006 Sep;36(9):678-85
references.pmid: 17017273
references.citation: Ann Neurol. 2008 Apr;63(4):507-12
references.pmid: 18300313
references.citation: Clin Orthop Relat Res. 1983 Sep;(178):190-7
references.pmid: 6603941
references.citation: Eur J Clin Invest. 1989 Apr;19(2):206-12
references.pmid: 2499480
references.citation: Med Sci Sports Exerc. 2005 Jun;37(6):973-8
references.pmid: 15947722
references.citation: Int J Sports Med. 1998 Jul;19(5):317-22
references.pmid: 9721054
references.citation: Exerc Sport Sci Rev. 2007 Oct;35(4):180-5
references.pmid: 17921786
references.citation: Phys Ther. 1988 May;68(5):660-3
references.pmid: 3258994
references.citation: Eur J Appl Physiol. 2005 Jul;94(4):424-33
references.pmid: 15843959
references.citation: J Orthop Sports Phys Ther. 2003 Sep;33(9):492-501
references.pmid: 14524508
references.citation: Sports Med. 2005;35(3):191-212
references.pmid: 15730336
references.citation: Horm Res. 2001;56 Suppl 1:24-8
references.pmid: 11786681
references.citation: Arch Phys Med Rehabil. 2004 Dec;85(12):2040-5
references.pmid: 15605345
references.citation: Pflugers Arch. 1983 Jul;398(2):139-41
references.pmid: 6622220
references.citation: J Appl Physiol (1985). 1993 Feb;74(2):532-7
references.pmid: 8458767
references.citation: Phys Ther. 1992 Jun;72(6):410-21; discussion on 421-4
references.pmid: 1589461
references.citation: Chest. 2006 Jun;129(6):1540-8
references.pmid: 16778272
references.citation: Int J Sports Med. 2005 Dec;26(10):847-53
references.pmid: 16320169
references.citation: Am J Sports Med. 1979 May-Jun;7(3):169-71
references.pmid: 313717
references.citation: Lancet. 1988 Oct 1;2(8614):767-70
references.pmid: 2901612
references.citation: Electromyogr Clin Neurophysiol. 2003 Sep;43(6):381-4
references.pmid: 14535052
references.citation: Exp Brain Res. 2003 May;150(1):33-9
references.pmid: 12698214
references.citation: Eur J Appl Physiol. 2003 Nov;90(5-6):601-7
references.pmid: 12923640
references.citation: Aviat Space Environ Med. 1989 Jul;60(7):671-8
references.pmid: 2764851
references.citation: Dev Med Child Neurol. 2009 Oct;51 Suppl 4:154-65
references.pmid: 19740224
references.citation: J Appl Physiol (1985). 2004 Nov;97(5):1954-61
references.pmid: 15247162
references.citation: J Strength Cond Res. 2007 May;21(2):431-7
references.pmid: 17530954
references.citation: Physiol Rev. 2001 Oct;81(4):1725-89
references.pmid: 11581501
references.citation: Sports Med. 1992 Aug;14(2):100-13
references.pmid: 1509225
references.citation: J Rheumatol. 1995 Sep;22(9):1757-61
references.pmid: 8523357
references.citation: Sports Med. 2008;38(5):437-8; author reply 438-40
references.pmid: 18416596
references.citation: Neurorehabil Neural Repair. 2007 Nov-Dec;21(6):475-85
references.pmid: 17369515
references.citation: Int J Sports Med. 1981 Feb;2(1):18-22
references.pmid: 7333731
references.citation: Eur J Appl Physiol Occup Physiol. 1988;57(1):1-5
references.pmid: 3342785
references.citation: J Cardiopulm Rehabil Prev. 2008 Mar-Apr;28(2):79-91
references.pmid: 18360183
references.citation: J Orthop Res. 1996 Jan;14(1):131-8
references.pmid: 8618155
references.citation: Crit Care. 2009;13(5):R161
references.pmid: 19814793
references.citation: Muscle Nerve. 2002 Jun;25(6):763-4
references.pmid: 12115963
references.citation: Phys Ther. 1994 Oct;74(10):901-7
references.pmid: 8090841
references.citation: Exp Brain Res. 1997 Mar;114(1):117-23
references.pmid: 9125456
references.citation: Respir Med. 2009 Apr;103(4):485-95
references.pmid: 19091537