title: Neuromuscular electrical stimulation training increases intermuscular fascial length but not tendon cross-sectional area after spinal cord injury.
abstract: OBJECTIVE
  To determine the effects of 12 weeks of neuromuscular electrical stimulation (NMES) training with ankle weights on intermuscular fascial length and patellar tendon cross-sectional area (CSA) in persons with spinal cord injury (SCI).
  
  
  METHODS
  This study was a pre-post intervention. Seven men with motor complete SCI were randomly assigned to a resistance training plus diet (RT + diet) group (n = 4) or a diet control group (n = 3). Participants in the RT + diet group were enrolled in a 12-week leg extension weight-lifting program via surface NMES of the knee extensor muscle group. The length of mid-thigh intermuscular fascia and the patellar tendon CSA were measured using MRI.
  
  
  RESULTS
  In the RT + diet group, a nonsignificant 8% increase in the CSA of the patellar tendon (P = .14) was noted. The length of the mid-thigh intermuscular fascia increased by 19% and 23% in the right (P = .029) and left (P = .015) legs, respectively, with no changes in the diet control group. Positive relationships were noted between skeletal muscle CSAs of the whole thigh (r = 0.77, P = .041) and knee extensors (r = 0.76, P = .048) and intermuscular fascial length.
  
  
  CONCLUSIONS
  The preliminary results suggest that noncontractile connective tissue structures of the knee extensors respond differently to NMES training after SCI. Skeletal muscle hypertrophy is associated with an increase in the intermuscular fascial length.
authors.affiliation: Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC , Richmond, Virginia ; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Gorgey
authors.affiliation: Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC , Richmond, Virginia.
authors.forename: Refka E
authors.initials: RE
authors.lastname: Khalil
mesh_terms: D000328:Adult; D004032:Diet; D004599:Electric Stimulation Therapy / Q000379:methods; D005205:Fascia / Q000473:pathology*; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000473:pathology*; D052097:Quadriceps Muscle / Q000473:pathology*; D055070:Resistance Training / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications / Q000473:pathology / Q000534:rehabilitation*; D013848:Thigh / Q000473:pathology
keywords: MRI; fascia length; neuromuscular electrical stimulation; rehabilitation; spinal cord injury; tendon