title: Can the Use of Neuromuscular Electrical   Stimulation Be Improved to Optimize   Quadriceps Strengthening?
abstract: BACKGROUND
  Neuromuscular electrical stimulation (NMES) is a common modality used to retrain muscles and improve muscular strength after injury or surgery, particularly for the quadriceps muscle. There are parameter adjustments that can be made to maximize the effectiveness of NMES. While NMES is often used in clinical practice, there are some limitations that clinicians should be aware of, including patient discomfort, muscle fatigue, and muscle damage.
  
  
  METHODS
  PubMed was searched through August 2014 and all articles cross-referenced.
  
  
  METHODS
  Clinical review.
  
  
  METHODS
  Level 3.
  
  
  RESULTS
  Clinicians can optimize torque production and decrease discomfort by altering parameter selection (pulse duration, pulse frequency, duty cycle, and amplitude). Pulse duration of 400 to 600 μs and a pulse frequency of 30 to 50 Hz appear to be the most effective parameters to optimize torque output while minimizing discomfort, muscle fatigue, or muscle damage. Optimal electrode placement, conditioning programs, and stimulus pattern modulation during long-term NMES use may improve results.
  
  
  CONCLUSIONS
  Torque production can be enhanced while decreasing patient discomfort and minimizing fatigue.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Glaviano
authors.forename: Susan
authors.initials: S
authors.lastname: Saliba
mesh_terms: D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D009119:Muscle Contraction; D018763:Muscle Fatigue; D009123:Muscle Hypotonia / Q000503:physiopathology / Q000628:therapy*; D052097:Quadriceps Muscle / Q000503:physiopathology*; D011999:Recruitment, Neurophysiological; D019415:Torque; D016896:Treatment Outcome