Combination of eccentric exercise and neuromuscular electrical stimulation to improve quadriceps function post-ACL reconstruction

Background: Neuromuscular electrical stimulation (NMES) has been shown to reduce quadriceps activation failure (QAF), and eccentric exercise has been shown to lessen muscle atrophy post-ACL reconstruction. Given that these are two critical components of quadriceps strength, intervention combining these therapies may be effective at reinstituting quadriceps function post-reconstruction. Thus, the aim of this study was to evaluate the effectiveness of a combined NMES and eccentric exercise intervention to improve the recovery of quadriceps activation and strength post-reconstruction. Methods: Thirty-six individuals post-injury were placed into four treatment groups (N&E, NMES and eccentrics; E-only, eccentrics only; N-only, NMES-only; and STND, standard of care) and ten healthy controls participated. N&E and N-only received the NMES protocol 2 x per week for the first 6 weeks post-reconstruction. N&E and E-only received the eccentric exercise protocol 2 x per week beginning 6 weeks post-reconstruction. Quadriceps activation was assessed via the superimposed burst technique and quantified via the central activation ratio. Quadriceps strength was assessed via maximal voluntary isomeric contractions (Nm/kg). Data was gathered on three occasions: pre-operative, 12-weeks-post-surgery and at return-to-play. Results: No differences in pre-operative measures existed (P > 0.05). E-only recovered quadriceps activation better than N-only or STND (P < 0.05). N&E and E-only recovered strength better than N-only or the STND (P < 0.05) and had strength values that were similar to healthy at return-to-play (P > 0.05). Conclusion: Eccentric exercise was capable of restoring levels of quadriceps activation and strength that were similar to those of healthy adults and better than NMES alone. Level of evidence: Level 3, Parallel longitudinal study (C) 2014 Elsevier B.V. All rights reserved.