神经肌肉电刺激(NMES)可以改善不同人群的身体功能。与NMES相关的结果可能会受到肌肉长度的影响(即,接头角度),肌肉纤维的力产生能力的调节剂。然而,到目前为止,关于最大限度地提高NMES有效性的最佳关节角度,没有全面综合的现有科学证据。我们进行了系统评价,以研究肌肉长度对NMES诱导的扭矩的影响,不适,收缩疲劳,健康和临床成人人群的力量训练适应(PROSPERO:CRD42022332965)。我们在七个电子数据库中进行了搜索:PUBMED,WebofScience,EMBASE,PEDro,BIREME,SCIELO,还有Cochrane,在2022年6月至2023年10月期间,不限制出版年份。我们纳入了使用NMES作为干预或评估工具的横断面和纵向研究,以比较成人人群的肌肉长度。我们排除了关于发声的研究,呼吸,或者盆底肌肉.数据提取通过标准化表格进行,以收集参与者的信息,干预措施,和结果。使用用于交叉试验的修订的Cochrane偏差风险工具和物理治疗证据数据库量表评估偏差风险。在通过我们的搜索策略检索到的1185篇文章中,我们在分析中纳入了36项研究,其中包括448名健康的年轻参与者(年龄:19-40岁),以调查最大诱发扭矩(n=268),收缩疲劳性(n=87),不适(n=82),和肌肉加强(n=22),以及六名脊髓损伤的参与者,和15名健康的老年参与者。根据股四头肌长度通过膝关节角度比较最大诱发扭矩的Meta分析是可能的。在膝关节屈曲的最佳肌肉长度为50°-70°时,其中0°是完全延伸),与非常短(0-30°)相比,神经刺激期间的诱发扭矩更大(p<0.001,CI95%:-2.03,-1.15用于肌肉腹部刺激,和-3.54,-1.16用于股神经刺激),短(31°-49°)(p=0.007,CI95%:-1.58,-0.25),和长(71°-90°)(p<0.001,CI95%:0.29,1.02)肌肉长度。在长肌肉长度上,NMES引起的扭矩大于非常短(p<0.001,CI95%:-2.50,-0.67)和短(p=0.04,CI95%:-2.22,-0.06)的长度。对于给定的电流幅度,最短的股四头肌长度产生最高的感知不适。当肌肉长度允许在疲劳前状态下产生更大的扭矩时,收缩疲劳性的量更大。在最佳肌肉长度下的方案的力量增益大于短肌肉长度。对于大多数诱发扭矩的比较,证据质量非常高。然而,需要进一步的研究来实现其他结果的确定性。最佳肌肉长度应被视为NMES干预期间的主要选择,因为它促进更高水平的力量产生,并可能促进肌肉力量和质量的保存/增益,减少不适。然而,也可以使用比最佳肌肉长度更长的肌肉长度,由于在高诱发张力下可能的肌肉延长。要为健康和临床人群提供适当的NMES处方,必须全面了解这些生理原理。
Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic
review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19-40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 - 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.