Sartori Francesco, Fagnani Pedro Luiz Flores, Monne-Guasch Laia, La Cagnina Giovanni, Picañol Javier, Puig-Diví Albert
Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
Independent Researcher, Barcelona, Spain.
Front Med (Lausanne). 2024 Jul 3;11:1410495. doi: 10.3389/fmed.2024.1410495. eCollection 2024.
Various pathophysiological contexts can be accompanied by weakness, arthrogenic muscle inhibition, and even disability. In this scenario, peripheral nerve stimulation has been studied not only for pain management but also for the improvement of neuromuscular parameters. For this purpose, the use of Transcutaneous Electrical Nerve Stimulation (TENS) has typically been investigated, but recently, the use of ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) has gained popularity. In this regard, electrical stimulation has a predisposition to activate Type II muscle fibers and has been shown to be capable of generating short-term potentiation by increasing calcium sensitivity. However, the evidence of pPNS applied in humans investigating such variables is rather limited.
This pilot study aimed to assess the feasibility of the methodology and explore the potential of pPNS in enhancing hip extension performance in individuals suffering from knee pain, comparing it with TENS.
Twelve participants were divided into pPNS and TENS groups, undergoing pre- and post-intervention assessments of peak concentric power (W), strength (N), execution speed (m/s), and one-repetition maximum (1RM) (kg) estimation. For pPNS, two needles were positioned adjacent to the superior and inferior gluteal nerves under ultrasound guidance. For TENS, electrodes were positioned between the posterosuperior iliac spine and the ischial tuberosity, and halfway between the posterosuperior iliac spine and the greater trochanter. The interventions consisted of 10 stimulations of 10 s at a frequency of 10 Hz with a pulse width of 240 μs, with rest intervals of 10 s between stimulations.
Peripheral nerve stimulation significantly improved concentric power at 30% ( = 0.03) and 50% ( = 0.03) of 1RM, surpassing TENS, which showed minimal changes. No significant strength differences were observed post-intervention in either group.
This work presents evidence where pPNS applied to the gluteal nerves results in an enhanced performance of hip extension at submaximal loads. However, this improvement does not seem to be reflected in short-term changes in the estimation of the 1RM by the force-velocity profile.
各种病理生理情况都可能伴有虚弱、关节源性肌肉抑制，甚至残疾。在这种情况下，外周神经刺激不仅被用于疼痛管理，还用于改善神经肌肉参数。为此，人们通常研究经皮电刺激神经（TENS）的应用，但最近，超声引导下经皮外周神经刺激（pPNS）的应用越来越普遍。在这方面，电刺激倾向于激活II型肌纤维，并且已被证明能够通过增加钙敏感性产生短期增强作用。然而，在人体中研究此类变量的pPNS证据相当有限。
这项初步研究旨在评估该方法的可行性，并探讨pPNS在改善膝关节疼痛患者髋关节伸展性能方面的潜力，并与TENS进行比较。
12名参与者被分为pPNS组和TENS组，在干预前后对向心峰值功率（瓦特）、力量（牛顿）、执行速度（米/秒）和一次重复最大负荷（1RM）（千克）估计值进行评估。对于pPNS，在超声引导下将两根针置于臀上神经和臀下神经附近。对于TENS，电极置于髂后上棘和坐骨结节之间，以及髂后上棘和大转子之间的中点。干预包括以10赫兹的频率进行10次10秒的刺激，脉冲宽度为240微秒，刺激之间的休息间隔为10秒。
外周神经刺激显著提高了1RM的30%（P = 0.03）和50%（P = 0.03）时的向心功率，超过了TENS，TENS显示变化极小。干预后两组均未观察到显著的力量差异。
这项研究表明，将pPNS应用于臀神经可提高次最大负荷下髋关节伸展的性能。然而，这种改善似乎并未反映在通过力-速度曲线估计的1RM的短期变化中。
