Neuromuskulær Elektrisk Stimulering / NMES til rehabilitering efter forreste korsbåndsoperation

Skribent: Thomas Bay, Idrætsfysioterapeut og fysisk træner, FysioDanmark Holstebro (www.fysio7500.dk)


Nedsat styrke i quadriceps er en hyppig følge af skade på forreste korsbånd / ACL samt ACL-rekonstruktion / ACLR. Flere studier har vist at quadricepsstyrken før operationen indikerer hvordan styrken omkring knæet og funktionsevnen efter operationen vil være (1,2). Mange patienter har efter ACLR vedvarende nedsat styrke i quadriceps, hvllket bl.a. medfører ændret gangfunktion, asymmetri samt nedsat præstationsevne.(3,45,6,7,8). Det er alt afgørende at få etableret quadricepsstyrken inden og efter operationen hurtigst mulig og til det er en af de vægtigste værktøjer, neuromuskulær elektrisk stimulering / NMES. NMES har i flere studier vist fantastiske egenskaber til ACL-rehabilitering



Effekter af NMES på ACL rehabilitering

1. Reducerer smerte (9)

2. Reducerer hævelse (9)

3. Reducerer ekstensionsdeficit (9)

4. Reducerer graden af atrofi (9,10,12)

5. Reducerer tab af muskelstyrke (10,12)

6. Opbygger muskelstyrke (10,11,12)

7. Øger funktionsevnen (11)

8. Hurtigere tilbage på arbejde (11)



Referencer

1. Silkman C et al. The Effect of Preoperative Quadriceps Strength on Strength and Function After Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2012;21:89-93.
2. Eitzen I et al. Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med. 2009 May;43(5):371-6.
3. Natri A et al. Isokinetic muscle performance after anterior cruciate ligament surgery. Int J Sports Med 1996;17:223–8.
4. Østeras H et al. Isokinetic muscle strength after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 1998;8:279–82.
5. Lewek M et al. The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon). 2002 Jan;17(1):56-63.
6. Keays SL et al. The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res. 2003 Mar;21(2):231-7.
7. Schmitt LC et al. The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2012 Sep;42(9):750-9.
8. Liu-Ambrose T et al. The effects of proprioceptive or strength training on the neuromuscular function of the ACL reconstructed knee: a randomized clinical trial. Scand J Med Sci Sports. 2003 Apr;13(2):115-23.
9. Ediz L et al. A randomised controlled trial of electrostimulation effects on effussion, swelling and pain recovery after anterior cruciate ligament reconstruction: a pilot study. Clin Rehabil. 2012 May;26(5):413-22.
10. Taradaj J et al. The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction. Biomed Res Int. 2013;2013:802534.
11. Feil S et al. The effectiveness of supplementing a standard rehabilitation program with superimposed neuromuscular electrical stimulation after anterior cruciate ligament reconstruction: a prospective, randomized, single-blind study. Am J Sports Med. 2011 Jun;39(6):1238-47.
12. Hasegawa S et al. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol. 2011 Aug;21(4):622-30.
13. Snyder-Mackler et al. Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation. J Bone Joint Surg Am. 1995 Aug;77(8):1166-73

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