Using Neuromuscular Electrical Stimulation to Enhance Quadriceps Recovery: A Patient Case Study

Quadriceps weakness is a common challenge after knee injury or surgery, often due to prolonged disuse and reflex inhibition. In this case study, we explore how neuromuscular electrical stimulation (NMES) can accelerate recovery when conventional exercise is limited. Using the Chattanooga Wireless Pro device, we demonstrate key clinical steps and practical tips to optimise treatment outcomes.

Patient Background

Natasha, recovering from a knee injury, presented with significant quadriceps deconditioning following a period of reduced activity. The goal was to restore strength and functional extension while ensuring comfort and safety.

Locating the Motor Point

Effective NMES begins with precise electrode placement.

• Motor Point Identification: The motor point is where the motor nerve enters the muscle, and its location varies between individuals.
• Technique: Using Chattanooga’s motor point pen with a water-based gel, we identified the optimal sites for the quadriceps and vastus medialis. Locating this point ensures efficient stimulation at lower intensities, improving comfort and treatment effectiveness.

Device Setup and Initial Stimulation

The Chattanooga Wireless Pro offers both wired and wireless modules.

• Programme Selection: “Disuse Atrophy” mode was chosen to gently reintroduce contraction to the dormant muscle.
• Customised Parameters: The device automatically calibrated stimulation intensity, accounting for factors like hydration, caffeine intake, and time of day—variables that can influence neuromuscular excitability.

Treatment Progression

1. Isometric Activation: Initial stimulation produced visible contractions, confirming effective electrode placement and neuromuscular response.
2. Functional Positioning: With improved knee extension, we progressed to open-chain exercises against gravity.
3. Concentric–Eccentric Training: Natasha performed active movements—dorsiflexing and extending the knee while the stimulator induced quadriceps contraction—followed by controlled hamstring activation for co-contraction.

Key Clinical Insights

• Patient Comfort: Start with low intensity (around level 5) and increase gradually based on feedback.
• Muscle Fatigue: Expect visible fasciculations during early sessions as the muscle re-learns sustained contraction.
• Integration with Exercise: Combining NMES with voluntary concentric and eccentric actions optimises neuromuscular recruitment and functional strength gains.

Outcomes and Next Steps

By the end of the session, Natasha demonstrated improved quadriceps activation and tolerance for progressive loading. Continued NMES, combined with targeted physiotherapy exercises, is expected to enhance strength recovery and expedite return to normal function.

Key Takeaways

NMES is a valuable adjunct in knee rehabilitation, particularly when voluntary contraction is limited. Accurate motor point identification, patient-specific parameter adjustments, and integration with active movement are critical for success.

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