How a Neuromuscular Electrical Stimulation Unit Aids Knee Rehab

A neuromuscular electrical stimulation (NMES) unit offers a valuable approach for patients recovering from knee replacement surgery, especially in addressing common quadriceps deficits. By delivering controlled electrical impulses to targeted muscle groups, NMES specifically activates weakened muscles—particularly the fast-twitch fibers of the quadriceps, which are often compromised post-surgery.

Integrating NMES into rehabilitation can significantly enhance strength recovery and improve functional mobility, helping patients regain essential abilities like walking and stair-climbing. Despite standard therapy, many patients experience persistent quadriceps deficits after surgery.

On average, individuals with knee osteoarthritis prior to undergoing a traditional Total Knee Arthroplasty (TKA) have a 20 percent quadriceps deficit.¹ It has been reported that at one year, this deficit increases to 40 percent despite standard rehabilitation programs.^{2, 3} This persistent quadriceps deficit has been linked to declines in walking speed, stair-climbing ability, and increased falls.²

Addressing quadriceps deficits with neuromuscular electrical stimulation

Researchers who have incorporated neuromuscular electrical stimulation (NMES) into post-operative rehabilitation alongside traditional strengthening exercises found that patients who received NMES walked and performed stairs faster and had fewer torque deficits than those who did not incorporate NMES into their rehabilitation program.^4-6

The use of a neuromuscular electrical stimulation unit in these cases provides consistent delivery of NMES therapy, allowing for controlled, targeted stimulation to the quadriceps muscle group. This equipment may be particularly valuable in clinical settings where consistent stimulation parameters are needed for optimal recovery.

How NMES benefits quadriceps recovery

So, what is it about NMES that aids quadriceps recovery? To answer this question, we must first review two aspects:

• Basic principles of electrical stimulation modality: NMES selectively recruits fast twitch type II muscle fibers before slow twitch type I fibers. Type II fibers are the first to atrophy following disuse immobilization. Therefore, using NMES provides the necessary neural drive to the quadriceps muscle, reducing the inhibitory effects of disuse immobilization.
• The effects of post-operative effusions on quadriceps inhibition: We can also clinically reason that post-operative NMES delivered to the quadriceps has a muscle pumping effect that reduces effusion.

How can a neuromuscular electrical stimulation unit benefit knee rehabilitation?

A neuromuscular electrical stimulation unit can help patients recover faster and more completely by targeting specific quadriceps muscle fibers that are often weakened after knee replacement surgery. By consistently activating these fast-twitch fibers, NMES aids in building strength and improving functional outcomes, such as walking speed and stair-climbing ability.

What if you don’t have a neuromuscular electrical stimulation unit?

All my life, I have been curious about how things worked and what the common denominators to successful methods were. My question now was, how can I implement this information to enhance my clinical outcomes if I do not have a neuromuscular electrical stimulation unit? I didn’t want to deprive my patients of this evidence, so I developed an alternative therapeutic approach – the neuromuscular exercise Church Pew Exercise (CPE).

Below, watch a case study of the Church Pew Exercise in a short video from my course, Knee Arthroplasty: Increasing Range of Motion. When you watch our patient walk, I’d really like for you to focus on his stride length and walking speed before and after the exercise.