Neuromuscular electrical stimulation therapy to restore quadriceps muscle function in patients after orthopaedic surgery

▸ Despite evidence supporting the use of neuromuscular electrical stimulation (NMES) as an adjunct exercise modality to improve voluntary activation, muscle strength, and functional recovery after knee surgery, NMES therapy remains a clinically underutilized modality. ▸ We propose a criteria-based treatment algorithm aimed at optimizing and simplifying the clinical application of NMES therapy following knee surgery. ▸ The suggested algorithm includes a short preoperative phase for patient education (1 visit) and familiarization with NMES, followed by 2 home-based treatment phases (each lasting 3 weeks): (1) a high-intensity, high-volume phase initiated within the first few days following surgery, and (2) a high-intensity, low-volume phase. ▸ Two evaluation sessions are also incorporated, with the first following 1 week of treatment to assess the responsiveness to NMES and the second after 3 weeks of treatment to assess whether voluntary activation failure has resolved. ▸ Practical guidelines for maximizing muscle response while minimizing discomfort and fatigue, including optimal pulse characteristics, electrode size and location, knee joint position, and patient instructions, are provided.