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A thread on a new piece from my former group “Neuromuscular Electrical Stimulation Reduces Leg #Cramps in Patients With Lumbar Degenerative Disorders: A Randomized Placebo-Controlled Trial”
@JNeuromod #openaccess
tinyurl.com/yxcknvx2
A thread on a new piece from my former group “Neuromuscular Electrical Stimulation Reduces Leg #Cramps in Patients With Lumbar Degenerative Disorders: A Randomized Placebo-Controlled Trial”
@JNeuromod #openaccess
tinyurl.com/yxcknvx2
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The psychological and physical strain as well as the social relevance of leg cramps in patients with lumbar degenerative disorders such as lumbar spinal stenosis (LSS) and disc herniation (LDH) are underestimated.
The psychological and physical strain as well as the social relevance of leg cramps in patients with lumbar degenerative disorders such as lumbar spinal stenosis (LSS) and disc herniation (LDH) are underestimated.
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Spinal cord compression, which often occurs simultaneously with LDH and LSS and has been shown to cause spastic weakness, is one of the mechanisms that may largely contribute to the higher susceptibility to cramps in these disorders.
Spinal cord compression, which often occurs simultaneously with LDH and LSS and has been shown to cause spastic weakness, is one of the mechanisms that may largely contribute to the higher susceptibility to cramps in these disorders.
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In patients with LDH the frequent incidence of muscle cramps appears to be characteristic to the extent that a cramp induction test is a diagnostic tool for LDH: the patient is asked to flex the knee against manual resistance to provoke cramping of the hamstring muscles.
In patients with LDH the frequent incidence of muscle cramps appears to be characteristic to the extent that a cramp induction test is a diagnostic tool for LDH: the patient is asked to flex the knee against manual resistance to provoke cramping of the hamstring muscles.
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Recently, we showed that neuromuscular electrical stimulation (NMES) of the gastrocnemius performed twice a week for six weeks reduced the frequency of leg cramps by up to 78%. But pain associated with NMES was high and a placebo-control was missing…
tinyurl.com/y3m2ongu
Recently, we showed that neuromuscular electrical stimulation (NMES) of the gastrocnemius performed twice a week for six weeks reduced the frequency of leg cramps by up to 78%. But pain associated with NMES was high and a placebo-control was missing…
tinyurl.com/y3m2ongu
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Aim: This study, therefore, set out to assess the efficacy and tolerability of NMES at various stimulation intensities in reducing the frequency of leg cramps in patients with LDH and LSS when compared to pseudo-stimulation.
Aim: This study, therefore, set out to assess the efficacy and tolerability of NMES at various stimulation intensities in reducing the frequency of leg cramps in patients with LDH and LSS when compared to pseudo-stimulation.
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32 men and women (63±9 years) with LSS and/or LDH suffering from cramps were randomly allocated to four different groups. Unilateral stimulation of the gastrocnemius was applied twice a week over four weeks.
32 men and women (63±9 years) with LSS and/or LDH suffering from cramps were randomly allocated to four different groups. Unilateral stimulation of the gastrocnemius was applied twice a week over four weeks.
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3×6×5 sec stimulation trains at 30 Hz above the individual cramp threshold frequency (CTF). Three groups received either 85%, 55%, or 25% of their maximum tolerated stimulation intensity, whereas one group only received pseudo-stimulation.
3×6×5 sec stimulation trains at 30 Hz above the individual cramp threshold frequency (CTF). Three groups received either 85%, 55%, or 25% of their maximum tolerated stimulation intensity, whereas one group only received pseudo-stimulation.
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All participants reported cramps occurring in everyday life in a cramp log and the CTF was remeasured at several time points.
All participants reported cramps occurring in everyday life in a cramp log and the CTF was remeasured at several time points.
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The number of reported leg cramps decreased in the 25% (25±14 to 7±4; p = 0.002), 55% (24±10 to 10±11; p = 0.014) and 85%NMES (23±17 to 1±1; p < 0.001) group, whereas it remained unchanged after pseudo-stimulation (20±32 to 19±33; p > 0.999).
The number of reported leg cramps decreased in the 25% (25±14 to 7±4; p = 0.002), 55% (24±10 to 10±11; p = 0.014) and 85%NMES (23±17 to 1±1; p < 0.001) group, whereas it remained unchanged after pseudo-stimulation (20±32 to 19±33; p > 0.999).
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In the 25% and 85%NMES group, this improvement was accompanied by an increased CTF (p < 0.001).
In the 25% and 85%NMES group, this improvement was accompanied by an increased CTF (p < 0.001).
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The 25%NMES perceived less pain associated with the stimulation than the 85%NMES group.
The 25%NMES perceived less pain associated with the stimulation than the 85%NMES group.
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The occurrence of leg cramps after the pseudo-stimulation protocol remained unchanged, indicating that the reduction of leg cramps in the three stimulation groups was indeed due to actions of NMES.
The occurrence of leg cramps after the pseudo-stimulation protocol remained unchanged, indicating that the reduction of leg cramps in the three stimulation groups was indeed due to actions of NMES.
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We hypothesize that the lumbar nerve damage disturbs the balance between inhibitory and excitatory inputs to the alpha motor neuron by either blunting inhibitory factors or promoting excitation leading to a state of hyperexcitability.
We hypothesize that the lumbar nerve damage disturbs the balance between inhibitory and excitatory inputs to the alpha motor neuron by either blunting inhibitory factors or promoting excitation leading to a state of hyperexcitability.
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As NMES led to strong reductions of leg cramps, we hypothesize that NMES was able to abolish this state of hyperexcitability by potentially increasing GTO Ib, recurrent Renshaw cell inhibition (and/or decreasing excitatory pathways.
As NMES led to strong reductions of leg cramps, we hypothesize that NMES was able to abolish this state of hyperexcitability by potentially increasing GTO Ib, recurrent Renshaw cell inhibition (and/or decreasing excitatory pathways.
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If future studies could determine the precise excitatory and inhibitory pathways that respond to NMES, the potential neurophysiologic mechanism underlying muscle cramps might be revealed.
If future studies could determine the precise excitatory and inhibitory pathways that respond to NMES, the potential neurophysiologic mechanism underlying muscle cramps might be revealed.
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Taking into account that there was no drop-out in the present study and the positive feedback of participants about the bearable pain associated with 25%NMES renders the here described NMES protocol feasible in the real-world scenario.
Taking into account that there was no drop-out in the present study and the positive feedback of participants about the bearable pain associated with 25%NMES renders the here described NMES protocol feasible in the real-world scenario.
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