Objective: The aim was to evaluate efficacy and clinical relevance of percutaneous  NM to alleviate muscle activation in physiotherapy practice.

Background: Muscle activation has a crucial role in physiotherapy practice for balancing posture. Muscle and CNS have rigorous evidence for effective targeted interventions. Nerves and neuromuscular junction lack effective therapeutic approach. Stimulation techniques are promising for pain management and rehabilitation [1,2]; percutaneous  neuromodulation  (NM) may be an effective therapeutic procedure for patients with pain, posture imbalance [3]. Ultrasound (US) control is effective for effective electrode positioning.

Method: We included 10 patients (4 females, 23-47 years old) with pain dysfunctions at various locations (low back pain, shoulder, limbs), impingement, postural imbalance. Rheumatic, neurological, trauma, cancer background were exclusion criteria. The intervention was a simple single-shot of US-controlled NM performed via precise percutaneous stimulation with US mapping to target peripheral nerves (tibial, peroneal, sural, femoral nerves, etc.) and muscles of trunk, shoulder, arm, ankle. We did percutaneous NM up to 30 sec using FDA approved equipment (2Hz, 15mA). Before the intervention we tested voluntary contraction and detected sites of lack of effective muscle activation. Before the next voluntary contraction we did NM on the nerves, muscles using US guidance. We tested baseline and post-procedure parameters: evaluated range of motion (ROM) clinically, detected on real time US and M-mode US; the assessments of pain, muscle strength, trunk control and gait recordings.

Results: We recorded effective  voluntary muscle activation in all cases that was impossible before NM. We found increasing of ROM for min. 50% vs baseline levels in muscles that did not respond for voluntary activation before NM. We recorded significant distant effects on limb muscles; in 4 patients it was possible to unblock shoulder, ankle joints. Levels of pain, core stability, gait parameters and overall efficacy of procedures improved after NM.

Conclusion: US-controlled NM performed via precise percutaneous stimulation is feasible and has clear clinical relevance promising for developing effective combined hybrid techniques of smart personalized physiotherapy in various location to target local muscles and nerves for distal effect.

References: 1. Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13. 2. Bubnov R, Kalika L, Babenko L. Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949 3. Nussbaum EL, Houghton P, Anthony J, Rennie S, Shay BL, Hoens AM. Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiother Can. 2017;69(5):1-76. doi:10.3138/ptc.2015-88

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ultrasound-controlled-percutaneous-neuromodulation-alleviates-muscle-activation-in-physiotherapy-practice/