Abstract
BackgroundStrengthening the intrinsic foot muscles is a poorly understood and largely overlooked area. In this study, we explore the feasibility of strengthening m. abductor hallucis (AH) with a specific paradigm of neuromuscular electrical stimulation; one which is low-intensity in nature and designed to interleave physiologically-relevant low frequency stimulation with high-frequencies to enhance effective current delivery to spinal motoneurones, and enable a proportion of force produced by the target muscle to be generated from a central origin. We use standard neurophysiological measurements to evaluate the acute (~ 30 min) peripheral and central adaptations in healthy individuals.MethodsThe AH in the dominant foot of nine healthy participants was stimulated with 24 × 15 s trains of square wave (1 ms), constant current (150% of motor threshold), alternating (20 Hz–100 Hz) neuromuscular electrical stimulation interspersed with 45 s rest. Prior to the intervention, peripheral variables were evoked from the AH compound muscle action potential (Mwave) and corresponding twitch force in response to supramaximal (130%) medial plantar nerve stimulation. Central variables were evoked from the motor evoked potential (MEP) in response to suprathreshold (150%) transcranial magnetic stimulation of the motor cortex corresponding to the AH pathway. Follow-up testing occurred immediately, and 30 min after the intervention. In addition, the force-time-integrals (FTI) from the 1st and 24th WPHF trains were analysed as an index of muscle fatigue. All variables except FTI (T-test) were entered for statistical analysis using a single factor repeated measures ANOVA with alpha set at 0.05.ResultsFTI was significantly lower at the end of the electrical intervention compared to that evoked by the first train (p < 0.01). Only significant peripheral nervous system adaptations were observed, consistent with the onset of low-frequency fatigue in the muscle. In most of these variables, the effects persisted for 30 min after the intervention.ConclusionsAn acute session of wide-pulse, high-frequency, low-intensity electrical stimulation delivered directly to abductor hallucis in healthy feet induces muscle fatigue via adaptations at the peripheral level of the neuromuscular system. Our findings would appear to represent the first step in muscle adaptation to training; therefore, there is potential for using WPHF for intrinsic foot muscle strengthening.
Highlights
Strengthening the intrinsic foot muscles is a poorly understood and largely overlooked area
Significant time effects were observed in Mmax130 latency (F = 29.5, p < 0.001; ŋ2 = 0.79), total area (F = 3.81, p < 0.05; ŋ2 = 0.32), and AHMT@50 (F = 15.44, p < 0.001; ŋ2 = 0.69)
Our findings concur with: (i) a significantly delayed transmission of the action potential along the motoneuron / muscle sarcolemma evidenced by an increased Mmax130 latency and total area of the compound muscle action potential (Mmax130; peakto-peak amplitude did not change, but the area of Mmax130TP did); (ii) a significantly reduced muscle excitability evidenced by an increased motor threshold (AHMT@50); and (iii) a significant impairment in muscle contractility evidenced by a prolonged twitch relaxation (HRT)
Summary
Strengthening the intrinsic foot muscles is a poorly understood and largely overlooked area. Like any other muscle subjected to repetitive strain, the intrinsic foot muscles require targeted muscle strengthening. This remains a poorly understood and largely overlooked area. Despite the merit of these exercises, approximately 20% of asymptomatic individuals are unable to voluntary activate AH [10] the strongest plantar intrinsic foot muscle [11], and this is manifested further in pathology (eg, Hallux Valgus) [5]. In light of the functional importance of this muscle [1,2,3, 6, 12], and for its superficial location along the medial-plantar aspect of the foot, targeted neuromuscular electrical stimulation (NMES) represents an alternative solution for strengthening
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