Femoral Nerve Stimulation Research Articles

Acute acetaminophen ingestion improves the recovery of neuromuscular fatigue following simulated soccer match-play

ObjectiveThis study aimed to investigate the impact of acute acetaminophen (ACT) ingestion on the responses of neuromuscular function, biomarkers of muscle damage, and physical performance during the 72-h recovery period following simulated soccer match-play. DesignThe study followed a crossover randomized, double-blind, placebo-controlled trial design. MethodsDuring the two experimental sessions, thirteen semi-professional male soccer players completed a 90-min simulated soccer match, 60 min after oral ingestion of 1 g ACT or placebo (PL). Maximal voluntary contraction (MVC) and twitch responses of the knee extensors muscles, elicited through electrical femoral nerve stimulation, were utilized to evaluate both peripheral fatigue (potentiated twitch force, Qtw,pot) and central fatigue (voluntary activation, VA). Performance was assessed through countermovement jump (CMJ) and 20 m sprint tests. Creatine kinase (CK) and lactate dehydrogenase (LDH) were also measured. ResultsSmaller reductions were observed in MVC (−13.3 ± 7.5 % vs. -24.7 ± 11.1 %) and VA (−3.8 ± 4.4 % vs. -12.9 ± 5.4 %) in the ACT compared to the PL condition immediately after simulated soccer match-play (p < 0.05). Afterwards, these parameters were recovered 24 h earlier in the ACT session compared to the PL session. Furthermore, the 20 m sprint performance was significantly better throughout the recovery period in the ACT session compared to the PL session. ConclusionThe findings of this study showed that acute ingestion of 1 g of ACT (1 h before exercise) attenuated the decrease in MVC and VA levels after exercise, as well as improved 20 m sprint performance.

Muscle fatigue, pedalling technique and the slow component during cycling.

Above the first lactate threshold, the steady-state is delayed or prevented due to the slow component ( ). This phenomenon has been associated with muscle fatigue, but evidence for a causal relationship is equivocal. Moreover, little is known about the contribution of pedalling technique adjustments to during fatiguing cycling exercise. Eleven participants completed constant power trials at 10% above the second lactate threshold. Muscle fatigue was assessed, utilizing femoral nerve stimulation and instrumented pedals, while , quadriceps oxygenation, electromyography (EMG) and pedal force components were measured. Correlations between physiological and mechanical variables were estimated at group and individual levels. Group correlations revealed moderate values for with quadriceps twitch force (r=-0.51) and muscle oxygenation (r=-0.52), while weak correlations were observed for EMG amplitude (r=0.26) and EMG mean power frequency (r=-0.16), and with pedalling mechanical variables such as peak total downstroke force (r=-0.16), minimum total upstroke force (r=-0.16) and upstroke index of effectiveness (r=0.16). The findings here align with prior literature reporting significant correlations between the magnitude of muscle fatigue and that of , although there was large interindividual variability for all the reported correlations. Considering the heterogeneity in the data, it is difficult to determine therelative impact of pedalling technique adjustments on overall, but the present study opens the possibility that in some cases, increases in secondary to technical adjustments may be 'superimposed' on the underlying .

Acute normobaric hypoxia causes a rightward shift in the torque-frequency relationship but has no effect on postactivation potentiation.

Low fractions of inspired oxygen ([Formula: see text]; i.e., hypoxia) affect aspects of skeletal muscle contractility in humans, but it remains unclear if postactivation potentiation (PAP) and the torque-frequency (T-F) relationship are altered. We investigated the effects of 2 (H2) and 4 (H4) h of normobaric hypoxia ([Formula: see text] = 0.11 ± 0.47) on the magnitude of PAP of the knee extensors and the T-F relationship of the dorsiflexors in 13 and 12 healthy participants, respectively. To assess PAP, a resting twitch was evoked via femoral nerve stimulation before and 2-300 s after a 10-s maximal voluntary contraction (MVC). A T-F relationship was obtained by stimulating the common fibular nerve with a single pulse and 1-s trains between 5 and 100 Hz. During hypoxia, peripheral oxygen saturation decreased by ∼18% from 98.0 ± 0.8% at baseline (P < 0.001). MVC force and voluntary activation (VA) of the knee extensors were lower than baseline throughout hypoxia (e.g., ∼8% and ∼5%, respectively, at H2; P ≤ 0.027); however, the magnitude of PAP was not altered by hypoxia (P ≥ 0.711). Surprisingly, PAP did increase with time across the control day (P ≤ 0.012). MVC torque and VA of the dorsiflexors were unaffected by hypoxia (P ≥ 0.127), but the estimated frequency required to evoke 50% of 100 Hz torque increased by ∼1.2 Hz at H2 (P ≤ 0.021). These results imply that 2 h of normobaric hypoxia were sufficient to 1) impair neural drive to the knee extensors but not the mechanism(s) responsible for PAP and 2) lead to a rightward shift of the T-F relationship for the dorsiflexors.NEW & NOTEWORTHY Postactivation potentiation of the knee extensors was unaffected by 4 h of normobaric hypoxia exposure but may be confounded by hypoxia-related impairments to the conditioning contraction. In the dorsiflexors, contractile rates increased in hypoxia, which led to a rightward shift of the torque-frequency relationship, such that a higher frequency was required to obtain 50% of maximal torque. These results expand our understanding of the acute effects of hypoxia on skeletal muscle function.

People with hip osteoarthritis have reduced quadriceps voluntary activation and altered motor cortex function

AimsCompare quadriceps voluntary activation, corticospinal and intracortical excitability between people with and without hip osteoarthritis (OA). Exploratory objectives include quantifying the association of corticospinal/intracortical excitability with voluntary activation, corticospinal/intracortical excitability with hip related pain, and motor threshold with motor cortex inhibition and facilitation. MethodsCase-control study including participants with clinically and radiologically confirmed hip OA and non-OA controls. Quadriceps voluntary activation was assessed using twitch interpolation via femoral nerve stimulation. Single- and paired-pulse transcranial magnetic stimulation over the motor cortex assessed resting motor threshold (RMT), active motor threshold (AMT), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF) and silent period. Generalized linear models assessed outcomes (p ​< ​0.05). ResultsWe included 17 hip OA (76% female) and 24 controls (92% female) with a mean (standard deviation) age of 58.7 (7.9) years. Compared to controls, people with hip OA had reduced quadriceps voluntary activation (β ​= ​-5.29, 95% confidence intervals [CI], -0.79–-9.79) and increased ICF (β ​= ​0.22, 95%CI, 0.01–0.43). People with hip OA did not differ from controls in RMT (β ​= ​−4.76, 95%CI, −14.08–4.56), AMT (β ​= ​−2.13, 95%CI, −7.12-2.86), SICI (β ​= ​−0.02, 95%CI, −0.15-0.006) or silent period (β= 8.72, 95%CI, −24.75–42.20). More facilitation was associated with increased hip pain (β= 24.55, 95%CI, 6.93–42.18), and more inhibition was associated with less voluntary activation (β= 10.50, 95%CI, 2.00–18.99). ConclusionPeople with hip OA demonstrate reduced quadriceps voluntary activation and complex changes in motor cortex excitability compared to controls. These findings suggest that hip OA can alter quadriceps neuromuscular function (facilitation associated with pain, inhibition associated with activation), thus having implications for rehabilitation.

Heteronymous feedback from quadriceps onto soleus in stroke survivors.

Recent findings suggest increased excitatory heteronymous feedback from quadriceps onto soleus may contribute to abnormal coactivation of knee and ankle extensors after stroke. However, there is lack of consensus on whether persons post-stroke exhibit altered heteronymous reflexes and, when present, the origin of increased excitation (i.e. increased excitation alone and/or decreased inhibition). This study examined heteronymous excitation and inhibition from quadriceps onto soleus in paretic, nonparetic, and age-matched control limbs to determine whether increased excitation was due to excitatory and/or reduced inhibitory reflex circuits. A secondary purpose was to examine whether heteronymous reflex magnitudes were related to clinical measures of lower limb recovery, walking-speed, and dynamic balance. Heteronymous excitation and inhibition from quadriceps onto soleus were examined in fourteen persons post-stroke and fourteen age-matched unimpaired participants. Heteronymous feedback was elicited by femoral nerve and quadriceps muscle stimulation in separate trials while participants tonically activated soleus at 20% max. Fugl-Myer assessment of lower extremity, 10-meter walk test, and Mini-BESTest were assessed in stroke survivors. Heteronymous excitation and inhibition onsets, durations, and magnitudes were not different between paretic, nonparetic or age-matched unimpaired limbs. Quadriceps stimulation elicited excitation that was half the magnitude of femoral nerve stimulation. Femoral nerve elicited paretic limb heteronymous excitation was positively correlated with walking speed but did not reach significance because only a subset of paretic limbs exhibited excitation (n = 8, Spearman r = 0.69, P = 0.058). Heteronymous feedback from quadriceps onto soleus assessed in a seated posture was not impaired in persons post-stroke. Despite being unable to identify whether reduced inhibition contributes to abnormal excitation reported in prior studies, our results indicate quadriceps stimulation may allow a better estimate of heteronymous inhibition in those that exhibit exaggerated excitation. Heteronymous excitation magnitude in the paretic limb was positively correlated with self-selected walking speed suggesting paretic limb excitation at the higher end of a normal range may facilitate walking ability after stroke. Future studies are needed to identify whether heteronymous feedback from Q onto SOL is altered after stroke in upright postures and during motor tasks as a necessary next step to identify mechanisms underlying motor impairment.

Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations: A systematic review.

Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19-40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 - 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.

The influence of biological sex on the relationship between inorganic phosphates, hydrogen ions, and the peripheral component of neuromuscular fatigue

Background: In males, the relationship between peripheral fatigue development and intramuscular inorganic phosphate (Pi) accumulation is more robust than that with hydrogen ion (H+) accumulation. Based on previous findings of greater peripheral fatigability during exercise in males vs females (as pre-post %changes in twitch force, Qtw) and thus the potential for sex differences in the mechanisms of fatigue, we aimed to: 1) establish whether the relationship between peripheral fatigue development and Pi accumulation is more robust than that with H+ accumulation in females, and 2) determine whether females and males differ in the development of peripheral fatigue for a given Pi or H+ accumulation. Methods: Eleven recreationally active, healthy, young individuals (5 females) performed two consecutive (interspersed by 5-min of rest) intermittent isometric single-leg knee-extensor trials (60 maximal voluntary contractions; 3-s contraction, 2-s relaxation). Throughout both trials, quadriceps intramuscular [Pi] and [H+] were quantified using phosphorus magnetic resonance spectroscopy (31P-MRS), and quadriceps Qtw was measured using electrical femoral nerve stimulation. Peripheral fatigue was quantified as the exercise-induced decrease in Qtw. The relationships between Qtw and [Pi] and [H+] were analyzed using linear mixed-effects models for the portion of exercise where peripheral fatigue was developing ( i.e., decreasing Qtw). The results are presented as the Z-score β coeffcients and p-values. Results: The exercise-induced reduction in Qtw (thus peripheral fatigue) was larger in males compared to females (-65±16 vs -43±21%; p&lt;0.05). During both trials, the decrease in Qtw for a given increase in [Pi] was not different between sexes, and these relationships were not altered from Trial 1 to Trial 2 (Female slope Trial 1: -1.5 vs Trial 2: -1.4; Male slope Trial 1: -1.7 vs Trial 2: -1.6, all p&gt;0.3). The decrease in Qtw for a given increase in [H+] was greater for men compared to women in both trials (both p&lt;0.01), and these relationships were not altered from Trial 1 to Trial 2 (both p&gt;0.4) (Female slope Trial 1: -0.8 vs Trial 2: -0.9; Male slope Trial 1: -1.2 vs Trial 2: -1.3). The overall relationship ( i.e., y-intercept) between Qtw and [Pi] did not shift up or down across the consecutive trials for either sex (Females y-intercept Trial 1: -1.0 vs Trial 2: -1.3; Males y-intercept Trial 1: 0.8 vs Trial 2: 0.7, both p&gt;0.2). In contrast, the overall relationship ( i.e., y-intercept) between Qtw and [H+] shifted down from Trial 1 to Trial 2 for both sexes (Females y-intercept Trial 1: 0.2 vs Trial 2: -0.3; Males y-intercept Trial 1: 0.3 vs Trial 2: -0.2, both p&lt;0.01). Conclusions: In males and females, the relationship between the magnitude of Qtw and Pi is more robust compared to the relationship between the magnitude of Qtw and H+, suggesting Pi accumulation as the stronger mediator of peripheral fatigue in both sexes. Furthermore, the susceptibility of Qtw to decrease in response to a given increase in Pi was not different between sexes. The difference in peripheral fatigability between males and females are therefore likely due to differences in [Pi] and factors determining the magnitude of its accumulation ( e.g., force output, muscle fiber type distribution, or O2 transport and utilization). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Post-activation potentiation after isometric contractions is strongly related to contraction intensity despite the similar torque-time integral.

Post-activation potentiation (PAP) is defined as an enhanced contractile response of a muscle following its own contractile activity and is influenced by the intensity and duration of the conditioning contraction. The aim of this study was to determine if the combination of intensity and duration, that is, torque-time integral (TTI) is a determinant of PAP amplitude. We compared PAP amplitude following low-to-maximal voluntary conditioning contraction intensities with and without similar TTI in the knee extensors. Twelve healthy males completed two experimental sessions. Femoral nerve stimulation was applied to evoke single twitches on the relaxed quadriceps before and after isometric conditioning contractions of knee extensors. In one session, participants performed conditioning contractions without similar TTI (6s at 100, 80, 60, 40 and 20% maximal voluntary contraction (MVC)), while they performed conditioning contractions with similar TTI in the other session (6s at 100%, 7.5s at 80%, 10s at 60%, 15s at 40%, and 30s at 20% MVC). In both sessions, PAP amplitude was related to conditioning contraction intensity. The higher the conditioning contraction intensity with or without similar TTI, the higher PAP. Significant correlations were found (i) between PAP and conditioning contraction intensity with (r2=0.70; P<0.001) or without similar TTI (r2=0.64; P<0.001), and (ii) between PAP with and without similar TTI (r2=0.82; P<0.001). The results provide evidence that TTI has a minor influence on PAP in the knee extensors. This suggests that to optimize the effect of PAP, it is more relevant to control the intensity of the contraction rather than the TTI.

Motor Point as an Alternative to Femoral Nerve Stimulation for the Assessment of Quadriceps Muscle Inhibition in Healthy Women.

The evaluation of quadriceps muscle inhibition with the interpolated twitch technique is usually performed by stimulating the femoral nerve (FN). However, there are some problems related to the use of this stimulation site, which may be partially overcome by delivering the stimulation over the motor point (MP). This study sought to compare MP to FN stimulation at different joint angles for the evaluation of quadriceps muscle inhibition, resting peak torque, and discomfort in healthy women. Cross-sectional study. Sixteen healthy women (age: 28 [4]y; body mass: 60 [5]kg; height: 162 [5]cm) participated in this study. Supramaximal paired stimuli were delivered to the FN and to the rectus femoris MP before and during maximal voluntary contractions at different knee angles (15°, 30°, 45°, 60°, and 90° of knee flexion) to assess muscle inhibition and resting peak torque. Discomfort was also recorded for each stimulation site and knee angle. Muscle inhibition was similar between the 2 stimulation sites (P > .05) and was higher at 45° than at 90° (P = .03). MP stimulation evoked lower resting peak torque at 30° (P = .004), 60° (P = .006), and 90° (P = .006) and higher discomfort at 30° (P = .008) and 90° (P = .027) compared to FN stimulation. Despite lower resting peak torque and higher discomfort at some angles, MP stimulation provided similar muscle inhibition to FN stimulation at all knee angles and is therefore a valid method to evaluate quadriceps muscle inhibition in healthy women. MP stimulation can be used as an alternative to FN stimulation for the evaluation of quadriceps muscle inhibition with no added discomfort at the angles where muscle inhibition is the highest.

Decreased neural drive affects the early rate of force development after repeated burst-like isometric contractions.

The neural drive to the muscle is the primary determinant of the rate of force development (RFD) in the first 50 ms of a rapid contraction. It is still unproven if repetitive rapid contractions specifically impair the net neural drive to the muscles. To isolate the fatiguing effect of contraction rapidity, 17 male adult volunteers performed 100 burst-like (i.e., brief force pulses) isometric contractions of the knee extensors. The response to electrically-evoked single and octet femoral nerve stimulation was measured with high-density surface electromyography (HD-sEMG) from the vastus lateralis and medialis muscles. Root mean square (RMS) of each channel of HD-sEMG was normalized to the corresponding M-wave peak-to-peak amplitude, while muscle fiber conduction velocity (MFCV) was normalized to M-wave conduction velocity to compensate for changes in sarcolemma properties. Voluntary RFD 0-50 ms decreased (d = -0.56, p < 0.001) while time to peak force (d = 0.90, p < 0.001) and time to RFDpeak increased (d = 0.56, p = 0.034). Relative RMS (d = -1.10, p = 0.006) and MFCV (d = -0.53, p = 0.007) also decreased in the first 50 ms of voluntary contractions. Evoked octet RFD 0-50 ms (d = 0.60, p = 0.020), M-wave amplitude (d = 0.77, p = 0.009) and conduction velocity (d = 1.75, p < 0.001) all increased. Neural efficacy, i.e., voluntary/octet force ratio, largely decreased (d = -1.50, p < 0.001). We isolated the fatiguing impact of contraction rapidity and found that the decrement in RFD, particularly when calculated in the first 50 ms of muscle contraction, can mainly be explained by a decrease in the net neural drive.

Differential effect of heteronymous feedback from femoral nerve and quadriceps muscle stimulation onto soleus H-reflex.

Excitatory feedback from muscle spindles, and inhibitory feedback from Golgi tendon organs and recurrent inhibitory circuits are widely distributed within the spinal cord to modulate activity between human lower limb muscles. Heteronymous feedback is most commonly studied in humans by stimulating peripheral nerves, but the unique effect of non-spindle heteronymous feedback is difficult to determine due to the lower threshold of excitatory spindle axons. A few studies suggest stimulation of the muscle belly preferentially elicits non-spindle heteronymous feedback. However, there remains a lack of consensus on the differential effect of nerve and muscle stimulation onto the H-reflex, and the relation of the heteronymous effects onto H-reflex compared to that onto ongoing EMG has not been determined. In this cross-sectional study, we compared excitatory and inhibitory effects from femoral nerve and quadriceps muscle belly stimulation onto soleus H-reflex size in 15 able-bodied participants and in a subset also compared heteronymous effects onto ongoing soleus EMG at 10% and 20% max. Femoral nerve stimulation elicited greater excitation of the H-reflex compared to quadriceps stimulation. The differential effect was also observed onto ongoing soleus EMG at 20% max but not 10%. Femoral nerve and quadriceps stimulation elicited similar inhibition of the soleus H-reflexes, and these results were better associated with soleus EMG at 20%. The results support surface quadriceps muscles stimulation as a method to preferentially study heteronymous inhibition at least in healthy adults. The primary benefit of using muscle stimulation is expected to be in persons with abnormal, prolonged heteronymous excitation. These data further suggest heteronymous feedback should be evaluated with H-reflex or onto ongoing EMG of at least 20% max to identify group differences or modulation of heteronymous feedback in response to treatment or task.

Persistent Contralateral Pain Compromises Exercise Tolerance but Does not Alter Corticomotor Responses During Repeated, Submaximal Isometric Knee Extensions to Task Failure

Muscle pain is an important determinant of exercise tolerance, but its relationship with neurophysiological responses during a submaximal exercise trial is unclear. The purpose of this study was to determine the effect of persistent contralateral pain on neurophysiological function and perceptual responses during ipsilateral isometric knee extensions to task failure. Ten participants performed a single-leg repeated submaximal isometric knee extensions with (PAIN) or without (CTRL) constant pain induced by intermittent blood flow occlusion combined with evoked muscle contraction applied to the contralateral, resting leg. Transcranial magnetic stimulation (TMS) applied over the motor cortex was used to assess corticospinal excitability (quantified as motor evoked potentials), corticospinal inhibition (quantified as silent period duration), and short interval intracortical inhibition. Maximal voluntary contractions (MVCs), coupled with femoral nerve stimulation to the exercising leg, were performed every 12 submaximal contractions to assess neuromuscular function. Perceived leg pain and effort were also assessed throughout the exercise. The experimental pain shortened the time to task failure compared to CTRL (P = 0.019). Although time effects were present, no differences appeared between conditions for MVC force, voluntary activation, or potentiated twitch force across both tasks (all P > 0.05). Additionally, no differences between CTRL and PAIN were demonstrated for any TMS-derived measures assessing corticospinal responses. Exercising leg pain was higher in CTRL (P = 0.018), as was perceived exertion (P = 0.030). Overall, when using a persistent, submaximal experimental pain intervention, it appears that although muscle pain compromises exercise tolerance, this phenomenon occurs independently of potential alterations in corticomotor mechanisms.

Acute effects of conventional versus wide-pulse neuromuscular electrical stimulation on quadriceps evoked torque and neuromuscular function.

The effectiveness of a neuromuscular electrical stimulation (NMES) program is proportional to the level of evoked torque, which can be achieved with either conventional or wide-pulse stimulations. The aim of this study was to compare evoked torque, objective fatigability, and related peripheral and central alterations, as well as changes in central nervous system (CNS) excitability induced by an acute session of conventional versus wide-pulse NMES. Seventeen young men underwent three 20-min NMES sessions: conventional (0.2 ms/50 Hz), wide-pulse at 50 Hz (1 ms/50 Hz), and wide-pulse at 100 Hz (1 ms/100 Hz). Neuromuscular measurements (i.e., maximal voluntary contraction, voluntary activation, evoked responses to femoral nerve stimulation, and CNS excitability) were performed on the right quadriceps femoris muscle before and after each NMES session. CNS excitability was measured using transcranial magnetic, thoracic, and transcutaneous spinal cord stimulations. The level of evoked torque was not significantly different between conventional and wide-pulse protocols applied at the maximal tolerable current intensity. All NMES protocols induced objective fatigability (~14% decrease in maximal voluntary contraction torque, p < 0.001) associated with peripheral (decrease in doublet torque and potentiated M-wave amplitude, p = 0.002 and p < 0.001, respectively) but not central (unchanged voluntary activation, p = 0.79) alterations. However, these acute changes did not differ between NMES protocols and none of the NMES protocols modified markers of CNS excitability. These results may allow to conjecture that chronic effects and treatment effectiveness could be comparable between conventional and wide-pulse NMES.

Sex differences in quadriceps and inspiratory muscle fatigability following high-intensity cycling.

As females have been hypothesized to have more fatigue resistant inspiratory muscles, this study aimed to compare the development of inspiratory and leg muscle fatigue between males and females following high-intensity cycling. Cross-sectional comparison. 17 healthy young males (27 ± 6 years, V̇O2peak 55 ± 10 ml･min-1･kg-1) and females (25 ± 4 years, V̇O2peak 45 ± 7 ml･min-1･kg-1) cycled until exhaustion at 90% of the peak power output achieved during an incremental test. Changes in quadriceps and inspiratory muscle function were assessed via maximal voluntary contractions (MVC) and assessments of contractility via electrical stimulation of the femoral nerve and cervical magnetic stimulation of the phrenic nerves. Time to exhaustion was similar between sexes (p = 0.270, 95% CI -2.4 - 0.7 min). MVC of the quadriceps was lower after cycling for males (83.9 ± 11.5% vs. 94.0 ± 12.0% of baseline for females, p = 0.018). Reductions in twitch forces were not different between sexes for the quadriceps (p = 0.314, 95% CI -5.5 - 16.6 percent-points) or inspiratory muscles (p = 0.312, 95% CI -4.0 - 2.3 percent-points). Changes in inspiratory muscle twitches were unrelated to the different measures of quadriceps fatigue. Females incur similar peripheral fatigue in the quadriceps and inspiratory muscles compared with men following high-intensity cycling, despite smaller reduction in voluntary force. This small difference alone does not seem sufficient to warrant different training strategies to be recommended for women.

Altered regulation of Ia afferent input during voluntary contraction in humans with spinal cord injury.

Sensory input converging on the spinal cord contributes to the control of movement. Although sensory pathways reorganize following spinal cord injury (SCI), the extent to which sensory input from Ia afferents is regulated during voluntary contraction after the injury remains largely unknown. To address this question, the soleus H-reflex and conditioning of the H-reflex by stimulating homonymous [depression of the soleus H-reflex evoked by common peroneal nerve (CPN) stimulation, D1 inhibition] and heteronymous (d), [monosynaptic Ia facilitation of the soleus H-reflex evoked by femoral nerve stimulation (FN facilitation)] nerves were tested at rest, and during tonic voluntary contraction in humans with and without chronic incomplete SCI. The soleus H-reflex size increased in both groups during voluntary contraction compared with rest, but to a lesser extent in SCI participants. Compared with rest, the D1 inhibition decreased during voluntary contraction in controls but it was still present in SCI participants. Further, the FN facilitation increased in controls but remained unchanged in SCI participants during voluntary contraction compared with rest. Changes in the D1 inhibition and FN facilitation were correlated with changes in the H-reflex during voluntary contraction, suggesting an association between outcomes. These findings provide the first demonstration that the regulation of Ia afferent input from homonymous and heteronymous nerves is altered during voluntary contraction in humans with SCI, resulting in lesser facilitatory effect on motor neurons.

Does The Countermovement Jump Accurately Assess Lower-limb Neuromuscular Fatigue?

Neuromuscular fatigue is monitored in athletes following intense exercise to inform future training prescription and to improve performance. Temporal analysis of the countermovement jump (CMJ) is frequently used to assess fatigue in athletes but is infrequently compared directly to low-frequency fatigue (LFF), a long-lasting fatigue typically assessed in the laboratory. LFF may be present in athletes. PURPOSE: To determine the time-course of changes in CMJ and lower limb LFF following an exhaustive cycling test and the relationship between LFF and temporal CMJ variables. METHODS: LFF and CMJ were assessed in seven active adults (24±2 years, 78±14 kg) prior to and following (0, 8, 15, 30, 60 mins and 24 and 48 hours) an incremental cycling test to exhaustion. Cycling began at 100 W and increased 25 W every 2 min until exhaustion. Temporal analysis of CMJ for peak power (PP), jump height (JH), and concentric contraction duration (CCD) were calculated from bilateral force plates. Low-frequency (10 Hz) force (F10) was elicited from transcutaneous femoral nerve stimulation prior to a maximal voluntary contraction (MVC). LFF was quantified as the F10:MVC ratio. The order of CMJ or LFF was randomized across time points. Changes in LFF and CMJ variables were assessed from two-way repeated measures analysis of variance (measure x time). RESULTS: Maximal aerobic power was 234±67 W (96±4% HRmax). A significant measure x time interaction (p<0.0001) and significant main effects of time (p=0.05) and method (p=0.02) were found. Compared to baseline, significant reductions in LFF (i.e., greater fatigue) were seen at 0-, 8-, 15- and 30-mins post-exercise (all p<0.02). No significant changes in any of the CMJ variables were observed post-exercise (p = 1.0). Furthermore, changes in LFF during exercise recovery was not correlated to changes in any of CMJ variables (r2<0.04, p>0.20), whereas all CMJ variables were significantly correlated with each other (0.22<r2<0.42, p<0.001). CONCLUSION: These results show that following exhaustive exercise, LFF persists for at least 30 mins whereas no change in CMJ performance variables were seen. These results call into question the practical utility of interpreting neuromuscular fatigue in athletes using the CMJ, even within 30 minutes of exhaustive exercise.

Cold Water Immersion Improves the Recovery of Both Central and Peripheral Fatigue Following Simulated Soccer Match-Play.

The present study aimed to investigate the effect of cold water immersion (CWI) on the recovery of neuromuscular fatigue following simulated soccer match-play. In a randomized design, twelve soccer players completed a 90-min simulated soccer match followed by either CWI or thermoneutral water immersion (TWI, sham condition). Before and after match (immediately after CWI/TWI through 72 h recovery), neuromuscular and performance assessments were performed. Maximal voluntary contraction (MVC) and twitch responses, delivered through electrical femoral nerve stimulation, were used to assess peripheral fatigue (quadriceps resting twitch force, Qtw,pot) and central fatigue (voluntary activation, VA). Performance was assessed via squat jump (SJ), countermovement jump (CMJ), and 20 m sprint tests. Biomarkers of muscle damages (creatine kinase, CK; Lactate dehydrogenase, LDH) were also collected. Smaller reductions in CWI than TWI were found in MVC (-9.9 ± 3%vs-23.7 ± 14.7%), VA (-3.7 ± 4.9%vs-15.4 ± 5.6%) and Qtw,pot (-15.7 ± 5.9% vs. -24.8 ± 9.5%) following post-match intervention (p < 0.05). On the other hand, smaller reductions in CWI than TWI were found only in Qtw,pot (-0.2 ± 7.7% vs. -8.8 ± 9.6%) at 72 h post-match. Afterwards, these parameters remained lower compared to baseline up to 48–72 h in TWI while they all recovered within 24 h in CWI. The 20 m sprint performance was less impaired in CWI than TWI (+11.1 ± 3.2% vs. +18 ± 3.6%, p < 0.05) while SJ and CMJ were not affected by the recovery strategy. Plasma LDH, yet no CK, were less increased during recovery in CWI compared to TWI. This study showed that CWI reduced both central and peripheral components of fatigue, which in turn led to earlier full recovery of the neuromuscular function and performance indices. Therefore, CWI might be an interesting recovery strategy for soccer players.

Quadriceps muscle stimulation evokes heteronymous inhibition onto soleus with limited Ia activation compared to femoral nerve stimulation.

Heteronymous excitatory feedback from muscle spindles and inhibitory feedback from Golgi tendon organs and recurrent inhibitory circuits can influence motor coordination. The functional role of inhibitory feedback is difficult to determine, because nerve stimulation, the primary method used in humans, cannot evoke inhibition without first activating the largest diameter muscle spindle axons. Here, we tested the hypothesis that quadriceps muscle stimulation could be used to examine heteronymous inhibition more selectively when compared to femoral nerve stimulation by comparing the effects of nerve and muscle stimulation onto ongoing soleus EMG held at 20% of maximal effort. Motor threshold and two higher femoral nerve and quadriceps stimulus intensities matched by twitch evoked torque magnitudes were examined. We found that significantly fewer participants exhibited excitation during quadriceps muscle stimulation when compared to nerve stimulation (14-29% vs. 64-71% of participants across stimulation intensities) and the magnitude of heteronymous excitation from muscle stimulation, when present, was much reduced compared to nerve stimulation. Muscle and nerve stimulation resulted in heteronymous inhibition that significantly increased with increasing stimulation evoked torque magnitudes. This study provides novel evidence that muscle stimulation may be used to more selectively examine inhibitory heteronymous feedback between muscles in the human lower limb when compared to nerve stimulation.

The influence of the reference electrode location on the M−wave characteristics in the quadriceps

IntroductionIn the compound muscle action potential (M wave) recorded using the belly-tendon configuration, the contribution of the tendon electrode is assumed to be negligible compared to the belly electrode. We tested this assumption by placing the reference electrode at a distant (contralateral) site, which allowed separate recording of the belly and tendon contributions. MethodsM waves were recorded at multiple selected sites over the right quadriceps heads and lower leg using two different locations for the reference electrode: the ipsilateral (right) and contralateral (left) patellar tendon. The general parameters of the M wave (amplitude, area, duration, latency, and frequency) were measured. Results(1) The tendon potential had a small amplitude (<30%) compared to the belly potential; (2) Changing the reference electrode from the ipsilateral to the contralateral patella produced moderate changes in the M wave recorded over the innervation zone, these changes affecting significantly the amplitude of the M−wave second phase (p = 0.006); (3) Using the contralateral reference system allowed recording of short-latency components occurring immediately after the stimulus artefact, which had the same latency and amplitude (p = 0.18 and 0.25, respectively) at all recording sites over the leg. ConclusionsThe potential recorded at the “tendon” site after femoral nerve stimulation is small (compared to the belly potential), but not negligible, and makes a significant contribution to the second phase of belly-tendon M wave. Adopting a distant (contralateral) reference allowed recording of far-field components that may aid in the understanding of the electrical formation of the M wave.

On the role of skeletal muscle acidosis and inorganic phosphates as determinants of central and peripheral fatigue: A 31 P-MRS study.

Intramuscular hydrogen ion (H+ ) and inorganic phosphate (Pi) concentrations were dissociated during exercise to challenge their relationships with peripheral and central fatigue in vivo. Ten recreationally active, healthy men (27±5years; 180±4cm; 76±10kg) performed two consecutive intermittent isometric single-leg knee-extensor trials (60 maximal voluntary contractions; 3s contraction, 2s relaxation) interspersed with 5min of rest. Phosphorus magnetic resonance spectroscopy (31 P-MRS) was used to continuously quantify intramuscular [H+ ] and [Pi] during both trials. Using electrical femoral nerve stimulation, quadriceps twitch force (Qtw ) and voluntary activation (VA) were quantified at rest and throughout both trials. Decreases in Qtw and VA from baseline were used to determine peripheral and central fatigue, respectively. Qtw was strongly related to both [H+ ] (β coefficient: -0.9, P<0.0001) and [Pi] (-1.1, P<0.0001) across trials. There was an effect of trial on the relationship between Qtw and [H+ ] (-0.5, P<0.0001), but not Qtw and [Pi] (0.0, P=0.976). This suggests that, unlike the unaltered association with [Pi], a given level of peripheral fatigue was associated with a different [H+ ] in Trial 1 vs. Trial 2. VA was related to [H+ ] (-0.3, P<0.0001), but not [Pi] (-0.2, P=0.243), across trials and there was no effect of trial (-0.1, P=0.483). Taken together, these results support intramuscular Pi as a primary cause of peripheral fatigue, and muscle acidosis, probably acting on group III/IV muscle afferents in the interstitial space,as a contributor to central fatigue during exercise. KEY POINTS: We investigated the relationship between intramuscular metabolites and neuromuscular function in humans performing two maximal, intermittent, knee-extension trials interspersed with 5min of rest. Concomitant measurements of intramuscular hydrogen (H+ ) and inorganic phosphate (Pi) concentrations, as well as quadriceps twitch-force (Qtw ) and voluntary activation (VA), were made throughout each trial using phosphorus magnetic resonance spectroscopy (31 P-MRS) and electrical femoral nerve stimulations. Although [Pi] fully recovered prior to the onset of the second trial, [H+ ] did not. Qtw was strongly related to both [H+ ] and [Pi] across both trials. However, the relationship between Qtw and [H+ ] shifted leftward from the first to the second trial, whereas the relationship between Qtw and [Pi] remained unaltered. VA was related to [H+ ], but not [Pi], across both trials. These in vivo findings support the hypotheses of intramuscular Pi as a primary cause of peripheral fatigue, and muscle acidosis, probably acting on group III/IV muscle afferents,as a contributor to central fatigue.