Ultrasound-guided Percutaneous Neuromodulation Research Articles

Effect of Ultrasound-Guided Percutaneous Neuromodulation of Sciatic Nerve on Hip Muscle Strength in Chronic Low Back Pain Sufferers: A Pilot Study.

Background: Limited hip internal rotation range of motion (IR-ROM) and hip abductor weakness are recognized in low back pain (LBP) sufferers. The main aim was to investigate the effect of a ultrasound (US)-guided percutaneous neuromodulation (PNM) technique on hip strength in people with LBP. A second purpose was to discover whether the location along the sciatic nerve, where percutaneous neuromodulation was applied, could influence the change of strength response in these patients. Methods: Sixty LBP sufferers were recruited and divided randomly into three groups. All participants received an isolated percutaneous electrical stimulation at one of three different locations of the sciatic nerve pathway (proximal, middle, and distal), depending on the assigned group. Pain intensity, hip passive IR-ROM, hip muscle strength, and the Oswestry disability index (ODI) were analyzed. All variables were calculated before the intervention and one week after the intervention. Results: All interventions significantly decreased pain intensity and improved the IR-ROMs, strength, and functionality after one week (p = 0.001). However, between-group (treatment x time) differences were reported for flexion strength in the non-intervention limb (p = 0.029) and ODI (p = 0.021), although the effect size was small (Eta2 = 0.1) in both cases. Conclusions: The application of an isolated intervention of the US-guided PNM technique may be a useful therapeutic tool to increase the hip muscle strength in patients with chronic LBP.

Correct Sciatic Nerve Management to Apply Ultrasound-Guided Percutaneous Neuromodulation in Patients With Chronic Low Back Pain: A Pilot Study

The objectives of this study were to evaluate the effects of an ultrasound (US)-guided percutaneous neuromodulation (PNM) intervention on the sciatic nerve, regarding pain, hip range of motion (ROM), balance, and functionality in patients with chronic low back pain (LBP); and to determine the optimal anatomical location of sciatic nerve stimulation to obtain therapeutic benefits in such patients. Thirty patients with chronic LBP were recruited and divided randomly into three groups. All patients received a single percutaneous electrical stimulation intervention on the sciatic nerve, with a different anatomical application location for each group (proximal, middle, and distal). Level of pain, hip passive ROM, dynamic balance, and Oswestry disability index were analyzed. All variables were calculated before the intervention, immediately postintervention, 48 hours and one week after the intervention, except the LBP questionnaire (before, and 48 hours and one week after the intervention). All interventions decreased the level of pain and increased the ROM, balance, and functionality. Besides, these therapeutic effects were maintained during one week, regardless of the anatomical location of application. The choice of an anatomical location of application of the US-guided PNM on the sciatic nerve by the physiotherapist does not influence the improvement of pain, ROM, balance, and function in patients with chronic LBP.

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial

Objective: The aim was to analyze effects of a percutaneous neuromodulation (PNM) treatment on the radial nerve, regarding pain, functionality, electrophysiologic excitability, and morphology, in patients with chronic lateral epicondylalgia (LE). Methods: Twenty-four patients with chronic unilateral elbow pain were recruited for this preliminary study and were divided into two groups: control (n = 12) and PNM group (n = 12). The subjects in the PNM group received percutaneous peripheral neurostimulation with an acupuncture needle that was located next to the nerve with ultrasound guidance. Pain using a numerical rating scale (NRS), functional ability using patient-rated tennis elbow evaluation (PRTEE), radial nerve cross-sectional area measured by ultrasound, and chronaxie and accommodation index (AI) measured by the strength–duration curve were evaluated. Results: Both groups showed no differences in the baseline measurements (all p = 0.001). However, at the end of the treatment, there were significant differences between groups since only the PNM group significantly improved their values compared to their baseline values: level of pain and cross-sectional area (CSA) values showed a significant decrease while the PRTEE scores showed a significant improvement. Then, regarding AI, the PNM group showed significant improvement for the electrophysiologic nerve excitability pattern, reporting normal function in all radial nerves after treatment (p = 0.001). However, chronaxie values always reported similar values with no differences between groups (p >0.05); Conclusion: Ultrasound-PNM technique may be an interesting therapeutic tool for the treatment of chronic LE due to the improvement in the level of pain, functionality, nerve morphology, and excitability in this population.

Comparative Effects of One-Shot Electrical Stimulation on Performance of the Flexor Hallucis Longus Muscle in Professional Dancers: Percutaneous Versus Transcutaneous?

High demand of flexor hallucis longus (FHL) in the positions of extreme flexion of the ankle and toes is required in the dance. The aim was to investigate the effects of single-shot of ultrasound-guided percutaneous neuromodulation (PNM) vs. single-shot of transcutaneous electrical nerve stimulation (TENS) in performance of the FHL muscle in professional dancers. Thirty-two female healthy dancers were divided into two groups: TENS group and PNM group. The stimulation interventions consisted in the application of a square wave biphasic electrical current for a total of 1.5 mins. Range of motion (ROM) of first metatarsophalangeal joint, balance test, and unilateral heel raise fatigue test were performed in dominance limb. There were no differences between both groups in the baseline measurements. Compared to their baseline values, the TENS group statistically improved balance (p < 0.01, d = 0.6), ROM (p < 0.001, d = 0.3), and endurance (p = 0.04, d = 0.5). The PNM group only statistically improved balance and endurance (p < 0.001), with a large effect size for both test (d = 0.8 and d = 2.24, respectively). After interventions, there were no significant differences between TENS and PNM groups for all variables. However, PNM was qualitatively more effective because the percentage change in mean was greater and effect size was large for the balance test and endurance test. Simple single-shot procedure with percutaneous or TENS provided immediate performance improvement of FHL muscle in dancers, being PNM the more effective intervention.

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Unilateral Anterior Knee Pain: A Randomized Clinical Trial

The objective of this study was to evaluate the short-term and crossover effects of a percutaneous neuromodulation (PNM) intervention on the femoral nerve, regarding the pain, knee flexion motion (range of motion (ROM)), and functionality, in patients with unilateral anterior knee pain (AKP). Our study used a randomized clinical trial design. Thirty patients were divided into two groups: one asymptomatic knee group in which patients received stimulation in the femoral nerve corresponding to the nonsymptomatic knee; and one symptomatic knee group, in which patients received stimulation in the femoral nerve corresponding to the painful knee. Pain, knee flexion ROM, Victorian Institute of Sport Assessment-Patella (VISA-P) and Kujala questionnaires were evaluated. Twenty-eight patients completed the study. Compared to their baseline values, both groups showed an increase immediately at 24 h, and at 1 week for the knee flexion ROM variable. In addition, the symptomatic knee group showed an increase for the Kujala score and a decrease for the numeric rating scale (NRS) variable from baseline to 1 week. VISA-P score did not show statistically significant differences for the time-group interaction. After the intervention, there were no differences between the groups in any measured time. Conclusion: a single-shot ultrasound-guided PNM intervention per week in the femoral nerve may be an effective treatment for improving the pain, knee flexion ROM, and knee functionality. In addition, this technique produces crossover benefits in the nonintervention limb.

Effect of ultrasound-guided percutaneous neuromodulation applied to the femoral nerve on pain and range of motion in patients with anterior knee pain: A case study

Abstract Introduction Anterior knee pain (AKP) is one of the most frequent reasons for physical therapy consultations, remaining a difficult treatment challenge for professionals. The aim of this study was to evaluate the effects of an intervention using ultrasound-guided percutaneous neuromodulation (US-guided PNM) applied to the femoral nerve on pain and knee flexion range of motion (ROM), in patients with unilateral chronic anterior knee pain. Methods Eight patients received a single intervention of NMP-e on the femoral nerve of the symptomatic knee. The level of pain and ROM were measured before, immediately after and 24 hours after the intervention. Results A decrease in pain and an increase of ROM were observed after the intervention and at 24 hours. For pain values, a medium effect size was observed (ES = 0.63 ± 0.43) after the intervention, and a large effect size (ES = 1.73 ± 0.44) was found at 24h. Concerning ROM, the effect size was large at both moments (ES = − 1.30 ± 1.14; −1.76 ± 0.80, respectively). Conclusion A single intervention of US-guided PNM on the femoral nerve produces a decrease of pain and increases the ROM, which is greater 24h after the stimulation. Level of Evidence Level II-3.

Crossover effects of ultrasound-guided percutaneous neuromodulation on contralateral hamstring flexibility

Crossover effects refer to the responses of a non-exercised contralateral limb. There is evidence of this effect, as it relates to muscle fatigue, strength, and stretch, but not as it relates to neuromodulation. To compare the crossover effects of percutaneous neuromodulation (PNM) on hip range of motion (ROM), observed in a straight leg raise (SLR) test, in asymptomatic participants with bilateral reduced hamstring flexibility, versus the neurodynamic sciatic sliding technique, hamstring stretching and mechanical stimulation of the sciatic nerve using a needle (without electrical stimulation). To evaluate the tensiomyographic changes between the two lower limbs after these interventions. 80 participants with bilateral reduced hamstring flexibility were randomized into four groups: Stretching, Neurodynamic, PNM, and Needle groups. All interventions were performed on the right limb. Each participant's leg was subjected to SLR testing and tensiomyography before and after the interventions. Each group improved their SLR values in the non-intervention limb compared to baseline values, but the PNM and Needle groups obtained higher values for the SLR test in the non-intervention limb compared with the Neurodynamic and Stretching groups. There were statistically significant differences for mean SLR measures between limbs pre- and post-intervention for all groups except the PNM group, suggesting crossover effects for PNM but not the other techniques studied. There were no differences in tensiomyographic assessments between groups or between sides, at baseline or upon completion of the study. PNM produced benefits in the SLR test in the non-intervention limb and only 1.5 min was enough to obtain this effect. In addition, no technique interfered with muscle activation.

Ultrasound-Guided percutaneous neuromodulation in non-radiating low back pain

Abstract Background Low back pain is very common, affecting 15–20% of the population each year, and representing of the main causes of physical therapy consultations. Multiple treatments have been defined for chronic low back pain, however, the findings are still controversial, and therefore new and improved solutions are necessary for the population who suffers from low back pain. Aims To evaluate the effectiveness of ultrasound-guided percutaneous neuromodulation (US-guided PNM) in patients with non-radiating low back pain. Material and Methods An experimental study was performed in patients with non-radiating low back pain, between the months of march and may of 2018 at the F&amp;S-Narón Physical Therapy clinic, in A Coruña. Functionality was evaluated via the Oswestry questionnaire and pain was evaluated using the visual analog scale (VAS). US-guided NMP was applied to stimulate the medial branch of a L2 posterior ramus and the iliohypogastric and ilioinguinal nerves, following the protocol described by Valera &amp; Minaya, which consists of the application of a PES type current at 10Hz and 240 microseconds, during 15 seconds and for 6 applications. In total, 3 sessions were applied (sequence 1:7:7), once a week after the first week of initiating treatment. Results Initially, 12 patients participated in the study, aged between 32 and 59 years. The mean age was 41.4 years. Two of the patients abandoned the study due to personal reasons, unrelated to the research. The final sample consisted of 10 subjects, 50% of each sex. 80% of patients improved after the application of the treatment protocol. An important decrease in activity limitations was observed, from 14 to 4.35 points out of 100 according to the Oswestry questionnaire, and a decrease of 6.8 to 2.15 points out of 10 was observed on the VAS scale, which was statistically significant according to the Wilcoxon test (p &lt; 0,05). Conclusions The ultrasound-guided percutaneous neuromodulation technique used was effective, obtaining positive results in relation to pain and functionality. Clinical studies are necessary with a greater sample size to confirm these findings.

Ultrasound-guided percutaneous neuromodulation in chronic lateral elbow pain

Abstract Background Lateral epicondylalgia (LE), also known as tennis elbow, refers to a painful condition around the lateral epicondyle of the humerus and the common extensor tendon, which worsens with dorsiflexion and/or wrist supination against resistance. The aim of this study was to evaluate the effect of ultrasound-guided percutaneous neuromodulation (PNM) applied to the radial nerve in relation to pain, functionality, electrophysiological excitation and the morphology of the nerve in patients with chronic lateral epicondylalgia. Material and Methods A randomized clinical trial was performed. In total, 28 patients (15 women, 13 men) with chronic unilateral LE were randomly divided into two groups: a control group (CG = 12) who did not receive any treatment and an experimental group (PNM = 16) who received a weekly session during three weeks of ultrasound-guided PNM on the affected radial nerve. Concretely, the therapy consisted of the application of an asymmetric biphasic current on the symptomatic side, with a frequency of 10 Hz, a phase duration of 250 microseconds, and sufficient current intensity to observe a contraction in the forearm during 1.5 minutes. The variables analyzed were: pain, measured via the visual analog scale (VAS); functionality, measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE); the morphology of the nerve with the calculation of the cross-sectional area (CSA) and the electrophysiological excitability with the intensity-time curve (accommodation coefficient) of the radial nerve studied Results There were no differences between the two groups in the initial assessment regarding pain, functionality and nerve morphology (all comparisons obtained a p &gt; 0.05). However, at the end of the study, the groups were significantly different. After treatment, there were significant differences in all variables: for the VAS (p &lt; 0.001) with a large effect size (d &gt; 0.8); for all values of the PRTEE (p &lt; 0.001) the effect size was median (d &gt; 0.5) and for the CSA (p = 0.001) the effect size was large (d &gt; 0.8). Only the PNM group displayed significant increases in their values compared to the initial assessment, with a large effect size for all variables (d &gt; 0.8). Regarding the accommodation coefficient, 75% of patients (12/16) displayed hypoexcitability of the nerve in the PNM group and 64% of patients (8/12) in the CG at the beginning of the study. After treatment, only the PNM group showed significant improvements in the pattern of excitability of the radial nerve, reaching normal nerve function in all subjects (p &lt; 0.001). Conclusion Ultrasound-guided PNM leads to a decrease in pain and CSA of the radial nerve; furthermore, it produces an increased functionality of the elbow and normalization of the electrophysiological excitability of the affected radial nerve. Ultrasound-guided PNM appears to be an appropriate tool for the treatment of patients with chronic LE.

Application of ultrasound-guided percutaneus neuromodulation (PNM) in women with anterior knee pain

Abstract Background Anterior knee pain (AKP) is one of the most common pathologies of the lower limb, with an incidence that is 2.2% greater in women than in men. Electric currents have been used as an effective treatment for pain in many pathologies, however, the percutaneous application of the same has represented a particularly great advancement. In the field of physical therapy, ultrasound-guided percutaneous neuromodulation (US-guided PNM), is a technique that is being developed with promising results, however there is still a scarcity of studies concerning this technique. Aim To evaluate the improvement in chronic anterior knee pain symptoms after the application of US-guided PNM on the femoral nerve of the affected side or the healthy side, in a population of women. Material and Methods The sample comprised 15 women with chronic unilateral AKP, who were randomly divided into two groups: experimental group 1 (n = 8), who received US-guided PNM upon the femoral nerve, on the leg of the affected side, and an experimental group 2 (n = 7), who received US-guided PNM on the femoral nerve of the non-affected side. The intervention was performed using a needle measuring 0.3 × 40mm on the motor fibers of the femoral nerve under ultrasound guidance and using a monopolar electrode, with a frequency of 10 Hz and a phase duration of 250 microseconds, during 1.5 minutes. We registered active ROM in both knees, pain according to the Visual Analog Scale (VAS) and functionality using the VISA-P questionnaire and the Kujala scale. All variables were evaluated pre-intervention, post-intervention and after 24 hours. Results No statistically significant differences were found in both groups between the pre and post intervention measurements. However, statistically significant changes were found in both groups between the pre and post intervention at 24 hours, regarding increased ROM and functionality and a decrease in pain (p &lt; 0.05). Nonetheless, the between-group comparison did not obtain a significant difference in any of the variables studied (p &gt; 0.05). The measurement of the effect size obtained a large clinical effect between both groups and between the pre-intervention measurement and the assessment at 24 hours. Conclusion Treatment of chronic AKP in women, using US-guided PNM, leads to an improvement of symptoms and functionality, 24 hours after application of the same, regardless of whether it is applied on the femoral nerve of the affected leg or on that of the healthy leg.

Changes in isometric quadriceps strength after the application of ultrasound-guided percutaneous neuromodulation. A case study

Abstract Background Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is an invasive physiotherapy technique which is employed for neurofunctional improvement and treatment of pain. To date, no study has related this technique with muscle stimulation and dynamometry changes. Within the functional assessment tools, dynamometry tests were performed with devices which enable the calculation of variables related with isometric and isokinetic movement. Aim To assess the changes in maximum isometric strength after the application of US-guided PNM. Material and Methods A retrospective case study comprising 13 subjects (26 lower limbs) receiving US-guided PNM, with pre and post-intervention measurements.The inclusion criteria comprised subjects without pain at the time of study, with coefficients of variation (COV) below 15% and in the process of improving loading work. We excluded subjects with pathology provoking pain at the time of the measurements and with contraindications for dynamometry or US-guided PNM. An isometricmeasurement was performed using the KINEO dynamometry system with 90° hip flexion and 45° knee extension, without strapping and with manual grips in lateral supports of the system. The lever arm was placed at 2 cm of the malleoli in the ventral aspect without strapping the ankle and a pre-intervention measurement was performed of the maximum isometric strength based on a mean of 3 repetitions (3 seconds' contraction and 6 seconds' relaxation). Subsequently, the US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva device and the PES modality (10 Hz frequency, 240 μs pulse width). Ten maximal and pain free stimulations were performed lasting 10 seconds each, with a 10 second rest between each contraction. After the intervention, a post intervention measurement was performed, in the same manner as the previous measurement. Results In total, 13 volunteer subjects participated in the study, aged between 27 and 59 years, of which, 2 were women and 11 were men. After the application of US-guided PNM on the femoral nerve, changes were observed in the maximum mean isometric strength of the quadriceps, which increased from 26.75 kg in the pre-intervention mean with a standard deviation of 7.42 kg to 30.05 kg for the post-intervention mean, with a standard deviation of 9.23 kg. The results were statistically significant with p &lt; 0.000. Conclusion US-guided PNM applied to the femoral nerve is able to produce changes in maximum isometric strength measured using dynamometry.

Effects of ultrasound-guided percutaneus neuromodulation in chronic shoulder pain in the hemiplegic patient. A case series

Abstract Background and Aims Hemiplegic shoulder pain (HSP) is a very common complaint among patients affected with cerebrovascular accident (CVA). This type of pathology is related with a neuropathic type of pain. Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a physical therapy technique consisting of low-frequency electric stimulation of peripheral nerves via an acupuncture needle under ultrasound guidance. Because of the relationship between the suprascapular and axillary nerves with the shoulder joint, these represent the target structure for US-guided PNM. This study aimed to observe the effects of the application of US-guided PNM in HSP and to evaluate the possible changes in variables such as pain, functionality and quality of life of patients. Material and Methods This study was a case series. Patients with HSP were selected between the months of April and June 2018 in the Hospital of Denia. Seven patients were interviewed, after which the experimental group was reduced to five participants. These patients received weekly PNM treatment during three weeks. The parameters used were: frequency (10Hz), pulse width (250 μs), intensity (pain threshold) and time (10 min). The main clinical variables examined were pain, measured using the VAS scale, functionality, via the SPADI scale and physical and mental components of quality of life using the SF12 scale. Results The results of the VAS scale, expressed as the mean (SD) was 7.2 (1.3) pre-intervention; 3.6 (0.89) post-intervention week 3; and 4 (1.23) post intervention week 5. The results revealed significant changes in the VAS scale which continued until week 5 (p &lt; 0.05). The mean obtained in the SPADI scale, expressed as the mean (SD) was 72.4 (1.3) pre-intervention, 55.7 (19.72) post-intervention in week 3 and 59.8 (20.66) post intervention week 5. The changes observed between the pre-intervention sample and the measurements obtained in week 3 and 5 were significant (p &lt; 0.05). Conclusions The US-guided PNM technique was effective in the sample under study for improvement of the patient's sensation of pain. The US-guided PNM technique improves functionality of HSP, as well as the emotional status of patients.

Effects of ultrasound-guided percutaneous neuromodulation on the activation of hip abductors in a professional tennis player: a single case study

Abstract Background Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is defined as electric stimulation of a peripheral nerve at some point of its trajectory via a needle, with analgesic objectives and for the improvement of muscle function. Hip abductor muscles play an important role in the performance of tennis players, participating primarily in the transfer of forces in situations such as stopping and starting, changes in direction and even hitting the ball. Aims The aims of this study were to confirm the effects of US-guided PNM on the superior gluteal nerve on strength and muscle activity in hip abductors and the reduction of the Q angle of the knee during a single-legged squat in a high performance athlete. Material and Methods The subject was a high performance athlete aged 17, without traumatic injuries to the lower limb. The study was conducted in the installations of AY360° Salud y Deporte. The following variables were measured before and after the intervention: force (MVIC), muscle activity (RMS) using surface electromyography and the knee Q angle during a single-legged squat using Kinovea video analysis. A treatment protocol was performed under ultrasound guidance using a PES current with 6 Hz pulses and a pulse duration of 250 μs. In total, 5 applications of 15 seconds' duration were applied with the help of a pointer. Results Improvements were obtained for strength measurements, from a MVIC of 0.13 mV (50.72%) to 0.26 mV (100%), for muscle activity RMS improved from 13.26% to 23.96%, and degrees changed from 23.6° to 21°. Conclusions The US-guided PNM technique, according to the parameters studied, appears to be a useful tool for the improvement of the cited variables.

Assessment of post-surgical pain after the application of ultrasound-guided percutaneous neuromodulation in total knee arthroplasty

Abstract Background and Aim The use of prosthetic knee replacements currently represent an alternative for patients who suffer from severe gonarthrosis. Treatment via the technique of ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a therapeutic alternative worth considering as a new tool in physical therapy for the post-surgical recovery of total knee arthroplasty (TKA). The aim of this study was to evaluate the effectiveness of treatment with US-guided PNM in the post-surgical stage among patients intervened with TKA. Material and Methods Patients were selected between February and May 2017 at the Hospital of Denia and were randomly assigned into two groups. The initial sample was 13 patients. The experimental group (n = 7) received treatment with US-guided PNM plus conventional treatment. The control group (n = 6) only received conventional physiotherapy treatment. Patients in the experimental group received an application of PNM, which consisted of an alternate low frequency current at 10 Hz¸ pulse width 250 μs, with an intensity to the pain threshold. The intervention was performed during four consecutive weeks after hospital discharge. The control group received conventional treatment based on manual therapy, active mobilization and the use of the arthromotor until 115° of knee flexion and 0° knee extension was achieved. The main clinical variables evaluated were pain, measured using the Visual Analog Scale (VAS), quality of life, based on physical and mental components, using the SF12 scale and functional assessment using the Oxford Knee Score. Lastly, pain, stiffness and functional capacity was measured using the WOMAC scale. Results Both groups obtained statistically significant results in the four variables evaluated compared to the pre-surgery stage, however, the changes were more evident in the intervention group (p &lt; 0.05). Furthermore, no significant differences were found in the variables evaluated regarding quality of life between the experimental and control group except for the emotional component of the SF-12 scale, where the result was only significant in the experimental group treated with US-guided PNM (P &lt; 0.05). Regarding the improvement in the health status and decreased pain in the postoperative stage after TKA, no significant differences were observed between groups (p &gt; 0.05). Conclusion The application of the US-guided PNM technique provides greater benefits than conventional therapy for decreasing the post-surgical pain in patients who have undergone knee arthroplasty and for emotional function, evaluated using the SF-12 questionnaire.

Effect of ultrasound-guided percutaneous neuromodulation in ankle instability: a case study

Abstract Background and Aims Ankle proprioception can be tested in many ways. Some studies have found improvements in individuals with chronic ankle instability after receiving treatment and training proprioceptive acuity and speed. Currently, there is a scarcity of evidence concerning percutaneous neuromodulation. The first findings were reported in the post-surgical stage after total knee arthroplasty and in neural improvements and symptoms in patients with hyperactive bladder. Aim To evaluate the effectiveness of percutaneous neuromodulation on the tibial nerve for the improvement of various proprioception parameters in patients with chronic ankle instability. Material and Methods Five men (age: 24.8 ± 4.9 years; height: 1.78 ± 0.08 m; weight: 86 ± 9.8 kg) with chronic ankle instability, who regularly practiced sports activities participated in the present study. People who had undergone an injury in the previous three months were excluded from the speed. Currently, there is a scarcity of evidence concerning test before and immediately after percutaneous neuromodulation. A single leg balance test was performed with eyes open and closed, maintaining the single-legged position on a force plate during 30 seconds (Accupower; AMTI, Watertown, MA) registering 1000 Hz. The displacement of the center of pressure (DOT) was determined based on the distances of its antero-posterior axes (DOT_AP) and medio-lateral (DOT_ML). Furthermore, the amplitudes of anteroposterior and mediolateral displacement were evaluated (ACPap and ACPml). The posterior tibial nerve was stimulated under ultrasound guidance using a 100 Vpp current, with a pulse width of 250 μs and a repetition frequency of 2 to 10 Hz. The process was performed on three occasions during 30 seconds, with an intensity that was acknowledged by the patient but which did not go beyond a score of 3 in the visual analog scale (VAS). The means and standard deviations were calculated for all variables. The effect size was calculated establishing the confidence interval at 90% and the probability of the change being significant was qualitatively calculated. Results A decrease was found in the ACPap (Pre-test eyes open: 5.42 ± 0.62 and eyes closed: 15.99 ± 0.60; Post-test eyes open 4.05 ± 0.36 and eyes closed 10.33 ± 0.49) after the neuromodulation intervention on the tibial nerve. This was a significant change and a “possible” effect size was found in the closed eyes condition (-0.54; ± 0.72), according to Hopkins. For the remaining variables, no significant differences were observed. Conclusions A decreased displacement of the center of mass was found in the antero-posterior axis after performing the neuromodulation technique on the tibial nerve in patients with chronic ankle instability.

Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series

Abstract Introduction For those individuals who have suffered an injury to the knee or undergone a surgical intervention, the early recovery of the muscle strength contraction properties of the quadriceps is essential for a favorable recovery and for a return to the activities of daily living and other work- or sports-related activities. Objectives To evaluate the changes in maximal isometric strength (MIS) of the quadriceps muscle after the application of ultrasound-guided percutaneous neuromodulation (US-guided PNM) on the femoral nerve. Materials and Methods A case series involving subjects who had previously presented unilateral knee pathology and were in the stage of recovery of quadriceps strength. The subjects were pain-free at the time of the dynamometry measurements, which were performed before and after the application of the US-guided PNM technique. The isometric measurement was performed using the KINEO dynamometry system, performing a preintervention measurement of the mean maximal isometric strength (mMIS) based on 3 repetitions (3 seconds contraction and 6 seconds relaxation). The US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva CE0120 device (Prim Physio, Madrid, Spain) and a GE Logiq e R7 ultrasound (GE Healthcare, Chicago, IL, USA). Results In total, 13 subjects participated in the present study. Significant changes were obtained (p &lt; 0.001) in the mMIS of the quadriceps of the affected knee, which progressed from a mean strength of 25.91 kg (standard deviation [SD]: 7.17 kg) to a mean strength of 29.98 kg (SD: 9.06 kg). Discussion In subjects with knee pathology, the quadriceps muscle is inhibited despite being pain-free during the strength measurements. This process of inhibition can improve with the application of low frequency percutaneous electrical stimulation on the femoral nerve. This technique represents a complementary strategy for the recovery of the normal strength values in pathological knees with or without prior surgery. Conclusions Ultrasound-guided PNM is an effective technique for the reestablishment of quadriceps strength in inhibited muscles.

Immediate effects of ultrasound-guided percutaneous neuromodulation versus physical exercise on performance of the flexor hallucis longus muscle in professional dancers: a randomised clinical trial.

Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a minimally invasive intervention. This technique consists of the application of percutaneous electrical stimulation (PES) through an acupuncture needle-like electrode that is placed in close proximity to the nerve or motor point of the target muscle under ultrasound guidance. To examine the immediate effects of a stretching exercise, an eccentric exercise and US-guided PNM on the performance of the flexor hallucis longus (FHL) muscle in young dancers. Randomised clinical trial. A total of 45 dancers were divided into three groups: Stretching group, Eccentric group and PNM group. The following performance parameters were assessed: range of motion (ROM) of the first metatarsophalangeal joint, balance test and unilateral heel raise fatigue test. There were no differences between these groups in baseline measurements; at the end of the study, mean balance and endurance values were only significantly higher for the PNM group compared to the Stretching (p = 0.007 and p < 0.001, respectively) and Eccentric groups (p = 0.003 and p < 0.001, respectively). The effect sizes were large for the balance (d = 0.8) and endurance (d = 1.83) tests in the PNM group. Both the Stretching and Eccentric groups exhibited improvements in ROM compared to their baseline values (p = 0.009 and p = 0.004, respectively), whereas there was no significant temporal improvement noted for the PNM group. The effect sizes with respect to ROM values were moderate for stretching (d = 0.6) and eccentric (d = 0.7) exercises. An isolated PES intervention provides a greater immediate increase in balance and muscular strength than an active stretching and eccentric exercise of the FHL muscle in young ballet dancers.