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MINI REVIEW
Does electrical stimulation enhance post-exercise performance
recovery?
Nicolas Babault •Carole Cometti •
Nicola A. Maffiuletti •Gae
¨lle Deley
Received: 5 March 2011 / Accepted: 3 August 2011 / Published online: 17 August 2011
Springer-Verlag 2011
Abstract Elite sport requires high-volume and high-
intensity training that inevitably induces neuromuscular
fatigue detrimental for physical performance. Improving
recovery processes is, therefore, fundamental and to this, a
wide variety of recovery modalities could be proposed.
Among them, neuromuscular electrical stimulation is lar-
gely adopted particularly by endurance-type and team sport
athletes. This type of solicitation, when used with low
stimulation frequencies, induces contractions of short
duration and low intensity comparable to active recovery.
This might be of interest to favour muscle blood flow and
therefore metabolites washout to accelerate recovery
kinetics during and after fatiguing exercises, training ses-
sions or competition. However, although electrical stimu-
lation is often used for recovery, limited evidence exists
regarding its effects for an improvement of most physio-
logical variables or reduced subjective rating of muscle
soreness. Therefore, the main aim of this brief review is to
present recent results from the literature to clarify the
effectiveness of electrical stimulation as a recovery
modality.
Keywords Sport Performance Muscle soreness
Strength
Introduction
Elite sport requires high-volume and high-intensity train-
ing. The stressful components of training as well as com-
petitions repetition (more particularly in team sport)
inevitably impair athletes’ performance. This transitory
fatigue state, which may last from several minutes to
several days post-exercise (Martin et al. 2004), depends on
peripheral changes occurring within the contractile appa-
ratus distal to the motor point (at the muscle level) and/or
on central changes leading to reductions of motor unit
activation. Multiple mechanisms, such as metabolic dis-
turbances (Pi, H
?
,…), glycogen depletion or muscle
damages may be involved (Gandevia 2001; Allen et al.
2008; Ament and Verkerke 2009). When considering that
fatigue appears to be detrimental for optimal training and
performance enhancements (Barnett 2006), optimising
recovery processes is of paramount importance. In turn,
this would allow athletes to compete and train altogether
with potentially reduced fatigue, muscle soreness or even
injury risks.
Depending on fatigue mechanisms, recovery of force
production capacity may take from seconds to days. Bishop
et al. (2008) defined three forms of recovery. Immediate
Communicated by Roberto Bottinelli.
This article is published as part of the Special Issue Cluster on the
XVIII Congress of the International Society of Electrophysiology and
Kinesiology (ISEK 2010) that took place in Aalborg, Denmark on
16-19 June 2010.
N. Babault C. Cometti G. Deley
Centre d’expertise de la Performance,
Faculte
´des Sciences du Sport,
Universite
´de Bourgogne, BP 27877,
21078 Dijon Cedex, France
N. Babault (&)
Faculte
´des Sciences du Sport,
Universite
´de Bourgogne, BP 27877,
21078 Dijon Cedex, France
e-mail: nicolas.babault@u-bourgogne.fr
N. A. Maffiuletti
Neuromuscular Research Laboratory,
Schulthess Clinic, Lengghalde 2,
8008 Zurich, Switzerland
123
Eur J Appl Physiol (2011) 111:2501–2507
DOI 10.1007/s00421-011-2117-7
recovery corresponds to recovery within rapid, time-prox-
imal finite efforts (e.g., leg recovery between strides while
walking). Short-term recovery is between sets. Training
recovery takes place between successive work-outs or
competitions.
Nowadays, athletes use a wide variety of strategies to
accelerate short-term recovery and more particularly
training recovery. Active recovery, massage, cryotherapy,
water immersion, compression garments are examples of
modalities often studied and reviewed (e.g., Cheung et al.
2003; Barnett 2006; Banfi et al. 2010; Cortis et al. 2010;
Pournot et al. 2011). As compared with passive rest,
applying one of these different modalities might enhance
recovery (e.g., Gill et al. 2006) by various mechanisms,
such as (a) increases in blood flow and therefore metabolic
by-products removal (for example with active recovery;
Toubekis et al. 2008), (b) decreases in vessels permeability
that would reduce muscle damage markers’ efflux (e.g.,
Eston and Peters (1999) using cold-water immersion) and
also (c) neuro-mediator release like endorphin that may
induce transient analgesia (for example with electrical
stimulation; Cheng and Pomeranz 1980).
Among the possible active recovery modalities, many
athletes use electrical stimulation (see manufacturers’
websites such as Compex). However, limited evidence
exists regarding its effects to improve recovery kinetic of
most physiological variables (strength, neuromuscular
parameters, etc.), to maintain athletic performance (vertical
jump, sprints, etc.) or to reduce subjective rating of muscle
soreness. Therefore, after a brief presentation of method-
ological aspects, this review will examine electrical stim-
ulation effects on the recovery of strength production
capacity and on the reduction of muscle soreness. Fur-
thermore, in the literature these effects have been explored
following various fatiguing exercises such as repeated
contractions of a single muscle group (Grunovas et al.
2007; Vanderthommen et al. 2010) but also in specific field
situations such as futsal games (Tessitore et al. 2008)or
climbing (Heyman et al. 2009). Therefore, care was taken
to differentiate these types of exercises in the present
review.
Electrical stimulation: methodological considerations
Electrical stimulation involves series of stimuli delivered
superficially using electrodes placed on the skin. It is a key
component for many medical and sport applications, and is
largely used for rehabilitation, training and recovery pur-
poses. When applied for recovery purposes, a considerable
heterogeneity exists regarding stimulation characteristics.
The different stimulation forms include microcurrent
electrical neuromuscular stimulation (MENS; e.g., Allen
et al. 1999), high-volt pulsed current electrical stimulation
(HVPC; e.g., Butterfield et al. 1997), monophasic high
voltage stimulation (MHVS; e.g., McLoughlin et al. 2004)
or the most frequently used transcutaneous electrical nerve
stimulation (TENS; e.g., Denegar and Perrin 1992). Other
stimulation forms are also applied (e.g., Lattier et al. 2004;
Martin et al. 2004; Tessitore et al. 2008; Cortis et al. 2010)
and are presented under the general term ‘low-frequency
electrical stimulation’ (LFES) for the clarity of the present
review. However, people often confound the terminology
since the difference between these modalities is not so
evident. Examples of stimulation characteristics are pre-
sented on Table 1.
When considering electrical stimulation for post-exer-
cise recovery, two main effects are expected (Fig. 1). The
first one, related to the increased muscle blood flow, is an
acceleration of muscle metabolites removal. To that pur-
pose, electrodes are generally applied over muscle motor
points (e.g., Lattier et al. 2004). The second effect is the
reduction of muscle pain through the stimulation analgesic
effect. To that purpose, electrodes are often applied at the
injured site (e.g., Butterfield et al. 1997) but also away
from it, such as at acupoints (So et al. 2007) or even
contralaterally (see DeSantana et al. 2008).
Depending on stimulation characteristics, electrical
stimulation is believed to alter blood flow. Indeed, while
TENS increases cutaneous blood flow (Cramp et al. 2000,
2002), LFES induces light muscle contractions responsible
for a muscle pump effect and therefore an enhanced muscle
blood flow. As suggested by Vanderthommen et al. (1997),
this muscle blood flow increase might also result from
vasoactive metabolites coming from muscular contractions.
However, to obtain this effect, stimulation has to be ade-
quately delivered. Indeed, some studies used ‘‘strong but
comfortable’’ intensities during LFES (Lattier et al. 2004;
Martin et al. 2004). However, an excessive intensity might
lead to partial ischemia whereas insufficient intensity might
be inadequate to significantly increase blood flow. In addi-
tion, authors have shown that electrical stimulation could be
an effective mean to increase venous blood return to the
heart and therefore cardiac output (Grunovas et al. 2007).
In addition to this increased blood flow, electrical
stimulation might reduce long-lasting DOMS symptoms.
Indeed, TENS is widely used in clinical settings for acute
and chronic pain treatments (Rushton 2002). High-fre-
quencies (50–100 Hz) are associated with low-intensity
stimulations (sensory intensity that causes strong but
comfortable sensation without muscle contractions)
whereas low-frequencies (\10 Hz) are associated with
high-intensity stimulations (motor intensity that produces
visible and light muscle contractions). It produces a tran-
sient analgesia originating from various central and
peripheral mechanisms attributed to stimulation parameters
2502 Eur J Appl Physiol (2011) 111:2501–2507
123
(see DeSantana et al. 2008). High-frequency and low-
intensity TENS has been shown to block the transmission
of nociceptive afferent fibres in the spinal cord by stimu-
lating large-diameter group II myelinated afferent fibres
(Wall 1985). Low-frequency and high-intensity TENS is
believed to stimulate group III and IV afferent fibres
causing release of endogenous opioids in the central
nervous system (Cox et al. 1993). According to DeSantana
et al. (2008), high-frequency and high-intensity stimulation
appeared to be the most effective TENS modality for pain
treatment.
Electrical stimulation and recovery of neuromuscular
parameters
Table 2summarises some studies investigating electrical
stimulation effects when used for recovery with different
stimulation characteristics. In a recent study, Vanderth-
ommen et al. (2010) examined the effects of LFES, active
and passive recovery following three sets of 25 submaxi-
mal isometric knee extensions. Stimulation was adminis-
tered at a low-frequency (5 Hz) associated with a motor
intensity. No effect of the recovery mode was found for
maximal torque production capacity. The absence of any
effects was partly attributed to the ‘‘low aggressiveness’’ of
the fatiguing exercise. To maximise fatigue, some authors
used repetitive eccentric contractions but they did not
observe any significant difference between electrical
stimulation and passive recovery for immediate torque
production capacity using either high-frequency TENS
(Denegar and Perrin 1992) or LFES (Vanderthommen et al.
2007). Similarly, within a 7-day follow-up, LFES was not
efficient to improve strength recovery kinetics (Vanderth-
ommen et al. 2007). These different studies applied
recovery treatments only once immediately after the
fatiguing sessions. However, the repetition of electrical
stimulation sessions within days following a fatiguing
Table 1 Examples of electrical stimulation characteristics used for recovery
Current characteristics Stimulation intensity Electrode
placement
Microcurrent electrical neuromuscular stimulation (MENS)
Allen et al. (1999) 10 min at 30 Hz ?10 min at 0.3 Hz Subsensory level (200 and 100 lA) Muscle belly
High-volt pulsed current (HVPC)
Butterfield et al. (1997) 30 min at 120 Hz (impulse duration =40 ls) Submotor – Sensory level
(comfortable sensation)
Site of pain
Low-Frequency Transcutaneous electrical nerve stimulation (TENS)
Craig et al. (1996) 20 min at 4 Hz (impulse duration =200 ls) Submotor – Sensory level
(comfortable sensation)
Site of pain
High-Frequency Transcutaneous electrical nerve stimulation (TENS)
Craig et al. (1996) 20 min at 110 Hz (impulse duration =200 ls) Submotor – Sensory level
(comfortable sensation)
Site of pain
Monophasic high voltage stimulation (MHVS)
McLoughlin et al. (2004) 30 min at 120 Hz (impulse duration =100 ls) Submotor – Sensory level
(comfortable sensation)
Muscle belly
Low-Frequency Electrical Stimulation (LFES)
Lattier et al. (2004) 20 min at 5 Hz (impulse duration =250 ls) Motor level (comfortable contractions) Muscle motor point
Fig. 1 Schematic view of known (arrow) and expected (dashed
arrow) effects of different electrical stimulation forms used for post-
exercise recovery. TENS: transcutaneous electrical nerve stimulation,
MENS microcurrent electrical neuromuscular stimulation, HVPC
high-volt pulsed current, MHVS monophasic high voltage stimulation,
LFES low frequency electrical stimulation
Eur J Appl Physiol (2011) 111:2501–2507 2503
123
exercise does not appear more effective to accelerate
recovery. This conclusion has been obtained using 30 min
MHVS (high-frequency stimulations at sensory intensity)
repeated eight times within 5 days after the fatiguing
exercise (McLoughlin et al. 2004).
Neuromuscular properties have also been investigated
following high-intensity intermittent running. In a first
study, Lattier et al. (2004) tested the effectiveness of dif-
ferent recovery strategies, including LFES (motor inten-
sity), after high-intensity intermittent uphill running. These
authors concluded that the knee extensors neuromuscular
properties, as attested by evoked contractile torque and
electromyography, were not different after the various
recovery modalities tested. In a second study, the same
research team (Martin et al. 2004), investigated recovery
time course using an intermittent but more strenuous
exercise, i.e., 15 min one-legged downhill runs. Quite
similarly, recovery time course (up to 4 days post-exercise)
was similar with LFES as compared with active (sub-
maximal running) and even passive recovery on knee ex-
tensors contractile properties (voluntary and evoked torque,
voluntary activation). Thus, to date, whatever the muscular
action mode, muscle group and stimulation parameters,
electrical stimulation applied for recovery has been shown
to be ineffective regarding torque production capacity and
neuromuscular parameters (Table 2).
Table 2 Main studies investigating recovery using electrical stimulation
Study Recovery modalities Fatiguing exercise Outcomes Effects
Denegar and Perrin
(1992)
TENS (20 min) versus sham, cold,
TENS ?cold
Max. eccentric of elbow flexors Strength NS
Muscle soreness ?
Butterfield et al. (1997) HVPC (30 min) versus sham 30 910 submax. knee extensions Strength NS
Muscle soreness NS
Lattier et al. (2004) LFES (20 min) versus PR and AR 10 min uphill running Neuromuscular
parameters
NS
Martin et al. (2004) LFES (30 min) versus PR and AR 15 min one-legged downhill running Neuromuscular
parameters
NS
NS
Muscle soreness
McLoughlin et al. (2004) MHVS (30 min) versus PR 25 max. eccentric of elbow flexors Strength NS
Muscle soreness ?
Grunovas et al. (2007) LFES (10 min) versus PR Submaximal ankle flexion Muscle working
capacity
?
?
Blood flow
Tessitore et al. (2007) LFES (20 min) versus PR and AR 100 min standardized soccer
training
Vertical jump – Sprint NS
?Subjective ratings
Vanderthommen et al.
(2007)
LFES (25 min) versus PR 3 930 max. eccentric knee flexions Isokinetic torque NS
Muscle soreness NS
CK activity ?
Tessitore et al. (2008) LFES (20 min) versus PR and AR 30 min futsal game Vertical jump – Sprint NS
NS
Hormone NS
Subjective ratings
Heyman et al. (2009) LFES (20 min) versus PR, AR and WI Climbing until exhaustion Climbing test NS
Blood lactate ?
Neric et al. (2009) LFES (20 min) versus PR and AR 200 yards frontcrawl swim Blood lactate ?
Cortis et al. (2010) LFES (20 min) versus PR, AR and WI Submaximal running test Vertical jump NS
Aerobic parameters NS
NSSubjective ratings
Vanderthommen et al.
(2010)
LFES (25 min) versus PR and AR 3 925 submax. isometric knee
extensions
Isometric torque NS
Muscle soreness NS
AR active recovery, CK creatine kinase, HVPC high-volt pulsed current, LFES low frequency electrical stimulation, MHVS monophasic high
voltage stimulation, PR passive recovery, TENS transcutaneous electrical nerve stimulation, WI water immersion, NS non-significant electrical
stimulation effect, ?positive electrical stimulation effect
2504 Eur J Appl Physiol (2011) 111:2501–2507
123
Electrical stimulation and recovery of athletic
performance
The lack of any beneficial effect of electrical stimulation
has also been observed during field situations in anaerobic
conditions, such as vertical jumps and sprints (Tessitore
et al. 2008), but also for aerobic variables such as oxygen
consumption (Cortis et al. 2010) (Table 2).
Several studies have investigated the effects of electrical
stimulation to evacuate muscle metabolic by-products
during specific sport activities. Neric et al. (2009) com-
pared the effects of passive, active (sub-maximal swim-
ming) and LFES (motor intensity) recovery interventions
following 200 yards frontcrawl sprint on blood lactate
concentration. In this study, LFES was delivered on rectus
femoris, latissimus dorsi and triceps brachii muscles.
Results indicated that active recovery was the most effi-
cient intervention to accelerate lactate removal. When
compared with passive recovery, electrical stimulation also
appeared useful for lactate removal but only at the end of
the 20-min recovery period. Quite similar results have been
obtained with active recovery and LFES following fatigu-
ing climbing exercises (Heyman et al. 2009).
Beside enhanced blood flow (Grunovas et al. 2007) and
lactate removal (Neric et al. 2009), the effects of LFES on
subsequent athletic performance are not clear. Indeed,
Lattier et al. (2004) tested the effectiveness of LFES after
high-intensity intermittent uphill running designed to
obtain metabolic fatigue. Although neuromuscular prop-
erties were not different after the various recovery
modalities, these authors obtained, with LFES, a small
trend toward a better performance during an all-out running
test performed 80 min after the fatiguing running exercise.
In opposition, compared with a first fatiguing bout,
climbing performance was still impaired during a second
bout after using LFES but returned to initial values
immediately after active recovery (Heyman et al. 2009).
The lack of any measurable or consistent effects on
muscle strength recovery and subsequent field performance
could partly originate from methodological aspects.
Indeed, as indicated previously, Martin et al. (2004)
pointed out the necessity to apply an optimal stimulation
intensity to maximise the muscle pump effect and therefore
favour a possible positive recovery effect. Accordingly,
Grunovas et al. (2007) recommended using stimulation
intensity inducing ‘fibrillation of individual muscle fibres
rather than the muscle as a whole’ to obtain an ‘‘electro-
massage’’ and limit muscle ischemia.
According to these different studies, it appears that
electrical stimulation, when used with low-frequency,
might be a valid treatment for metabolites washout such as
lactate (Neric et al. 2009). Beside this benefit, no study has
been able to report any short-term effect and muscle
recovery acceleration on neuromuscular, anaerobic and
aerobic variables.
Electrical stimulation and recovery of muscle soreness
Practitioners widely use TENS currents for pain treatment.
Hence, electrical stimulation has been applied to produce a
transient analgesia and therefore diminish DOMS symp-
toms and muscle pain for example after fatiguing eccentric
exercises. Conflicting results are however often reported.
Craig et al. (1996) compared the effectiveness of high and
low-frequency TENS on subjective pain scores. Although
some lower pain scores were obtained with both TENS
treatments, no statistical significant effect was noticed
among the conditions (high and low frequency TENS vs.
placebo and control). Contrarily, Denegar and Huff (1988)
concluded that, independently of the frequency, TENS was
a valuable technique for reducing muscle pain. For this
parameter, high-frequency TENS appeared as effective as
cold or cold combined with TENS when compared to
control and placebo conditions (Denegar and Perrin 1992).
These treatments also had positive effects for DOMS-
associated joint range of motion recovery. However, pain
reduction was not accompanied by a faster restoration of
muscle strength.
The application of different current types (i.e., MENS,
HVPC and MHVS) also revealed contradictory results. For
example, no significant differences have been observed
between MENS (0.3 Hz frequency and 30 lA intensity),
massage and control conditions in minimising muscle
soreness immediately and 24 h after exercise (Weber et al.
1994). This stimulation treatment, when applied immedi-
ately and several days after DOMS induction also appeared
ineffective for reducing subjective pain scores or loss of
elbow extension range of motion (Allen et al. 1999). In
opposition, some authors concluded that this type of
stimulation could induce a transient analgesia (Denegar
et al. 1992) as pain was significantly reduced 24 and 48 h
after the fatiguing exercise (repeated eccentric contractions
of elbow flexors). Finally, HVPC has been shown to be as
ineffective as MENS in reducing muscle pain (Butterfield
et al. 1997) while McLoughlin et al. (2004) noticed that
early and frequent application of MHVS transiently atten-
uates muscle soreness (Table 2).
LFES also conducts to conflicting results (Table 2).
Nevertheless most studies noticed a lack of positive effects
for subjective pain sensations after fatiguing isometric
(Vanderthommen et al. 2010) or eccentric contractions
(Vanderthommen et al. 2007), submaximal running (Cortis
et al. 2010), futsal games (Tessitore et al. 2008) and one-
legged downhill runs (Martin et al. 2004). In contradiction,
one study registered lower muscle pain after soccer training
Eur J Appl Physiol (2011) 111:2501–2507 2505
123
using LFES and dry-aerobic exercises as compared with
water-aerobic exercises and passive recovery (Tessitore
et al. 2007).
These contradictory results might be due to the hetero-
geneity in fatiguing exercises inducing DOMS, subjects’
characteristics and to the stimulation parameters adopted.
The previously cited fatiguing exercises produced different
muscle soreness levels. While Tessitore et al. (2007)
induced only a light muscle pain (*2 on a 10-point pain
scale), other studies induced severe soreness sensations
(*6 on a 10-point pain scale for Vanderthommen et al.
2007). Concerning stimulation parameters, Wolcot et al.
(1991) noticed that HVPC used with submotor stimulation
intensity was more effective in reducing DOMS perception
than subsensory HVPC and MENS.
Exercise-induced muscle damages have also been indi-
rectly quantified using serum creatine kinase levels.
Accordingly, three days after three sets of 30 maximal
eccentric contractions of knee flexor muscles, Vanderth-
ommen et al. (2007) noticed significantly lower creatine
kinase activity using LFES (motor intensity) compared to
passive recovery. No difference was obtained for initial
muscle damage (1 and 2 days post-exercise). A similar
result has previously been obtained using MENS (Rapaski
et al. 1991). This reduced creatine kinase activity, indi-
cating cellular debris washout, was attributed to the elec-
tro-induced muscle blood flow increase (Vanderthommen
et al. 2007). A decreased inflammatory response could
therefore be obtained. However, no comparison has been
made with other recovery strategy and this aspect needs
further investigation.
Concluding remarks
When used as a recovery modality, electrical stimulation
demonstrated some positive effects on lactate removal or
creatine kinase activity but evidence regarding perfor-
mance indicators restoration, such as muscle strength, is
still lacking. The absence of any positive effect could
partly be attributed to methodological concerns such as the
arbitrary choice of stimulation intensity. In addition, most
positive electrical stimulation effects have been obtained
on subjective parameters such as pain perception. This
recovery strategy might therefore improve subjective
feeling of well-being and could also aid athletes’ attitude
toward training (Tessitore et al. 2008). Indeed, as indicated
in Cortis et al.’s (2010) study, most subjects cited electrical
stimulation as the most effective intervention as compared
with water exercises and sitting rest. Accordingly, although
no effect was obtained for performance, electrical stimu-
lation (applied alone or combined with another recovery
modality) appeared to be a valid alternative treatment for
post-exercise recovery when soreness is the most important
limiting factor.
References
Allen JD, Mattacola CG, Perrin DH (1999) Effect of microcurrent
stimulation on delayed-onset muscle soreness: a double-blind
comparison. J Athl Train 34:334–337
Allen DG, Lamb GD, Westerblad H (2008) Skeletal muscle fatigue:
cellular mechanisms. Physiol Rev 88:287–332
Ament W, Verkerke GJ (2009) Exercise and fatigue. Sports Med
39:389–422
Banfi G, Lombardi G, Colombini A, Melegati G (2010) Whole-body
cryotherapy in athletes. Sports Med 40:509–517
Barnett A (2006) Using recovery modalities between training sessions
in elite athletes. Does it help? Sports Med 36:781–196
Bishop PA, Jones E, Woods AK (2008) Recovery from training: a
brief review. J Strength Cond Res 22:1015–1024
Butterfield DL, Draper DO, Ricard MD, Myrer JW, Durrant E,
Schulthies SS (1997) The effects of high-volt pulsed current
electrical stimulation on delayed-onset muscle soreness. J Athl
Train 32:15–20
Cheng R, Pomeranz B (1980) Electroacupuncture analgesia could be
mediated by at least two pain-relieving mechanisms: endorphin
and non-endorphin systems. Life Sci 25:1957–1962
Cheung K, Hume PA, Maxwell L (2003) Delayed onset muscle
soreness. Treatment strategies and performance factors. Sports
Med 33:145–164
Cortis C, Tessitore A, D’Artibale E, Meeusen R, Capranica L (2010)
Effects of post-exercise recovery interventions on physiological,
psychological, and performance parameters. Int J Sports Med
31:327–335
Compex website. http://www.compex.info/en_UK/Who_uses_it_.html.
Accessed 3 March 2011
Cox PD, Kramer JF, Hartsell H (1993) Effect of different TENS
stimulus parameters on ulnar motor nerve conduction velocity.
Am J Phys Med Rehab 72:294–300
Craig JA, Cunningham MB, Walsh DM, Baxter GD, Allen JM (1996)
Lack of effect of transcutaneous electrical nerve stimulation
upon experimentally induced delayed onset muscle soreness in
humans. Pain 67:285–289
Cramp AFL, Gilsenan C, Lowe AS, Walsh DM (2000) The effect of
high- and low-frequency transcutaneous electrical nerve stimu-
lation upon blood flow and skin temperature in healthy subjects.
Clin Physiol 20:150–157
Cramp AFL, McCullough GR, Lowe AS, Walsh DM (2002)
Transcutaneous electric nerve stimulation: the effect of intensity
on local and distal cutaneous blood flow and skin temperature in
healthy subjects. Arch Phys Med Rehabil 83:5–9
Denegar CR, Huff CB (1988) High and low frequency TENS in the
treatment of induced musculoskeletal pain: a comparison study.
Athletic Train 23:235–237
Denegar CR, Perrin DH (1992) Effect of transcutaneous electrical
nerve stimulation, cold, and a combination treatment on pain,
decreased range of motion, and strength loss associated with
delayed onset muscle soreness. J Athl Train 27:200–206
Denegar CR, Yoho AP, Borowicz AJ, Bifulco N (1992) The effects of
low-volt microamperage stimulation on delayed onset muscle
soreness. J Sport Rehab 1:95–102
DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA (2008)
Effectiveness of transcutaneous electrical nerve stimulation for
treatment of hyperalgesia and pain. Curr Rheumatol Rep
10:492–499
2506 Eur J Appl Physiol (2011) 111:2501–2507
123
Eston R, Peters D (1999) Effects of cold-water immersion on the
symptoms of exercise-induced muscle damage. J Sports Sci
17:231–238
Gandevia SC (2001) Spinal and supraspinal factors in human muscle
fatigue. Physiol Rev 81:1725–1789
Gill ND, Beaven CM, Cook C (2006) Effectiveness of post-match
recovery strategies in rugby players. Br J Sports Med
40:260–263
Grunovas A, Silinskas V, Poderys J, Trinkunas E (2007) Peripheral
and systemic circulation after local dynamic exercise and
recovery using passive foot movement and electrostimulation.
J Sports Med Phys Fitness 47:335–343
Heyman E, De Geus B, Mertens I, Meeusen R (2009) Effects of four
recovery methods on repeated maximal rock climbing perfor-
mance. Med Sci Sports Exerc 41:1303–1310
Lattier G, Millet GY, Martin A, Martin V (2004) Fatigue and
recovery after high-intensity exercise. Part II: Recovery inter-
ventions. Int J Sports Med 25:509–515
Martin V, Millet GY, Lattier G, Perrod L (2004) Effects of recovery
modes after knee extensor muscles eccentric contractions. Med
Sci Sports Exerc 36:1907–1915
McLoughlin TJ, Snyder AR, Brolinson PG, Pizza FX (2004) Sensory
level electrical muscle stimulation: effect on markers of muscle
injury. Br J Sports Med 38:725–729
Neric FB, Beam WC, Brown LE, Wiersma LD (2009) Comparison of
swim recovery and muscle stimulation on lactate removal after
sprint swimming. J Strength Cond Res 23:2560–2567
Pournot H, Bieuzen F, Duffield R, Lepretre PM, Cozzolino C,
Hausswirth C (2011) Short term effects of various water
immersions on recovery from exhaustive intermittent exercise.
Eur J Appl Physiol. doi:10.1007/s00421-010-1754-6
Rapaski D, Isles S, Kulig K, Boyce D (1991) Microcurrent electrical
stimulation: a comparison of two protocols in reducing delayed
onset muscle soreness. Phys Ther 71:S116
Rushton DN (2002) Electrical stimulation in the treatment of pain.
Disabil Rehabil 24:407–415
So RCH, Ng JKF, Ng GYF (2007) Effect of transcutaneous electrical
acupoint stimulation on fatigue recovery of the quadriceps. Eur J
Appl Physiol 100:693–700
Tessitore A, Meeusen R, Cortis C, Capranica L (2007) Effects of
different recovery interventions on anaerobic performances
following preseason soccer training. J Strength Cond Res
21:745–750
Tessitore A, Meeusen R, Pagano R, Benvenuti C, Tiberi M, Capranica
L (2008) Effectiveness of active versus passive recovery
strategies after futsal games. J Strength Cond Res 22:1402–1412
Toubekis AG, Tsolaki A, Smilios I, Douda HT, Kourtesis T,
Tokmakidis SP (2008) Swimming performance after passive
and active recovery of various durations. Int J Sports Physiol
Perform 3:375–386
Vanderthommen M, Depresseux JC, Bauvir P, Degueldre C, Delfiore
G, Peters JM, Sluse F, Crielaard JM (1997) A positron emission
tomography study of voluntary and electrically contracted
human quadriceps. Muscle Nerve 20:505–507
Vanderthommen M, Soltani K, Maquet D, Crielaard JM, Croisier JL
(2007) Does neuromuscular electrical stimulation influence
muscle recovery after maximal isokinetic exercise? Isokinetics
Exerc Sci 15:143–149
Vanderthommen M, Makrof S, Demoulin C (2010) Comparison of
active and electrostimulated recovery strategies after fatiguing
exercise. J Sports Sci Med 9:164–169
Wall PD (1985) The discovery of transcutaneous electrical nerve
stimulation. Physiotherapy 71:348–352
Weber MD, Servedio FJ, Woodall WR (1994) The effects of three
modalities on delayed onset muscle soreness. J Orthop Sports
Phys Ther 20:236–242
Wolcot C, Dubek D, Kulig K, Weiss M, Clark T (1991) A comparison
of the effects of high volt and microcurrent stimulation on
delayed onset muscle soreness. Phys Ther 71:S117
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