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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 largely 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 sessions or competition. However, although electrical stimulation is often used for recovery, limited evidence exists regarding its effects for an improvement of most physiological 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.
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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.
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... Besides the basics of recovery, techniques such as electrostimulation, localised heating and compression can also be used as effective recovery tools [5,6]. Electrostimulation is a sequence of stimuli that is provided by electrodes put superficially on the skin [7] and entails applying a series of intermittent stimuli to the superficial skeletal muscles to activate the intramuscular nerve branches and cause visible muscle contractions [8]. The possible effects of electrostimulation are enhanced blood flow, speeding up the removal of muscle Sensors 2023, 23, 7634 2 of 13 metabolites [9] and the promotion of recovery by reducing muscle pain through central and peripheral mechanisms [7]; however, adequate intensities must be used as excessive intensities might lead to partial ischemia and insufficient ones may not increase blood flow. ...
... Electrostimulation is a sequence of stimuli that is provided by electrodes put superficially on the skin [7] and entails applying a series of intermittent stimuli to the superficial skeletal muscles to activate the intramuscular nerve branches and cause visible muscle contractions [8]. The possible effects of electrostimulation are enhanced blood flow, speeding up the removal of muscle Sensors 2023, 23, 7634 2 of 13 metabolites [9] and the promotion of recovery by reducing muscle pain through central and peripheral mechanisms [7]; however, adequate intensities must be used as excessive intensities might lead to partial ischemia and insufficient ones may not increase blood flow. The literature still presents some controversy on this matter, with studies showing that electrical stimulation is not as effective as is supposed to be; this is mostly because the protocols applied are very heterogeneous and this fact must be taken into account [10]. ...
... This is the first study that has analysed acute recovery using a Sensors 2023, 23, 7634 9 of 13 device that assembles three different recovery methods applied to different muscles. It is known that electrostimulation enhances blood flow, speeding up the removal of muscle metabolites [9] and enhancing recovery by reducing muscle pain through central and peripheral mechanisms [7]. However, the data from the literature are still controversial, showing that electrostimulation is not as effective as expected; however, this might be justified by the heterogeneity of the samples and protocols [10]. ...
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Citation: Silva, G.; Goethel, M.; Machado, L.; Sousa, F.; Costa, M.J.; Magalhães, P.; Silva, C.; Midão, M.; Leite, A.; Couto, S.; et al. Acute Recovery after a Fatigue Protocol Using a Recovery Sports Legging: An Experimental Study. Sensors 2023, 23, 7634. https://doi.org/10.3390/ s23177634 Academic Editors: Abstract: Enhancing recovery is a fundamental component of high-performance sports training since it enables practitioners to potentiate physical performance and minimise the risk of injuries. Using a new sports legging embedded with an intelligent system for electrostimulation, localised heating and compression (completely embodied into the textile structures), we aimed to analyse acute recovery following a fatigue protocol. Surface electromyography-and torque-related variables were recorded on eight recreational athletes. A fatigue protocol conducted in an isokinetic dynamometer allowed us to examine isometric torque and consequent post-exercise acute recovery after using the sports legging. Regarding peak torque, no differences were found between post-fatigue and post-recovery assessments in any variable; however, pre-fatigue registered a 16% greater peak torque when compared with post-fatigue for localised heating and compression recovery methods. Our data are supported by recent meta-analyses indicating that individual recovery methods, such as localised heating, electrostimulation and compression, are not effective to recover from a fatiguing exercise. In fact, none of the recovery methods available through the sports legging tested was effective in acutely recovering the torque values produced isometrically.
... Particularly, neuromuscular electrical stimulation techniques can activate the skeletal muscle pump via the transcutaneous stimulation of muscle fibers, in turn increasing local blood flow. Therefore, even if with conflicting results, a great number of studies have investigated the potential of reducing muscle soreness when adopting different electrical stimulation techniques and methods [40,41], while the electrical stimulation (ES) efficacy in DOMS prevention and/or treatment and its effects on muscle recovery remain still unclear [41]. ...
... As already pointed out, many literature studies investigated the potential of muscle soreness reduction by adopting different electrical stimulation devices but returning conflicting results [40]. This study's results also appear conflicting. ...
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Intense, long exercise can increase oxidative stress, leading to higher levels of inflammatory mediators and muscle damage. At the same time, fatigue has been suggested as one of the factors giving rise to delayed-onset muscle soreness (DOMS). The aim of this study was to investigate the efficacy of a specific electrical stimulation (ES) treatment (without elicited muscular contraction) on two different scenarios: in the laboratory on eleven healthy volunteers (56.45 ± 4.87 years) after upper limbs eccentric exercise (Study 1) and in the field on fourteen ultra-endurance athletes (age 47.4 ± 10.2 year) after an ultra-running race (134 km, altitude difference of 10,970 m+) by lower exercising limbs (Study 2). Subjects were randomly assigned to two experimental tasks in cross-over: Active or Sham ES treatments. The ES efficacy was assessed by monitoring the oxy-inflammation status: Reactive Oxygen Species production, total antioxidant capacity, IL-6 cytokine levels, and lactate with micro-invasive measurements (capillary blood, urine) and scales for fatigue and recovery assessments. No significant differences (p > 0.05) were found in the time course of recovery and/or pre–post-race between Sham and Active groups in both study conditions. A subjective positive role of sham stimulation (VAS scores for muscle pain assessment) was reported. In conclusion, the effectiveness of ES in treating DOMS and its effects on muscle recovery remain still unclear.
... Systematic reviews on NMES [90,91] present mixed findings on the effectiveness on recovery, where NMES may alleviate pain better than passive recovery, but advantages compared to active recovery methods are less clear. Heyman et al. [92] similarly reported that NMES does not consistently improve performance recovery and may even impair it compared to active recovery. ...
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Purpose This narrative umbrella review evaluates the efficacy of recovery strategies for elite winter sports athletes by comparing their scientific and clinical validity. It aims to provide evidence-based recommendations for coaches and athletes, preparing them for the Milano-Cortina 2026 Olympic Games through a critical evaluation of various post-training and competition recovery methods. Methods This narrative umbrella review involved a systematic literature search on PubMed, focusing on recent meta-analyses and review articles related to recovery strategies. Special emphasis was placed on their practical applications to ensure the findings are relevant to real-world settings. Results The study examined multiple recovery strategies, including sleep, nutrition, and physical methods, revealing a general scarcity of high-quality studies and insufficient control over placebo effects. A key finding emphasizes the crucial roles of nutrition and sleep in the recovery process, highlighting the need for personalized recovery plans tailored to the athlete's and sport's specific demands. The effectiveness of physical recovery methods varied, with some demonstrating significant benefits in specific contexts (e.g., massage and cold-water immersion to alleviate muscle pain and fatigue), whereas others (e.g., stretching and sauna) lacked robust evidence of their efficacy as recovery methods. Conclusion This paper presents recommendations for optimizing recovery strategies in elite winter sports, focusing on the specific demands of the Milano-Cortina 2026 Olympic Games. It provides a framework for athletes and coaches aiming to enhance performance recovery and achieve optimal athletic condition.
... This finding may be particularly important given that some recovery techniques are claimed to enhance recovery by increasing muscle blood flow (Babault et al., 2011). (Rhind et al., 2004). ...
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Post‐exercise hot (HWI) and cold (CWI) water immersion are popular strategies used by athletes in a range of sporting contexts, such as enhancing recovery or adaptation. However, prolonged heating bouts increase neuroendocrine responses that are associated with perceptions of fatigue. Fourteen endurance‐trained runners performed three trials consisting of two 45‐min runs at 95% lactate threshold on a treadmill separated by 6 h of recovery. Following the first run, participants completed one of HWI (30 min, 40°C), CWI (15 min, 14°C) or control (CON, 30 min rest in ambient conditions) in a randomised order. Perceived effort and recovery were measured using ratings of perceived exertion (RPE) and the Acute Recovery and Stress Scale (ARSS), whilst physiological responses including venous concentrations of a range of neuroendocrine markers, superficial femoral blood flow, heart rate and rectal temperature were measured. Exercise increased neuroendocrine responses of interleukin‐6, adrenaline and noradrenaline (all P < 0.001). Additionally, perceptions of overall recovery (P < 0.001), mental performance capacity (P = 0.02), physical performance capability (P = 0.01) and emotional balance (P = 0.03) were reduced prior to the second run. However, there was no effect of condition on these variables (P > 0.05), nor RPE (P = 0.68), despite differences in rectal temperature, superficial femoral blood flow following the first run, and participants’ expected recovery prior to the intervention (all P < 0.001). Therefore, athletes may engage in post‐exercise hot or cold‐water immersion without negatively impacting moderate‐intensity training sessions performed later the same day.
... Nevertheless, there is a possibility that such events are masked by the replacement of atrophic muscle fibers and collagen by fat [14][15][16][17][18] . Although FES has been discussed for muscle recovery 19,20 and physical activity may prevent fat infiltration 21 , it remains unclear whether this leads to intramuscular fat accumulations, which may restrict the PCA from generating sufficient tension to open the vocal folds even by using FES 17,22 . Therefore, the studies performed so far, will be extended by analyzing muscle cross-sections from our earlier study with regard to fat infiltration using a quantitative imaging approach. ...
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Quantitative imaging in life sciences has evolved into a powerful approach combining advanced microscopy acquisition and automated analysis of image data. The focus of the present study is on the imaging-based evaluation of the posterior cricoarytenoid muscle (PCA) influenced by long-term functional electrical stimulation (FES), which may assist the inspiration of patients with bilateral vocal fold paresis. To this end, muscle cross-sections of the PCA of sheep were examined by quantitative image analysis. Previous investigations of the muscle fibers and the collagen amount have not revealed signs of atrophy and fibrosis due to FES by a laryngeal pacemaker. It was therefore hypothesized that regardless of the stimulation parameters the fat in the muscle cross-sections would not be significantly altered. We here extending our previous investigations using quantitative imaging of intramuscular fat in cross-sections. In order to perform this analysis both reliably and faster than a qualitative evaluation and time-consuming manual annotation, the selection of the automated method was of crucial importance. To this end, our recently established deep neural network IMFSegNet, which provides more accurate results compared to standard machine learning approaches, was applied to more than 300 H&E stained muscle cross-sections from 22 sheep. It was found that there were no significant differences in the amount of intramuscular fat between the PCA with and without long-term FES, nor were any significant differences found between the low and high duty cycle stimulated groups. This study on a human-like animal model not only confirms the hypothesis that FES with the selected parameters has no negative impact on the PCA, but also demonstrates that objective and automated deep learning-based quantitative imaging is a powerful tool for such a challenging analysis.
... Despite some benefits reported in perceptive parameters after shortterm and long-term application (15,22,31,39,41,42,60,72,74), most of the recovery methods (e.g., cold water immersion, massage, compression garments) have failed to show benefits in the recovery of physical and physiologic parameters (2,21,44,72,79). Likewise, some recovery methods (e.g., active recovery, stretching, and electrostimulation) have also shown no effectiveness in postmatch recovery (2,4,8,21,31,40,59,61,72). However, the low studies' methodologic quality, risk of bias, and high heterogeneity widely reported in literature (2,31,41,72,79) need to be highlighted and new experimental studies with more robust methodologic procedures are needed. ...
Article
Several recovery methods have been proposed to optimize postmatch recovery in elite soccer. However, practical guidance for the implementation of recovery methods that somehow confer benefits on the recovery process immediately postmatch (MD), 1 day postmatch (MD + 1), and 2 days postmatch (MD + 2) is lacking. This article aimed to review the existing literature and provide a practical guide for sports scientists, coaches, clinicians, and players concerning implementing the most-used recovery methods after male and female soccer matches. For this purpose, we first presented a general 5-level recovery model that divides the recovery methods according to their relevance in recovery, based on their effectiveness in recovery, frequency of use, and reported detrimental effects. In addition, practical recommendations were provided for implementing each recovery method following two days post-match according to the recovery of various parameters (i.e., physical, physiologic, and perceptual) and physiologic and psychosocial assumptions. It was concluded that the application of recovery methods should be prioritized, periodized, and individualized over the recovery period postmatch. In addition, some recovery methods with limited effectiveness in postmatch recovery should be recommended based on physiologic assumptions and potential psychosocial benefits.
... Cupping therapy has been suggested to reduce muscle fatigue without mediating adverse effects on the skeletal muscle (Lowe 2017) and has been shown to improve local blood flow , alleviate muscle pain (Kim et al. 2012), and reduce muscle stiffness . Electrical stimulation has been demonstrated to be a safe and effective modality to reduce muscle soreness (Babault et al. 2011), but the effects on inflammation are unclear (Lambernd et al. 2012). Compression garments have also been observed to minorly attenuate post-exercise muscle soreness and perceived levels of fatigue but induce no changes in indicators of inflammation such as creatine-kinase or CRP (Pruscino et al. 2013). ...
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Background Cannabis use, be it either cannabidiol (CBD) use and/or delta-9-tetrahydrocannabinol (THC) use, shows promise to enhance exercise recovery. The present study aimed to determine if individuals are using CBD and/or THC as a means of recovery from aerobic and/or resistance exercise, as well as additional modalities that might be used to aid in recovery. Methods Following consent, 111 participants (Mean ± SD: Age: 31 ± 13 years) completed an anonymous survey. All participants were regularly using cannabis (CBD and/or THC) as well as were currently exercising. Questions pertained to level of cannabis use, methods used for consumption of cannabis, exercise habits, exercise recovery strategies, and demographics. Results Eighty-five percent of participants reported participating in aerobic training. In addition, 85% of participants also reported regular participation in resistance exercise. Seventy-two percent of participants participated in both aerobic and resistance exercise. Ninety-three percent of participants felt that CBD use assisted them with recovery from exercise, while 87% of participants felt the same regarding THC use. Conclusions Individuals who habitually use cannabis, CBD or THC, and regularly engage in exercise do feel that cannabis assists them with exercise recovery. More data are necessary to understand the role of cannabis in exercise recovery as well as perceived ergogenic benefits of cannabis by individuals who both regularly participate in exercise and habitually use cannabis.
Conference Paper
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VARYSTIM uses the property of Pulse Width Modulation for designing a portable stimulator both for nerves and muscles. The level of stimulation ranges from minimum ±1.6mA to maximum ±2.5mA with multiple frequency settings. To reduce the circuit complexity varystim can be designed in a micro level with low voltage of 9V overcoming the disadvantage of a conventional microstimulator. It is exercised in particularly to aid the rehabilitation of people with paraplegia. For that application, a low cost, portable, battery powered muscular stimulator is designed. GENERAL TERMS Stimulator, NEMS, TENS.
Chapter
Objective: To determine whether electrical stimulation therapy is effective at reducing pain in people with knee osteoarthritis. Methods: Various literatures on the treatment of pain in osteoarthritis of knee joint with electrical stimulation were searched. According to the title and abstract, the search records were independently screened, and the author, study design, study population, type of electrical stimulation, evaluation criteria, results and other information were extracted. Results: Ten randomized controlled trials involving 405 patients diagnosed with knee osteoarthritis found that both TENS and NMES had a positive effect on the analgesic effects of knee arthritis, but further work is still needed to clarify the long-term treatment effect of electrical stimulation in terms of knee arthritis pain. Conclusion: TENS treatment is more effective than NMES treatment in relieving joint pain in people who have KOA. In future studies, In future studies, the experimental analysis of the same parameter of TENS is needed to determine better methods of pain relief.
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The purpose of this study was to compare an electrostimulated to an active recovery strategy after a submaximal isometric fatiguing exercise. Nineteen healthy men completed three sessions (separated by at least 4 weeks) which included a knee extensors provocation exercise consisting of 3 sets of 25 isometric contractions. Contraction intensity level was fixed respectively at 60%, 55% and 50% of previously determined maximal voluntary contraction for the first, second and third sets. This provocation exercise was followed by either an active (AR) recovery (25 min pedaling on a cycle ergometer), an electrostimulated (ESR) recovery (25-min continuous and non-tetanic (5 Hz) stimulation of the quadriceps) or a strictly passive recovery (PR). Peak torques of knee extensors and subjective perception of muscle pain (VAS, 0-10) were evaluated before (pre-ex), immediately after the provocation exercise (post-ex), after the recovery period (post-rec), as well as 75 minutes (1h15) and one day (24h) after the exercise bout. Time course of peak torque was similar among the different recovery modes: ~ 75% of initial values at post-ex, ~ 90% at post-rec and at 1h15. At 24h, peak torque reached a level close to baseline values (PR: 99.1 ± 10.7%, AR: 105.3 ± 12.2%, ESR: 104.4 ± 10.5%). VAS muscle pain scores decreased rapidly between post-ex and postrec (p < 0.001); there were no significant differences between the three recovery modes (p = 0.64). In conclusion, following a submaximal isometric knee extension exercise, neither electrostimulated nor active recovery strategies significantly improved the time course of muscle function recovery.
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Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted. A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1–2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.
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In order to investigate the effectiveness of different techniques of water immersion recovery on maximal strength, power and the post-exercise inflammatory response in elite athletes, 41 highly trained (Football, Rugby, Volleyball) male subjects (age = 21.5 ± 4.6 years, mass = 73.1 ± 9.7 kg and height = 176.7 ± 9.7 cm) performed 20 min of exhaustive, intermittent exercise followed by a 15 min recovery intervention. The recovery intervention consisted of different water immersion techniques, including: temperate water immersion (36°C; TWI), cold water immersion (10°C; CWI), contrast water temperature (10-42°C; CWT) and a passive recovery (PAS). Performances during a maximal 30-s rowing test (P(30 s)), a maximal vertical counter-movement jump (CMJ) and a maximal isometric voluntary contraction (MVC) of the knee extensor muscles were measured at rest (Pre-exercise), immediately after the exercise (Post-exercise), 1 h after (Post 1 h) and 24 h later (Post 24 h). Leukocyte profile and venous blood markers of muscle damage (creatine kinase (CK) and lactate dehydrogenase (LDH)) were also measured Pre-exercise, Post 1 h and Post 24 h. A significant time effect was observed to indicate a reduction in performance (Pre-exercise vs. Post-exercise) following the exercise bout in all conditions (P < 0.05). Indeed, at 1 h post exercise, a significant improvement in MVC and P(30 s) was respectively observed in the CWI and CWT groups compared to pre-exercise. Further, for the CWI group, this result was associated with a comparative blunting of the rise in total number of leucocytes at 1 h post and of plasma concentration of CK at 24 h post. The results indicate that the practice of cold water immersion and contrast water therapy are more effective immersion modalities to promote a faster acute recovery of maximal anaerobic performances (MVC and 30″ all-out respectively) after an intermittent exhaustive exercise. These results may be explained by the suppression of plasma concentrations of markers of inflammation and damage, suggesting reduced passive leakage from disrupted skeletal muscle, which may result in the increase in force production during ensuing bouts of exercise.
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Cold therapy is commonly used as a procedure to relieve pain symptoms, particularly in inflammatory diseases, injuries and overuse symptoms. A peculiar form of cold therapy (or stimulation) was proposed 30 years ago for the treatment of rheumatic diseases. The therapy, called whole-body cryotherapy (WBC), consists of exposure to very cold air that is maintained at −110°C to −140°C in special temperature-controlled cryochambers, generally for 2 minutes. WBC is used to relieve pain and inflammatory symptoms caused by numerous disorders, particularly those associated with rheumatic conditions, and is recommended for the treatment of arthritis, fibromyalgia and ankylosing spondylitis. In sports medicine, WBC has gained wider acceptance as a method to improve recovery from muscle injury. Unfortunately, there are few papers concerning the application of the treatment on athletes. The study of possible enhancement of recovery from injuries and possible modification of physiological parameters, taking into consideration the limits imposed by antidoping rules, is crucial for athletes and sports physicians for judging the real benefits and/or limits of WBC. According to the available literature, WBC is not harmful or detrimental in healthy subjects. The treatment does not enhance bone marrow production and could reduce the sport-induced haemolysis. WBC induces oxidative stress, but at a low level. Repeated treatments are apparently not able to induce cumulative effects; on the contrary, adaptive changes on antioxidant status are elicited — the adaptation is evident where WBC precedes or accompanies intense training. WBC is not characterized by modifications of immunological markers and leukocytes, and it seems to not be harmful to the immunological system. The WBC effect is probably linked to the modifications of immunological molecules having paracrine effects, and not to systemic immunological functions. In fact, there is an increase in antiinflammatory cytokine interleukin (IL)-10, and a decrease in proinflammatory cytokine IL-2 and chemokine IL-8. Moreover, the decrease in intercellular adhesion molecule-1 supported the anti-inflammatory response. Lysosomal membranes are stabilized by WBC, reducing potential negative effects on proteins of lysosomal enzymes. The cold stimulation shows positive effects on the muscular enzymes creatine kinase and lactate dehydrogenase, and it should be considered a procedure that facilitates athletes’ recovery. Cardiac markers troponin I and high-sensitivity C-reactive protein, parameters linked to damage and necrosis of cardiac muscular tissue, but also to tissue repair, were unchanged, demonstrating that there was no damage, even minimal, in the heart during the treatment. N-Terminal pro B-type natriuretic peptide (NT-proBNP), a parameter linked to heart failure and ventricular power decrease, showed an increase, due to cold stress. However, the NT-proBNP concentrations observed after WBC were lower than those measured after a heavy training session, suggesting that the treatment limits the increase of the parameter that is typical of physical exercise. WBC did not stimulate the pituitary-adrenal cortex axis: the hormonal modifications are linked mainly to the body’s adaptation to the stress, shown by an increase of noradrenaline (norepinephrine). We conclude that WBC is not harmful and does not induce general or specific negative effects in athletes. The treatment does not induce modifications of biochemical and haematological parameters, which could be suspected in athletes who may be cheating. The published data are generally not controversial, but further studies are necessary to confirm the present observations.
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The efficacy of low-volt, microamperage stimulation (LVMAS) in the treatment of wounds and fractures has been demonstrated. Although these devices are also commonly used to treat musculoskeletal conditions, the efficacy of this practice has not been demonstrated. In this study, delayed onset muscle soreness (DOMS) served as a model for musculoskeletal injury to compare daily treatment with LVMAS and static stretching to a placebo treatment and static stretching. DOMS was induced in the elbow flexor muscle group in 16 subjects, who were evaluated for pain, elbow flexor muscle group strength, and elbow extension range of motion. These data were collected before the eccentric exercise bout, before and after treatment 24, 48, 72, and 96 hours following the exercise bout, and again 196 hours after the exercise bout. No significant differences were found between LVMAS and placebo treatments on any of the variables across the duration of the study, but the LVMAS did provide a transient analgesic effect 24 and 48 hours following the eccentric exercise.
Article
Neuromuscular electrical stimulation (ES) and passive recovery (PR) were compared in ten healthy men after a provocation exercise inducing delayed onset of muscle soreness (DOMS). The exercise consisted of 3 sets of 30 maximal eccentric contractions performed by the knee flexor muscles of the dominant leg on an isokinetic dynamometer at 60°/s angular velocity. There was an interval of 8 weeks between both bouts and the order of the recovery mode (ES or PR) was block-randomly assigned. ES recovery consisted of a 25-min continuous and non-tetanic (5 Hz) stimulation of the hamstring muscles. Concentric and eccentric hamstrings peak torques were evaluated before and immediately after the provocation exercise, after the recovery period, as well as 24 h (d1), 48 h (d2), 72 h (d3) and 168 h (d7) after the bout. Subjective perception of muscle soreness (VAS, 0-10 a.u.) was evaluated before exercise and at d1, d2, d3 and d7. To assess the CK activity, five blood samples were drawn before exercise and at d1, d2, d3 and d7. For both recovery modes, the greatest reductions in isokinetic muscle performances were measured on d2 (66.3 ± 24.1% of initial values (ES) vs. 57.4 ± 26.5% (PR) for the concentric mode and 55.6 ± 16% (ES) vs. 53.1 ± 19.3% (PR) for the eccentric mode). d2 also corresponded to the highest painful sensations (5.4 ± 2.14 a.u. (ES) vs. 6.15 ± 2.55 a.u. (PR)). Peak activities of CK were reached on d3 (47507 ± 19973 IU/l (ES) vs. 75887 ± 41962 IU/l (PR)). Serum CK was lower with ES than PR at d3 (p≤0.05) but all other parameters changed in a manner that was not statistically different between the two recovery protocols (p>0.05). This strong trend could be explained by an electro-induced hyperperfusion that may efficiently wash out the muscle from the cellular debris resulting from the initial injury, and hence diminish the inflammatory response and the delayed amplification of tissue damages.
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This paper traces the origin of the gate control theory in pain transmission and describes the development of transcutaneous electrical nerve stimulation.