Update article/Mise au point

Electrical stimulation and muscle strengthening

Electrostimulation et gain de force musculaire

P. Dehail a,*, C. Duclos b,1, M. Barat a

a EA 4136 handicap et systeme nerveux, service de medecine physique et readaptation, hopital Pellegrin,

CHU de Bordeaux et universite Victor-Segalen Bordeaux-2, place Amelie-Raba-Leon, 33076 Bordeaux cedex, Franceb Centre de recherche interdisciplinaire en readaptation, institut de readaptation de Montreal et ecole de readaptation,

universite de Montreal, Quebec, Canada

Received 22 March 2008; accepted 20 May 2008

Abstract

Objectives. To identify the effects of application methods and indications of direct muscle electrostimulation on strength gain.

Methods. Literature review and analysis of articles from Medline database with the following entries: muscular or neuromuscular, electro-

myostimulation, electrical stimulation, strengthening, strength training, immobilization, muscle dystrophy, bed-rest, bed-bound, knee or hip

surgery, postoperative phase, cachexia, sarcopenia, and their French equivalent.

Results. Because of its specific muscle recruitment order, different from that of voluntary contraction, direct muscle electrostimulation is

theoretically a complementary tool for muscle strengthening. It can be used in healthy subjects and in several affections associated with muscle

function loss. Its interest seems well-established for post-traumatic or postsurgery lower-limb immobilizations but too few controlled studies have

clearly shown the overall benefits of its application in other indications. Whatever the indication, superimposed or combined electrostimulation

techniques are generally more efficient than electrostimulation alone.

Conclusion. Even though widely used, the level of evidence for the efficiency of electromyostimulation is still low. For strength gains, it yielded

no higher benefits than traditional strengthening methods. Its interest should be tested in medical affections leading to major muscle deconditioning

or in sarcopenia.

# 2008 Elsevier Masson SAS. All rights reserved.

Resume

Objectifs. Preciser les effets, en termes de gain de force, les methodes dapplication et les indications de lelectrostimulation musculaire directe.

Methode. Revue de la litterature et analyse darticles selectionnes a partir de la base de donnees Medline selon les mots cles suivants : muscular

or neuromuscular, electromyostimulation, electrical stimulation, strengthening, strength training, immobilization, muscle dystrophy, bed-rest, bed-

bound, knee or hip surgery, postoperative phase, cachexia, sarcopenia ou leurs equivalents francais.

Resultats. En entranant un recrutement musculaire specifique, different de celui obtenu par la contraction volontaire, lelectrostimulation

musculaire directe represente en theorie un moyen complementaire de renforcement musculaire utilisable chez le sujet sain et lors de differentes

affections saccompagnant dune degradation de la fonction musculaire. Si dans le cadre des immobilisations segmentaires des membres inferieurs,

post-traumatiques ou postchirurgicales, linteret de lelectromyostimulation parat bien etabli, le nombre insuffisant detudes controlees dans les

autres indications ne permet pas de determiner avec precision lensemble des benefices de cette technique. Quelle que soit lindication, les

techniques delectrostimulation musculaire surimposee ou combinee aux contractions volontaires paraissent plus performantes que lutilisation

isolee de lelectrostimulation.

Conclusion. Bien que couramment employee, lefficacite de lelectromyostimulation reste insuffisamment demontree. En termes de gain de

force, la superiorite de cette technique par rapport aux methodes traditionnelles de renforcement musculaire nest pas etablie. Son interet, dans le

http://france.elsevier.com/direct/ANNRMP/

Disponible en ligne sur www.sciencedirect.com

Annales de readaptation et de medecine physique 51 (2008) 441451* Corresponding author.

E-mail address: patrick.dehail@chu-bordeaux.fr (P. Dehail).1 Equipe multidisciplinaire en readaptation locomotrice (initiative strategique des IRSC, nanomedecine et medecine regenerative S. Rossignol).

0168-6054/$ see front matter # 2008 Elsevier Masson SAS. All rights reserved.doi:10.1016/j.annrmp.2008.05.001

mailto:patrick.dehail@chu-bordeaux.frhttp://dx.doi.org/10.1016/j.annrmp.2008.05.001

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451442cadre daffections medicales conduisant a un deconditionnement musculaire majeur ou dans la sarcopenie, meriterait detre precise a travers des

etudes controlees.

# 2008 Elsevier Masson SAS. All rights reserved.

Keywords: Electromyostimulation; Strength training; Immobilization; Sarcopenia; Muscle dystrophy

Mots cles : Electromyostimulation ; Renforcement musculaire ; Immobilisation ; Sarcopenie ; Dystrophie musculaire1. English version

1.1. History of direct muscle electrostimulation

Physiological applications of motor electrostimulation

began in the 19th century, with Duchenne de Boulogne. Using

the technique of inductive currents developed by Faraday in

1831 (faradic currents), Duchenne de Boulogne meticulously

described muscle kinesiology and its limits: If it is true that

electromuscular exploration can help to know exactly the actual

action of a muscle, I must say that it seldom teach what are the

other muscles involved in the physiological movement it is

bound to yield. . . [14].The description by Remak, in 1858, of muscle motor points

and observations of the increase in volume of denervated

(Debedat in 1894 in ref. [43]) and healthy muscles (Bordier in

1902 in ref. [43]) by means of direct electrostimulation led to

the development of excitomotor treatments for muscles

deprived of their peripheral nervous control (Jackson 1945

in [43]), muscle force increase in athletes (Kotz in 1971 in ref.

[43]), and overnight electrical stimulation of paraspinal

muscles in juvenile scoliosis treatments [1].

In parallel, histochemical alterations of muscle fibres were

described in relation to electrostimulation [35], leading to

muscle strengthening programs and treatments of muscle

atrophy due to immobilization.

1.2. Physiological effects of direct muscle

electrostimulation on sound muscles

Direct muscle electrostimulation produces muscle contrac-

tion by transcutaneous peripheral nerve stimulation. The

contraction can be produced either directly, through the

depolarization of motoneurons, or indirectly, through the

depolarization of sensory afferents [810]. The stimulation

recruits motor units in a specific way, which is different from

physiological muscle recruitment during voluntary contraction

and furthermore could be responsible for the strength gain

measured after electrostimulation training in healthy subjects

(see below). Electrostimulation was often considered to recruit

motor units in the opposite order from voluntary drive, contrary

to Hennemanns size principle. The principle states that slow

motor units, associated with small-diameter motoneuron axons,

are active before fast motor units, which are associated with

larger-diameter axons. However, the current view acknowled-

ges that the recruitment is nonselective to the type of motor unit

and in synchrony, contrary to voluntary contraction [20,25].

The recruitment pattern seems to depend on the location,

surface and type of electrodes and on the stimulated muscle,which determine the conductive volume and the current density.

This nonphysiological pattern may partially explain the

noticeable local fatigue associated with muscle electrostimula-

tion and, particularly, because of the synchrony of motor unit

recruitment [50].

Several physiological phenomena are associated with the

electrically-induced contraction. RMN spectroscopy and

biopsy were used among other techniques to show the

following. Muscle stimulation increases the metabolic demand

compared to voluntary contraction, with higher rates of

inorganic phosphates and higher cell oxygen level; this

phenomenon is directly related to the intensity of the induced

contraction [42,51]. Cardiorespiratory activity is also affected,

with a higher oxygen consumption, ventilation and respiratory

exchange ratio associated with concentric contraction of the

quadriceps femoris induced electrically rather than voluntarily

during resistance training [50]. Finally, the contraction due to

electromyostimulation may be associated with brain activity in

the primary sensorimotor cortex and supplementary motor area

[21], although this activity may not be directly linked to the

contraction because movements, and thus sensory afferences,

accompanied the stimulation.

In healthy subjects, adaptation of muscle physiology is

observed when repeated electrical stimulations are used, such

as during muscle training. An increase was observed in the

cross-sectional area of type I muscle fibres or of the overall

muscle group that was trained [18,22,29,42]. This was

associated with an increase in the amount of the IIa isoform

of heavy chains of myosin [29] and seemed to be greater when

voluntary contraction was combined with the stimulation [42].

These alterations depend on the type of stimulation used and

could be paralleled with an improved maximal strength of the

trained muscle and higher muscle electrical activity [18,29,42].

Four weeks after the end of training with electrostimulation, the

strength gain decreased, as well as the muscle cross-sectional

area, but not to the pretraining values. On the other hand,

muscle activity came back to basal level after four weeks. The

latter results suggest that the observed gain of strength may be

due to both local muscle and motor command adaptation [18].

1.3. Use of electromyostimulation

1.3.1. With athletes

Several studies of training programs have tested the impact

of electromyostimulation on strength gain. In rugby players, for

example, isolated stimulation of the quadriceps femoris,

gluteus maximus and triceps surae muscles during a 12-week

period led to a marked increase in the strength and power of

these muscles [2]. However, the technical skills of rugby, such

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451 443as scrummaging and sprinting, did not benefit from these

improvements. In another study, the combination of electro-

stimulation and pliometric training improved the maximal

strength of the quadriceps femoris, as well as vertical jump and

sprint [22] but electrostimulation alone reduced the sprint

velocity and its benefits did generally not exceed those

observed when applied in combination with pliometric training.

In a recent review, electrostimulation combined with fast

concentric (1808/s) or eccentric training was acknowledged toincrease maximal concentric moment [42]. However, these

examples, as in most of the published studies on the subject,

have poor methodological qualities [4]. In this systematic

review, Bax et al. [4] showed that electrical stimulation is more

effective to increase the quadriceps femoris strength, only

compared to no exercise, and even more effective when the

stimulation was combined with simultaneous voluntary activity

[4]. Electrical stimulation was still not more effective than

classical training, except when associated with eccentric

training. Thus, as summarized by Vanderthommen and

Duchateau [51], strength gains due to electrostimulation do

not seem to be higher than those due to training with voluntary

contractions. Because these gains are likely due to the intensity

of the stimulation, it is extremely important to use comfortable

currents, even if no standardized method exists. Electro-

stimulation in healthy subjects and athletes looks more like a

complement to classical strengthening programs, particularly

in combination with simultaneous voluntary contraction. Its

main advantages are (1) to increase the muscle workload, as a

complement to classical training, and (2) to induce a

contraction pattern different from the pattern during voluntary

contraction [39,51]. Finally, even if strength gain could be

transferred to sports activities, negative outcomes [22] suggest

that skill training is always needed to improve the muscle

coordination necessary for the task to be trained [42].

1.3.2. During limb immobilization periods

Knees are usually immobilized after surgery or severe

traumatic lesions, such as anterior cruciate ligament rupture. In

this situation, amyotrophy and strength loss appear rapidly in

the quadriceps femoris. Numerous clinicians use direct muscle

stimulation to limit the appearance of these muscle changes and

accelerate their return to normal functional level. This

technique is believed to help fight post-traumatic or postsurgery

muscle sideration. Electrostimulation is used during and/or

after the immobilization period alone or associated with

voluntary muscle contraction. Even if several open studies

evoked benefits from electrostimulation, randomized trials led

to nuanced results. In studies comparing patients with and

without electrostimulation during the immobilization period

[19,34,48,54], electrostimulation seems to offer interest, as

shown in a recent meta-analysis [4]. The main result was less

reduction in muscle strength in patients receiving the electro-

stimulation treatment. Most of the studies on the post-

immobilization period showed the positive effect of the

stimulation quadriceps femoris [4] with a faster return to

normal walking pattern after surgery [48]. However, Lieber

et al. [28] did not find any significant difference in maximalknee extension force between electrostimulation and voluntary

contraction, when the intensity of the contraction was similar.

One year postsurgery (anterior cruciate ligamentoplasty), no

difference appeared between the two groups of patients. The

potential strength gain benefits are generally correlated to the

intensity of the stimulation and the frequency of the training

sessions [40,47]. Moreover, electrostimulation combined with

voluntary contractions (either at different times or simulta-

neously) seems more efficient than when used in isolation

[12,39,48]. A hybrid model was recently developed based on

the association of voluntary contractions of agonist muscles and

electrostimulation of the antagonists, in order to (1) obtain a

resistance to the voluntary contraction and (2) strengthen the

knee flexion and extension muscles [23]. More studies are

needed to compare this strategy to the usual techniques of

muscle strengthening against resistance, or in combination with

electrostimulation.

Electrostimulation of the quadriceps femoris was also

proposed after hip fractures [27] or hip arthroplasty due to

arthritis [49] to fight muscle atrophy that quickly appears in

these situations. Strength loss associated with decreased muscle

mass was estimated at 4% a day during the first week

postsurgery. In Suetta et al.s randomized study [49], the authors

compared the benefits of a classical rehabilitation program

alone or associated with either strengthening exercises against

resistance or electrostimulation, after prosthetic hip replace-

ment. Electrostimulation was provided from the first day

postsurgery, for 12 weeks, one hour a day. Only the patients in

the strengthening against resistance program had a shorter

length of stay in hospital after surgery. On the other hand, both

groups showed better functional results (walking velocity, time

to climb up 10 stairs, Stand-up Test) after the 12-week program.

Only the resistance muscle strengthening influenced the cross-

sectional area of the quadriceps, as measured by tomodensi-

tometry, and increased the isokinetic strength in knee extension.

In a randomized study against placebo (sham electrostimula-

tion) with much older women (83.4 3.7 years old) after hipfracture [27], electrostimulation of the quadriceps femoris (3 h

a day for six weeks) brought these women back to their previous

mobility level faster than the other group.

Thus, for traumatic and orthopaedic affections of the lower

limbs, electrostimulation seems to be useful in the first phase of

treatment. This treatment helps to limit the amytrophy and

strength loss associated with the traumatism, the surgery and

the following transitory segment immobilization.

1.3.3. During affections leading to cachexia and extended

bed-rest

Several studies showed the benefits of direct muscle

electrostimulation during medical affections (cardiac insuffi-

ciencies and chronic obstructive pulmonary disease (COPD)

especially) associated with cachexia in their severe form.

Cachexia is characterized in particular by diffuse amyotrophy

and a major decrease in muscle force. Vivodtzev et al.

emphasized the interest of associating muscle electrostimula-

tion (quadriceps femoris) with usual rehabilitation (slow gait

training on treadmill and active limb mobilization) in COPD

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451444and malnourished patients [52]. In this randomized controlled

study, patients who participated in such a program showed

significant improvement in the strength of their quadriceps,

their walking distance and their body mass index. Moreover, a

significant reduction in dyspnoea was observed during their

daily living activities. Similar effects were obtained in other

randomized controlled trials [6,36] with different electro-

stimulation programs of the quadriceps alone or in association

with the knee flexors. In addition to the strength gain, these

studies confirmed the positive effect of electrostimulation on

dyspnoea, gait abilities and exercise tolerance. Zanotti et al.

[56] also indicated a positive effect of muscle electro-

stimulation associated with active exercises on the duration

of bed-rest time in patients with chronic respiratory insuffi-

ciency who needed mechanical ventilation.

In the patients with chronic cardiac insufficiency, low-

intensity electrostimulation of the lower limb muscles

(quadriceps and/or hamstrings and/or triceps surae, depending

on the studies) also brought similar benefits to those observed in

patients with COPD [30,37,41]. In addition to the strength gain

measured in the stimulated muscles, aerobic capacity was

improved [37] as well as quality of life assessed by the SF-36,

particularly in patients waiting for a heart transplant [41].

Nuhr et al. [37] also observed a modification in the

expression of myosin heavy chain in biopsy samples from the

vastus lateralis muscle after a relatively high-intensity

electrostimulation program (4 h a day, seven days a week for

10 weeks, with a contraction intensity between 25 and 30% of

the maximal voluntary contraction). The expression of MHC

type 1 increased to the detriment of MHC II d/x.

Apart from pathologies, electromyostimulation is also one

of the tools commonly used by astronauts during microgravity

flights to fight amyotrophy and loss of muscle strength [11].

Several studies on simulated microgravity (long-duration bed

rest in anti-orthostatic position) analyzed the benefits of

electrostimulation in this situation [15,26]. The hybrid method

described above could be of particular interest [31].

1.3.4. In subjects with sarcopenia

Muscle strengthening against resistance is currently the

principal means to fight body mass and strength reduction

observed with aging. In the elderly, large strength or power

gains were measured, proportionally similar to those obtained

in healthy subjects in the same exercise program [5,24]. Even if

nervous adaptation factors seem more important than muscle

adaptation factors, the increased protein synthesis associated

with strengthening against resistance is almost comparable to

that observed in young subjects [55].

However, the strengthening programs used in published

research protocols [3,46] were particularly intensive and are

harder to apply in daily practice. Polypathology, limited

motivation, reduced cognitive functions, often limits the

implementation of such protocols. Direct muscle electro-

stimulation could be a good tool to fight installation or

worsening of the sarcopenia process, particularly in the frail

elderly. Currently, however, there are only very few studies

examining this idea. In their study, Caggiano et al. [7] found animprovement in the quadriceps femoris maximal isometric

strength similar after 12 sessions of usual strengthening or

electrostimulation in subjects 72 4 years old. Recently,Paillard et al. [38] analyzed the effects of electrostimulation

superimposed or not by voluntary muscle contractions on

muscle strength, body composition, different posturographic

data and vertical jump height in women between 62 and 75

years old. After randomization, participants received either

electrostimulation of their quadriceps or up-and-down stair-

climbing exercises, or the two programs associated. They

attended four sessions a week for 6 weeks. The results showed

that the three programs are similarly good, with an

improvement in the isometric and isokinetic strength of the

lower limbs and vertical jump height. No better effect of the

superimposed electrostimulation appeared in comparison with

the two programs alone. None of the three programs altered the

body composition or posture of the participants. To our

knowledge, no study to date has focused specifically on isolated

or superimposed electrostimulation used to improve muscle

function in persons with diagnosed sarcopenia.

1.3.5. In muscle and neuromuscular pathologies

Therapeutic application of electromyostimulation to muscle

and neuromuscular pathology is still a much debated subject.

Duchenne de Boulogne [14] already remarked its poor results

on the degenerescence musculaire graisseuse or muscle

dystrophy called after him.

A few controlled studies on the muscle strength gain

obtained by means of electromyostimulation were published in

the 1980s and 1990s. Milner-Brown et al. [32] compared two

types of programs in a series of 16 [33] and 10 adults [32]

respectively with facio-scapulo-humeral, Becker, myotonic or

girdle muscle dystrophy: training of two to three months with muscle strengtheningagainst strong resistance did not improve the deficient

muscles (whose strength was less than 10% of the normal

expected strength). However, the strength of less affected

muscles (more than 15% of the normal expected strength)

was improved, even more so when the progression of the

illness was slow; training combining unilateral electrical stimulation of thetibialis anterior and quadriceps femoris with voluntary

extension of the knee against low resistance, 2 h a day, five

days a week, for two to 14 months, showed that the maximal

extension strength of the knee increased significantly

(108 56%). The contralateral knee extensors, not trained,showed a strength gain as well, contrary to the ankle

dorsiflexors, whose stimulation did not produce any strength

change. Again, the gain was largely influenced by the level of

affection and the progression of the illness.

In children with Duchenne or Becker muscle dystrophy,

electrical stimulation of the affected muscles produced

conflicting results. Low-frequency stimulation seems more

effective but its effect on the contractile properties of muscle

was not better than those observed after early tenotomy in the

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451 445case of retraction [13]. This was experimentally verified in a

chronic stimulation program which induced better resistance

to fatigue in dystrophic mice [53]. Furthermore, on a group of

16 boys with Duchenne myopathy, compared to controls,

chronic stimulation of the tibialis anterior and rectus femoris

at low frequency showed that (1) the contractile properties are

characterized by a longer mean relaxation time, (2) there is no

strength loss during a fatigue test but (3) contrary to healthy

children, there is no potentialization at the lowest stimulation

frequencies. Finally, continuing the low-frequency stimula-

tion in six walking children led to a significant increase in

maximal strength compared to the nonstimulated contralateral

muscles [45]. These authors concluded that long-duration

low-frequency electrostimulation training of the quadriceps

femoris improves fatigue resistance in children with

Duchenne myopathy who are still walking; this technique

opens up interesting therapeutic perspectives [44]. The results

obtained by Zupan et al. [57,58] point in the same direction.

Twelve dystrophic children (10 Duchenne two Becker) were

studied in a program of low-frequency electrical stimulation

of the tibialis anterior, for three months [58]. Muscle force

was evaluated with a short voluntary isometric contraction in

the direction of dorsal flexion of the foot. Muscle fatigue was

measured by the strength decrease during a maximal voluntary

contraction held for 1 min. At the end of the training period,

peak torque was significantly improved in 10 out of 12

children, on the stimulated side. Fatigue resistance had not

improved.

In a recent work on a family with nemalin myopathy,

whose evolution is acknowledged to be slow in adults, Gerrits

et al. [17] compared voluntary activity in knee extension

alone or combined with electrostimulation of the quadriceps

femoris at different extension angles. Between 308 and 708 ofknee flexion, the ability to maintain the isometric voluntary

contraction assisted by the electrical stimulation, was higher

than in healthy subjects. Maximal force was obtained with low-

frequency (10 Hz), not with high-frequency (150 Hz) stimula-

tion. The authors concluded that there was a deficit in the

excitation-contraction coupling for high frequencies and

suggested a deficit in the actin-myosin interaction at a high

activation threshold. The interest of this work was to confirm

the use of low-frequency stimulation associated with voluntary

work in pathological muscle strengthening.

To our knowledge, only one controlled study has evaluated

the therapeutic effect of electrical stimulation on progressive

spinal atrophy type II/III [16]. This randomized study analyzed

the effect of low-frequency and low-intensity stimulation

applied at night on the deltoid and biceps muscles for six to

12 months. The other arm received placebo stimulation.

Thirteen patients from 5 to 19-years-old were followed for six

months, and eight for one year. No difference in muscle strength

appeared between the trained arm and the other one. Nor did

any difference appear between electrophysiological M-waves

or in functional abilities.

Finally, the results of electrostimulation on muscle or

neuromuscular affections are contrasted. Since the mid-1990s,

no new study has allowed this technique to be added to atreatment program of muscle dystrophy in children or adults.

Two explanations can be proposed: first, follow-ups in therapeutic trials were often short, withshort-term results only, because of the fast evolution of the

muscle affection. Information is insufficient to compare

homogenous groups of patients stimulated or not at different

stages of their illness; second, treatment constraints are often high and, for short-term positive results, require long-time participation, not

always compatible with school, family or work life.

1.4. Conclusion

Even if the use of direct muscle electrostimulation is fairly

common, the evidence level of its efficiency is relatively low,

mainly because of the lack of controlled studies. Furthermore,

no superiority of this method over traditional muscle

strengthening techniques has been clearly shown for strength

gain.

In athletic training or pathology treatments, the programs

that associate electrostimulation with voluntary muscle

contractions (superimposed or combined electrostimulation)

seem to have more effect than electrostimulation alone. Apart

from its application in exercise traumatology or orthopaedics,

direct muscle electrostimulation could be an efficient tool to

fight the reduction in muscle mass and function observed in

numerous affections leading to long bed rest, including those in

the context of intensive care. Currently, the number of studies

on this topic is low. The efficiency of muscle electrostimulation

in the battle against sarcopenia, a major cause of activity

reduction in the elderly, also needs to be evaluated.

2. Version francaise

2.1. Historique de lelectrostimulation musculaire directe

Les applications physiologiques de lelectrostimulation

motrice ont debute au XIXe siecle avec Duchenne de Boulogne.

Appliquant la technique des courants par induction mise au

point par Faraday en 1831 (courant faradique), Duchenne de

Boulogne sattache a une observation minutieuse de la

cinesiologie musculaire, tout en en soulignant les limites :

en effet, sil est vrai que lexploration electromusculaire peut

faire connatre exactement laction propre dun muscle, je dois

faire observer que rarement elle apprend quels sont les autres

muscles dont le concours est necessaire a la production du

mouvement physiologique quil est destine a executer. . . [14].La description par Remak en 1858 des points moteurs des

muscles, les observations de gain du volume des muscles

denerves (Debedat, en 1894 dans la ref. [43]) et des muscles

sains (Bordier, en 1902 dans la ref. [43]), sous leffet de

lelectrostimulation directe, ont amene au developpement du

traitement excitomoteur des muscles lorsquils sont prives du

controle nerveux peripherique (Jackson, en 1945 dans la ref.

[43]), au recours a laccroissement de la force musculaire chez

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451446le sportif (Kotz, en 1971 dans la ref. [43]), au traitement par

stimulation electrique nocturne des muscles paravertebraux

dans le traitement des scolioses juveniles [1].

Parallelement, ont ete precisees les modifications histo-

chimiques des fibres musculaires sous linfluence de lelectro-

stimulation [35], ouvrant la voie aux programmes de

renforcement musculaire et de lutte contre latrophie dimmo-

bilisation.

2.2. Effets physiologiques de lelectrostimultion

musculaire directe sur muscle sain

Lelectrostimulation musculaire directe agit en fait princi-

palement par stimulation percutanee des axones des nerfs

moteurs peripheriques. Le seuil dexcitabilite des axones, qui

est nettement inferieur a celui des cellules musculaires,

explique cette chronologie et le caractere secondaire de la

stimulation des fibres musculaires. La contraction serait induite

par la depolarisation des motoneurones et, indirectement, par la

depolarisation des afferences sensorielles [810]. Elle entrane

un recrutement musculaire specifique, dont les caracteristiques

different du recrutement physiologique lors des contractions

volontaires. Ce recrutement particulier serait a lorigine des

gains de force observes lors de lutilisation de lelectro-

stimulation chez des sujets sains (cf. infra). Il a souvent ete

propose que la stimulation electrique recrute les unites motrices

dans lordre inverse de la commande volontaire, a lencontre du

principe de taille dHennemann. Ce principe stipule que les

unites motrices lentes, associees aux fibres nerveuses de petit

diametre, sont activees les premieres, avant que les unites

motrices rapides, associees aux fibres de gros diametre,

nentrent en jeu. Cependant, la vision actuelle propose plutot

un recrutement non selectif par rapport au type dunite motrice

et synchrone, contrairement a la contraction volontaire [20,25].

Le patron de recrutement pourrait dependre notamment du

placement, de la surface et du type delectrode, du muscle

stimule, qui determinent le volume conducteur et la densite du

courant. Ce patron non physiologique , en particulier son

aspect synchrone, expliquerait en partie la fatigue locale

importante induite par lelectrostimulation [50]. Differents

phenomenes physiologiques accompagnent la contraction

induite par stimulation electrique. La spectroscopie RMN, la

biopsie, entre autres, ont permis de mettre en avant les elements

suivants. Au cours de la stimulation musculaire, la demande

metabolique serait plus elevee que lors de la contraction

volontaire, avec des taux de phosphates inorganiques et

doxygenation cellulaire plus eleves, et ce de facon pro-

portionnelle a lintensite de la contraction [42,51]. De plus, la

demande cardiorespiratoire serait egalement modifiee : la

consommation doxygene, la frequence ventilatoire et le

quotient respiratoire etaient superieurs pendant un entrane-

ment en resistance lorsque la contraction concentrique du

quadriceps etait induite par stimulation electrique plutot que

realisee volontairement [50]. Enfin, il faut noter que la

contraction induite par stimulation electrique saccompagne

dune activite cerebrale du cortex sensorimoteur primaire et de

laire motrice supplementaire [21]. Ces resultats ne permettentcependant pas daffirmer que lactivite cerebrale est directe-

ment liee a la contraction puisque des mouvements, et donc des

afferences sensorielles, etaient induits par la stimulation.

Chez le sujet sain, lorsque la stimulation electrique

musculaire est utilisee de facon repetee, au cours dun

entranement par exemple, la physiologie musculaire montre

differents signes dadaptation. Plusieurs etudes ont montre une

augmentation de la surface de section des fibres musculaires du

type I ou des groupes musculaires entranes [18,22,29,42].

Cette augmentation de la surface de section etait associee a une

augmentation de la presence de lisoforme IIa des chanes

lourdes de myosine [29] et semble plus importante lorsquune

activite volontaire est associee a la stimulation [42]. Ces

modifications musculaires dependraient du type de stimulation

applique et peuvent etre associees a une augmentation de la

force maximale du muscle entrane, ainsi que de lactivite

electromyographique associee [18,29,42]. Quatre semaines

apres lentranement, le gain de force tend a se reduire, tout

comme la surface de section musculaire, sans toutefois revenir

au niveau initial et ce contrairement a lactivite electro-

myographique. Ces derniers resultats laissent penser que le gain

de force serait lie a la fois a des adaptations musculaires locales

et de la commande motrice [18].

2.3. Applications

2.3.1. Chez le sportif

Differents programmes dentranement ont evalue leffet de la

stimulation electrique musculaire sur la force musculaire et ses

eventuelles repercussions sur la masse et la fonction motrice.

Chez des rugbymen, par exemple, la stimulation isolee des

muscles quadriceps femoris, gluteus maximus et triceps surae a

permis une augmentation de leur force et de leur puissance, de

facon marquee apres 12 semaines [2]. En revanche, les

mouvements specifiques au rugby, comme la melee ou le sprint,

ne beneficiaient pas de ces ameliorations. En combinant

lelectrostimulation et un entranement plyometrique, une

augmentation des performances en saut vertical et de la vitesse

de sprint peut accompagner laugmentation de force maximale

du quadriceps femoris [22]. Cependant, lelectrostimulation

seule a reduit la vitesse de sprint et ses benefices sont en general

inferieurs a ceux observes en combinaison avec lentranement

plyometrique. Dans une revue recente, Requena Sanchez et al.

[42] indiquent que le moment maximal isocinetique peut etre

augmente si lentranement par electrostimulation est combine a

un entranement en mode concentrique rapide (1808/s) ouexcentrique. Cependant, ces exemples, comme la plupart des

etudes publiees, ont des qualites methodologiques faibles [4].

Dans cette revue de Bax et al. [4], les auteurs montrent que la

stimulation electrique est plus efficace pour augmenter la force

musculaire du quadriceps femoris, seulement lorsquelle est

comparee a labsence dexercice, et ce dautant plus que la

stimulation est combinee avec une activite volontaire simultanee.

Neanmoins, la stimulation electrique nest pas plus efficace

quun entranement classique, hormis, peut-etre, lorsquelle est

combinee a un entranement excentrique. Ainsi, comme lont

resume Vanderthommen et Duchateau [51], les gains de force lies

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451 447a lelectrostimulation sont, au mieux, aussi eleves que ceux

obtenus lors dun entranement utilisant des contractions

volontaires. Comme les gains semblent lies a lintensite de

stimulation, le confort des courants utilises est primordial, meme

si aucun protocole standardise nexiste actuellement. Lelectro-

stimulation chez les sujets sains ou sportifs represente donc un

outil complementaire a lentranement de force classique,

dautant plus lorsquil est combine a une contraction volontaire

simultanee, grace a laugmentation possible de la charge de

travail en dehors des entranements classiques et de par son

patron de stimulation different du patron volontaire [39,51].

Enfin, bien que le gain de force semble pouvoir etre transfere

dans les activites sportives, des resultats negatifs [22] laissent

penser quun entranement technique est toujours obligatoire

pour ameliorer la coordination musculaire necessaire a la tache a

ameliorer [42].

2.3.2. Lors de situations dimmobilisation segmentaire

Les genoux operes ou presentant des lesions traumatiques

severes, telle quune rupture des ligaments croises anterieurs,

conduisent habituellement a une immobilisation segmentaire

plus ou moins complete et prolongee. Dans cette situation, la

rapidite dinstallation de lamyotrophie et de la perte de force du

quadriceps femoris a conduit de nombreux therapeutes a utiliser

lelectrostimulation musculaire directe dans le but de limiter

cette atteinte musculaire et permettre aux patients de retrouver

plus rapidement leur niveau fonctionnel habituel. Cette

technique est en outre reputee permettre la levee de la sideration

musculaire post-traumatique ou postoperatoire. Lelectrostimu-

lation peut etre appliquee au cours et/ou au decours de la periode

dimmobilisation de maniere isolee ou associee aux exercices

musculaires volontaires. Meme si lelectrostimulation semble

particulierement interessante dans les situations dimmobilisa-

tion segmentaire, les essais randomises realises dans cette

indication apportent des resultats nuances. Dans les etudes qui

ont compare, au cours de la periode dimmobilisation, des

patients beneficiant ou non de seances delectrostimulation

[19,34,48,54], les resultats sont globalement en faveur de la

pratique de lelectrostimulation, comme cela est mis en evidence

dans la meta-analyse realisee par Bax et al. [4]. Le principal

resultat etant une moindre degradation de la force musculaire

chez les patients electrostimules. La majorite des etudes realisees

au decours de la periode dimmobilisation souligne egalement

leffet favorable de lelectrostimualtion quadricipitale [4] avec

meme, pour certains, [48] une normalisation plus rapide du

pattern de marche en postoperatoire. Neanmoins, Lieber et al.

[28] nont pas retrouve de difference significative, en termes de

force maximale dextension du genou, entre des patients ayant

beneficie de seances delectrostimulation et ceux ayant realise

des contractions musculaires volontaires, avec une intensite

dexercice comparable. A un an postoperatoire (ligamentoplastie

des croises anterieurs), aucune difference netait retrouvee entre

les deux groupes de patients.

Lorsquils sont observes, les benefices en termes de gain de

force paraissent correles a lintensite [47] de lelectrostimula-

tion et a la frequence des seances [40]. Par ailleurs,

lassociation des seances delectrostimulation aux exercicesde contractions volontaires, selon differentes modalites

(surimposition ou combinaison), semble etre plus efficace

que chacune de ces deux techniques employees de maniere

isolee [12,39,48]. Recemment, une methode hybride associant

des exercices de contractions volontaires de muscles agonistes

a une electrostimualtion des antagonistes, avec comme objectif

de creer une resistance au mouvement volontaire, a ete

proposee pour renforcer les flechisseurs et extenseurs du genou

[23]. Des etudes complementaires visant a comparer ce procede

aux techniques habituelles de renforcement musculaire contre

resistance ou aux techniques de surimposition (electrostimu-

lation + contractions volontaires) paraissent necessaires.

Lelectrostimulation du quadriceps femoris a egalement ete

proposee au decours de fractures de hanche [27] ou de la pose

de protheses de hanche sur coxarthrose [48] afin de lutter contre

lamyotrophie qui se developpe rapidement dans ces situations.

La perte de force qui accompagne la diminution de la masse

musculaire est estimee a 4 % par jour au cours de la premiere

semaine suivant une chirurgie de hanche. Dans letude

randomisee de Suetta et al. [49], les auteurs ont compare,

apres un remplacement prothetique de hanche, les benefices

dun programme de reeducation classique seul ou associe, soit a

des exercices de renforcement musculaire du quadriceps contre

resistance soit a des seances delectrostimulation. Dans ce

dernier cas, les seances etaient debutees des le premier jour

postoperatoire et poursuivies a raison dune heure par jour

pendant 12 semaines. Seuls les patients ayant beneficie de

seances de renforcement musculaire contre resistance avaient

une duree de sejour significativement plus courte que les autres.

En revanche, les patients des deux groupes (electrostimulation

et renforcement contre resistance) amelioraient significative-

ment leurs resultats fonctionnels (vitesse de marche, temps de

montee de dix marches descalier, cinq levers successifs de

chaise) apres 12 semaines de programme. Seul le renforcement

musculaire contre resistance avait une influence favorable sur la

surface de section du quadriceps femoris, mesuree par

tomodensitometrie, et sur la force isocinetique dextension

du genou. Dans letude randomisee contre placebo (electro-

stimulation simulee) realisee par Lamb et al. [27], chez des

femmes tres agees (83,4 3,7 ans) victimes dune fracture dehanche, le programme delectrostimulation du quadriceps

(trois heures par jour pendant six semaines) permettait aux

femmes qui en beneficiaient de retrouver leur niveau de

mobilite habituel plus rapidement que les autres.

Ainsi, dans le cadre daffections traumatiques ou orthope-

diques des membres inferieurs, lelectromyostimulation parat

avoir toute sa place dans la prise en charge initiale des patients.

Lobjectif de ce traitement est daider a limiter lamyotrophie et

la perte de force induites par le traumatisme, lacte chirurgical

lui-meme et aggravees par une eventuelle immobilisation

segmentaire transitoire.

2.3.3. Lors daffections cachectisantes et de situations

dalitement prolonge

Plusieurs etudes ont demontre linteret de lelectrostimula-

tion musculaire directe au cours daffections medicales

(bronchopneumopathie chronique obstructive [BPCO] et

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451448insuffisance cardiaque [IC] en particulier) qui dans leur forme

severe saccompagnent dun etat cachectique. Cet etat se

caracterise notamment par une amyotrophie diffuse et par une

degradation severe de la force musculaire. Ainsi, Vivodtzev

et al. [52] soulignent linteret dassocier des seances delectro-

stimulation musculaire (quadriceps femoris) a un programme

de reeducation traditionnelle, associant marche lente sur tapis

roulant et exercices de mobilisation active des membres, chez

des sujets BPCO et denutris. Dans cette etude controlee et

randomisee, les patients beneficiant dune telle association

amelioraient significativement la force de leurs quadriceps, leur

perimetre de marche et leur indice de masse corporelle. Par

ailleurs, une diminution significative de la dyspnee au cours

dactivites de la vie quotidienne etait notee. Des effets

comparables ont ete rapportes dans dautres essais randomises

[6,36] avec des protocoles delectrostimulation variables, qui

interessaient les quadriceps seuls ou associes aux flechisseurs

du genou. Outre lamelioration de force musculaire, ces etudes

ont confirme un effet benefique de lelectromyostimulation sur

la dyspnee, les capacites de marche ainsi que la tolerance aux

exercices. Zanotti et al. [56] ont par ailleurs rapporte un effet

benefique de lelectrostimulation musculaire, associee a des

exercices de mobilisation active, sur la duree dalitement

dinsuffisants respiratoires chroniques qui necessitaient une

assistance ventilatoire mecanique.

Chez les patients presentant une IC chronique, lelectro-

stimulation a basse frequence des muscles des membres

inferieurs (quadriceps femoris ischiojambiers tricepssurae suivant les etudes) ont apporte egalement des benefices

comparables a ceux observes chez les sujets BPCO [30,37,41].

En dehors du gain de force retrouve au niveau des muscles

stimules, une amelioration des capacites aerobies a ete

rapportee [37] de meme quune amelioration de la qualite de

vie (evaluee par la SF-36), en particulier chez des patients en

attente de transplantation cardiaque [41].

Nuhr et al. [37] ont rapporte egalement, apres lapplication

dun protocole delectrostimulation relativement intense (4 h/j,

sept jours par semaine pendant dix semaines, avec une intensite

de contraction comprise entre 25 et 30 % de la contraction

volontaire maximale) une modification de lexpression des

chanes lourdes de myosine au niveau de prelevements

biopsiques du muscle vastus lateralis. En effet, les auteurs

observaient une augmentation de lexpression des MHC de type

I au detriment des MHC II d/x.

En dehors des situations pathologiques, rappelons que

lelectromyostimulation est un des moyens habituellement

utilises par les astronautes lors des vols en microgravite pour

lutter contre lamyotrophie et la perte de force musculaire [11].

Differents travaux realises en microgravite simulee (alitement

prolonge en position anti-orthostatique) ont permis danalyser

les benefices de lelectrostimulation dans cette situation

[15,26]. La methode hybride, precedemment decrite (cf supra),

pourrait saverer particulierement interessante [31].

2.3.4. Chez le sujet age sarcopenique

Le renforcement musculaire contre resistance represente a

lheure actuelle le principal moyen de lutte contre ladegradation de la masse et de la force musculaires observee

au cours du vieillissement. Chez la personne agee, des gains de

force ou de puissance importants, proportionnellement equi-

valents a ceux obtenus chez des sujets jeunes soumis a des

exercices comparables, ont ete observes [5,24]. Meme si les

facteurs nerveux dadaptation paraissent plus importants

que les facteurs dadaptation musculaire, laugmentation de

la synthese proteique sous leffet du renforcement contre

resistance est, dans une certaine mesure, comparable a celle

observee chez des sujets jeunes [55].

Neanmoins, meme si dans le cadre des protocoles de

recherche clinique publies, des programmes particulierement

intenses de renforcement ont pu etre effectues [3,46], cela

savere beaucoup plus complique en pratique quotidienne. La

polypathologie, le manque de motivation, les troubles des

fonctions superieures rendent souvent difficile la realisation

de tels protocoles. Lelectrostimulation musculaire directe

pourrait representer un bon moyen de lutte contre linstalla-

tion ou laggravation du processus sarcopenique, en particu-

lier chez les sujets ages fragiles. Cependant, pour lheure, tres

peu detudes se sont interessees a ce sujet. Dans leur travail,

Caggiano et al. [7] ont retrouve, chez des sujets dage

moyen 72 4 ans, une amelioration equivalente de la forceisometrique maximale du quadriceps apres 12 sessions de

renforcement conventionnel ou delectrostimulation quadri-

cipitale. Plus recemment, Paillard et al. [38] ont analyse les

effets de lelectrostimulation surimposee ou non aux

contractions musculaires volontaires. Les parametres analyses

etaient la force musculaire, la composition corporelle,

certaines donnees de posturographie et la detente verticale

de femmes agees de 62 a 75 ans. Apres randomisation, les

participantes ont beneficie soit de seances delectrostimula-

tion des quadriceps, soit dexercices de montee et de descente

de marche descalier, soit des deux precedents programmes

associes. Le rythme de prise en charge, quel que soit le

programme realise, etait de quatre seances par semaine

pendant six semaines. Les resultats montrent que les trois

programmes etaient efficaces, de maniere comparable, sur la

force isometrique et isocinetique des membres inferieurs et

sur la detente verticale. La superiorite du programme

delectrostimulation surimposee par rapport aux deux autres

napparaissait pas clairement. Aucun des trois programmes ne

modifiait la composition corporelle des personnes ni les

parametres de posturographie. A notre connaissance et jusqua

present, aucune etude ne sest interessee specifiquement aux

effets de lelectromyostimulation isolee ou surimposee afin

dameliorer la fonction musculaire de sujets presentant une

sarcopenie averee.

2.3.5. Dans les pathologies musculaires et

neuromusculaires

Lapplication therapeutique de lelectromyostimulation a la

pathologie musculaire ou neuromusculaire reste un sujet

controverse. Duchenne de Boulogne [14] avait exprime son

depit des pietres resultats quil avait observes dans la

degenerescence musculaire graisseuse ou dystrophie

musculaire qui porte son patronyme.

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451 449Quelques etudes controlees du gain de force musculaire

obtenu par electromyostimulation ont ete publiees dans les

annees 19801990. Milner-Brown et al. ont compare deux

types de programmes dans une serie de respectivement 16 [33]

et dix patients [32] adultes atteints de dystrophie musculaire

de type facio-scapulo-humerale, Becker, myotonique ou de

ceinture : un entranement de deux a trois mois par renforcementmusculaire contre forte resistance nameliorait pas les

muscles deficitaires (ceux dont la force est inferieure a

10 % de la force normale attendue) ; en revanche, la force des

muscles plus moderement deficitaires (plus de 15 % de la

force normale) etait amelioree, ce dautant plus que la

progression de la maladie etait lente ; un entranement, combinant une stimulation electriqueunilaterale du muscle tibialis anterior et du quadriceps

femoris a une extension volontaire du genou contre faible

resistance, a raison de deux heures par jour, cinq jours par

semaine pendant deux a 14 mois, montrait que la force

dextension maximale du genou augmentait de facon

significative (108 56 %) ; les extenseurs du genoucontrolateral, non stimules, presentaient egalement un gain

de force ; cependant, la stimulation des muscles de la flexion

dorsale de la cheville etait inefficace. La encore, il etait note

une nette difference de gain selon la severite de latteinte et la

progression de la maladie.

La stimulation electrique des muscles atteints a donne des

resultats discordants chez lenfant atteint de dystrophie

musculaire de type Duchenne ou Becker. La stimulation de

basse frequence semblait la plus benefique, mais ses resultats,

sur les proprietes contractiles des muscles, netaient pas

superieurs a ceux observes apres tenotomie precoce, en cas de

retractions [13]. Ces faits ont pu etre verifies experimentale-

ment chez la souris dystrophique au cours dun programme de

stimulation chronique soulignant lamelioration de la resistance

a la fatigue [53]. Sur un groupe de 16 garcons atteints de

maladie de Duchenne compare a un groupe temoin, la

stimulation chronique de basse frequence des muscles tibialis

anterior et rectus femoris a montre que les proprietes

contractiles etaient caracterisees par un temps de relaxation

moyen tres allonge, quil ny avait pas par ailleurs de perte de la

force lors dun test de fatigabilite mais, au contraire de lenfant

normal, quil ny avait pas de potentialisation aux frequences

les plus basses de stimulation. Enfin, la poursuite de la

stimulation de basse frequence chez six enfants marchant

montrait une amelioration significative de la force maximum,

par comparaison aux muscles non stimules du membre inferieur

controlateral [45]. Ces memes auteurs ont conclu que

lentranement myoelectrique de basse frequence prolonge

au niveau du quadriceps femoris permettait une amelioration de

la resistance a la fatigue chez lenfant atteint de Duchenne qui

marche encore et que cette technique ouvrait des perspectives

therapeutiques seduisantes [44]. Les resultats obtenus par

Zupan et al. [57,58] vont globalement dans le meme sens.

Douze enfants atteints de dystrophie musculaire (dixDuchenne, deux Becker) ont ete inclus dans un programme

de stimulation electrique de basse frequence du muscle tibialis

anterior pendant trois mois [58]. La force musculaire etait

evaluee par une contraction isometrique breve des flechisseurs

dorsaux de la cheville. La fatigue musculaire etait mesuree par

la baisse de la force au cours dune contraction maximale

soutenue pendant une minute. A la fin de la periode de

stimulation, le moment de force maximal etait ameliore

significativement chez dix enfants sur 12 du cote du membre

inferieur stimule. En revanche, la resistance a la fatigue netait

pas modifiee.

Dans un travail recent portant sur une famille atteinte de

myopathie a batonnets (nemaline myopathy) dont on admet

levolutivite moderee chez ladulte, Gerrits et al. [17] ont

compare lactivation volontaire de lextension du genou seule et

couplee a lelectrostimulation du quadriceps femoris a

differents degres dextension. Entre 30 et 708 de flexion degenou, la capacite a maintenir la contraction volontaire

isometrique, renforcee par la stimulation electrique, etait

superieure a celle des sujets sains. La force maximale etait

obtenue avec une stimulation electrique de basse frequence

(10 Hz) et non pour des frequences elevees (150 Hz). Les

auteurs en concluaient a un deficit du couplage excitation-

contraction pour les hautes frequences et suggeraient un deficit

dinteraction actine-myosine au seuil eleve dactivation.

Linteret de ce travail est de confirmer lutilisation des

stimulations de basse frequence associee au travail volontaire

dans le renforcement du muscle pathologique.

A notre connaissance, une seule etude controlee a evalue

leffet therapeutique de la stimulation electrique dans lamyo-

trophie spinale progressive de type II/III [16]. Cette etude

randomisee a evalue leffet dune stimulation de basse

frequence et basse intensite appliquee la nuit sur le deltode

et le biceps brachii pendant six a 12 mois ; lautre membre

superieur recevait une stimulation placebo. Treize patients de

cinq a 19 ans ont ete suivis pendant six mois et huit pendant un

an. Aucune difference netait constatee sur le bras traite, par

rapport au bras oppose, sur la force de flexion du coude ou de

labduction de lepaule. Il ny avait pas non plus de difference

des ondes M en electrophysiologie ni damelioration fonc-

tionnelle.

Finalement, les resultats de lelectromyostimulation dans les

affections musculaires ou neuromusculaires sont contrastes.

Depuis le milieu des annees 1990, il ny a pas eu a notre

connaissance de nouvelles etudes permettant dintegrer

clairement lelectrotherapie musculaire dans un programme

consensuel de traitement des dystrophies musculaires de

lenfant ou de ladulte. Peut-etre y a-t-il a cela deux types

dexplications : dune part, les essais therapeutiques ont ete effectues sur uneperiode relativement courte et les resultats analyses a court

terme, au regard dune evolutivite parfois rapide de

laffection musculaire. Nous ne disposons pas dinformation

suffisante permettant de comparer des groupes homogenes de

patients stimules et non stimules aux differents stades

evolutifs de leur affection ;

P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451450 dautre part, les contraintes du traitement sont importantes et,pour les resultats positifs rapportes a court terme, elles

imposent une forte disponibilite des patients qui semble peu

compatible avec la poursuite de la vie familiale, scolaire et,

pour certains, socioprofessionnelle.

2.4. Conclusion

Meme si son utilisation est de pratique courante, le niveau de

preuve defficacite de lelectrostimulation musculaire directe

reste, selon les indications, relativement modeste du fait

notamment du faible nombre detudes controlees. En outre, la

superiorite de cette technique par rapport aux methodes

traditionnelles de renforcement musculaire, sur le gain de force

obtenu, nest pas clairement demontree.

Que ce soit dans le cadre de lentranement du sportif ou a

visee therapeutique, les effets des programmes associant

lelectrostimulation aux contractions musculaires volontaires

(electrostimulation surimposee ou combinee) paraissent supe-

rieurs a ceux obtenus par lelectrostimulation seule. En dehors

de ses applications en traumatologie sportive ou en orthopedie,

lelectrostimulation musculaire directe pourrait representer un

moyen de lutte efficace contre la degradation de la masse et de

la fonction musculaire observee dans bon nombre daffections

conduisant a un alitement prolonge, y compris dans un contexte

de reanimation. Pour lheure, le nombre detudes consacrees a

ces applications reste faible. De la meme maniere, lefficacite

des programmes delectrostimulation musculaire dans la lutte

contre la sarcopenie, qui represente une source majeure de

limitation dactivite chez les personnes agees, meriterait detre

analysee.

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Electrical stimulation and muscle strengtheningEnglish versionHistory of direct muscle electrostimulationPhysiological effects of direct muscle electrostimulation on sound musclesUse of electromyostimulationWith athletesDuring limb immobilization periodsDuring affections leading to cachexia and extended bed-restIn subjects with sarcopeniaIn muscle and neuromuscular pathologies

Conclusion

Version franaiseHistorique de lelectrostimulation musculaire directeEffets physiologiques de lelectrostimultion musculaire directe sur muscle sainApplicationsChez le sportifLors de situations dimmobilisation segmentaireLors daffections cachectisantes et de situations dalitement prolongeChez le sujet ge sarcopeniqueDans les pathologies musculaires et neuromusculaires

Conclusion

References