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Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation
Pietrosimone BG, Hart JM, Saliba SA, Hertel J, Ingersoll CD
Medicine and Science in Sports and Exercise 2009 Jun;41(6):1175-1181
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: To determine whether transcutaneous electrical nerve stimulation (TENS) and focal knee joint cooling will affect the quadriceps central activation ratio (CAR) in patients with tibiofemoral osteoarthritis. METHODS: Thirty-three participants with diagnosed tibiofemoral osteoarthritis were randomly allocated to the 45-min TENS treatment (six males and four females, 56 +/- 10.1 yr, 174.11 +/- 10.78 cm, 89.34 +/- 21.3 kg), the 20-min focal knee joint cooling treatment (six males and five females, 58 +/- 8.4 yr, 176.41 +/- 8.29 cm, 83.18 +/- 17.97 kg), or the control group (five males and seven females, 54 +/- 9.9 yr, 166.37 +/- 13.07 cm, 92.14 +/- 25.37 kg). Volitional quadriceps activation, maximal voluntary isometric contraction, and subjective pain measurements were conducted at baseline and at 20, 30, and 45 min. The 20-min focal knee joint cooling intervention consisted of two 1.5-L ice bags to the anterior and posterior aspects of the knee. The TENS group received 45 min of a sensory, biphasic square wave stimulation (150-mus phase duration and 150 pps) from four 2x2-inch electrodes positioned around the patella. RESULTS: TENS resulted in a significantly higher percent change in CAR scores compared with control at 20 min (6.4 +/- 4.8 versus -3.5 +/- 8, p = 0.006), 30 min (9.7 +/- 10.16 versus -1 +/- 7.9, p = 0.025), and 45 min (11.25 +/- 6.96 versus 0.81 +/- 9.4, p = 0.029). Focal knee joint cooling resulted in significantly higher percent change scores compared with the control group at 20 min (5.75 +/- 7.25 versus -3.5 +/- 8, p = 0.009) and trended to be higher at 45 min (9.06 +/- 9.63 versus 0.81 +/- 9.4, p = 0.098). No significant differences in percent change for CAR were found between the TENS and the focal knee joint cooling group. CONCLUSIONS: Both TENS and focal knee joint cooling increased the quadriceps CAR immediately after application in participants with tibiofemoral osteoarthritis.

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