CLINICAL APPLICATIONS OF NMES IN ACL REHABILITATION
1. Muscle Re-education NMES is particularly useful in the early phase post-ACLR when voluntary control is reduced. By artificially activating muscle fibers, NMES reinforces the brain-muscle connection through cortical and spinal-level plasticity, aiding in motor relearning. Buckthorpe supports combining NMES with functional tasks (e.g. sit-to-stand), which enhances neuromuscular re-education (Buckthorpe et al, 2023). 2 2. Prevention of Muscle Atrophy During periods of limited activity or weightbearing, NMES helps preserve quadriceps muscle mass. Research shows that early NMES application within the first 1–3 weeks post-op mitigates disuse atrophy and supports faster return of strength (Palmieri-Smith et al., 2022). 3 3. Strength Augmentation When paired with voluntary contractions, NMES has been shown to amplify motor unit recruitment, especially in the presence of persistent inhibition. Buckthorpe highlights its role within a multimodal strength strategy, alongside blood flow restriction (BFR) and progressive loading (Buckthorpe et al, 2019; 2023). 1,2 4. Improved Force Control and Motor Unit Behavior Beyond raw strength gains, NMES enhances force steadiness and motor unit coordination— Bickel et al 2011), 22 crucial for safe, controlled movements in the return-to-sport phase. A systematic review and meta-analysis by Hauger et al. (2018) concluded that NMES in addition to standard physical therapy significantly improves quadriceps strength and physical function in the early post operative period compared to standard physical therapy alone. 10
Conclusion
NMES is more than just a passive modality—it’s an evidence-backed intervention that addresses early-stage neuromuscular deficits post-ACLR. Research in this field affirms NMES value as part of an integrated, progressive rehabilitation plan, especially when strength and movement quality are used as benchmarks for progression, and not time alone.
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