The Role of Neuromuscular Electrical Stimulation in Improving Muscle Strength in Spinal Cord Injury Patients

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Published: 2026-03-14
DOI: https://doi.org/10.61919/dmhzc186
Keywords:
neuromuscular electrical stimulation; spinal cord injury; quadriceps strength; rehabilitation; functional independence; SCIM-III; muscle bulk

Main Article Content

Maaham Ali
DPT, MSPT Neuro, Khyber Medical University, Peshawar, Pakistan
Muhammad Hassan Shafiq
MPhil Biological Sciences, Assistant Professor Biology, Federal Directorate of Education, Islamabad, Pakistan
Namra Urooj
MSNMPT, Lecturer, Mukabbir University of Science and Technology, Gujrat, Pakistan
Ifra Ashraf
Associate Professor, Shifa College of Medicine, Islamabad, Pakistan
Wardha Hameed
Doctor of Physical Therapy, Rashid Latif Medical College, Lahore, Pakistan
Fahad Hassan
Doctor of Physical Therapy, Master of Public Health, Dear Life Rehabilitation Center, Lahore, Pakistan
Adil Khaliq
Assistant Professor, Department of Pharmacy, Vertex Institute of Science and Technology, Mardan, Pakistan

Abstract

Background: Spinal cord injury is associated with lower-limb weakness, disuse-related muscle wasting, reduced functional independence, and prolonged rehabilitation needs. Neuromuscular electrical stimulation may help activate weak or poorly recruited muscles and support strength recovery when combined with conventional rehabilitation. Objective: To evaluate the effect of adjunctive neuromuscular electrical stimulation on quadriceps strength, muscle bulk, spasticity, and functional independence in patients with spinal cord injury. Methods: This parallel-group controlled experimental study was conducted in a tertiary care rehabilitation department in Islamabad, Pakistan. Forty patients with spinal cord injury were allocated equally to conventional physiotherapy alone or conventional physiotherapy plus NMES for 12 weeks. NMES was applied bilaterally to the quadriceps for 20 minutes per session, five days per week. Outcomes included handheld dynamometry-based quadriceps strength, thigh circumference, ultrasonographic mid-thigh cross-sectional area, Modified Ashworth Scale score, SCIM-III score, adherence, and adverse events. Results: Four participants did not complete the intervention. Quadriceps strength increased from 11.6 ± 3.0 kg to 22.8 ± 4.8 kg in the NMES group and from 11.4 ± 3.1 kg to 14.0 ± 3.9 kg in the conventional physiotherapy group. SCIM-III improved from 37.8 ± 7.9 to 52.3 ± 9.1 with NMES and from 38.2 ± 8.4 to 44.1 ± 8.9 with conventional physiotherapy. Greater numerical improvements were also observed in thigh circumference and mid-thigh cross-sectional area with NMES. Conclusion: Adjunctive NMES was associated with greater improvement in quadriceps strength, muscle bulk, and functional independence over 12 weeks, with minor adverse events. Larger controlled trials with robust inferential analysis are required.

Article Details

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Vol. 4 No. 5 (2026)

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Articles
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This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

1.
Ali M, Muhammad Hassan Shafiq, Namra Urooj, Ifra Ashraf, Wardha Hameed, Fahad Hassan, et al. The Role of Neuromuscular Electrical Stimulation in Improving Muscle Strength in Spinal Cord Injury Patients. JHWCR [Internet]. 2026 Mar. 14 [cited 2026 Jul. 4];4(5):1-10. Available from: https://jhwcr.com/index.php/jhwcr/article/view/1866

References

1. de Freitas GR, Szpoganicz C, Ilha J. Does neuromuscular electrical stimulation therapy increase voluntary muscle strength after spinal cord injury? A systematic review. Top Spinal Cord Inj Rehabil. 2018;24(1):6-17. doi:10.1310/sci16-00048.

2. Borzuola R, Laudani L, Labanca L, Macaluso A. Superimposing neuromuscular electrical stimulation onto voluntary contractions to improve muscle strength and mass: a systematic review. Eur J Sport Sci. 2023;23(8):1547-1559. doi:10.1080/17461391.2022.2104656.

3. Alashram AR, Annino G, Padua E, Romagnoli C, Mercuri NB. A review of functional electrical stimulation treatment in spinal cord injury. Neuromolecular Med. 2020;22(4):447-463. doi:10.1007/s12017-019-08589-9.

4. Hamid S, Hayek R. Role of electrical stimulation for rehabilitation and regeneration after spinal cord injury: an overview. Eur Spine J. 2008;17(9):1256-1269. doi:10.1007/s00586-008-0729-3.

5. Rahman MA, Tharu NS, Gustin SM, Zheng YP, Alam M. Trans-spinal electrical stimulation therapy for functional rehabilitation after spinal cord injury: review. J Clin Med. 2022;11(6):1550. doi:10.3390/jcm11061550.

6. Dorrian RM, Berryman CF, Lauto A, Leonard AV. Electrical stimulation for the treatment of spinal cord injuries: a review of the cellular and molecular mechanisms that drive functional improvements. Front Cell Neurosci. 2023;17:1095259. doi:10.3389/fncel.2023.1095259.

7. Dolbow DR, Gorgey AS, Johnston TE, Bersch I. Electrical stimulation exercise for people with spinal cord injury: a healthcare provider perspective. J Clin Med. 2023;12(9):3150. doi:10.3390/jcm12093150.

8. Dolbow DR, Bersch I, Gorgey AS, Davis GM. The clinical management of electrical stimulation therapies in the rehabilitation of individuals with spinal cord injuries. J Clin Med. 2024;13(10):2995. doi:10.3390/jcm13102995.

9. Atkins KD, Bickel CS. Effects of functional electrical stimulation on muscle health after spinal cord injury. Curr Opin Pharmacol. 2021;60:226-231. doi:10.1016/j.coph.2021.07.025.

10. Gater DR Jr, Dolbow D, Tsui B, Gorgey AS. Functional electrical stimulation therapies after spinal cord injury. NeuroRehabilitation. 2011;28(3):231-248. doi:10.3233/NRE-2011-0652.

11. Mahoney ET, Bickel CS, Elder C, Black C, Slade JM, Apple D Jr, Dudley GA. Changes in skeletal muscle size and glucose tolerance with electrically stimulated resistance training in subjects with chronic spinal cord injury. Arch Phys Med Rehabil. 2005;86(7):1502-1504. doi:10.1016/j.apmr.2004.12.021.

12. Gorgey AS, Mather KJ, Cupp HR, Gater DR. Effects of resistance training on adiposity and metabolism after spinal cord injury. Med Sci Sports Exerc. 2012;44(1):165-174. doi:10.1249/MSS.0b013e31822672aa.

13. Ryan TE, Brizendine JT, Backus D, McCully KK. Electrically induced resistance training in individuals with motor complete spinal cord injury. Arch Phys Med Rehabil. 2013;94(11):2166-2173. doi:10.1016/j.apmr.2013.05.005.

14. Castro MJ, Apple DF Jr, Rogers S, Dudley GA. A simple means of increasing muscle size after spinal cord injury: a pilot study. Eur J Appl Physiol Occup Physiol. 1999;80(4):394-396. doi:10.1007/S004210050609.

15. Castro MJ, Apple DF Jr, Hillegass EA, Dudley GA. Influence of complete spinal cord injury on skeletal muscle cross-sectional area within the first 6 months of injury. Eur J Appl Physiol Occup Physiol. 1999;80(4):373-378. doi:10.1007/s004210050606.

16. Mohr T, Andersen JL, Biering-Sørensen F, Galbo H, Bangsbo J, Wagner A, et al. Long-term adaptation to electrically induced cycle training in severe spinal cord injured individuals. Spinal Cord. 1997;35(1):1-16. doi:10.1038/sj.sc.3100343.

17. Zbogar D, Eng JJ, Krassioukov AV, Scott JM, Esch BTA, Warburton DER. The effects of functional electrical stimulation leg cycle ergometry training on arterial compliance in individuals with spinal cord injury. Spinal Cord. 2008;46(11):722-726. doi:10.1038/sc.2008.34.

18. Dolbow DR, Gorgey AS, Recio AC, Stiens SA, Groah SL. Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury. J Spinal Cord Med. 2013;36(6):623-631. doi:10.1179/2045772313Y.0000000101.

19. Bekhet AH, Bochkezanian V, Saab IM, Gorgey AS. The effects of electrical stimulation parameters in managing spasticity after spinal cord injury: a systematic review. Am J Phys Med Rehabil. 2019;98(6):484-499. doi:10.1097/PHM.0000000000001064.

20. Sivaramakrishnan A, Solomon JM, Manikandan N. Comparison of transcutaneous electrical nerve stimulation and functional electrical stimulation for spasticity in spinal cord injury: a pilot randomized cross-over trial. J Spinal Cord Med. 2018;41(4):397-406. doi:10.1080/10790268.2017.1390930.

21. Gorgey AS, Lai RE, Khalil RE, Rivers J, Cardozo C, Chen Q, et al. Neuromuscular electrical stimulation resistance training enhances oxygen uptake and ventilatory efficiency independent of mitochondrial complexes after spinal cord injury: a randomized clinical trial. J Appl Physiol. 2021;131(1):265-276. doi:10.1152/japplphysiol.01029.2020.

22. Gorgey AS, Khalil RE, Carter W, Rivers J, et al. Skeletal muscle hypertrophy and enhanced mitochondrial bioenergetics following electrical stimulation exercises in spinal cord injury: a randomized clinical trial. Eur J Appl Physiol. 2025;125:1075-1089. doi:10.1007/s00421-024-05661-6.

23. Gorgey AS, Khalil RE, Carter W, Ballance B, Gill R, Khan R, et al. Effects of two different paradigms of electrical stimulation exercise on cardio-metabolic risk factors after spinal cord injury: a randomized clinical trial. Front Neurol. 2023;14:1254760. doi:10.3389/fneur.2023.1254760.

24. Harkema SJ, et al. The effect of lower limb combined neuromuscular electrical stimulation and nutritional counselling interventions on myofiber type and metabolic function after acute spinal cord injury. Int J Environ Res Public Health. 2023;20(20):6958. doi:10.3390/ijerph20206958.

25. Hoekstra S, King JA, Fenton J, Kirk N, Willis SA, Phillips SM, et al. The effect of home-based neuromuscular electrical stimulation-resistance training and protein supplementation on lean mass in persons with spinal cord injury: a pilot study. Physiol Rep. 2024. doi:10.14814/phy2.70073.

26. Wasim MA, Alazzam AM, Gorgey AS. Role of electrically evoked muscle hypertrophy on spasticity in persons with spinal cord injury. J Clin Med. 2025;14(11):3972. doi:10.3390/jcm14113972.

27. Pelletier C, et al. Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines. Appl Physiol Nutr Metab. 2023;48(12):882-895. doi:10.1139/apnm-2023-0227.