Comparing the Effect of Transcutaneous Electrical Nerve Stimulation, Biofeedback Electromyography and Functional Electrical Stimulation on Quadriceps Disinhibition after Anterior Cruciate Ligament Reconstruction

Introduction: Patients with ACL reconstruction often return back to activity with diminished quadriceps activity and strength.  (Patients suffering from ACL can be often rehabilitated with the help of ACL reconstruction, although quadriceps strength and muscle activity might be weak or limited after the surgery.)The present study aimed to compare the effect of Transcutaneous Electrical Nerve Stimulation (TENS), Functional Electrical Stimulation (FES) and Biofeedback Electromyography (B-EMG) on improvement in quadriceps strength and mean value of VMO activation pattern (MVVA) among patients with reconstruction of ACL. Materials and Methods: The study was designed as a randomized control trial. 102 patients, who filled a demographic questionnaire relating to important factors mainly age, height, and weight before the intervention, (all sportsmen) were randomly divided into four groups known as, FES (n=21), TENS (n=21), B-EMG (n=22) and control (n=38). In this study, hand-held dynamometry and biofeedback electromyography were used to assess Quadriceps strength and MVVA respectively. All samples were evaluated at three different time intervals, including prior to the, after and 4 weeks after the treatment.  Additionally, all four groups received Ice pack around the knee and Michle Duck exercise therapy protocol. The treatments provided totally lasted 3 to 5 weeks. The participants in 4 groups received TENS, FES and B-EMG as their main treatments 5 times a week for 45, 15 and 15 minutes successively. Results: The mean scores of MVVA and quadriceps strength after the intervention and after the follow-up increased significantly in all four groups. However the effect of FES on MVVA in comparison with TENS and control group was statistically meaningful in favor of FES group. (As instructed here the last sentence omitted) Conclusion: TENS, FES and B-EMG in combination with cryotherapy and exercise as well as cryotherapy with exercise can reduce VMO inhibition and improve quadriceps strength in patients who undergo ACL reconstruction. However FES in combination with cryotherapy and exercise can be the most effective one.Key words: ACL Reconstruction, Biofeedback, Functional Electrical Stimulation, Quadriceps Inhibition, TEN

Effects of High-Power Diode Laser Irradiation Combined with Electrical Stimulation on Wrist Pain and Function Following Carpal Tunnel Syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common and most well-known compression neuropathy which may manifest as mild, moderate, or severe and lead to various degrees of disability in people. The present study aimed to compare the effect of high-power diode laser beam and Transcutaneous Electrical Nerve Stimulation (TENS) separately and in combination on improvement of wrist pain and function in patients with CTS. Method and Materials: The study was designed as a randomized trial. A total of 45 patients (7 men and 38 women) were randomly divided into three groups of high-power laser (n=15), TENS (n=15), and high-power laser with TENS (n=15). The TENS group received conventional TENS on pain site for two weeks as 5 sessions per week and 30 minutes per session. The high-power laser group received 6.5 J/cm2 laser for two weeks, 5 sessions per week. The group of high-power laser with TENS received conventional TENS and then 6.5 J/cm2 laser for two weeks as 5 sessions per week and 30 minutes per session. The Persian McGill Pain Questionnaire, Visual Analogue Scale (VAS), and the 5-point scale of pain severity of McGill Pain Questionnaire (pain severity) were used to assess pain and the Persian version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was administered to evaluate hand function before and after treatment. All the patients filled a demographic questionnaire including age, height, and weight prior to the intervention. Results: The mean scores of McGill, VAS, pain severity, and DASH questionnaires reduced significantly in high-power laser and high-power laser with TENS groups; however, these variables had no significant difference in the TENS group. Conclusions: High-power laser diode (808 nm, 6.5 j/cm2) can reduce pain and improve hand function in patients with mild to moderate CTS. Laser-induced anti-inflammatory effects and blood flow improvement are possible causes of decreased pain and sensory signs followed by improvement in hand function.Key words: Carpal Tunnel Syndrome, High-Power Laser, Hand, Pain, Transcutaneous Electrical Nerve Stimulatio