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Annales de readaptation et de medecine physique 51 (2008) 441451

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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 syste`me 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, France
b
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, electromyostimulation, 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, bedbound, 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

* 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

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P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451

cadre 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 musculaire

1. 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 contraction 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 acknowledges 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 electrostimulation 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

as scrummaging and sprinting, did not benefit from these

improvements. In another study, the combination of electrostimulation 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 to
increase 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. Electrostimulation 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 electrostimulation treatment. Most of the studies on the postimmobilization 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 maximal

443

knee 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 simultaneously) 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 replacement. 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 crosssectional area of the quadriceps, as measured by tomodensitometry, and increased the isokinetic strength in knee extension.
In a randomized study against placebo (sham electrostimulation) with much older women (83.4  3.7 years old) after hip
fracture [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 insufficiencies 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 electrostimulation (quadriceps femoris) with usual rehabilitation (slow gait
training on treadmill and active limb mobilization) in COPD

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and 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 electrostimulation 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 electrostimulation associated with active exercises on the duration
of bed-rest time in patients with chronic respiratory insufficiency who needed mechanical ventilation.
In the patients with chronic cardiac insufficiency, lowintensity 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 electrostimulation 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 an

improvement 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 stairclimbing 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 strengthening
against 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 the
tibialis 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

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case 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 stimulation 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 of
knee 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 lowfrequency (10 Hz), not with high-frequency (150 Hz) stimulation. 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 a

445

treatment program of muscle dystrophy in children or adults.

Two explanations can be proposed:
 first, follow-ups in therapeutic trials were often short, with
short-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 shortterm 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 sie`cle 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

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le sportif (Kotz, en 1971 dans la ref. [43]), au traitement par

stimulation electrique nocturne des muscles paravertebraux
dans le traitement des scolioses juveniles [1].
Paralle`lement, ont ete precisees les modifications histochimiques des fibres musculaires sous linfluence de lelectrostimulation [35], ouvrant la voie aux programmes de
renforcement musculaire et de lutte contre latrophie dimmobilisation.
2.2. Effets physiologiques de lelectrostimultion
musculaire directe sur muscle sain
Lelectrostimulation musculaire directe agit en fait principalement 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 caracte`re 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
diffe`rent du recrutement physiologique lors des contractions
volontaires. Ce recrutement particulier serait a` lorigine des
gains de force observes lors de lutilisation de lelectrostimulation 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
diame`tre, sont activees les premie`res, avant que les unites
motrices rapides, associees aux fibres de gros diame`tre,
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
phenome`nes 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 proportionnelle a` lintensite de la contraction [42,51]. De plus, la
demande cardiorespiratoire serait egalement modifiee : la
consommation doxyge`ne, la frequence ventilatoire et le
quotient respiratoire etaient superieurs pendant un entranement 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 permettent

cependant pas daffirmer que lactivite cerebrale est directement 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
apre`s 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 electromyographique. 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 apre`s 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) ou
excentrique. 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

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a` 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. Lelectrostimulation 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
seve`res, telle quune rupture des ligaments croises anterieurs,
conduisent habituellement a` une immobilisation segmentaire
plus ou moins comple`te 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. Lelectrostimulation peut etre appliquee au cours et/ou au decours de la periode
dimmobilisation de manie`re isolee ou associee aux exercices
musculaires volontaires. Meme si lelectrostimulation semble
particulie`rement interessante dans les situations dimmobilisation 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
` un an postoperatoire (ligamentoplastie
dexercice comparable. A
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 lelectrostimulation et a` la frequence des seances [40]. Par ailleurs,
lassociation des seances delectrostimulation aux exercices

447

de contractions volontaires, selon differentes modalites

(surimposition ou combinaison), semble etre plus efficace
que chacune de ces deux techniques employees de manie`re
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 (electrostimulation + contractions volontaires) paraissent necessaires.
Lelectrostimulation du quadriceps femoris a egalement ete
proposee au decours de fractures de hanche [27] ou de la pose
de prothe`ses 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 premie`re
semaine suivant une chirurgie de hanche. Dans letude
randomisee de Suetta et al. [49], les auteurs ont compare,
apre`s 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 de`s 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 significativement leurs resultats fonctionnels (vitesse de marche, temps de
montee de dix marches descalier, cinq levers successifs de
chaise) apre`s 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 (electrostimulation simulee) realisee par Lamb et al. [27], chez des
femmes tre`s agees (83,4  3,7 ans) victimes dune fracture de
hanche, 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 orthopediques 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 lelectrostimulation musculaire directe au cours daffections medicales
(bronchopneumopathie chronique obstructive [BPCO] et

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P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451

insuffisance cardiaque [IC] en particulier) qui dans leur forme

seve`re saccompagnent dun etat cachectique. Cet etat se
caracterise notamment par une amyotrophie diffuse et par une
degradation seve`re de la force musculaire. Ainsi, Vivodtzev
et al. [52] soulignent linteret dassocier des seances delectrostimulation 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
perime`tre 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, lelectrostimulation a` basse frequence des muscles des membres
inferieurs (quadriceps femoris  ischiojambiers  triceps
surae 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, apre`s 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 prele`vements
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 particulie`rement 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 la

degradation 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 equivalents 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 synthe`se 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 particulie`rement
intenses de renforcement ont pu etre effectues [3,46], cela
save`re 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 linstallation ou laggravation du processus sarcopenique, en particulier chez les sujets ages fragiles. Cependant, pour lheure, tre`s
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 force
isometrique maximale du quadriceps apre`s 12 sessions de
renforcement conventionnel ou delectrostimulation quadricipitale. Plus recemment, Paillard et al. [38] ont analyse les
effets de lelectrostimulation surimposee ou non aux
contractions musculaires volontaires. Les parame`tres analyses
etaient la force musculaire, la composition corporelle,
certaines donnees de posturographie et la detente verticale
de femmes agees de 62 a` 75 ans. Apre`s randomisation, les
participantes ont beneficie soit de seances delectrostimulation 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 manie`re 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
` notre connaissance et jusqua`
parame`tres de posturographie. A
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 pie`tres resultats quil avait observes dans la
degenerescence musculaire graisseuse ou dystrophie
musculaire qui porte son patronyme.

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Quelques 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 renforcement
musculaire 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 electrique
unilaterale 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 genou
controlateral, 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 apre`s tenotomie precoce, en cas de
retractions [13]. Ces faits ont pu etre verifies experimentalement 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 tre`s 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 (dix

449

Duchenne, 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 bre`ve des flechisseurs
dorsaux de la cheville. La fatigue musculaire etait mesuree par
la baisse de la force au cours dune contraction maximale
` la fin de la periode de
soutenue pendant une minute. A
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 de
genou, 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 excitationcontraction 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.
` notre connaissance, une seule etude controlee a evalue
A
leffet therapeutique de la stimulation electrique dans lamyotrophie 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 fonctionnelle.
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 une
periode 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 homoge`nes de
patients stimules et non stimules aux differents stades
evolutifs de leur affection ;

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P. Dehail et al. / Annales de readaptation et de medecine physique 51 (2008) 441451

 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 superieurs 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 manie`re, 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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