R. Castillo-Lozano portional to the energy used for the contraction of skeletal muscle fibres during brief periods of isometric activity31. On this basis, op-timal stimulation is obtained when a contraction (power) is reached during stimulation of the motor point of the quadriceps muscle1. The motor point stimulation showed statistically significant changes in metabolic parameters when compared to the challenges suggested by a guide that comes with the NMES equipment32. The energy required to maintain ATP turnover during muscle contraction is initially derived from immediate intramuscular phosphocreatine subsequently restored in the recovery phase by oxidative metabo-lism33. The higher oxygen consumption after muscle contraction, the greater the energy expenditure during the following quadriceps muscle contractions. At the point when the motor is energized, HHB increased during recovery, suggesting a higher metabolic stress27. Moreover, considering that the regulation of muscle perfusion de-pends proportionally on the local release of metabolites automatic adaptation hyperemic response was observed in the recovery pha-se34. The decrease in tissue oxygen saturation during contraction has been attributed to improved cellular uptake by mitochondria oxygen as resulting from increased metabolism of the active motor units and intramuscular increased pressure reduces blood supply and oxygen in muscle fibres34. TENS stimulation protocol One of the most used in treatment by electrical equipment is the TENS strengthening. Its acquisition and effectiveness/cost make it an item widely used by physiotherapists35,36. After reviewing recent studies, we can see that TENS parameters vary between studies. Pulse frequencies ranged from 25 to 100 Hz; phase duration ranged from 140-600 milliseconds (ms), pulsed wave varied between mo-nophasic and biphasic symmetrical. Similarly, therapy times ranged from 15-60 minutes per day, 3-5 days a week, and between 4-12 weeks of treatment. Despite this variation in parameters, using sym-metrical biphasic current pulses, preferably using as benchmarks between 250-400 ms duration of phase with stimulation frequencies between 40-80 Hz and the highest intensity tolerated by the sub-ject, all suggested it as the ideal intervention for quadriceps muscle strengthening37, as the muscle work is assimilated to that made with regular exercises to improve strength levels. Immune response during and after the electrical capacity by NMES The proper functioning of the immune system is essential for good health. In recent years, great effort has been invested in cla-rifying the possible health risks from electromagnetic fields of the environment and the different artificial sources38. NMES is used as a complementary tool for muscle strengthening, either in clinical practice or for preventive purposes. The stimulation parameters to test the influence of NMES in the immunology system were mea-sured by monophasic rectangular pulses of 0.3 ms width and fre-quency of 20 Hz39. The intensity of electrical stimulation remained below the pain threshold (tolerable limit – not tolerable). This was enough to cause a contraction of the muscles stimulated. Electrical stimulation was cyclic (7seg / 7seg), lasting 20 minutes. 244 Sanid. mil. 2015; 71 (4) There was no statistically significant change or clinically sig-nificant effect on the immunological changes after application of NMES40: • Biochemical Determination of sodium, potassium, calcium, chloride, glucose, urea, creatinine, creatine kinase, cortisol and C-reactive protein (CRP). • Differential white blood cells (leukocytes, lymphocytes, neu-trophils, monocytes). • Determination of the lymphocytes with the following cha-racteristics: CD3, CD19, CD4, CD8, CD4 / CD8, HLA-DR / CD3, CD56 + CD4 + CD25 + (Th reg), CD25 + CD3 +, CD4 + CD25 +, CD25 + CD8 +, CD69 + CD3 +, CD4 + CD69 +, CD8 + CD69 +. • Test phagocytosis of FITC-labelled neutrophil granulocytes E. coli (FTG), proof of phagocytosis of monocytes with FITC labeled E. coli (FTM). • Test E. coli oxidative cleavage of neutrophilic granulocytes stimulated with dihydrorhodamine 123 (ECG). • Test oxidative cleavage of E. coli stimulates monocytes with dihydrorhodamine 123 (ECM). Electrical stimulation resulted in the acceleration of immune processes (IgM, IgG, IgA, T and B lymphocytes) activity and rege-nerative processes. As NMES can be used in healthy people for pre-ventive purposes, and people affected by muscle disease for thera-peutic purposes41, this leads to the certain conclusion that treatment with NMES does not produce significant physiological changes in the immune system. Influence of gender on NMES NMES should be similar to the response of the subject’s voluntary contractions42,43. NMES response can be determined by the intrinsic properties of the individual tissue18,24-26,41,44,45. Because men tend to have a higher proportion of muscle mass and a lower proportion of fat tissue they may be more sensitive to NMES46. Some studies with healthy individuals have examined gender differences in terms of strength induced by NMES and tolerance to the intensity of the cu-rrent, where it has been shown that male subjects tolerate stronger contractions with electrical NMES than women46. However, when the strength of the electrical contraction was expressed in terms of a percentage of maximum voluntary isometric contraction and stren-gth gain, no gender differences were demonstrated. All force mea-surements increased significantly over time in men and women, and the pattern of habituation to the current intensity was similar for both genders41,44,46. There is a need to put Army physical therapists in either combat zone? The answer would be no if strictly utilized as a prescription ser-vice with the use of historical definitions of long-term rehabilitation. However, using the sports medicine model, US Army physical the-rapists were deemed to be a valuable asset to not only the medical team but equally to the warfighters because of their ability to prevent,
Revista de Sanidad Militar de las FAS 71_4
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