Effect of neuromuscular electrostimulation with blood flow restriction on muscle morphology and strength of abductor hallucis: Randomized controlled single-blind trial

Shusaku Kanai, Naotaka Nagamune, Nonomi Yamamoto, Joichiro Higashida, Takuya Kiyochika, Syoma Uehara, Kazunori Okamura
Purpose:

The purpose of this study was to determine the effects of NMES training with BFR on muscle morphology and strength of the abductor hallucis.

Methods:

Thirty healthy university students participated in this study. Participants were randomly allocated to the NMES + BFR (10 males, 5 females; Height = 166.3 ± 7.8 cm; BMI = 21.6 ± 2.1 kg/m2) or NMES (10 males, 5 females; Height = 164.7 ± 8.9 cm; BMI = 21.9 ± 2.4 kg/m2) groups. All participants received 15 minutes of abductor hallucis NMES three times per week for 6 weeks. Participants in the NMES + BFR group received NMES with BFR. The cross-sectional area of the abductor hallucis and the toe flexor strength were measured before and after intervention. All measurements were performed by an investigator blinded to participant allocation. Mixed-model repeated-measures analyses of variance was used to assess statistical significance in the cross-sectional area and toe flexor strength measurements. The within-subject factor was time (before vs. after intervention), and the between-subject factor was the group. If there was a significant interaction, post hoc paired t-tests were performed on the individual group data, and post hoc independent sample t-tests were performed on the individual time data.

Results:

After the 6-week intervention, the cross-sectional area of the abductor hallucis (p = 0.001, effect size d = 0.22) and toe flexor strength (p = 0.004, effect size d = 0.77) significantly increased in the NMES + BFR group. There were no statistically significant changes in the NMES group.

Conclusion(s):

Six weeks of NMES training with BFR on abductor hallucis resulted in muscle hypertrophy and strengthening. The results of this study suggested that NMES training with BFR is a method that can achieve hypertrophy and strengthening of intrinsic foot muscles regardless of the individual's technique. The small effect size for muscle hypertrophy may be due to the relatively short training period of 6 weeks. Therefore, it is possible that continuing NMES training with BFR for a longer period may result in more significant muscle hypertrophy. Future studies should target individuals with symptoms or foot morphological problems, such as pain or flat feet.

Implications:

NMES training with BFR is an effective method to achieve hypertrophy and strengthening of intrinsic foot muscles, even in subjects who do not achieve sufficient results with traditional training methods.

Funding acknowledgements:
This work was supported by JSPS KAKENHI [Grant Number 22K17675].
Keywords:
plantar intrinsic foot muscle
neuromuscular electrostimulation
blood flow restriction
Primary topic:
Musculoskeletal: lower limb
Second topic:
Sport and sports injuries
Third topic:
Disability and rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The Ethics Committee of the Prefectural University of Hiroshima.
Provide the ethics approval number:
22MH073
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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