Percutaneous Peripheral Nerve Stimulation of Gluteus Nerves to Improve Hip Strength and Power

Chronic Pain Clinical Trial

Official title:

Ultrasound Guided Peripheral Nerve Stimulation of Gluteal Nerves to Enhance Strength and Power in Individuals With Chronic Knee Pain: A Randomized Controlled Pilot Study

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT06340035
• Other study ID #: 20230901
• Status: Active, not recruiting
• Phase: N/A
• Start date: September 1, 2023
• Est. completion date: June 2024

Study information

• Verified date: March 2024
• Source: Hospital Clinic of Barcelona
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this pilot clinical trial is to evaluate whether the ultrasound-guided percutaneous peripheral nerve stimulation through a needle results in greater gains in strength and power compared to the administration of current through surface electrodes in patients undergoing strength and power assessments. The main questions it aims to answer are:

Does percutaneous stimulation of the superior and inferior gluteal nerves using ultrasound-guided needles enhance strength and power more effectively than transcutaneous stimulation through electrodes?

Is the effectiveness of current delivery significantly different between percutaneous and transcutaneous methods when assessed with a linear encoder in a standarized hip extension exercise?

Participants will:

Be randomized into two groups: one undergoing ultrasound-guided percutaneous stimulation of the gluteal nerves (experimental group) and the other undergoing transcutaneous stimulation through electrodes (control group).

The same stimulation protocol at 10 Hz frequency with the maximum muscle contraction evoked without pain will be performed in both groups. Then, the participants will undergo strength and power assessment before and after therapy administration using a linear encoder in a hip extension exercise.

Researchers will compare the experimental group to the control group to see if the method of current delivery (percutaneous vs. transcutaneous) has a significant impact on the gains in strength and power. This comparison is based on the hypothesis that percutaneous delivery of current, guided by ultrasound, is more effective than simply positioning a surface electrode for transcutaneous stimulation. The evaluation of strength and power will be performed through a linear encoder that measures peak strength and concentric power in each repetition, conducted by a blind operator unaware of the patients' group allocations.

Description:

This study delves into the comparative efficacy of two modalities of nerve stimulation for enhancing muscular strength and power: the percutaneous application of electrical current via acupuncture needles versus traditional transcutaneous electrical nerve stimulation (TENS). The overarching objective is to discern whether percutaneous peripheral nerve stimulation (pPNS), guided by ultrasound, facilitates superior gains in muscle strength and power in the gluteal muscles compared to conventional TENS.

Participants, suffering from chronic knee pain, were systematically randomized into two cohorts: the experimental group underwent ultrasound-guided pPNS targeting the superior and inferior gluteal nerves, whereas the control group received TENS. The experimental setup was meticulously designed to ensure the sole variable of distinction between groups was the method of electrical stimulation applied. pPNS was delivered using a biphasic asymmetric electric current, set to a frequency of 10 Hz, a pulse width of 240 microseconds, and an intensity tailored to achieve maximal muscle contraction without inducing pain, based on a protocol of ten 10-second stimulations interspersed with 10-second rest periods. This regimen was predicated on prior findings demonstrating its efficacy in augmenting isometric strength following femoral nerve stimulation. The control group was subjected to a parallel protocol, differing only in the application technique, wherein electrodes replaced needles, adhering to the same stimulation parameters.

The therapeutic efficacy of both interventions was assessed through a rigorous evaluation of strength and power before and after the administration of therapy. This assessment employed a linear encoder to measure peak strength and concentric power during the Hip Thrust exercise, a method chosen for its reliability in quantifying these parameters. The procedure entailed performing the exercise under three different loads (30%, 50%, and 70% of the participant's maximum capacity, 1RM), with the evaluation aimed at capturing the concentric peak power in each repetition until a noticeable decline in performance was observed.

The hypothesis posits that pPNS, by virtue of its targeted and invasive nature, will yield greater improvements in muscle strength and power than TENS, attributed to its more direct stimulation of the nerve fibers and the encompassing muscle groups. The underpinning rationale is that pPNS's ultrasound-guided approach allows for a more precise delivery of electrical current to the nerves, potentially overcoming limitations associated with the superficial and diffuse application of TENS.

For the analysis of the collected data, an initial evaluation of distribution characteristics will be performed utilizing visual tools such as Q-Q plots and density plots, complemented by statistical measures of kurtosis and skewness to understand the data's underlying structure. The Shapiro-Wilk test will be applied to assess the normality of residuals, ensuring the validity of subsequent statistical tests. Descriptive statistics, including the mean, median, mode, and standard deviation of the collected quantitative measures, will be thoroughly examined to summarize the data effectively. Additionally, the homogeneity of these variables across the dataset will be scrutinized.

Regarding inferential statistics, an exploratory approach will be adopted to estimate confidence intervals and discern trends in the data, particularly focusing on pre- and post-treatment differences both within individual subjects and between the groups. Due to the anticipation of non-normal data distribution and the structure of the study design (pretest-posttest control group), non-parametric statistical tests will be employed for the analysis. Specifically, the Mann-Whitney U test will facilitate between-group comparisons, while the Wilcoxon test will be used for related measurements to detect changes within groups over time.

Data analysis and visualization efforts will be supported by SPSS 23.0 software (SPSS Inc., IBM Chicago, IL, USA) and/or GraphPad Software (San Diego, CA, USA). For the interpretation of results, a 95% confidence interval and an alpha level of 0.05 will be established as thresholds for statistical significance. The creation of figures and graphical representations of the findings will be executed using Adobe Illustrator (San José, CA, USA), ensuring that the visual presentation of data is both clear and informative. This comprehensive approach to data analysis and visualization aims to elucidate the potential differences in efficacy between percutaneous peripheral nerve stimulation and transcutaneous electrical nerve stimulation in enhancing muscle strength and power, guiding future research and clinical applications in the field.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 12
• Est. completion date: June 2024
• Est. primary completion date: April 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion criteria:

• Adult athletes above the legal age threshold

• Amateur athletes

• Experiencing chronic knee pain

• Possessing a prior diagnosis related to their knee condition

• Competent in the execution of the hip thrust exercise

Exclusion criteria:

• Underage or elderly

• Significant co-existing medical conditions and/or comorbidities

• Professional athletes

• Sedentary lifestyle

• Lack of familiarity with the hip thrust exercise

• Needle phobia or rejection to peripheral stimulation techniques

• Considerable contraindications such as a history of knee surgery, current pregnancy, or issues related to blood clotting.

Related Conditions & MeSH terms

• Chronic Knee Pain
• Chronic Pain

Intervention

Other:
• TENS
The TENS group is subjected to transcutaneous current. Two surface electrodes are inserted at the level of the superior gluteal and inferior gluteal nerve tract. A protocol of 10 stimulations x 10 seconds of stimulations x 10 times is performed with a 10 second rest between each repetition. A maximum contraction evoked without pain is sought.
• Percutaneous Peripheral Nerve Stimulation
In the pPNS group, the superior gluteal nerve and inferior gluteal nerve are stimulated percutaneously. The nerves are localized at an ultrasound-guided level and with respect to the vascular-nervous package two acupuncture needles are inserted, one for each nerve. The stimulation is the same as the TENS group: 10 stimulations x 10 times x 10 seconds, evoking the maximum contraction without pain.

Locations

Country	Name	City	State
Spain	University of Barcelona	Barcelona

Sponsors (1)

Lead Sponsor	Collaborator
Hospital Clinic of Barcelona

Country where clinical trial is conducted

Spain, 

References & Publications (5)

Beltra P, Ruiz-Del-Portal I, Ortega FJ, Valdesuso R, Delicado-Miralles M, Velasco E. Sensorimotor effects of plasticity-inducing percutaneous peripheral nerve stimulation protocols: a blinded, randomized clinical trial. Eur J Pain. 2022 May;26(5):1039-1055. doi: 10.1002/ejp.1928. Epub 2022 Mar 3. — View Citation

de-la-Cruz-Torres B, Barrera-Garcia-Martin I, Romero-Morales C. Comparative Effects of One-Shot Electrical Stimulation on Performance of the Flexor Hallucis Longus Muscle in Professional Dancers: Percutaneous Versus Transcutaneous? Neuromodulation. 2020 Aug;23(6):865-870. doi: 10.1111/ner.13040. Epub 2019 Aug 25. — View Citation

Gallego-Sendarrubias GM, Arias-Buria JL, Ubeda-D'Ocasar E, Hervas-Perez JP, Rubio-Palomino MA, Fernandez-de-Las-Penas C, Valera-Calero JA. Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial. J Clin Med. 2021 Feb 10;10(4):690. doi: 10.3390/jcm10040690. — View Citation

Requena Sanchez B, Padial Puche P, Gonzalez-Badillo JJ. Percutaneous electrical stimulation in strength training: an update. J Strength Cond Res. 2005 May;19(2):438-48. doi: 10.1519/13173.1. — View Citation

Zhou S, Huang LP, Liu J, Yu JH, Tian Q, Cao LJ. Bilateral effects of 6 weeks' unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study. Arch Phys Med Rehabil. 2012 Jan;93(1):50-5. doi: 10.1016/j.apmr.2011.08.010. Epub 2011 Nov 8. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Hip Extension Concentric Peak Power (Watts)	This parameter quantifies the maximum power output a participant can generate during the concentric phase of a barbell hip thrust, performed at maximal velocity. The measurement is facilitated by a validated linear encoder system, ChronoJump, which captures motion data at a high sampling rate of 1000 Hz. This system translates the vertical displacement of the barbell and the execution time of the concentric phase into real-time power output. By integrating the bar's velocity with the mass being lifted.	Through study completion, 1 day
Primary	Hip Extension Concentric Peak Strength (Newtons)	Real-time generated force, measured in newtons (N), is a pivotal outcome for assessing the impact of the interventions on the muscular strength during a hip extension exercise, specifically the barbell hip thrust performed at maximal velocity. This metric is derived using the ChronoJump linear encoder system, which accurately captures the motion and force exerted by the participant in real-time.	Through study completion, 1 day
Secondary	Concentric Phase Velocity (m/s)	The velocity of movement execution, quantified in meters per second (m/s), is a parameter for evaluating athletic performance during strength exercises. It measures the speed at which an individual can complete the concentric phase of a lift, such as a barbell hip thrust. This velocity is indicative of the athlete's power and explosiveness.	Through study completion, 1 day
Secondary	Maximum Strength (1RM in kgs)	The one-repetition maximum (1RM) indirectly measured through the load-velocity profile incorporates three distinct points along the curve to estimate the maximum weight a participant can lift for a single repetition with maximal effort. This methodological approach leverages the relationship between the velocity of a lift and the load being moved, underpinning the premise that the speed at which a participant can perform an exercise decreases as the weight increases. By recording the velocity of the barbell at three different loads during the concentric phase of an exercise, such as the barbell hip thrust, and plotting these velocities against the respective weights, a linear or curvilinear relationship is established. This relationship is then extrapolated to determine the load corresponding to the theoretical velocity at which 1RM would occur.	Through study completion, 1 day