Acute modulation of common synaptic inputs and motor unit discharge rates following neuromuscular electrical stimulation superimposed onto voluntary contractions

Riccardo Borzuola^1*Stefano Nuccio¹Alessandro Del Vecchio²Ilenia Bazzucchi¹Francesco Felici¹Giuseppe De Vito³Andrea Macaluso¹

• ¹Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, Rome, Italy
• ²Artificial Intelligence in Medical Imaging Lab, Department Artificial Intelligence in Biomedical Engineering, Technische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany
• ³Department of Biomedical Sciences, University of Padova, Padova, Veneto, Italy

Introduction: Superimposing neuromuscular electrical stimulation (NMES) onto voluntary contractions induces specific neuro-physiological adaptations that may have a direct effect on force related outcomes. This study investigated motor unit discharge characteristics and force steadiness following three acute experimental conditions: NMES superimposed onto isometric contractions (NMES+ISO), passive NMES, and isometric contractions only (ISO).Methods: Seventeen healthy volunteers participated in the study. Each condition involved 20 intermittent (6s contraction/6s rest) isometric ankle dorsi flexions at 20% of their maximum voluntary contraction (MVIC). NMES was delivered to the tibialis anterior (TA) during NMES and NMES+ISO. High-density surface electromyography (HDsEMG) was used to record myoelectric activity in the TA during steady force-matching contractions, at 10% MVIC, performed immediately after each experimental condition. Motor unit discharge rate (DR) and inter-spike variability (ISIvar) were analyzed from decomposed HDsEMG signals. Coherence analysis was performed to evaluate the strength of common synaptic input across different frequency bands and the proportion of common synaptic input (pCSI) received by spinal motoneurons. Force steadiness was evaluated using the coefficient of variation of force (ForceCoV).Results: NMES+ISO significantly increased motor unit DR compared to baseline and postintervention NMES. NMES+ISO also induced an increase in pCSI compared to baseline, ISO and NMES. ForceCoV was reduced after NMES+ISO compared to all experimental conditions, indicating improved force steadiness.Discussion: These results suggest that superimposing NMES onto voluntary contractions can enhance motor unit firing rate and pCSI at low force levels. These adaptations seem to positively contribute to force steadiness, likely by engaging filtering mechanisms which minimize the independent synaptic noise affecting motor control. These findings provide new perspectives on the adaptations induced by NMES exercise, highlighting some of the neuro-physiological mechanisms involved and enriching our knowledge of how the neuromuscular system responds and adapts to NMES-based interventions.