Initial electrical stimulation frequency and cramp threshold frequency and force

Kevin C. Miller, Kenneth L. Knight

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Context: In the electrically induced cramp model, the tibial nerve is stimulated at an initial frequency of 4 Hz with increases in 2-Hz increments until the flexor hallucis brevis cramps. The frequency at which cramping occurs (ie, threshold frequency [TF]) can vary considerably. A potential limitation is that multiple subthreshold stimulations before TF might induce fatigue, which is operationally defined as a decrease in maximal voluntary isometric contraction (MVIC) force, thereby biasing TF. Objective: To determine if TF is similar when initially stimulated at 4 Hz or 14 Hz and if MVIC force is different among stimulation frequencies or over time (precramp, 1 minute postcramp, and 5 minutes postcramp). Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Twenty participants (13 males: age=20.6 ± 2.9 years, height=184.4 ± 5.7 cm, mass=76.3 ± 7.1 kg; 7 females: age = 20.4 ± 3.5 years, height = 166.6 ± 6.0 cm, mass = 62.4 ± 10.0 kg) who were prone to cramps. Intervention(s): Participants performed 20 practice MVICs. After a 5-minute rest, three 2-second MVICs were recorded and averaged for the precramp measurement. Participants were stimulated at either 4 Hz or 14 Hz, and the frequency was increased in 2-Hz increments from each initial frequency until cramp. The MVIC force was reevaluated at 1 minute and 5 minutes postcramp. Main Outcome Measure(s): The TF and MVIC force. Results: Initial stimulation frequency did not affect TF (4 Hz = 16.2 ± 3.8 Hz, 14 Hz = 17.1 ± 5.0 Hz; t19=1.2, P = .24). Two participants had inaccurate TFs when initially stimulated at 14 Hz; they cramped at 10 and 12 Hz in the 4-Hz condition. The MVIC force did not differ between initial frequencies (F1,19=0.9, P=.36) but did differ over time (F2,38 =5.1, P=.01). Force was lower at 1 minute postcramp (25.1 ± 10.1 N) than at precramp (28.7 ± 7.8 N; P < .05) but returned to baseline at 5 minutes postcramp (26.7 ± 8.9 N; P > .05). Conclusions: The preferred initial stimulation frequency might be 4 Hz because it did not alter or overestimate TF. The MVIC force was lower at 1 minute postcramp, suggesting the induced cramp rather than the varying electrical frequencies affected force. A 1- to 5-minute rest should be provided postcramp induction if multiple cramps are induced.

Original languageEnglish
Pages (from-to)643-647
Number of pages5
JournalJournal of Athletic Training
Issue number6
StatePublished - Dec 2012


  • Electromyography
  • Fatigue
  • Neuromuscular stimulation
  • Tetany


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