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Although there were no RCTs that assessed the effect of NMES, Bélanger et al. (2000) produced impressive results with a level 2, non-randomized trial which used one limb as the treatment and the other as the control. Following training (93.4% compliance), the BMD recovered close to 30% of BMD decline when compared with non-disabled values. Stimulation effects only occur over the areas of stimulation and returned to baseline within months once stimulation is stopped (Mohr et al. 1997). However, there is a clear need for further studies, especially RCTs, testing the long-term effects of NMES with weight-bearing on bone health.

Table 12: NMES for Treatment of Bone Loss in Chronic SCI

Author Year; Country
Research Design
Total Sample Size
Bélanger et al. 2000


Prospective Controlled Trial

Level 2


Population: 14 participants (11 men, 3 women); age: 32.4 ± 5.9 (range: 23-42) years; complete and incomplete injuries between C5-T6. 14 non-disabled matched controls.

Treatment: NMES. Quadriceps training was conducted 5 days/week for 24 weeks. Participants trained for 1hr/day or until fatigue. Right quadriceps were stimulated with no resistance (but against gravity) while the left quadriceps were stimulated against a resistance.

Outcome measures: BMD by DXA

1.   At baseline BMD from the experimental group was lower at the distal femur, proximal tibia, and mid-tibia (decreased range: 25.8% to 44.4%) than non-disabled controls.

2.  Increased BMD with training (p<0.05) for both sides of SCI participants, but the type of training had no effect (resistance vs. no resistance). There was a significant increase in the BMD of the distal femur and proximal tibia, but not in the mid-tibia.

Rodgers et al. 1991;



Level 4



Population: 9 men and 3 women; age: 38.3 ± 12.9 years; TPI: 6.4 ± 6.1 years; para/tetraplegia; complete/incomplete; no controls (only 9 participants had BMD)

Treatment: Knee extension NMES. Each participant trained for a total of 36 sessions (3x/week for 12 weeks) using a progressive intensity protocol. This progression was continued to a maximum 15 kg load.

Outcome measures: BMD of the tibia by DXA

1.        Tibial BMD was not significantly changed after NMES protocol (p>0.05), but BMD was better than predicted values.

* All data expressed as mean±SD, unless expressed otherwise.


There is level 2 evidence (from 1 prospective controlled trial) (Bélanger et al. 2000) that NMES either increased or maintained BMD over the stimulated areas.


NMES can maintain or increase BMD over the stimulated areas.