Neuromuscular electrical stimulation and testosterone did not influence heterotopic ossification size after spinal cord injury: A case series

Abstract

Neuromuscular electrical stimulation (NMES) and testosterone replacement therapy (TRT) are effective rehabilitation strategies to attenuate muscle atrophy and evoke hypertrophy in persons with spinal cord injury (SCI). However both interventions might increase heterotopic ossification (HO) size in SCI patients. We present the results of two men with chronic traumatic motor complete SCI who also had pre-existing HO and participated in a study investigating the effects of TRT or TRT plus NMES resistance training (RT) on body composition. The 49-year-old male, Subject A, has unilateral HO in his right thigh. The 31-year-old male, Subject B, has bilateral HO in both thighs. Both participants wore transdermal testosterone patches (4-6 mg/d) daily for 16 wk. Subject A also underwent progressive NMES-RT twice weekly for 16 wk. Magnetic resonance imaging scans were acquired prior to and post intervention. Cross-sectional areas (CSA) of the whole thigh and knee extensor skeletal muscles, femoral bone, and HO were measured. In Subject A (NMES-RT + TRT), the whole thigh skeletal muscle CSA increased by 10%, the knee extensor CSA increased by 17%, and the HO + femoral bone CSA did not change. In Subject B (TRT), the whole thigh skeletal muscle CSA increased by 13% in the right thigh and 6% in the left thigh. The knee extensor CSA increased by 7% in the right thigh and did not change in the left thigh. The femoral bone and HO CSAs in both thighs did not change. Both the TRT and NMES-RT + TRT protocols evoked muscle hypertrophy without stimulating the growth of pre-existing HO.

Keywords: Heterotopic ossification; Neuromuscular electrical stimulation; Resistance training; Spinal cord injury; Testosterone.

Figures

Figure 1

Representative magnetic resonance images of (A) pre- and (B) post-intervention showing different regions of interest (1) whole thigh skeletal muscle cross-sectional areas; (2) Heterotopic ossification bone formation; (3) posterior and medial compartments mid-thigh muscles; (4) knee extensor cross-sectional area.

Figure 2

The cross-sectional area of heterotopic ossification size from hip to knee in (A) and (B). Note that the CSA in (A) is larger than in (B) because we could not separate the subperiosteal femoral bone from HO formation. CSA: Cross-sectional area; HO: Heterotopic ossification.