Electrical stimulation is a popular and widely used approach for physical rehabilitation. When used for muscle strengthening, it is necessary to take into account the fact that electrical stimulation produces muscle contractions in a relatively inefficient way.

In this article, we take a brief look at muscle fibre types. Following a neurological insult, muscle fibre types undergo transformation, producing changes that affect the ability of muscles to do work. We examine the particular case of spinal cord injury and consider how this affects the effectiveness of electrical stimulation.

Approaches to combat fatigue are examined. Finally, we consider attempts being made to improve the performance of stimulators and produce consistent muscle contractions under all circumstances.

Electrical stimulation can be an effective way to strengthen skeletal muscle, but outcomes depend heavily on how it’s applied. This article explores what the research suggests about effectiveness, and which stimulation parameters appear most important - such as intensity, frequency, pulse duration, and session length. It highlights why correct dosing and progression matter, and how stimulation can be tailored to support different strength and rehabilitation goals. A useful overview for clinicians and individuals looking to understand evidence-based stimulation for muscle strengthening.