When Strength Work Alone Isn't Enough: Incorporating Neuromuscular Stimulation in Rehab
- Colin O'Banion, DPT
- Apr 28
- 6 min read
Updated: 22 minutes ago
You’re consistent with your strength work.
You lift, you train, you’re not skipping the basics. On paper, you’re doing what you’re supposed to be doing.
But something still feels off.
There’s a sense that a certain area just isn’t contributing the way it should. Maybe it feels weaker than expected, or harder to engage, even though you’ve been training it.
Is this actually a strength issue, or is something else getting in the way?
The Limitation of Strengthening Alone
Strength and stretching aren’t the problem.
Many of the people I work with have already done both and seen some improvement.
Strength work is an essential part of good physical therapy. It’s why I put a lot of emphasis on prescribing effective, functional exercises.
But if the right muscles aren’t doing their job, the problem doesn’t go away. It just shifts. Remember, the human body is a master of compensation, and will take the path of least resistance even if it is at your long-term detriment.
At that point, it’s not about adding more exercises.
It’s about helping your body actually find and use the muscles that are supposed to be working, and we can activate and accelerate that with interactive neuromuscular stimulation.
What Is Neuromuscular Stimulation?
Interactive Neuromuscular Stimulation (iNMS) therapy is a way to help muscles contract using a controlled electrical signal.
It’s commonly used in rehab settings for things like chronic pain, post-surgical recovery, and injuries where muscles aren’t working the way they should.
A lot of people I work with will say something like, “my glutes aren’t firing” or “my core just isn’t turning on.”
In many cases, the problem isn’t that a muscle is completely off. It’s that it’s not contributing well. It might be late to activate, not working hard enough, or not coordinating with the rest of the system.
Submaximal Contraction refers to any contraction that is not at the maximum potential of the muscle's ability, meaning not all fiber types or total available fibers are activatedat once.
This is exactly what iNMS can address.
There are several types of electrical stimulation used in rehab, each with a different purpose:
TENS (Transcutaneous Electrical Nerve Stimulation) is primarily used for pain relief
NMES / EMS (Neuromuscular Electrical Stimulation) is used to improve muscle contraction and activation
FES (Functional Electrical Stimulation) applies that same concept during specific movements
Interferential Current (IFC) is often used for deeper pain modulation and circulation
Russian stimulation is a higher-intensity form used for muscle strengthening
The approach I use falls into the neuromuscular stimulation category, where the focus is on helping muscles actually do their job.
Neuromuscular stimulation gives your body a more direct signal to activate a specific muscle.
From there, we pair it with movement so your body can start to recognize and repeat a better pattern.
How I Use Neuromuscular Stimulation in Rehab
Neuromuscular stimulation is just one tool I use, and not something everyone needs.
When I do use it, I use the NeuX NXPro, which is different from the more common units people may have seen before.
It uses a form of interactive neuromuscular stimulation (iNMS), combining direct and alternating currents to work with the nervous system in a more natural way. Instead of just forcing a muscle to contract, it helps improve how that muscle is recruited and coordinated during movement.
This is not your grandma's TENS unit for helping pain and stiffness. This is a high-end, expensive machine that is usually found in training rooms of professional sports teams and rehab centers of serious clinicians.
In most cases, you’re not lying on a table when applied.
We’re working through exercises, and I’m using the stimulation to support how specific muscles contribute while you move.
This is especially useful for people who are already training and want to keep moving forward while dealing with something that hasn’t fully resolved.
That includes:
lifters working around back or shoulder limitations
clients with recurring back pain
field sport athletes like soccer or football players managing ongoing strains
active adults who want to stay consistent without flare-ups
In some cases, it makes it easier to feel a muscle working. In others, it helps improve timing, coordination, and overall efficiency.
It can also be useful from a recovery standpoint, helping reduce lingering discomfort and allowing people to get back to training more consistently.
The goal isn’t to rely on the stimulation.
The goal is to use it to reinforce better movement patterns, so your body can carry that over on its own.
I first diagnose what muscle group(s) aren't firing correctly. Then, I teach you the specific exercises we will use to target these underperforming muscles. We apply the iNMS in a session. You feel the muscles working.
A stronger connection is made between these muscles and your brain. I show you the exercises you then do at home or in the gym to continue to reinforce the firing of these muscles and the movement patterns we want. We decide if it makes sense for you to come back in for more visits using the NeuX NXPro.
How the NXPro Works
Most sessions start by using the pads to identify where things aren’t working as well as they should.
As we move through simple positions or movements, we’re paying attention to how your body responds. Areas that are more sensitive or harder to control often point to muscles that aren’t contributing well or aren’t being coordinated effectively.
From there, we use the stimulation more intentionally.
You’ll feel a controlled muscle contraction, and the intensity is adjusted based on your tolerance. It’s noticeable, but not meant to be painful.
At the same time, you’re moving. We’re working through exercises that make sense for you, using the stimulation to support how specific muscles contribute during those movements.
This isn’t usually a session on its own. It’s integrated into a broader rehab session alongside movement work, strength work, and whatever else makes sense for your situation.
For a lot of people, the biggest difference is awareness. They can feel a muscle working in a way they haven’t before, or notice that a movement feels more connected and efficient.
The goal is to help your body recognize a better pattern so it carries over outside of the clinic.
Who This Approach Is Best For
This tends to work best for people who are already active and trying to stay that way.
That includes Boulder runners and active adults dealing with recurring hip, knee, or calf issues, lifters working around back or shoulder limitations, and field sport athletes managing ongoing strains or setbacks.
It’s also a good fit for people who have already done some form of rehab in Boulder or physical therapy and saw partial improvement, but never fully got back to where they want to be.
Remember, using the iNMS machine is just half of the equation. Diagnosing where the compensation is and precisely what exercises to use and where to place the pads is where my 20 years of clinical experience comes into play.
In those cases, the issue is often less about effort and more about how the body is functioning.
This approach gives us a way to work on that directly.
Taking the Next Step
At a certain point, doing more of the same stops being useful.
That’s where a more individualized approach can help. In some cases, that includes using tools like neuromuscular stimulation to better understand and improve how your body is actually functioning during movement.
If this sounds like something that might enhance your recovery, we can discuss during a consultation call.
How to Connect with Me:
Colin O’Banion, Doctor of Physical Therapy
Colin is a licensed Physical Therapist and founder of Colin O’Banion Physical Therapy in Boulder, Colorado. With 20 years of experience, he specializes in solving complex and chronic pain cases through a root-cause, integrative approach. Colin combines expert manual therapy with powerful tools like shockwave therapy, blood flow restriction, dry needling, and movement re-education to help clients return to the activities they love. His one-on-one practice is dedicated to clients seeking lasting solutions when traditional PT has fallen short.
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