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Pain and Spine Medicine

Functional Electrical Stimulation Combined With Antigravity Treadmill Aids Distal Reinnervation and Motor Strength Recovery in Chronic Lumbar Radiculopathy Post-Laminectomy: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Case Report Theater

    Primary Author(s)

  • Anthony Ascoli, MD (he/him/his)

    Resident Physician
    University of Pennsylvania PM&R
    Philadelphia, Pennsylvania

    • Poster Presenter(s)

  • Juan Polanco, MD, MS

    Resident Physician
    University of Pennsylvania Health System PM&R Program
    Philadelphia, Pennsylvania

    • Co-Author(s)

  • KM

    Kevin Michels, PT

    Physical Therapist
    Good Shepard Penn Partners
    Philadelphia, Pennsylvania

  • Michael DeCapua, MD

    Fellow
    University of Pennsylvania Health System PM&R Program
    Philadelphia, Pennsylvania

  • DL

    David Lenrow, MD

    Associate Professor
    University of Pennsylvania Health System PM&R Program
    Philadelphia, Pennsylvania

  • MS

    Malathy Srinivasan, MD

    Clinical Assistant Professor, Physical Medicine and Rehabilitation
    Penn Spine Center, Rittenhouse
    Philadelphia, Pennsylvania

Disclosure(s):
Anthony Ascoli, MD: No financial relationships to disclose
Juan Polanco, MD, MS: No financial relationships to disclose
Michael DeCapua, MD: No financial relationships to disclose
Case Diagnosis: A 29-year-old male with post-laminectomy chronic left L5/S1 radiculopathy and foot drop.

Case Description or Program Description: Patient presented to our clinic with left lower extremity weakness after L4-5 discectomy and laminectomy. At his initial evaluation three years after surgery, his manual muscle testing (MMT) was notable for left ankle dorsiflexion (ADF) 3/5, plantar flexion 2+/5, inversion 3/5, eversion 3+/5 and extensor hallicus longus (EHL) 0/5 with gait speed of 0.93m/s with a trekking pole. His physical therapy (PT) program focused on mobility and core stability with overground gait training using a carbon fiber ankle-foot orthosis (AFO) and seated ankle resistance exercises. Electrodiagnostic testing confirmed chronic left L5/S1 radiculopathy with proximal reinnervation but persistent distal denervation. With PT, neurorestorative exercises were incorporated using a handheld neuromuscular electrical stimulation unit timed to gait cycle with functional electrical stimulation (FES), 65-75Hz, 364-400us based on target muscle size. This was combined with antigravity treadmill training set at 75% bodyweight support at 2.0-2.4mph at 10-15 inclination.

Setting: Outpatient PM&R Clinic, Physical Therapy

Assessment/Results: After 20 sessions with dual FES and antigravity treadmill training, gait speed improved to 1.42m/s. Ankle MMT showed improvement in ADF and eversion strength to 4/5 and EHL strength 4-/5, as well as improved sensory perception and restored vibration. He was able to transition off ambulatory assistive devices and was able to complete strenuous physical activity with a carbon fiber AFO.

Discussion (relevance): Per review of the literature, this is the first reported case of functional improvement of foot drop in the setting of post-laminectomy chronic lumbosacral radiculopathy using a dual treatment program of FES with antigravity treadmill training.

Conclusions: The synergistic benefits of dual FES and antigravity treadmill training highlight the possibility of establishing combined treatment applications for patients with chronic lumbosacral radiculopathies.