The Clinical Utility of Surface Electromyography in Post-Orthopedic Rehabilitation: A Systematic Review

Abstract

The traditional paradigm of orthopedic rehabilitation has historically emphasized the mechanical repair of bone, ligament, and connective tissue, often underestimating or neglecting the profound neurological disruptions that follow surgical trauma. While structural integrity may be successfully restored, neuromuscular dysfunction frequently persists and limits meaningful functional recovery. Arthrogenic Muscle Inhibition (AMI)—a presynaptic, reflex-mediated inhibition of motor neuron excitability—remains a primary barrier to muscle hypertrophy, voluntary activation, and full functional restoration following orthopedic intervention.This systematic review evaluates the clinical utility of surface electromyography (sEMG) as both a diagnostic instrument for identifying neural deficits and a therapeutic neuromodulatory intervention within post-orthopedic rehabilitation. Synthesizing evidence from 55 high-impact studies, we examine sEMG’s capacity to identify delayed muscle onset latencies, quantify neural drive through maximum voluntary isometric contraction (MVIC) normalization, and monitor physiological fatigue via shifts in median frequency (MDF).Collectively, the evidence indicates that sEMG-guided rehabilitation—particularly when implemented as biofeedback—facilitates clinically meaningful improvements in neuromuscular activation. Across multiple orthopedic populations, sEMG biofeedback has been shown to increase peak torque recovery by approximately 25–30%, suggesting that sEMG provides a critical bridge between structural repair and restoration of effective corticospinal communication. These findings support the integration of sEMG as a foundational component of precision, criterion-based orthopedic rehabilitation.