Electromyographic fatigue characteristics of the quadriceps in patellofemoral pain syndrome

Bioelectrical Activity of Vastus Medialis and Rectus Femoris Muscles in Recreational Runners with Anterior Knee Pain

Patellofemoral pain syndrome (PFPS), the most common source of knee pain among physically active individuals, is defined as anterior knee pain involving the patella and retinaculum that excludes other intraarticular and peri-patellar pathology. Differences in the activation and endurance of the quadriceps components, causing an imbalance in the forces controlling patellar tracking during flexion and extension in the knee joint, appear to be the most commonly reported risk factors for PFPS. The aim of this study was to determine the differences in bioelectric activity of vastus medialis and rectus femoris muscles during half knee bend position in runners with PFPS. The sample comprised 20 recreational runners (15 males, 5 females; aged 27 ± 5 years) reporting knee pain and diagnosed with PFPS. The age- and sex-matched control group consisted of recreational runners who did not report knee pain. The myon electromyographic system was used to determine the changes in the electromyographic median frequency during a half squat position. The decrease in the median frequency of vastus medialis and rectus femoris muscles was significantly greater in runners with PFPS in comparison to the control group (p < 0.01 for right and left vastus medialis and right rectus femoris; p < 0.05 for left rectus femoris). There is a relationship between knee pain related to PFPS and the imbalance of bioelectric activity of vastus medialis and rectus femoris muscles. Achieving the muscular balance within the thigh muscles can be an important factor in the rehabilitation process of PFPS.

Patellar bracing affects sEMG activity of leg and thigh muscles during stance phase in patellofemoral pain syndrome

BACKGROUND

Decreases in patellofemoral pain symptoms with bracing treatment have been established; but, the mechanisms remain unclear. The purpose of this study was to determine the immediate and long-term effects of the patellar bracing on electromyography (EMG) activity of the Vastus Medialis (VM) and Lateralis (VL), Rectus Femoris, lateral Gastrocnemius, Biceps Femoris and Semitendinosus (ST) muscles during level walking.

METHODS

12 eligible women aged 20-30 years with diagnosis of patellofemoral pain participated in the before and after study. Intervention consisted of 8 weeks of patellar bracing. First, patients were tested without brace, then with a brace, and finally eight weeks later without a brace. Surface EMG activation of the selected muscles during level walking was recorded.

RESULTS

After eight weeks of patellar bracing, EMG activity of VM muscle was significantly higher when compared to first session without brace (p=0.011) at mid-stance sub-phase. Additionally, EMG activity of ST muscle during first session with brace was significantly lower when compared to first session without brace at mid-stance sub-phase (without brace) (p=0.012). EMG activity of VM muscle after eight weeks of patellar bracing was significantly higher than the first session without brace at late stance and preswing sub-phase (p=0.013).

CONCLUSION

Long-term wearing of patellar bracing increases EMG activity of VM during mid-stance and late stance and preswing sub-phases of gait and immediate effect of patellar brace is decrease of EMG activity of ST muscle during mid-stance.

Voluntary activation of quadriceps femoris in patients with unilateral anterior cruciate ligament rupture within 6 months of injury: A cross-sectional observational study

BACKGROUND

Deficits in quadriceps femoris strength and voluntary activation have been well documented in chronic anterior cruciate ligament (ACL) injuries, but less is known about the acute or early phase after injury.

OBJECTIVES

The aim of this study was to evaluate and compare the levels of quadriceps voluntary activation (VA) and strength in both limbs of participants with unilateral ACL ruptures (complete tears) within 6 months of injury.

DESIGN

Cross-sectional observational study.

METHOD

Seventeen participants, 12 male, mean age 30 (17-45) years, performed maximal voluntary isometric contractions with the interpolated twitch technique.

RESULTS

Mean (SD) peak VA was significantly lower in the injured limb 76.5 (15.0) % than the uninjured limb 85.9 (6.7) % (p = 0.02). Mean (SD) peak torque in the injured limb was significantly lower 162.7 (74.1) Nm than the uninjured limb 240.5 (81.0) Nm (p < 0.01).

CONCLUSIONS

This between-limb difference in VA has not previously been observed in patients within 6 months of ACL rupture. Our findings suggest that early rehabilitation programs for adults with ACL rupture should focus on reducing VA deficits to facilitate improvement of the quadriceps femoris muscle strength in the injured limb to comparable values of the uninjured limb.

Vastus medialis oblique and vastus lateralis activity during a double-leg semisquat with or without hip adduction in patients with patellofemoral pain syndrome

Background

The purpose was to investigate the effect of double-leg semisquat with hip adduction on the activation of vastus medialis oblique (VMO) and vastus lateralis (VL) in patients with patellofemoral pain syndrome (PFPS).

Methods

Thirty patients with PFPS were designated to the study group, while 30 healthy matched subjects were enrolled in the control group. The activation of VL and VMO was recorded with surface electromyography (EMG) during double-leg semisquat (DS) and double-leg semisquat with hip adduction (DS-HA). The time domain and frequency domain indexes of the electromyography data were collected for analysis.

Results

In the study group, the time domain indexes (RMS, IEMG) and frequency domain index (MPF) of VL were significant higher than VMO in the test of DS (P < 0.05); and the time domain of VMO was significantly higher in the test of DS-HA when compared to DS (P < 0.05) while there was no difference in the activation of VL.

Conclusions

In the study group, an increase in activity of the VMO was observed through the surface EMG signal in the double-leg semisquat exercise with hip adduction compared to the exercise without hip adduction. This finding indicates that VMO activation can be more selectively obtained through the exercise with hip adduction which can help balance the VL and VMO.

Reliability and fatigue characteristics of a standing hip isometric endurance protocol

Muscle fatigue is a common consideration when evaluating and rehabilitating athletic injuries. The presence of muscular fatigue has been previously determined by quantifying median frequency (MF) through a power spectral analysis on EMG signals collected throughout an endurance task. Research has not yet determined if a prolonged isometric test in a standing position generates muscular fatigue of the hip. The purpose of this study was to determine the reliability and fatigue characteristics of a standing hip isometric endurance test. Twenty healthy participants completed one 60-s Maximum Voluntary Isometric Contraction of standing hip flexion, extension, adduction, and abduction. MF of the participants' dominant limb rectus femoris (RF), biceps femoris (BF), gluteus maximus (GMax), gluteus medius (GMed) and adductor longus (ADD) was determined via surface electromyography during two sessions, 30-min apart. Reliability values (ICC2,1) were moderate-to-excellent for all time intervals of each action (FlexionRF: >0.80; ExtensionBF: >0.89; ExtensionGMax: >0.60; AdductionADD: >0.78; AbductionGMed: >0.60) and MF significantly decreased over time for all actions. Results suggest the endurance test is a reliable technique to generate muscular fatigue for hip flexion, extension, adduction and abduction. It can be used as a time efficient fatigue protocol specific to the RF, BF, GMax, ADD and GMed.

The effects of muscle fatigue on dynamic standing balance in people with and without patellofemoral pain syndrome

The aim was to examine the effects of muscle fatigue of knee extensor and hip abductor muscles on dynamic standing balance of patients with patellofemoral pain syndrome (PFPS) compared to their healthy matched controls. Thirty participants (15 with PFPS, 15 controls) were recruited. Isolated muscle fatigue of two muscles was induced isokinetically in three separate sessions (one practice and two testing sessions) with a rest interval of at least 72h. In each testing session, fatigue protocol of only one muscle group was performed for the both legs with a rest time of 30min. After determining peak torque, participants were encouraged to perform continuous maximal concentric-eccentric contraction of the target muscle until the torque output dropped below 50% of peak value for 3 consecutive repetitions. Immediately after the completion of the fatigue protocol, balance testing of participants was undertaken during single leg standing using the Biodex stability system. Balance stability measures included the overall, anteroposterior and mediolateral stability indices (OSI, APSI and MLSI, respectively). Patients exhibited decreased balance stability in the sagittal plane (higher APSI) when compared to controls. Isolated muscle fatigue of the knee extensors and hip abductors reduced balance stability in both study groups. Fatigue of hip abductors was associated with greater balance instability (higher OSI and APSI) than fatigue of knee extensors.

Competitive athletic participation, thigh muscle strength, and bone density in elite senior athletes and controls

The relationship between participation in highly competitive exercise, thigh muscle strength, and regional and total body bone mineral density (BMD) in elite senior athletes and healthy elderly controls was investigated. One hundred and four elite senior athletes (age: 72.6 ± 6.4 years, height: 168.7 ± 8.6 cm, mass: 72.6 ± 13.5 kg, 57 male:47 female) and 79 healthy controls (age: 75.4 ± 5.6 years, height: 170.8 ± 25.5 cm, mass: 79.5 ± 11.7 kg, 46 male:33 female) participated in this cross-sectional study. Vitamin D and calcium intake were assessed via a recall survey. Isometric knee extension and flexion peak torque were measured via a custom strength measurement device. Total body and regional BMD of the hip, radius, and spine were assessed with a dual-energy x-ray absorptiometer. For each BMD site assessed, multivariate linear regression analysis was performed in 4 steps (α = 0.10) to examine the contribution of (a) age, sex, bodyweight, and calcium and vitamin D intake; (b) group (elite senior athlete, control); (c) knee extension peak torque; and (d) knee flexion peak torque on BMD. Sex, age, bodyweight, and calcium and vitamin D intake explained a significant amount of variance in BMD in each site. Group was not significant. Knee extension peak torque explained an additional 3.8% of the variance in hip BMD (p = 0.06). Knee flexion peak torque was not correlated to BMD at any of the sites assessed. In conclusion, participation in highly competitive athletics was not related to total body or regional BMD. Age, sex, bodyweight, and vitamin D and calcium intake were significantly related to BMD at all the sites assessed. Quadriceps strength contributed slightly to hip BMD. Our results imply that participation in highly competitive senior athletics does not have a protective effect on BMD, perhaps because of a lower bodyweight or other confounding factors.

The utility of electromyography and mechanomyography for assessing neuromuscular function: a noninvasive approach

This article introduces the utility of electromyography (EMG) and mechanomyography (MMG) for the assessment of neuromuscular function, and discusses the interpretation of the EMG and MMG signals for various exercise perturbations. The results of these studies suggest that the use of EMG and MMG to determine muscle fatigue is robust. Future studies with clinical populations are needed, however, to determine the optimal use of EMG and/or MMG for assessing muscle function in rehabilitative settings.

Hip and knee muscle function following aerobic exercise in individuals with patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is a commonly experienced knee disorder that can result in altered muscle activation of the surrounding musculature. There is little evidence on effects of aerobic exercise on quadriceps torque and EMG activation of the vastus medialis obliquus (VMO), vastus lateralis (VL), and gluteus medius (GM). In this study 20 healthy individuals and 20 patients with PFPS had measures of torque and muscle activation taken following aerobic exercise. A modified Balke-Ware protocol was used for the exercise intervention. Baseline and post-aerobic measurements of knee extension torque and VMO, VL, and GM activation during a single leg anterior reaching task. These measurements were only taken on the injured limb. Following exercise, knee extension torque was lower in PFPS patients when compared to controls (p=0.03). Patients reporting no pain after exercise experienced decreases (p=0.021) in GM activation following exercise. There was a decrease in VMO (p=0.010) and VL (p=0.021) activation in PFPS patients with elevated knee pain. Recreationally active individuals with PFPS may experience different responses in the quadriceps and GM after exercise. Responses may be confounded by whether or not pain is exacerbated by exercise.

An electromyographic exploratory study comparing the difference in the onset of hamstring and quadriceps contraction in patients with anterior knee pain

Idiopathic anterior knee pain in teenagers and young adults is a common condition. Patellar maltracking has been considered as a causative factor. The aim of our study was to investigate whether there was a difference in the timing of electromyographic (EMG) activity in the medial and lateral hamstring and quadriceps muscles of patients with anterior knee pain compared to asymptomatic control participants. This was a cross sectional observational study measuring EMG activation patterns. Two groups of participants were tested, one patient (mean age 15 years, n = 20) and one asymptomatic control (mean age 16 years, n = 17). Surface EMG (sampling rate 1000 Hz) was recorded from vastus medialis obliqus, vastus lateralis, and the medial and lateral hamstrings during three repetitions of maximal voluntary isometric contractions. The relative timing of the medial and lateral quadriceps and hamstrings was evaluated. The mean (95% confidence interval) difference between the groups in the lateral-medial hamstring onset timing was 53.8(1.9 to 105.6)ms during the maximal contraction. An independent t test showed that this difference was statistically significant (p = 0.043). The differences between the groups in the relative VMO to VL onset did not reach statistical significance. The results of this study suggest that the lateral hamstrings contract significantly earlier in patients with AKP compared to healthy controls for this small cohort. This altered activation pattern could produce external rotation of the tibia on the femur and cause lateral patella tracking.

Thigh muscle strength in senior athletes and healthy controls

Exercise is commonly recommended to counteract aging-related muscle weakness. While numerous exercise intervention studies on the elderly have been performed, few have included elite senior athletes, such as those who participate in the National Senior Games. The extent to which participation in highly competitive exercise affects muscle strength is unknown, as well as the extent to which such participation mitigates any aging-related strength losses. The purpose of this study was to examine isometric thigh muscle strength in selected athletes of the National Senior Games and healthy noncompetitive controls of similar age, as well as to investigate strength changes with aging in both groups. In all, 95 athletes of the Games and 72 healthy controls participated. Of the senior athletes, 43 were runners, 12 cyclists, and 40 swimmers. Three trials of isometric knee flexion and extension strength were collected using a load cell affixed to a custom-designed chair. Strength data were normalized to dual-energy x-ray absorptiometry-obtained lean mass of the leg. A 3-factor multivariate analysis of variance (group x gender x age group) was performed, which included both the extension and flexion variables (alpha = 0.05). Athletes exhibited 38% more extension strength and 66% more flexion strength than the controls (p < 0.001). Strength did not decrease with advancing age in either the athletes or the controls (p = 0.345). In conclusion, senior athletes who participate in highly competitive exercise have greater strength than healthy aged-matched individuals who do not. Neither group displayed the expected strength losses with aging. Our subject cohorts, however, were not typical of those over age 65 years because individuals with existing health conditions were excluded from the study.

Delayed vastus medialis obliquus to vastus lateralis onset timing contributes to the development of patellofemoral pain in previously healthy men: a prospective study

BACKGROUND

Delayed onset of vastus medialis obliquus activity has been described in patellofemoral pain patients. No prospective study investigating the development of patellofemoral pain has tested the onset timing of electromyographic activity of the vastus medialis obliquus and vastus lateralis muscles during a functional task.

HYPOTHESIS

Before the development of patellofemoral pain, subjects demonstrate an altered firing order of the vastus medialis obliquus and vastus lateralis muscles compared with healthy subjects during a functional task.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

The onset of vastus medialis obliquus and vastus lateralis activity was measured with surface electromyography during a functional task (rocking back on the heels) in 79 healthy subjects subsequently submitted to a 6-week strenuous basic military training. Afterward, these subjects were reassessed.

RESULTS

Thirty-two percent of the recruits developed patellofemoral pain during training. Patellofemoral pain subjects demonstrated a significant delay of onset of vastus medialis obliquus electromyographic activity compared with the healthy controls (P = .023), even before basic military training. In healthy subjects, no significant differences in electromyographic activity onset of the vastus medialis obliquus compared with the vastus lateralis could be identified before and after basic military training. A significant (P < .001) delay could be demonstrated in the patellofemoral pain group after basic military training. A binary logistic regression could be constructed wherein the onset of the electromyographic activity of the vastus medialis obliquus and vastus lateralis was withheld in the model. The most optimal cutoff value, which is based on the receiver operating characteristic curve, is a timing difference of -0.67 milliseconds (vastus medialis obliquus - vastus lateralis). The area under the receiver operating characteristic curve is considered as fair (0.68).

CONCLUSION

Delayed onset of electromyographic activity of the vastus medialis obliquus-vastus lateralis is one of the contributing risk factors to the development of patellofemoral pain.

Electromyographic analysis of selected shoulder muscles during a rugby football tackle

Background

Epidemiological studies have shown that the incidence of shoulder injuries is increasing in rugby and the majority are related to the contact/tackle phase of play. However, no data currently exists that describes preparatory muscle activity during tackle. This information could aid in guiding training and rehabilitation, if available. The purpose of the study was to assess the sequence of onset of EMG activity of selected scapulohumeral muscles during rugby tackle. 15 healthy professional rugby players participated in the study. Surface EMG activity was assessed for timing of onset relative to time of impact during a modified tackle activity in pectorialis major, biceps brachii, latissimus dorsi, serratus anterior and infraspinatus muscles.

Results

Onset of activity occurred in all muscles prior to impact. Factorial ANOVA showed significant differences between muscles in activation timing (p = 0.0001), paired t-tests revealed that serratus anterior was activated prior to all other muscles tested (p < 0.04, for all comparisons), with comparison between all other muscles showing no significant differences (p > 0.05), except pectorialis major on all comparisons showed significantly later activation timing than all other muscles (p < 0.001).

Conclusion

Muscle activation timing may if not properly balanced around the shoulder girdle expose the glenohumeral joint to excessive load and stress. This paper demonstrates a simple method which sets out some preliminary normative data in healthy players. Further studies relating these data to injured players are required.

The reliability of surface electromyography to assess quadriceps fatigue during multi joint tasks in healthy and painful knees

This study's aim was to determine the between days reliability of surface EMG recordings from the superficial quadriceps during a multi joint sub-maximal fatiguing protocol. Three subject groups (healthy n=29; patellofemoral pain syndrome n=74; knee osteoarthritis n=55) performed the task at 60 maximum voluntary isometric contraction on three separate days. Spectral and amplitude EMG parameters were recorded from vastus medialis oblique, vastus lateralis and rectus femoris and were analysed for between days reliability using intraclass correlation coefficient (ICC((2,1))), the standard errors of measure and smallest detectable differences. For frequency results, initial and final frequency values had 'good' or 'excellent' reliability in all groups for all muscles. ICCs for median frequency slopes for vastus medialis oblique, vastus lateralis, and rectus femoris respectively, in the osteoarthritis group were 0.04, 0.55, and 0.72; in the patellofemoral pain group were 0.41, 0.17, and 0.33; in the healthy group were 0.68, 0.64, and 0.31. The standard errors of measurement and smallest detectable differences for all groups and for all muscles were unacceptably high. For amplitude results, ICC root mean squared initial and final values were 'good' to 'excellent' for all groups and all muscles, albeit with high measurement error. The ICCs for root mean squared slopes in all tests were 'poor' with extremely high measurement error. The poor between days reliability and high measurement error suggests that surface EMG should not be adopted to assess fatigue during multi joint sub-maximal isometric quadriceps testing.

Atividade eletromiográfica do vasto medial oblíquo em portadoras da síndrome da dor patelofemoral

A síndrome da dor patelofemoral (SDPF) é uma das afecções que mais acometem a articulação do joelho. Embora sua etiologia não seja completamente conhecida, uma disfunção do músculo vasto medial oblíquo (VMO) tem sido apontada como possível fator desencadeante. Este estudo visou avaliar, por meio de eletromiografia, se algum exercício, dentre dez exercícios resistidos usuais, produz ativação seletiva do VMO, com vistas a sua utilização clínica. Vinte voluntárias do sexo feminino, sendo dez com SDPF (24,7±4,35 anos) e dez saudáveis, controle (22,5±1,58 anos), foram submetidas à avaliação eletromiográfica dos músculos VMO, vasto lateral longo e vasto lateral oblíquo (VLO) durante a realização de 10 exercícios, incluindo cadeia cinética aberta e fechada, em diferentes angulações do joelho e posições do quadril. Os resultados mostram que nenhum dos exercícios se revelou seletivo para o VMO, tendo alguns mostrado ativação seletiva do VLO. No grupo com SDPF observou-se menor atividade eletromiográfica de todos os vastos em oito dos dez exercícios propostos, quando comparado ao controle; observou-se ainda, no grupo SDPF, menor relação VMO/VLO (0,63) do que no grupo controle (0,82, p<0,05). Embora, dentre os propostos, nenhum exercício tenha se mostrado eficaz para promover a ativação seletiva do VMO, os exercícios de agachamento unipodal com rotação medial e lateral da tíbia mostraram-se mais indicados para sujeitos com SDPF.

The reliability of isometric strength and fatigue measures in patients with knee osteoarthritis

Patients with knee osteoarthritis have both poor strength and endurance of their quadriceps muscles. It is possible to assess muscle fatigue by monitoring frequency spectrum using electromyography (EMG). This study used the closed kinetic chain approach to muscle assessment. Fifty-five subjects with knee osteoarthritis were examined twice within 1 week. To test maximum voluntary isometric contraction into extension an isokinetic dynamometer, with a closed kinetic chain "leg press" attachment was used. EMG assessment of signal median frequency was done by measuring median frequency shift associated with fatiguing of muscle during a 60s isometric contraction at 60% of maximum isometric contraction. Intra-class correlation coefficients with 95% confidence intervals, standard errors of measurement and smallest detectable differences were calculated. Results showed the reliability of the maximum voluntary isometric contraction extension strength test was ICC 0.99 and SEM 3.95Nm. The initial median frequency indices also demonstrated excellent ICC and SEM statistics (ICC 0.84-0.91, SEM 9.2-11Hz) for the three heads of the quadriceps; however, the fatigue slopes for all three muscles were unreliable with poor ICCs (0.04-0.72) and SDD values (2207-4000%). The assessment of peak muscle torque using a closed kinetic chain isometric technique is reliable, as is the determination of median frequency values for the quadriceps. Error for the assessment of fatigue was of an unacceptable scale. While the use of a closed kinetic chain leg press technique provides a reliable measurement of lower limb strength, EMG power spectrum decrease during an isometric contraction is of little value.

Does Exercise Type Affect Relative Activation Levels of Vastus Medialis Oblique and Vastus Laterialis?

Context:

One factor believed to affect Patella tracking is an alteration in the timing of the contraction of the muscular stabilizers of the patella. The muscles responsible for this are Vastus Medialis Oblique (VMO) and Vastus Laterialis (VL). A number of authors believe that asynchronous recruitment of the VMO muscle occurs in patella mal-tracking, with the VL muscle firing first and VMO firing first with normal tracking. This has lead to a variety of exercise interventions to reverse the situation with varying success. The discrepancy between the majority of the available research findings and the clinical hypothesis of VMO action or facilitation of this action may in part be due to methodological variability between studies, especially lack of control of the exercise variables of angular velocity and relative load.

Objective:

To assess the effect of different quadriceps exercises on VMO and VL EMG recruitment timing, while controlling load and velocity of contraction.

Design:

Repeated measures.

Setting:

Biomechanics laboratory.

Main Outcome Measures:

Differences in time of onset of muscle activity between VMO and VL.

Results:

No significant difference existed between gender (P= 0.78). Analysis factorial ANOVA (muscle, contraction type and exercise type) showed the main effects of muscle (P= 0.15) and type of contraction (P= 0.79) did not have a significant effect, the nature of exercise (OKC or CKC) had a significant effect (P< 0.001). The interaction of muscle and exercise type (P= 0.34) also had a nonsignificant effect.

Conclusions:

Onset timing does not differ significantly between VMO and VL during a variety of exercise tasks.

Lateralization of brain activity during lower limb joints movement. An fMRI study

Studies of unilateral finger movement in right-handed subjects have shown asymmetrical patterns of activation in primary motor cortex and subcortical regions. In order to investigate the existence of an analogous pattern during lower limb joints movements, functional magnetic resonance imaging (fMRI) was used. Eighteen healthy, right leg dominant volunteers participated in a motor block design study, performing unilateral right and left repetitive knee, ankle and toes flexion/extension movements. Aiming to relate lower limb joints activation to the well-described patterns of finger movement, serial finger-to-thumb opposition was also assessed. All movements were auditory paced at 72 beats/min (1.2 Hz). Brain activation during movement of the nondominant joints was more bilateral than during the same movement performed with the dominant joints. Finger movement had a stronger lateralized pattern of activation in comparison with lower limb joints, implying a different functional specialization. Differences were also evident between the joints of the lower limb. Ankle and toes movements elicited the same extend of MR signal change in the majority of the examined brain regions, whereas knee joint movement was associated with a different pattern. Finally, lateralization index in primary sensorimotor cortex and basal ganglia was significantly affected by the main effect of dominance, whereas the lateralization index in cerebellum was significantly affected by the joint main effect, demonstrating a lateralization index increase from proximal to distal joints.

Does level of load affect relative activation levels of vastus medialis oblique and vastus laterialis?

The purpose of the study was to evaluate the effect of different relative loading levels on the EMG activity of Vastus Medialis Oblique (VMO) and Vastus Laterialis (VL). Previous research into the EMG temporal and spatial relationship between VMO and VL has increased the controversy surrounding the topic, due to the majority of studies failing to be consistent in electrode placement, level of loading and subject selection. It is generally believed that the nature of the loading task will significantly affect results; despite this few studies have controlled relative load level between subjects. EMG activity of VMO and VL was measured at four load levels (MIVC, 75%, 50% and 25% of MIVC) in 10 asymptomatic male subjects. No difference in onset of activity was found between VMO and VL (p>0.05) and onset of activity was not affected by level of load (p>0.05). The relative level of load had a significant effect both on overall activity of VMO and VL, and the ratio of their activity. The study has shown that relative level of load can have significant effects on the parameters measured and if this variable is not controlled for within the study design it becomes a potential confounding effect.

The effect of hip abduction on the EMG activity of vastus medialis obliquus, vastus lateralis longus and vastus lateralis obliquus in healthy subjects

Study design

Controlled laboratory study.

Objectives

The purposes of this paper were to investigate (d) whether vastus medialis obliquus (VMO), vastus lateralis longus (VLL) and vastus lateralis obliquus (VLO) EMG activity can be influenced by hip abduction performed by healthy subjects.

Background

Some clinicians contraindicate hip abduction for patellofemoral patients (with) based on the premise that hip abduction could facilitate the VLL muscle activation leading to a VLL and VMO imbalance

Methods and measures

Twenty-one clinically healthy subjects were involved in the study, 10 women and 11 men (aged X = 23.3 ± 2.9). The EMG signals were collected using a computerized EMG VIKING II, with 8 channels and three pairs of surface electrodes. EMG activity was obtained from MVIC knee extension at 90° of flexion in a seated position and MVIC hip abduction at 0° and 30° with patients in side-lying position with the knee in full extension. The data were normalized in the MVIC knee extension at 50° of flexion in a seated position, and were submitted to ANOVA test with subsequent application of the Bonferroni multiple comparisons analysis test. The level of significance was defined as p ≤ 0.05.

Results

The VLO muscle demonstrated a similar pattern to the VMO muscle showing higher EMG activity in MVIC knee extension at 90° of flexion compared with MVIC hip abduction at 0° and 30° of abduction for male (p < 0.0007) and MVIC hip abduction at 0° of abduction for female subjects (p < 0.02196). There were no statistically significant differences in the VLL EMG activity among the three sets of exercises tested.

Conclusion

The results showed that no selective EMG activation was observed when comparison was made between the VMO, VLL and VLO muscles while performing MVIC hip abduction at 0° and 30° of abduction and MVIC knee extension at 90° of flexion in both male and female subjects. Our findings demonstrate that hip abduction do not facilitated VLL and VLO activity in relation to the VMO, however, this study included only healthy subjects performing maximum voluntary isometric contraction contractions, therefore much remains to be discovered by future research

Avaliação eletromiográfica dos músculos estabilizadores da patela durante exercício isométrico de agachamento em indivíduos com síndrome da dor femoropatelar

O objetivo deste trabalho foi comparar a atividade elétrica dos músculos vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) durante os exercícios isométricos de agachamento wall slide a 45º (WS 45º) e 60º (WS 60º) de flexão do joelho. Foram avaliadas 15 mulheres clinicamente saudáveis e 15 mulheres com síndrome da dor femoropatelar (SDFP). Os registros eletromiográficos foram obtidos por eletrodos ativos simples conectados a um eletromiógrafo durante a contração isométrica voluntária máxima (CIVM) do WS 45º e WS 60º. Os dados foram analisados pela média dos valores do root mean square (RMS) do sinal eletromiográfico, normalizado pela média do RMS obtido no agachamento a 75º de flexão do joelho. A análise estatística empregada foi o teste ANOVA two way (p < 0,05) e teste de Duncan post hoc (p < 0,05). Os resultados revelaram que o exercício WS 60º apresentou maior atividade elétrica nos músculos VMO, VLL e VLO quando comparado com o WS 45º, para os grupos controle e SDFP. Durante o WS 60º, para o grupo controle, não foram observadas diferenças na atividade dos músculos VMO, VLO e VLL, sugerindo um equilíbrio na atividade elétrica destes músculos, enquanto que no WS 45º o músculo VLL apresentou maior ativação quando comparado com os músculos VMO e VLO. Para o grupo SDFP, esse equilíbrio entre as porções medial e lateral do músculo quadríceps foi observado em ambos os exercícios. Esses dados sugerem que WS 60º, para o grupo controle, pode ser mais efetivo para programas de fortalecimento muscular. Contudo, para o grupo com SDFP, ambos os exercícios podem ser indicados durante o programa de reabilitação. Além disso, a ausência de diferenças na atividade eletromiográfica dos músculos VMO, VLO e VLL entre os grupos, neste estudo, sugere que o desequilíbrio muscular pode não ser um fator predisponente da SDFP.

Combining isometric knee extension exercises with hip adduction or abduction does not increase quadriceps EMG activity

OBJECTIVE

To determine if the combined isometric contractions of knee extension/hip adduction and knee extension/hip abduction will elicit a different quadriceps and gluteus medius electromyographic (EMG) pattern as compared to isometric contraction of a uniplanar knee extension exercise.

METHODS

Eight healthy young adult volunteers without history of knee or quadriceps injury participated. Surface EMG data were collected from the vastus medialis oblique (VMO), vastus lateralis (VL), and gluteus medius (Gmed) muscles of the dominant leg of each subject during three single leg, weight bearing, isometric exercises (uniplanar knee extension, knee extension/hip adduction, knee extension/hip abduction). All exercises were performed at a position of 60 degrees knee flexion. Three trials lasting 5 s each were performed for each of the three exercises. EMG data from each muscle were integrated and the maximum root mean square activity over a 0.5 s window for each trial was averaged. Analyses of variance were performed with exercise (straight extension, extension/adduction, extension/abduction) as the independent variable and VMO, VL, and Gmed activity and VMO:VL ratio as dependent variables.

RESULTS

A significant main effect for exercise was found for the VMO (p = 0.006) and VL (p = 0.02), but not the Gmed (p = 0.25) or the VMO:VL ratio (p = 0.13). For the VMO and VL, the uniplanar knee extension task produced significantly more EMG activity than the extension/adduction or extension/abduction tasks.

CONCLUSIONS

Uniplanar knee extension exercises may be more appropriate than combining isometric knee extension exercises with hip adduction or abduction when eliciting maximal VMO and VL contractions.