Electromyographic and kinematic analysis of therapeutic knee exercises under water.

OBJECTIVE: This study aimed to evaluate muscle function and kinematics during commonly used knee rehabilitation exercises performed in water. DESIGN: Maximal effort single extension and flexion trials in still water and repeated extension-flexion trials in flowing water in barefoot condition were analysed from 18 healthy participants (8 men, 10 women). BACKGROUND: Despite the fact that water exercises are widely used, there are only few studies involving biomechanical and hydrodynamical analysis of aquatic exercises in rehabilitation. METHODS: Electromyography of the quadriceps (vastus medialis, vastus lateralis) and hamstring muscles (biceps femoris, semitendinosus) and angular velocities of the movements were recorded under water. RESULTS: In the repeated extension-flexion exercises the early reduction of agonist activity occurred concurrently with a high level of activity of the antagonists. In the single trial exercises the level of antagonistic activity was low throughout the range of motion, whereas the level of agonist activity was higher during the final phase of the range of motion as compared with the repeated exercises. Angular velocity patterns and values were similar between the two types of exercises. CONCLUSIONS: The present data demonstrated that the flowing properties of water modified the neuromuscular function of the quadriceps and hamstring muscles acting as agonists and antagonists in the knee flexion-extension exercises.     

Electromyographic analysis of knee exercises in healthy subjects and in patients with knee pathologies

Little information exists about the intensity of contraction required from knee and hip musculature during common therapeutic exercises used for patient populations. This study, therefore, was designed to compare electromyographic data obtained from the vastus medialis, rectus femoris, gluteus medius, and biceps femoris muscles during maximally resisted straight-leg-raising (SLR) exercises with EMG data obtained from the same muscles during quadriceps femoris muscle setting (QS) exercises in healthy subjects and in patients with knee pathologies. Of the 30 participants in the study, 16 had a history of knee injury or surgery. All participants performed randomly ordered trials of the SLR and QS exercises while the EMG data were recorded from surface electrodes and normalized to values derived from maximal effort isometric contraction trials. An analysis of variance demonstrated significantly greater activity (p less than .05) of the vastus medialis, biceps femoris, and gluteus medius muscles during QS exercises than during SLR exercises. The rectus femoris muscle was significantly more active (p less than .05) during SLR exercises than during QS exercises. The study demonstrated remarkably different degrees of muscle activation between the SLR and QS exercises, indicating that the exercise selected will affect the therapeutic intention.     

Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis

BACKGROUND: To compare hamstring to quadriceps muscle coactivity during level walking, stair ascent, and stair decent between individuals with and without knee osteoarthritis. METHODS: In a cross-sectional study, subjects with grade II knee osteoarthritis (n = 26), healthy age- and gender-matched (n = 20) and healthy, young adults (n = 20) performed three activities of daily living. During the stance phase of these activities surface electromyography was measured. Two coactivity ratios were computed, the biceps femoris to vastus lateralis ratio and the ratio of the biceps femoris EMG activity relative to the EMG activity measured during contraction- and velocity-specific maximal voluntary biceps femoris contraction, i.e., biceps femoris to maximal biceps femoris activity. FINDINGS: Subjects with knee osteoarthritis had significantly higher coactivity than age-matched healthy adults and young adults and healthy adults had more coactivity than young adults regardless the type of coactivity ratio. The biceps femoris to vastus lateralis ratio yielded 25% higher coactivity value than the biceps femoris to maximal biceps femoris ratio (P < 0.0001). The EMG activity of the vastus lateralis relative to maximal vastus lateralis EMG activity was 92% in subjects with knee osteoarthritis, 57% in age-matched controls, and 47% in young adults (P < 0.0001). INTERPRETATION: Patients with knee osteoarthritis revealed increased hamstring muscle activation while executing activities of daily living. Altered muscle activation at the knee may interfere with normal load distribution in the knee and facilitate disease progression. Therapeutic interventions should focus not only on quadriceps strengthening but also on improving muscle balance at the knee.     

COMPARISON OF HIP AND KNEE STRENGTH AND NEUROMUSCULAR ACTIVITY IN SUBJECTS WITH AND WITHOUT PATELLOFEMORAL PAIN SYNDROME

Purpose/Background:

Historically, patellofemoral pain syndrome (PFPS) has been viewed exclusively as a knee problem. Recent findings have suggested an association between hip muscle weakness and PFPS. Altered neuromuscular activity about the hip also may contribute to PFPS; however, more limited data exist regarding this aspect. Most prior investigations also have not concurrently examined hip and knee strength and neuromuscular activity in this patient population. Additional knowledge regarding the interaction between hip and knee muscle function may enhance the current understanding of PFPS. The purpose of this study was to compare hip and knee strength and electromyographic (EMG) activity in subjects with and without PFPS.

Methods:

Eighteen females with PFPS and 18 matched controls participated in this study. First, surface EMG electrodes were donned on the gluteus medius, vastus medialis, and vastus lateralis. Strength measures then were taken for the hip abductors, hip external rotators, and knee extensors. Subjects completed a standardized stair-stepping task to quantify muscle activation amplitudes during the loading response, single leg stance, and preswing intervals of stair descent as well as to determine muscle onset timing differences between the gluteus medius and vastii muscles and between the vastus medialis and vastus lateralis at the beginning of stair descent.

Results:

Females with PFPS demonstrated less strength of the hip muscles. They also generated greater EMG activity of the gluteus medius and vastus medialis during the loading response and single leg stance intervals of stair descent. No differences existed with respect to onset activation of the vastus medialis and vastus lateralis. All subjects had a similar delay in gluteus medius onset activation relative to the vastii muscles.

Conclusion:

Rehabilitation should focus on quadriceps and hip strengthening. Although clinicians have incorporated gluteus medius exercise in rehabilitation programs, additional attention to the external rotators may be useful.Level of Evidence: 4     

Muscle activation during proprioceptive neuromuscular facilitation (PNF) stretching techniques

Proprioceptive neuromuscular facilitation (PNF) techniques are often used to induce muscle relaxation and increase joint range of motion (ROM). However, the relationship between muscle activation and ROM with PNF is not well understood. The purpose of this study was to investigate the effect of three common PNF stretching techniques on hamstring muscle activation and knee extension. Three PNF techniques: stretch-relax (SR), contract-relax (CR) and agonist contract-relax (ACR) were applied to ten male and female subjects aged 23-36 years who were stabilized to isolate knee extension measurements. Knee joint position and EMG activity from quadriceps and hamstring muscles were computer processed throughout technique application. The results revealed mean hamstring EMG activity increased 8-43% within a given trial of ACR and CR respectively, and did not diminish across trials. SR produced a 11% decrease in mean hamstring EMG activity. ACR produced 3-6% greater knee extension values than CR and SR respectively, in spite of 71-155% greater hamstring EMG activity during ACR. The data suggest that CR and ACR do not evoke sufficient relaxation in muscles opposing knee extension to overcome tension facilitation generated by stretch. Thus, increases in ROM are achieved while the hamstrings are under considerable tension. Such tension increases muscle vulnerability to soreness and strain if stretching continues. The degree of knee extension produced via SR, although 3-6% less than CR and ACR, was achieved during simultaneous reduction in hamstring activity and may be the safer stretching technique.     

Comparison of gluteal and hamstring activation during five commonly used plyometric exercises

Background

Anterior cruciate ligament injuries occur frequently in athletics, and anterior cruciate ligament injury prevention programs may decrease injury risk. However, previous prevention programs that include plyometrics use a variety of exercises with little justification of exercise inclusion. Because gluteal and hamstring activation is thought to be important for preventing knee injuries, the purpose of this study was to determine which commonly used plyometric exercises produce the greatest activation of the gluteals and hamstrings.

Methods

EMG (Electromyography) amplitudes of the hamstring and gluteal muscles during preparatory and loading phases of landing were recorded in 41 subjects during 5 commonly used plyometric exercises. Repeated measures ANOVAs (Analysis of Variance) were used on 36 subjects to examine differences in muscle activation.

Findings

Differences in hamstring (P < .01) and gluteal (P < .01) activities were identified across exercises during the preparatory and landing phases. The single-leg sagittal plane hurdle hops produced the greatest gluteal and hamstring activity in both phases. The 180° jumps did not produce significantly greater gluteal or hamstring activity than any other exercise.

Interpretation

Single-leg sagittal plane hurdle hops may be the most effective exercise to activate the gluteals and hamstrings and may be important to include in anterior cruciate ligament injury prevention programs, given the importance of these muscles for limiting valgus loading of the knee. Because 180° jumps do not produce greater gluteal and hamstring activation than other plyometric exercises, their removal from injury prevention programs may be warranted without affecting program efficacy.     

Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises

Background

A critical issue for constructing a progressive rehabilitation program is the knowledge of muscle activation levels across exercises and within exercise modifications. Many exercises are offered to enhance gluteal muscle activation during functional rehabilitation but little data exists to guide the progression of exercise intensity during rehabilitation. The objective of this paper was to examine the effects of altering resistance band placement during ‘Monster Walks’ and ‘Sumo Walks.’

Methods

Nine healthy male volunteers formed a convenience sample. Sixteen electromyography channels measured neural drive of selected muscles of the right hip and torso muscles. Three resistance band placements (around the knees, ankles and feet) during the two exercises were utilized to provide a progressive resistance to the gluteal muscles while repeated measures ANOVA with Bonferroni adjustment was used to assess differences in mean EMG. The presentation of exercises and band placement were randomized.

Findings

Examining muscle activation profiles in the three hip muscles of interest revealed the progressive nature of the neural drive when altering band placement. Tensor fascia latae (TFL) demonstrated a progressive activation moving the band from the knee to the distal band placement, but not between the ankle and foot placements. Gluteus medius demonstrated a progressive activation moving distally between band placements. Gluteus maximus was preferentially activated only during the foot placement.

Interpretation

The band placements offered a progressive increase in resistance for hip rehabilitation, specifically the gluteal muscles. The added benefit of placing the band around the forefoot was selective enhancement of the gluteal muscles versus TFL presumably by adding an external rotation effort to the hips. This information may assist those who address gluteal activation patterns for patients suffering hip and back conditions where gluteal activation has been affected.     

Muscular function during ergometer cycling

Quantified EMG and calculated mechanical muscular power output data were combined to provide further analysis of muscular function during ergometer cycling. The single-joint muscles; gluteus maximus, gluteus medius, vastus medialis, vastus lateralis and soleus all showed a more predictable function with approximately linear relationship between calculated power output and recorded EMG. The function for the two-joint muscles was found to be more complex. Biceps femoris seemed to act mainly as a hip extensor and medial hamstring mainly as a knee flexor. Gastrocnemius medialis was proposed to act more as a plantar flexor and gastrocnemius lateralis as a knee flexor.     

Relative electromyographic activity in trunk,hip, and knee muscles during unilateral weight bearing exercises: Implications for rehabilitation

Background: Clinicians routinely prescribe unilateral weight bearing exercises to strengthen the lower extremity. Researchers have primarily examined thigh muscle activation with minimal attention to the hip and trunk muscles. The purpose of this study was to quantify trunk, hip, and thigh muscle activation during these types of exercises. Methods: Electromyographic (EMG) activity was collected for the abdominal obliques (AO), lumbar extensors (LE), gluteus maximus (GMX), gluteus medius (GM), and vastus medialis (VM) as subjects performed four unilateral weight bearing exercises. Data were expressed as 100% of a maximum voluntary isometric contraction (% MVIC). Separate analyses of variance with repeated measures were used to identify muscle activity differences across exercise. The sequentially-rejective Bonferroni test was used for all post-hoc analyses. Results: EMG activity for the AO, LE, and GMX was low (5.7–18.9% MVIC) during all the exercises. The GM activity was moderate (21.4–26.5% MVIC) while VM activity was high (40.0–45.2% MVIC). Conclusion: Lower AO and LE activation most likely resulted from subjects maintaining a vertical trunk position over the stance limb during each exercise. The fact that the exercises required greater frontal plane control (from balancing on a single limb) most likely accounted for lower GMX activity. The exercises would provide little, if any, benefit for individuals with AO, LE, or GMX weakness. The unilateral weight bearing exercises would be beneficial for GM neuromuscular re-education and endurance and VM strengthening.     

Editorial

Abstract

The aim of this study was to compare the magnitude of selective core muscle activation during supine bridging to neutral exercises (three on a stable and three on an unstable surface). Surface EMG analysis was performed on the lumbar multifidus, gluteus medius, gluteus maximus, and hamstrings from 13 male and 13 female subjects. Lumbar multifidus recruitment was not influenced by exercise or condition and ranged between 29.2 and 35.9% of maximum voluntary isometric contraction (MVIC). Peak gluteus medius activation (42.0% MVIC) occurred in unstable single-leg bridge. Maximum recruitment of gluteus maximus (32.6% MVIC) appeared during stable single-leg bridge. Peak hamstring activation (59.6% MVIC) occurred during stable double-leg hamstring curl. Regardless of condition, hamstrings demonstrated high (51.9–59.6% MVIC) muscle recruitment during double-leg hamstring curls compared with the single-leg bridge or double-leg bridge. Various supine bridging to neutral exercises activated the hamstrings at levels conducive to strengthening, whereas recruitment of lumbar multifidus, gluteus medius, and gluteus maximus promoted endurance training. Clinically, we were unable to conclude the unstable support surface was preferable to the stable surface for boosting muscle recruitment of spine stabilizers, gluteals, and hamstring muscles during supine bridge to neutral position.     

EMG comparison of quadriceps femoris activity during knee extension and straight leg raises.

Both knee extension and straight leg raises have been used to rehabilitate atrophied quadriceps musculature following knee immobilization. A comparison of the tension developed during these two exercises was made in each of the three surface quadriceps muscles (quadriceps femoris, vastus lateralis, vastus medialis) at three different levels of activity (20%, 50%, and 80% of 1RM). Integrated EMG (m Volt-seconds) was used to measure tension developed during a seven second contraction. Tension developed was significantly greater during a seven second contraction. Tension developed was significantly greater during knee extension than during straight leg raises at each exercise intensity. For both exercises and at all three exercise levels, the vastus lateralis was the most active; the vastus medialis was the least active. The difference between knee extension and straight leg raises became greater with increasing levels of activity. Therefore, unless contraindicated by chondromalacia of lack of knee flexibility, knee extensions should be used for post-surgical knee rehabilitation. The greater tension development would lead to a more rapid return of strength, and therefore quicker rehabilitation.     

Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study

OBJECTIVES: To evaluate the electromyographic activities of vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles in open and closed kinetic chain exercises in subjects with patellofemoral pain syndrome (PFPS). DESIGN: Case-controlled study. SETTING: Rehabilitation science center in a tertiary medical center. PARTICIPANTS: Ten patients with bilateral knee pain diagnosed with PFPS and 10 healthy volunteers. INTERVENTIONS: Subjects performed open kinetic chain exercise on an isokinetic dynamometer and closed kinetic chain exercise by squat-to-stand and stand-to-squat tasks. Surface electromyography was done for the VMO and VL muscles. MAIN OUTCOME MEASURES: VMO/VL ratios were calculated after normalization of muscle activities. RESULTS: The VMO/VL ratios of PFPS subjects were significantly lower than were those of unimpaired subjects during knee isokinetic closed kinetic chain exercises (p = .047). However, there was no statistical difference in VMO/VL ratio between subjects with and without PFPS during closed kinetic chain exercises (p = .623). Maximum VMO/VL ratio was obtained at 60 degrees knee flexion in closed kinetic chain exercise. CONCLUSION: In closed kinetic chain exercises, more selective VMO activation can be obtained at 60 degrees knee flexion. Maximal VMO/VL ratio was observed at this knee flexion angle, and muscle contraction intensity was also greatest.     

Comparative effects of resistance training on peak isometric torque, muscle hypertrophy, voluntary activation and surface EMG between young and elderly women

We compared the effect of a 10-week resistance training program on peak isometric torque, muscle hypertrophy, voluntary activation and electromyogram signal amplitude (EMG) of the knee extensors between young and elderly women. Nine young women (YW; range 20-30 years) and eight elderly women (EW; 64-78 years) performed three sets of ten repetitions at 75% 1 repetition maximum for the bilateral leg extension and bilateral leg curl 3 days per week for 10 weeks. Peak isometric torque, EMG and voluntary activation were assessed before, during, and after the training period, while knee extensor lean muscle cross-sectional area (LCSA) and lean muscle volume (LMV) were assessed before and after the training period only. Similar increases in peak isometric torque (16% and 18%), LCSA (13% and 12%), LMV (10% and 9%) and EMG (19% and 21%) were observed between YW and EW, respectively, at the completion of training (P<0.05), while the increase in voluntary activation in YW (1.9%) and EW (2.1%) was not significant (P>0.05). These findings provide evidence to indicate that participation in regular resistance exercise can have significant neuromuscular benefits in women independent of age. The lack of change in voluntary activation following resistance training in both age groups despite the increase in EMG may be related to differences between measurements in their ability to detect resistance training-induced changes in motor unit activity. However, it is possible that neural adaptation did not occur and that the increase in EMG was due to peripheral adaptations.     

Neuromuscular function during therapeutic knee exercise under water and on dry land

OBJECTIVES: To compare muscle activity and resistive drag force during knee extension-flexion exercises while barefoot and while wearing a Hydro Boot (increased frontal area) both under water and on dry land. DESIGN: Participants performed the exercises while seated on an elevator chair under water. SETTING: A hydrotherapy pool. PARTICIPANTS: Eighteen healthy persons (10 women, 8 men). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isokinetic and isometric forces were measured with a dynamometer. The electromyographic activity of the quadriceps (vastus medialis, vastus lateralis) and hamstring muscles (biceps femoris) was recorded. The underwater drag for the range of motion was calculated by using the general fluid equation. RESULTS: The underwater electromyographic patterns showed an early decrease in the concentric activity of the agonists with coincidental activation of the antagonists. In addition, the electromyographic amplitudes were similar between the 2 underwater conditions, but the Hydro Boot produced a higher level (p < .001) of drag than did the barefoot condition. As expected, in most cases the forces on dry land were higher (p < .001) than underwater drag. In flexion, however, the peak drag with Hydro Boot and isokinetic force did not differ. CONCLUSIONS: Increasing the frontal area of the lower leg with a Hydro Boot significantly increased the level of water resistance, thus, providing flexion forces that approach those measured on dry land. This type of water training offers stimulation to enhance the functional capacity and performance of the neuromuscular system. In addition, hydrodynamic principles and forces that influence the exercising limb must be considered to ensure appropriate progression.     

Influence of Altered Knee Angle on Electromyographic Activity of Hamstring Muscles Between Nordic Hamstring Exercise and Nordic Hamstring Exercise with Incline Slope Lower Leg Board

BackgroundPrevious studies have shown that performing the Nordic hamstring exercise (NHE) with different board slope angles can affect hamstring activation. However, changes in muscle length with different board slopes can alter joint angles leading to the moment arm (MA) at the knee changing during the NHE.PurposeThis study aimed to investigate the influence of changing muscle length on hamstring electromyographic activity during an isometric NHE, while maintaining an equal moment arm.Study DesignA crossover study designMethodsSixteen male volunteers performed two types of conventional NHE, one with knees on the floor (NHE) and one with the legs placed upon an incline slope of a lower leg board (NHEB). To compare between the conventional and inclined NHE, the moment arm at the knee was calculated to be equal by an examiner holding the lower legs at points marked at 77% and 94% of the length of the lower leg. The four sub-groups comprised of: 1) NHE-77%, 2) NHE-94%, 3) NHEB-77%, and 4) NHEB-94%. The hamstring EMG activity was measured at the biceps femoris long head (BFlh) and at the semitendinosus (ST) and related compensatory muscles. The RMS data were normalized as a percentage of the maximum isometric values (normalized EMG [nEMG]). Significant main effects findings were followed up with Tukey’s post-hoc test using SPSS software and statistical significance was set at the p < 0.05 level.ResultsThe BFlh EMG activity values for NHE-77% were significantly higher than those for NHE-94% (p= 0.036) and NHEB-77% (p < 0.001), respectively, while ST during NHE-77% was significantly higher only in NHEB-77% (p < 0.001). In addition, NHEB-94% was significantly greater than NHEB-77% for both BFlh (p < 0.001) and ST (p < 0.001).ConclusionThese results indicate that hamstring electromyographic activity is decreased when the hamstring muscle is lengthened during the Nordic hamstring exercise.Level of Evidence3     

Effect of foot rotation on knee kinetics and hamstring activation in older adults with and without signs of knee osteoarthritis

BACKGROUND: To determine the effects of changing the natural foot progression angle during gait (internal and external foot rotation) on the knee's adduction moment, lateral-medial shear force, and the ratio of medial-lateral hamstring muscle activation in those with signs of knee osteoarthritis and a matched healthy control group. METHODS: Twelve subjects with signs of knee osteoarthritis and 12 matched healthy control subjects were evaluated. A 3D gait analysis system calculated forces and moments at the knee while the subjects walked in three conditions: (1) normal foot position, (2) external foot rotation, (3) internal foot rotation. Medial and lateral hamstring EMG data was also collected simultaneously and used to calculate the medial-lateral hamstring activation ratio during the stance phase of the gait cycle. Repeated measures ANOVAs were used to compare foot rotation conditions within each group; while between group comparisons were performed in the normal rotation condition only using t-tests. FINDINGS: Those with knee osteoarthritis (OA) had an increased late stance knee adduction moment and a decreased medial-lateral hamstring activation ratio as compared to the healthy control group. Also, external foot rotation decreased the late stance knee adduction moment, lateral-medial shear force, and hamstring activation ratio. However, internal foot rotation did not increase these measures. INTERPRETATION: Changes in foot position during gait have the ability to alter both the external loading of the knee joint and hamstring muscle activation patterns during gait. This may have implication in helping to unload the knee's articular cartilage.     

One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke

OBJECTIVE: To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients. DESIGN: A randomized controlled study. SETTING: A rehabilitation centre. SUBJECTS: Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke. INTERVENTIONS: Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration. MAIN MEASURES: Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors. RESULTS: Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction. CONCLUSION: These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.     

Activation of abdominal muscles during some physiotherapeutic exercises.

The aim was to evaluate the theoretical efficiency of some abdominal muscle exercises for strength training. Sit-up with rounded back (curl-up) from the supine position up to 45 degrees activates the straight and oblique abdominal muscles to 50% of the values for maximum isometric contraction measured as integrated EMG. This exercise was compared with two previously suggested exercises: curl-up with simultaneous activation of the plantar-flexors of the ankle activated the abdominal muscles to the same level and curl-up from a position with dorsally extended spine did not activate the muscles more. Curl-up with lateral rotation of the trunk gave a high activation of the oblique muscles. This exercise was compared with two completely isometric exercises suggested for patients with back pain: only somewhat lower activation was obtained during an exercise in supine position with lateral resistance to the knees, but with lateral resistance against the elevated forearms there was only little activation.     

Cross-sectional Study of EMG and EMG Rise During Fast and Slow Hamstring Exercises

BackgroundHamstring injuries remain a major burden in football while the effective prevention exercise the Nordic Hamstring is poorly adopted, despite the added positive effects on performance. Better understanding of hamstring function during Nordic Hamstring compared to other exercises may provide better insight to the physiological adaptations of different types of hamstring curls.PurposeThis cross-sectional study therefore aimed to compare the Nordic Hamstring curl with a conventional prone Leg Curl at different loads, and novel high velocity Hamstring Catches; in terms of peak normalized electromyographical activity (nEMG) and rate of electromyographic rise (RER) of Biceps Femoris long head, and angular velocity of the knee.Study designCross-sectional study.MethodsOut of 28 participants enrolled, the final sample included 23 recreationally active male participants who attended a session for determining RM (repetition maximum) to establish loading (8 and 16RM for Hamstring Catches, and 8, 16 and 24RM for Leg Curl) and to familiarize themselves with the three different exercises (Nordic Hamstring, Leg Curl and Hamstring Catch), and a testing session >4 days after during which EMG data were collected during 3 repetitions of each exercise performed in a random order.ResultsThe Nordic Hamstring evoked higher RER (1091.8 nEMG/s) than Hamstring Catches (mean difference: 421 nEMG/s, p<0.0001) and Leg Curl (mean difference: 705 nEMG/s, p<0.001), and at the earliest numerical timepoint from onset of muscle contraction (the Nordic Hamstring: 6 ms; Hamstring Catches: 36-41 ms; Leg Curl: 12-14 ms). Hamstring Catches displayed high peak angular velocity (mean: 471°/s). There was no difference in peak nEMG, irrespective of load for Leg Curl (8, 16 or 24RM) or Hamstring Catches (8- or 16RM).ConclusionThe Nordic Hamstring displayed the highest level muscle activity and most explosive recruitment characteristics with early and high rate of electromyographic rise, compared to even high velocity exercises, thus providing a possible mechanism by which it may increase performance and reduce injuries.Levels of evidence3What is known about the subjectEarly phase force and muscle recruitment have been linked to both performance and hamstring-related inhibition and fatiguability. However, the potential for different hamstring exercises to elicit explosive recruitment is unknown.What this study adds to existing knowledgeEarly phase recruitment was higher and faster during the Nordic Hamstring exercise compared with conventional hamstring Leg Curl exercises with different loads and a high-velocity hamstring exercise.Clinical RelevanceThe surprisingly fast and explosive recruitment characteristics during the Nordic Hamstring exercise suggests the possibility that this exercise have the potential to improve the rate of force development and perhaps counter the effects of hamstring-related inhibition and fatigue.     

Comparison of muscle activation levels and knee valgus between individuals with medial patellofemoral ligament reconstruction and healthy individuals during fatiguing step down task

BackgroundMedial patellofemoral ligament reconstruction becomes first-choice surgical procedure for patients with a history of lateral patellar dislocations but there is limited knowledge about neuromuscular activation patterns of individuals with a history of patellar dislocation who underwent medial patellofemoral ligament reconstruction.ObjectiveThe aim of this study was to compare muscle activation levels and knee valgus during step down performance test between individuals with a history of medial patellofemoral ligament reconstruction and healthy individuals.MethodsFifteen individuals with medial patellofemoral ligament reconstruction and 15 healthy individuals were included. Vastus medialis obliquus, vastus lateralis and gluteus medius muscle activation levels and knee valgus were measured during 60-s- step down performance test. Two-way repeated-measures of analysis of covariance was used for statistical analysis.FindingsCompared to the healthy individuals, individuals with medial patellofemoral ligament reconstruction showed lower vastus medialis obliquus (p = .04) and gluteus medius (p = .005) activation levels, and higher knee valgus (p = .002) in last period of the step down performance test.InterpretationSince the significant results were only observed in the fatiguing section of the test, endurance tests may provide more information about neuromuscular control of the individuals with history of medial patellofemoral ligament reconstruction. Future studies should investigate whether endurance exercises that target to improve vastus medialis obliquus and gluteus medius activity result in better clinical outcomes than conventional programs for individuals with medial patellofemoral ligament reconstruction.