Biomedical Engineering: Applications, Basis and Communications, Vol. 19, No.

6 (2007) 383388

EMG AND PLANTAR PRESSURE PATTERNS AFTER PROLONGED RUNNING

Wen-Lan Wu, , Jyh-Jong Chang , Jia-Hroung Wu , Lan-Yuen Guo and Hwai-Ting Lin
of Sports Medicine Kaohsiung Medical University, Kaohsiung City, Taiwan School of Occupational Therapy Kaohsiung Medical University, Kaohsiung City, Taiwan Department of Industrial Management Hsiuping Institute of Technology, Taichung City, Taiwan wenlanwu@kmu.edu.tw Accepted 4 December 2007
Faculty

ABSTRACT
The aim of this paper is to investigate the eect of prolonged running on lower limb muscle activity, foot pressure and foot contact area. The treadmill running test was performed at a running velocity of 12 km/h for 20 minutes. Twenty-nine male students from the Army Infantry School took part in this study. For all subjects in our study, a number of variables were analyzed by the prolonged running. The EMG variables included the signal maximum amplitude of EMG linear envelope of all the muscles. Meanwhile, maximal forces and peak foot pressures in 10 anatomically dened areas of the foot, and contact area of the whole foot were analyzed. Running EMG data in each of the phases (phase 24) were compared to those at the beginning of the run (phase 1). Dynamic pedography data in phase 4 was compared to those of phase 1. Pedography analysis revealed a signicant increase in the maximal forces and peak pressures under the medial midfoot and all forefoot regions. From phase 1 to phase 4, the maximal force increased by 32% under the medial midfoot, 29% under the rst metatarsal, 34% under the second and third metatarsal, and 21% under the fourth and fth metatarsal. The peak pressure under the medial midfoot increased by 19%, under the rst metatarsal increased by 21%, under the second and third metatarsal increased by 31%, and under the fourth and fth metatarsal increased by 21%. The averaged maximum EMG amplitudes of almost all the muscles were increased gradually as time increased. Among them, rectus femoris, gastrocnemius, soleus, and tibialis anterior muscles reach a signicant amplitude at the p < 0.05 level. In conclusion, our results showed that a prolonged running under a 20 minutes limitation led to a greater increase in muscle amplitude, midfoot and forefoot loading compared with the beginning of running. Keywords : Prolonged running; Muscle fatigue; Electromyographic signal; Foot pressure.

INTRODUCTION
In recent years, there have been more and more participation in distance running. Although running is a natural activity that can maintain and improve aerobic

tness, racing, and particularly training for long distances have their risks. The most common musculoskeletal problems in the runner are overuse injuries (i.e. shin splints, stress fractures). The incidence of such injuries seems to be related to the total distance

Corresponding author: Wen-Lan Wu, P.T. PhD Faculty of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan ROC. Tel.: +886-7-3121101/2646; Fax: +886-7-3138359; E-mail: wenlanwu@kmu.edu.tw.

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covered in training and competition.1 Such overuse injuries may lead to chronic disability. Runners have been shown to be at a very high risk for stress fractures of the metatarsals. The demonstrated alternation of the rollover process with an increased forefoot loading explains the incidence of stress fractures of the metatarsals under fatiguing loading conditions.2,3 Researchers have found that there was an increased maximal force, peak pressure, and impulse under the forefoot and medial midfoot toward the end of the fatiguing run.2 Previous investigations of the fatigued state also showed that the runners use a change in the landing technique as a compensatory strategy. This may cause an external dorsiexion moment.3 This adaptational change in forefoot and midfoot loading has been suggested as a potential mechanism for the development of stress fractures.4 Previous studies24 have demonstrated that muscle fatigue can cause running strategy changes. In order to understand the problems of fatigue and the adverse eects of prolonged running, the analysis of surface electromyographic (SEMG) activity has been widely used in order to study muscle fatigue.2,513 It has been shown that an increase in EMG amplitude with time has been associated with prolonged submaximal muscle contractions.5,11 However, some studies demonstrated that local muscle fatigue as a result of intensive exercise could be evaluated by reduced EMG activity,2,9 especially in the quadriceps,10,14 tibialis anterior9 and biceps femoris, gastrocnemius, peroneus longus, and soleus muscles2 during prolonged treadmill running. Among them, the few published works on fatigue of the muscles of the leg have dealt with short-distance running, i.e. in a 400-m time trial.10 In prolonged running, studies can be found on muscle fatigue after a 30 km run,14 and after 30 min of treadmill running with the running intensity above normal anaerobic thresholds.9 Despite inconsistent results, it can be explained by Vredenbregt et al.s argument.15 In order to maintain a constant tension (i.e. keeping up the running speed) after onset of fatigue, a runner requires increased motor unit recruitment of new motor units to compensate for the decreased ring rate of the already recruited unit, and the EMG amplitude increases. As soon as there are no additional motor units to be recruited, the EMG amplitude decreases. To understand the potentially causative factors for the development of stress fractures, it is necessary to understand how progressive changes in recruitment of the lower leg muscles are correlated with the changes in loading pattern during fatigue. Therefore, the aims of our study are (1) to investigate the eect of prolonged

running on lower limb muscle activity; (2) to compare the maximal forces and peak foot pressures in 10 anatomically dened areas of the foot, and contact area of the whole foot following running with the beginning of running.

METHODS Subjects
In this study, twenty-nine male students from the Army Infantry School were used as examinees. Their mean age was 22.93 4.27 years (aged 1937 years). The examinees had been regularly running at least 4 km per week. They were injury free at the time of the study. Moreover, they all had passed their physical, electrocardiogram examinations to verify them as physically healthy participants. The pretest ECG and BP were normal for all subjects. They were comprehensively informed of the requirements and procedures of the experiment, and written consent was obtained before the test. A brieng session was conducted in order to familiarize the subjects with the treadmill that was to be used during the investigation. Subjects were asked not to perform any exhausting exercise in the 48 hours preceding the test. To assure uniformity of the testing conditions, all subjects wore identical running shoes, without anatomical support for the foots arch.

Instrumentation
A MA-300 surface EMG system (Motion Lab System Inc. L.A., USA) with six preamplier surface electrodes, which includes four foot switches per foot, was used in this study to measure the myoelectrical activities of muscles of the lower leg and simultaneously with the recording of the plantar pressures by a pedar insole pressure system (Novel Inc, M unchen, Germany) to monitor local loads between the foot and the shoe. Foot switches were used to mark the ground contact duration to distinguish single steps in the EMG signals. The foot pressure insoles contain 99 capacitive pressure sensors which produce on the software screen a grid representing pressure distribution as the sensors were sampled at a rate of 50 Hz. Each insole is 2.5 mm thick and available in a range of sizes so they were tted to each subjects shoe.

Protocol and Experimental Procedures

In our study, all subjects performed a test run of 20 minutes at 12 km/h running velocity. Our treadmill

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speed was selected and modied based on Weisr et al.s study.2 In that study, the subjects ran at speeds of about 14.8 1.3 km/h for 13.6 6.5 minutes. However, our subjects were unable reach this speed in our practice trials. Therefore, our subjects ran slower over a longer period of time to maintain a similar level of exercise intensity. All subjects began their warm-up routine by doing a few minutes of slow jogging and a gentle stretch of each major muscle group. During the treadmill run, the air conditioning was constantly set at 25 C. The EMG activity was recorded 10 seconds after 5 min (phase 1), 10 min (phase 2), 15 min (phase 3), and 20 min (phase 4) of running, respectively. After 20 min of running, a 5 min cool-down period at a running velocity of 6 km/h was allowed for the heart rate and breathing to return to normal. During the treadmill run, the right leg EMG activity of the rectus femoris, hamstring, gastrocnemius, soleus, tibialis anterior and peroneus longus muscles were recorded using a sampling rate of 1000 HZ. The surface electrodes were placed longitudinally over the belly of the muscle. The skin was prepared by surface abrasion, and cleaned with alcohol. The electrodes were xed lengthwise over the motor point and secured with surgical tape and cloth wrap, and electrode wires were also secured to an elastic belt worn by subjects to minimize disruption during movement. Prior to the experiment, a PEDAR box was attached around the subjects waist and connected to the insoles. Before any data were collected, the insoles were calibrated by the subject standing on one leg to unload the left then the right foot, to calculate the base line, and the subject ran in the room to get used to the equipment. Simultaneously, with the recording of the EMG, foot pressure data was collected with pressure sensing insoles during the treadmill run from the same 10 second recording segment. After running, the fatigue score was recorded for each of our participants in this test. Lower scores indicated less fatigue (range 010).

EMG Analysis
Our EMG values were calculated using the data from each 10 second recording segment. Ten consecutive running cycles were normalized and averaged for each recording segment. The EMG linear envelope (LE) was calculated from the raw EMG signal through fourthorder Butterworth 40400 Hz band-pass ltering, rectifying, and normalization procedures where timing was represented by percent of running cycle and graphed as linear envelopes. The ensemble averaging of EMG LEs was used to demonstrate the pooled data of all data from ten running cycles. The highest levels of EMG activity were investigated for the muscles. According to dierent functions in the gait of each muscle,12,13 the maximum amplitude of EMG linear envelope of the rectus femoris, gastrocnemius, soleus, peroneus longus muscles were culled during contact phase, and the maximum hamstring, tibialis anterior EMG magnitude were culled during the swing phase. Finally, the running data at each of the phase from 24 will be compared to those from the beginning of running (phase 1).

Foot Pressure Analysis

Foot pressure data was simultaneously collected with the EMG signal. For accurate analysis, the steps at the beginning and end of 10 seconds data recording were removed from the data. Using the PEDAR software, the area of the insoles was divided up into 10 regions (see Fig. 1) by creating a mask that groups sensors into anatomical areas. Maximal forces (N) and peak pressures (N/m2 ) in these 10 anatomically dened areas of the foot, and contact area (cm2 ) of the whole foot, were recorded for further analysis. The measurements for the left and right foot were averaged together. Finally, we used a simplied approach for dynamic pedography data analysis. The data in phase 1 was compared only to those of phase 4.

A1: Medial heel area A2: Lateral heel area A3: Medial midfoot area A4: Lateral midfoot area A5: First metatarsal area
Fig. 1

A6: Second and third metatarsal area A7: Fourth and fifth metatarsal area A8: Hallux area A9: Second toe area A10: Lateral toe area

Each footprint was divided into 10 regions to enable analysis of the pressure.

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Rectus femoris EMG amplitude (mV) EMG amplitude (mV) 2.0 1.5 1.0 0.5 0.0
P=0.04 P=0.04 P=0.04

Hamstring 2.0 1.5 1.0 0.5 0.0 phase 1 phase 2 phase 3 phase 4 Gastrocnemius EMG amplitude (mV)
P=0.04

phase 1 phase 2 phase 3 phase 4 Tibialis anterior

EMG amplitude (mV)

2.0 1.5 1.0 0.5 0.0

P=0.03

P=0.02

2.0 1.5 1.0 0.5 0.0

P=0.03

phase 1 phase 2 phase 3 phase 4 Soleus

phase 1 phase 2 phase 3 phase 4 Peroneus longus

EMG amplitude (mV)

2.0 1.5 1.0 0.5 0.0

EMG amplitude (mV)

P=0.04

2.0 1.5 1.0 0.5 0.0 phase 1 phase 2 phase 3 phase 4

phase 1 phase 2 phase 3 phase 4

Fig. 2 Averaged maximum EMG amplitude for rectus femoris, hamstring, gastrocnemius, soleus, tibialis anterior, and peroneus longus muscles during four phases. Asterisks present statistical signicant dierent of the muscle between the phase 1 and the marked phase.

Statistical Analysis
In our study, SPSS statistical software (SPSS Inc, Chicago) was used for data analysis. The comparison of variables between the experimental conditions (phases) was conducted with repeated one-way ANOVA combined with LSD post hoc multiple comparison. All values were expressed as mean and standard deviation (SD). For all statistical tests, the level of signicance was set at P < 0.05.

RESULTS
The mean post-exercise fatigue score was 6.38 1.86 for our participants in this test. The averaged maximum amplitude of the EMG data of the rectus femoris, hamstring, gastrocnemius, soleus, tibialis anterior and peroneus longus muscles in four phases are presented in Fig. 2. It showed that almost all muscle EMG magnitudes are increased gradually as time increased. Among them, the averaged maximum amplitude of rectus femoris, tibialis anterior, gastrocnemious are significantly increased from phase 2 (p < 0.05). Meanwhile, the maximum amplitude of soleus in phase 4 is significantly greater than in phase 1 (p < 0.05). The maximum amplitude of hamstring and peroneus longus did not change signicantly along with the time increase.

Insole pressure measurement comparisons (see Fig. 3) between phase 1 and phase 4 revealed that there are statistically signicant increases (p < 0.05) in the maximal forces and peak pressures under all midfoot and forefoot regions. From phase 1 to phase 4, the maximal force increased by 32% under the medial midfoot (from 76 N to 101 N), 29% under the rst metatarsal (from 358 N to 463 N), 34% under the second and third metatarsal (from 117 N to 158 N), and 21% under the fourth and fth metatarsal (from 253 N to 306 N). The peak pressure under the medial midfoot increased by 19% (from 9.4 N/m2 to 11.2 N/m2 ), under the rst metatarsal increased by 21% (from 28.3 N/m2 to 34.3 N/m2 ), under the second and third metatarsal increased by 31% (from 24.8 N/m2 to 32.5 N/m2 ), and under the fourth and fth metatarsal increased by 21% (from 18.5 N/m2 to 22.5 N/m2 ). The contact area did not change signicantly.

DISCUSSION
During the heel-toe running, the heel is normally slightly supinated at heel strike, pronates during the contact phase, and returns into supination at propulsion.3 However, in the fatigued state, the runners use a change in the landing technique as a compensatory

EMG and Plantar Pressure Patterns after Prolonged Running

peak pressure 60
N/m^2
P=0.04

387

40 20 0 1 2

P=0.04

P=0.04

P=0.03

phase1 phase4

10

m a xium force 600 500 N 400 300 200 100 0 1 2 3 4 5 6 7 8 9 10

P=0.04 P=0.04 P=0.03

P=0.04

* * *

phase1 phase4

contact areas 30 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10

Fig. 3 Regional maximal force and peak pressure in phase 1 and 4 (1:medial heel, 2:lateral heel, 3:medial midfoot, 4:lateral midfoot, 5:rst metatarsal head, 6:second and third metatarsal head, 7: fourth and fth metatarsal head, 8:hallux, 9:second toe, 10:lateral toes). Asterisks present statistical signicant dierent between the phase 1 and the phase 4.

strategy.3 The present results showed that the peder insole pressure distribution patterns changes during prolonged running state. There was a signicant increase of the peak pressures and maximal forces under the forefoot and the medial midfoot. Sharkey et al. study16 has explained that the increased forefoot loading may be due to a decrease in fatigue-related activity of the exor digitorum longus. The increased forefoot loading under fatigued conditions would increase the likelihood of the development of the fatigue fracture.4 Furthermore, previous research also has described the increased loading under the medial midfoot2 after prolonged running. They explained that the result appears to be due to a more pronounced pronation after prolonged running, and then accompanied with more pressure underneath the medial side of the foot.2 We know that the exor digitorum longus can also play a role for the support of the medial longitudinal arch and also in fatigue-related changes of medial midfoot loading. That explains why the foot arch tends to be more at

cm^2

phase1 phase4

after long-time running. Clinical evidence also showed that midfoot and forefoot is unstable after long-time running. This will greatly increase the chance of plantar fascia injury as the plantar fascia plays an integral role in stabilization of the midfoot and forefoot during running gait. An unstable foot may cause injury to the plantar fascia. Meanwhile, this unstable foot caused by the at arch may be a cause of the increased muscle activation demand on lower limbs to avoid the longer time in internal rotation of tibia. The EMG magnitudes of all muscles are gradually increased during prolonged running. The increased percentage from phase 1 to phase 4 was 22% in the rectus femoris, 17% in the hamstring, 19% in the tibialis anterior, 95% in the gastrocnemius, 44% in the soleus, and 12% in the peroneus longus. The EMG change patterns after prolonged running agree well with the previous studies reported by Nummela et al.11 It reported that there was a 15% decrease in the running speed and a 23% 24% increase in the EMG magnitudes during the 400 m run. In addition, ArendtNielsen et al.s5 study also showed that EMG amplitude was signicantly increased from submaximal contractions. Their conclusion was that the mean EMG voltage increased up to the endurance point, however, after the endurance point, the eect of fatigue had a decreasing inuence on mean EMG voltage. The mean fatigue score is only 6.38 1.86 for our participants in this test. Therefore, we infer that our testing intensity (12 km/hr 20 min) is not high enough to reach endurance point for our strong army of students. However, it is fairly close to this point because the EMG magnitude of m. tibialis anterior and gastrocnemius after phase 3 didnt increase signicantly (p > 0.05) anymore. There are large standard deviations in the m. tibialis anterior and gastrocnemius after phase 3. In fact, the increase in percentage from phase 1 to phase 3 was 31% in the tibialis anterior and only 59% in the gastrocnemius. Another relevant explanation for the discussion of the relationship between our EMG and insole pressure data could be found in Nigg BM et al.s study.17 They explained it from the view point below. Forces acting on the foot during the stance phase act as an input signal producing a muscle reaction. The increased muscle activation used in this adaptation process is to maintain a preferred joint movement path for a given movement task. Therefore, in this study, unstable foot following prolonged running by at arch may be a reason to cause the increased muscle activation demand on lower limb. In addition, the initial fatigue period shows a tendency for the motor units to re synchronously instead of ring independently of others in the same muscle so

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W.-L. Wu et al. 2. Weist R, Eils E, Rosenbaum D, The inuence of muscle fatigue on electromyogram and plantar pressure patterns as an explanation for the incidence of metatarsal stress fractures, Am J Sports Med 32(8):18931898, 2004. 3. Nigg BM, Biomechanics, load analysis and sports injuries in the lower extremities, Sports Med 2:367378, 1985. 4. Arndt A, Ekenman I, Westblad P et al., Eects of fatigue and load variation on metatarsal deformation measured in vivo during barefoot walking, J Biomech 35:621628, 2002. 5. ArendtNielsen L, Mills K, Muscle bre conduction velocity, mean power frequency, mean EMG voltage and force during submaximal fatiguing contractions of human quadriceps, EUR J Appl Physiol 58:2025, 1988. 6. De Luca CJ, Myoelectrical manifestations of localized muscular fatigue in humans, Crit Rev Biomed Eng 11:251279, 1984. 7. Hausswirth C, Brisswalter J, Vallier JM, Smith D, Lepers R, Evolution of electrographic signal, running economy, and perceived exertion during dierent prolonged exercises, Int J Sports Med 21:429436, 2000. 8. Mero A, Komi PV, Electromyographic activity in sprinting at speeds ranging from submaximal to supramaximal, Med Sci Sports Exerc 19:266274, 1987. 9. Mizrahi J, Verbitsky O, Isakov E, Fatigue-related loading imbalance on the shank in running: A possible factor in stress fractures, Ann Biomed Eng 28:463469, 2000. 10. Nummela A, Rusko H, Mero A, EMG activities and ground reaction forces during fatigued and nonfatigued sprinting, Med Sci Sports Exerc 26(5):605609, 1994. 11. Nummela A, Vuorimaa T, Rusko H, Changes in force production, blood lactate and EMG activity in the 400m sprint, J Sport Sci 10:217228, 1992. 12. Pinnington HC, Lloyd DG, Besier TF, Dawson B, Kinematics and electromyography analysis of submaximal dierences running on a rm surface compared with soft, dry sand, Eur J Appl Physiol 94:242253, 2005. 13. Wank V, Frick U, Schmidtbleicher D, Kinematics and electromyography of lower limb muscles in overground and treadmill running, Int J Sports Med 19:455461, 1998. 14. Millet GY, Martin V, Lattier G, Ballay Y, Mechanisms contributing to knee extensor strength loss after prolonged running exercise, J Appl Physiol 94(1):193198, 2003. 15. Vredenbregt J, Rau G, Surface electromyography in relation to force, muscle length and endurance, in Desmedt JE (ed.), New developments in electromyography and clinical neurophysiology, Karger, Basel, Switzerland, pp. 607622, 1973. 16. Sharkey NA, Ferris L, Smith TS, Matthews DK, Strain and loading of the second metatarsal during heel-lift, J Bone Joint Surg Am 77:10501057, 1995. 17. Nigg BM, The role of impact forces and foot pronation: A new paradigm, Clin J Sport Med 11:29, 2001.

that the EMG will increase the amplitude of the EMG. However, this compensatory mechanism will fail with the loss of the ability of continuing activity when the central fatigue level is reached. In clinical applications, the information from muscle activation detection can serve as a prescribed tool for analysis and distinguish individual physical limitations when executing running activity. The analysis of the running fatigue is complicated by the fact that the extent of the fatigue may vary according to the level of the individual physical tness, even though they are running under the same physical conditions. Our study provides continuous observation of the progressive changes in EMG and plantar pressure patterns that occur following a long period running activity. Compared with other treadmill running studies,2 our results make it possible to quantify how progressive the changes are in the degree of fatigue after prolonged running. It also avoids the loss of some valuable information before the state of complete exhaustion after prolonged running.

CONCLUSIONS
In conclusion, our results showed that prolonged running with a limitation of 20 minutes led to a greater increase in muscle amplitude, midfoot and forefoot loading compared with the beginning of running. The results suggest that the role of the increased EMG activation may contribute to an adaptation for an unstable foot following prolonged running and to provide a constant joint movement pattern. Among them, the most likely aected muscles after prolonged running are rectus femoris, tibialis anterior, gastrocnemious, and soleus. The degree of EMG change was dierent in each working muscle. In addition, the change in the foot loading conditions may cause an increase in the peak pressures under the medial midfoot and all forefoot regions. Therefore, we need to pay more attention to the high probability of development of metatarsal stress fracture in long-time running.

ACKNOWLEDGMENTS
This work was supported by National Scientic Council, Taiwan (NSC95-2314-B-037-047).

REFERENCES
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