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[ RESEARCH REPORT ]

RICHARD A. EKSTROM, PT, DSc, OCS1 ROBERT A. DONATELLI, PT, PhD, OCS2 KENJI C. CARP, PT, OCS, ATC3

Electromyographic Analysis of Core


Trunk, Hip, and Thigh Muscles During
9 Rehabilitation Exercises
ehabilitation or performance enhancement training should muscular performance decits. Electro-

R be based on the principle that specic imposed demands on


the musculoskeletal system will produce specic adaptations
within the system. Exercises designed to increase strength or
endurance should target specic muscle groups that are weak or are
important to the activities in which the individual wants to participate.
myographic (EMG) analysis can provide
information as to the relative amount of
muscular activity an exercise requires, as
well as the optimal positioning for the
exercise.
Researchers have recently reported
A clinician should be able to establish a specic exercise program on the importance of specic trunk, hip,
that includes optimal exercise positions to target specic identied and thigh muscle strengthening and en-
durance/stabilization training for the
prevention of athletic injuries.6,31,52 Weak-
ness and poor endurance of the lumbar
T STUDY DESIGN: Prospective, single-group, obliquus, and hamstring muscles were studied.
repeated-measures design. extensor, gluteus maximus, and hip exter-
T RESULTS: In healthy subjects, the lateral nal rotator muscles have also been noted
T OBJECTIVE: To identify exercises that could be step-up and the lunge exercises produced EMG
used for strength development and the exercises in individuals with lower extremity inju-
levels greater than 45% maximum voluntary
that would be more appropriate for endurance or isometric contraction (MVIC) in the vastus ries and low back pain.9,28,31,32,36,39 Leetun
stabilization training. medialis obliquus, which suggests that they may et al31 found that athletes who were not
T BACKGROUND: The exercises analyzed are be benecial for strengthening that muscle. The injured had stronger hip abductor and
often used in rehabilitation programs for the spine, side-bridge exercise could be used for strengthen- external rotator muscles. It has also been
hip, and knee. They are active exercises using body ing the gluteus medius and the external oblique reported that females with patellofemo-
weight for resistance; thus a clinician is unable abdominis muscles, and the quadruped arm/lower
ral joint pain have weaker hip abduc-
to determine the amount of resistance being extremity lift exercise may help strengthen the
applied to a muscle group. Electromyographic gluteus maximus muscle. All the other exercises
tors, extensors, and external rotators as
(EMG) analysis can provide a measure of muscle produced EMG levels less than 45% MVIC, so they compared to age-matched controls.26,43
activation so that the clinician can have a better may be more benecial for training endurance or Mascal et al,34 in a case series including
idea about the effect the exercise may have on the stabilization in healthy subjects. 2 patients, reported that strengthening
muscle for strength, endurance, or stabilization.
T CONCLUSION: Our results suggest that these these muscles resulted in a signicant
T METHODS AND MEASURES: Surface EMG exercises could be used for a core rehabilitation or improvement in patellofemoral pain,
analysis was carried out in 19 males and 11 performance enhancement program. Depending lower extremity kinematics, and return
females while performing the following 9 exercises: on the individual needs of a patient or athlete,
active hip abduction, bridge, unilateral-bridge, to function.
some of the exercises may be more benecial than
side-bridge, prone-bridge on elbows and toes, In addition to injury prevention,
others for achieving strength. J Orthop Sports
quadruped arm/lower extremity lift, lateral studies have demonstrated that specic
Phys Ther 2007;37(12):754-762. doi:10.2519/
step-up, standing lunge, and using the Dynamic strengthening of the core hip and trunk
jospt.2007.2471
Edge. The rectus abdominis, external oblique ab-
muscles may improve athletic perfor-
dominis, longissimus thoracis, lumbar multidus, T KEY WORDS: endurance, lower extremity,
gluteus maximus, gluteus medius, vastus medialis spine, stabilization, strength mance.13,46,51,54 The trunk and hip muscles
have been shown to be very important for

1
Associate Professor, Department of Physical Therapy, University of South Dakota, Vermillion, SD. 2 National Director of Sports Specic Rehabilitation and Performance
Enhancement Programs, Physiotherapy Associates, Las Vegas, NV. 3 Clinical Director, Physiotherapy Associates, Eugene, OR. This study was approved by the Institutional
Review Board at the University of South Dakota. Address correspondence to Dr Richard Ekstrom, Department of Physical Therapy, University of South Dakota, 414 East Clark
Street, Vermillion, SD 57069. E-mail: rekstrom@usd.edu

754 | december 2007 | volume 37 | number 12 | journal of orthopaedic & sports physical therapy
obtaining maximal power and accuracy maximus, gluteus medius, vastus media- placed at a 55 oblique angle over the
of the golf and baseball swing.46,51,54 lis obliquus, and hamstring muscles. center of the muscle belly of the vastus
The purpose of this investigation was The following steps were taken to medialis obliquus muscle, 2 cm medially
to quantify muscle activation with EMG minimize EMG signal cross-talk between from the superior rim of the patella.16 A
analysis during 9 exercises involving the muscles. The electrodes were positioned reference electrode was placed over the
trunk, hip, and thigh muscles. We hy- well within the borders of the muscles anterior superior iliac spine.
pothesized that in the muscles analyzed, and applied in parallel arrangement to For normalization of the EMG data,
specic exercises would generate signi- the muscle bers, with a center-to-cen- a maximum voluntary isometric con-
cantly greater levels of EMG signal am- ter interelectrode distance of 20 mm. The traction (MVIC) was performed for each
plitude than other exercises. skin impedance was checked with an ohm muscle and the EMG amplitude recorded.
meter attached to the connecting snap of The test positions were consistent with
METHODS each electrode pair and was judged ac- those demonstrated in manual muscle
ceptable if less than 5000 6.16 testing books commonly used by physi-
Subjects The electrodes were applied unilater- cal therapists, but in some cases addi-
ally, with no preference for left or right tional manual resistance was applied.25,29

T
hirty healthy subjects, 19 males
and 11 females (mean  SD height, sides. It was felt that this was consistent Manual resistance was applied gradually
176  8 cm; body mass, 74 11 kg), with exercise of muscle groups in clinical up to the maximum amount, and then
whose ages ranged from 19 to 58 years practice. We were not aware of any evi- held for 5 seconds. Each muscle test was
(mean  SD, 27  8 years), participated dence indicating a signicant difference repeated 3 times, with a 30-second rest
in the study. The subjects were recruit- of muscle activity between sides of normal period between. Proper electrode place-
ed from the University of South Dakota individuals when exposed to the exercises ment was also conrmed by observing
community and volunteered to partici- used in this study. For the rectus abdomi- the EMG signal amplitude during the
pate. Subjects were accepted for the study nis muscle, the electrodes were placed 3 manual muscle tests.
if they were in good health, with no cur- cm lateral and 3 cm superior to the umbi- The MVIC performed for the rectus
rent or previous lower extremity or back licus, which is slightly different than that abdominis muscle was a partial curl-up
problems. They were excluded if they recommended by Cram and Kasman.16 By with the feet secured and resistance ap-
had low back or lower extremity pain, or placing the electrodes slightly superior to plied at the shoulders.29 For the external
any recent surgery. The rights of subjects the umbilicus, the thickest layer of adi- oblique abdominis muscle, the subject
were protected. Participants signed an pose tissue was avoided. The electrodes performed an oblique curl-up, attempt-
informed consent form prior to partici- were placed midway between the anterior ing to move the resisted shoulder toward
pation and the protocol for this study was superior iliac spine and the rib cage for the opposite knee.29 The MVIC for the
approved by the University of South Da- the external oblique abdominis muscle.16 lumbar multidus and longissimus tho-
kota Institutional Review Board. For the longissimus thoracis muscle, the racis muscles was performed with prone
electrodes were placed 4 cm lateral to trunk extension to end range, with resis-
Procedures the L1 spinous process and for the lum- tance applied at the upper thoracic area.29
Prior to electrode placement, each subject bar multidus muscle the electrodes were The gluteus medius muscle MVIC was
was familiarized to the procedures by be- placed 2 cm lateral to the lumbosacral performed in the side-lying position, with
ing instructed in and practicing the mus- junction.18 The electrodes for the gluteus the hip in neutral rotation and slightly
cle tests and exercises to be performed. medius muscle were placed anterosupe- extended and then actively abducted to
Once assured that the subjects could cor- rior to the gluteus maximus muscle and end range as resistance was applied just
rectly perform the muscle tests and ex- just inferior to the iliac crest on the lat- above the ankle.25 The MVIC for the glu-
ercises, the sites for electrode placement eral side of the pelvis.16 For the gluteus teus maximus muscle was performed in
were prepared by abrading the skin with maximus muscle, electrodes were placed the prone position, with the knee exed
ne sandpaper and cleansing the area in the center of the muscle belly between to 90 and the hip extended with resis-
with 70% isopropyl alcohol. Shaving of the lateral edge of the sacrum and the tance applied just above the knee.29 The
hair was performed if necessary. Dual posterosuperior edge of the greater tro- MVIC of the hamstring muscles was per-
disposable silver/silver chloride surface chanter.16 A general electrode placement formed in the prone position, with the
recording electrodes (Noraxon USA, Inc, was used for the entire hamstring muscle knee exed 45 with resistance applied
Scottsdale, AZ) were applied. EMG data group midway between the gluteal fold just above the ankle.25 The vastus media-
were collected from the rectus abdomi- and the popliteal line on the posterior lis obliquus MVIC was performed in the
nis, external oblique abdominis, longissi- surface of the knee in the center of the sitting position, with the knee exed be-
mus thoracis, lumbar multidus, gluteus posterior thigh.16 Electrodes were also tween 45 to 60 and resistance applied

journal of orthopaedic & sports physical therapy | volume 37 | number 12 | december 2007 | 755
[ RESEARCH REPORT ]

FIGURE 3. Unilateral bridge exercise with 1 knee


FIGURE 1. Active hip abduction in the side-lying FIGURE 2. Bridge exercise to the neutral spine extended and the opposite hip extended so that the
position with neutral hip rotation. alignment position. trunk is in neutral spine alignment.

FIGURE 4. Side-bridge exercise with the trunk in FIGURE 5. Prone-bridge exercise with the trunk in FIGURE 6. Quadruped arm and lower extremity lift
neutral spine alignment. neutral spine alignment. with the trunk in neutral spine alignment.

FIGURE 7. Lateral step-up exercise to a 20.32-cm FIGURE 9. Dynamic Edge exercise with resistance to
platform. FIGURE 8. Standing lunge exercise. side-to-side motions simulating downhill skiing.

just above the ankle.15,56 toes with the spine in neutral alignment maximal knee exion. The Dynamic Edge
The following 9 exercises were ran- (FIGURE 5), quadruped arm and opposite exercise was performed with a continu-
domly performed: active hip abduction lower extremity lift to the neutral spine ous side-to-side motion similar to that
in the frontal plane in the side-lying po- position with the electrodes on the side of performed during slalom snow skiing.
sition with neutral hip rotation (FIGURE the hip being extended (FIGURE 6), lateral Rest periods of 30 seconds were allowed
1), bridge to the neutral spine position step-up to a 20.32-cm (8-in) platform between repetitions of the exercises and
(FIGURE 2), unilateral-bridge to the neu- (FIGURE 7), standing lunge (FIGURE 8), and a 1-minute rest period was given between
tral spine position with the opposite knee Dynamic Edge (The Skiers Edge Com- exercises. Considering these rest periods
extended and the electrodes on the side of pany, Park City, UT) (FIGURE 9). The trunk and the fact that the exercises did not
the supporting lower extremity (FIGURE 3), stabilization exercises were performed 3 always activate the same muscle to high
side-bridge with the trunk in neutral spi- times and held for 5 seconds. The lateral levels, we felt that fatigue was not a factor
nal alignment and the electrodes placed step-up and lunge exercises were per- in this study.
on the side of the supporting extremities formed slowly through full range of mo- Following data collection, 2 of the ex-
(FIGURE 4), prone-bridge on the elbows and tion, with a 5-second hold at the point of ercises were repeated a second time in 13

756 | december 2007 | volume 37 | number 12 | journal of orthopaedic & sports physical therapy
lters. The Myosystem 1200 was inter-
EMG Activity of the Gluteus Medius
faced with a computer with a 16-channel,
TABLE 1 and Gluteus Maximus Muscles During
12-bit A/D card (Computer Boards, Inc,
9 Different Exercises*
Middleboro, MA). The sampling rate was
Exercise Gluteus Medius Gluteus Maximus set at 1000 Hz per channel.
1. Side-bridge 74  30 21  16 All data were stored on a Gateway
2. Unilateral-bridge 47  24 40  20 Solo 9300LS personal computer (Gate-
3. Lateral step-up 43  18 29  13 way, Inc, Irvine, CA) and MyoResearch
4. Quadruped arm/lower extremity lift 42  17 56  22 2.02 software (Noraxon USA, Inc, Scott-
5. Active hip abduction 39  17 21  16 sdale, AZ) was used for data processing
6. Dynamic Edge 33  16 19  14 and analysis. During data collection, the
7. Lunge 29  12 36  17 raw EMG recordings were monitored.
8. Bridge 28  17 25  14 The raw EMG data were full-wave recti-
9. Prone-bridge 27  11 97 ed, processed using a root-mean-square
* Values expressed as mean  SD percentage of maximum voluntary isometric contraction (MVIC); n
(RMS) algorithm, and smoothed with a
= 30; P .05. 20-millisecond moving window. The am-

For the gluteus medius muscle, exercise 1 produced signicantly greater EMG signal amplitude when plitude was calculated from a 1-second
compared to exercises 2 to 9. For the gluteus maximus muscle, exercise 4 produced signicantly greater
EMG signal amplitude when compared to all the other exercises.
window centered about the peak activity

For the gluteus medius muscle, there was no signicant difference in the EMG signal amplitude for each of the MVICs and exercises.
between exercises 2 to 5, but the EMG signal amplitude was signicantly greater in these exercises com- The maximum EMG signal amplitude
pared to exercises 7 to 9. For the gluteus maximus muscle, there was no signicant difference between
exercises 2 and 7, but the EMG signal amplitude was signicantly greater for these exercises compared
during the MVIC of each muscle was re-
to exercises 1, 3, 5, 6, 8, and 9. corded and represented 100% muscle
activity. The muscle activity recorded
during the exercises was then expressed
EMG Activity of the Vastus Medialis as a percentage of the MVIC.
TABLE 2 Obliquus and Hamstring Muscles
During 9 Different Exercises* Data Analysis
The SPSS Base 10.0 for Windows (SPSS
Exercise Vastus Medialis Obliquus Hamstrings
Inc, Chicago, IL) computer program was
1. Lateral step-up 85  17 10  6
used for data analysis. An intraclass cor-
2. Lunge 76  19 11  6
relation coefficient (ICC3,1) was used to
3. Dynamic Edge 36  12 63
determine the same day test-retest reli-
4. Prone-bridge 23  13 46
ability of the EMG recordings.42
5. Side-bridge 19  11 12  11
A 1-way repeated-measures analysis of
6. Unilateral-bridge 18  13 40  17
variance (ANOVA) was applied for each
7. Quadruped arm/lower extremity lift 16  11 39  14
muscle, with the factor being exercises
8. Active hip abduction 88 43
with 9 levels. Post hoc analysis for pair-
9. Bridge 33 24  14
wise comparisons followed when a signif-
* Values expressed as mean  SD percentage of maximum voluntary isometric contraction (MVIC); n icant main effect was found. Signicance
= 30; P .05.

For the vastus medialis obliquus muscle, there was no signicant difference in the EMG signal ampli- was established at the .05 level.
tude between exercises 1 and 2, but these exercises produced signicantly greater EMG signal amplitude
when compared to all the other exercises. For the hamstring muscles, there was no signicant difference
between exercises 6 and 7, but these exercises produced signicantly greater EMG signal amplitude
RESULTS
when compared to all the other exercises.
Reliability of EMG Recordings

T
he same day test-retest ICCs
subjects to determine if there was consis- cations include a differential input im- for the EMG recordings from the
tency in the EMG recordings. pedance of greater than 10 M6, a gain of muscles during the bilateral bridge
1000, and a common-mode rejection ra- and quadruped arm/lower extremity lift
EMG Analysis tio of greater than 100 dB at 60 Hz. The exercises were 0.86 (SEM, 20.0% MVIC)
An 8-channel EMG Noraxon Myosystem EMG signals were band-pass ltered from and 0.93 (SEM, 20.7% MVIC), respec-
1200 (Noraxon, USA, Inc, Scottsdale, AZ) 10 to 500 Hz using rst-order high-pass tively. Therefore, there was good consis-
was used for data collection. Unit speci- and fourth-order low-pass Butterworth tency in the EMG recordings.

journal of orthopaedic & sports physical therapy | volume 37 | number 12 | december 2007 | 757
[ RESEARCH REPORT ]
Electromyography Data During the Exercises
EMG Activity of the Longissimus
The mean EMG activity of each muscle
TABLE 3 Thoracis and Lumbar Multifidus Muscles
expressed as a percent of MVIC for
During 9 Different Exercises*
each exercise is displayed in TABLES 1
through 4. Exercise Longissimus Thoracis Lumbar Multidus
The gluteus medius muscle showed 1. Unilateral-bridge 40  16 44  18
signicantly greater activation (P = .005) 2. Side-bridge 40  17
42  24
with the side-bridge exercise (mean  3. Bridge 39  15
39  15
SD, 74%  30% MVIC) and the gluteus 4. Quadruped arm/lower extremity lift 36  18
46  21
maximus muscle showed signicantly 5. Lateral step-up 25  10 28  10
greater activation (P = .008) with the 6. Dynamic Edge 21  10 21  11
quadruped arm/lower extremity lift ex- 7. Active hip abduction 18  14 20  12
ercise (mean  SD, 56%  22% MVIC) 8. Lunge 17  8 25  11
than with any other exercise (TABLE 1). 9. Prone bridge 64 54
For the hamstring muscles (TABLE 2), * Values expressed as mean  SD percentage of maximum voluntary isometric contraction (MVIC); n
the quadruped arm/lower extremity lift = 30; P .05.

(mean  SD, 39%  14% MVIC) and the For the longissimus thoracis and lumbar multidus muscles there was no signicant difference in the
EMG signal amplitude between exercises 1 to 4, but these exercises produced signicantly greater EMG
unilateral bridge (mean  SD, 40%  signal amplitude when compared to exercises 5 to 9.
17% MVIC) exercises produced the most
muscular activity with no signicant dif-
ference between them (P = 1.00). The EMG Activity of the External Oblique
vastus medialis obliquus muscle (TABLE 2) TABLE 4 Abdominis and Rectus Abdominis Muscles
showed the greatest activation with the During 9 Different Exercises*
lateral step-up (mean  SD, 85%  17%
MVIC) and lunge exercises (mean  SD, Exercise External Oblique Abdominis Rectus Abdominis
77%  19% MVIC), with no signicant 1. Side-bridge 69  26 34  13
difference between the two (P = .057). 2. Prone-bridge 47  21 43  21
The longissimus thoracis (mean  SD, 3. Quadruped arm/lower extremity lift 30  18 87
36%  18 to 40%  17% MVIC) and lum- 4. Unilateral-bridge 23  16 14  13
bar multidus (mean  SD, 39%  15% 5. Bridge 22  13 13  11
to 46%  21% MVIC) muscles (TABLE 3) 6. Active hip abduction 18  10 64
demonstrated similar activity levels with 7. Dynamic Edge 18  12 75
the bilateral bridge, unilateral bridge, side- 8. Lunge 17  11 75
bridge, and the quadruped arm/lower ex- 9. Lateral step-up 15  10 53
tremity lift exercises (P = .199-1.00). The * Values expressed as mean  SD percentage of maximum voluntary isometric contraction (MVIC); n
external oblique abdominis muscle (TABLE = 30; P .05.

For the external oblique obdominis muscle, exercise 1 produced signicantly greater EMG signal
4) showed the greatest activity (P = .001) amplitude when compared to exercises 2 to 9. For the rectus abdominis muscle, there was no signicant
with the side-bridge exercise (mean  SD, difference in the EMG signal amplitude between exercises 1 and 2, but these exercises produced signi-
69%  26% MVIC). The rectus abdomi- cantly greater EMG signal amplitude when compared to exercises 3 to 9.

nis muscle (TABLE 4) activity was greatest


with both the prone-bridge (mean  SD, on the amplitude of the EMG signal, a tion during isometric contractions.7
43%  21% MVIC) and side-bridge (34% judgment can be made about exercises Marras and Davis33 found strong linear
 13% MVIC) exercises, with no signi- that may be benecial for strengthening relationships for the erector spinae, rec-
cant difference between them (P = .430). and those that may be more benecial for tus abdominis, and external and internal
endurance or stabilization training. oblique abdominis muscles during iso-
DISCUSSION When the surface EMG signal is recti- metric exion and extension exertions.
ed and smoothed, its amplitude is gen- Alkner et al1 found linearity in the force
erally positively related to the amount of production-EMG signal amplitude rela-

T
he purpose of this study was to
examine the activity level of several force produced by the muscle.20 Investi- tionship for the vastus lateralis and biceps
muscles during exercises that are gators have reported both linear and non- femoris muscles, but more of a curvilin-
commonly used for core stabilization and linear relationships between EMG signal ear relationship when evaluating the vas-
strengthening exercise programs. Based amplitude and increasing force produc- tus medialis and rectus femoris muscles.

758 | december 2007 | volume 37 | number 12 | journal of orthopaedic & sports physical therapy
Therefore, for the purpose of developing they recorded EMG signal amplitude in resistance, produces moderate activity of
exercise programs, the EMG signal am- the 100% to 120% MVIC range, which is the back muscles so may be most useful
plitude can provide a general guideline as higher than our ndings. The difference for developing muscle endurance.
to the difficulty of the exercise. in EMG activity of the quadriceps found Arokoski et al4 previously analyzed the
Loads of 45% to 50% of 1 repetition in our study as compared to other studies bridge (FIGURE 2) and unilateral-bridge
at maximum effort (1 RM) have been could be due to the following variables: (FIGURE 3) exercises and found a signi-
shown to increase strength in previously method of MVIC determination, peak cant difference between men and women.
untrained individuals.2,23,45,50 Therefore, versus a 1-second window of activity, iso- The EMG signal amplitude values were
those exercises that produced EMG sig- metric versus various speeds of concen- consistently higher in the longissimus
nal amplitude in the muscles on an aver- tric muscle contraction, or the fact that thoracis and lumbar multidus muscles
age greater than 45% MVIC may provide we just recorded from the vastus medialis in women compared to men. For the
sufficient stimulus for strength gains obliquus muscle. bridge exercise, they recorded values of
in some individuals. However, because The lunge exercise (FIGURE 8) produced about 14% MVIC for men and 35% MVIC
the standard deviation of the EMG sig- a mean  SD EMG signal amplitude of for women in the longissimus thoracis
nal amplitude is often quite large, some 76%  19% MVIC in the vastus me- muscles, whereas we recorded mean 
individuals, depending on their initial dialis obliquus muscle. Pincivero et al40 SD values of 39%  15% MVIC for the
strength level, may benet from the exer- recorded the EMG signal amplitude of combined population. For the lumbar
cises less than others. Individuals that are the vastus medialis and lateralis muscles multidus muscle, they recorded values
better conditioned will need higher levels during the lunge exercise, and found peak of about 33% MVIC for men and 53%
of stimulus to obtain a strengthening re- muscle activity of 150% to 175% MVIC. MVIC for women, as compared to a mean
sponse. Most of the exercises used in this The side-bridge exercise (FIGURE 4)  SD of 39%  15% MVIC in the current
study produced EMG signal amplitude of produced a mean  SD EMG signal study.
less than 45% MVIC, so we would con- amplitude of 74%  30% MVIC in the For the unilateral-bridge, Arokoski
sider those to be most benecial for en- gluteus medius muscle, and 69%  26% et al4 recorded EMG signal amplitude of
durance or motor control training. MVIC in the external oblique abdominis 38% MVIC for men and 71% MVIC for
The exercises that may provide a muscle. McGill35 had previously recorded women in the longissimus thoracis, and
strengthening stimulus for certain mus- EMG activity of 50% MVIC in the ex- we recorded a mean  SD of 40%  16%
cles would be the side-bridge, the lateral ternal oblique abdominis with the side- MVIC. We recorded a mean  SD of 44%
step-up, the lunge, and possibly the quad- bridge exercise. To our knowledge this  18% MVIC in the lumbar multidus
ruped arm/lower extremity lift. These ex- exercise is not routinely used for gluteus muscle of the supporting lower extrem-
ercises produced EMG signal amplitude medius strengthening, but could be one ity, and Aroskoski et al4 recorded 34%
markedly greater than the 45% MVIC added to such a program. MVIC EMG signal amplitude for men
level. During the quadruped arm/lower ex- and 65% for women. Because we did not
The lateral step-up exercise (FIGURE 7) tremity lift exercise (FIGURE 6), 1 muscle differentiate between men and women in
produced a mean  SD EMG signal am- generated sufficient EMG signal ampli- this study, we would conclude that these
plitude of 85%  17% MVIC in the vas- tude to be considered in the strengthen- exercises are better suited for endurance
tus medialis obliquus muscle. During the ing range: the gluteus maximus (mean training. But analysis of the work of Aro-
step-up exercise, a 20.32-cm platform  SD, 56%  23% MVIC). We recorded koski et al4 suggests that some subjects,
was used and a 5-second isometric hold a mean  SD EMG signal amplitude of especially women, may derive some
was added at maximum knee exion of 36%  18% MVIC for the longissimus strengthening benets from the bridge
about 45 to 55. Others have reported thoracis and 46%  21% MVIC for the and unilateral-bridge exercises.
EMG signal amplitude ranging from 47% lumbar multidus on the side of the The prone-bridge exercise (FIGURE 5)
to 80% MVIC during this exercise.12,15,56 extended hip during this exercise. Oth- should provide adequate stimulus for en-
Ayotte et al5 recorded EMG signal ampli- ers have recorded values ranging from durance training of the rectus abdominus
tude of 55% MVIC in the vastus medialis about 20% to 40% MVIC for the erector (mean  SD, 47%  21% MVIC) and the
obliquus muscle during the concentric spinae on the side of the lower extrem- external oblique abdominis (mean  SD,
phase of a 15.24-cm lateral step-up. Beu- ity lifted and 27% to 56% MVIC for the 43%  21% MVIC) muscles. Escamilla
tler et al8 recorded EMG signal amplitude lumbar multidus muscle.3,4,14,35,47,48 The et al21,22 have demonstrated other exer-
for the whole quadriceps as high as 207% quadruped arm/lower extremity lift is cises that would be more appropriate for
 50% MVIC at about 83 of knee ex- often utilized as an exercise for lumbar strengthening the abdominal muscles.
ion when performing step-ups to a higher spine rehabilitation. This exercise when Studies have clearly linked the impor-
platform. In the 45 to 55 exion range, performed actively, without additional tance of sufficient endurance and strength

journal of orthopaedic & sports physical therapy | volume 37 | number 12 | december 2007 | 759
[ RESEARCH REPORT ]
of the above muscle groups to prevention proximity of the electrode placements for benet in rehabilitation programs.
of injury and improved athletic perfor- the 2 muscles may have allowed the elec- There is the potential that subjects did
mance.10,36,51,54,53 Thus, individuals with trodes over the multidus muscle to pick not generate a true MVIC of each muscle.
poor endurance of the abdominal and up EMG activity from the longissimus This could be due to a lack of effort, or
back muscles will benet from appropri- thoracis and vice versa. Most researchers the muscle testing positions may not have
ate use of bridging, unilateral bridging, place the electrodes further apart, with been optimal for producing maximum
side-bridging, prone bridging on elbows the multidus electrodes lateral to the EMG signal. Muscle length at the time of
and toes, and the quadruped arm/lower spine at L5 or lower,3,4,14,18-19,38,48 and the the MVIC may also be a factor. We ob-
extremity lift exercises. All the above electrodes for the longissimus thoracis at tained the MVIC of the gluteus medius
exercises demonstrated coactivation of the L2 level3,4,18-19,48 or above. Arokoski et muscle at end range abduction, whereas
muscle groups and should be benecial al3 found a high correlation between the Bolgla and Uhl11 used a position of 25
for stabilization or endurance training. average intramuscular and surface activi- hip abduction. Our results with active hip
Active hip abduction (FIGURE 1) did not ties of the normalized EMG signal of the abduction were very similar, even though
produce signicant activation of the core multidus muscle at the L2 and L5 levels, Neumann et al37 found that EMG signal
stabilizers, but was effective in isolating and Danneels et al17 have demonstrated amplitude increases as the hip is abducted
function of the gluteus medius muscle. good reliability in the use of surface elec- to greater degrees, possibly due to length-
Active hip abduction produced a mean trodes for the lumbar multidus muscle. tension changes in the muscles. Optimal
 SD EMG signal amplitude of 39%  We believe additional research should be positions for producing a MVIC for each
17% MVIC of the gluteus medius muscle performed before a denite conclusion muscle group have not been clearly es-
in this study as compared to 42%  23% can be derived about the use of surface tablished. While interpretation of the
MVIC in the study by Bolgla and Uhl.11 electrodes for the lumbar multidus absolute muscular effort expressed as a
Therefore, active hip abduction will allow muscle. percent of MVIC may be affected by the
for nonweight-bearing strengthening In our study, the EMG signal was MVIC testing, the within-subject design
of the gluteus medius if additional resis- generally collected during static muscle of this study provides a solid comparison
tance is applied to the lower extremity. contractions, except during the Dynamic of the relative difference in muscular ef-
Weakness specic to the gluteus medius Edge exercise. Static holds are common- fort among the exercises.
muscle has clearly been correlated with ly performed during the trunk exercises Finally, because these results were
hip,11 knee,26,31,32,36,41 and back28,32,36,44 in- evaluated, but may seldom be used during obtained by studying subjects without
juries and good strength of the gluteus the step-up and lunge exercises. In other pathology, caution is warranted in ex-
medius has been linked to better per- EMG studies of the lateral step-up exer- trapolating these ndings to a patient
formance when swinging a golf club or cise, the quadriceps muscle activity has population.
baseball bat.46,51,54 been recorded during dynamic contrac-
tions. However, the isometric hold in the CONCLUSIONS
Limitations most stressful part of the range may be
Cross-talk may be a limitation when us- benecial for adding stimulus to promote

T
he bridge, unilateral-bridge,
ing surface electrodes. The electrode additional muscle adaptations. Danneels side-bridge, prone-bridge on elbows
placement for the gluteus medius muscle et al19 found increased hypertrophy of the and toes, and quadruped arm/lower
may have allowed for some cross-talk lumbar multidus muscles when a 5-sec- extremity lift exercises provide muscle
from the gluteus maximus muscle be- ond isometric hold was performed be- activation without external loading for
cause of its proximity. Stokes et al49 have tween the concentric and eccentric phase training endurance and stabilization of
questioned the validity of using surface during prone back extension exercises. the trunk and hips. Active hip abduc-
electrodes to monitor the activity of the Further research needs to be performed tion is effective for nonweight-bearing
lumbar multidus muscle. They conclud- to determine if this is also true with the strength training of the gluteus medius
ed that surface electrodes over the mul- lower extremity muscles. muscle. The lateral step-up and lunge
tidus muscle pick up EMG signal from Often it is difficult to assess the clini- exercises provide adequate stimulus to
the longissimus thoracis muscle; how- cal importance of exercises that produce the vastus medialis obliquus muscle for
ever, we feel that their results should be very low levels of EMG signal, because strength and endurance training, and
questioned, because they placed surface the standard deviations may be almost as the Dynamic Edge exercise unit may be
electrodes for the multidus muscle just large as the mean EMG values. Exercises used for endurance training. The ndings
lateral to the L2 and L4 levels and the that produce very low levels of muscle in this study may be used to select spe-
electrode for the longissimus thoracis 30 EMG signal, as was found with some of cic exercises to enhance a core training
mm lateral to the L3 spinous process. The the exercises in this study, may be of little program.

760 | december 2007 | volume 37 | number 12 | journal of orthopaedic & sports physical therapy
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762 | december 2007 | volume 37 | number 12 | journal of orthopaedic & sports physical therapy