Christoffer H. Andersen

Muscle Activation and Perceived Loading During Rehabilitation Exercises: Comparison of Dumbbells and Elastic Resistance

Background High-intensity resistance training plays an essential role in the prevention and rehabilitation of musculoskeletal injuries and disorders. Although resistance exercises with heavy weights yield high levels of muscle activation, the efficacy of more user-friendly forms of exercise needs to be examined. Objective The aim of this study was to investigate muscle activation and perceived loading during upper-extremity resistance exercises with dumbbells compared with elastic tubing. Design A single-group, repeated-measures study design was used. Setting Exercise evaluation was conducted in a laboratory setting. Participants Sixteen female workers (aged 26–55 years) without serious musculoskeletal diseases and with a mean neck and shoulder pain intensity of 7.8 on a 100-mm visual analog scale participated in the study. Measurements Electromyographic (EMG) activity was measured in 5 selected muscles during the exercises of lateral raise, wrist extension, and shoulder external rotation during graded loadings with dumbbells (2–7.5 kg) and elastic tubing (Thera-Band, red to silver resistance). The order of exercises and loadings was randomized for each individual. Electromyographic amplitude was normalized to the absolute maximum EMG amplitude obtained during maximal voluntary isometric contraction and exercise testing. Immediately after each set of exercise, the Borg CR10 scale was used to rate perceived loading during the exercise. Results Resistance exercise with dumbbells as well as elastic tubing showed increasing EMG amplitude and perceived loading with increasing resistance. At the individually maximal level of resistance for each exercise—defined as the 3 repetitions maximum—normalized EMG activity of the prime muscles was not significantly different between dumbbells (59%–87%) and elastic tubing (64%–86%). Perceived loading was moderately to very strongly related to normalized EMG activity (r=.59–.92). Limitations The results of this study apply only for exercises performed in a controlled manner (ie, without sudden jerks or high acceleration). Conclusions Comparably high levels of muscle activation were obtained during resistance exercises with dumbbells and elastic tubing, indicating that therapists can choose either type in clinical practice. The Borg CR10 can be a useful aid in estimating intensity of individual rehabilitation protocols.

Implementation of neck/shoulder exercises for pain relief among industrial workers: a randomized controlled trial.

BackgroundAlthough leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers.MethodsCluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9).Results85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders.ConclusionHigh-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain.Trial registrationNCT01071980.

Kettlebell training for musculoskeletal and cardiovascular health: a randomized controlled trial

OBJECTIVE The aim of this trial was to investigate the effectiveness of a worksite intervention using kettlebell training to improve musculoskeletal and cardiovascular health. METHODS This single-blind randomized controlled trial involved 40 adults from occupations with a high prevalence of reported musculoskeletal pain symptoms (mean age 44 years, body mass index 23 kg/m², 85% women, with pain intensity of the neck/shoulders 3.5 and of the low back 2.8 on a scale of 0-10). A blinded assessor took measures at baseline and follow-up. Participants were randomly assigned to training--consisting of ballistic full-body kettlebell exercise 3 times per week for 8 weeks--or a control group. The main outcome measures were pain intensity of the neck/shoulders and low back, isometric muscle strength, and aerobic fitness. RESULTS Compared with the control group, pain intensity of the neck/shoulders decreased 2.1 points [95% confidence interval (95% CI) -3.7- -0.4] and pain intensity of the low back decreased 1.4 points (95% CI -2.7- -0.02) in the training group. Compared with the control group, the training group increased muscle strength of the trunk extensors (P<0.001), but not of the trunk flexors and shoulders. Aerobic fitness remained unchanged. CONCLUSIONS Worksite intervention using kettlebell training reduces pain in the neck/shoulders and low back and improves muscle strength of the low back among adults from occupations with a high prevalence of reported musculoskeletal pain symptoms. This type of training does not appear to improve aerobic fitness.

Muscle Activation During Selected Strength Exercises in Women With Chronic Neck Muscle Pain

Background and Purpose: Muscle-specific strength training has previously been shown to be effective in the rehabilitation of chronic neck muscle pain in women. The aim of this study was to determine the level of activation of the neck and shoulder muscles using surface electromyography (EMG) during selected strengthening exercises in women undergoing rehabilitation for chronic neck muscle pain (defined as a clinical diagnosis of trapezius myalgia). Subjects: The subjects were 12 female workers (age=30–60 years) with a clinical diagnosis of trapezius myalgia and a mean baseline pain intensity of 5.6 (range=3–8) on a scale of 0 to 9. Method: Electromyographic activity in the trapezius and deltoid muscles was measured during the exercises (lateral raises, upright rows, shrugs, one-arm rows, and reverse flys) and normalized to EMG activity recorded during a maximal voluntary static contraction (MVC). Results: For most exercises, the level of muscle activation was relatively high (>60% of MVC), highlighting the effectiveness and specificity of the respective exercises. For the trapezius muscle, the highest level of muscle activation was found during the shrug (102±11% of MVC), lateral raise (97±6% of MVC), and upright row (85±5% of MVC) exercises, but the latter 2 exercises required smaller training loads (3–10 kg) compared with the shrug exercise (20–30 kg). Discussion and Conclusion: The lateral raise and upright row may be suitable alternatives to shrugs during rehabilitation of chronic neck muscle pain. Several of the strength exercises had high activation of neck and shoulder muscles in women with chronic neck pain. These exercises can be used equally in the attempt to achieve a beneficial treatment effect on chronic neck muscle pain.

Torque-EMG-velocity relationship in female workers with chronic neck muscle pain.

The present study investigated the effect of chronic neck muscle pain (defined as trapezius myalgia) on neck/shoulder muscle function during concentric, eccentric and static contraction. Forty-two female office workers with trapezius myalgia (MYA) and 20 healthy matched controls (CON) participated. Isokinetic (-60, 60 and 180 degrees s(-1)) and static maximal voluntary shoulder abductions were performed in a Biodex dynamometer, and electromyography (EMG) obtained in the trapezius and deltoideus muscles. Muscle thickness in the trapezius was measured with ultrasound. Pain and perceived exertion were registered before and after the dynamometer test. The main findings were that shoulder abduction torque (at -60 and 60 degrees s(-1)) and trapezius EMG amplitude (at -60, 0 and 60 degrees s(-1)) were significantly lower in MYA compared with CON (p<0.001-0.05). Deltoideus EMG and trapezius muscle thickness were not significantly different between the groups. While perceived exertion increased in both groups in response to the test (p<0.0001), pain increased in MYA only (p<0.0001). In conclusion, having trapezius myalgia was associated with decreased strength capacity and lowered activity of the painful trapezius muscle. The most consistent differences-in terms of both torque and EMG-were found during slow concentric and eccentric contractions. Activity of the synergistic pain free deltoideus muscle was not significantly lower, indicating specific inhibitory feedback of the painful trapezius muscle only. Parallel increase in pain and perceived exertion among MYA were observed in response to the maximal contractions, emphasizing that heavy physical exertion provokes pain increase only in conditions of myalgia.

Effect of physical training on function of chronically painful muscles: A randomized controlled trial

Pain and tenderness of the upper trapezius muscle is frequent in several occupational groups. The objective of this study is to investigate the effect of three contrasting interventions on muscle function and pain in women with trapezius myalgia. A group of employed women (n = 42) with a clinical diagnosis of trapezius myalgia participated in a 10-wk randomized controlled intervention: specific strength training of the neck/shoulder muscles, general fitness training performed as leg bicycling, or a reference intervention without physical activity. Torque and electromyography (EMG) were recorded during maximal shoulder abductions in an isokinetic dynamometer at -60, 60, 0, and 180 degrees /s. Furthermore, a submaximal reference contraction with only the load of the arms was performed. Significant changes were observed only in the specific strength training group. Pain decreased by 42-49% (P < 0.01-0.05). Whereas the EMG activity of the unaffected deltoid remained unchanged during the maximal contractions, an increase in EMG amplitude (42-86%; P < 0.001-0.05) and median power frequency (19%; P < 0.001) were observed for the painful trapezius muscle. Correspondingly, torque increased by 18-53% (P < 0.001-0.05). EMG during the reference contraction decreased significantly for both the trapezius and deltoid muscles (P < 0.01). In conclusion, specific strength training relieves pain and increases maximal activity specifically of the painful trapezius muscle, leading to increased shoulder abduction strength in women with trapezius myalgia. Furthermore, decreased relative workload may indirectly augment pain reduction.

Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial

Background Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed. Methods A total of 447 office workers with and without neck and/or shoulder pain were randomly allocated at the cluster-level to one of four groups; 1×60 (1WS), 3×20 (3WS) or 9×7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0–9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)). Results The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF. Among those with pain ≥3 at baseline (n=256), all three training groups achieved significant reduction in neck pain compared with REF (p<0.01). From a baseline pain rating of 3.2 (SD 2.3) in the neck among neck cases, 1WS experienced a reduction of 1.14 (95% CI 0.17 to 2.10), 3WS 1.88 (0.90 to 2.87) and 9WS 1.35 (0.24 to 2.46) which is considered clinically significant. DASH was reduced in 1WS and 3WS only. Conclusion One hour of specific strength training effectively reduced neck and shoulder pain in office workers. Although the three contrasting training groups showed no statistical differences in neck pain reduction, only 1WS and 3WS reduced DASH. This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace.

Kettlebell swing targets semitendinosus and supine leg curl targets biceps femoris: an EMG study with rehabilitation implications.

Background The medial hamstring muscle has the potential to prevent excessive dynamic valgus and external rotation of the knee joint during sports. Thus, specific training targeting the medial hamstring muscle seems important to avoid knee injuries. Objective The aim was to investigate the medial and lateral hamstring muscle activation balance during 14 selected therapeutic exercises. Study design The study design involved single-occasion repeated measures in a randomised manner. Sixteen female elite handball and soccer players with a mean (SD) age of 23 (3) years and no previous history of knee injury participated in the present study. Electromyographic (EMG) activity of the lateral (biceps femoris – BF) and medial (semitendinosus – ST) hamstring muscle was measured during selected strengthening and balance/coordination exercises, and normalised to EMG during isometric maximal voluntary contraction (MVC). A two-way analysis of variance was performed using the mixed procedure to determine whether differences existed in normalised EMG between exercises and muscles. Results Kettlebell swing and Romanian deadlift targeted specifically ST over BF (Δ17–22%, p<0.05) at very high levels of normalised EMG (73–115% of MVC). In contrast, the supine leg curl and hip extension specifically targeted the BF over the ST (Δ 20–23%, p<0.05) at very high levels of normalised EMG (75–87% of MVC). Conclusion Specific therapeutic exercises targeting the hamstrings can be divided into ST dominant or BF dominant hamstring exercises. Due to distinct functions of the medial and lateral hamstring muscles, this is an important knowledge in respect to prophylactic training and physical therapist practice.

Muscle activity during leg strengthening exercise using free weights and elastic resistance: effects of ballistic vs controlled contractions

The present studys aim was to evaluate muscle activity during leg exercises using elastic vs. isoinertial resistance at different exertion and loading levels, respectively. Twenty-four women and eighteen men aged 26-67 years volunteered to participate in the experiment. Electromyographic (EMG) activity was recorded in nine muscles during a standardized forward lunge movement performed with dumbbells and elastic bands during (1) ballistic vs. controlled exertion, and (2) at low, medium and high loads (33%, 66% and 100% of 10 RM, respectively). The recorded EMG signals were normalized to MVC EMG. Knee joint angle was measured using electronic inclinometers. The following results were obtained. Loading intensity affected EMG amplitude in the order: low<medium<high loads (p<.001). Ballistic contractions always produced greater EMG activity than slow controlled contractions, and for most muscles ballistic contractions with medium load showed similar EMG amplitude as controlled contractions with high load. At flexed knee joint positions with elastic resistance, quadriceps and gluteus EMG amplitude during medium-load ballistic contractions exceeded that recorded during high-load controlled contractions. Quadriceps and gluteus EMG amplitude increased at flexed knee positions. In contrast, hamstrings EMG amplitude remained constant throughout ROM during dumbbell lunge, but increased at more extended knee joint positions during lunges using elastic resistance. Based on these results, it can be concluded that lunges performed using medium-load ballistic muscle contractions may induce similar or even higher leg muscle activity than lunges using high-load slow-speed contractions. Consequently, lunges using elastic resistance appear to be equally effective in inducing high leg muscle activity as traditional lunges using isoinertial resistance.

Muscle Activation Strategies During Strength Training With Heavy Loading vs. Repetitions to Failure

Abstract Sundstrup, E, Jakobsen, MD, Andersen, CH, Zebis, MK, Mortensen, OS, and Andersen, LL. Muscle activation strategies during strength training with heavy loading vs. repetitions to failure. J Strength Cond Res 26(7): 1897–1903, 2012—Going to failure, or not, has probably been one of the most debated issues during the history of strength training. However, few studies have directly compared the physiological effect of failure vs. nonfailure strength training. The purpose of this study was to evaluate muscle activation strategies with electromyography (EMG) during heavy repetitions vs. repetitions to failure with lighter resistance. Fifteen healthy untrained women performed a set with heavy loading (3 repetition maximum [RM]) and a set of repetitions to failure with lower resistance (∼15 RM) during lateral raise with elastic tubing. Electromyographic amplitude and median power frequency of specific shoulder and neck muscles were analyzed, and the BORG CR10 scale was used to rate perceived loading immediately after each set of exercise. During the failure set, normalized EMG was significantly lower during the first repetition and significantly higher during the latter repetitions compared with the heavy 3-RM set (p < 0.05). Normalized EMG for the examined muscles increased throughout the set to failure in a curvilinear fashion—e.g., for the trapezius from 86 to 124% maximal voluntary contraction (p < 0.001)—and reached a plateau during the final 3–5 repetitions before failure. Median power frequency for all examined muscles decreased throughout the set to failure in a linear fashion, indicating progressively increasing fatigue. In conclusion, going to complete failure during lateral raise is not necessary to recruit the entire motor unit pool in untrained women—i.e., muscle activity reached a plateau 3–5 repetitions from failure with an elastic resistance of approximately 15 RM. Furthermore, strengthening exercises performed with elastic tubing seem to be an efficient resistance exercise and a feasible and practical alternative to traditional resistance equipment.