Jun G. San Juan

Effects Of Pelvic Stabilization On Lumbar Muscle Activity During Dynamic Exercise

Many commonly utilized lowback exercise devices offer mechanisms to stabilize the pelvis and to isolate the lumbar spine, but the value of these mechanisms remains unclear. The purpose of this study was to examine the effect of pelvic stabilization on the activity of the lumbar and hip extensor muscles during dynamic back extension exercise. Fifteen volunteers in good general health performed dynamic extension exercise in a seated upright position on a lumbar extension machine with and without pelvic stabilization. During exercise, surface electromyographic activity of the lumbar multifidus and biceps femoris was recorded. The activity of the multifidus was 51% greater during the stabilized condition, whereas there was no difference in the activity of the biceps femoris between conditions. This study demonstrates that pelvic stabilization enhances lumbar muscle recruitment during dynamic exercise on machines. Exercise specialists can use these data when designing exercise programs to develop low back strength.

Measuring humeral head translation using fluoroscopy: A validation study

Numerous techniques have been employed to monitor humeral head translation due to its involvement with several shoulder pathologies. However, most of the techniques were not validated. The objective of this study is to compare the accuracy of manual digitization and contour registration in measuring superior translation of the humeral head. Eight pairs of cadaver scapulae and humerii bones were harvested for this study. Each scapula and humerus was secured in a customized jig that allowed for control of humeral head translations and a vise that permitted rotations of the scapula about three axes. Fluoroscopy was used to take images of the shoulder bones. Scapular orientation was manipulated in different positions while the humerus was at 90 degrees of humeral elevation in the scapular plane. Humeral head translation was measured using the two methods and was compared to the known translation. Additionally, accuracy of the contour registration method to measure 2-D scapular rotations was assessed. The range for the root mean square (RMS) error for manual digitization method was 0.27 mm-0.43 mm and the contour registration method had a RMS error ranging from 0.18 mm-0.40 mm. In addition, the RMS error for the scapular angle rotation using the contour registration method was 2.4 degrees . Both methods showed acceptable errors. However, on average, the contour registration method showed lesser measurement error compared to the manual digitization method. In addition, the contour registration method was able to show good accuracy in measuring rotation that is useful in 2-D image analysis.

Scapular Kinematics and Shoulder Elevation in a Traditional Push-Up

CONTEXT Proper scapulothoracic motion is critical for the health and function of the shoulder and represents a principal focus in the rehabilitation setting. Variants of the traditional push-up are used frequently to help restore proper scapular kinematics. To date, substantial research has focused on muscle activation levels of rotator cuff and scapular-stabilizing musculature, whereas a dearth of literature exists regarding scapular kinematics during push-up variants. OBJECTIVE To examine the effect of shoulder position on scapular kinematics across the range of motion (ROM) of a traditional push-up. DESIGN Cross-sectional study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Sixteen healthy participants without a history of upper extremity or spine injury requiring rehabilitation or surgery. INTERVENTION(S) Participants performed a traditional push-up while kinematic measurements were acquired from multiple upper extremity segments. The 3 shoulder position conditions were (1) self-selected position, (2) shoulder adducted upon ascent (at side), and (3) shoulder elevated to approximately 90°. MAIN OUTCOME MEASURE(S) Scapular posterior tilt, upward rotation, and external rotation were examined across elbow-extension ROM and compared across conditions. RESULTS Posterior tilt was greater in the self-selected and at-side conditions than in the elevated condition and increased linearly with elbow extension. External rotation was greater in the self-selected and at-side conditions compared with that in the elevated condition. In the at-side condition, upward rotation began lower than in the other conditions at the start of the concentric phase but increased above the others soon after the elbow started to extend. CONCLUSIONS Performing a traditional push-up with the shoulders elevated may place the scapula in a position of impingement. Clinicians should be cognizant of shoulder elevation when prescribing and monitoring exercise progression. The results of this study will provide further direction for clinicians in prescribing rehabilitation exercises for the upper extremity, especially closed chain exercises for shoulder conditions.

The effects of exercise type and elbow angle on vertical ground reaction force and muscle activity during a push-up plus exercise

BackgroundProper alignment of the scapula during upper extremity motion is important in maintaining shoulder joint function and health. Push-up plus exercise is considered as one of the best exercise to strengthen the muscles that stabilize the scapula. The purpose of the study is to examine the effects of push-up plus variants and elbow position on vertical ground reaction force and electromyographical activity of four shoulder muscles during concentric contraction.MethodsA total of 22 healthy subjects volunteered for the study. Each of the subjects performed both modified and traditional push-up plus. Modified push-up plus was performed with both knees and hands touching the ground while the traditional push-up plus was executed with hands and feet contacting the ground. Electromyography (EMG) of the upper trapezius (UT), lower trapezius (LT), infraspinatus (INFRA), and serratus anterior (SA), and vertical ground reaction forces (vGRF) were collected.ResultsThe traditional push-up plus exhibited higher EMG activity in all muscles tested (P < .05) and vertical ground reaction force (P < .001) compared to modified push-up plus. The highest difference in EMG activity between the two exercises was observed with the Serratus Anterior muscle (22%). Additionally, the traditional push-up plus presented a higher vGRF compared to the modified push-up plus (P < .001) by 17%. The SA had the greatest EMG activity compared to the other muscles tested during the concentric phase of the traditional push-up plus, and this did not occur during the plus phase of the exercise.ConclusionThe highest activity of the serratus anterior occurred at 55° of elbow extension during the concentric phase of the traditional PUP and not at the plus phase of the exercise. This suggests that when prescribing an exercise to target the serratus anterior, a traditional push-up is adequate and the plus-phase is not necessary. However, for patients that cannot perform a traditional push-up, the modified push-up plus would be a great alternative to strengthen their serratus anterior.

Scapular kinematic is altered after electromyography biofeedback training.

Electromyography (EMG) biofeedback training affords patients a better sense of the different muscle activation patterns involved in the movement of the shoulder girdle. It is important to address scapular kinematics with labourers who have daily routines involving large amounts of lifting at shoulder level or higher. This population is at a heightened risk of developing subacromial impingement syndrome (SAIS). The purpose of this study was to investigate the acute effects of scapular stabilization exercises with EMG biofeedback training on scapular kinematics. Twenty-three healthy subjects volunteered for the study. Electrodes were placed on the upper and lower trapezius, serratus anterior, and lumbar paraspinals to measure EMG activity. Subjects underwent scapular kinematic testing, which consisted of humeral elevation in the scapular plane, before and after biofeedback training. The latter consisted of 10 repetitions of the I, W, T, and Y scapular stabilization exercises. Subjects were told to actively reduce the muscle activation shown on the screen for the upper trapezius during the exercises. The scapular external rotation had a statistically significant difference at all humeral elevation angles (p<0.004) after biofeedback was administered. After the exercises, the scapula was in a more externally rotated orientation with a mean difference of 6.5°. There were no significant differences found with scapular upward rotation, or posterior tilt at all humeral elevation angles following biofeedback. Scapular kinematics are altered by EMG biofeedback training utilizing scapular stabilization exercises. However, only scapular external rotation was affected by the exercises.

COMPARISON OF AN ELECTROMAGNETIC AND OPTICAL SYSTEM DURING DYNAMIC MOTION

Few studies have concurrently investigated the accuracy and repeatability of an optical and electromagnetic (EM) system during dynamic motion. The purposes of this study were to: (1) assess the accuracy of both an EM and optical system when compared to a gold standard and (2) to compare the intra- and inter-day repeatability during 3D kinematic motion of both systems. The gold standard used for accuracy assessment was a robot programmed to manipulate a carbonber beam through pre-dened motions within the capture volume of both systems at 30, 45 and 60� /s. A total of 12 healthy young adults were tested for intra- and inter-day repeatability of hip, knee and ankle joint angles during a sit-to-stand movement. Marker trajectories were captured using an 8-camera Motion Analysis system and a Polhemus Liberty system. Optical markers for both portions of the study were precisely marked to allow for digitization by the EM system, with collections taken at 120Hz. Accuracy and repeatability were assessed using the RMS error and coe±cient of multiple correlations (CMC), respectively. The optical system demonstrated a 1-2.5� lower RMS error in tracking the robot movements in the transverse and sagittal planes when compared to the EM system. However, it was possible that metal interference a®ected the accuracy of the EM system. High intra-day and inter-day repeatability was demonstrated by both systems during the sit-to-stand task. The optical system did dem- onstrate slightly higher CMC values for between day trials, though skin motion artifact might have a®ected the EM system to a greater extent. Overall, both systems demonstrated an adequate ability to track dynamic motion.

Lower Extremity Strength and Range of Motion in High School Cross-Country Runners

Cross-country running is becoming an increasingly popular sport, with a significant participation noted at the high school level. The aim of this study was to compare gender and bilateral hip extension range of motion and hip and knee extension strength of high school cross-country runners. 31 participants volunteered from a local high school cross-country team (16 males and 15 females). The modified Thomas test was utilized to measure hip extension range of motion bilaterally using a digital inclinometer. In order to measure hip and knee isometric strengths, an isokinetic dynamometer was employed. A mixed model approach revealed a statistically significant difference in peak hip extension strength between genders but not the side. Male athletes demonstrated a 29.2 Nm/kg (P < 0.05) greater force production than females during isometric hip extension strength testing. There were no significant differences in peak knee extension isometric strength, hip extension range of motion, and the ratio of peak hip and knee strength between genders and the dominant and nondominant leg. Female cross-country runners should focus on increasing hip extension strength to help maintain hip stability during running. This may be beneficial in decreasing the chances of experiencing patellofemoral pain in long-distance runners.

Eccentric, Concentric, And Isometric Strength In Trained And Untrained Older Adults: 153 Board #4 May 27, 9

The process of aging includes changes in muscle and connective tissue architecture and function, increased stiffness, loss of strength and functionality. Nonetheless, older adults are able to maintain eccentric (ECC) strength levels in a greater proportion, when compared to maintaining isometric (ISO) strength and concentric (CON) strength. The purpose of this study was to compare CON, ECC and ISO leg extension torque between trained (T) and untrained (U) older adults. Twenty older adults (60 years and older) who had no knee pathologies were recruited. A Biodex dynamometer was used to measure leg extensor torque for ISO, CON and ECC, in T and U subjects. Torque values relative to body weight (relative torques) were determined for each subject and compared between groups. The ratio of ECC: ISO was calculated and compared across groups. The T group were significantly stronger for ISO (p = 0.009). No significant differences were found for CON (p = 0.088) and ECC (p = 0.220). In addition, the U group registered a significantly higher ratio of ECC: ISO (p = 0.029), when compared to the T group. The findings in this study demonstrate older adults are able to maintain ECC, regardless of training status.