Sung-Min Ha

Effects of the Abdominal Drawing-In Maneuver on Muscle Activity, Pelvic Motions, and Knee Flexion During Active Prone Knee Flexion in Patients With Lumbar Extension Rotation Syndrome

OBJECTIVE To investigate the effects of performing an abdominal drawing-in maneuver (ADIM) during active prone knee flexion on the hamstrings and erector spinae muscle activity, the amounts of pelvic motion and knee flexion, and onset of pelvic movements. DESIGN Comparative, repeated-measures study. SETTING University research laboratory. PARTICIPANTS Men patients (N=18) with lumbar extension rotation syndrome. INTERVENTION Subjects performed prone knee flexion in 2 conditions. MAIN OUTCOME MEASURES To measure muscle activity, surface electromyogram (EMG) of both erector spinae and the medial and lateral hamstrings was performed. Kinematic data on the pelvic motion and knee flexion were measured using a 3-dimensional motion analysis system. Repeated 1-way analysis of variance was used for the statistical analysis. RESULTS Significantly decreased electromyographic activity in the right and left erector spinae and significantly increased electromyographic activity in the medial and lateral hamstrings activity were shown during prone knee flexion in ADIM condition using the pressure biofeedback unit. In addition, the amounts of anterior pelvic tilt, pelvic rotation, knee flexion, and perceived pain decreased significantly during prone knee flexion in the ADIM condition compared with the same maneuver in the non-ADIM condition. The onset of anterior pelvic tilt and pelvic rotation occurred significantly earlier in the non-ADIM condition, compared with the ADIM condition. CONCLUSIONS ADIM effectively increased activation of knee flexors, decreased activation of back extensors, and reduced the pelvic motions and low back pain during prone knee flexion in patients with lumbar extension rotation syndrome.

Effects of the pelvic rotatory control method on abdominal muscle activity and the pelvic rotation during active straight leg raising

The aim of this study was to examine the effects of the pelvic rotatory control method on abdominal muscle activity and the amount of pelvic rotation while maintaining active straight leg raising (ASLR) at the level of the target bar. In this study, 27 healthy female volunteers were instructed to perform ASLR, ASLR with a pelvic compression belt, and ASLR with the pelvic rotatory control method. Surface electromyography (EMG) data were collected from the bilateral rectus abdominis (RA), external oblique abdominis (EO), and internal oblique abdominis (IO) muscles, and angles of pelvic rotation were measured using a 3-dimensional motion-analysis system. EMG activity of all abdominal muscles was greater and pelvic rotation was less in the pelvic rotatory control method compared with both the conventional ASLR method and the ASLR with pelvic compression belt method (p < 0.05). The findings suggest that ASLR with the pelvic rotatory control method is effective in activating the abdominal muscles and minimizing unwanted lumbopelvic rotation during ASLR exercise.

Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises

OBJECTIVE To determine the most effective exercise to specifically activate the scapular posterior tilting muscles by comparing muscle activity generated by different exercises (wall facing arm lift, prone arm lift, backward rocking arm lift, backward rocking diagonal arm lift). DESIGN Repeated-measure within-subject intervention. PARTICIPANTS The subjects were 20 healthy young men and women. MAIN OUTCOME MEASURES Lower trapezius (LT) and serratus anterior (SA) muscle activity was measured when subjects performed the four exercises. RESULTS Muscle activity was significantly different among the four exercise positions (p<0.05). The backward rocking diagonal arm lift elicited significantly greater activity in the LT muscle than did the other exercises (p<0.05). The backward rocking arm lift showed significantly more activity in the SA muscle than did the other exercises (p<0.05). CONCLUSIONS Clinicians can use these results to develop scapular posterior tilting exercises that specifically activate the target muscle.

Correlation of the Y-Balance Test with Lower-limb Strength of Adult Women.

[Purpose] The purpose of this study was to elucidate the relationship between Y-balance test (YBT) distance and the lower-limb strength of adult women. [Subjects] Forty women aged 45 to 80 years volunteered for this study. [Methods] The participants were tested for maximal muscle strength of the lower limbs (hip extensors, hip flexors, hip abductors, knee extensors, knee flexors, and ankle dorsiflexors) and YBT distances in the anterior, posteromedial, and posterolateral directions. Pearson’s correlation coefficient was used to quantify the linear relationships between YBT distances and lower-limb strength. [Results] Hip extensor and knee flexor strength were positively correlated with YBT anterior distance. Hip extensor, hip abductor, and knee flexor strength were positively correlated with the YBT posteromedial distance. Hip extensor and knee flexor strength were positively correlated with YBT posterolateral distance. [Conclusion] There was a weak correlation between lower-limb strength (hip extensors, hip abductors, and knee flexors) and dynamic postural control as measured by the YBT.

Selective Activation of the Infraspinatus Muscle

CONTEXT To improve selective infraspinatus muscle strength and endurance, researchers have recommended selective shoulder external-rotation exercise during rehabilitation or athletic conditioning programs. Although selective strengthening of the infraspinatus muscle is recommended for therapy and training, limited information is available to help clinicians design a selective strengthening program. OBJECTIVE To determine the most effective of 4 shoulder external-rotation exercises for selectively stimulating infraspinatus muscle activity while minimizing the use of the middle trapezius and posterior deltoid muscles. DESIGN Cross-sectional study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 30 healthy participants (24 men, 6 women; age = 22.6 ± 1.7 years, height = 176.2 ± 4.5 cm, mass = 65.6 ± 7.4 kg) from a university population. INTERVENTION(S) The participants were instructed to perform 4 exercises: (1) prone horizontal abduction with external rotation (PER), (2) side-lying wiper exercise (SWE), (3) side-lying external rotation (SER), and (4) standing external-rotation exercise (STER). MAIN OUTCOME MEASURE(S) Surface electromyography signals were recorded from the infraspinatus, middle trapezius, and posterior deltoid muscles. Differences among the exercise positions were tested using a 1-way repeated-measures analysis of variance with Bonferroni adjustment. RESULTS The infraspinatus muscle activity was greater in the SWE (55.98% ± 18.79%) than in the PER (46.14% ± 15.65%), SER (43.38% ± 22.26%), and STER (26.11% ± 15.00%) (F3,87 = 19.97, P < .001). Furthermore, the SWE elicited the least amount of activity in the middle trapezius muscle (F3,87 = 20.15, P < .001). Posterior deltoid muscle activity was similar in the SWE and SER but less than that measured in the PER and STER (F3,87 = 25.10, P < .001). CONCLUSIONS The SWE was superior to the PER, SER, and STER in maximizing infraspinatus activity with the least amount of middle trapezius and posterior deltoid activity. These findings may help clinicians design effective exercise programs.

Reliability and validity of goniometric and photographic measurements of clavicular tilt angle

The aims of the present study were to assess the reliability of clavicular tilt angle measurement using goniometric and photographic measurements and to test the validity of the measurement by comparing the results with radiographic findings (gold standard). Clavicular tilt angles were measured in 18 healthy subjects (36 clavicles) using goniometric, photographic, and radiographic measurement. Repeated measurements using goniometric and photographic measurements were made in two test sessions conducted on different days by two examiners to assess inter-rater and intra-rater reliability of the two methods. Radiographic measurement was taken once, and the correlation between the radiographic findings and those of the indirect methods was calculated to test the validity of the goniometric and photographic measurement of clavicular tilt angle. No significant difference in clavicular tilt angle measurement was found between test sessions. The reliability of goniometric measurement (inter-rater intraclass correlation coefficients (ICC) = 0.85 (95% CI = 0.72-0.92) - 0.87 (95% CI = 0.77-0.87); intra-rater ICC = 0.80 (95% CI = 0.64-0.89)) and photographic measurement (inter-rater ICC = 0.89 (95% CI = 0.80-0.94) - 0.95 (95% CI = 0.91-0.98); intra-rater ICC = 0.84 (95% CI = 0.71-0.92) - 0.84 (95% CI = 0.69-0.91)) were excellent. The goniometric and photographic measurements of clavicular tilt angle were highly correlated with the radiographic findings (r = 0.83, 0.78, respectively). Goniometric and photographic measurements of clavicular tilt angle obtained by raters in this study may be considered reliable, and data obtained using the goniometric and photographic measurements are representative of radiographic findings of clavicular tilt angle.

Reliability of the modified Thomas test using a lumbo-plevic stabilization

[Purpose] The purpose of this study was to examine the test-retest reliability of the modified Thomas test using lumbo-pelvic stabilization. [Subjects] Thirteen subjects (male=10, female=3) with hip flexor tightness voluntarily participated in the study. [Methods] The participants underwent the modified Thomas test under three conditions: 1) the general modified Thomas test (GM), 2) active lumbo-pelvic stabilization (ALS), and 3) passive lumbo-pelvic stabilization (PLS). Intra-class correlation coefficients (ICC) were used to determine the test-retest reliability of the knee joint angle measurement under three conditions. The standard error of measurement (SEM) and minimal detectable difference (95% confidence interval) (MDD95) were calculated for each measurement to assess absolute consistency. [Results] The ALS (ICC = 0.99) and PLS (ICC = 0.98) methods for the modified Thomas test were more reliable than GM method (ICC = 0.97). The MDD95 score for the ALS method, 2.35 degrees, indicated that a real difference existed between two testing sessions compared with the scores for the PLS (3.70 degrees) and GM methods (4.17 degrees) [Conclusion] Lumbo-pelvic stabilization is one of the considerations for precise measurement and may help to minimize measurement error when evaluating hip flexor tightness using the modified Thomas test.

The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain

[Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain.

Effects of scapular upward rotation exercises on alignment of scapula and clavicle and strength of scapular upward rotators in subjects with scapular downward rotation syndrome

The purpose of this study was to investigate the effects of a 6-week scapular upward rotation exercise (SURE) on scapular and clavicular alignment and scapular upward rotators strength in subjects with scapular downward rotation syndrome (SDRS). Seventeen volunteer subjects with SDRS were recruited from university populations. The alignment of the scapula and clavicle was measured using radiographic analysis and compared in subjects before and after a 6-week self-SURE program. A hand-held dynamometer was used to measure the strength of the scapular upward rotators. The subjects were instructed how to perform the self-SURE program at home. The 6-week self-SURE program was divided into two sections (the first section with non-resistive SURE during weeks 1-3, and the second section with resistive SURE using thera-band during weeks 4-6). The significance of the difference between pre- and post-program was assessed using a paired t-test, with the level of statistical significance set at p<0.05. Significant differences between pre- and post-program were found for scapular and clavicular alignment (p<0.05). Additionally, the comparison between pre- and post-program measurements of the strength of the scapular upward rotators showed significant differences (p<0.05). The results of this study showed that a 6-week self-SURE program is effective for improving scapular and clavicular alignment and increasing the strength of scapular upward rotator muscles in subjects with SDRS.

Comparison of Posterior Oblique Sling Activity during Hip Extension in the Prone Position on the Floor and on a Round Foam Roll

[Purpose] The aim of this study was to compare muscle activity of the posterior oblique sling during prone hip extension (PHE) on the floor and on a round foam roll. [Subjects] Twenty-two (11 male, 11 female) healthy volunteers were recruited for this study. [Methods] The participants performed PHE on the floor and on a round foam roll. Surface electromyography (EMG) was recorded from the contralateral latissimus dorsi (LD), contralateral erector spinae (ES), ipsilateral ES, ipsilateral gluteus maximus (GM), and ipsilateral biceps femoris (IBF). A paired t-test was used to compare muscle activity under the floor and round foam roll conditions. [Results] EMG activity of the contralateral LD, ipsilateral ES, and ipsilateral GM was significantly greater when PHE was performed on the round foam roll than on the floor. [Conclusion] Performing PHE on the round foam roll induced greater posterior oblique sling EMG activity than did exercise on the floor. These results suggest that the activation pattern of the posterior oblique sling during PHE is differs according to the type of surface (stable vs. unstable) on which it is performed.