Innervation zone locations in 43 superficial muscles: Toward a standardization of electrode positioning

The Effect of Blood Flow Restriction during Low-Load Resistance Training Unit on Knee Flexor Muscle Fatigue in Recreational Athletes: A Randomized Double-Blinded Placebo-Controlled Pilot Study

Background/Objectives: Despite the growing popularity of training with a controlled form of vascular occlusion, known as blood flow restriction (BFR) training, in the rehabilitation of orthopedic patients and sports medicine, there remains ample space for understanding the basis of its mechanism. The pilot study assessed the effect of BFR during a low-load resistance training unit on knee flexor muscle fatigue, intending to decide whether a larger trial is needed and feasible. Methods: The study used a prospective, randomized, parallel, double-blind, placebo-controlled design. Fifteen male healthy recreational athletes were randomly assigned to three equal groups: BFR Group, Placebo Group, and Control Group. The primary outcome was the change in the surface electromyography-based (sEMG-based) muscle fatigue index, which was determined by comparing the results obtained before and after the intervention. The intervention was the application of BFR during low-load resistance training for knee flexors. The occurrence of any adverse events was documented. Results: In all groups, the sEMG-based fatigue index for semitendinosus and biceps femoris muscles decreased after low-load resistance training, with the largest decrease in the BFR group. Although not statistically significant, BFR showed moderate and large effect sizes for the fatigue index of semitendinosus and biceps femoris, respectively. No adverse events were noted. Conclusions: The pilot study suggested that BFR during a low-load resistance training unit might affect knee flexor muscle fatigue, supporting the development of a larger randomized clinical trial.

Neuromuscular disease auxiliary diagnosis using a portable magnetomyographic system

Objective. The measurement of electromyography (EMG) signals with needle electrodes is widely used in clinical settings for diagnosing neuromuscular diseases. Patients experience pain during needle EMG testing. It is significant to develop alternative diagnostic modalities.Approach. This paper proposes a portable magnetomyography (MMG) measurement system for neuromuscular disease auxiliary diagnosis. Firstly, the design and operating principle of the system are introduced. The feasibility of using the system for auxiliary diagnosis of neuromuscular diseases is then studied. The magnetic signals and needle EMG signals of thirty subjects were collected and compared.Main results. It is found that the amplitude of muscle magnetic field signal increases during mild muscle contraction, and the signal magnitudes of the patients are smaller than those of normal subjects. The diseased muscles tested in the experiment can be distinguished from the normal muscles based on the signal amplitude, using a threshold value of 6 pT. The MMG diagnosis results align well with the needle EMG diagnosis. In addition, the MMG measurement indicates that there is a persistence of spontaneous activity in the diseased muscle.Significance.The experimental results demonstrate that it is feasible to auxiliary diagnose neuromuscular diseases using the portable MMG system, which offers the advantages of non-contact and painless measurements. After more in-depth, systematic, and quantitative research, the portable MMG could potentially be used for auxiliary diagnosis of neuromuscular diseases. The clinical trial registration number is ChiCTR2200067116.

Changes in motor unit behaviour across repeated bouts of eccentric exercise

Unaccustomed eccentric exercise (EE) is protective against muscle damage following a subsequent bout of similar exercise. One hypothesis suggests the existence of an alteration in motor unit (MU) behaviour during the second bout, which might contribute to the adaptive response. Accordingly, the present study investigated MU changes during repeated bouts of EE. During two bouts of exercise where maximal lengthening dorsiflexion (10 repetitions × 10 sets) was performed 3 weeks apart, maximal voluntary isometric torque (MVIC) and MU behaviour (quantified using high-density electromyography; HDsEMG) were measured at baseline, during (after set 5), and post-EE. The HDsEMG signals were decomposed into individual MU discharge timings, and a subset were tracked across each time point. MVIC was reduced similarly in both bouts post-EE (Δ27 vs. 23%, P = 0.144), with a comparable amount of total work performed (∼1,300 J; P = 0.905). In total, 1,754 MUs were identified and the decline in MVIC was accompanied by a stepwise increase in discharge rate (∼13%; P < 0.001). A decrease in relative recruitment was found immediately after EE in Bout 1 versus baseline (∼16%; P < 0.01), along with reductions in derecruitment thresholds immediately after EE in Bout 2. The coefficient of variation of inter-spike intervals was lower in Bout 2 (∼15%; P < 0.001). Our data provide new information regarding a change in MU behaviour during the performance of a repeated bout of EE. Importantly, such changes in MU behaviour might contribute, at least in part, to the repeated bout phenomenon.

Nerve entry points in the mimic musculature of the horse head

Facial expressions are important in pain recognition in horses, but current observation-based pain scales remain subjective. A promising technique to quantitatively measure subtle changes in expression patterns, including changes invisible to the human eye, is surface electromyography (sEMG). To achieve high-quality and reliable sEMG signals, unilateral placement of bipolar electrodes is required in relation to the motor endplates (MEP). We aimed to localize the nerve entry points (NEPs; where the nerve branch first pierced the muscle belly) and the direction of the terminal nerve endings to estimate MEP locations of the innervating nerves in five equine facial muscles involved in pain expression. Three cadaveric Dutch Warmblood horse heads were dissected to identify the NEPs in the musculi caninus, levator anguli oculi medialis, nasolabialis, masseter and zygomaticus. These points were marked with pins and measured in relation to a reference line between two anatomical landmarks near the origin and insertion of the respective muscle. Relative distances were calculated from the most caudally situated landmark. NEPs were located at 33%-38% (caninus), 69%-86% (levator anguli oculi medialis) and 0%-18% (zygomaticus) from the caudal landmark. The nasolabialis showed two innervations zones. Its NEPs were located at 47%-72% (dorsal muscle branch) and 52%-91% (ventral branch). All terminal nerve endings were found to run in rostral direction. The masseter showed numerous NEPs diffusely spread within the muscle belly. Therefore, calculation of relative positions was not performed. These results could form the basis for feasibility studies and standardization of bipolar electrode positioning in vivo to measure facial muscle activity patterns in horses.

Upper-Limb Muscle Fatigability in Para-Athletes Quantified as the Rate of Force Development in Rapid Contractions of Submaximal Amplitude

This study aimed to compare neuromuscular fatigability of the elbow flexors and extensors between athletes with amputation (AMP) and athletes with spinal cord injury (SCI) for maximum voluntary force (MVF) and rate of force development (RFD). We recruited 20 para-athletes among those participating at two training camps (2022) for Italian Paralympic veterans. Ten athletes with SCI (two with tetraplegia and eight with paraplegia) were compared to 10 athletes with amputation (above the knee, N = 3; below the knee, N = 6; forearm, N = 1). We quantified MVF, RFD at 50, 100, and 150 ms, and maximal RFD (RFDpeak) of elbow flexors and extensors before and after an incremental arm cranking to voluntary fatigue. We also measured the RFD scaling factor (RFD-SF), which is the linear relationship between peak force and peak RFD quantified in a series of ballistic contractions of submaximal amplitude. SCI showed lower levels of MVF and RFD in both muscle groups (all p values ≤ 0.045). Despite this, the decrease in MVF (Cohen's d = 0.425, p < 0.001) and RFDpeak (d = 0.424, p = 0.003) after the incremental test did not show any difference between pathological conditions. Overall, RFD at 50 ms showed the greatest decrease (d = 0.741, p < 0.001), RFD at 100 ms showed a small decrease (d = 0.382, p = 0.020), and RFD at 150 ms did not decrease (p = 0.272). The RFD-SF decreased more in SCI than AMP (p < 0.0001). Muscle fatigability impacted not only maximal force expressions but also the quickness of ballistic contractions of submaximal amplitude, particularly in SCI. This may affect various sports and daily living activities of wheelchair users. Early RFD (i.e., ≤50 ms) was notably affected by muscle fatigability.

Towards standardisation of surface electromyography measurements in the horse: Bipolar electrode location

The use of surface electromyography in the field of animal locomotion has increased considerably over the past decade. However, no consensus exists on the methodology for data collection in horses. This study aimed to start the development of recommendations for bipolar electrode locations to collect surface electromyographic data from horses during dynamic tasks. Data were collected from 21 superficial muscles of three horses during trot on a treadmill using linear electrode arrays. The data were assessed both quantitatively (signal-to-noise ratio (SNR) and coefficient of variation (CoV)) and qualitatively (presence of crosstalk and activation patterns) to compare and select electrode locations for each muscle. For most muscles and horses, the highest SNR values were detected near or cranial/proximal to the central region of the muscle. Concerning the CoV, there were larger differences between muscles and horses than within muscles. Qualitatively, crosstalk was suspected to be present in the signals of twelve muscles but not in all locations in the arrays. With this study, a first attempt is made to develop recommendations for bipolar electrode locations for muscle activity measurements during dynamic contractions in horses. The results may help to improve the reliability and reproducibility of study results in equine biomechanics.

Muscle innervation zone estimation from monopolar high-density M-waves using principal component analysis and radon transform

This study examined methods for estimating the innervation zone (IZ) of a muscle using recorded monopolar high density M waves. Two IZ estimation methods based on principal component analysis (PCA) and Radon transform (RT) were examined. Experimental M waves, acquired from the biceps brachii muscles of nine healthy subjects were used as testing data sets. The performance of the two methods was evaluated by comparing their IZ estimations with manual IZ detection by experienced human operators. Compared with manual detection, the agreement rate of the estimated IZs was 83% and 63% for PCA and RT based methods, respectively, both using monopolar high density M waves. In contrast, the agreement rate was 56% for cross correlation analysis using bipolar high density M waves. The mean difference in estimated IZ location between manual detection and the tested method was 0.12 ± 0.28 inter-electrode-distance (IED) for PCA, 0.33 ± 0.41 IED for RT and 0.39 ± 0.74 IED for cross correlation-based methods. The results indicate that the PCA based method was able to automatically detect muscle IZs from monopolar M waves. Thus, PCA provides an alternative approach to estimate IZ location of voluntary or electrically-evoked muscle contractions, and may have particular value for IZ detection in patients with impaired voluntary muscle activation.

Location In Vivo of the Innervation Zone in the Human Medial Gastrocnemius Using Imposed Contractions: A Comparison of the Usefulness of the M-Wave and H-Reflex

The anatomical territory where the neuromuscular junctions are grouped corresponds to the innervation zone (IZ). This can be located in-vivo using high-density electromyography and voluntary muscle contractions. However, in patients with motor impairment, the use of contractions imposed by electrical stimulation (ES) could be an alternative. The present study has two aims: Firstly, to describe the location of the IZ in-vivo of the medial gastrocnemius (MG) using imposed contractions by ES. Secondly, to compare the usefulness of M-waves and H-reflexes to localize the IZs. Twenty-four volunteers participated (age: 21.2 ± 1.5 years). ES was elicited in the tibial nerve to obtain M-waves and H-reflexes in the MG. The evaluators used these responses to localize the IZs relative to anatomical landmarks. M-wave and H-reflex IZ frequency identification were compared. The IZs of the MG were mostly located in the cephalocaudal direction, at 39.7% of the leg length and 34% of the knee’s condylar width. The IZs were most frequently identified in the M-wave (83.33%, 22/24) compared to the H-reflex (8.33%, 2/24) (p > 0.001). Imposed contractions revealed that the IZ of the MG is located at 39.7% of the leg length. To locate the IZs of the MG muscle, the M-wave is more useful than the H-reflex.

Teaching Essential EMG Theory to Kinesiologists and Physical Therapists Using Analogies Visual Descriptions, and Qualitative Analysis of Biophysical Concepts

Electromyography (EMG) is a multidisciplinary field that brings together allied health (kinesiology and physical therapy) and the engineering sciences (biomedical and electrical). Since the physical sciences are used in the measurement of a biological process, the presentation of the theoretical foundations of EMG is most conveniently conducted using math and physics. However, given the multidisciplinary nature of EMG, a course will most likely include students from diverse backgrounds, with varying levels of math and physics. This is a pedagogical paper that outlines an approach for teaching foundational concepts in EMG to kinesiologists and physical therapists that uses a combination of analogies, visual descriptions, and qualitative analysis of biophysical concepts to develop an intuitive understanding for those who are new to surface EMG. The approach focuses on muscle fiber action potentials (MFAPs), motor unit action potentials (MUAPs), and compound muscle action potentials (CMAPs) because changes in these waveforms are much easier to identify and describe in comparison to the surface EMG interference pattern (IP).

Kinematics of individual muscle units in natural contractions measured in vivo using ultrafast ultrasound

OBJECTIVE

The study of human neuromechanical control at the motor unit (MU) level has predominantly focussed on electrical activity and force generation, whilst the link between these, i.e., the muscle deformation, has not been widely studied. To address this gap, we analysed the kinematics of muscle units in natural contractions.

APPROACH

We combined high-density surface electromyography (HDsEMG) and ultrafast ultrasound (US) recordings, at 1000 frames per second, from the tibialis anterior muscle to measure the motion of the muscular tissue caused by individual MU contractions. The MU discharge times were identified online by decomposition of the HDsEMG and provided as biofeedback to 12 subjects who were instructed to keep the MU active at the minimum discharge rate (9.8 ± 4.7 pulses per second; force less than 10% of the maximum). The series of discharge times were used to identify the velocity maps associated with 51 single muscle unit movements with high spatio-temporal precision, by a novel processing method on the concurrently recorded US images. From the individual MU velocity maps, we estimated the region of movement, the duration of the motion, the contraction time, and the excitation-contraction (E-C) coupling delay.

MAIN RESULTS

Individual muscle unit motions could be reliably identified from the velocity maps in 10 out of 12 subjects. The duration of the motion, total contraction time, and E-C coupling were 17.9 ± 5.3 ms, 56.6 ± 8.4 ms, and 3.8 ± 3.0 ms (n = 390 across 10 participants). The experimental measures also provided the first evidence of muscle unit twisting during voluntary contractions and MU territories with distinct split regions.

SIGNIFICANCE

The proposed method allows for the study of kinematics of individual MU twitches during natural contractions. The described measurements and characterisations open new avenues for the study of neuromechanics in healthy and pathological conditions.

Quantification of high and low sEMG spectral components during sustained isometric contraction

Superficial Electromyography (sEMG) spectrum contains aggregated information from several underlying physiological processes. Due to technological limitations, the isolation of these processes is challenging, and therefore, the interpretation of changes in muscle activity frequency is still controversial. Recent studies showed that the spectrum of sEMG signals recorded from isotonic and short-term isometric contractions can be decomposed into independent components whose spectral features recall those of motor unit action potentials. In this paper sEMG spectral decomposition is tested during muscle fatigue induced by long-term isometric contraction where sEMG spectral changes have been widely studied. The main goals of this work are to validate spectral component extraction during long-term isometric muscle activation and the quantification of energy exchange between the low- and high-frequency bands of sEMG signals during muscle fatigue.

A Study on the Relationship between RPE and sEMG in Dynamic Contraction Based on the GPR Method

The rating of perceived exertion (RPE) and surface electromyography (sEMG) describe exercise intensity subjectively and objectively, while there has been a lack of research on the relationship between them during dynamic contractions to predict exercise intensity, comprehensively. The purpose of this study was to establish a model of the relationship between sEMG and RPE during dynamic exercises. Therefore, 20 healthy male subjects were organized to perform an incremental load test on a cycle ergometer, and the subjects’ RPEs (Borg Scale 6–20) were collected every minute. Additionally, the sEMGs of the subjects’ eight lower limb muscles were collected. The sEMG features based on time domain, frequency domain and time–frequency domain methods were extracted, and the relationship model was established using Gaussian process regression (GPR). The results show that the sEMG and RPE of the selected lower limb muscles are significantly correlated (p < 0.05) but that they have different monotonic correlation degrees. The model that was established with all three domain features displayed optimal performance and when the RPE was 13, the prediction error was the smallest. The study is significant for lower limb muscle training strategy and quantification of training intensity from both subjective and objective aspects, and lays a foundation for sEMG further applications in rehabilitation medicine and sports training.

Distribution of innervation zone and muscle fiber conduction velocity in the biceps brachii muscle

The spatial distributions of muscle innervation zone (IZ) and muscle fiber conduction velocity (CV) were examined in nine healthy young male participants. High-density surface electromyography (EMG) was collected from the biceps brachii muscle when subjects performed isometric elbow flexions at 20% to 80% of the maximal voluntary contraction (MVC). A total of 9498 samples of IZs were identified and CVs were calculated using the Radon transform. The center and width of IZ sample distribution were compared within four different force levels and six medial to lateral electrode column positions using repeated measures ANOVA and multiple comparison tests. Significant shifts of IZ center were observed in the medial columns (Columns 5, 6, and 7) compared with the lateral columns (Columns 3 and 4) (p < 0.05). Similarly, significant differences in the IZ width were found in Column 7 and 8 compared to Column 3 (p < 0.05). In contrast, muscle CV was unaffected by column position. Instead, muscle CV was faster at 40% and 80% MVC compared to 20% MVC (p < 0.05). The findings of this study add further insights into the physiological properties of the biceps brachii muscle.

Pain-induced changes in motor unit discharge depend on recruitment threshold and contraction speed

At high forces, the discharge rates of lower- and higher-threshold motor units (MU) are influenced in a different way by muscle pain. These differential effects may be particularly important for performing contractions at different speeds since the proportion of lower- and higher-threshold MUs recruited varies with contraction velocity. We investigated whether MU discharge and recruitment strategies are differentially affected by pain depending on their recruitment threshold (RT), across a range of contraction speeds. Participants performed ankle dorsiflexion sinusoidal-isometric contractions at two frequencies (0.25 and 1 Hz) and two modulation amplitudes [5% and 10% of the maximum voluntary contraction (MVC)] with a mean target torque of 20%MVC. High-density surface electromyography recordings from the tibialis anterior muscle were decomposed and the same MUs were tracked across painful (hypertonic saline injection) and nonpainful conditions. Torque variability, mean discharge rate (MDR), DR variability (DRvar), RT, and the delay between the cumulative spike train and the resultant torque output (neuromechanical delay, NMD) were assessed. The average RT was greater at faster contraction velocities (P = 0.01) but was not affected by pain. At the fastest contraction speed, torque variability and DRvar were reduced (P < 0.05) and MDR was maintained. Conversely, MDR decreased and DRvar and NMD increased significantly during pain at slow contraction speeds (P < 0.05). These results show that reductions in contraction amplitude and increased recruitment of higher-threshold MUs at fast contraction speeds appear to compensate for the inhibitory effect of nociceptive inputs on lower-threshold MUs, allowing the exertion of fast submaximal contractions during pain.NEW & NOTEWORTHY Pain induces changes in motor performance, motor unit recruitment, and rate coding behavior that varies across different contraction speeds. Here we show that that pain reduces motor unit discharge rate and prolongs the neuromechanical delay at slow contraction speeds only. This new evidence suggests that there are differential nociceptive inhibitory effects across the motor unit pool, which allows fast submaximal contractions to be exerted despite the presence of pain.

Neurophysiological Factors Affecting Muscle Innervation Zone Estimation Using Surface EMG: A Simulation Study

Surface electromyography (EMG) recorded by a linear or 2-dimensional electrode array can be used to estimate the location of muscle innervation zones (IZ). There are various neurophysiological factors that may influence surface EMG and thus potentially compromise muscle IZ estimation. The objective of this study was to evaluate how surface-EMG-based IZ estimation might be affected by different factors, including varying degrees of motor unit (MU) synchronization in the case of single or double IZs. The study was performed by implementing a model simulating surface EMG activity. Three different MU synchronization conditions were simulated, namely no synchronization, medium level synchronization, and complete synchronization analog to M wave. Surface EMG signals recorded by a 2-dimensional electrode array were simulated from a muscle with single and double IZs, respectively. For each situation, the IZ was estimated from surface EMG and compared with the one used in the model for performance evaluation. For the muscle with only one IZ, the estimated IZ location from surface EMG was consistent with the one used in the model for all the three MU synchronization conditions. For the muscle with double IZs, at least one IZ was appropriately estimated from interference surface EMG when there was no MU synchronization. However, the estimated IZ was different from either of the two IZ locations used in the model for the other two MU synchronization conditions. For muscles with a single IZ, MU synchronization has little effect on IZ estimation from electrode array surface EMG. However, caution is required for multiple IZ muscles since MU synchronization might lead to false IZ estimation.

Hip and Core Muscle Activation During High-Load Core Stabilization Exercises

BACKGROUND

There is some evidence that high-load lumbar stabilization exercises, such as back bridge, can recruit both local and global muscles.

HYPOTHESIS

Therapeutic exercises would optimize gluteus maximus (GMax), gluteus medius (GMed), multifidus (MF), and transversus abdominis (TrA) activation, while minimizing the activation of the tensor fascia latae (TFL) and erector spinae (ES) muscles in healthy individuals.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

LEVEL OF EVIDENCE

Level 4.

METHODS

In this cross-sectional study, surface electromyography (EMG) of GMax, GMed, TFL, TrA, MF, and ES was used to quantify the gluteal-to-TFL muscle activation (GTA) index and a ratio of local to global (L/G) lumbar muscles during (1) the elbow-toe exercise in the prone position, (2) the elbow-toe with right left lifted, (3) the hand-knee with left arm and right leg lifted, (4) the back bridge, (5) the back bridge with right leg lifted, (6) the back bridge with left leg lifted, (7) the side bridge with left leg lifted, (8) the side bridge with right leg lifted, and (9) the elbow-toe with right leg horizontally lifted exercises in healthy individuals (20 men, 20 women; age, 25 ± 4 years).

RESULTS

The back bridge exercise with left leg lift generated the highest L/G muscles activity ratio (L/G = 3.35) while the hand-knee exercise yielded the lowest L/G muscles activity ratio (L/G = 1.21). The side bridge exercise with left elbow and foot and lifting the right leg (GTA = 63.78), hand-knee exercise (GTA = 49.62), back bridge (GTA = 28.05), and elbow-toe exercise with left leg horizontally lifted (GTA = 23.02) generated the highest GTA indices, respectively. Meanwhile, the normalized EMG amplitude for GMax was significantly less than the TFL, for elbow-toe exercise (P < 0.001), back bridge with left leg lift (P = 0.001), side bridge exercise with the right elbow and foot and lifting the left leg (P = 0.002), and elbow-toe exercise with right leg horizontally lifted (P < 0.001).

CONCLUSION

The highest GTA indexes were observed during (1) the side bridge lifting the dominant leg and (2) the hand-knee horizontally lifting dominant leg, respectively. The L/G ratio was highest during (1) the back bridge lifting nondominant leg, (2) back bridge, and (3) back bridge lifting dominant leg, respectively. This study supports the use of back bridge exercises to strengthen the MF and side bridges to improve gluteal muscle activation.

CLINICAL RELEVANCE

The highest GTA index was observed in the side bridge lifting the right leg. Highest L/G ratio was in the back bridge with nondominant leg lifted. This study supports the use of back bridge exercises to strengthen the MF. This study supports the use of side bridges to improve gluteal muscle activation.

Assessing redistribution of muscle innervation zones after spinal cord injuries

This study aimed to examine the redistribution of neuromuscular junctions or innervation zones (IZs) after spinal cord injuries (SCI). Fifteen able-bodied subjects and 15 subjects with SCI (American Spinal Injury Association Impairment Scale A to D), participated in the study. Surface electromyography (EMG) signals were collected from the biceps brachii muscle by a customized linear electrode array when subjects generated maximal isometric voluntary contractions. The Radon transform was applied to detect the IZ locations in the multiple channel surface EMG signals which were differentiated between consecutive channels. The distribution of IZs was compared between the SCI and control groups using the student-t test. Statistical analysis disclosed a significantly wider range of IZs in the SCI group compared with the control group (SCI: 3.83 ± 1.32 IED, control: 2.83 ± 0. 87 IED, IED: inter-electrode distance, p < 0.05). No remarkable shifts of the center of the distribution were observed between the two groups (SCI: 9.23 ± 2.35 IED, control: 8.53 ± 2.33 IED, p = 0.42). Changes of IZ distribution in the paralyzed muscles could be associated with the complex neuromuscular reorganization after the SCI.

High-density surface electromyographic assessment of pelvic floor hypertonicity in IC/BPS patients: a pilot study

INTRODUCTION AND HYPOTHESIS

To assess the feasibility of objectively assessing pelvic floor hypertonicity (PFH) in women with interstitial cystitis/bladder pain syndrome (IC/BPS) using an intra-vaginal high-density surface electromyography (HD-sEMG) probe.

METHODS

Seven female subjects (mean age 44 ± 13 years) with a prior diagnosis of IC/BPS were recruited. A full digital pelvic examination was administered to identify hypertonic muscles. Intra-vaginal HD-sEMG was acquired during rest. Root-mean-squared (RMS) amplitude during rest was calculated for each channel to define a hypertonicity index and hypertonic zone. Innervation zones (IZs) were identified from the bipolar mapping of decomposed HD-sEMG signals and summarized into an IZ distribution mapping.

RESULTS

Of the seven subjects recruited, five had normal pelvic floor muscle tone and two exhibited hypertonicity upon muscle palpation. Subjects with PFH demonstrated a higher hypertonicity index (12.6 ± 3.5 vs. 4.5 ± 1.2) in sessions 1 and 2. The hypertonic zone defined by the 64-channel RMS mapping coincided with the digital pelvic examination findings. The corresponding IZs were localized for each motor unit. The hypertonicity indices between two consecutive sessions were well correlated (CC = 0.95).

CONCLUSIONS

This study represents the first effort to employ intra-vaginal HD-sEMG to assess PFH in women with IC/BPS. Our results demonstrate the feasibility of HD-sEMG to provide a quantitative diagnosis of PFH and the precise localization of hypertonic muscles and IZs. The proposed HD-sEMG-based techniques provide promising tools for clinical diagnosis and treatment of PFH, such as the personalized guidance of BoNT injections.

Evaluation of Respiratory Muscle Activity by Means of Concentric Ring Electrodes

Surface electromyography (sEMG) can be used for the evaluation of respiratory muscle activity. Recording sEMG involves the use of surface electrodes in a bipolar configuration. However, electrocardiographic (ECG) interference and electrode orientation represent considerable drawbacks to bipolar acquisition. As an alternative, concentric ring electrodes (CREs) can be used for sEMG acquisition and offer great potential for the evaluation of respiratory muscle activity due to their enhanced spatial resolution and simple placement protocol, which does not depend on muscle fiber orientation. The aim of this work was to analyze the performance of CREs during respiratory sEMG acquisitions. Respiratory muscle sEMG was applied to the diaphragm and sternocleidomastoid muscles using a bipolar and a CRE configuration. Thirty-two subjects underwent four inspiratory load spontaneous breathing tests which was repeated after interchanging the electrode positions. We calculated parameters such as (1) spectral power and (2) median frequency during inspiration, and power ratios of inspiratory sEMG without ECG in relation to (3) basal sEMG without ECG (R_ins/noise), (4) basal sEMG with ECG (R_ins/cardio) and (5) expiratory sEMG without ECG (R_ins/exp). Spectral power, R_ins/noise and R_ins/cardio increased with the inspiratory load. Significantly higher values (p < 0.05) of R_ins/cardio and significantly higher median frequencies were obtained for CREs. R_ins/noise and R_ins/exp were higher for the bipolar configuration only in diaphragm sEMG recordings, whereas no significant differences were found in the sternocleidomastoid recordings. Our results suggest that the evaluation of respiratory muscle activity by means of sEMG can benefit from the remarkably reduced influence of cardiac activity, the enhanced detection of the shift in frequency content and the axial isotropy of CREs which facilitates its placement.

Intramuscular innervation of plantaris muscle evaluated using a modified Sihler's staining protocol - Proposal for a new classification

PURPOSE

The plantaris muscle is a morphologically variable structure with regard to both its origin and insertion, and the course of the tendon. We here determined the pattern of branching and distribution of intramuscular nerves of the plantaris muscle to determine its usability for autologous transplantation. No information exists on the innervation of the plantaris muscle using Sihler's staining technique, and hence its intramuscular nerves. The main purpose of the work is to determine the pattern of branching and distribution of the intramuscular nerves of the plantaris muscle. Is the plantaris muscle a good transplant candidate?

MATERIALS AND METHODS

Eighty lower limbs from cadavers (40 left, 40 right, 40 male, 40 female, age range 41-94 years) were fixed in 10% formalin solution and examined macroscopically as well as morphometrically with regard to the innervation pattern of the respective plantaris muscle. Afterwards Sihler's staining was used in all 80 plantaris muscles to identify the exact distribution of the muscular branch originating from the main nerve trunk in the muscle belly.

RESULTS

Two patterns of branching and nerve distribution could be intensified in the plantaris muscle: Type I, with a single pattern entire up to the muscle and then divided into superior and inferior intramuscular branches.; type II with a double innervation pattern (superior and inferior). The superior and inferior pattern were not connected to each other.

CONCLUSION

The plantaris muscle reveals variability with two different innervation patterns. Type II is ideally suited for autologous transplantation. New classifications of innervation are desirable for individual muscles rather than a generalized approach.

High day-to-day repeatability of lower extremity muscle activation patterns and joint biomechanics of dual-belt treadmill gait: A reliability study in healthy young adults

PURPOSE

The reliability of lower extremity muscle activation patterns has not been clearly studied in a dual-belt instrumented treadmill environment. The primary study objective was to quantify the day-to-day reliability of quadriceps, hamstrings, gastrocnemius and gluteus medius activation patterns in healthy young adult gait. Secondarily, the reliability of spatiotemporal, and knee/hip motion and moment-based gait outcomes was assessed.

SCOPE

20 young adults were recruited and tested on two separate days. Using standardized procedures, participants were prepared for surface electromyography and lower extremity motion capture. All individuals walked on a dual-belt instrumented treadmill while muscle activation, segment motions and ground reaction forces were recorded. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Discrete biomechanical and muscle activation measures were calculated, and non-negative matrix factorization extracted amplitude and temporal muscle activation features. Intraclass Correlation Coefficients, Standard Error of Measurement and Minimum Detectable Change were calculated.

CONCLUSIONS

High to excellent Intraclass correlation coefficients were found between visits for most primary and secondary outcomes. The absolute and relative reliability, including Minimum Detectable Change values, provided in this study support the use of dual-belt instrumented treadmill walking as an acceptable medium to collect biomechanical and lower extremity EMG outcomes for future studies.

Regional activation in the human longissimus thoracis pars lumborum muscle

KEY POINTS

•Longissimus activity in the lumbar region was measured using indwelling electromyography to characterize the territory of its motor units. •The distribution of motor units in the longissimus pars lumborum muscle was mainly grouped into two distinct regions. •Regional activation of the longissimus pars lumborum was also observed during functional tasks involving trunk movements. •The regional activation of the longissimus pars lumborum muscle may play a role in segmental stabilization of the lumbar spine.

ABSTRACT

The longissimus pars lumborum contributes to lumbar postural control and movement. While animal studies suggest a segmental control of this muscle, the territory of motor units constituting the human longissimus pars lumborum remains unknown. The aims of this study were to identify the localization of motor unit territories in the longissimus and assess the activation of this muscle during functional tasks. Eight healthy participants were recruited. During isometric back extension contractions, single motor-unit (at L1, L2, L3 and L4) and multi-unit indwelling recordings (at L1, L1-L2, L2, L2-L3, L3, L3-L4 and L4) were used to estimate motor unit territories in the longissimus pars lumborum based on the motor-unit spike-triggered averages from fine-wire electrodes. A series of functional tasks involving trunk and arm movements were also performed. A total of 73 distinct motor units were identified along the length of the longissimus: only two motor units spanned all recording sites. The majority of the recorded motor units had muscle fibres located in two main rostro-caudal territories (32 motor units spanned L1 to L3 and 30 spanned ∼L3 to L4) and 11 had muscle fibres outside these two main territories. We also observed distinct muscle activation between the rostral and caudal regions of the longissimus pars lumborum during a trunk rotation task. Our results show clear rostral and caudal motor unit territories in the longissimus pars lumborum muscle and suggest that the central nervous system can selectively activate regions of the superficial lumbar muscles to provide local stabilization of the spine.

Myofascial trigger points alter the modular control during the execution of a reaching task: a pilot study

Myofascial trigger points (TP) constitute a conundrum in research and clinical practice as their etiopathogenesis is debated. Several studies investigating one or few muscles have shown that both active and latent TP causes an increased muscle activity, however the influence of TP on modular motor control during a reaching task is still unclear. Electromyographic signals, recorded from the muscles of the shoulder girdle and upper arm during a reaching task, were decomposed with Non-Negative Matrix Factorization algorithm. The extracted matrices of motor modules and activation signals were used to label the muscles condition as dominant or non-dominant. The presence of latent and active TP was detected in each muscle with manual examination. Despite a similar muscle activity was observed, we found that muscles with active TP had increased weighting coefficients when labeled in the dominant condition. No influences were found when muscles were in the non-dominant condition. These findings suggest that TP altered the motor control without co-contraction patterns. As a preliminary evidence, the present results suggest that the increased weighting coefficients in presence of TPs are associated with an alteration of the modular motor control without affecting the dimensionality of motor modules for each individual and reciprocal inhibition.

Innervation zone distribution of the biceps brachii muscle examined using voluntary and electrically-evoked high-density surface EMG

BACKGROUND

High density surface electromyography (EMG) can be used to estimate muscle innervation zones (IZ). The objective of this study was to compare the differences in the distribution of the biceps brachii (BB) IZ derived from voluntary contractions (VC) and electrical stimulation (ES) of the musculocutaneous nerve.

METHODS

Surface EMG signals were recorded from the medial and lateral BB with two 64-channel high density electrode matrices in eight healthy men. The surface EMG was recorded at different percentages of the maximal voluntary contraction (MVC) force (20-100% MVC) and at different percentages of the current needed to elicit a maximal M-wave (20-100% Imax). The IZs of the medial and lateral BB were identified from the EMG signals and expressed as a row number within a given medial-lateral column.

RESULTS

ES current intensity had no significant effect on the group mean IZ location (p > 0.05). However, The IZ during VC was located more proximally with increasing force (p < 0.05), likely due to muscle shortening. The position of the IZ varied slightly (by up to ~ 8 mm) in a medial-lateral direction under both contraction types, but this spatial effect was not significant. The IZ during ES and weak VC (20, 40% MVC) was similar (p > 0.05), but was more proximal in the latter than the former during 60-100% MVC (p < 0.05).

CONCLUSION

ES can be used to detect spatial differences in IZ location free of the confounding effects of muscle shortening and recruitment order of different sized motor units. The method may prove beneficial for locating the IZ in patients who lack voluntary control of their musculature.

Global Innervation Zone Identification With High-Density Surface Electromyography

OBJECTIVE

The aim of this study is to compare the performance of three strategies in determining the global innervation zone (IZ) distribution.

METHODS

High-density surface electromyography was recorded from the biceps brachii muscle of seven healthy subjects under isometric voluntary contractions at 20%, 50%, and 100% of the maximal voluntary contraction and supramaximal musculocutaneous nerve stimulations. IZs were detected: first, by visual identification in a column-specific manner (IZ-1D); second, based on decomposed bipolar mapping of motor unit action potentials (IZ-2D); and third, by source imaging in the three-dimensional muscle space (IZ-3D).

RESULTS

All three IZ detection approaches have exhibited excellent trial-to-trial repeatability. Consistent IZ results were found in the axial direction of the arm across all three approaches, yet a difference was observed in the mediolateral direction.

CONCLUSIONS

Among all three approaches, IZ-3D is capable of providing the most comprehensive information regarding the global IZ distribution, while maintaining high consistency with IZ-1D and IZ-2D results.

SIGNIFICANCE

IZ-3D approach can be a potential tool for global IZ imaging, which is critical to the clinical diagnosis and treatment of neuromuscular disorders.

Determining the most effective exercise for gluteal muscle activation in children with cerebral palsy using surface electromyography

BACKGROUND

Reduced lumbo-pelvic postural control is a common feature of gait in children with Cerebral Palsy (CP). These features are commonly attributed to insufficiency of the hip musculature as well as underlying bony geometry. Exercises aimed at strengthening the hip muscles are frequently prescribed in children with Cerebral Palsy (CP). There is a lack of evidence indicating the most effective exercises in targeting gluteal muscle activation in this population.

RESEARCH QUESTION

To determine the most effective exercise for gluteal muscle activation in children with CP.

METHODS

This was a cross-sectional study of children with CP. Surface EMG data from the gluteus medius (GMed) and maximus (GMax) on the more involved limb were recorded as participants completed 6 commonly prescribed gluteal strengthening exercises. EMG was assessed for peak activation, normalised to functional reference values.

RESULTS

Data from ten children (5 males, 5 females; mean +- SD age, 13+-3 years) were included for final analysis. The single leg bridge and step up were the most effective exercises for gluteal muscle activation. Differences in activation were found to be statistically significant using Friedman's rank test (GMax p = 0.0001, GMed p = 0.0023).

SIGNIFICANCE

This study is the first to show clear differences in activation across gluteal strengthening exercises in a CP population. Exercises which involve weight bearing through a single limb appear most effective in activating the target muscles i.e the single leg bridge and the step up. Exercises involving double limb support or open-chain movements were less effective. The results of this study indicate that careful exercise selection is required to achieve targeted muscle activation in a paediatric CP population. The results of this study will provide guidance for exercise prescription for gluteal strengthening in this population and will inform future research studies on the effectiveness hip muscle strengthening programmes in CP.

Oscillations in neural drive and age-related reductions in force steadiness with a cognitive challenge

A cognitive challenge when imposed during a low-force isometric contraction will exacerbate sex- and age-related decreases in force steadiness, but the mechanism is not known. We determined the role of oscillations in the common synaptic input to motor units on force steadiness during a muscle contraction with a concurrent cognitive challenge. Forty-nine young adults (19-30 yr; 25 women, 24 men) and 36 old adults (60-85 yr; 19 women, 17 men) performed a cognitive challenge (counting backward by 13) during an isometric elbow flexion task at 5% of maximal voluntary contraction. Single-motor units were decomposed from high-density surface EMG recordings. For a subgroup of participants, motor units were matched during control and cognitive challenge trials, so the same motor unit was analyzed across conditions. Reduced force steadiness was associated with greater oscillations in the synaptic input to motor units during both control and cognitive challenge trials ( r = 0.45-0.47, P < 0.01). Old adults and young women showed greater oscillations in the common synaptic input to motor units and decreased force steadiness when the cognitive challenge was imposed, but young men showed no change across conditions (session × age × sex, P < 0.05). Oscillations in the common synaptic input to motor units is a potential mechanism for altered force steadiness when a cognitive challenge is imposed during low-force contractions in young women and old adults. NEW & NOTEWORTHY We found that oscillations in the common synaptic input to motor units were associated with a reduction in force steadiness when a cognitive challenge was imposed during low-force contractions of the elbow flexor muscles in young women and old men and women but not young men. Age- and sex-related muscle weakness was associated with these changes.

Greater fatigability in knee-flexors vs. knee-extensors after a standardized fatiguing protocol

The present study aimed to investigate the effects of a standardized fatiguing protocol on central and peripheral fatigue in knee-flexors and knee-extensors. Thirteen healthy men (age: 23 ± 3 years; height: 1.78 ± 0.09 m; body-mass: 73.6 ± 9.2 kg) volunteered for the present study. Maximal voluntary contraction (MVC), Electromyography (EMG) activity, voluntary activation level (VAL) as an index of central fatigue and twitch potentiation as an index of peripheral fatigue were measured before and after the fatiguing protocol. The fatiguing protocol consisted of a 0.6 duty-cycle to exhaustion (6 s isometric contraction, 4 s recovery) at 70% MVC. After the fatiguing protocol, MVC decreased in both (Effect-size (ES) = 1.14) and knee-extensors (ES = 1.14), and EMG activity increased in both knee-flexors (ES = 2.33) and knee-extensors (ES = 1.54). Decreases in VAL occurred in knee-flexors (ES = 0.92) but not in knee-extensors (ES = 0.04). Decreases in potentiation occurred in both knee-flexors (ES = 0.84) and knee-extensors (ES = 0.58). The greater central occurrence of fatigue in knee-flexors than in knee-extensors may depend on the different muscle morphology and coupled with a greater tolerance to fatigue in knee-extensors. The present data add further insight to the complicated knee-flexors-to-knee-extensors strength relationship and the mechanisms behind the different occurrence of fatigue.

Relationship between Isometric Muscle Force and Fractal Dimension of Surface Electromyogram

The relationship between fractal dimension of the surface electromyogram (sEMG) and the intensity of muscle contraction is still controversial in simulated and experimental conditions. To support the use of fractal analysis to investigate myoelectric fatigue, it is crucial to establish the interdependence between fractal dimension and muscle contraction intensity. We analyzed the behavior of fractal dimension, conduction velocity, mean frequency, and average rectified value in twenty-eight volunteers at nine levels of isometric force. sEMG was obtained using bidimensional arrays in the biceps brachii muscle. The values of fractal dimension and mean frequency increased with force unless a plateau was reached at 30% maximal voluntary contraction. Overall, our findings suggest that, above a certain level of force, the use of fractal dimension to evaluate the myoelectric manifestations of fatigue may be considered, regardless of muscle contraction intensity.

Muscular and metabolic responses to different Nordic walking techniques, when style matters

Due to poling action and upper body engagement, Nordic walking (NW) has additional health benefits with respect to conventional walking. The aim of this study was to evaluate the differences in muscle activation and metabolic responses between NW, performed with the technique suggested by NW instructors, and with some modifications in the way to move upper limb and poles. Ten NW instructors volunteered to walk on a treadmill at 5.5 km•h-1 in five conditions: walking (W), Nordic walking (NW), NW with a weak poling action (NWweak), with straight-upper limbs moving the shoulders (NWshoulder) and with elbow flexion-extension pattern and shoulder freezed (NWelbow). Poling forces, body segments and poles movement, upper and lower body muscle activation, as well as metabolic parameters were measured.All modified NW techniques elicited lower muscular activation and metabolic responses with respect to the suggested NW technique (P < 0.05). All NW techniques elicited higher muscular activation and metabolic responses than W. All parameters observed with the NWweak were lower than NW. A decreased activation of shoulder extensor muscles and increased activation of anterior deltoid muscle were the main features of NWshoulder. Lower triceps brachii muscle activation and reduced propulsive poling action with respect to NW were seen for NWelbow, resulting also in shorter steps.Nordic walking instructors, sport technicians and practitioners should be aware that any deviation from the technique usually suggested might lead to lower benefits. However it is worth to note that any walking technique with poles elicits higher metabolic responses and muscular activation than walking.

Shared and task-specific muscle synergies of Nordic walking and conventional walking

Nordic walking is a form of walking that includes a poling action, and therefore an additional subtask, with respect to conventional walking. The aim of this study was to assess whether Nordic walking required a task-specific muscle coordination with respect to conventional walking. We compared the electromyographic (EMG) activity of 15 upper- and lower-limb muscles of 9 Nordic walking instructors, while executing Nordic walking and conventional walking at 1.3 ms^-1 on a treadmill. Non-negative matrix factorization method was applied to identify muscle synergies, representing the spatial and temporal organization of muscle coordination. The number of muscle synergies was not different between Nordic walking (5.2 ± 0.4) and conventional walking (5.0 ± 0.7, P = .423). Five muscle synergies accounted for 91.2 ± 1.1% and 92.9 ± 1.2% of total EMG variance in Nordic walking and conventional walking, respectively. Similarity and cross-reconstruction analyses showed that 4 muscle synergies, mainly involving lower-limb and trunk muscles, are shared between Nordic walking and conventional walking. One synergy acting during upper limb propulsion is specific to Nordic walking, modifying the spatial organization and the magnitude of activation of upper limb muscles compared to conventional walking. The inclusion of the poling action in Nordic walking does not increase the complexity of movement control and does not change the coordination of lower limb muscles. This makes Nordic walking a physical activity suitable also for people with low motor skill.

Imaging three-dimensional innervation zone distribution in muscles from M-wave recordings

OBJECTIVE

To localize neuromuscular junctions in skeletal muscles in vivo which is of great importance in understanding, diagnosing and managing of neuromuscular disorders.

APPROACH

A three-dimensional global innervation zone imaging technique was developed to characterize the global distribution of innervation zones, as an indication of the location and features of neuromuscular junctions, using electrically evoked high-density surface electromyogram recordings.

MAIN RESULTS

The performance of the technique was evaluated in the biceps brachii of six intact human subjects. The geometric centers of the distributions of the reconstructed innervation zones were determined with a mean distance of 9.4  ±  1.4 cm from the reference plane, situated at the medial epicondyle of the humerus. A mean depth was calculated as 1.5  ±  0.3 cm from the geometric centers to the closed points over the skin. The results are consistent with those reported in previous histology studies. It was also found that the volumes and distributions of the reconstructed innervation zones changed as the stimulation intensities increased until the supramaximal muscle response was achieved.

SIGNIFICANCE

Results have demonstrated the high performance of the proposed imaging technique in noninvasively imaging global distributions of the innervation zones in the three-dimensional muscle space in vivo, and the feasibility of its clinical applications, such as guiding botulinum toxin injections in spasticity management, or in early diagnosis of neurodegenerative progression of amyotrophic lateral sclerosis.

Core Muscle Activation in Suspension Training Exercises

A quantitative observational laboratory study was conducted to characterize and classify core training exercises executed in a suspension modality on the base of muscle activation. In a prospective single-group repeated measures design, seventeen active male participants performed four suspension exercises typically associated with core training (roll-out, bodysaw, pike and knee-tuck). Surface electromyographic signals were recorded from lower and upper parts of rectus abdominis, external oblique, internal oblique, lower and upper parts of erector spinae muscles using concentric bipolar electrodes. The average rectified values of electromyographic signals were normalized with respect to individual maximum voluntary isometric contraction of each muscle. Roll-out exercise showed the highest activation of rectus abdominis and oblique muscles compared to the other exercises. The rectus abdominis and external oblique reached an activation higher than 60% of the maximal voluntary contraction (or very close to that threshold, 55%) in roll-out and bodysaw exercises. Findings from this study allow the selection of suspension core training exercises on the basis of quantitative information about the activation of muscles of interest. Roll-out and bodysaw exercises can be considered as suitable for strength training of rectus abdominis and external oblique muscles.

Spatial characterization of innervation zones under electrically elicited M-wave

The three dimensional (3D) innervation zone (IZ) imaging approach (3DIZI) has been developed in our group to localize the IZ of a particular motor unit (MU) from its motor unit action potentials decomposed from high-density surface electromyography (EMG) recordings. In this study, the developed 3DIZI approach was combined with electrical stimulation to investigate global distributions of IZs in muscles from electrically elicited M-wave recordings. Electrical stimulations were applied to the musculocutaneous nerve to activate supramaximal muscle response of the biceps brachii in one healthy subject, and high-density (128 channels) surface EMG signals of the biceps brachii muscles were recorded. The 3DIZI approach was then employed to image the IZ distribution of IZs in the 3D space of the biceps brachii. The performance of the M-wave based 3DIZI approach was evaluated with different stimulation intensities. Results show that the reconstructed IZs under supramaximal stimulation are spatially distributed in the center region of muscle belly which is consistent with previous studies. With sub-maximal stimulation intensity, the imaged IZ centers became more proximally and deeply located. The proposed M-wave based 3DIZI approach demonstrated its capability of imaging global distribution of IZs in muscles, which provide valuable information for clinical applications such as guiding botulinum toxin injection in treating muscle spasticity.

Guidelines to electrode positioning for human and animal electrical impedance myography research

The positioning of electrodes in electrical impedance myography (EIM) is critical for accurately assessing disease progression and effectiveness of treatment. In human and animal trials for neuromuscular disorders, inconsistent electrode positioning adds errors to the muscle impedance. Despite its importance, how the reproducibility of resistance and reactance, the two parameters that define EIM, are affected by changes in electrode positioning remains unknown. In this paper, we present a novel approach founded on biophysical principles to study the reproducibility of resistance and reactance to electrode misplacements. The analytical framework presented allows the user to quantify a priori the effect on the muscle resistance and reactance using only one parameter: the uncertainty placing the electrodes. We also provide quantitative data on the precision needed to position the electrodes and the minimum muscle length needed to achieve a pre-specified EIM reproducibility. The results reported here are confirmed with finite element model simulations and measurements on five healthy subjects. Ultimately, our data can serve as normative values to enhance the reliability of EIM as a biomarker and facilitate comparability of future human and animal studies.

Muscle Activation During Peripheral Nerve Field Stimulation Occurs Due to Recruitment of Efferent Nerve Fibers, Not Direct Muscle Activation

BACKGROUND

Peripheral nerve field stimulation (PNFS) is a potential treatment for chronic low-back pain. Pain relief using PNFS is dependent on activation of non-nociceptive Aβ-fibers. However, PNFS may also activate muscles, causing twitches and discomfort. In this study, we developed a mathematical model, to investigate the activation of sensory and motor nerves, as well as direct muscle fiber activation.

METHODS

The extracellular field was estimated using a finite element model based on the geometry of CT scanned lumbar vertebrae. The electrode was modeled as being implanted to a depth of 10-15 mm. Three implant directions were modeled; horizontally, vertically, and diagonally. Both single electrode and "between-lead" stimulation between contralateral electrodes were modeled. The extracellular field was combined with models of sensory Aβ-nerves, motor neurons and muscle fibers to estimate their activation thresholds.

RESULTS

The model showed that sensory Aβ fibers could be activated with thresholds down to 0.563 V, and the lowest threshold for motor nerve activation was 7.19 V using between-lead stimulation with the cathode located closest to the nerves. All thresholds for direct muscle activation were above 500 V.

CONCLUSIONS

The results suggest that direct muscle activation does not occur during PNFS, and concomitant motor and sensory nerve fiber activation are only likely to occur when using between-lead configuration. Thus, it may be relevant to investigate the location of the innervation zone of the low-back muscles prior to electrode implantation to avoid muscle activation.

Central and peripheral fatigue in knee and elbow extensor muscles after a long-distance cross-country ski race

Although elbow extensors (EE) have a great role in cross-country skiing (XC) propulsion, previous studies on neuromuscular fatigue in long-distance XC have investigated only knee extensor (KE) muscles. In order to investigate the origin and effects of fatigue induced by long-distance XC race, 16 well-trained XC skiers were tested before and after a 56-km classical technique race. Maximal voluntary isometric contraction (MVC) and rate of force development (RFD) were measured for both KE and EE. Furthermore, electrically evoked double twitch during MVC and at rest were measured. MVC decreased more in KE (-13%) than in EE (-6%, P = 0.016), whereas the peak RFD decreased only in EE (-26%, P = 0.02) but not in KE. The two muscles showed similar decrease in voluntary activation (KE -5.0%, EE -4.8%, P = 0.61) and of double twitch amplitude (KE -5%, EE -6%, P = 0.44). A long-distance XC race differently affected the neuromuscular function of lower and upper limbs muscles. Specifically, although the strength loss was greater for lower limbs, the capacity to produce force in short time was more affected in the upper limbs. Nevertheless, both KE and EE showed central and peripheral fatigue, suggesting that the origins of the strength impairments were multifactorial for the two muscles.