Characteristics of stabilizer muscles: a systematic review

Electromyographic Activity of Lower Limb Muscles during Ankle Destabilizing Tests

Ankle destabilizing devices were developed to improve the recruitment of the evertor muscles. Nevertheless, the activity of lower-leg muscles has never been compared to each other during functional tests performed with destabilization. The objectives were i) to compare the electromyographic activity between the lower-leg muscles during four functional tests performed with ankle destabilization, and ii) to determine sex-related differences in neuromuscular activation. Twenty-six healthy volunteers (13 males, 13 females) performed the modified Star Excursion Balance Test (mSEBT), unipedal balance and weight-bearing inversion and eversion tests with a destabilizing device, while recording electromyographic activity of the peroneus longus and brevis, tibialis anterior, gastrocnemius lateralis and gluteus medius. The activity of peroneal muscles was significantly greater than other muscles during all functional tests. Furthermore, the anterior direction of the mSEBT was the one implying the greatest activity of the peroneus longus muscle compared to the posteromedial (p=0.003) or posterolateral (p<0.001) directions. Finally, no significant sex-related differences in neuromuscular activity were reported. This study highlights the effectiveness of the destabilizing device to involve specifically the peroneal muscles when performing various functional tests. This device should be used by clinicians to be more specific to the stabilizers of the ankle joint during functional exercises.

Active workstations: A literature review on workplace sitting

The purpose of this paper is to further understand current literature on prolonged sitting, sitting posture and active sitting solutions. This paper is divided into three sections: The first section (Part I) is a comprehensive overview of the literature on how a static prolonged seated posture can affect: spinal health, trunk posture, contact pressure/discomfort development and vascular issues. The second section (Part II) reviews and qualitatively compares the four working postures recognized in ANSI/HFES 100-2007: reclined sitting, upright sitting, declined sitting and standing. The final section (Part III) is a summary of research on active chairs that revolves around the two types of movement patterns: 1- sustaining continual movement over a range of postures, occasionally reaching neutral lordosis, and 2- maintaining high frequency and duration of daily light contractile activity in the legs (or lower limbs).

Evaluation of balance in patients with systemic sclerosis

BACKGROUND

The aim was to examine static/dynamic balance and proprioception of Systemic Sclerosis by comparing healthy and relationship with demographic and disease-related data.

METHODS

21 Systemic Sclerosis and 19 healthy were included.Berg Balance Scale (functional balance), Sensamove Sensbalance Maxiboard Software (static, dynamic balance:reaction time and travel time and proprioception), Scleroderma Health Assessment Questionnaire/Health Assessment Questionnaire (health status), Medsger's Disease Severity Scale, Modified Rodnan Skin Score were used in evaluation.

FINDINGS

Comparing the groups, there was significant difference in Berg Balance Scale (p:0.036); Health Assessment Questionnaire/Scleroderma Health Assessment Questionnaire (p:0.001); Static balance-center (p:0.001), front (p:0.001), back (p:0.001), left (p:0.001), right (p:0.021); proprioception-front (p:0.025);Reaction Time-front (p:0.031) and left (p:0.010);Travel Time-front (p:0.041) and left (p:0.014) in favor of healthy group.In Systemic Sclerosis, disease severity had moderate correlation with static balance-back (r:-0.504,p:0.020).Skin thickness had low correlation with Reaction Time-front (r:-0.449,p:0.041).Age had low correlation with Travel time-front (r:0.458,p:0.037) and proprioception-left (r:0.450,p:0.041); moderate with Travel time-back (r:0.515;p:0.017) and proprioception-front (r:0.539,p:0.012).

INTERPRETATION

Compared to healthy, Systemic Sclerosis had worse health status, functional balance, static/dynamic balance and proprioception.This situation is related to disease severity, skin thickness and age. Evaluations made with objective methods may have the potential to determine the extent of the problem.Clinicians can guide the treatment of patients with SSc by evaluating their static/dynamic balance and proprioception.With early treatment, additional problems that may occur due to worsening of balance and proprioception can be prevented.Proprioception and dynamic balance evaluation can be performed for older patients, static balance when disease activity is high, and dynamic balance when skin thickness score is high.

Changes in Muscle Activation During and After a Shoulder-Fatiguing Task: A Comparison of Elite Female Swimmers and Water Polo Players

This study compared female athletes with different aquatic sports expertise in their neuromuscular activation before, during, and after a shoulder internal rotation fatigue protocol. Eleven water polo players, 12 swimmers, and 14 controls completed concentric maximal voluntary external and internal shoulder rotations before and after a fatigue protocol consisting of concentric internal rotations at 50% of maximal voluntary contraction for at least 3 min or until reporting a rating of perceived effort RPE of 8/10 or higher. Muscle activation was measured for the maximal voluntary contractions, as well as for the first (T1), middle (T2), and third (T3) minute of the fatigue protocol using surface electromyography (EMG) on pectoralis major, anterior and posterior deltoid, upper and middle trapezius, and latissimus dorsi. Intramuscular EMG was used for supraspinatus, infraspinatus, and subscapularis. Pre-fatigue internal rotation torque was significantly correlated with shorter task duration (r = −0.39, p = 0.02), with water polo players producing significantly greater torque than controls but having significantly lower endurance. Swimmers demonstrated decreased latissimus dorsi activation at T3 compared to T2 (p = 0.020, g = 0.44) and T1 (p = 0.029, g = 0.74), differing from water polo players and controls who exhibited increased agonist activation and decreased activation of stabilizers. Comparing the pre-fatigue to the post-fatigue maximal shoulder rotations, water polo players had decreased activation in subscapularis (p = 0.018, g = 0.67); all groups had decreased activation in latissimus dorsi (p < 0.001), though swimmers demonstrated a large effect (g = 0.97); and controls had decreased activation in supraspinatus (p = 0.005, g = 0.71). Together, these results suggest that sports expertise may be associated with different muscle activation both while and after fatigue is induced. Further research should continue to explore sports-specific patterns of muscle recruitment and fatigue adaptations, as well as if certain strategies are adaptive or maladaptive. This may have important consequences for injury prevention among athletes who perform repetitive overhead movements in their sports and who are susceptible to overuse injuries.

Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and Function: A Narrative Review of Current Evidence and Practical Considerations

Resistance training (RT) is the only non-pharmacological intervention known to consistently improve, and therefore offset age-related declines in, skeletal muscle mass, strength, and power. RT is also associated with various health benefits that are underappreciated compared with the perceived benefits of aerobic-based exercise. For example, RT participation is associated with reduced all-cause and cancer-related mortality and reduced incidence of cardiovascular disease, hypertension, and symptoms of both anxiety and depression. Despite these benefits, participation in RT remains low, likely due to numerous factors including time constraints, a high-perceived difficulty, and limited access to facilities and equipment. Identification of RT strategies that limit barriers to participation may increase engagement in RT and subsequently improve population health outcomes. Across the lifespan, declines in strength and power occur up to eight times faster than the loss of muscle mass, and are more strongly associated with functional impairments and risks of morbidity and mortality. Strategies to maximise healthspan should therefore arguably focus more on improving or maintaining muscle strength and power than on increasing muscle mass per se. Accumulating evidence suggests that minimal doses of RT, characterised by lower session volumes than in traditional RT guidelines, together with either (1) higher training intensities/loads performed at lower frequencies (i.e. low-volume, high-load RT) or (2) lower training intensities/loads performed at higher frequencies and with minimal-to-no equipment (i.e. resistance 'exercise snacking'), can improve strength and functional ability in younger and older adults. Such minimal-dose approaches to RT have the potential to minimise various barriers to participation, and may have positive implications for the feasibility and scalability of RT. In addition, brief but frequent minimal-dose RT approaches (i.e. resistance 'exercise snacking') may provide additional benefits for interrupting sedentary behaviour patterns associated with increased cardiometabolic risk. Compared to traditional approaches, minimal-dose RT may also limit negative affective responses, such as increased discomfort and lowered enjoyment, both of which are associated with higher training volumes and may negatively influence exercise adherence. A number of practical factors, including the selection of exercises that target major muscle groups and challenge both balance and the stabilising musculature, may influence the effectiveness of minimal-dose RT on outcomes such as improved independence and quality-of-life in older adults. This narrative review aims to summarise the evidence for minimal-dose RT as a strategy for preserving muscle strength and functional ability across the lifespan, and to discuss practical models and considerations for the application of minimal-dose RT approaches.

Muscle Contraction Has a Reduced Effect on Increasing Glenohumeral Stability in the Apprehension Position

PURPOSE

Glenohumeral instability accounts for 23% of all shoulder injuries among collegiate athletes. The apprehension position-combined shoulder abduction and external rotation-commonly reproduces symptoms in athletes with instability. Rehabilitation aims to increase glenohumeral stability by strengthening functional positions. However, it is unclear how much glenohumeral stability increases with muscle contraction in the apprehension position. The purpose of this study was to determine whether the ability to increase translational glenohumeral stiffness, a quantitative measure of glenohumeral stability, with muscle contraction is reduced in the apprehension position.

METHODS

Seventeen asymptomatic adults participated. A precision-instrumented robotic system applied pseudorandom, anterior-posterior displacements to translate the humeral head within the glenoid fossa and measured the resultant forces as participants produced isometric shoulder torques. Measurements were made in neutral abduction (90° abduction/0° external rotation) and apprehension (90° abduction/90° external rotation) positions. Glenohumeral stiffness was estimated from the relationship between applied displacements and resultant forces. The ability to increase glenohumeral stiffness with increasing torque magnitude was compared between positions.

RESULTS

On average, participants increased glenohumeral stiffness from passive levels by 91% in the neutral abduction position and only 64% in the apprehension position while producing 10% of maximum torque production. The biggest decrease in the ability to modulate glenohumeral stiffness in the apprehension position was observed for torques generated in abduction (49% lower, P < 0.001) and horizontal abduction (25% lower, P < 0.001).

CONCLUSION

Our results demonstrate that individuals are less able to increase glenohumeral stiffness with muscle contraction in the apprehension position compared with a neutral shoulder position. These results may help explain why individuals with shoulder instability more frequently experience symptoms in the apprehension position compared with neutral shoulder positions.

Responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects

PURPOSE

To compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects.

SCOPE

Nine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions.

RESULTS

Perturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait.

CONCLUSIONS

Healthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.

A review of the role of lower-leg strength measurements in ankle sprain and chronic ankle instability populations

Lower-leg strength training has been a cornerstone of ankle sprain and chronic ankle instability (CAI) rehabilitation and an important consideration for return-to-play in athletes with ankle injuries. The purpose of this literature review is to offer a contemporary, evidence-based overview of the role of ankle strength measurements as they relate to acute ankle sprain rehabilitation and those who have developed CAI. A comprehensive 20-year scan of the relevant research was conducted to assist us in providing this important update for clinicians and biomechanists working with patients and subjects with acute and chronic ankle sprains. While variability exists with measurement devices and methodology, strength assessment remains a critical component of ankle sprain and CAI treatment schemes. Helpful tips on obtaining and processing the most accurate strength assessments for lower-leg musculature are presented.

Neuromuscular control of the ankle during pre-landing in athletes with chronic ankle instability: Insights from statistical parametric mapping and muscle co-contraction analysis

OBJECTIVE

The present study aimed to compare the neuromuscular control of the muscles around the ankle between athletes with CAI and without history of any ankle sprain (Non-CAI) by using statistic parametric mapping (SPM) and co-contraction analyses.

DESIGN

Cross-sectional study; Setting: Laboratory; Participants: 40 athletes (20 CAI, 20 Non-CAI) were pair-matched for age and gender.

MAIN OUTCOME MEASURES

Neuromuscular control was examined using surface electromyography (EMG) amplitude and muscle co-contraction 200 ms before foot-contact with the ground during a jump-landing task.

RESULTS

The EMG amplitude of tibialis anterior, peroneus longus, and gastrocnemius medialis were analyzed using statistic parametric mapping. The CAI group exhibited decreased EMG amplitude of peroneus longus during preparation for foot-contact. There were no significant co-contraction differences between groups.

CONCLUSIONS

Our findings demonstrate that SPM combined with the co-contraction provides a comprehensive EMG analysis to detect the differences of neuromuscular control between athletes with and without chronic ankle instability. Additionally, this finding indicates that CAI contributed to altered neuromuscular control during the pre-landing phase, which may contribute to re-injury mechanisms.

Effects of a 4-Week Intrinsic Foot Muscle Exercise Program on Motor Function: A Preliminary Randomized Control Trial

Context: Intrinsic foot muscle (IFM) exercises are utilized clinically in the treatment of foot and ankle conditions. However, the effectiveness of training on IFM motor function is unknown. Objective: To study the effects of a 4-week IFM exercise program on motor function, perceived difficulty, and IFM motor activation measured using ultrasound imaging (USI) during 3 IFM exercises. Design: Single-blinded randomized control trial. Setting: Laboratory. Participants: A total of 24 healthy, recreationally active young adults without history of ankle-foot injury who have never performed IFM exercises participated (12 males and 12 females; mean age = 21.5 [4.8] y; body mass index = 23.5 [2.9] kg/m²) Intervention: Following randomization, participants allocated to the intervention group received a 4-week progressive home IFM exercise program performed daily. Participants in the control group did not receive any intervention. Main Outcome Measures: Clinician-assessed motor performance (4-point scale: 0 = does not initiate movement and 3 = performs exercise in standard pattern), participant-perceived difficulty (5-point Likert scale: 1 = very easy and 5 = very difficult), and USI motor activation measures (contracted measurementresting measurement) of the abductor hallucis, flexor digitorum brevis, quadratus plantae, and flexor hallucis brevis were assessed during toe-spread-out, hallux-extension, and lesser-toe-extension exercises. Results: The intervention group demonstrated significant improvement in motor performance in the toe-spread-out exercise (pre = 1.9 [0.5], post = 2.6 [0.5], P = .008) and less perceived difficulty in the toe-spread-out (pre = 3.1 [1.3], post = 2.3 [1.2], P = .01), hallux-extension (pre = 3.2 [1.5], post = 2.0 [1.2], P = .005), and lesser-toe-extension (pre = 1.9 [0.7], post = 1.2 [0.4], P = .03) exercises. Both groups demonstrated increased USI motor activation in the abductor hallucis during the toe-spread-out exercise (intervention: pre = 1.07 [0.06], post = 1.11 [0.08] and control: pre = 1.08 [0.06], post = 1.11 [0.06]; P = .05). No other significant main effects or group by time interactions were observed. Conclusion: A 4-week IFM exercise intervention resulted in improved motor performance and decreased perceived difficulty when performing the exercises, but not changes in USI measures of IFM activation compared with a control group.

Different strength declines in leg primary movers versus stabilizers across age-Implications for the risk of falls in older adults?

This study investigated differences in the declines of isometric strength in hip abductors and adductors versus knee extensors across four different age groups (n = 31: 11.2 ± 1.0 y, n = 30: 23.1 ± 2.7 y, n = 27: 48.9 ± 4.4 y, and n = 33: 70.1 ± 4.2 y) with a total of 121 female subjects. As a starting point, we assumed that, during their daily activities, elderly people would use their leg stabilizers less frequently than their leg primary movers as compared to younger people. Given that muscle strength decreases in the course of the aging process, we hypothesized that larger strength declines in hip abductors and hip adductors as compared to knee extensors would be detected across age. Maximal isometric force for these muscle groups was assessed with a digital hand-held dynamometer. Measurements were taken at 75% of the thigh or shank length and expressed relative to body weight and lever arm length. Intratester reliability of the normalized maximal torques was estimated by using Cronbach’s alpha and calculated to be larger than 0.95. The obtained results indicate a clearly more pronounced strength decline in hip abductors and hip adductors across age than in the knee extensors. Therefore, a particular need for strength training of the lower extremity stabilizer muscles during the aging process is implied.

Evolution of muscular fatigue in periscapular and rotator cuff muscles during isokinetic shoulder rotations

To this day, how shoulder muscles react to a strong fatigue stimulus during dynamic shoulder rotations remains unknown. The aims of this study were to assess the effect of repeated maximal internal-external isokinetic shoulder rotations on shoulder strength and muscle activity. Twenty-four individuals completed a 50-repetition fatiguing isokinetic protocol while electromyography was recorded on eleven muscles of the shoulder girdle. Time-frequency transformation and an ANOVA model using statistical parametric mapping methods were used to analyze shifts in instantaneous median frequency (MDF) between each 10-repetition Blocks. Peak torques decreased in both internal and external rotation (P < 0.01) by 24.8% on average which indicated the presence of fatigue. Significant decrease in MDF (P < 0.01) was observed for pectoralis, middle deltoid, upper, middle and lower trapezius, infraspinatus and subscapularis muscles. The observed fatigue to the periscapular and rotator cuff muscles suggests that shoulder stability could be compromised during repeated shoulder rotations, which could underlie the increased risk of scapular dyskinesis and shoulder impingement during fatiguing tasks. The present study provides a deeper understanding on the manifestations of fatigue within muscles of the shoulder girdle and the results could be applied toward improvements in athlete shoulder injury prevention and rehabilitation programs.