Recruitment of Shoulder Complex and Torso Stabilizer Muscles With Rowing Exercises Using a Suspension Strap Training System.

BACKGROUND: Suspension training systems, which use body weight resistance under unstable conditions, may be effective for muscle strengthening in persons with scapular dyskinesis or subacromial impingement syndrome. HYPOTHESIS: Greater arm, scapular, and trunk muscle recruitment will occur during horizontal abduction row exercises. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 5. METHODS: Surface electromyography data were collected from 28 participants (14 men, 14 women). A total of 13 right-sided muscles were studied at a sampling frequency of 1000 Hz. Maximal voluntary isometric contractions (MVICs) were established. Participants completed 3 repetitions per exercise in random order. We compared muscle recruitment during 3 rowing exercises: low row, high row, and horizontal abduction row. Data were compared with repeated-measures analyses of variance and post hoc Bonferroni corrections. RESULTS: For high row and horizontal abduction row conditions, the upper, middle, and lower trapezius and posterior deltoid demonstrated >60% MVIC magnitudes of recruitment, and the upper erector spinae demonstrated 40% to 60% MVIC magnitudes of recruitment, respectively. In contrast, in the low row exercise, 40% to 60% MVIC magnitudes of recruitment were observed only in the middle trapezius, latissimus dorsi, and posterior deltoid. CONCLUSION: With the suspension system, high row and horizontal abduction row exercises promote muscle strengthening (>50% MVIC) in the upper, middle, and lower fibers of the trapezius, posterior deltoid, and upper erector spinae. CLINICAL RELEVANCE: Rowing exercises performed with suspension straps may be recommended for muscle strengthening in patients with scapular dyskinesis and subacromial impingement syndrome as well as for healthy persons in need of enhanced scapular muscle performance.

Recruitment of Shoulder Prime Movers and Torso Stabilizers During Push-Up Exercises Using a Suspension Training System.

CONTEXT: Suspension training devices use body weight resistance and unstable support surfaces that may facilitate muscle recruitment during push-up exercises. OBJECTIVE: The authors examined muscle recruitment with surface electromyography on 4 shoulder and 4 torso muscles during (1) standard push-ups, (2) feet-suspended push-ups, (3) hands-suspended push-ups, and (4) dual-instability push-ups in which feet were suspended and hands were on unstable surfaces. DESIGN: Cross-sectional design with repeated measures. SETTING: Biomechanics laboratory. PARTICIPANTS: Thirty-two healthy men and women (mean age, 24.3 y; mean body mass index, 24.6 kg·m-2) participated. INTERVENTION: Participants were tested while performing 2 repetitions each of 4 variations of push-ups. MAIN OUTCOME MEASURES: Muscle recruitment, normalized to maximum voluntary isometric contraction, was measured in 4 prime movers (anterior deltoid, pectoralis major, serratus anterior, and triceps brachii) and 4 torso stabilizers (external oblique, internal oblique, rectus abdominis, and upper erector spinae). RESULTS: Muscle recruitment in the anterior deltoid, pectoralis major, and serratus anterior during suspended exercises was no greater than during standard push-ups. In contrast, torso stabilizer recruitment was significantly greater in the external oblique, internal oblique, and rectus abdominis during all 3 suspended exercises compared with standard push-ups. Suspended exercises under a dual-instability condition did not generate greater levels of muscle activation compared with conditions of single instability. CONCLUSIONS: Push-ups performed with suspension training systems may provide benefit if one's goal is to enhance torso muscle training. One unstable surface may be sufficiently challenging for the client or athlete when performing push-up exercises with a suspension training device.

Scapular muscle balance and spinal stabilizer recruitment during an inverted row.

Persons with subacromial impingement syndrome (SIS) have an imbalance in scapular muscle recruitment. To avoid humeral head compression against the coracoacromial arch during the early stages of rehabilitation, physical therapists recommend movements targeting scapular retraction, shoulder depression, and arm extension such as the inverted row (IR) exercise. The purposes of this study were to describe: (1) scapular balance ratios during an IR and (2) the magnitudes of recruitment of spinal stabilizer muscles. Scapular muscle balance ratios from 26 healthy participants were calculated from electromyographic (EMG) activity of the upper trapezius (UTP), lower trapezius (LTP), middle trapezius (MTP), serratus anterior (SA), posterior deltoid (PD), latissimus dorsi (LD), and biceps brachii (BB) during an IR on stable and unstable support surfaces. Balance ratios were obtained by dividing normalized EMG activity of the UTP by the normalized EMG values from each of the other six muscles. Four median scapular balance ratios (UTP/MTP, UTP/PD, UTP/LD, and UTP/BB) ranged from 0.9 to 2.2, whereas the UTP/LTP ratio ranged from 1.6 to 2.2 and the UTP/SA ratio ranged from 1 to 4.7. Activation of seven muscles promoted safe containment of the humeral head within the glenoid fossa during the IR in healthy persons and potentially people with the tendency for development of SIS. Four spinal stabilizer muscles were examined: longissimus thoracis (LT), multifidus (MF), rectus abdominis (RA), and external oblique (EO). Spinal stabilizer EMG activation values ranged from 34% to 40% maximum voluntary isometric contraction (MVIC) for the RA and EO and from 54% to 66% MVIC for the LT and MF.

Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial.

CONTEXT: Hip extension with hamstring-dominant rather than gluteus maximus-dominant recruitment may increase anterior femoracetabular forces and contribute to conditions that cause hip pain. Cueing methods during hip extension exercises may facilitate greater gluteus maximus recruitment. OBJECTIVE: We examined whether specific verbal and tactile cues facilitate gluteus maximus recruitment while inhibiting hamstring recruitment during a bridging exercise. DESIGN: Randomized controlled trial. SETTING: Biomechanics laboratory. PARTICIPANTS: 30 young adult women (age 24 [3] y; BMI 22.2 [2.4] kg/m2). INTERVENTION: Participants were tested over 2 sessions, 1 week apart, while performing 5 repetitions of a bridging exercise. At their second visit, participants in the experimental group received verbal and tactile cues intended to facilitate gluteus maximus recruitment and inhibit hamstring recruitment. Control group participants received no additional cues beyond original instructions. MAIN OUTCOME MEASURES: Gluteus maximus and hamstring recruitment were measured with surface electromyography, normalized to maximal voluntary isometric contractions (MVICs). RESULTS: Gluteus maximus recruitment was unchanged in the control group and increased from 16.8 to 33.0% MVIC in the cueing group (F = 33.369, P < .001). Hamstring recruitment was unchanged in the control group but also increased from 16.5 to 29.8% MVIC in the cueing group (F = 6.400, P = .02). The effect size of the change in gluteus maximus recruitment in the cueing group (Cohen's d = 1.5, 95% CI = 0.9 to 2.2) was not significantly greater than the effect size in hamstring recruitment (Cohen's d = 0.8, 95% CI = 0.1 to 1.5). CONCLUSIONS: Verbal and tactile cues hypothesized to facilitate gluteus maximus recruitment yielded comparable increases in both gluteus maximus and hamstring recruitment. If one intends to promote hip extension by facilitating gluteus maximus recruitment while inhibiting hamstring recruitment during bridging exercises, the cueing methods employed in this study may not produce desired effects.

Magnitudes of muscle activation of spine stabilizers in healthy adults during prone on elbow planking exercises with and without a fitness ball.

Prone planking exercises have been used by rehabilitation professionals to activate torso muscles in healthy persons and those with low back pain. The aim of this study was to compare the magnitude of electromyographic (EMG) muscle activation from 10 right-sided muscles as demonstrated by the percentage of maximum voluntary isometric contraction (%MVIC) during four planking procedures. Surface EMG activity was acquired from the following muscles: (1) iliocostalis lumborum (IL), (2) longissimus thoracis (LT), (3) lumbar multifidus (LM), (4) rectus abdominis (RA), (5) external oblique (EO), (6) internal oblique (IO), (7) serratus anterior (SA), (8) latissimus dorsi (LD), (9) hamstrings (HS), and (10) gluteus maximus (GM). Thirteen male and 13 females performed prone plank on floor (PPOF), prone plank on ball (PPOB), stir-the-pot on ball (STP), and prone plank on ball with hip extension (PPHE). Previous investigators have not studied the STP and PPHE. During STP, three muscles (RA, EO, and IO) demonstrated very high (>61% MVIC) EMG activation and one muscle (SA) demonstrated high (41-60% MVIC) EMG activation. During PPHE, five muscles (GM, HS, EO, IO, and LM) demonstrated very high EMG activation and two muscles (RA and SA) demonstrated high EMG activation. Clinically, we concluded that STP and PPHE exercises were effective ways to activate RA, EO, IO, and SA at levels conducive to strengthening (> 50% MVIC), with PPHE able to additionally activate GM, HS, and LM at a strengthening level.

Simulating the multi-disciplinary care team approach: Enhancing student understanding of anatomy through an ultrasound-anchored interprofessional session.

Quality of healthcare delivery is dependent on collaboration between professional disciplines. Integrating opportunities for interprofessional learning in health science education programs prepares future clinicians to function as effective members of a multi-disciplinary care team. This study aimed to create a modified team-based learning (TBL) environment utilizing ultrasound technology during an interprofessional learning activity to enhance musculoskeletal anatomy knowledge of first year medical (MD) and physical therapy (PT) students. An ultrasound demonstration of structures of the upper limb was incorporated into the gross anatomy courses for first-year MD (n = 53) and PT (n = 28) students. Immediately before the learning experience, all students took an individual readiness assurance test (iRAT) based on clinical concepts regarding the assigned study material. Students observed while a physical medicine and rehabilitation physician demonstrated the use of ultrasound as a diagnostic and procedural tool for the shoulder and elbow. Following the demonstration, students worked within interprofessional teams (n = 14 teams, 5-6 students per team) to review the related anatomy on dissected specimens. At the end of the session, students worked within interprofessional teams to complete a collaborative clinical case-based multiple choice post-test. Team scores were compared to the mean individual score within each team with the Wilcoxon signed-rank test. Students scored higher on the collaborative post-test (95.2 ±10.2%) than on the iRAT (66.1 ± 13.9% for MD students and 76.2 ±14.2% for PT students, P < 0.0001). Results suggest that this interprofessional team activity facilitated an improved understanding and clinical application of anatomy. Anat Sci Educ 11: 94-99. © 2017 American Association of Anatomists.

Electromyographic analysis of gluteus maximus and hamstring activity during the supine resisted hip extension exercise versus supine unilateral bridge to neutral.

Hip extension strengthening exercises which maximize gluteus maximus contributions and minimize hamstring influences may be beneficial for persons with hip pain. This study's aim was to compare muscle activation of the gluteus maximus and hamstrings from healthy subjects during a supine resisted hip extension exercise versus supine unilateral bridge to neutral. Surface electromyographic (EMG) signals were obtained from the right gluteus maximus and hamstrings in 13 healthy male and 13 healthy female subjects. Maximum voluntary isometric contractions (MVICs) were collected to normalize data and permit meaningful comparisons across muscles. Peak median activation of the gluteus maximus was 33.8% MVIC for the bridge and 34.7% MVIC for the hip extension exercise, whereas peak median recruitment for hamstrings was 28.4% MVIC for the bridge and 51% MVIC for the hip extension exercise. The gluteus maximus to hamstrings ratio was compared between the two exercises using the Wilcoxon signed-ranks test (α = 0.05). The ratio (p = 0.014) was greater in the supine unilateral bridge (median = 111.3%) than supine hip extension exercise (median = 59.2%), suggesting a reduction of hamstring recruitment in the unilateral bridge to neutral compared to the supine resisted hip extension exercise. The supine hip extension exercise demonstrated higher EMG activity of hamstrings in comparison with supine unilateral bridge and, therefore, may be less appropriate in subjects who need to increase gluteus maximus activation.

Activation of Spinal Stabilizers and Shoulder Complex Muscles During an Inverted Row Using a Portable Pull-up Device and Body Weight Resistance.

Youdas, JW, Keith, JM, Nonn, DE, Squires, AC, and Hollman, JH. Activation of spinal stabilizers and shoulder complex muscles during an inverted row using a portable pull-up device and body weight resistance. J Strength Cond Res 30(7): 1933-1941, 2016-We recorded muscle activation normalized to a maximum voluntary isometric contraction (% MVIC) during an inverted body weight row using a commercially available portable pull-up device. Surface electromyographic (EMG) analysis was conducted on 13 male and 13 female subjects performing 4 inverted row exercises: (a) pronated grip both feet weight-bearing (WB); (b) supinated grip both feet WB; (c) pronated grip one leg WB; and (d) supinated grip single-leg WB. Nine muscles were analyzed: (a) posterior deltoid (PD), (b) latissimus dorsi (LD), (c) biceps brachii (BB), (d) lower trapezius (LT), (e) upper trapezius (UT), (f) lumbar multifidus (LM), (g) middle trapezius (MT), (h) lumbar thoracis (LTh), and (i) rectus abdominis (RA). Normalized peak EMG activity was examined separately for each muscle with 9 repeated measures analysis of variance (ANOVA) at α = 0.05. Post hoc comparisons of EMG activation across exercises for statistically significant ANOVAs were conducted with Bonferroni corrections for multiple comparisons. We observed statistically significant differences in EMG activation of the LD between supinated and pronated double-leg WB (p = 0.001) condition. Additionally, we found statistical significance in the UT between pronated and supinated single-leg WB (p = 0.007). No statistically significant differences in muscle activation existed between single- and double-leg WB in any muscles. Four muscles (BB, LD, LT, and PD) demonstrated very high (>61% MVIC) EMG activation during all 4 exercise conditions. Three muscles (UT, MT, and LM) demonstrated high (41-60% MVIC) activation, whereas 2 muscles (LTh and RA) demonstrated moderate (21-40% MVIC) activation. Four inverted row exercises activated the LD, UT, MT, LT, and BB at levels conducive to strengthening.

Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars. SUMMARY OF BACKGROUND DATA: This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications. METHODS: A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex. RESULTS: All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar. CONCLUSION: All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.

Long-term effect of a short interprofessional education interaction between medical and physical therapy students.

Medicine is increasingly focused on team-based practice as interprofessional cooperation leads to better patient care. Thus, it is necessary to teach teamwork and collaboration with other health care professionals in undergraduate medical education to ensure that trainees entering the workforce are prepared to work in teams. Gross anatomy provides an opportunity to expose students to interprofessional education (IPE) early in their training. The purpose of this study is to describe an IPE experience and report if the experience has lasting influence on the participating students. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was administered to first year medical (MD) and physical therapy (PT) students at Mayo Medical School and Mayo School of Health Sciences. Results demonstrated an openness on the part of the students to IPE. Interprofessional education experiences were incorporated into gross anatomy courses in both medical and PT curricula. The IPE experiences included a social event, peer-teaching, and collaborative clinical problem-solving sessions. These sessions enhanced gross anatomy education by reinforcing previous material and providing the opportunity to work on clinical cases from the perspective of two healthcare disciplines. After course completion, students again completed the RIPLS. Finally, one year after course completion, students were asked to provide feedback on their experience. The post-curricular RIPLS, similar to the pre-curricular RIPLS, illustrated openness to IPE from both MD and PT students. There were however, significant differences in MD and PT perceptions of roles and responsibilities. One-year follow-up indicated long-term retention of lessons learned during IPE.

Magnitudes of muscle activation of spine stabilizers, gluteals, and hamstrings during supine bridge to neutral position.

The aim of this study was to compare the magnitude of selective core muscle activation during supine bridging to neutral exercises (three on a stable and three on an unstable surface). Surface EMG analysis was performed on the lumbar multifidus, gluteus medius, gluteus maximus, and hamstrings from 13 male and 13 female subjects. Lumbar multifidus recruitment was not influenced by exercise or condition and ranged between 29.2 and 35.9% of maximum voluntary isometric contraction (MVIC). Peak gluteus medius activation (42.0% MVIC) occurred in unstable single-leg bridge. Maximum recruitment of gluteus maximus (32.6% MVIC) appeared during stable single-leg bridge. Peak hamstring activation (59.6% MVIC) occurred during stable double-leg hamstring curl. Regardless of condition, hamstrings demonstrated high (51.9-59.6% MVIC) muscle recruitment during double-leg hamstring curls compared with the single-leg bridge or double-leg bridge. Various supine bridging to neutral exercises activated the hamstrings at levels conducive to strengthening, whereas recruitment of lumbar multifidus, gluteus medius, and gluteus maximus promoted endurance training. Clinically, we were unable to conclude the unstable support surface was preferable to the stable surface for boosting muscle recruitment of spine stabilizers, gluteals, and hamstring muscles during supine bridge to neutral position.

Magnitudes of gluteus medius muscle activation during standing hip joint movements in spiral-diagonal patterns using elastic tubing resistance.

The aim of this study was to simultaneously quantify electromyographic (EMG) activation levels (% maximum voluntary isometric contraction [MVIC]) within the gluteus medius muscles on both moving and stance limbs across the performance of four proprioceptive neuromuscular facilitation (PNF) spiral-diagonal patterns in standing using resistance provided by elastic tubing. Differential EMG activity was recorded from the gluteus medius muscle of 26 healthy participants. EMG signals were collected with surface electrodes at a sampling frequency of 1000 Hz during three consecutive repetitions of each spiral-diagonal movement pattern. Significant differences existed among the four-spiral-diagonal movement patterns (F3,75 = 19.8; p < 0.001). The diagonal two flexion [D2F] pattern produced significantly more gluteus medius muscle recruitment (50 SD 29.3% MVIC) than any of the other three patterns and the diagonal one extension [D1E] (39 SD 37% MVIC) and diagonal two extension [D2E] (35 SD 29% MVIC) patterns generated more gluteus medius muscle recruitment than diagonal one flexion [D1F] (22 SD 21% MVIC). From a clinical efficiency standpoint, a fitness professional using the spiral-diagonal movement pattern of D2F and elastic tubing with an average peak tension of about 9% body mass may be able to concurrently strengthen the gluteus medius muscle on both stance and moving lower limbs.

Using a spine stabilizer instrument to control postural sway in standing lumbar curvature measurements by flexible curve.

BACKGROUND AND OBJECTIVE: The amount of postural sway and sagittal deviation of lumbar lordosis angle in measurements of standing lumbar curvature obtained by flexible curve can be decreased when using a spine stabilizer instrument. However, this assumption has not been investigated so far. This study aims to determine the effect of using a spine stabilizer instrument on the validity, reliability, and standard errors of measurement of flexible curve in the standing lumbar curvature measurements. MATERIAL AND METHOD: Thirty-four volunteer men aged between 19 and 30 years participated in the study By using a 50-cm flexible curve, with and without spine stabilizer instrument, and a lumbar simple lateral radiograph (LSLR), the standing lumbar curvature was measured by three methods for each subject. These methods were called A, B and C, respectively. RESULTS: By using the Pearson's correlation analysis at significance level of 0.05, the coefficient of correlation between standing lumbar curvature measurements in methods A and B with C were 0.95 and 0.84, respectively. In addition, the intraclass correlation coefficient for methods A and B were 0.94 and 0.79, respectively. Also, results of the one-way analysis of variance for comparison of pairs indicated a significant difference in the mean values of standing lumbar curvature angles between methods B and C. CONCLUSIONS: Results indicated the flexible curve was an appropriate instrument for standing lumbar curvature measurements. Using spine stabilizer instrument to control postural sway increases the validity and reliability of flexible curve method and decreases its standard errors of measurement.

Surface electromyographic analysis of core trunk and hip muscles during selected rehabilitation exercises in the side-bridge to neutral spine position.

BACKGROUND: Strengthening of core hip, trunk, and abdominal muscles has been utilized with injury prevention and low back pain and has the potential to improve athletic performance. HYPOTHESIS: During a side-bridge, trunk and thigh muscles on the ipsilateral weightbearing side would produce greater activation than their counterparts on the contralateral nonweightbearing side. STUDY DESIGN: Descriptive laboratory study. METHODS: Twelve females and 13 males participated. Electromyography (EMG) signals were gathered for 5 right-sided muscles (rectus abdominis [RA], external oblique [EO], longissimus thoracis [LT], lumbar multifidus [LM], and gluteus medius [GM]) during 3 repetitions of 4 side-bridging exercises (trunk-elevated side support [TESS], foot-elevated side support [FESS], clamshell, and rotational side-bridge [RSB]) performed bilaterally in random order using surface electrodes. EMG signals were normalized to peak activity in maximum voluntary isometric contraction (MVIC) trials and expressed as a percentage. Descriptive EMG data were calculated for EMG recruitment (% MVIC) and compared between right side up and right side down conditions and between exercises with 2-way repeated-measures analyses of variance at α = 0.05. RESULTS: RSB created the most muscle activation in 3 of 4 recorded trunk muscles (RA, 43.9% MVIC; EO, 62.8 % MVIC; and LT, 41.3% MVIC). Activation of the GM exceeded 69% MVIC for TESS, FESS, and RSB. With the exception of the RA in RSB and LT in TESS, recruitment within muscles of the ipsilateral weightbearing trunk and thigh (% MVIC) was significantly greater than their counterparts on the nonweightbearing trunk and thigh for all muscles during the side-bridge exercise conditions. CONCLUSION: Muscle recruitment was greater within muscles of the ipsilateral weightbearing trunk and thigh for all examined muscles except RA during RSB and LT during TESS. Activation at or above 50% MVIC is needed for strengthening. Activation of the GM and EO meets these requirements. CLINICAL RELEVANCE: Side-bridge exercises appear to provide strengthening benefits to core hip, trunk, and abdominal muscles on the ipsilateral weightbearing side.

Muscle activation levels of the gluteus maximus and medius during standing hip-joint strengthening exercises using elastic-tubing resistance.

CONTEXT: No published studies have compared muscle activation levels simultaneously for the gluteus maximus and medius muscles of stance and moving limbs during standing hip-joint strengthening while using elastic-tubing resistance. OBJECTIVE: To quantify activation levels bilaterally of the gluteus maximus and medius during resisted lower-extremity standing exercises using elastic tubing for the cross-over, reverse cross-over, front-pull, and back-pull exercise conditions. DESIGN: Repeated measures. SETTING: Laboratory. PARTICIPANTS: 26 active and healthy people, 13 men (25 ± 3 y) and 13 women (24 ± 1 y). INTERVENTION: Subjects completed 3 consecutive repetitions of lower-extremity exercises in random order. MAIN OUTCOME MEASURES: Surface electromyographic (EMG) signals were normalized to peak activity in the maximum voluntary isometric contraction (MVIC) trial and expressed as a percentage. Magnitudes of EMG recruitment were analyzed with a 2 × 4 repeated-measures ANOVA for each muscle (α = .05). RESULTS: For the gluteus maximus an interaction between exercise and limb factor was significant (F3,75 = 21.5; P < .001). The moving-limb gluteus maximus was activated more than the stance limb's during the back-pull exercise (P < .001), and moving-limb gluteus maximus muscle recruitment was greater for the back-pull exercise than for the cross-over, reverse cross-over, and front-pull exercises (P < .001). For the gluteus medius an interaction between exercise and limb factor was significant (F3,75 = 3.7; P < .03). Gluteus medius muscle recruitment (% MVIC) was greater in the stance limb than moving limb when performing the front-pull exercise (P < .001). Moving-limb gluteus medius muscle recruitment was greater for the reverse cross-over exercise than for the cross-over, front-pull, and back-pull exercises (P < .001). CONCLUSIONS: From a clinical standpoint there is no therapeutic benefit to selectively activate the gluteus maximus and gluteus medius muscles on the stance limb by resisting sagittal- and frontal-plane hip movements on the moving limb using resistance supplied by elastic tubing.

Use of individual feedback during human gross anatomy course for enhancing professional behaviors in doctor of physical therapy students.

Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high-quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy education and before the first significant clinical internship could be enhanced in a semester course in gross human anatomy using individual formative feedback. During the human anatomy course, 28 first-year physical therapy students completed six biweekly, anonymous self- and peer assessment surveys that targeted ten professional behaviors important to physical therapists. All professional behaviors were assessed using a five-point Likert scale. Feedback reports occurred at week eight (mid-semester) and week 16 (end-of-semester) and comprised the direct intervention components of this study. At the midpoint of the semester, professional behavior scores and narrative comments from weeks two, four, and six were compiled and shared with each student by one of three faculty members in a feedback session. Students then submitted biweekly self-and peer professional behavior assessments (weeks 10, 12, and 14) for the remainder of the human anatomy course. Differences between preintervention and postintervention scores for each of the ten professional behaviors were compared using the Wilcoxon signed-ranks test. Upon receiving mid-semester individual feedback, students demonstrated significant improvement in each of the ten professional behaviors. Results from this study indicated a gross anatomy laboratory dissection experience during the first academic semester provided an effective opportunity for teaching and assessing professional behaviors of doctoral students in physical therapy.

Electromyographic analysis of trunk and hip muscles during resisted lateral band walking.

The purpose of this study was to simultaneously quantify bilateral activation/recruitment levels (% maximum voluntary isometric contraction [MVIC]) for trunk and hip musculature on both moving and stance lower limbs during resisted lateral band walking. Differential electromyographic (EMG) activity was recorded in neutral, internal, and external hip rotation in 21 healthy participants. EMG signals were collected with DE-3.1 double-differential surface electrodes at a sampling frequency of 1,000 Hz during three consecutive lateral steps. Gluteus medius average EMG activation was greater (p = 0.001) for the stance limb (52 SD 18% MVIC) than moving limb (35 SD 16% MVIC). Gluteus maximus EMG activation was greater (p = 0.002) for the stance limb (19 SD 13% MVIC) than moving limb (13 SD 9% MVIC). Erector spinae activation was greater (p = 0.007) in hip internal rotation (30 SD 13% MVIC) than neutral rotation (26 SD 10% MVIC) and the moving limb (31 SD 15% MVIC) was greater (p = 0.039) than the stance limb (23 SD 11% MVIC). Gluteus medius and maximus muscle activation were greater on the stance limb than moving limb during resisted lateral band walking. Therefore, clinicians may wish to consider using the involved limb as the stance limb during resisted lateral band walking exercise.

Comparison of muscle activation levels during arm abduction in the plane of the scapula vs. proprioceptive neuromuscular facilitation upper extremity patterns.

This study quantified activation of 8 muscles of the shoulder, trunk, and back during standing performance of (a) arm abduction in the plane of the scapula (scaption), (b) proprioceptive neuromuscular facilitation (PNF) diagonal 1 flexion (D1F), and (c) PNF diagonal 2 flexion (D2F) while lifting a dumbbell with the dominant hand. Twelve men (26.1 ± 4.4 years) and 13 women (24.5 ± 1.9 years) volunteered to participate. Electromyographic signals were collected with DE-3.1 double-differential surface electrodes at a sampling frequency of 1,000 Hz. Electromyographic signals were normalized to peak activity in the maximum voluntary isometric contraction (MVIC) trial and expressed as a percentage. One-way repeated-measures analysis of variance with Bonferroni corrections (α = 0.05) examined muscle activation patterns across the 3 conditions. For the middle trapezius, average activation was greater (p < 0.001) for D2F (70.5 ± 23.4% MVIC) than D1F (46.4 ± 19.6% MVIC). Lower trapezius average activation was greater (p < 0.001) for D2F (55.3 ± 23.8% MVIC) than D1F (40.1 ± 16% MVIC). The anterior deltoid showed greater activation (p = 0.009) for scaption (92.4 ± 26% MVIC) than D1F (74.4 ± 21.4% MVIC). The erector spinae showed greater activation for D2F (34.2 ± 12% MVIC; p < 0.001) and D1F (41.7 ± 21.4% MVIC; p < 0.001) than scaption (14.5 ± 12.3% MVIC). During D2F and scaption, all 6 muscles of the shoulder complex demonstrated very high activation levels (>60% MVIC) with the exception of the lower trapezius (55% MVIC). In contrast, erector spinae and external oblique muscles exhibited moderate activation (21-40% MVIC) during arm elevation. The 6 muscles of the shoulder complex displayed high to very high muscle activation at a level appropriate for strength training during all 3 exercise conditions.

Pilates for breast cancer survivors.

Pilates has been advocated for rehabilitation of breast cancer survivors despite little scientific evidence. The authors of this article have examined the feasibility of a Pilates program in postmastectomy breast cancer survivors and the impact on physical and psychological parameters. Fifteen breast cancer survivors were recruited in a one-arm study of 12 weeks of Pilates exercises. The authors assessed recruitment, adherence, and attrition, and measured changes in shoulder and neck range of motion, posture, height, arm volume, quality of life, mood, and body image from pre- to postintervention. Of 26 eligible patients, 15 enrolled, 13 completed the study, and 10 performed more than 50% of the recommended sessions. Statistically significant improvements emerged for shoulder abduction and internal rotation on the affected side, neck rotation toward the unaffected side, and neck flexion. The affected side arm volume and the interlimb volume discrepancy increased. Significant improvements were reported in quality of life, mood, and body image. The improvements in physical and psychological outcomes are promising and deserve further evaluation in a randomized, controlled study. The increase in affected arm volume also warrants additional investigation.

Learning of musculoskeletal ligament stress testing in a gross anatomy laboratory.

Human anatomy in physical therapy programs is a basic science course serving as a foundation for subsequent clinical courses. Integration of anatomy with a clinical emphasis throughout a curriculum provides opportunities for reinforcement of previously learned material. Considering the human cadaver laboratory as a fixed cost to our program, we sought opportunities to add value to the resource via vertical integration into a clinical skills course taught later in the curriculum. We designed an opportunity for second-year physical therapy students to revisit the human anatomy laboratory to study select clinical musculoskeletal tests and the associated anatomy in a clinically relevant context. Students performed select orthopedic ligament test on human cadavers, then incised specific structures and repeated the tests. Students were able to feel and visualize the function of pertinent anatomy associated with the clinical tests. Ninety-five percent of respondents reported that the ligament stress testing experience enhanced their understanding of orthopedic clinical tests with 91% reporting an enhanced understanding of anatomy related to specific clinical tests. Likewise, the experience was perceived as enjoyable and valuable with 86% of respondents reporting the experience as enjoyable and 100% responding the experience should continue as part of the curriculum.