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Terry L. Grindstaff, L. Colby Mangum, and Michael Voight

Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.

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Andrew Skibski, Luk Devorski, Nolan Orfield, and L. Colby Mangum

Context: Isometric core stability exercises are commonly used to target muscles of the lumbopelvic–hip complex, including the rectus abdominis (RA) and erector spinae (ES). These exercises can be implemented in rehabilitation protocols to increase muscle strength and endurance. Difficulty can be progressed by modifying the base of support or adding an unstable element. Load cells can be affixed to suspension training devices to measure force exerted through the straps during exercise. The primary purpose of this study was to assess the relationship between activity of the RA and ES to force measured through a load cell fixed to suspension straps during bilateral and unilateral suspended bridge exercises. Design: Forty asymptomatic, active individuals completed a single laboratory visit. Methods: Participants completed 2 bilateral suspended bridges and 2 unilateral suspended bridges held to failure. Surface electromyography sensors were placed over the bilateral RA and ES to quantify muscle activity (% maximum voluntary isometric contraction). A load cell was affixed to the suspension straps to measure force exerted through the straps throughout the duration of the exercise. Pearson correlations were used to determine relationships between force and muscle activity of the RA and ES throughout exercise duration. Results: Force was negatively related to RA muscle activity in bilateral suspended bridges (r = −.735 to −.842, P < .001) and unilateral suspended bridges (r = −.300 to −.707, P = .002 to <.001). Force had a positive relationship with ES muscle activity in bilateral suspended bridges (r = .689 to .791, P < .001) and unilateral suspended bridges (r = .418 to .448, P < .001). Conclusions: Suspended bridge exercises can be a valuable tool to target posterior abdominal musculature such as the ES to contribute to core stability and endurance. Load cells can be applied during suspension training to quantify the interaction between individuals and the exercise equipment.

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Luk Devorski, David M. Bazett-Jones, L. Colby Mangum, and Neal R. Glaviano

Context: Lumbopelvic-hip complex (LPHC) exercises are used to increase stabilization within the human body. Torso-elevated side support (TESS), foot-elevated side support (FESS), prone bridge plank (PBP), and V-sit are common LPHC exercises. Objective: To evaluate muscle activation in the shoulder girdle and LPHC during 4 LPHC exercises and evaluate the reasoning for termination. Study Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: Seventeen healthy participants (12 males and 5 females; age: 21.47 [3.16] y, height: 179.73 [8.92] cm, mass: 76.89 [11.17] kg). Main Outcome Measures: Participants completed 2 repetitions of the TESS, FESS, PBP, and V-sit until failure. Surface electromyography of the middle deltoid, latissimus dorsi, middle trapezius, rectus abdominis, erector spinae, external oblique, and gluteus medius were recorded and normalized to maximum voluntary isometric contraction (MVIC). The duration of exercise and subjective reasoning for termination of exercise was completed following the 4 tasks. Results: The TESS and PBP had significantly greater middle deltoid muscle activation (TESS: 55.66% [24.45%] MVIC and PBP: 42.63% [18.25%] MVIC) compared with the FESS (10.10% [10.04%] MVIC) and V-sit (2.21% [1.94%] MVIC), P < .05. The TESS produced significantly greater external oblique activity (78.13% [32.32%] MVIC) than the PBP (54.99% [19.54%] MVIC), P < .05. Due to shoulder fatigue and pain, 41.1% and 17.0% of participants terminated the TESS, respectively. The PBP was terminated due to abdominal fatigue (41.1%) and upper-extremity fatigue (47.0%). Conclusions: The V-sit resulted in isolated activity of the abdominal portion of the LPHC. The FESS had increased global co-contraction of the LPHC compared with the TESS. The PBP and TESS had significant muscle activation in the upper-extremity.

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Eileen Krepkovich, Mandeep Kaur, L. Colby Mangum, Susan Saliba, Matthew Lichter, Aaron Olowin, Neal Richardson, and Joseph Hart

Context: A novel virtual game system Knee Biofeedback Rehabilitation Interface for game-based home therapy (KneeBright) was developed for strength training using integrated electromyography biofeedback of the quadriceps muscle to control the game. The study aimed to compare the KneeBright and electromyography biofeedback interface among patients with knee osteoarthritis. Design: Controlled before and after design. Methods: Nineteen patients with knee osteoarthritis took part in this laboratory-based study. Exercise sessions took place on 2 separate days. During session 1, participants used a conventional electromyography biofeedback system while performing 3 sets of lower body exercises with emphasis on maximal muscle activation, endurance, and precision. During session 2, participants used the KneeBright game to match the exercise sets in the first session. For both sessions, knee extension torque during the isometric muscle activation exercises and time to voluntary additional exercise were recorded. Patient engagement was assessed using the technology acceptance model and System Usability Score questionnaires. Results: The peak knee extension torque produced during the control exercise session and the KneeBright exercise session were positively correlated. Knee extension torque generated during KneeBright game exercise sessions was increased by an average of 25% compared to the control sessions (2.14 vs 1.77 N·m/kg, P = .02). The mean technology acceptance model score for the KneeBright system was 3.4/5 and the mean System Usability Score was 79, both indicating positive patient engagement. Conclusions: Patients using the KneeBright game produced greater knee torque than patients using the conventional system, had positive levels of engagement, and exercised longer with the KneeBright game.

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Neal R. Glaviano, Ashley N. Marshall, L. Colby Mangum, Joseph M. Hart, Jay Hertel, Shawn Russell, and Susan Saliba

Context: Patellofemoral pain (PFP) is a challenging condition, with altered kinematics and muscle activity as 2 common impairments. Single applications of patterned electrical neuromuscular stimulation (PENS) have improved both kinematics and muscle activity in females with PFP; however, the use of PENS in conjunction with a rehabilitation program has not been evaluated. Objective: To determine the effects of a 4-week rehabilitation program with PENS on lower-extremity biomechanics and electromyography (EMG) during a single-leg squat (SLS) and a step-down task (SDT) in individuals with PFP. Study Design: Double-blinded randomized controlled trial. Setting: Laboratory. Patients of Other Participants: Sixteen females with PFP (age 23.3 [4.9] y, mass 66.3 [13.5] kg, height 166.1 [5.9] cm). Intervention: Patients completed a 4-week supervised rehabilitation program with or without PENS. Main Outcome Measures: Curve analyses for lower-extremity kinematics and EMG activity (gluteus maximus, gluteus medius, vastus medialis oblique, vastus lateralis, biceps femoris, and adductor longus) were constructed by plotting group means and 90% confidence intervals throughout 100% of each task, before and after the rehabilitation program. Mean differences (MDs) and SDs were calculated where statistical differences were identified. Results: No differences at baseline in lower-extremity kinematics or EMG were found between groups. Following rehabilitation, the PENS group had significant reduction in hip adduction between 29% and 47% of the SLS (MD = 4.62° [3.85°]) and between 43% and 69% of the SDT (MD = 6.55° [0.77°]). Throughout the entire SDT, there was a decrease in trunk flexion in the PENS group (MD = 10.91° [1.73°]). A significant decrease in gluteus medius activity was seen during both the SLS (MD = 2.77 [3.58]) and SDT (MD = 4.36 [5.38]), and gluteus maximus during the SLS (MD = 1.49 [1.46]). No differences were seen in the Sham group lower-extremity kinematics for either task. Conclusion: Rehabilitation with PENS improved kinematics in both tasks and decreased EMG activity. This suggests that rehabilitation with PENS may improve muscle function during functional tasks.