Patellar taping increases vastus medialis oblique activity in the presence of patellofemoral pain.

A common rehabilitation strategy for patellofemoral pain syndrome (PFPS), which lacks scientific evidence, includes pulling the patella medially with tape to reduce pain and increase the vastus medialis oblique (VMO) muscle activity. The purpose of this study was to examine the effect of various patellar taping procedures on force production, EMG activity of the VMO and vastus lateralis (VL) muscles, and perceived pain experienced by 30 women (27.3 +/- 1.53), half diagnosed with PFPS. The perceived pain, force, and EMG of the VMO and VL, were recorded while subjects performed maximal isokinetic leg presses at 30 degrees /s for each of the following patellar taping conditions: no tape (control), no glide (placebo), medial and lateral glide (experimental). The medial and placebo procedures significantly (P < 0.01) reduced perceived pain (70-80%) in PFPS subjects. Although patellar taping did not influence leg press force (P > 0.05), it increased the VMO activity and decreased the VL activity in PFPS subjects but had the opposite effect in healthy subjects. The findings suggest that taping the patella medially can contribute positively to PFPS rehabilitation. Because the medial glide and placebo taping conditions had similar effects, it is proposed that the benefits of patellar taping are not due to a change in patellar position but rather due to enhanced support of the patellofemoral ligaments and/or pain modulation via cutaneous stimulation.     

In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain

Patellofemoral pain is a common knee disorder with a multi-factorial etiology related to abnormal patellar tracking. Our hypothesis was that the pattern of three-dimensional rotation and translation of the patella induced by selective activation of individual quadriceps components would differ between subjects with patellofemoral pain and healthy subjects. Nine female subjects with patellofemoral pain and seven healthy female subjects underwent electrical stimulation to selectively activate individual quadriceps components (vastus medialis obliquus, VMO; vastus medialis lateralis, VML; vastus lateralis, VL) with the knee at 0° and 20° flexion, while three-dimensional patellar tracking was recorded. Normalized direction of rotation and direction of translation characterized the relative amplitudes of each component of patellar movement. VMO activation in patellofemoral pain caused greater medial patellar rotation (distal patellar pole rotates medially in frontal plane) at both knee positions (p<0.01), and both VMO and VML activation caused increased anterior patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects at 20° knee flexion. VL activation caused more lateral patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects. In healthy subjects the 3-D mechanical action of the VMO is actively modulated with knee flexion angle while such modulation was not observed in PFP subjects. This could be due to anatomical differences in the VMO insertion on the patella and medial quadriceps weakness. Quantitative evaluation of the influence of individual quadriceps components on patellar tracking will aid understanding of the knee extensor mechanism and provide insight into the etiology of patellofemoral pain.     

Preferential vastus medialis oblique activation achieved as a treatment for knee disorders

The purpose of this study was to compare the effect of an open-stance cycling protocol (OSCP) with the traditional cycling foot position (TCFP) for preferential vastus medialis oblique (VMO) muscle activation, measured by surface electromyography (SEMG), and preferential VMO activation as defined by achieving significantly increased VMO/VL (vastus lateralis muscle) ratio values. Forty subjects of both sexes participated, 18 symptomatic with patellofemoral pain and 22 control subjects; ages ranged from 18 to 60 years (mean = 28.7 +/- 8 years). The OSCP and TCFP were ridden in randomized order while SEMG recordings were taken of the VMO and VL muscles, collecting the mean of peak amplitudes to calculate VMO/VL ratio values. The SEMG readings were taken 4 times per testing session with randomized resistance and a consistent cycling cadence of 85 rpm. The OSCP displayed preferential VMO activation for all subject groups (F = 40.47, p = 0.0001), and this study revealed a protocol that effectively treats patellofemoral pain.     

Activation of the VMO and VL during dynamic mini-squat exercises with and without isometric hip adduction

Objective: the purpose of this study was to compare vastus medialis obliquus (VMO) and vastus lateralis (VL) activity while performing a mini-squat with and without isometric hip adduction.

Design and setting: a repeated measures within subjects design was used. Subjects performed two sets of three repetitions of a traditional mini-squat and a mini-squat with concurrent hip adduction (squeeze).

Subjects: 20 recreationally active subjects (10 men, 10 women AGE=28.10±5.91 years, HEIGHT=170.94±11.03 cm, MASS=72.32±16.66 kg) with no history of patellofemoral pain (PFP), quadriceps injury, or other knee injury participated in the study.

Measurements: the EMG signal of the VMO and VL was recorded bilaterally during both exercises. EMG data were normalized to the maximal voluntary isometric contraction (MVIC) of the quadriceps produced during seated, isometric knee extension.

Results: results of repeated measures ANOVA's revealed that the squeeze squat produced significantly greater VMO and VL activity than the traditional squat (p=0.02). For both the traditional and squeeze squats, intrasession reliability from the first to the second set was calculated using intraclass correlation coefficient (ICC) formula (3:1) bilaterally for both the VMO and the VL. All ICC values were greater than 0.9.

Conclusion: combining isometric hip adduction with a mini-squat exercise significantly increases the activity of the quadriceps. Performing mini-squats with isometric hip adduction will be beneficial to patellofemoral patients as they increase quadriceps activity, however, based on our data we cannot conclude that this exercise preferentially recruits the VMO. Further research is needed to determine the exact mechanism by which quadriceps function is altered.     

Influence of infrapatellar and suprapatellar straps on quadriceps muscle activity and onset timing during the body-weight squat

The use of knee braces for the treatment of patellofemoral pain syndrome (PFPS) is widely documented, yet the mechanism by which such braces alleviate knee pain remains unclear. This study attempted to clarify this issue by simplifying the brace to the level of only straps. The effectiveness of an infrapatellar strap for PFPS remains controversial, and the use of a suprapatellar strap has not yet been studied. Quadriceps muscle activity and onset timing parameters were measured with surface electromyography (EMG) during a body-weight squat in 19 healthy subjects during 4 different knee-strapping conditions (infra, supra, both, and none). No differences in normalized mean or peak EMG activity in any part of the quadriceps were found. The onset timing of the vastus lateralis (VL) was significantly delayed when using an infrapatellar strap (p < 0.05) or both straps (p < 0.05) and marginally delayed when using a suprapatellar strap (p < 0.10) in comparison with the no-strap (control) condition. No differences in the vastus medialis oblique (VMO) onset timing or VMO-VL onset timing difference were found among the strapping conditions, although an improvement in timing was noted with the suprapatellar condition. The results provide novel evidence that the application of an infrapatellar strap, suprapatellar strap, or both straps improves quadriceps muscle timing imbalances by delaying VL onset. Because the largest delay in VL onset occurred when wearing both straps, the combined application of an infrapatellar and suprapatellar strap may be the most beneficial in managing patellofemoral pain. Knee straps, unlike braces, are cost effective, nonrestrictive, and can be universally fitted to any knee and based on the results deserve further study in the patellofemoral pain population.     

Biofeedback exercise improved the EMG activity ratio of the medial and lateral vasti muscles in subjects with patellofemoral pain syndrome.

Patellofemoral pain syndrome (PFPS) is usually due to weakness of vastus medialis obliquus (VMO) resulting in abnormal patellar tracking. One of the objectives of rehabilitation is to strengthen the VMO so as to counterbalance the vastus lateralis (VL) action during normal activities. This study compared the effects of an 8-week exercise program with and without EMG biofeedback on the relative activations of VMO and VL. Twenty-six subjects with PFPS were randomly allocated into an "exercise" group (Group 1) and a "biofeedback+exercise" group (Group 2). Both groups performed the same exercise program but subjects in Group 2 received real time EMG biofeedback information on the relative activations of VMO and VL during the exercises. After 8 weeks of training, Group 1 had insignificant changes in their VMO/VL EMG ratio (p=0.355), whereas Group 2 had significantly greater VMO/VL EMG ratio (p=0.017) when performing normal activities throughout a 6-h assessment period. The present result reveals that the incorporation of an EMG biofeedback into a physiotherapy exercise program could facilitate the activation of VMO muscle such that the muscle could be preferentially recruited during daily activities.     

Computational assessment of the influence of vastus medialis obliquus function on patellofemoral pressures: Model evaluation

A study was performed to evaluate a computational model used to characterize the influence of vastus medialis obliquus (VMO) function on the patellofemoral pressure distribution. Ten knees were tested in vitro at 40°, 60° and 80° of knee flexion with quadriceps loads applied to represent a normal VMO, and with the VMO force decreased by approximately 50% to represent a weak VMO. The tests were performed with the cartilage intact and with a full thickness cartilage lesion centered on the lateral facet of the patella. The experimental tests were replicated computationally by applying discrete element analysis to a model of each knee constructed from MRI images. Repeated measures statistical comparisons were used to compare computational to experimental data and identify significant (p<0.05) differences due to the lesion and the applied VMO force. Neither the lateral force percentage nor the maximum lateral pressure varied significantly between the computational and experimental data. Creating a lesion significantly increased the maximum lateral pressure for all comparisons, except for the experimental data at 40°. Both computationally and experimentally, decrease in the VMO force increased the lateral force percentage by approximately 10% for all cases, and each increase was statistically significant. The maximum lateral pressure increase was typically less than 10% but was still significant for the majority of comparisons focused on the VMO strength. The results indicate that computational modeling can be used to characterize how varying quadriceps loading influences the patellofemoral force and pressure distributions while varying the condition of cartilage.     

How changing the inversion/eversion foot angle affects the nondriving intersegmental knee moments and the relative activation of the vastii muscles in cycling

Nondriving intersegmental knee moment components (i.e., varus/valgus and internal/external axial moments) are thought to be primarily responsible for the etiology of overuse knee injuries such as patellofermoral pain syndrome in cycling because of their relationship to muscular imbalances. However the relationship between these moments and muscle activity has not been studied. Thus the four primary objectives of this study were to test whether manipulating the inversion/eversion foot angle alters the varus/valgus knee moment (Objective 1) and axial knee moment (Objective 2) and to determine whether activation patterns of the vastus medialis oblique (VMO), vastus lateralis (VL), and tensor fascia latae (TFL) were affected by changes in the varus/valgus (Objective 3) and axial knee moments (Objective 4). To fulfill these objectives, pedal loads and lower limb kinematic data were collected from 15 subjects who pedaled with five randomly assigned inversion/eversion angles: 10 deg and 5 deg everted and inverted and 0 deg (neutral). A previously described mathematical model was used to compute the nondriving intersegmental knee moments throughout the crank cycle. The excitations of the VMO, VL, and TFL muscles were measured with surface electromyography and the muscle activations were computed. On average, the 10-deg everted position decreased the peak varus moment by 55% and decreased the peak internal axial moment by 53% during the power stroke (crank cycle region where the knee moment is extensor). A correlation analysis revealed that the VMO/VL activation ratio increased significantly and the TFL activation decreased significantly as the varus moment decreased. For both the VMO/VL activation ratio and the TFL activation, a path analysis indicated that the varus/valgus moment was highly correlated to the axial moment but that the correlation between muscle activation and the varus moment was due primarily to the varus/valgus knee moment rather than the axial knee moment. The conclusion from these results is that everting the foot may be beneficial towards either preventing or ameliorating patellofemoral pain syndrome in cycling.     

Taping the patella medially: a new treatment for osteoarthritis of the knee joint?

OBJECTIVE--To test the hypothesis that medial taping of the patella reduces the symptoms of osteoarthritis of the knee when the patellofemoral joint is affected. DESIGN--Randomised, single blind, crossover trial of three different forms of taping of the knee joint. Each tape (medial, lateral, or neutral) was applied for four days, with three days of no treatment between tape positions. SUBJECTS--14 patients with established, symptomatic osteoarthritis of the knee and both clinical and radiographic evidence of patellofemoral compartment disease. MAIN OUTCOME MEASURES--Daily visual analogue scale ratings for pain; patients'' rating of change with each treatment; and tape preference. RESULTS--Medial taping of the patella was significantly better than the neutral or lateral taping for pain scores, symptom change, and patient preference. The medial tape resulted in a 25% reduction in knee pain. CONCLUSION--Patella taping is a simple, safe, cheap way of providing short term pain relief in patients with osteoarthritis of the patellofemoral joint.     

Patella tendon moment arm function considerations for human vastus lateralis force estimates

In vivo muscle forces are typically estimated using literature-based or subject-specific moment arms (MAs) because it is not possible to measure in vivo muscle forces non-invasively. However, even subject-specific muscle-tendon MAs vary across contraction levels and are impossible to determine at high contraction levels without techniques that use ionized radiation. Therefore, different generic MA functions are often used to estimate in vivo muscle forces, which may alter force predictions and the shape of the muscle’s force-length relationship. The aim of this study was to examine the influence of different literature-based patella tendon MA functions on the vastus lateralis (VL) force-angle relationship. Participants (n = 11) performed maximum voluntary isometric knee extension contractions at six knee flexion angles, ranging from 40° to 90°. To estimate in vivo VL muscle force, the peak knee extension torque at each joint angle was multiplied by the VL’s physiological cross-sectional area (PCSA) relative to the quadriceps’ PCSA (34%) and then divided by the angle-specific patella tendon MA for 19 different functions. Maximum VL force was significantly different across MA functions (p ≤ 0.039) and occurred at different knee flexion angles. The shape of the VL force-angle relationship also differed significantly (p < 0.01) across MA functions. According to the maximum force generated by VL based on its literature-derived PSCA, only the VL force-angle relationships estimated using geometric imaging-based MA functions are feasible across the knee angles studied here. We therefore recommend that an average of these MA functions is calculated to estimate quadriceps muscle forces if subject-specific MAs cannot be determined.     

The effect of vastus medialis forces on patello-femoral contact: a model-based study

A mathematical model of the patello-femoral joint was introduced to investigate the impact of the vastus medialis (longus, obliquus) forces on the lateral contact force levels. In the model, the quadriceps were represented as five separate forces: vastus lateralis, vastus intermedius, rectus femoris, vastus medialis longus (VML), and obliquus (VMO). By varying the relative force generation ratios of the quadriceps heads, the patello-femoral contact forces were estimated. We sought to analytically determine the range of forces in the VMO and VML that cause a reduction or an increase of lateral contact forces, often the cause of patello-femoral pain. Our results indicated that increased contact forces are more dependent on combinations of muscle forces than solely VMO weakness. Moreover, our simulation data showed that the contact force levels are also highly dependent on the knee flexion angle. These findings suggest that training targeted to reduce contact forces through certain joint angles could actually result in a significant increase of the contact forces through other joint angles.     

Myoelectric manifestations of fatigue in vastus lateralis,medialis obliquus and medialis longus muscles

The purpose of this study was to determine whether surface electromyography (EMG) assessment of myoelectric manifestations of muscle fatigue is capable of detecting differences between the vastus lateralis and medialis muscles which are consistent with the results of previous biopsy studies. Surface EMG signals were recorded from the vastus medialis longus (VML), vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during isometric knee extension contractions at 60% and 80% of the maximum voluntary contraction (MVC) for 10 s and 60 s, respectively. Initial values and rate of change of mean frequency (MNF), average rectified value (ARV) and conduction velocity (CV) of the EMG signal were calculated. Comparisons between the two force levels revealed that the initial values of MNF for the VL muscle were greater at 80% MVC compared to 60% MVC (P < 0.01). Comparisons between the vasti muscles demonstrated lower initial values of CV for VMO compared to VL at 60% MVC (P < 0.01) and lower than VML and VL at 80% MVC (P < 0.01). In addition, initial values of MNF were higher for VL with respect to both VML and VMO at 80% MVC (P < 0.01) and initial estimates of ARV were higher for VMO compared to VML at both force levels (P < 0.01 at 60% MVC and P < 0.05 at 80% MVC). For the sustained contraction at 80% MVC, VL demonstrated a greater decrease in CV over time compared to VMO (P < 0.05).These findings suggest that surface EMG signals and their time course during sustained isometric contractions may be useful to non-invasively describe functional differences between the vasti muscles.     

Activation of vastus medialis obliquus among individuals with patellofemoral pain syndrome

The purpose of this study was to determine whether various positions of the lower extremity affect the muscle activity of the vastus medialis obliquus (VMO) differently during both open and closed kinetic chain exercise conditions among patients with patellofemoral pain syndrome (PFPS). Patients who presented with symptoms consistent with PFPS completed a series of open kinetic chain and closed kinetic chain exercises in which VMO activity was measured and compared. Statistical analysis revealed that there is less than a 0.001% (open kinetic chain) or 0.005% (closed kinetic chain) chance that all positions activate the VMO equally. In open kinetic exercise, maximum VMO activity was achieved with terminal knee extension with medial tibial rotation. During closed kinetic exercises, squats with external rotation were preferred for maximum VMO activation. Therefore, our results highlight the importance of including both the open and closed kinetic chain exercises into rehabilitation programs for patients with PFPS.     

Vastus lateralis and vastus medialis produce distinct mediolateral forces on the patella but similar forces on the tibia in the rat

Improper activation of the quadriceps muscles vastus medialis (VM) and vastus lateralis (VL) has been implicated in the development of patellofemoral pain (PFP). This explanation of PFP assumes that VM and VL produce opposing mediolateral forces on the patella. Although studies have provided evidence for opposing actions of VM and VL on the patella, other studies have suggested that their actions might be similar. In this study, we took advantage of the experimental accessibility of the rat to directly measure the forces on the patella produced by VM and VL. We found that VM and VL produce opposing mediolateral forces on the patella when the patella was lifted away from the femur. These distinct mediolateral forces were not transmitted to the tibia, however: forces measured at the distal tibia were very similar for VM and VL. Further, when the patella was placed within the trochlear groove, the forces on the patella produced by VM and VL were very similar to one another. These results suggest that mediolateral forces produced by VM and VL are balanced by reaction forces from the trochlear groove and so are not transmitted to the tibia. These results provide a rich characterization of the mechanical actions of VM and VL and have implications about the potential role of these muscles in PFP and their neural control during behavior.     

Patellofemoral cartilage stresses are most sensitive to variations in vastus medialis muscle forces

The purpose of this study was to evaluate the effects of variations in quadriceps muscle forces on patellofemoral stress. We created subject-specific finite element models for 21 individuals with chronic patellofemoral pain and 16 pain-free control subjects. We extracted three-dimensional geometries from high resolution magnetic resonance images and registered the geometries to magnetic resonance images from an upright weight bearing squat with the knees flexed at 60°. We estimated quadriceps muscle forces corresponding to 60° knee flexion during a stair climb task from motion analysis and electromyography-driven musculoskeletal modelling. We applied the quadriceps muscle forces to our finite element models and evaluated patellofemoral cartilage stress. We quantified cartilage stress using an energy-based effective stress, a scalar quantity representing the local stress intensity in the tissue. We used probabilistic methods to evaluate the effects of variations in quadriceps muscle forces from five trials of the stair climb task for each subject. Patellofemoral effective stress was most sensitive to variations in forces in the two branches of the vastus medialis muscle. Femur cartilage effective stress was most sensitive to variations in vastus medialis forces in 29/37 (78%) subjects, and patella cartilage effective stress was most sensitive to variations in vastus medialis forces in 21/37 (57%) subjects. Femur cartilage effective stress was more sensitive to variations in vastus medialis longus forces in subjects classified as maltrackers compared to normal tracking subjects (p?=?0.006). This study provides new evidence of the importance of the vastus medialis muscle in the treatment of patellofemoral pain.     

Functional and EMG responses to a physical therapy treatment in patellofemoral syndrome patients.

There are several pathologies related to the patellofemoral joint, in which the patellofemoral syndrome is one of the most common and challenging to treat. The patellofemoral syndrome results from a malalignment of the knee extensor mechanism. The purpose of our study was to describe and compare EMG responses of the vastus medialis and vastus lateralis muscles while walking up and down stairs and other clinical and functional responses in PFS subjects before and after a physical therapy intervention. Eleven subjects were studied and divided in two groups: six subjects with clinically diagnosed patellofemoral syndrome and five healthy control subjects. Subjects were evaluated by a functional and biomechanical evaluation protocol: postural evaluation, pain and knee function evaluation, and electromyographic activity of vastus medialis and lateralis muscles while walking up and down a staircase. Results showed higher efficiency of the vastus medialis muscle in carrying out eccentric exercises and increased muscle activity in both the vastus medialis and vastus lateralis muscles while climbing stairs after physical therapy treatment. We were able to identify an improvement in postural alignment of lower limb muscles and knee functionality among patellofemoral syndrome group subjects after treatment.     

Knee and Hip Joint Kinematics Predict Quadriceps and Hamstrings Neuromuscular Activation Patterns in Drop Jump Landings

PurposeThe purpose was to assess if variation in sagittal plane landing kinematics is associated with variation in neuromuscular activation patterns of the quadriceps-hamstrings muscle groups during drop vertical jumps (DVJ).MethodsFifty female athletes performed three DVJ. The relationship between peak knee and hip flexion angles and the amplitude of four EMG vectors was investigated with trajectory-level canonical correlation analyses over the entire time period of the landing phase. EMG vectors consisted of the {vastus medialis(VM),vastus lateralis(VL)}, {vastus medialis(VM),hamstring medialis(HM)}, {hamstring medialis(HM),hamstring lateralis(HL)} and the {vastus lateralis(VL),hamstring lateralis(HL)}. To estimate the contribution of each individual muscle, linear regressions were also conducted using one-dimensional statistical parametric mapping.ResultsThe peak knee flexion angle was significantly positively associated with the amplitudes of the {VM,HM} and {HM,HL} during the preparatory and initial contact phase and with the {VL,HL} vector during the peak loading phase (p<0.05). Small peak knee flexion angles were significantly associated with higher HM amplitudes during the preparatory and initial contact phase (p<0.001). The amplitudes of the {VM,VL} and {VL,HL} were significantly positively associated with the peak hip flexion angle during the peak loading phase (p<0.05). Small peak hip flexion angles were significantly associated with higher VL amplitudes during the peak loading phase (p = 0.001). Higher external knee abduction and flexion moments were found in participants landing with less flexed knee and hip joints (p<0.001).ConclusionThis study demonstrated clear associations between neuromuscular activation patterns and landing kinematics in the sagittal plane during specific parts of the landing. These findings have indicated that an erect landing pattern, characterized by less hip and knee flexion, was significantly associated with an increased medial and posterior neuromuscular activation (dominant hamstrings medialis activity) during the preparatory and initial contact phase and an increased lateral neuromuscular activation (dominant vastus lateralis activity) during the peak loading phase.     

Muscle activation profiles about the knee during Tai-Chi stepping movement compared to the normal gait step.

The purpose of this study was to investigate knee muscle activity patterns in experienced Tai-Chi (TC) practitioners during normal walking and TC stepping. The electromyographic (EMG) activity of vastus lateralis (VL), vastus medialis (VM), bicep femoris (BF), and gastrocnemius (GS) muscles of 11 subjects (five females and six males) during the stance phase of normal walking was compared to stance phase of a TC step. Knee joint motion was also monitored by using an Optotrak motion analysis system. Raw EMG was processed by root-mean-square (RMS) technique using a time constant of 50 ms, and normalized to maximum of voluntary contraction for each muscle, referred to as normalized RMS (nRMS). Peak nRMS and co-contraction (quantified by co-contraction index) during stance phase of a gait cycle and a TC step were calculated. Paired t-tests were used to compare the difference for each muscle group peak and co-contraction pair between the tasks. The results showed that only peak values of nRMS in quadriceps and co-contraction were significantly greater in TC stepping compared to normal walking (Peak values of nRMS for VL were 26.93% for normal walking and 52.14% for TC step, p=0.001; VM are 29.12% for normal walking and 51.93% for TC stepping, p=0.028). Mean co-contraction index for VL-BF muscle pairs was 13.24+/-11.02% during TC stepping and 9.47+/-7.77% in stance phase of normal walking (p=0.023). There was no significant difference in peak values of nRMS in the other two muscles during TC stepping compared to normal walking. Preliminary EMG profiles in this study demonstrated that experienced TC practitioners used relatively higher levels of knee muscle activation patterns with greater co-contraction during TC exercise compared to normal walking.     

Experimental quadriceps muscle pain impairs knee joint control during walking.

Pain is a cardinal symptom in musculoskeletal diseases involving the knee joint, and aberrant movement patterns and motor control strategies are often present in these patients. However, the underlying neuromuscular mechanisms linking pain to movement and motor control are unclear. To investigate the functional significance of muscle pain on knee joint control during walking, three-dimensional gait analyses were performed before, during, and after experimentally induced muscle pain by means of intramuscular injections of hypertonic saline (5.8%) into vastus medialis (VM) muscle of 20 healthy subjects. Isotonic saline (0.9%) was used as control. Surface electromyography (EMG) recordings of VM, vastus lateralis (VL), biceps femoris, and semitendinosus muscles were synchronized with the gait analyses. During experimental muscle pain, the loading response phase peak knee extensor moments were attenuated, and EMG activity in the VM and VL muscles was reduced. Compressive forces, adduction moments, knee joint kinematics, and hamstring EMG activity were unaffected by pain. Interestingly, the observed changes persisted when the pain had vanished. The results demonstrate that muscle pain modulated the function of the quadriceps muscle, resulting in impaired knee joint control and joint instability during walking. The changes are similar to those observed in patients with knee pain. The loss of joint control during and after pain may leave the knee joint prone to injury and potentially participate in the chronicity of musculoskeletal problems, and it may have clinically important implications for rehabilitation and training of patients with knee pain of musculoskeletal origin.     

The effects of an isometric knee extension with hip adduction (KEWHA) exercise on selective VMO muscle strengthening

We investigated the effects of four weeks of training using a knee extension with hip adduction (KEWHA) exercise in asymptomatic participants. In addition, we compared different methods of electromyographic (EMG) onset-time detection. Eighteen participants who achieved earlier activation of the vastus lateralis (VL) muscle compared to that of the vastus medialis obliquus (VMO) muscle performed the isometric KEWHA exercise in the sitting position for four weeks. A 15° hip adduction was added to the existing knee extension in the KEWHA exercise. EMG onset times were detected using a computer-analyzed system and evaluated using two methods in which the thresholds for activity onset were set at two and three standard deviations (SDs) of the mean baseline activity. No significant difference in the EMG onset-time for the VMO muscle was observed compared to that of the VL muscle between the pre- and post-tests (p > 0.05) when data at 2 SDs of the mean baseline activity were analyzed. However, a significant difference in the onset times for the VMO muscle and VL muscle was found between the pre- and post-tests (p < 0.05) when data at 3 SDs of the mean baseline activity were analyzed. In addition, less variation was observed in data analyzed at 3 SDs compared to that of the data at 2 SDs. The normalized VMO:VL muscle ratio was not significantly different between the pre- and post-tests. These findings show that the KEWHA exercise may decrease the difference between the onset times of VMO and VL muscles. In addition, we suggest that task-specific EMG onset-time detection methods are required to minimize variations in the data obtained during the recording of muscle activation.