Assessment of the activation modalities of gastrocnemius lateralis and tibialis anterior during gait: A statistical analysis

Aim of the study was to identify the different modalities of activation of gastrocnemius lateralis (GL) and tibialis anterior (TA) during gait at self-selected speed, by a statistical analysis of surface electromyographic signal from a large number (hundreds) of strides per subject. The analysis on fourteen healthy adults showed a large variability in the number of activation intervals, in their occurrence rate, and in the on-off instants, within different strides of the same walk. For each muscle, the assessment of the different modalities of activation (five for muscle) allowed to identify a single pattern, common for all the modalities and able to characterize the behavior of muscles during normal gait. The pattern of GL activity centered in two regions of the gait cycle: the transition between flat foot contact and push-off (observed in 100% of total strides) and the final swing (67.1 ± 15.9%). Two regions characterized also the pattern of TA activity: from pre-swing to following loading response (100%), and the mid-stance (30.5 ± 15.0%). This “normality” pattern represents the first attempt for the development in healthy young adults of a reference for dynamic EMG activity of GL and TA, in terms of variability of on-off muscular activity and occurrence rate during gait.     

Regional neuromuscular regulation within human rectus femoris muscle during gait

The spatial distribution pattern of neuromuscular activation within the human rectus femoris (RF) muscle was investigated during gait by multi-channel surface electromyography (surface EMG). Eleven healthy men walked on a treadmill with three gait speeds (4, 5, and 6 km/h) and gradients (0°, 12.5°, and 25°). The spatial distribution of surface EMG was tested by central locus activation (CLA), which is calculated from 2-D multi-channel surface EMG with 46 surface electrodes. For all conditions, CLA was around the middle regions during the swing-to-stance transition and moved in a proximal direction during the stance phase and stance-to-swing transition (p<0.05). CLA during the stance-to-swing transition and early swing phase significantly moved to proximal site with increasing gait speed (p<0.05). During the early stance and swing phases, with increasing grade, CLA significantly moved distally (p<0.05). These results suggest that the RF muscle is regionally activated during a gait cycle and is non-uniformly regulated longitudinally.     

Loading and knee flexion after stroke: Less does not equal more

It is believed that force feedback can modulate lower extremity extensor activity during gait. The purpose of this research was to determine the role of limb loading on knee extensor excitability during the late stance/early swing phase of gait in persons post-stroke. Ten subjects with chronic hemiparesis post-stroke participated in (1) seated isolated quadriceps reflex testing with ankle loads of 0–0.4N m/kg and (2) gait analysis on a treadmill with 0%, 20% or 40% body weight support. Muscle reflex responses were recorded from vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) during seated testing. Knee kinematics and quadriceps activity during late stance/early swing phase of gait were compared across loading conditions. Although isolated loading of the ankle plantarflexors at 0.2 N m/kg reduced VM prolonged response (p = 0.04), loading did not alter any other measure of quadriceps excitability (all p > 0.08). During gait, the use of BWS did not influence knee kinematics (p = 0.18) or muscle activity (all p > 0.17) during late stance/early swing phase. This information suggests that load sensed at the ankle has minimal effect on the ipsilateral quadriceps of individuals post-stroke during late stance. It appears that adjusting limb loading during rehabilitation may not be an effective tool to address stiff-knee gait following stroke.     

Electromyographic patterns of lower limb muscles during apprehensive gait in younger and older female adults

ObjectiveInvestigate the influence of apprehensive gait on activation and cocontraction of lower limb muscles of younger and older female adults.MethodsData of 17 younger (21.47 ± 2.06 yr) and 18 older women (65.33 ± 3.14 yr) were considered for this study. Participants walked on the treadmill at two different conditions: normal gait and apprehensive gait. The surface electromyographic signals (EMG) were recorded during both conditions on: rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), tibialis anterior (TA), gastrocnemius lateralis (GL), and soleus (SO).ResultsApprehensive gait promoted greater activation of thigh muscles than normal gait (F = 5.34 and p = 0.007, for significant main effect of condition; RF, p = 0.002; VM, p < 0.001; VL, p = 0.003; and BF, p = 0.001). Older adults had greater cocontraction of knee and ankle stabilizer muscles than younger women (F = 4.05 and p = 0.019, for significant main effect of groups; VM/BF, p = 0.010; TA/GL, p = 0.007; and TA/SO, p = 0.002).ConclusionApprehensive gait promoted greater activation of thigh muscles and older adults had greater cocontraction of knee and ankle stabilizer muscles. Thus, apprehensive gait may leads to increased percentage of neuromuscular capacity, which is associated with greater cocontraction and contribute to the onset of fatigue and increased risk of falling in older people.     

Electromyographic assessment of Gait function following limb salvage procedures for bone sarcoma

Bone sarcomas are the fourth most common cancer in individuals under 25 years of age. Limb salvage procedures have become increasingly popular for the treatment of osteosarcomas as they have functional and physiological benefits over traditional amputative procedures. The purpose of this study was to assess locomotor patterns post lower limb salvage surgery via electromyographic and energetic measurement techniques on a group of intra-articular knee osteosarcoma patients greater than one year post surgery. A retrospective outcome study was undertaken on 20 limb salvage patients (10♀, 10♂) recruited from the Queensland Bone Tumour Registry. Results showed prolonged activation of rectus femoris and prolonged co-contraction of the rectus femoris and hamstring muscles (p > 0.05) in the affected limb of the limb salvage group compared to a control group. Prolonged rectus femoris activation and co-contraction was also evident in the unaffected lower limb suggesting alterations in gait programming within higher neuronal centres. The results are important for the development of rehabilitation programs as they suggest an overall reprogramming of the gait pattern, thereby limiting the impact of conventional strength and stretching interventions.     

Electromyographic,but not mechanomyographic amplitude–force relationships,distinguished differences in voluntary activation capabilities between individuals

The purpose of the present study was to examine the influence of activation capabilities on the electromyography (EMG_RMS) and mechanomyography amplitude (MMG_RMS)–force relationships of the vastus lateralis (VL) and rectus femoris (RF). Thirteen men (mean ± SD; age = 22 ± 3 year) performed nine submaximal contractions (10–90% maximal voluntary contraction [MVC]) with the interpolated twitch technique performed during a separate contraction at 90% MVC to calculate percent voluntary activation (%VA). Nine participants with >90% VA were categorized into the high-activated group with the remaining categorized into the moderate-activated group. Slopes (b terms) were calculated from the log-transformed EMG_RMS and MMG_RMS–force relationships. The b terms (collapsed across the VL and RF) for the EMG_RMS–force relationships were greater for the high- (1.29 ± 0.31) than the moderate-activated (1.10 ± 0.20) group. In contrast, there were no differences in the b terms for the MMG_RMS–force relationships between the high- and moderate-activated groups. For the EMG_RMS and MMG_RMS–force relationships, the b terms were greater for the RF (1.38 ± 0.30, 0.81 ± 0.20) than the VL (1.08 ± 0.19, 0.60 ± 0.13) collapsed across groups. The b terms from the EMG_RMS–force relationships, but not the MMG_RMS–force relationships, reflected differences in %VA.     

Differences in lower-extremity muscular activation during walking between healthy older and young adults

Previous studies have identified differences in gait kinetics between healthy older and young adults. However, the underlying factors that cause these changes are not well understood. The objective of this study was to assess the effects of age and speed on the activation of lower-extremity muscles during human walking. We recorded electromyography (EMG) signals of the soleus, gastrocnemius, biceps femoris, medial hamstrings, tibialis anterior, vastus lateralis, and rectus femoris as healthy young and older adults walked over ground at slow, preferred and fast walking speeds. Nineteen healthy older adults (age, 73 ± 5 years) and 18 healthy young adults (age, 26 ± 3 years) participated. Rectified EMG signals were normalized to mean activities over a gait cycle at the preferred speed, allowing for an assessment of how the activity was distributed over the gait cycle and modulated with speed. Compared to the young adults, the older adults exhibited greater activation of the tibialis anterior and soleus during mid-stance at all walking speeds and greater activation of the vastus lateralis and medial hamstrings during loading and mid-stance at the fast walking speed, suggesting increased coactivation across the ankle and knee. In addition, older adults depend less on soleus muscle activation to push off at faster walking speeds. We conclude that age-related changes in neuromuscular activity reflect a strategy of stiffening the limb during single support and likely contribute to reduced push off power at fast walking speeds.     

Timing of muscle activation of the lower limbs can be modulated to maintain a constant pedaling cadence

This study investigated changes in muscle activity when subjects are asked to maintain a constant cadence during an unloaded condition. Eleven subjects pedaled for five loaded conditions (220 W, 190 W, 160 W, 130 W, 100 W) and one unloaded condition at 80 rpm. Electromyographic (EMG) activity of six lower limb muscles, pedal forces and oxygen consumption were calculated for every condition. Muscle activity was defined by timing (EMG onset and offset) and level (integrated values of EMGrms calculated between EMG onset and EMG offset) of activation, while horizontal and vertical impulses were computed to characterize pedal forces. Muscle activity, pedal forces and oxygen consumption variables measured during the unloaded condition were compared with those extrapolated to 0 W from the loaded conditions, assuming a linear relationship. The muscle activity was changed during unloaded condition: EMG onset and/or offset of rectus femoris, biceps femoris, vastus medialis, and gluteus maximus muscles were delayed (p < 0.05); iEMGrms values of rectus femoris, biceps femoris, gastrocnemius medialis and tibialis anterior muscles were higher than those extrapolated to 0 W (p < 0.05). Vertical impulse over the extension phase was lower (p < 0.05) while backward horizontal impulse was higher (p < 0.05) during unloaded condition than those extrapolated to 0 W. Oxygen consumptions were higher during unloaded condition than extrapolated to 0W (750 ± 147 vs. 529 ± 297 mLO₂.min^?1; p < 0.05). Timing of activation of rectus femoris and biceps femoris was dramatically modified to optimize pedal forces and maintain a constant cadence, while systematic changes in the activation level of the bi-articular muscles induced a relative increase in metabolic expenditure when pedaling during an unloaded condition.     

Mechanisms that influence accuracy of the soccer kick

Goal scoring represents the ultimate purpose of soccer and this is achieved when players perform accurate kicks. The purpose of the present study was to compare accurate and inaccurate soccer kicks aiming to top and bottom targets. Twenty-one soccer players performed consecutive kicks against top and bottom targets (0.5 m²) placed in the center of the goal. The kicking trials were categorized as accurate or inaccurate. The activation of tibialis anterior (TA), rectus femoris (RF), biceps femoris (BF) and gastrocnemius muscle (GAS) of the swinging leg and the ground reaction forces (GRFs) of the support leg were analyzed. The GRFs did not differ between kicking conditions (P > 0.05). There was significantly higher TA and BF and lower GAS EMG activity during accurate kicks to the top target (P < 0.05) compared with inaccurate kicks. Furthermore, there was a significantly lower TA and RF activation during accurate kicks against the bottom target (P < 0.05) compared with inaccurate kicks. Enhancing muscle activation of the TA and BF and reducing GAS activation may assist players to kick accurately against top targets. In contrast, players who display higher TA and RF activation may be less accurate against a bottom target. It was concluded that muscle activation of the kicking leg represents a significant mechanism which largely contributes to soccer kick accuracy.     

Electromyographic analysis of rectus femoris activity during seated to standing position and walking in water and on dry land in healthy children and children with cerebral palsy

Purpose: To analyze rectus femoris activity during seated to standing position and walking in water and on dry land comparing a group of children with the spastic diparesis type of cerebral palsy (CP) and a group of children without neurological disorders. Methods: This study included a group of nine children with CP and a control group of 11 children. The study compared the electromyographic activity of the rectus femoris during seated to standing position and walking, in water and on land. Results: A greater activation of the rectus femoris was observed in the group of children with CP compared with the control group when moving from a seated position to a standing position in water (p = 0.0039) and while walking on land (p = 0.0014) or in the pool (p = 0.007). Conclusion: This study demonstrated the activation of the rectus femoris while walking or standing up from a seated position in water was greater in the group of children with CP. Further studies should be performed to better understand the extent of muscular activation during body immersion in individuals with neurological disorders.     

EMG normalization to study muscle activation in cycling

The value of electromyography (EMG) is sensitive to many physiological and non-physiological factors. The purpose of the present study was to determine if the torque–velocity test (T–V) can be used to normalize EMG signals into a framework of biological significance. Peak EMG amplitude of gluteus maximus (GMAX), vastus lateralis (VL), rectus femoris (RF), biceps femoris long head (BF), gastrocnemius medialis (GAS) and soleus (SOL) was calculated for nine subjects during isometric maximal voluntary contractions (IMVC) and torque–velocity bicycling tests (T–V). Then, the reference EMG signals obtained from IMVC and T–V bicycling tests were used to normalize the amplitude of the EMG signals collected for 15 different submaximal pedaling conditions. The results of this study showed that the repeatability of the measurements between IMVC (from 10% to 23%) and T–V (from 8% to 20%) was comparable. The amplitude of the peak EMG of VL was 99 ± 43% higher (p < 0.001) when measured during T–V. Moreover, the inter-individual variability of the EMG patterns calculated for submaximal cycling exercises differed significantly when using T–V bicycling normalization method (GMAX: 0.33 ± 0.16 vs. 1.09 ± 0.04, VL: 0.07 ± 0.02 vs. 0.64 ± 0.14, SOL: 0.07 ± 0.03 vs. 1.00 ± 0.07, RF: 1.21 ± 0.20 vs. 0.92 ± 0.13, BF: 1.47 ± 0.47 vs. 0.84 ± 0.11). It was concluded that T–V bicycling test offers the advantage to be less time and energy-consuming and to be as repeatable as IMVC tests to measure peak EMG amplitude. Furthermore, this normalization method avoids the impact of non-physiological factors on the amplitude of the EMG signals so that it allows quantifying better the activation level of lower limb muscles and the variability of the EMG patterns during submaximal bicycling exercises.     

A new parameter for quantifying the variability of surface electromyographic signals during gait: The occurrence frequency

Natural variability of myoelectric activity during walking was recently analyzed considering hundreds of strides. This allowed assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides when a muscle is recruited with that specific activation modality. Aim of present study was to propose the occurrence frequency as a new parameter for assessing sEMG-signal variability during walking. Aim was addressed by processing sEMG signals acquired from Gastrocnemius Lateralis, Tibialis Anterior, Rectus Femoris and Biceps femoris in 40 healthy subjects in order to: (1) show that occurrence frequency is not correlated with ON/OFF instants (R_mean = 0.11 ± 0.07; P > 0.05) and total time of activation (R_mean = 0.15 ± 0.08; P > 0.05); (2) confirm the above results by two handy examples of application (analysis of gender and age) which highlighted that significant (P < 0.05) gender-related and age-related differences within population were detected in occurrence frequency, but not in temporal sEMG parameters. In conclusion, present study demonstrated that occurrence frequency is able to provide further information, besides those supplied by classical temporal sEMG parameters and thus it is suitable to complement them in the evaluation of variability of myoelectric activity during walking.     

Effectiveness of roundhouse kick in elite Taekwondo athletes

The roundhouse kick is a powerful attack in Taekwondo. Most athletes intently perform this kick for scoring in competition. Therefore, kinematic and kinetic analyzes of this kick were the topics of interest; however, they were separately investigated and rarely recorded for impact force. Our objectives were to investigate knee and ankle joint kinematics and electromyographic (EMG) activity of leg muscle and compare them between high-impact (HI) and low-impact (LO) kicks. Sixteen male black-belt Taekwondo athletes performed five roundhouse kicks at their maximal effort. Electrogoniometer sensors measured angular motions of ankle and knee joints. Surface EMG activities were recorded for tibialis anterior, gastrocnemius medialis, rectus femoris, and biceps femoris muscles. Based on maximal impact forces, the athletes were classified into HI and LO groups. All athletes in both groups showed greater activation of rectus femoris than other muscles. The HI group only showed significantly less plantarflexion angles than the LO group during preimpact and impact phases (P < 0.05). During the impact phase, the HI group demonstrated significantly greater biceps femoris activation than the LO group (P < 0.05). In conclusion, rectus femoris activation could predominantly contribute to the powerful roundhouse kicks. Moreover, high biceps femoris co-activation and optimal angle of ankle plantarflexion of about 35° could help achieve the high impact force.     

Is myoelectric activity distributed equally within the rectus femoris muscle during loaded,squat exercises?

Recent evidence suggests different regions of the rectus femoris (RF) muscle respond differently to squat exercises. Such differential adaptation may result from neural inputs distributed locally within RF, as previously reported for isometric contractions, walking and in response to fatigue. Here we therefore investigate whether myoelectric activity distributes evenly within RF during squat. Surface electromyograms (EMGs) were sampled proximally and distally from RF with arrays of electrodes, while thirteen healthy volunteers performed 10 consecutive squats with 20% and 40% of their body weight. The root mean square (RMS) value, computed separately for thirds of the concentric and eccentric phases, was considered to assess the proximo-distal changes in EMG amplitude during squat. The channels with variations in EMG amplitude during squat associated with shifts in the muscle innervation zone were excluded from analysis. No significant differences were observed between RF regions when considering squat phases and knee joint angles individually (P > 0.16) while a significant interaction between phase and knee joint angle with detection site was observed (P < 0.005). For the two loads considered, proximal RMS values were greater during the eccentric phase and for the more flexed knee joint position (P < 0.001). Our results suggest inferences on the degree of RF activation during squat must be made cautiously from surface EMGs. Of more practical relevance, there may be a potential for the differential adaption of RF proximal and distal regions to squat exercises.     

Tensiomyography of selected lower-limb muscles in professional soccer players

Tensiomyography is a non-invasive method of neuromuscular assessment used to measure muscle action characteristics, muscle tone, and muscle fiber type, and provides information on acute and chronic responses of muscle to different training loads. The aims of the present study were: to analyse differences in muscle response and mechanical characteristics of two major muscles of the lower extremity in a large group of Spanish soccer players according to playing position, and to provide group norms against which clinical findings may be compared. Data were collected from 78 professional soccer players (age 26.6 ± 4.4 years; height: 179.2 ± 5.3 cm; body mass: 75.8 ± 5.3 kg). Tensiomyography was recorded from the rectus femoris (RF) and biceps femoris (BF) muscles after 2 days without take part in any strenuous exercise or training. Five tensiomyographic parameters were analyzed: maximal displacement (D_m), contraction time (T_c), sustain time (T_s), delay time (T_d), and half-relaxation time (T_r). A good to excellent intra-session reliability was found for all contractile parameters (ICC ranged from 0.78 to 0.95). No significant differences between players of any position were observed in absolute values of BF. However, significant differences were observed for T_c, T_r and T_s between the different playing positions on RF (P < 0.05, effect size ranged from 1.3 to 1.6). Professional soccer players showed muscles with ability to rapidly generate force during contractions. The neuromuscular profile provided could help in identifying the normative data that are important for the different positions in order to optimize the training and recovery process of each individual player.     

Intra-session repeatability of lower limb muscles activation pattern during pedaling

Assessment of intra-session repeatability of muscle activation pattern is of considerable relevance for research settings, especially when used to determine changes over time. However, the repeatability of lower limb muscles activation pattern during pedaling is not fully established. Thus, we tested the intra-session repeatability of the activation pattern of 10 lower limb muscles during a sub-maximal cycling exercise.Eleven triathletes participated to this study. The experimental session consisted in a reference sub-maximal cycling exercise (i.e. 150 W) performed before and after a 53-min simulated training session (mean power output = 200 ± 12 W). Repeatability of EMG patterns was assessed in terms of muscle activity level (i.e. RMS of the mean pedaling cycle and burst) and muscle activation timing (i.e. onset and offset of the EMG burst) for the 10 following lower limb muscles: gluteus maximus (GMax), semimembranosus (SM), Biceps femoris (BF), vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), gastrocnemius medianus (GM) and lateralis (GL), soleus (SOL) and tibialis anterior (TA).No significant differences concerning the muscle activation level were found between test and retest for all the muscles investigated. Only VM, SOL and TA showed significant differences in muscle activation timing parameters. Whereas ICC and SEM values confirmed this weak repeatability, cross-correlation coefficients suggest a good repeatability of the activation timing parameters for all the studied muscles.Overall, the main finding of this work is the good repeatability of the EMG pattern during pedaling both in term of muscle activity level and muscle activation timing.     

A new measure of trip risk integrating minimum foot clearance and dynamic stability across the swing phase of gait

Minimum toe clearance (MTC) is thought to quantify the risk of the toe contacting the ground during the swing phase of gait and initiating a trip, but there are methodological issues with this measure and the risk of trip-related falls has been shown to also be associated with gait speed and dynamic stability. This paper proposes and evaluates a new measure, trip risk integral (TRI), that circumvents many issues with MTC as typically calculated at a single point by considering minimum foot clearance across the entire swing phase and taking into account dynamic stability to estimate risk of falling due to a trip rather than risk of the foot contacting the floor. Shoes and floor surfaces were digitized and MTC and TRI calculated for unimpaired younger (N = 14, age = 26 ± 5), unimpaired older (N = 14, age = 73 ± 7), and older adults who had recently fallen (N = 11, age = 72 ± 5) walking on surfaces with no obstacles, visible obstacles, and hidden obstacles at slow, preferred, and fast gait speeds. MTC and TRI had significant (F ≥ 5, p ≤ 0.005) but differing effects of gait speed and floor surface. As gait speed increased (which increases risk of trip-related falls) MTC indicated less and TRI greater risk, indicating that TRI better quantifies risk of falling due to a trip. While MTC and TRI did not differ by subject group, strong speed-related effects of TRI (F ≥ 8, p ≤ 0.0007) resulted in improved TRI for fallers due to their slower self-selected preferred gait. This demonstrates that slower gait is both an important covariate and potential intervention for trip-related falls.     

Muscle fiber conduction velocity in different gait phases of early and late-stage diabetic neuropathy

We investigated the muscle fiber conduction velocity (MFCV) during gait phases of the lower limb muscles in individuals with various degrees of diabetic peripheral neuropathy (DPN). Forty-five patients were classified into severity degrees of DPN by a fuzzy model. The stages were absent (n = 11), mild (n = 14), moderate (n = 11) and severe (n = 9), with 10 matched healthy controls. While walking, all subjects had their sEMG (4 linear electrode arrays) recorded for tibialis anterior (TA), gastrocnemius medialis (GM), vastus lateralis (VL) and biceps femoris (BF). MFCV was calculated using a maximum likelihood algorithm with 30 ms standard deviation Gaussian windows. In general, individuals in the earlier stages of DPN showed lower MFCV of TA, GM and BF, whilst individuals with severe DPN presented higher MFCV of the same muscles. We observed that mild patients already showed lower MFCV of TA at early stance and swing, and lower MFCV of BF at swing. All diabetic groups showed a markedly reduction in MFCV of VL, irrespective of DPN. Severe patients presented higher MFCV mainly in distal muscles, TA at early and swing phases and GM at propulsion and midstance. The absent group already showed MFCV of VL and GM reductions at the propulsion phase and of VL at early stance. Although MFCV changes were not as progressive as the DPN was, we clearly distinguished diabetic patients from controls, and severe patients from all others.     

Neuromuscular activation of vastus intermedius muscle during fatiguing exercise

The purpose of this study was to investigate neuromuscular activation of the vastus intermedius (VI) muscle during fatiguing contraction. Seven healthy men performed sustained isometric knee extension exercise at 50% of maximal voluntary contraction until exhaustion. During the fatiguing task, surface electromyograms (EMGs) were recorded from four muscle components of the quadriceps femoris muscle group: VI; vastus lateralis (VL); vastus medialis (VM); and rectus femoris (RF) muscles. For the VI muscle, our recently developed technique was used. Root mean square (RMS) and median frequency (MF) of the surface EMG signal were calculated and these variables were then normalized by the value at the beginning of the task. Normalized RMS of the VI muscle resembled those of the other three muscles at all given times. At 95% of exhaustion time, normalized MF of the VI muscle was significantly higher than that of the VL muscle (p < 0.05). These results suggested that neuromuscular activation is not consistent between the VI and VL muscles at the exhaustion for isometric submaximal contraction and this could reflect the dissimilar intramuscular metabolism between these muscles.     

Alternating stimulation of synergistic muscles during functional electrical stimulation cycling improves endurance in persons with spinal cord injury

Therapeutic effects of functional electrical stimulation (FES) cycling for persons with spinal cord injury (SCI) are limited by high rates of muscular fatigue. FES-cycling performance limits and surface mechanomyography (MMG) of 12 persons with SCI were compared under two different stimulation protocols of the quadriceps muscles. One strategy used the standard “co-activation” protocol from the manufacturer of the FES cycle which involved intermittent simultaneous activation of the entire quadriceps muscle group for 400 ms. The other strategy was an “alternation” stimulation protocol which involved alternately stimulating the rectus femoris (RF) muscle for 100 ms and the vastus medialis (VM) and vastus lateralis (VL) muscles for 100 ms, with two sets with a 400 ms burst. Thus, during the alternation protocol, each of the muscle groups rested for two 100 ms “off” periods in each 400 ms burst. There was no difference in average cycling cadence (28 RPM) between the two protocols. The alternation stimulation protocol produced longer ride times and longer virtual distances traveled and used lower stimulation intensity levels with no differences in average MMG amplitudes compared to the co-activation protocol. These results demonstrate that FES-cycling performance can be enhanced by a synergistic muscle alternation stimulation strategy.