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.     

Walking speed effects on the lower limb electromyographic variability of healthy children aged 7–16 years

The evaluation of surface electromyography (sEMG) is commonly performed in children with cerebral palsy (CP) and reliable interpretation necessitates knowledge of the variability in age-matched, typically developing (TD) children. Variance ratio was calculated for inter-trial sEMG linear envelope (LE) and the Instantaneous Mean Frequency (IMNF) variability in the lower limb muscle in TD children, in three different age groups during slow, comfortable speed, and fast walking. Significantly greater variability was found in the 7–9 group compared to the 13–16 years. Variability during both slow and fast walking was significantly greater compared to comfortable speed walking and was profound in the 7–9 year age group. Variability of the IMNF was significantly greater than LE in the Tibialis-Anterior, Biceps-Femoris (BF), Vastus-Lateralis (VL), and Rectus-Femoris (RF). Clinical implications are that children under 10 years are more variable than older children when walking either slower or faster than self-selected walking speed. This suggests that muscle activation patterns in gait mature at a later stage of childhood than do kinematic gait patterns. Greater precaution, therefore, is needed when comparing sEMG patterns of less than 10 years of age patient and TD children.     

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.     

Effect of functional electrical stimulation on the effort and walking speed,surface electromyography activity,and metabolic responses in stroke subjects

ObjectiveTo investigate the effects of functional electrical stimulation (FES) combined with conventional rehabilitation program on the effort and speed of walking, the surface electromyographic (sEMG) activity and metabolic responses in the management of drop foot in stroke subjects.MethodsFifteen patients with a drop foot resulting from stroke at least 3 months prior to the start of the trial took part in this study. All subjects were treated 1 h a day, 5 days a week, for 12 weeks, including conventional stroke rehabilitation program and received 30 min of FES to the tibialis anterior (TA) muscle of the paretic leg in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral EMG parameters of TA muscle, walking speed, the effort of walking as measured by physiological cost index (PCI) and metabolic responses.ResultsThe experimental results showed a significant improvement in mean-absolute-value (21.7%), root-mean-square (66.3%) and median frequency (10.6%) of TA muscle EMG signal, which reflects increased muscle strength. Mean increase in walking speed was 38.7%, and a reduction in PCI of 34.6% between the beginning and at end of the trial. Improvements were also found in cardiorespiratory responses with reduction in oxygen consumption (24.3%), carbon dioxide production (19.9%), heart rate (7.8%) and energy cost (22.5%) while walking with FES device.ConclusionsThe results indicate that the FES may be a useful therapeutic tool combined with conventional rehabilitation program to improve the muscle strength, walking ability and metabolic responses in the management of drop foot with stroke patients.     

Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity

Mandibular kinematic and standardized surface electromyography (sEMG) characteristics of masticatory muscles of subjects with short lasting TMD of mild-moderate severity were examined.Volunteers were submitted to clinical examination and questionnaire of severity. Ten subjects with TMD (age 27.3 years, SD 7.8) and 10 control subjects without TMD, matched by age, were selected.Mandibular movements were recorded during free maximum mouth opening and closing (O–C) and unilateral, left and right, gum chewing. sEMG of the masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position, and during gum chewing. sEMG indices were obtained. Subjects with TMD, relative to control subjects, had lower relative mandibular rotation at the end of mouth opening, larger mean number of intersection between interincisal O–C paths during mastication and smaller asymmetry between working and balancing side, with participation beyond the expected of the contralateral muscles (P < 0.05, t-test). Overall, TMD subjects showed similarities with the control subjects in several kinematic parameters and the EMG indices of the static test, although some changes in the mastication were observed.     

Changes in sEMG parameters among trunk and thigh muscles during a fatiguing bilateral isometric multi-joint task in trained and untrained subjects

This study aimed to explore changes in the electrical activity distribution among synergist muscles involved in the maintenance of this bilateral multi-joint task. It also tested relations between changes in surface electromyographic (sEMG) parameters with endurance time. Eighteen subjects, trained and untrained in hiking, performed a submaximal (50% of maximal contraction) isometric hiking test until exhaustion. The electrical activity of main superficial muscles implicated in this posture was recorded bilaterally. Trained subjects sustained the hiking position for 315 ± 82 s, versus 225 ± 68 s for untrained subjects. Patterns of electrical activity and mean power frequency (MPF) were different between populations. MPF shift in abdominal muscles was higher than in other synergists for both groups. Although typical changes in sEMG parameters were observed, few relations with endurance time were found, and for untrained subjects only. Changes in the relative contribution among synergists were observed, mainly for trained subjects. It is hypothesized that the task (a complex multi-joint posture involving numerous joints and muscles) may allow some variability in the contribution of synergist muscles during fatigue especially for the trained group. This probably explains the absence of relationship between endurance time and sEMG changes for trained subjects.     

Biceps brachii myoelectric and oxygenation changes during static and sinusoidal isometric exercises

Surface myoelectric signal changes occurring during sustained isometric contractions have been extensively studied with quantitative surface electromyography (sEMG) and are described by means of some sEMG global variables in time and frequency domain (such as the median power spectral frequency). Recently, the possibility of studying local muscle O₂ saturation during exercise using non-invasive methods has been enhanced thanks to the use of near-infrared spectroscopy (NIRS). The purpose of this work was to combine NIRS and sEMG techniques to analyze the relationship between modifications of sEMG parameters and the underlying metabolic status of the exercising biceps brachii muscle. This relationship was tested under different isometric contraction modalities, namely static (ST) at 20, 40, 60 and 80%MVC and sinusoidal (SIN) at 40 ± 20 and 60 ± 20%MVC. Results clearly indicated the presence of an initial fast phase of muscle O₂ desaturation followed by a slow phase, regardless of the contraction modality. Moreover, the initial rate of muscle O₂ desaturation was related to the level of force output (R = 0.92), but it was independent on the contraction modality (p < 0.05). Similarly, changes in sEMG parameters were related to force level (Conduction Velocity-CV vs. Force: R = 0.87; sEMG Median Frequency-MDF vs. Force: R = 0.86). The high correlation found between CV-MDF and Tissue Oxygenation Index (TOI) slope (R = 0.73 and 0.72, respectively) suggests a strong relationship between NIRS and sEMG data. This study indicates that muscle O₂ demand during isometric contractions from low to high force levels is influenced by the type of active motor units and not from the type of isometric exercise modality.     

The vastus lateralis neuromuscular activity during all-out cycling exercise

ObjectiveThe objective of this work was to study modifications in motor control through surface electromyographic (sEMG) activity during a very short all-out cycling exercise.MethodsTwelve male cyclists (age 23 ± 4 years) participated in this study. After a warm-up period, each subject performed three all-out cycling exercises of 6 s separated by 2 min of complete rest. This protocol was repeated three times with a minimum of 2 days between each session. The braking torque imposed on cycling motion was 19 N m. The sEMG of the vastus lateralis was recorded during the first seven contractions of the sprint. Time–frequency analysis of sEMG was performed using continuous wavelet transform. The mean power frequency (MPF, qualitative modifications in the recruitment of motor units) and signal energy (a quantitative indicator of modifications in the motor units recruitment) were computed for the frequency range 10–500 Hz.ResultssEMG energy increased (P ? 0.05) between contraction number 1 and 2, decreased (P ? 0.05) between contraction number 2 and 3 then stabilized between contraction number 3 and 7 during the all-out test. MPF increased (P ? 0.05) during the all-out test. This increase was more marked during the first two contractions.ConclusionsThe decrease in energy and the increase in the sEMG MPF suggest a large spatial recruitment of motor units (MUs) at the beginning of the sprint followed by a preferential recruitment of faster MUs at the end of the sprint, respectively.     

Changes in knee joint muscle activation patterns during walking associated with increased structural severity in knee osteoarthritis

PurposeTo determine whether alterations in knee joint muscle activation patterns during gait were related to structural severity determined by Kellgren–Lawrence (KL) radiographic grades, for those with a moderate knee OA classification.ScopeEighty-two individuals with knee OA, classified as moderate using a functional and clinical criterion were stratified on KL-grade (KL II, KL III and KL IV). Thirty-five asymptomatic individuals were matched for age and walking velocity. Lower limb motion and surface electromyograms from rectus femoris plus lateral and medial sites for the gastrocnemii, vastii and hamstring muscles were recorded during self-selected walking. Gait velocity and characteristics from sagittal plane knee angular displacement waveforms were calculated. Principal component analysis extracted amplitude and temporal features from electromyographic waveform. Analysis of variance models tested for main effects (group, muscle) and interactions (α = 0.05) for these features. No differences in anthropometrics, velocity, knee muscle strength and symptoms were found among the three OA groups (p > 0.05). Specific features from medial gastrocnemius, lateral hamstring and quadriceps amplitude and temporal patterns were significantly different among OA groups (p < 0.05).ConclusionsSystematic alterations in specific knee joint muscle activation patterns were associated with increasing structural severity based on KL-grades whereas other alterations were associated with the presence of OA.     

Do patients with diabetic neuropathy use a higher proportion of their maximum strength when walking?

Diabetic patients have an altered gait strategy during walking and are known to be at high risk of falling, especially when diabetic peripheral neuropathy is present. This study investigated alterations to lower limb joint torques during walking and related these torques to maximum strength in an attempt to elucidate why diabetic patients are more likely to fall. 20 diabetic patients with moderate/severe peripheral neuropathy (DPN), 33 diabetic patients without peripheral neuropathy (DM), and 27 non-diabetic controls (Ctrl) underwent gait analysis using a motion analysis system and force plates to measure kinetic parameters. Lower limb peak joint torques and joint work done (energy expenditure) were calculated during walking. The ratio of peak joint torques and individual maximum joint strengths (measured on a dynamometer) was then calculated for 59 of the 80 participants to yield the ‘operating strength’ for those participants. During walking DM and DPN patients showed significantly reduced peak torques at the ankle and knee. Maximum joint strengths at the knee were significantly less in both DM and DPN groups than Ctrls, and for the DPN group at the ankle. Operating strengths were significantly higher at the ankle in the DPN group compared to the Ctrls. These findings show that diabetic patients walk with reduced lower limb joint torques; however due to a decrement in their maximum ability at the ankle and knee, their operating strengths are higher. This allows less reserve strength if responding to a perturbation in balance, potentially increasing their risk of falling.     

The 3D path of body centre of mass during adult human walking on force treadmill

Three-dimensional (3D) path of the body centre of mass (CM) over an entire stride was computed from ground reaction forces during walking at constant average speed on a treadmill mounted on 3D force sensors. Data were obtained from 18 healthy adults at speeds ranging from 0.30 to 1.40 m s^?1, in 0.1 m s^?1 increments. Six subsequent strides were analyzed for each subject and speed (total strides=1296). The test session lasted about 30 min (10 min for walking). The CM path had an upward concave figure-of-eight shape that was highly consistent within and across subjects. Vertical displacement of the CM increased monotonically as a function of walking speed. The forward and particularly lateral displacements of the CM showed a U-shaped relationship to speed. The same held for the total 3D displacement (25.6–16.0 cm, depending on the speed). The results provide normative benchmarks and suggest hypotheses for further physiologic and clinical research. The familiar inverted pendulum model might be expanded to gyroscopic, “spin-and-turn” models. Abnormalities of the 3D path might flag motor impairments and recovery.     

Effects of medially posted insoles on foot and lower limb mechanics across walking and running in overpronating men

Anti-pronation orthoses, like medially posted insoles (MPI), have traditionally been used to treat various of lower limb problems. Yet, we know surprisingly little about their effects on overall foot motion and lower limb mechanics across walking and running, which represent highly different loading conditions. To address this issue, multi-segment foot and lower limb mechanics was examined among 11 overpronating men with normal (NORM) and MPI insoles during walking (self-selected speed 1.70 ± 0.19 m/s vs 1.72 ± 0.20 m/s, respectively) and running (4.04 ± 0.17 m/s vs 4.10 ± 0.13 m/s, respectively). The kinematic results showed that MPI reduced the peak forefoot eversion movement in respect to both hindfoot and tibia across walking and running when compared to NORM (p < 0.05–0.01). No differences were found in hindfoot eversion between conditions. The kinetic results showed no insole effects in walking, but during running MPI shifted center of pressure medially under the foot (p < 0.01) leading to an increase in frontal plane moments at the hip (p < 0.05) and knee (p < 0.05) joints and a reduction at the ankle joint (p < 0.05). These findings indicate that MPI primarily controlled the forefoot motion across walking and running. While kinetic response to MPI was more pronounced in running than walking, kinematic effects were essentially similar across both modes. This suggests that despite higher loads placed upon lower limb during running, there is no need to have a stiffer insoles to achieve similar reduction in the forefoot motion than in walking.     

Primary stability of uncemented femoral resurfacing implants for varying interface parameters and material formulations during walking and stair climbing

Primary stability of uncemented resurfacing prosthesis is provided by an interference fit between the undersized implant and the reamed bone. Dependent on the magnitude of interference, the implantation process causes high shear forces and large strains which can exceed the elastic limit of cancellous bone. Plastification of the bone causes reduced stiffness and could lead to bone damage and implant loosening. The purpose in this study was to determine press-fit conditions which allow implantation without excessive plastic bone deformation and sufficient primary stability to achieve bone ingrowth. In particular, the influence of interference, bone quality and friction on the micromotion during walking and stair-climbing was investigated. Therefore elastic and plastic finite element (FE) models of the proximal femur were developed. Implantation was realized by displacing the prosthesis onto the femur while monitoring the contact pressure, plastic bone deformation as well as implantation forces. Subsequently a physiologic gait and stair-climbing cycle was simulated calculating the micromotion at the bone-implant interface. Results indicate that plastic deformation starts at an interference of 30 μm and the amount of plastified bone at the interface increases up to 90% at 150 μm interference. This effect did not reduce the contact pressure if interference was below 80 μm. The micromotion during walking was similar for the elastic and plastic FE models. A stable situation allowing bony ingrowth was achieved for both constitutive laws (elastic, plastic) for walking and stair climbing with at least 60 μm press-fit, which is feasible with clinically used implantation forces of 4 kN.     

Changes in relative work of the lower extremity joints and distal foot with walking speed

The modulation of walking speed results in adaptations to the lower limbs which can be quantified using mechanical work. A 6 degree-of-freedom (DOF) power analysis, which includes additional translations as compared to the 3 DOF (all rotational) approach, is a comprehensive approach for quantifying lower limb work during gait. The purpose of this study was to quantify the speed-related 6 DOF joint and distal foot work adaptations of all the lower extremity limb constituents (hip, knee, ankle, and distal foot) in healthy individuals. Relative constituent 6 DOF work, the amount of constituent work relative to absolute limb work, was calculated during the stance and swing phases of gait. Eight unimpaired adults walked on an instrumented split-belt treadmill at slow, moderate, and typical walking speeds (0.4, 0.6, and 0.8 statures/s, respectively). Using motion capture and force data, 6 DOF powers were calculated for each constituent. Contrary to previously published results, 6 DOF positive relative ankle work and negative relative distal foot work increased significantly with increased speed during stance phase (p < 0.05). Similar to previous rotational DOF results in the sagittal plane, negative relative ankle work decreased significantly with increased speed during stance phase (p < 0.05). Scientifically, these findings provide new insight into how healthy individuals adapt to increased walking speed and suggest limitations of the rotational DOF approach for quantifying limb work. Clinically, the data presented here for unimpaired limbs can be used to compare with speed-matched data from limbs with impairments.     

Multi-channel electromyography during maximal isometric and dynamic contractions

Motor unit behavior differs between contraction types at submaximal contraction levels, however is challenging to study during maximal voluntary contractions (MVCs). With multi-channel surface electromyography (sEMG), mean physiological characteristics of the active motor units can be extracted. Two 8-electrode sEMG arrays were attached on biceps brachii muscle (one on each head) to examine behavior of sEMG variables during isometric, eccentric and concentric MVCs of elbow flexors in 36 volunteers.On average, isometric (364 ± 88 N) and eccentric (353 ± 74 N) MVCs were higher than concentric (290 ± 73 N) MVC (p < 0.001). Mean muscle fiber conduction velocity (CV) was highest during eccentric MVC (4.42 ± 0.49 m/s) than concentric (4.25 ± 0.49 m/s, p < 0.01) and isometric (4.14 ± 0.45 m/s, p < 0.001) MVCs. Furthermore, eccentric MVC showed lower sEMG amplitude at the largest elbow joint angles (120–170°) and higher CV at the smallest (70–150°) elbow joint angles (p < 0.05–0.001) than concentric MVC.The differences in CV and sEMG amplitude between the MVCs suggest that the control strategy of motor units differs between the contraction types during MVCs, and is dependent on the muscle length between the dynamic MVCs.     

Walking kinematics and kinetics following eccentric exercise-induced muscle damage

The goal of this investigation was to investigate how walking patterns are affected following muscle-damaging exercise by quantifying both lower limb kinematics and kinetics. Fifteen young women conducted a maximal isokinetic eccentric exercise (EE) muscle damage protocol (5 × 15) of the knee extensors and flexors of both legs at 60°/s. Three-dimensional motion data and ground reaction forces (GRFs) were collected 24 h pre-EE while the participants walked at their preferred self-selected walking speed (SWS). Participants were asked to perform two gait conditions 48 h post-EE. The first condition (COND1) was to walk at their own speed and the second condition (COND2) to maintain the SWS (±5%) they had 24 h pre-EE. Walking speed during COND1 was significantly lower compared to pre-exercise values. When walking speed was controlled during COND2, significant effects of muscle damage were noticed, among other variables, for stride frequency, loading rate, lateral and vertical GRFs, as well as for specific knee kinematics and kinetics. These findings provide new insights into how walking patterns are adapted to compensate for the impaired function of the knee musculature following muscle damage. The importance to distinguish the findings caused by muscle damage from those exhibited in response to changes in stride frequency is highlighted.     

Micro movements of the upper limb in fibromyalgia: The relation to proprioceptive accuracy and visual feedback

The purpose of this study was to explore the role of visual and proprioceptive feedback in upper limb posture control in fibromyalgia (FM) and to assess the coherence between acceleration measurements of upper limb micro movements and surface electromyography (sEMG) of shoulder muscle activity (upper trapezius and deltoid). Twenty-five female FM patients and 25 age- and sex-matched healthy controls (HCs) performed three precision motor tasks: (1) maintain a steady shoulder abduction angle of 45° while receiving visual feedback about upper arm position and supporting external loads (0.5, 1, or 2 kg), (2) maintain the same shoulder abduction angle without visual feedback (eyes closed) and no external loading, and (3) a joint position sense test (i.e., assessment of proprioceptive accuracy). Patients had more extensive increase in movement variance than HCs when visual feedback was removed (P < 0.03). Proprioceptive accuracy was related to movement variance in HCs (R ⩾ 0.59, P ⩽ 0.002), but not in patients (R ⩽ 0.25, P ⩾ 0.24). There was no difference between patients and HCs in coherence between sEMG and acceleration data. These results may indicate that FM patients are more dependent on visual feedback and less reliant on proprioceptive information for upper limb posture control compared to HCs.     

An electromyographic analysis of two handwriting grasp patterns

BackgroundHandwriting is a fundamental skill needed for the development of daily-life activities during lifetime and can be performed using different forms to hold the writing object. In this study, we monitored the sEMG activity of trapezius, biceps brachii, extensor carpi radialis brevis and flexor digitorum superficialis during a handwriting task with two groups of subjects using different grasp patterns.Subjects and methodsTwenty-four university students (thirteen males and eleven females; mean age of 22.04 ± 2.8 years) were included in this study. We randomly invited 12 subjects that used the Dynamic Tripod grasp and 12 subjects that used the Static Tripod grasp.ResultsThe static tripod group showed statistically significant changes in the sEMG activity of trapezium and biceps brachii muscles during handwriting when compared to dynamic tripod group’s subjects. No significant differences were found in extensor carpi radialis brevis and flexor digitorum superficialis activities among the two groups.ConclusionThe findings in this study suggest an increased activity of proximal muscles among subjects using a transitional grasp, indicating potential higher energy expenditure and muscular harm with the maintenance of this motor pattern in handwriting tasks, especially during the progression in academic life.     

Distribution of motor unit potential velocities in the biceps brachii muscle of sprinters and endurance athletes during prolonged dynamic exercises at low force levels

In surface electromyography (sEMG), the distribution of motor unit potential (MUP) velocities has been shown to reflect the proportion of faster and slower propagating MUPs. This study investigated whether the distribution of MUP velocities could distinguish between sprinters (n = 11) and endurance athletes (n = 12) in not-specifically trained muscle (biceps brachii) during prolonged dynamic exercises at low forces. sEMG was acquired during 4 min’ exercises: unloaded, 5%, 10% and 20% of maximal voluntary contraction (MVC). The features extracted from the sEMG were: the mean muscle conduction velocity – estimated using the inter-peak latency and cross-correlation methods, the within-subject skewness (expressing the proportions of faster and slower propagating MUPs) and the within-subject standard deviation of MUP velocities (SD-mup). Sprinters showed a greater proportion of faster propagating MUPs than endurance athletes. During fatigue, the SD-mup of sprinters broadened progressively, whereas that of endurance athletes did not. The findings suggest that sprinters conveyed a greater proportion of faster motor units than endurance athletes and that motor unit behavior during fatigue differed between groups. Thus, the distribution of MUP velocities enables distinction between a muscle of sprinters and endurance athletes during prolonged dynamic exercises at low forces.     

Detection of surface electromyography recording time interval without muscle fatigue effect for biceps brachii muscle during maximum voluntary contraction

The effects of fatigue on maximum voluntary contraction (MVC) parameters were examined by using force and surface electromyography (sEMG) signals of the biceps brachii muscles (BBM) of 12 subjects. The purpose of the study was to find the sEMG time interval of the MVC recordings which is not affected by the muscle fatigue. At least 10 s of force and sEMG signals of BBM were recorded simultaneously during MVC. The subjects reached the maximum force level within 2 s by slightly increasing the force, and then contracted the BBM maximally. The time index of each sEMG and force signal were labeled with respect to the time index of the maximum force (i.e. after the time normalization, each sEMG or force signal’s 0 s time index corresponds to maximum force point). Then, the first 8 s of sEMG and force signals were divided into 0.5 s intervals. Mean force, median frequency (MF) and integrated EMG (iEMG) values were calculated for each interval. Amplitude normalization was performed by dividing the force signals to their mean values of 0 s time intervals (i.e. ?0.25 to 0.25 s). A similar amplitude normalization procedure was repeated for the iEMG and MF signals. Statistical analysis (Friedman test with Dunn’s post hoc test) was performed on the time and amplitude normalized signals (MF, iEMG). Although the ANOVA results did not give statistically significant information about the onset of the muscle fatigue, linear regression (mean force vs. time) showed a decreasing slope (Pearson-r = 0.9462, p < 0.0001) starting from the 0 s time interval. Thus, it might be assumed that the muscle fatigue starts after the 0 s time interval as the muscles cannot attain their peak force levels. This implies that the most reliable interval for MVC calculation which is not affected by the muscle fatigue is from the onset of the EMG activity to the peak force time. Mean, SD, and range of this interval (excluding 2 s gradual increase time) for 12 subjects were 2353, 1258 ms and 536–4186 ms, respectively. Exceeding this interval introduces estimation errors in the maximum amplitude calculations of MVC–sEMG studies for BBM. It was shown that, simultaneous recording of force and sEMG signals was required to calculate the maximum amplitude of the MVC–sEMG more accurately.