Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke

Although it has been reported that strengthening exercise in stroke patients is beneficial for their motor recovery, there is little evidence about which exercise method is the better option. The purpose of this study was to compare isotonic and isokinetic exercise by surface electromyography (EMG) analysis using standardized methods.Nine stroke patients performed three sets of isotonic elbow extensions at 30% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic elbow extensions with standardization of mean angular velocity and the total amount of work for each matched set in two strengthening modes. All exercises were done by using 1-DoF planner robot to regulate exact resistive torque and speed. Surface electromyographic activity of eight muscles in the hemiplegic shoulder and elbow was recorded. Normalized root mean square (RMS) values and co-contraction index (CCI) were used for the analysis.The isokinetic mode was shown to activate the agonists of elbow extension more efficiently than the isotonic mode (normalized RMS for pooled triceps: 96.0 ± 17.0 (2nd), 87.8 ± 14.4 (3rd) in isokinetic, 80.9 ± 11.0 (2nd), 81.6 ± 12.4 (3rd) in isotonic contraction, F[1, 8] = 11.168; P = 0.010) without increasing the co-contraction of muscle pairs, implicating spasticity or synergy.     

Continuous thickness measurement of rectus femoris muscle in ultrasound image sequences: A completely automated approach

Muscle thickness is one of the most widely used parameters for quantifying muscle function in both diagnosis and rehabilitation assessment. Ultrasound imaging has been frequently used to non-invasively study the thickness of human muscles as a reliable method. However, the measurement is traditionally conducted by manual digitization of reference points at the superior and inferior muscle fascias, thus it is subjective and time-consuming. In this paper, a novel method is proposed to detect the muscle thickness automatically. The superficial and deep fascias of a muscle are detected by line detection algorithm at the first ultrasound frame, and the image regions of interest (ROI) for the fascias are subsequently located and tracked by optical flow technique. The muscle thickness is geometrically obtained based on the location of the fascias for each frame. Six ultrasound sequences (250 frames in each sequence) are used to evaluate this method. The correlation coefficient of the detection results between the proposed method and manual method is 0.95 ± 0.01, and the difference is ?0.05 ± 0.22 mm. The linear regression of the total 1500 detections show that a good linear correlation between the results of the two methods is obtained (R² = 0.981). The automated method proposed here provides an accurate, high repeatable and efficient approach for estimating fascicle thickness during human motion, thus justifying its application in biological sciences.     

Electromyographic responses of erector spinae and lower limb’s muscles to dynamic postural perturbations in patients with adolescent idiopathic scoliosis

The aim of this study was to evaluate electromyographic (EMG) responses of erector spinae (ES) and lower limbs’ muscles to dynamic forward postural perturbation (FPP) and backward postural perturbation (BPP) in patients with adolescent idiopathic scoliosis (AIS) and in a healthy control group. Ten right thoracic AIS patients (Cobb = 21.6 ± 4.4°) and 10 control adolescents were studied. Using bipolar surface electrodes, EMG activities of ES muscle at T10 (ES_T10) and L3 (ES_L3) levels, biceps femoris (BF), gastrocnemius lateralis (G) and rectus femoris (RF) muscles in the right and the left sides during FPP and BPP were evaluated. Muscle responses were measured over a 1s time window after the onset of perturbation. In FPP test, the EMG responses of right ES_T10, ES_L3 and BF muscles in the scoliosis group were respectively about 1.40 (p = 0.035), 1.43 (p = 0.07) and 1.45 (p = 0.01) times greater than those in control group. Also, in BPP test, at right ES_L3 muscle of the scoliosis group the EMG activity was 1.64 times higher than that in the control group (p = 0.01). The scoliosis group during FPP displayed asymmetrical muscle responses in ES_T10 and BF muscles. This asymmetrical muscle activity in response to FPP is hypothesized to be a possible compensatory strategy rather than an inherent characteristic of scoliosis.     

Contraction intensity and sex differences in knee-extensor fatigability

Females are less fatigable than males during isometric contractions across various muscles and intensities. However, sex differences in knee-extensor fatigability remain relatively unexplored. Purpose: To determine the sex difference in performance fatigability for intermittent, isometric contractions of the knee-extensor muscles. Methods: Eighteen participants (10 males, 8 females) performed intermittent, isometric, knee-extensor contractions at 30% of their maximal voluntary force (MVC) for 30 min and in a separate session at 50% MVC until task-failure. During both fatiguing protocols a MVC was performed every 60 s and electromyography (EMG) was recorded during all contractions. Results: At task completion males had a larger reduction in MVC force for the 30% MVC task (−32 ± 15% vs. −15 ± 16%, P = 0.042) and the 50% MVC task (−34 ± 8% vs. −24 ± 1%, P = 0.045). Furthermore, for the 50% MVC task, females had a longer task duration (937 ± 525 s vs. 397 ± 153 s, P = 0.007). The rise in EMG activity and force fluctuations were more rapid for the males than females (P < 0.05). When participants were matched for strength post hoc (n = 10), a sex difference in fatigability for both tasks was still evident. Conclusions: Females were less fatigable than males during intermittent, isometric, knee-extensor contractions at moderate relative forces and this difference was independent of strength.     

Validity of trunk extensor and flexor torque measurements using isokinetic dynamometry

This study aimed to evaluate the validity and test–retest reliability of trunk muscle strength testing performed with a latest-generation isokinetic dynamometer. Eccentric, isometric, and concentric peak torque of the trunk flexor and extensor muscles was measured in 15 healthy subjects. Muscle cross sectional area (CSA) and surface electromyographic (EMG) activity were respectively correlated to peak torque and submaximal isometric torque for erector spinae and rectus abdominis muscles. Reliability of peak torque measurements was determined during test and retest sessions. Significant correlations were consistently observed between muscle CSA and peak torque for all contraction types (r = 0.74−0.85; P < 0.001) and between EMG activity and submaximal isometric torque (r ⩾ 0.99; P < 0.05), for both extensor and flexor muscles. Intraclass correlation coefficients were comprised between 0.87 and 0.95, and standard errors of measurement were lower than 9% for all contraction modes. The mean difference in peak torque between test and retest ranged from −3.7% to 3.7% with no significant mean directional bias. Overall, our findings establish the validity of torque measurements using the tested trunk module. Also considering the excellent test–retest reliability of peak torque measurements, we conclude that this latest-generation isokinetic dynamometer could be used with confidence to evaluate trunk muscle function for clinical or athletic purposes.     

Neural control of leg stiffness during hopping in boys and men

The purpose of the study was to investigate whether boys and men utilise different control strategies whilst hopping. Eleven boys (11–12 yr old) and ten men completed hopping at 1.5 Hz, 3.0 Hz and at their preferred frequency. A footswitch measured contact and flight times, from which leg stiffness was calculated. Simultaneously, surface electromyograms (EMGs) of selected lower limb muscles were recorded and quantified for each 30 ms period during the first 120 ms post-ground contact. At 1.5 Hz there were no differences between the groups in relative stiffness or muscle activity. At 3.0 Hz men had significantly shorter contact times (P = 0.013), longer flight times (P = 0.002), greater relative stiffness (P = 0.01) and significantly greater soleus (P = 0.012) and vastus lateralis (P < 0.001) activity during the initial 30 ms post-ground contact. At the preferred frequency men hopped significantly faster than the boys (P = 0.007), with greater leg stiffness (P < 0.01) and with more extensor activity in most time periods. Boys and men demonstrated similar control strategies when hopping at a slow frequency, but when hopping frequency increased men were able to better increase feedforward and reflex muscle activity to hop with greater relative stiffness.     

Upregulation of MuRF1 and MAFbx participates to muscle wasting upon gentamicin-induced acute kidney injury

Acute Kidney Injury (AKI) is frequently encountered in hospitalized patients where it is associated with increased mortality and morbidity notably affecting muscle wasting. Increased protein degradation has been shown to be the main actor of AKI-induced muscle atrophy, but the proteolytic pathways involved are poorly known. The Ubiquitin Proteasome System (UPS) is almost systematically activated in various catabolic situations, and the E3 ligases MuRF1 and MAFbx are generally up regulated in atrophying muscles. We hypothesized that the UPS may be one of the main actors in catabolic skeletal muscles from AKI animals. We used gentamicin-induced acute kidney disease (G-AKI) in rats fed a high protein diet to promote acidosis. We first addressed the impact of G-AKI in the development of mild catabolic conditions. We found that both muscle atrophy and UPS activation were induced with the development of G-AKI. In addition, the phasic muscles were more sensitive to 7-days G-AKI (−11 to −17%, P < 0.05) than the antigravity soleus muscle (−11%, NS), indicating a differential impact of AKI in the musculature. We observed an increased expression of the muscle-specific E3 ligases MuRF1 and MAFbx in phasic muscles that was highly correlated to the G-AKI severity (R² = 0.64, P < 0.01 and R² = 0.71, P < 0.005 respectively). Conversely, we observed no variation in the expression of three other E3 ligases (Nedd4, Trim32 and Fbxo30/MUSA1). Altogether, our data indicate that MuRF1 and MAFbx are sensitive markers and potential targets to prevent muscle atrophy during G-AKI.     

Influence of muscle activity on musculotendinous stiffness quantification in stunted,prepubertal children

The quick-release technique to estimate musculotendinous (MT) stiffness has been extensively used over the last years, in both animals and humans, to gain insights in the adaptive process of the series elastic component (SEC). Recently, MT stiffness quantification, i.e., SEC behavior, has been revisited for subjects not able to fully activate their muscles (effects of long-term spaceflight or non-mature muscles). Such a phenomenon can also be encountered in stunted children. So, the aim of the present study was to analyze the effect of stunting on MT stiffness taking into account possible defect in muscle activation. For this study, 20 eutrophic children (EU) with an average age of 9 years ± 4 months were compared to 11age matched stunted children (S) evaluated by the height-to-age index. The MT stiffness index was obtained with regard to stiffness–torque and stiffness–soleus EMG relationships. The children of the S group presented a significantly lower Maximal Voluntary Contraction (MVC) in plantar flexion in comparison with children of the EU group (?37.8%). The significantly lower MT stiffness index for S children (?42.6%) was evidenced only when quantified with regard to the stiffness–soleus EMG relationship (66.5 ± 42.8 vs. 38.2 ± 19.9 Nm rad^?1%^?1). Possible delay in fiber type differentiation or tendinous structure maturation can account for the lower MT stiffness index in S children. In conclusion, stunting during early childhood delays the differentiation and maturation processes of musculotendinous structures as shown by the lower MT stiffness quantified with regards to muscle activity, also altered for stunted prepubertal children.     

Electromyographic analysis of muscle activation during pull-up variations

This study sought to identify any differences in peak muscle activation (EMGPEAK) or average rectified variable muscle activation (EMGARV) during supinated grip, pronated grip, neutral grip and rope pull-up exercises. Nineteen strength trained males (24.9 ± 5 y; 1.78 ± 0.74 m; 81.3 ± 11.3 kg; 22.7 ± 2.5 kg m⁻²) volunteered to participate in the study. Surface electromyography (EMG) was collected from eight shoulder-arm-forearm complex muscles. All muscle activation was expressed as a percentage of maximum voluntary isometric contraction (%MVIC). Over a full repetition, the pronated grip resulted in significantly greater EMGPEAK (60.1 ± 22.5 vs. 37.1 ± 13.1%MVIC; P = 0.004; Effect Size [ES; Cohen’s d] = 1.19) and EMGARV (48.0 ± 21.2 vs. 27.4 ± 10.7%MVIC; P = 0.001; ES = 1.29) of the middle trapezius when compared to the neutral grip pull-up. The concentric phases of each pull-up variation resulted in significantly greater EMGARV of the brachioradialis, biceps brachii, and pectoralis major in comparison to the eccentric phases (P = <0.01). Results indicate that EMGPEAK and EMGARV of the shoulder-arm-forearm complex during complete repetitions of pull-up variants are similar despite varying hand orientations; however, differences exist between concentric and eccentric phases of each pull-up.     

Assessment of quadriceps muscle weakness in patients after total knee arthroplasty and total hip arthroplasty: Methodological issues

The aim of this exploratory study was to verify whether the evaluation of quadriceps muscle weakness is influenced by the testing modality (isometric vs. isokinetic vs. isoinertial) and by the calculation method (within-subject vs. between-subject comparisons) in patients 4–8 months after total knee arthroplasty (TKA, n = 29) and total hip arthroplasty (THA, n = 30), and in healthy controls (n = 19). Maximal quadriceps strength was evaluated as (1) the maximal voluntary contraction (MVC) torque during an isometric contraction, (2) the peak torque during an isokinetic contraction, and (3) the one repetition maximum (1-RM) load during an isoinertial contraction. Muscle weakness was calculated as the difference between the involved and the uninvolved side (within-subject comparison) and as the difference between the involved side of patients and controls (between-subject comparison). Muscle weakness estimates were not significantly affected by the calculation method (within-subject vs. between-subject; P > 0.05), whereas a significant main effect of testing modality (P < 0.05) was observed. Isometric MVC torque provided smaller weakness estimates than isokinetic peak torque (P = 0.06) and isoinertial 1-RM load (P = 0.008), and the clinical occurrence of weakness (proportion of patients with large strength deficits) was also lower for MVC torque. These results have important implications for the evaluation of quadriceps muscle weakness in TKA and THA patients 4–8 months after surgery.     

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.     

Muscle architecture variations along the human semitendinosus and biceps femoris (long head) length

The purpose of this study was to examine whether muscle architecture of the long head of biceps femoris (BF) and semitendinosus (ST) muscles varies along their length. The ST and BF muscles were dissected and removed from their origins in eight cadaveric specimens (age range 67.8–73.4 years). One-way analysis of variance designs were used to compare fascicle length (FL), pennation angle (PA) and muscle thickness (MT) between proximal, mid-belly and distal positions. Tendon and muscle length properties were also quantified. For the BF muscle, one-way analysis of variance tests showed a higher PA (23.96 ± 3.82°) and FL (7.12 ± 0.48 cm) proximally than distal positions (PA = 17.78 ± 1.95° and FL = 6.35 ± 0.89 cm, respectively). For the ST, there was a significantly (p < 0.05) lower PA (8.81 ± 1.22°) and FL (13.10 ± 1.54 cm) proximally than distally (PA = 14.69 ± 1.09° and FL = 15.49 ± 2.30 cm, respectively). Muscle thickness significantly increased from distal to more proximal positions (p < 0.05). These data suggest that the ST and BF architecture is not uniform and that measurement of these parameters largely depends on the measurement site. Modeling these muscles by assuming a uniform architecture along muscle length may yield less accurate representation of human hamstring muscle function.     

Asociación de la fuerza muscular con marcadores tempranos de riesgo cardiovascular en adultos sedentarios

ObjectiveTo assess the association between muscle strength and early cardiovascular risk (CVR) markers in sedentary adults.Materials and methodsA total of 176 sedentary subjects aged 18-30 years were enrolled. Body mass index and fat percentage were calculated, and waist circumference, grip strength by dynamometry, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and maximal oxygen uptake by VO_2max were measured as CVR markers. A multivariate logistic regression analysis was used to assess associations between muscle strength and CVR markers.ResultsInverse correlations were found between muscle strength and adiposity (r = -.317; P = .001), waist circumference (r = -.309; P = .001), systolic blood pressure (r = -.401; P = .001), and mean arterial pressure (r = -.256; P = .001). Subjects with lower levels of muscle strength had a 5.79-fold (95% CI 1.57 to 9.34; P = .008) risk of having higher adiposity levels (≥ 25%) and a 9.67-fold (95% CI = 3.86 to 19.22; P < .001) risk of having lower physical capacity values for VO_2max (≤ 31.5 mL/kg/min^-1).ConclusionsIn sedentary adults, muscle strength is associated to early manifestations of CVR. It is suggested that muscle strength testing is added to routine measurement of VO_2max and traditional risk factors for prevention and treatment of cardiovascular risk.     

In a dynamic lifting task,the relationship between cross-sectional abdominal muscle thickness and the corresponding muscle activity is affected by the combined use of a weightlifting belt and the Valsalva maneuver

It has been shown that under isometric conditions, as the activity of the abdominal muscles increases, the thicknesses of the muscles also increase. The purpose of this experiment was to determine whether change in muscle thickness could be used as a measure of muscle activity during a deadlift as well as determining the effect of a weightlifting belt and/or the Valsalva maneuver on the muscle thicknesses. The Transversus Abdominis (TrA) and Internal Obliques (IO) muscles were analyzed at rest and during a deadlift. Muscle thickness was measured using ultrasound imaging and muscle activity was simultaneously recorded using electromyography. Each subject performed deadlift under normal conditions, while performing the Valsalva maneuver, while wearing a weightlifting belt and while both utilizing the belt and the Valsalva maneuver. There was no relationship between change in muscle thickness and muscle activity for both the TrA and IO (R² < 0.13 for all conditions). However it was found that the Valsalva maneuver increased abdominal muscle thickness whereas the belt limited muscle expansion; each with an increase in activity. These results indicate that ultrasound cannot be used to measure muscle activity for a deadlift and that the belt affects how the IO and TrA function together.     

Prognostic significance of plasma visfatin levels in patients with ischemic stroke

Plasma visfatin concentration has been enhanced in ischemic stroke. The aim of the current investigation was to test whether determination of visfatin in plasma is associated with 6-month clinical outcomes including mortality and unfavorable outcome (modified Rankin Scale score > 2) in the patients with ischemic stroke. Between July 2009 and January 2012, plasma visfatin concentrations of 186 patients and 100 healthy individuals were quantified by enzyme-linked immunosorbent assay. Plasma visfatin concentrations were higher in patients than in healthy individuals (108.5 ± 41.1 ng/mL vs. 13.8 ± 3.9 ng/mL, P < 0.001). A logistic regression analysis selected plasma visfatin concentration as an independent predictor for 6-month clinical outcomes (both P < 0.01). Using receiver operating characteristic curve analysis, plasma visfatin concentration was found to predict 6-month clinical outcomes with the high predictive performance. The predictive value of visfatin was in the range of National Institutes of Health Stroke Scale score (both P > 0.05). Combined use of visfatin and National Institutes of Health Stroke Scale score did not improve the predictive significance (both P > 0.05). Thus, visfatin may help in the prediction of long-term clinical outcomes in patients with ischemic stroke.     

An in vivo microdialysis characterization of the transient changes in the interstitial dialysate concentration of metabolites and cytokines in human skeletal muscle in response to insertion of a microdialysis probe

Skeletal muscle has recently been described as an endocrine organ, capable of releasing cytokines and regulators of metabolism. Microdialysis of the interstitial space of skeletal muscle enables analysis of the release of such cytokines. The purpose of this study was to determine the transient changes in concentration of metabolites and cytokines in human skeletal muscle in a 7 h period following the insertion of a microdialysis probe. In total, sixteen microdialysis catheters were inserted into the vastus lateralis of male participants (age 26.2 ± 1.35 y, height 180.8 ± 3.89 cm, mass 83.9 ± 3.86 kg, BMI 25.7 ± 0.87 kg m⁻², body fat 26.1 ± 3.0%). Serial samples were analyzed by micro-enzymatic and multiplexed immunoassay. Muscle interstitial glucose and lactate levels remained stable throughout, amino acid concentrations stabilized after 2.5 h, however, insertion of a microdialysis catheter induced a 29-fold increase in peak IL-6 (p < 0.001) and 35-fold increase in peak IL-8 concentrations (p < 0.001) above basal levels 6 h post insertion. In contrast to stable amino acid, glucose and lactate concentrations after 2 h, commonly reported markers of tissue homeostasis in in vivo microdialysis, the multi-fold increase in IL-6 and IL-8 following insertion of a microdialysis catheter is indicative of a sustained disturbance of tissue homeostasis.     

Muscular responses to handle perturbation with different glove condition

Effect of wearing gloves on timely muscle reaction to stabilize handle perturbation was investigated. Thirteen adults gripped a horizontal overhead handle to which an upward force was applied at a random time. Muscle reaction time, integrated EMGs for eight muscles, and handle displacement were compared among three glove conditions affecting the coefficient of friction (COF = 0.32, 0.50, and 0.74 for the polyester glove, bare hand, and latex glove, respectively). Lower COF increased the integrated EMGs and handle displacement until stabilization of the perturbed handle. The low-friction glove resulted in 16% (p = .01) greater muscular effort and 20% (p = .002) greater handle displacement, compared to the high-friction glove. Muscle reaction time was not influenced by glove condition. Cutaneous sensation and reflex eliciting forearm muscle activity appear to play an important role in detecting and responding to the perturbation initially, while the forearm and latissimus dorsi muscles primarily contribute to stabilizing the perturbed handle compared to other shoulder and upper arm muscles. Therefore, low-friction gloves, cutaneous sensory dysfunction, and weakened forearm and latissimus dorsi muscles may jeopardize persons’ ability to stabilize a grip of a handle after perturbation.     

Relación del factor de crecimiento de fibroblastos 21 con indicadores de masa y función muscular en personas mayores con sobrepeso u obesidad. Estudio exploratorio

BackgroundAge-related decreases in muscle mass and function are associated with the development of metabolic impairments, particularly in the context of obesity. Fibroblast growth factor 21 (FGF-21) has been suggested as a common mediator of both processes. No known studies have examined the association between FGF-21 and muscle mass and function in overweight or obese older adults. With this in mind, this study aimed to investigate the association between plasma levels of FGF-21 and muscle mass and function outcomes in overweight or obese older adults.Materials and methodsExploratory study, which included 39 adults of 60-70 years old with body mass indexes > 25 kg/m². As study outcomes, measurements were made of appendicular muscle mass (AMM), grip strength, 5 times sit-to-stand test (5xSTT), as well as plasma levels of FGF-21, fasting glucose, and insulin. The homeostatic model assessment index (HOMA-IR) was also calculated to determine the presence of insulin resistance.ResultsSignificant relationships were found between plasma levels of FGF-21 vs 5xSTT (rho = 0.49; P < .05). Moreover, FGF-21 levels were significantly higher in those with insulin resistance (P < .05), as well as with having lower levels of AMM (P < .05).ConclusionThere is a relationship between the plasma levels of FGF-21 and muscle function outcomes in overweight or obese older adults. Future studies should investigate the potential causalities between these relationships.     

The minimum number of contractions required to examine the EMG amplitude versus isometric force relationship for the vastus lateralis and vastus medialis

Studies have demonstrated that the electromyographic (EMG) amplitude versus submaximal isometric force relationship is relatively linear. The purpose of this investigation was to determine the minimum number of contractions required to study this relationship. Eighteen men (mean age = 23 years) performed isometric contractions of the leg extensors at 10–90% of the maximum voluntary contraction (MVC) in 10% increments while surface EMG signals were detected from the vastus lateralis and vastus medialis. Linear regression was used to determine the coefficient of determination, slope coefficient, and y-intercept for each muscle and force combination with successively higher levels included in the model (i.e., 10–30%, … 10–90% MVC). For the slope coefficients, there was a main effect for force combination (P < .001). The pairwise comparisons showed there was no difference from 10–60% through 10–90% MVC. For the y-intercepts, there were main effects for both muscle (vastus lateralis [4.3 μV RMS] > vastus medialis [−3.7 μV RMS]; P = .034) and force combination (P < .001), with similar values shown from 10–50% through 10–90% MVC. The linearity of the absolute EMG amplitude versus isometric force relationship for the vastus lateralis and vastus medialis suggests that investigators may exclude high force contractions from their testing protocol.