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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The effect of patella taping on vastus medialis oblique and vastus laterialis EMG activity and knee kinematic variables during stair descent

The purpose of this study was to evaluate the effect of patella taping in normal subjects. Previous work has established positive effects of patella taping on patellofemoral pain syndrome patients, but the mode of action remains unclear. It has been hypothesized that taping brings about subtle changes in the internal physiological environment of the joint. It could be expected that in normal joints taping would bring about a measurable change in function, as the joint is no longer operating in an optimal physiological environment. 10 normal female subject’s (21.4 ± 1.2 years) vastus medialis oblique (VMO) and vastus laterialis (VL) EMG activity and knee kinematics (peak stance flexion angle and angular velocity) were assessed during a step descent, with and without a taped patella. The effect of taping was to significantly decrease VMO and VL EMG activity. Taping also significantly reduced peak stance phase knee flexion and peak stance phase knee flexion angular velocity. In normal asymptomatic subjects patella taping created a situation in which their performance was changed to one similar to that of the pathological patellofemoral pain syndrome population. It would appear that taping caused the joint to function sub-optimally supporting the hypothesis that taping could change the functioning of the patellofemoral joint.     

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

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

The VMO:VL activation ratio while squatting with hip adduction is influenced by the choice of recording electrode

Concomitant hip adduction during squatting has long been advocated as a rehabilitative method to preferentially activate the VMO in persons with patellofemoral pain. This practice however has been based on research using surface electrodes which are prone to crosstalk from neighboring muscles (i.e., adductor magnus). This study sought to determine whether activation levels of the VMO relative to the VL while squatting with hip adduction would differ based on the choice of recording electrode. Ten healthy subjects performed a maneuver with hip adduction and without hip adduction. The mean VMO and VL activation levels were recorded simultaneously with surface and indwelling fine-wire electrodes. For both recording electrodes, the VMO and VL activity increased significantly with the addition of hip adduction (p < 0.05). However, the increase in VMO activation was more pronounced with surface electrodes, resulting in a significantly higher VMO:VL ratio with the incorporation of hip adduction compared to without hip adduction (p < 0.05). No difference in the VMO:VL ratio was observed between the two squat conditions for the fine-wire electrodes (p > 0.05). Our findings suggest that the VMO:VL activation ratio when squatting with hip adduction is influenced by electrode choice.     

Repeatability of maximal voluntary force and of surface EMG variables during voluntary isometric contraction of quadriceps muscles in healthy subjects

The repeatability of initial values and rate of change of EMG signal mean spectral frequency (MNF), average rectified values (ARV), muscle fiber conduction velocity (CV) and maximal voluntary contraction (MVC) was investigated in the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles of both legs of nine healthy male subjects during voluntary, isometric contractions sustained for 50 s at 50% MVC. The values of MVC were recorded for both legs three times on each day and for three subsequent days, while the EMG signals have been recorded twice a day for three subsequent days. The degree of repeatability was investigated using the Fisher test based upon the ANalysis Of VAriance (ANOVA), the Standard Error of the Mean (SEM) and the Intraclass Correlation Coefficient (ICC).

Data collected showed a high level of repeatability of MVC measurement (normalized SEM from 1.1% to 6.4% of the mean). MNF and ARV initial values also showed a high level of repeatability (ICC>70% for all muscles and legs except right VMO). At 50% MVC level no relevant pattern of fatigue was observed for the VMO and VL muscles, suggesting that other portions of the quadriceps might have contributed to the generated effort. These observations seem to suggest that in the investigation of muscles belonging to a multi-muscular group at submaximal level, the more selective electrically elicited contractions should be preferred to voluntary contractions.     

EMG versus oxygen uptake during cycling exercise in trained and untrained subjects.

The aim of this study was to test the hypothesis that bicycle training may improve the relationship between the global SEMG energy and VO2. We already showed close adjustment of the root mean square (RMS) of the surface electromyogram (SEMG) to the oxygen uptake (VO2) during cycling exercise in untrained subjects. Because in these circumstances an altered neuromuscular transmission which could affect SEMG measurement occurred in untrained individuals only, we searched for differences in the SEMG vs. VO2 relationship between untrained subjects and well-trained cyclists. Each subject first performed an incremental exercise to determine VO2max and the ventilatory threshold, and second a constant-load threshold cycling exercise, continued until exhaustion. SEMG from both vastus lateralis muscles was continuously recorded. RMS was computed. M-Wave was periodically recorded. During incremental exercise: (1) a significant non-linear positive correlation was found between RMS increase and VO2 increase in untrained subjects, whereas the relationship was best fitted by a straight line in trained cyclists; (2) the RMS/VO2 ratio decreased progressively throughout the incremental exercise, its decline being significantly and markedly accentuated in trained cyclists; (3) in untrained subjects, significant M-wave alterations occurred at the end of the trial. These M-wave alterations could explain the non-linear RMS increase in these individuals. During constant-load exercise: (1) after an initial increase, the VO2 ratio decreased progressively to reach a plateau after 2 min of exercise, but no significant inter-group differences were noted; (2) no M-wave changes were measured in the two groups. We concluded that the global SEMG energy recorded from the vastus lateralis muscle is a good estimate of metabolic energy expenditure during incremental cycling exercise only in well-trained cyclists.     

Activation of vastus medialis obliquus among individuals with patellofemoral pain syndrome

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

Analysis on the activation of the VMO and VLL muscles during semisquat exercises with and without hip adduction in individuals with patellofemoral pain syndrome

Objective: The purpose of this study was to investigate the effect of hip adduction on the activity of the Vastus Medialis Obliquus (VMO) and Vastus Lateralis Longus (VLL) muscles during semisquat exercises.

Methods: Twenty female subjects, divided into two groups comprising healthy and patellofemoral pain syndrome (PFPS) subjects (ten volunteers for each group), performed three double-leg semisquat exercise trials with maximum hip adduction isometric contraction (DLSS-HA) and three double-leg semisquat exercise trials without hip adduction (DLSS). The normalized electromyographic muscle data were analysed using Repeated Measure ANOVA (p  0.05).

Results: The electrical activity of both VMO and VLL muscles was significantly greater during DLSS-HA exercise than during DLSS (p = 0.0002) for both groups. Additionally, an independent Repeated Measure ANOVA revealed that the electric activity of the VLL muscle was significantly greater (p = 0.0149) than that of the VMO muscle during DLSS exercises only for the PFPS group. However, no differences were found during DLSS-HA exercises.

Conclusions: Although there was no preferential VMO muscle activation, the association of hip adduction with squat exercise promoted a greater balance between the medial and lateral portions of the quadriceps femoris muscle and could be indicated for the conservatory treatment of PFPS patients. The association of isometric hip adduction with isometric semisquat exercises produced a more overall quadriceps activity and could be indicated for clinical rehabilitation or muscle strengthening programs.     

Agonist-antagonist common drive during fatiguing knee extension efforts using surface electromyography.

AIM: This study examined the electromyographic (EMG) activity of knee extensor agonists and a knee extensor antagonist muscle during fatiguing isometric extensions across a range of force levels. METHODS: Five female subjects performed isometric knee extensions at 25%, 50%, 75% and 100% of their maximal voluntary contraction (MVC) with the knee flexed to 75 degrees. Surface EMG (SEMG) was recorded with bipolar electrodes from the vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF) and biceps femoris (BF) and the root-mean-squared (RMS) amplitude and the percentage frequency compression of these recordings were calculated. Commonality and cross talk between recordings were also examined. RESULTS: Cross talk between recordings was deemed negligible despite significant levels of commonality between the agonist and antagonist SEMG, which was attributed to common drive. SEMG RMS amplitude increased significantly for all muscles during the 25%, 50%, 75% MVC knee extensions until task failure, and decreased significantly for 100% MVC. The frequency spectrum of the SEMG compressed significantly for all muscles and % MVC levels. The VM, VL and BF SEMG recordings responded similarly to fatigue. The RF's frequency spectrum compressed to a significantly higher degree. CONCLUSIONS: The VM, VL, RF, and BF fatigue in parallel, with high similarity between VM, VL and BF, giving support to the concept of a shared agonist-antagonist motoneuron pool.     

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

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

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

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

The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles

The purpose of this study was to measure the relative contributions of 4 hip and thigh muscles while performing squats at 3 depths. Ten experienced lifters performed randomized trials of squats at partial, parallel, and full depths, using 100-125% of body weight as resistance. Electromyographic (EMG) surface electrodes were placed on the vastus medialis (VMO), the vastus lateralis, (VL), the biceps femoris (BF), and the gluteus maximus (GM). EMG data were quantified by integration and expressed as a percentage of the total electrical activity of the 4 muscles. Analysis of variance (ANOVA) and Tukey post hoc tests indicated a significant difference (p < 0.001*, p = 0.056**) in the relative contribution of the GM during the concentric phases among the partial- (16.9%*), parallel- (28.0%**), and full-depth (35.4%*) squats. There were no significant differences between the relative contributions of the BF, the VMO, and the VL at different squatting depths during this phase. The results suggest that the GM, rather than the BF, the VMO, or the VL, becomes more active in concentric contraction as squat depth increases.     

Surface electromyography as a tool to assess the responses of car passengers to lateral accelerations. Part II: Objective comparison of vehicles

The purpose of this study was to objectively assess the response of car passengers to lateral accelerations. Surface EMG signals were collected bilaterally from the cervical erector spinae (CES), latissimus dorsi (LD), erector spinae (ES), external oblique (EO), and vastus lateralis (VL) muscles of 10 subjects. Lateral acceleration was also recorded. Three chassis-seat configurations AA, BA and BB were tested, with the first letter denoting the chassis and the second the seat. SEMG signals were often contaminated by noise, and were, therefore, denoised using the methods explained in part I. Reciprocal phasic activity was observed for all muscles except for the EO, and the reaction of passengers to lateral accelerations was interpreted as a bust torsion. The RMS of EMG segments was used as an indication of muscle activity. Muscle activation of VL and ES were significantly affected by the configuration tested (p < 0.05), with greater activation levels observed for the chassis A than for the chassis B. Such a finding implies that greater roll requires greater muscle activity, thus resulting in less comfortable vehicles. Therefore, SEMG can be used to provide an objective measure of discomfort in passengers subjected to lateral accelerations in a car seat.     

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

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

The effects of electrode placement and innervation zone location on the electromyographic amplitude and mean power frequency versus isometric torque relationships for the vastus lateralis muscle.

The purposes of this investigation were to examine the effects of electrode placement and innervation zone (IZ) location on: (a) the torque-related patterns of responses for absolute and normalized electromyographic (EMG) amplitude and mean power frequency (MPF) and (b) the mean absolute and normalized EMG amplitude and MPF values. In addition, the present study examined the variability between subjects for the location of the IZ for the vastus lateralis (VL). Eight men (mean+/-SD age=23.0+/-4.3yr) performed submaximal to maximal isometric muscle actions of the dominant leg extensors. During each muscle action, fifteen channels of bipolar surface EMG signals were detected from the vastus lateralis using a linear electrode array aligned with the long axis of the muscle fibers. The results indicated that there were differences among channels 1-15 for the patterns of responses and mean values for absolute and normalized EMG amplitude and MPF versus isometric torque. Thus, normalized EMG amplitude and MPF values from different individuals cannot be compared if the EMG signals were detected from different locations over the muscle. In addition, absolute and relative (to femur length) estimates of IZ location for the VL resulted in similar inter-subject variability.