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Concept: Flexion


Back extension exercises are often used in the rehabilitation of low back pain. However, at present it is not clear how the posterior muscles are recruited during different types of extension exercises. Therefore the present study will evaluate the myoelectric activity of thoracic, lumbar and hip extensor muscles during different extension exercises in healthy persons. Based on these physiological observations we will make recommendations regarding the use of extensions exercises in clinical practice.

Concepts: Spinal disc herniation, Hip, Thigh, Flexion, Extension


BACKGROUND: A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature. METHODS: Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program. RESULTS: An median increase of 0.07 (Range [-0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support. CONCLUSIONS: For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance.

Concepts: Knee, Sartorius muscle, Flexion, Extension, Semitendinosus muscle, Semimembranosus muscle, Popliteus muscle, Musculoskeletal system


It has been suggested that deep squats could cause an increased injury risk of the lumbar spine and the knee joints. Avoiding deep flexion has been recommended to minimize the magnitude of knee-joint forces. Unfortunately this suggestion has not taken the influence of the wrapping effect, functional adaptations and soft tissue contact between the back of thigh and calf into account. The aim of this literature review is to assess whether squats with less knee flexion (half/quarter squats) are safer on the musculoskeletal system than deep squats. A search of relevant scientific publications was conducted between March 2011 and January 2013 using PubMed. Over 164 articles were included in the review. There are no realistic estimations of knee-joint forces for knee-flexion angles beyond 50° in the deep squat. Based on biomechanical calculations and measurements of cadaver knee joints, the highest retropatellar compressive forces and stresses can be seen at 90°. With increasing flexion, the wrapping effect contributes to an enhanced load distribution and enhanced force transfer with lower retropatellar compressive forces. Additionally, with further flexion of the knee joint a cranial displacement of facet contact areas with continuous enlargement of the retropatellar articulating surface occurs. Both lead to lower retropatellar compressive stresses. Menisci and cartilage, ligaments and bones are susceptible to anabolic metabolic processes and functional structural adaptations in response to increased activity and mechanical influences. Concerns about degenerative changes of the tendofemoral complex and the apparent higher risk for chondromalacia, osteoarthritis, and osteochondritis in deep squats are unfounded. With the same load configuration as in the deep squat, half and quarter squat training with comparatively supra-maximal loads will favour degenerative changes in the knee joints and spinal joints in the long term. Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity. Contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues.

Concepts: Vertebral column, Cartilage, Osteoarthritis, Knee, Joint, Flexion, Extension, Semimembranosus muscle


Why do some hamstring and quadriceps strains take much longer to repair than others? Which injuries are more prone to recurrence? Intramuscular tendon injuries have received little attention as an element in ‘muscle strain’. In thigh muscles, such as rectus femoris and biceps femoris, the attached tendon extends for a significant distance within the muscle belly. While the pathology of most muscle injures occurs at a musculotendinous junction, at first glance the athlete appears to report pain within a muscle belly. In addition to the musculotendinous injury being a site of pathology, the intramuscular tendon itself is occasionally injured. These injuries have a variety of appearances on MRIs. There is some evidence that these injuries require a prolonged rehabilitation time and may have higher recurrence rates. Therefore, it is important to recognise the tendon component of a thigh ‘muscle strain’.

Concepts: Muscle, Strain, Injuries, Injury, Flexion, Extension, Sprain, Thigh muscles


Hamstring strain injuries are amongst the most common and problematic injuries in a wide range of sports that involve high speed running. The comparatively high rate of hamstring injury recurrence is arguably the most concerning aspect of these injuries. A number of modifiable and nonmodifiable risk factors are proposed to predispose athletes to hamstring strains. Potentially, the persistence of risk factors and the development of maladaptations following injury may explain injury recurrence. Here, the role of neuromuscular inhibition following injury is discussed as a potential mechanism for several maladaptations associated with hamstring re-injury. These maladaptations include eccentric hamstring weakness, selective hamstring atrophy and shifts in the knee flexor torque-joint angle relationship. Current evidence indicates that athletes return to competition after hamstring injury having developed maladaptations that predispose them to further injury. When rehabilitating athletes to return to competition following hamstring strain injury, the role of neuromuscular inhibition in re-injury should be considered.

Concepts: Strain, Knee, Injuries, Injury, Flexion, Potential, Hamstring, Sprain


The squat is a closed-chain lower body exercise commonly performed by many athletes. Muscle activity has been examined during partial and parallel squats in male weightlifters, but not in male and female runners. Therefore, this study measured muscle activity with surface electromyography (EMG) during partial and parallel squats in 20 Division I collegiate cross-country runners (10 males and 10 females) in a randomized crossover design. We hypothesized the parallel squat would increase extensor muscle activitation (i.e., hamstrings and erector spinae). Furthermore, we sought to determine if changes in muscle activity were different between males and females. Participants performed 6 repetitions using their 10 repetition maximum loads for each condition during EMG testing. EMG was performed on the right rectus femoris, biceps femoris, lumbar erector spinae, and lateral head of the gastrocnemius. Rectus femoris activity (0.18±0.01 vs. 0.14±0.01 mV) and erector spinae activity (0.16±0.01 vs. 0.13±0.01 mV) were significantly higher (p<0.05) during the parallel squat than during the partial squat condition. This increase in muscle activity may be attributed to greater ranges of motion at the hip and knee joints. Biceps femoris and gastrocnemius activity were similar between conditions. No significant differences existed between males and females (squat condition x gender; p>0.05). During preliminary isokinetic testing, both male and female runners demonstrated deficient hamstrings-to-quadriceps ratios, which would not likely improve by performing parallel squats based on our EMG findings. Despite the reduced load of the parallel squat, rectus femoris and erector spinae activity were elevated. Thus, parallel squats may help runners to train muscles vital for uphill running and correct posture, while preventing injury by using lighter weights through a larger range of motion.

Concepts: Male, Female, Gender, Sex, Knee, Electromyography, Flexion, Extension


Hooper, DR, Szivak, TK, DiStefano, LJ, Comstock, BA, Dunn-Lewis, C, Apicella, JM, Kelly, NA, Creighton, BC, Volek, JS, Maresh, CM, and Kraemer, WJ. Effects of resistance training fatigue on joint biomechanics. J Strength Cond Res 27(1): 146-153, 2013-Resistance training has been found to have a multitude of benefits. However, when performed with short rest, resistance training can result in substantial fatigue, which may have a negative impact on exercise technique. The purpose of this study is to examine the effects of fatigue from resistance exercise on joint biomechanics to determine what residual movement effects may exist after the workout. Twelve men with at least 6 months of resistance training experience (age 24 ± 4.2 years, height 173.1 ± 3.6 cm, weight 76.9 ± 7.8 kg) performed 5 body weight squats before (pretest) and after (posttest) a highly fatiguing resistance training workout. Lower extremity biomechanics were assessed using a 3-dimensional motion analysis system during these squats. Peak angle, total displacement, and rate were assessed for knee flexion, trunk flexion, hip flexion, hip rotation, and hip adduction. Results showed a significant decrease in peak angle for knee flexion (Pre: 120.28 ± 11.93°, Post: 104.46 ± 9.85°), hip flexion (Pre: -109.42 ± 12.49°, Post: -95.8 ± 12.30°), and hip adduction (Pre: -23.32 ± 7.04°, Post: -17.30 ± 8.79°). There was a significant reduction in angular displacement for knee flexion (Pre: 115.56 ± 10.55°, Post: 103.35 ± 10.49°), hip flexion (Pre: 97.94 ± 10.69°, Post: 90.51 ± 13.22°), hip adduction (Pre: 17.79 ± 7.36°, Post: 11.89 ± 4.34°), and hip rotation (Pre: 30.72 ± 12.28, Post: 20.48 ± 10.12). There was also a significant reduction in displacement rate for knee flexion (Pre: 2.20 ± 0.20, Post: 1.98 ± 0.20), hip flexion (Pre: 1.92 ± 0.20, Post: 1.76 ± 0.27), hip adduction (Pre: -0.44 ± 0.17, Post: -0.31 ± 0.17), and hip rotation (Pre: 0.59 ± 0.23, Post: 0.38 ± 0.21). This study demonstrated that there are lasting residual effects on movement capabilities after a high-intensity short rest protocol. Thus, strength and conditioning coaches must be careful to monitor movements and exercise techniques after such workouts to prevent injury and optimize subsequent exercise protocols that might be sequenced in order.

Concepts: Physical exercise, Exercise, Knee, Strength training, Weight training, Resistance training, Flexion, Gracilis muscle


Forelimb posture has been a controversial aspect of reconstructing locomotor behaviour in extinct quadrupedal tetrapods. This is partly owing to the qualitative and subjective nature of typical methods, which focus on bony articulations that are often ambiguous and unvalidated postural indicators. Here we outline a new, quantitatively based forelimb posture index that is applicable to a majority of extant tetrapods. By determining the degree of elbow joint adduction/abduction mobility in several tetrapods, the carpal flexor muscles were determined to also play a role as elbow adductors. Such adduction may play a major role during the stance phase in sprawling postures. This role is different from those of upright/sagittal and sloth-like creeping postures, which, respectively, depend more on elbow extensors and flexors. Our measurements of elbow muscle moment arms in 318 extant tetrapod skeletons (Lissamphibia, Synapsida and Reptilia: 33 major clades and 263 genera) revealed that sprawling, sagittal and creeping tetrapods, respectively, emphasize elbow adductor, extensor and flexor muscles. Furthermore, scansorial and non-scansorial taxa, respectively, emphasize flexors and extensors. Thus, forelimb postures of extinct tetrapods can be qualitatively classified based on our quantitative index. Using this method, we find that Triceratops (Ceratopsidae), Anhanguera (Pterosauria) and desmostylian mammals are categorized as upright/sagittally locomoting taxa.

Concepts: Knee, Reptile, Hip, Qualitative research, Flexion, Extension, Tetrapod, Semitendinosus muscle


The aim of this study was to investigate the acute effects of static and dynamic stretching on explosive power, flexibility and sprinting ability of adolescent boys and girls and report possible gender interactions. Forty-seven active adolescent boys and girls were randomly tested following static and dynamic stretching of 40 s on quadriceps, hamstrings, hip extensors and plantar flexors; no stretching was performed at the control condition. Pre- and post-treatment tests examined the effects of stretching on 20 m sprint run (20 m), countermovement jump height (CMJ) and sit and reach flexibility test (SR). In terms of performance static stretching hindered 20 m and CMJ in boys and girls by 2.5% and 6.3% respectively. Dynamic stretching had no effect on 20m in boys and girls but impaired CMJ by 2.2%. In terms of flexibility both static and dynamic stretching improved performance with static stretching being more beneficial (12.1%) compared to dynamic (6.5%). No gender interaction was found. It can therefore be concluded that static stretching significantly negates sprinting performance and explosive power in adolescent boys and girls, whereas dynamic stretching deteriorates explosive power and has no effect on sprinting performance. This diversity of effects denotes that the mode of stretching used in adolescent boys and girls should be task specific.

Concepts: Effect, Exercise, Torque, English-language films, Flexion, Running, Stretching, Sprint


Previous studies have compared muscle activity between different types of sit-ups and curl-ups. However, few have examined exercises used by the armed forces or investigated the influence of exercise duration on muscle activation. The aim of this study was to compare abdominal and hip flexor activity between the style of sit-up used by the British Army and four variations of a curl-up, at the start, middle and end of a 2 min exercise period. Surface electromyograms (EMGs) were recorded from the upper and lower rectus abdominis, external oblique, transversus abdominis/internal oblique, and the rectus femoris (RF) of 23 British Army personnel. Isometric maximal voluntary contractions were used to normalize integrated EMGs to allow them to be compared between exercises. Curl-ups with arms crossed and feet restrained produced the highest integrated EMG in all of the abdominal muscles (p<0.05). Feet restrained sit-ups and curl-ups also resulted in significantly higher activity in the RF than non-restrained versions of the curl-up (p<0.001). The significant increase observed in muscle activity between the start and the end of the exercises (p<0.001) was deemed to be in response to a reduction in force producing capacity of existing motor units. The RF experienced the greatest increase during exercises that activated the muscle the most; i.e. sit-ups and curl-ups with feet restrained (p<0.001). Previous research has indicated that such exercises produce high shear and compressive forces in the lower back, which can be injurious. Thus, if an organisation wishes to assess the endurance of abdominal muscles, rather than hip flexors, then curl-ups without restraint of the feet should be performed instead of exercises in which the feet are restrained.

Concepts: Muscle, Electromyography, Human anatomy, Flexion, Rectus femoris muscle, Hip flexors, Iliopsoas, British Army