The purpose of this study was to determine the effect of contralateral hip adduction (CHA) on thickness of lumbar stabilizers during hip abduction in side-lying. Twenty healthy subjects without back pain were recruited for this study. The thickness of transverse abdominis (TrA), internal oblique (IO) and quadratus lumborum (QL) were measured by ultrasonography. Pelvic lateral tilting motion was measured using a three-dimensional motion analysis system. Measurements were performed at rest position (RP), preferred hip abduction (PHA) and abduction with contralateral hip adduction (CHA) in side-lying at the end of expiration. During the measurements, subjects were asked to maintain steady trunk alignment without hand support. Thickness of TrA and IO was significantly greater in CHA than in PHA and RP conditions. There was no significant difference in thickness of TrA and IO between PHA and RP conditions. Medio-lateral (M-L) thickness of QL was not significant between PHA and CHA conditions. Anterio-posterior (A-P) thickness of QL in PHA and CHA significantly decreased compared to RP condition. Angle of pelvic lateral tilting was significantly decreased in CHA compared to PHA condition. In conclusion, CHA can be recommended for increasing trunk stability without compensatory pelvic motion during hip abduction exercise in side-lying.

The lumbrical muscles contribute to the intrinsic plus position, that is simultaneous metacarpophalangeal (MCP) flexion and interphalangeal (IP) extension. The strength of the lumbrical muscles is necessary for normal hand function. However, there is no objective and efficient method of strength measurement for the lumbrical muscles. In addition, previous studies have not investigated the measurement of the cross-sectional area (CSA) of the lumbrical muscles using ultrasonography (US) and the relationship between lumbrical muscle strength in the intrinsic plus position and the CSA. Therefore, the purpose of this study was to identify the measurement method of the CSA of the lumbrical muscles using US and to examine the relationship between maximal isometric strength and the CSA of lumbrical muscles. Nine healthy males participated in this study. Maximal isometric strength of the second, third, and fourth lumbrical muscles was assessed using a tensiometer in the intrinsic plus position which isolated MCP flexion and IP extension. The CSA of the lumbrical muscles was measured with an US. The US probe was applied on the palmar aspect of the metacarpal head with a transverse view of the hand in resting position. There was no significant difference between maximal isometric strength of the lumbrical muscles, but the fourth lumbrical muscle was stronger than the others. The CSA of the lumbrical muscles was significantly different and the fourth lumbrical muscle was significantly larger than the second lumbrical muscle. There was moderate to good correlation between maximal isometric strength and the CSA of the lumbrical muscles. Therefore, we conclude that maximal isometric strength of the lumbrical muscles was positively correlated to the CSA of the lumbrical muscle in each finger, while the measurement of the CSA of the lumbrical muscles, using US protocol in this study, was useful for measuring the CSA of the lumbrical muscles.

This study compared the stability of the cervical spine according to the presence of neck pain and deep neck flexor performance. Thirty subjects with neck pain, and thirty subjects without neck pain were recruited for this study. The Cranio-cervical flexion (CCF) test was applied using a pressure biofeedback unit to classify the subjects into four subgroups; no cervical pain and good deep neck flexor performance (NG group), no cervical pain and poor deep neck flexor performance (NP group), cervical pain and good deep neck flexor performance (PG group), and cervical pain and poor deep neck flexor performance (PP group). The head sway angle was measured using a three-dimensional motion analysis system. A 3-kg weight was used for external perturbation with the subject sitting in a chair in the resting and erect head positions with voluntary contraction of the deep neck flexors. A one-way analysis of variance (ANOVA) was performed with a Bonferroni post hoc test. The deep neck flexor performance differed significantly among the four groups (p<.05). The NG group had significantly greater deep neck flexor performance than NP and PP groups. The stability of the cervical spine also differed significantly among the four groups in the resting head position (p<.05). The head sway angle was significantly smaller in NG group as compared with the other groups. The PP group had the greatest head sway angle in the resting head position. However, there was no significant difference in the stability of the cervical spine among the groups in the erect head position with voluntary contraction of deep neck flexors (p=.57). The results of this study suggest that the deep neck flexor performance is important for maintaining the stability of cervical spine from external perturbation.

The purpose of this study was to assess the agreement of manual muscle testing (MMT) and test-retest reliability of a hand held dynamometer for the posterior gluteus medius muscle, with and without lumbar stabilization, using a pressure biofeedback unit for patients with low back pain. The pressure biofeedback unit was used to minimize the substitute motion of the lumbopelvic region during hip abduction in patients lying on their side. Fifteen patients with low back pain participated in this study. A tester determined the MMT grades of the posterior gluteus medius with and without the pressure biofeedback unit. Active hip abduction range of motion with an inclinometer and the strength of their posterior gluteus medius using a hand held dynamometer were measured with and without the pressure biofeedback unit in the MMT position. The agreement of the grade of muscle strength in the MMT, and intra-rater reliability of both the active hip abduction range of motion and the strength of posterior gluteus medius were analyzed using the weighted kappa and intraclass correlation coefficient (ICC), respectively. The agreement of MMT with the pressure biofeedback unit (weighted kappa=.92) was higher than the MMT (weighted kappa=.34)(p<.05). The inclinometer with pressure biofeedback unit measurement of the active hip abduction range of motion had an excellent intra-rater reliability (ICC=.90). Also, the hand held dynamometer with pressure biofeedback unit measure of strength of the posterior gluteus medius had a good intra-rater reliability (ICC=.85). Therefore, the test for muscle strength with pressure biofeedback unit will be a reliable method for the determination of the MMT grades or amount of posterior gluteus medius muscle strength and the measurement of the range of motion for hip abduction in patients with low back pain.

The purpose of this study was to compare electromyography (EMG) activity for the middle and lower trapezius muscle according to various shoulder abduction angles. Thirty healthy male subjects were recruited for this study. Each subject performed three repetitions of horizontal abduction at 75˚, 90˚, 125˚, 160˚, and 180˚ of shoulder abduction angle in a prone position. Surface EMG activity was recorded from the middle and lower trapezius while the subjects held for five seconds at a predetermined position. The EMG activity was normalized using the maximal voluntary isometric contraction (MVIC) elicited using a manual muscle testing technique. A repeatedly measured ANOVA was performed by Bonferroni's post hoc test. The EMG activity of the middle and lower trapezius was significantly different among shoulder abduction angles (p<.05). The greatest level of muscle activity for the middle and lower trapezius were demonstrated at and of shoulder abduction angle, respectively. These results suggest that middle and lower trapezius strengthening exercise and manual muscle testing should be performed at different shoulder abduction angles.

The aim of this study was to compare electromyography activity for long and lateral heads of triceps brachii muscle according to forearm positions during different triceps strengthening exercises. The muscle activities for long and lateral head of triceps brachii were measured by surface electromyography. Fifteen healthy volunteers participated for this study and performed elbow extension in three different elbow extension exercises (elbow extension in a supine position; EES, elbow extension with shoulder abduction at 90 degrees in a prone position; EESA, and elbow extension with one arm at the side of the trunk in a prone position; EESP) and forearm positions (supination, neutral, and pronation). A two-way repeated measures ANOVA was used to compare the effects of the exercise positions and forearm positions. The EMG activities of the long head of the triceps brachii increased significantly during EESP with forearm supination, whereas the activity of the lateral head of the triceps brachii increased significantly during EESA with the forearm in a neutral position (p<.05). The results of this study suggest that exercise positions and forearm positions should be considered for selectively strengthening the long and lateral heads of triceps brachii muscles.

The purpose of this study was to investigate the effects of a workplace-based work-conditioning program (WCP) on the management of work-related musculoskeletal disorders (WRMDs) in an automobile-parts manufacturing company. In total, 1,110 subjects with WRMDs participated in workplace-based WCP emphasizing function-centered management and ergonomics. We investigated the incidence of WRMDs variables (number of persons diagnosed with industrial accident-related WHMDs, number of cases of WRMD) and financial benefits (cost of workers' compensation insurance and lost work days related to WRMDs) per year before and after WCP. Additionally, we compared self-reported pain intensity and functional disability in subjects with musculoskeletal pain before and after the WCP. Pain intensity was measured using a visual analog scale (VAS), and functional disability was measured by the neck disability index (NDI) and the Oswestry disability Index (ODI). The number of person diagnosed with industrial accident-related WRMDs, the number of cases of WRMD, the cost of workers' compensation insurance and lost work days related to WRMDs per year decreased by 51%, 37%, 34%, and 47%, respectively, and VAS, NDI, and ODI scores decreased significantly after implementation of WCP (p<.05). Thus, the results of the present study suggest that function-centered, workplace-based WCP was effective in managing WRMDs at an automobile-parts manufacturing company.

The purpose of this study was to measure intra-rater and inter-rater reliability and range of motion for measurement of passive shoulder internal rotation range of motion and to compare anterior glide distance of humeral head in three methods. Fifty healthy subjects and fifty patients with shoulder musculoskeletal pain were recruited for this study. The subjects' passive shoulder internal rotation range of motion was measured by visual estimation, manual stabilization, and pressure biofeedback unit methods. In two trials, measurements were performed on each subject by two examiners. Intraclass correlation coefficient (ICC(3,1)) was used to determine the reliability of each measurement. The intra-rater reliability of the three methods was excellent (ICC=.77~.93) in both groups. The inter-rater reliability of the visual estimation method was poor (ICC=.20, .29), the manual scapular stabilization method was poor and fair (ICC=.09, .50), and the pressure biofeedback unit method was excellent (ICC .86, .75) in the experimental and control groups. In the experimental group, the difference of examined range of motion by each examiner was significant in the visual estimation method and manual scapular stabilization method, but there was an insignificant difference between the groups is the pressure biofeedback unit method. This result suggests that the intra-rater and inter-rater reliability of a pressure biofeedback unit was better than the other methods. The difference in distance of the anterior glide of humeral head was insignificant among all the methods. The pressure biofeedback unit method was the most reliable method, so it is proposed to be a new and reliable method to measure internal rotation range of motion.

The purpose of this study was to compare EMG activity for pectoralis major muscle during shoulder movement with various abduction angle and rotation position in supine position. Fifteen healthy subjects were recruited for this study. All subjects performed shoulder horizontal adduction holding a 2 kg dumbbell in shoulder abduction 40˚, 70˚, 90˚, 130˚, 160˚ with shoulder neutral, internal rotation (IR), and external rotation (ER). Surface EMG activity was recorded from pectoralis major clavicle part and pectoralis major sternum part for 5 seconds and EMG activity was normalized to the value of maximal voluntary isometric contraction (%MVIC). Dependent variables were examined with 3 (Neutral, IR, ER) 5 (40˚, 70˚, 90˚, 130˚, 160˚) analysis of variance with repeated measures. The EMG activity of pectoralis major muscle was significantly different between shoulder abduction angles and between shoulder rotation positions (p<.05). The highest value of EMG activity of pectoralis major clavicle part among shoulder abduction angles was in 70˚ and, 90˚ in that order. The highest value of EMG activity of pectoralis major sternum part among shoulder abduction angles was in and 130˚, 90˚ in that order. According to the rotation degree, shoulder ER showed the highest value and IR showed the lowest value in both muscle parts. These results suggest that shoulder abduction 70˚, 90˚, 130˚ will be effective during manual muscle testing (MMT) and strengthening exercise for pectoralis major muscle. It is also supposed that shoulder ER is the efficient posture for strengthening of pectoralis major muscle.

The purpose of this study was to examine contraction of abdominal muscles on surface electromyographic (EMG) activity of superficial cervical flexors, rib cage elevation and angle of craniocervical flexion during deep cervical flexion exercise in supine position. Fifteen healthy subjects were participated for this study. All subjects performed deer cervical flexion exercise with two methods. The positions of two methods were no volitional contraction of abdominal muscles in hook-lying position with 45 degree hip flexion (method 1) and 90 degrees hip and knee flexion with feet off floor for inducing abdominal muscle contraction (method 2). Surface EMG activities were recorded from five muscles (sternocleidmastoid, anterior scaleneus, recuts abdominis, external oblique, internal oblique). And distance of rib cage elevation and angle of craniocervical flexion were measured using a three dimensional motion analysis system. The EMG activity of each muscle was normalized to the value of reference voluntary contraction (%RVC). The EMG activities, distance of rib cage elevation. and angle of craniocervical were compared using a paired t-test between two methods. The results showed that the EMG activities of sternocleidmastoid and anterior scaleneus during deep cervical flexion exercise in method 2 were significantly decreased compared to method 1 (p<.05). Distance of rib cage elevation and angle of craniocervical flexion were significantly decreased in method 2 (p<.05). The findings of this study indicated that deep cervical flexion exercise with contraction of abdominal muscles could be an effective method to prevent substitute motion for rib cage elevation and contraction of superficial neck flexor muscles.

The purpose of this study was to measure intrarater and interrater reliability of a portable digital pressure algometer. Fifty healthy subjects were recruited for this study. Pressure pain thresholds of splenius capitis, levator scapular, and upper trapezius muscles were measured using by FPK algometer and portable digital pressure algometer. Three trials were done on each subject by two examiners. Intraclass correlation coefficients (ICCs) were used to determine the reliability of each measure. The intrarater reliability of the FPK algometer was good and excellent (ICC .63~.79) and the interrater reliability was poor and good (ICC .15~.57). The intrarater reliability of a portable digital pressure algometer was excellent (ICC .75~.86) and the interrater reliability was poor and good (ICC .35~.61). This result suggests that the intrarater reliability and interrater reliability of a portable digital pressure algometer were better than an FPK algometer.

To improve abdominal muscles strengthening, double straight leg lowering (DSLL) has been widely used in physical therapy, fitness program, and athletic program. The purpose of this study was to investigate the effects of the lumbar stabilization maneuver with a pressure biofeedback unit on the muscle activity of rectus abdominis (RA), external oblique (EO), and internal oblique (IO) during DSLL. Fourteen healthy young men were recruited from university population. The electromyography (EMG) activity was recorded from the RA, EO, and IO of both sides. The normalized EMG activity was compared using a paired t-test. The study showed that EMG activity in the RA, EO, and IO was significantly higher during DSLL with lumbar stabilization (DSLL-LS) compared to performed DSLL (p<.05). These results suggest that DSLL-LS is recommended as an effective method for strengthening exercise for the abdominal muscles.

The purpose of this study was to determine the influence of muscle fatigue in elbow flexors on the sense of force reproduction. Fifteen healthy subjects were recruited for this study. Maximum voluntary force (MVF) of elbow flexor muscles was measured by a digital tensiometer. Force errors were measured to test accuracy of the sense of force reproduction in elbow flexors. The subject was required to flex the elbow joint, to maintain and concentrate on about 20% of the MVF target force under visual feedback for 3 seconds. After a 5 second period rest, the subject was asked to duplicate the target force actively. Muscle fatigue was evoked with isometric contraction of the elbow flexors. Isometric contraction was continued until a 50% drop in MVF. The difference, in kilogram between the target force and the reproduced force was calculated for measuring force error. Force errors were compared between the non-fatigued condition and the fatigued condition by the paired t-test. Force errors were significantly increased in the fatigued condition compare to non-fatigued condition. This result suggests that the sense of force reproduction can be disturbed by localized muscle fatigue.

The purpose of this study was to identify the effect of the hip internal rotation on gluteal and erector spinae muscle electromyographic (EMG) activity during treadmill walking. Eleven healthy subjects were recruited. All subjects performed treadmill walking while maintaining the hip in neutral position (condition 1) and in internal rotation (condition 2). Surface EMG activity was recorded from four muscles (gluteus maximus (GM), gluteus medius (GMED), tensor fascia latae (TFL), and erector spinae (ES)) and the hip internal rotation angle was measured using a three dimensional motion analysis system. The gait cycle was determined with two foot switches, and stance phase was normalized as 100% stance phase (SP) for each condition using the MatLab 7.0 program. The normalized EMG activities according to the hip rotation (neutral or internal rotation) were compared using a paired t-test. During the entire SP of treadmill walking, the EMG activities of GM in condition 1 were significantly greater than in condition 2 (p<.05). The EMG activities of TFL and ES in condition 2 were significantly greater than in condition 1 (p<.05). The EMG activities of the GMED in condition 1 were significantly greater than in condition 1 (p>.05) except for 80~100% SP. Further studies need randomized control trials regarding the effect of hip internal rotation on the hip and lumbar spine muscle activity. Kinetic variables during gait or going up and down stairs are also needed.