Background: The external rotation (ER) exercise in performed at a 90° abduction of the shoulder joint is an effective to strengthen the infraspinatus. However, failure of the humeral head to control axial rotation during exercise can be increased the posterior deltoid over activity. Biofeedback training is an effective method of promoting motor learning and control it could look forward to activate the infraspinatus selectively by controlling the humeral head during exercise. Objects: The aim of this study was investigated that whether biofeedback for axial rotation was effective to activate selectively the infraspinatus during ER exercise. Methods: The 15 healthy males participated, and all subjects performed both ER exercise in a sitting position with shoulder abducted 90° under conditions with and without axial rotation biofeedback. Exercise was performed in a range of 90° ER, divided into three phases: concentric, isometric, and eccentric. The infraspinatus and posterior deltoid muscle activity were observed using surface electromyography. Results: Both infraspinatus activity (p < 0.01) and infraspinatus to posterior deltoid activity ratio (p = 0.01) were significantly higher with biofeedback however, posterior deltoid activity was significantly lower with biofeedback (p = 0.01). The infraspinatus muscle activity and muscle activity ratio were the highest in the isometric contraction type, and there were significant differences for all contraction types (p < 0.05). Whereas, the posterior deltoid activity was the lowest in the isometric contraction type, and showed a significant difference between isometric and other two contraction types (p < 0.05), but no significant different between concentric and eccentric contraction. Conclusion: Our results indicate that the axial rotation biofeedback during sitting ER exercise might be effective method to activating selective infraspinatus muscle and recommended to enhance the dynamic stability of the shoulder joint.

Previous studies have reported that deep neck flexor (DNF) exercise can improve neck problems, including neck pain, forward head posture, and headache, by targeting the deep and superficial muscles of the neck. Despite the prevailing opinion across studies, the benefits of DNF can vary according to the type of neck problems and the outcome measures adopted, ranging from positive outcomes to non-significant benefits. A meta-analysis was conducted in this study to assess conclusive evidence of the impact of DNF exercise on individuals with neck problems. We used PUBMED, MEDLINE, NDSL, EMBASE, and Web of Science to search for primary studies and the key terms used in these searches were “forward head posture (FHP),” “biofeedback,” “pressure biofeedback unit,” “stabilizer,” “headache,” and “neck pain.” Twenty- four eligible studies were included in this meta-analysis and were coded according to the type of neck problems and outcome measures described, such as pain, endurance, involvement of neck muscle, craniovertebral angle (CVA), neck disability index (NDI), cervical range of motion (CROM), radiographs of the neck, posture, strength, endurance, and headache disability index. The overall effect size of the DNF exercise was 0.489. The effect sizes of the neck problems were 0.556 (neck pain), –1.278 (FHP), 0.176 (headache), and 1.850 (mix). The effect sizes of outcome measures were 1.045 (pain), 0.966 (endurance), 0.894 (deep neck flexor), 0.608 (superficial neck flexor), 0.487 (CVA), 0.409 (NDI), and 0.252 (CROM). According to the results of this study, DNF exercise can effectively reduce neck pain. Thus, DNF exercise is highly recommend as an effective exercise method for individuals suffering from neck pain.

Background: Ipsilateral pelvic elevation has been reported as a common compensatory movement during side-lying hip abduction. It has been reported that pelvic elevation inhibits sufficient contraction of gluteus medius. However, few studies have identified the effects of controlled pelvic elevation on the trunk and hip muscles. Objective: To examine the effects of controlled pelvic elevation using visual biofeedback on the muscle activity of the trunk and hip muscles. Design: Crossover study. Methods: Twelve healthy males performed side-lying hip abduction exercises with and without visual biofeedback for pelvic elevation. Electromyography (EMG) activities of the gluteus medius, quadratus lumborum, and multifidus were analyzed using a wireless EMG system while the ipsilateral pelvic elevation angle was measured using a motion sensor during side-lying hip abduction exercises. Results: EMG activities of the gluteus medius (p = .002), quadratus lumborum (p = .022), and multifidus (p = .020) were significantly increased and ipsilateral pelvic elevation was significantly decreased (p = .001) during side-lying hip abduction with visual biofeedback compared to without visual biofeedback. Conclusions: The results of this study suggest that the application of biofeedback for pelvic motion could improve the trunk and hip muscle activation pattern and decrease compensatory pelvic motion during side-lying hip abduction exercise.

Background: Passive straight leg raising (PSLR) is the common clinical test to measure of hamstring muscle length. Hip flexion angle contributes to change the lumbopelvic rotation during PSLR. Pressure biofeedback unit (PBU) is commonly used to detect lumbopelvic movement during lower limb movements. Thus, there may be the relationship between pressure of PBU and lumbopelvic motion during PSLR. Objects: The objective of this study was to determine the relationship between pressure of PBU and lumbopelvic motion during PSLR. Methods: Thirty two subjects participated in this study. A three-dimensional motion analysis system were used to measure the lumbopelvic angle during PSLR, while recording the pressure of PBU according to angle of PSLR by 10 degree increments. Pearson product moment correlations and linear regression analysis were used to describe the relationship between variables. Results: The results showed that there was a significant relationship between the lumbopelvic and angle of PSLR (Pearson’s r=.83, p<.05), between the pressure of PBU and angle of PSLR (Pearson’s r=.75, p<.05), and between lumbopelvic motion and pressure of PUB (Pearson’s r=.83, p<.05). Linear regression equation using lumbopevic angle as an independent factor was as follows: Pressure of PBU = 47.35 + (2.55 × angle of lumbopelvic motion) (R2=.69, p<.05). Conclusion: Results of the present study indicate that pressure of PBU can be used to indirectly detect the amounts of lumbobevic motion during muscle length test or stretching of hamstring.

Background: Shoulder external rotation exercises are commonly used to improve the stabilizing ability of the infraspinatus. Although the side-lying wiper exercise (SWE) is the most effective shoulder external rotation exercise to maximize infraspinatus activity, the effect of adduction force on the infraspinatus and posterior deltoid has not been demonstrated. Objects: This study was conducted to investigate whether horizontal adduction force increases infraspinatus activity and decreases posterior deltoid activity. Methods: Twenty-eight healthy subjects (male: 21, female: 7; age=23.5±1.8 years; height=170.1±7.4 ㎝; weight=69.4±9.6 ㎏) were recruited. Subjects were asked to perform the SWE under two conditions: (1) general SWE and (2) SWE with adduction force using pressure biofeedback. Surface electromyography (EMG) signals of the infraspinatus and posterior deltoid were recorded during SWE. Paired t-tests were used to compare the EMG activity of the infraspinatus and posterior deltoid between the two conditions. Results: Posterior deltoid muscle activity was significantly decreased following SWE with adduction force (7.53±4.52%) relative to general SWE (11.68±8.42%) (p<.05). However, there was no significant difference in the infraspinatus muscle activity between the SWE with adduction force (28.33±12.16%) and the general SWE (26.54±13.69%) (p>.05). Conclusion: Horizontal adduction force while performing SWE is effective at decreasing posterior deltoid activity.

The purpose of this study was to examine the effects of abdominal hollowing with ultrasound biofeedback on multifidus and transversus abdominis/internal oblique muscle activities during lifting tasks. This study recruited 12 healthy men. All subjects received training on expiration without and with abdominal hollowing with ultrasound biofeedback. After receiving training for each condition, the thickness of transversus abdominis was measured using ultrasound, and then, electromyography activities of transversus abdominis/internal oblique and multifidus during lifting tasks were measured using a surface electromyography system. The differences in thickness of transversus abdominis and electromyography activities of transversus abdominis/ internal oblique and multifidus between the two conditions were analyzed using paired t-test. Thickness of transversus abdominis and transversus abdominis/internal oblique and multifidus activities were significantly increased during expiration with abdominal hollowing with ultrasound biofeedback compared to during expiration without abdominal hollowing (p < 0.05). These findings suggest that abdominal hollowing with ultrasound biofeedback is effective in increasing trunk stabilizer muscle activities during both static and dynamic tasks such as lifting.

Background: The active knee extension (AKE) test commonly used to assess the flexibility of the hamstring muscles. Many researchers have tested the reliability of the AKE test; however, no published studies have examined the intrarater and interrater reliability of the AKE test using a PBU. Objects: The purpose of this study was to determine the intrarater and interrater reliability of the AKE test performed with a pressure biofeedback unit (PBU) on healthy subjects. Methods: Sixteen healthy male participants volunteered and gave informed consent to participate in this study. Two raters conducted AKE tests independently with a PBU. Each knee was measured twice, and the AKE testing was repeated one week after the first round of testing. Results: The interrater reliability’s intraclass correlation coefficients (ICC2,1) were .887∼.986 for the right knees and .915∼.988 for the left knees. In addition, the intrarater (test-retest) reliability (ICC3,1) values ranged between .820∼.915 and .820∼.884 for Raters 1 and 2, respectively. The values for the standard error of mesurement were low for all tests (.81∼2.97˚); the calculated minimum detectable change was 2.24∼8.21˚. Conclusion: These findings suggest that the AKE test performed with a PBU had excellent interrater and intrarater reliability for assessing hamstring flexibility in healthy young males.

Background:After a stroke, the control of the trunk muscle may be severely impaired. Due to the importance of trunk control in complex daily postures, the ability to adopt a correct sitting posture is considered a determinant of the recovery of independent function after a stroke.Objects:The purposes of this study were to compare differences in buttock pressure between the left and right sides of hemiplegic patients and differences in their pelvic tilting angles (sagittal and coronal planes) after sitting training with visual biofeedback (VBF) in real time.Methods:Twenty-two individuals with unilateral strokes (11 left-side and 11 right-side hemiplegic stroke patients) participated in this study. Buttock pressure was measured using a pressure mat, and pelvic angles were measured using a palpation meter.Results:The asymmetry of pressure between the right and left (first and third chamber) sides was significantly decreased after the VBF training. The measurements obtained using the palpation meter revealed a significant decrease in the pelvic angles pre- versus post-intervention.Conclusion:VBF training may be distribute a patient’s buttock pressure equally while in a sitting posture and increase the length of time a stroke patient can maintain a symmetrical sitting posture. It can also improve pelvic control while sitting in a neutral position.

Background: Short foot exercise (SFex) is often prescribed and performed in the sport and rehabilitation fields to strengthen intrinsic foot muscles. However, SFex is difficult to perform because of lack of feedback methods. Objects: The aim of this study was to compare the effects of SFex with and without electromyography (EMG) biofeedback on the medial longitudinal arch (MLA) of healthy individuals who maintained a static standing position. Methods: All participants (14 males and 12 females) were randomly divided into two groups (biofeedback and non-biofeedback groups). The EMG activity of the abductor hallucis (AbdH) and tibialis anterior (TA) and the MLA angle on the dominant leg side were measured with the participant in the standing position in the pre- and post-intervention conditions. The intervention session consisted of 15 minutes of SFex with (biofeedback group) or without (non-biofeedback group) EMG biofeedback. The groups were compared using two-way repeated measures analysis of variance. Results: The post-intervention activities of the AbdH muscle (p<.05) and the AbdH/TA ratio (p<.05) were significantly greater in the biofeedback group than in the non-biofeedback group. The activity of the TA (p<.05) and the MLA angle (p<.05) in the biofeedback group were significantly lower in the post-intervention condition than in the pre-intervention condition. Conclusion: The present findings demonstrate that the combination of SFex and EMG biofeedback can effectively facilitate the muscle activity of the AbdH and strengthen the medial longitudinal arch.

Background: Lumbar stabilization (LS) improve the thickness of the quadratus lumborum (QL) muscle and muscle activity of the gluteus medius (GM) muscle during hip abduction in a side-lying position in patients with low back pain (LBP). Objects: The purpose of this study was to assess the effects of LS on muscle thickness of QL and muscle activity of GM during hip abduction in side-lying in patients with LBP. Methods: The study included 32 patients with LBP, who were randomly divided into the control group and experimental group, each with 16 patients. All subjects performed 35° preferred hip abduction (control group) and 35° hip abduction with LS (experimental group) during side-lying. An ultrasonography and a surface electromyography were used to measure the thickness of the QL muscle, and the muscle activities of the GM muscle respectively. Independent t-test was used to compare the muscle thickness of the QL and the muscle activity of the GM muscle, respectively. Results: Anterio-posterior diameter in the muscle thickness of QL muscle was decreased significantly in hip abduction with LS more than in preferred hip abduction (p<.001), but medio-lateral diameter in the muscle thickness of QL muscle was not significantly different between in preferred hip abduction and in hip abduction with LS (p=.06). The muscle activity of GM was increased significantly in hip abduction with LS more than in preferred hip abduction (p<.001). Conclusion: These findings suggest that hip abduction with LS could be recommended as a hip abduction for LS and a prevention unwanted compensatory pelvic lateral tilting movement.

The aims of the current study were to assess reliability of range of motion (ROM) measurement of glenohumeral internal rotation (GIR) with a pressure biofeedback stabilization (PBS) method and to compare the reliability between manual stabilization (MS) and the PBS method. In measurement of pure glenohumeral joint motion, scapular stabilization is necessary. The MS method in GIR ROM measurement was used to restrict scapular motion by pressing the palm of the tester’s hand over the subject’s clavicle, coracoid process, and humeral head. The PBS method was devised to maintain consistent pressure for scapular stabilization during GIR ROM measurement by using a pressure biofeedback unit. GIR ROM was measured by 2 different stabilization methods in 32 subjects with GIR deficit using a smartphone clinometer application. Repeated measurements were performed in two test sessions by two testers to confirm inter- and intra-rater reliability. After tester A performed measurements in test session 1, tester B’s measurements were conducted one hour later on the same day to assess the inter-rater reliability and then tester A performed again measurements in test session 2 for confirming the intra-rater reliability. Intra-class correlation coefficient (ICC) (2,1) was applied to assess the inter-rater reliability and ICC (3,1) was applied to determine the intra-rater reliability of the two methods. In the PBS method, the intra-rater reliability was excellent (ICC=.91) and the inter-rater reliability was good (ICC=.84). The inter-rater and intra-rater reliability of the PBS method was higher than in the MS method. The PBS method could regulate manual scapular stabilization pressure in inter- and intra-rater measuring GIR ROM. Results of the current study recommend that the PBS method can provide reliable measurement data on GIR ROM.

The purpose of this study was to investigate the effects of visual electromyography (EMG) biofeedback on the EMG activity of the lower trapezius (LT), serratus anterior (SA), and upper trapezius (UT) muscles, the LT/UT and SA/UT EMG activity ratios, and the scapular upward rotation angle during scapular posterior tilting exercise (SPTE). Twenty-four subjects with round-shoulder posture participated in this study. The EMG activities of the LT, SA, and UT were collected during SPTE both without and with visual EMG biofeedback. The scapular upward rotation angle was measured at the baseline, after SPTE without visual EMG biofeedback, and after SPTE with visual EMG biofeedback. The LT, SA, and UT EMG activities, and the LT/UT and SA/UT EMG activity ratios were analyzed by paired t-test. The scapular upward rotation angle was statistically analyzed using one-way repeated analysis of variance. If a significant difference was found, a Bonferroni correction was performed (p=.05/3=.017). The EMG activities of LT and SA significantly increased, and the EMG activity of UT significantly decreased during SPTE with visual EMG biofeedback compared to SPTE without visual EMG biofeedback (p<.05). In addition, the LT/UT and SA/UT EMG activity ratios significantly increased during SPTE with visual EMG biofeedback compared to SPTE without visual EMG biofeedback (p<.05). Significant increases were found in the scapular upward rotation angle after SPTE without and with visual EMG biofeedback compared to baseline (p<.017), and no significant differences were observed in the scapular upward rotation angle between SPTE without and with visual EMG biofeedback. In conclusion, SPTE using visual EMG biofeedback may be an effective method for increasing LT and SA activities while reducing UT activity.

The objective of this study was to examine the effects of auditory biofeedback training and kicking training on walking times in patients with hemiplegia to determine if the effects of such training would be maintained even after stopping the intervention. Thirty hemiplegia patients were selected and randomly assigned to a control group of 10 patients to receive general exercise treatment; an auditory biofeedback training group of 10 patients to receive auditory biofeedback training, along with general exercise; and a kicking training group to receive kicking training, along with general exercise. All the patients received their respective training 12 times in total, three times per week for four weeks. In addition, all those in the control and experimental groups received the same general exercise treatment 12 times in total, three times per week for four weeks, and underwent follow-up tests thereafter. The patients’10m walking times were measured using a stopwatch. The significance was analyzed using repeated-ANOVAs. In cases where there were interactions between measuring times and groups, in each group were examined using repeated-ANOVAs. In cases where there were differences, post-hoc tests were conducted using repeated of contrast test. The 10m walking times of the control and experimental groups were significant differences in 10m walking times were shown between measurement times(p<.05), and significant differences in the interactions between measuring times and groups were shown between the groups(p <.05). However, no significant differences in 10m walking times were shown between the groups(p>.05). The auditory biofeedback training group showed significant decreases in walking times four weeks after the beginning of the intervention(p<.05) and significant increases eight weeks after the beginning of the intervention(p<.05). The kicking training group showed significant decreases in walking time four weeks after the beginning of the intervention(p<.05) and maintained the walking times without showing any significant differences eight weeks after the beginning of the intervention(p>.05). The walking speeds of only the kicking training group were maintained until eight weeks after the beginning of the intervention.

The objective of this study was to examine the effects of auditory biofeedback training and kicking training on walking times in patients with hemiplegia to determine if the effects of such training would be maintained even after stopping the intervention. Thirty hemiplegia patients were selected and randomly assigned to a control group of 10 patients to receive general exercise treatment; an auditory biofeedback training group of 10 patients to receive auditory biofeedback training, along with general exercise; and a kicking training group to receive kicking training, along with general exercise. All the patients received their respective training 12 times in total, three times per week for four weeks. In addition, all those in the control and experimental groups received the same general exercise treatment 12 times in total, three times per week for four weeks, and underwent follow-up tests thereafter. The patients’10m walking times were measured using a stopwatch. The significance was analyzed using repeated-ANOVAs. In cases where there were interactions between measuring times and groups, in each group were examined using repeated-ANOVAs. In cases where there were differences, post-hoc tests were conducted using repeated of contrast test. The 10m walking times of the control and experimental groups were significant differences in 10m walking times were shown between measurement times(p<.05), and significant differences in the interactions between measuring times and groups were shown between the groups(p <.05). However, no significant differences in 10m walking times were shown between the groups(p>.05). The auditory biofeedback training group showed significant decreases in walking times four weeks after the beginning of the intervention(p<.05) and significant increases eight weeks after the beginning of the intervention(p<.05). The kicking training group showed significant decreases in walking time four weeks after the beginning of the intervention(p<.05) and maintained the walking times without showing any significant differences eight weeks after the beginning of the intervention(p>.05). The walking speeds of only the kicking training group were maintained until eight weeks after the beginning of the intervention.

The purpose of this study was to assess visual biofeedback's influence on trunk muscles' (EMG) activity and endurance holding time for correct position during whole-body tilt exercise. For the study, we recruited 14 volunteers who showed no symptom of lumbar disease during medical tests. We measured the EMG activity of their rectus abdominis, external abdominal oblique, internal abdominal oblique and erector spinae muscles, and their endurance holding time for correct position during anterior and posterior whole-body tilt under two conditions: whole-body tilt with and without visual biofeedback. Resistance with gravitational force on the trunk during whole-body tilt was applied by using a device that had a monitor on which the subjects could check their alignment and that sounded an alarm if a subject's alignment collapsed. The study showed an increase in the EMG activity of external abdominal oblique, internal abdominal oblique/rectus abdominis ratio and endurance holding time for correct position during both anterior and posterior whole-body tilt with visual biofeedback compared with without visual biofeedback (p<.05). We suggest that the whole-body tilt exercise with visual biofeedback could be a beneficial strategy for selectively strengthening the internal abdominal oblique muscle and minimizing the rectus abdominis muscle's activity while maintaining correct alignment during whole-body tilt exercise.

Push-up plus has been advocated for increasing the activity of the serratus anterior muscle, the most critical scapular stabilizer. However, no previous study has reported the possibility of compensatory motion on the part of the pectoralis major, which could substitute for the action of the serratus anterior during push-up plus. The aim of the current study was to investigate the immediate effect of electromyography (EMG) biofeedback of the pectoralis major muscle on the pectoralis major, upper trapezius, and serratus anterior muscles during push-up plus. Fourteen healthy young subjects voluntarily participated in this study; each subject performed push-up plus from the quadruped position, in two conditions (i.e., with or without visual and auditory biofeedback). Surface EMG was used to measure pectoralis major, serratus anterior, and upper trapezius activity. A paired t-test was used to determine any statistically significant difference between the two conditions. Additionally, effect size was calculated to quantify the magnitude of EMG biofeedback in each muscle. Visual and auditory feedback reduced pectoralis major muscle activity significantly (p=.000) and increased the serratus anterior muscle activity significantly (p=.002), but did not induce a significant difference in upper trapezius muscle activity (p=.881). Thus, it is concluded that the visual and auditory feedback of pectoralis major muscle activity can be used to facilitate serratus anterior muscle activity during push-up plus.

최근 기능성 게임 개발의 연구가 활발히 진행되고 있다. 바이오피드백 기술은 인간의 신체적인 신호들로부터 나온 신호들을 통하여 신체의 신호를 제어하고 향상 시킬 수 있는 기술이다. 자율신경계의 컨트롤도 훈련을 통하여 스스로 가능하다는 사실이 입증되면서 감성 분야에서 활발한 연구가 진행 중이다. 본 연구에서는 심전도를 이용하여 스트레스를 측정하고 바이오피드백을 통하여 피험자의 스트레스 해소에 사용되도록 하였다. 피험자의 스트레스를 정략적으로 측정하기 위하여 심전도 신호로 부터 R파를 추출하고 교감 부교감 신경의 활성도를 통하여 스트레스 상태를 추출하였다. 개발된 스트레스 측정 모듈은 바이오피드백 게임에 적용하여 스트레스 해소를 위한 기능성 게임에 활용될 수 있다.

목적 : 본 연구의 목적은 뇌졸중 환자의 손기능에 대한 근전도 바이오피드백 훈련의 효과를 조사하는 것이다. 연구 방법 : 발병 6개월 이상인 뇌졸중 환자 10명을 무작위로 실험군과 대조군으로 각각 5명씩 배정하였다. 실험군은 근전도 바이오피드백 훈련을 1일 1회, 주 5일, 6주 동안 수행하도록 하였다. 훈련의 1회기는 15초의 휴식기와 5초간의 추적과제를 수행하는 활동기로 구성되며 1회 훈련동안 추적과제를 총 40번 시행하였다. 반면, 대조군의 모든 치료 상황은 바이오피드백 훈련을 제외하고는 실험군과 같았다. 손기능을 검사하기 위하여 훈련 전·후에 개정된 Ashworth 척도, Fugl-Meyer 평가, 상자와 나무토막 검사, 뇌졸중 상지기능 검사를 실험군과 대조군 모두에게 실시하였다. 결과 : 실험군은 개정된 Ashworth 척도를 제외한 모든 검사에서 훈련 후의 결과가 훈련 전의 결과와 비교하여 통계적으로 유의한 차이를 보였다(p<.05). 대조군은 모든 검사에서 유의한 차이를 보이지 않았다(p>.05). 또한 집단간 비교에서 실험군의 훈련 후 손기능 향상이 모든 검사에서 대조군에 비하여 통계적으로 유의하게 높았다(p<.05). 결론 : 본 연구는 실시된 근전도 바이오피드백 훈련이 뇌졸중 환자의 손기능 향상에 효과적임을 지지한다.

To reduce winging scapula, various exercise protocols have been widely used by clinicians. Selective serratus anterior strengthening, and restoring balanced function, are especially recommended to reduce winging scapula. The purpose of this study was to investigate visual biofeedback using a real time video camera display system for monitoring scapular winging during arm lowering. For this study, 13 males with winging scapular were recruited during arm lowering. Electromyography (EMG) activity was recorded from the serratus anterior (SA) and upper trapezius (UT) of the right side and compared with normal EMG activity using a paired t-test. The study showed, through visual biofeedback, that EMG activity significantly increased in the SA and significantly decreased in the UT (p<.05). These results suggest that visual biofeedback can be recommended as an effective method for scapular eccentric control, to prevent scapular winging during arm lowering.

This study examined the effects of the abdominal drawing-in (ADI) maneuver using a pressure biofeedback on muscle recruitment pattern of erector spinae and hip extensors and anterior pelvic tilt during hip extension in the prone position. Fourteen able-bodied volunteers, who had no medical history of lower extremity or lumbar spine disease, were recruited for this study. The muscle onset time of erector spinae, gluteus maximus, and medial hamstring and angle of anterior pelvic tilt during hip extension in prone position were measured in two conditions: ADI maneuver condition and non-ADI maneuver condition. Muscle onset time was measured using a surface electromyography (EMG). Kinematic data for angle of anterior pelvic tilt were measured using a motion analysis system. The muscle onset time and angle of anterior pelvic tilt were compared using a paired t-test. The study showed that in ADI maneuver during hip extension in prone position, the muscle onset time for the erector spinae was delayed significantly by a mean of 43.20 ms (SD 43.12), and the onset time for the gluteus maximus preceded significantly by a mean of -4.83 ms (SD 14.10) compared to non-ADI maneuver condition (p<.05). The angle of anterior pelvic tilt was significantly lower in the ADI maneuver condition by a mean of 7.03 degrees (SD 2.59) compared to non-ADI maneuver condition (15.01 degrees) (p<.05). The findings of this study indicated that prone hip extension with the ADI maneuver was an effective method to recruit the gluteus maximus earlier than erector spinae and to decrease anterior pelvic tilting.