Background: People these days use smartphone extensively as a means of diverse social activities, but excessive use of it has also created increasing forward head posture (FHP) with neck pain. To improve this FHP, neck stabilization exercise is necessary. Objectives: This study was to investigate the effects of stabilization exercise using biofeedback on FHP subjects with neck pain. Design: A non-randomized, controlled intervention study. Methods: This study chose 18 college students in their 20s whose neck disability index (NDI) was equal to or higher than 10 and cranio-vertebral angle indicated FHP as experimental group. The control group selected 18 persons with no neck pain and a normal range of cranio-vertebral angle. The stabilization movement was performed by applying three phases of pressure, with low of 20 mmHg, intermediate of 25 mmHg, and high of 30 mmHg, using the Stabilizer. To check the effects of stabilization exercise according to pressure, the circumference of deep neck muscles was measured with ultrasonic waves, and the activity of surface muscle of sternocleidomastoid (SCM) was measured using electromyography (EMG). Results: When the circumference of the deep neck flexor was analyzed according to the pressure change during stabilization exercise, the experimental group showed increase at all pressures. The activity of the SCM of the surface muscle increased in both groups as the pressure increased. Conclusion: The application of stabilization exercise was found to be more effective on forward head posture subjects with neck pain at lower pressures.

Background: Several factors contribute to shoulder pain, including abnormal neck posture, repeated use of the upper limbs, work involving raising the upper limbs above the head, and the effects of vibration. However, previous study has reported that constant vibration exposure could impact improvement of the stability on joints related with muscle recruitment and activation. For this difference reason, we need to verify for the complex study of relationship with repetitive upper limb movements, poor head posture, and constant vibration exposure. Objects: Our study was made to investigate the influence of vibration exposure on the shoulder muscle activity during forward-head and over-head tasks with isometric shoulder flexion. Methods: In a total of 22 healthy subjects, surface electromyography (EMG) data were collected from shoulder muscles (upper/lower trapezius, serratus anterior, and lumbar erector spinae) on tasks (neutral-head task [NHT], forward-head task [FHT], and over-head task [OHT]) with and without vibration exposure. Results: In all tasks, the EMG data of the upper trapezius and serratus anterior significantly increased with vibration exposure (p < 0.05). Furthermore, the EMG data of the lumbar erector spinae significantly increased with vibration exposure in the NHT and FHT (p < 0.05). Conclusion: We suggest that continuous vibration exposure during the use of hand-held tools in the tasks could be associated with harmful effects in the workplace. Lastly, we clinically need to examine the guidelines regarding the optimal posture and vibration exposure.

Background: Excessive hamstring (HS) activation due to the weakness of the gluteus maximus (GM) causes pain in the hip joint. A single-leg deadlift is a hip extensor exercise, especially GM, that includes functional movements in daily life and complex multi-joint training. In single-leg deadlift, the muscle activity depends on the forward trunk lean angle, and it's necessary to study which muscles are used dominantly depending on the angle. Objects: The purpose of this study was to compare the effect on the muscle activity of the GM and HS during single-leg deadlift according to different forward trunk lean angles and the ratio of the GM vs HS (GM/HS). Methods: Twenty-one healthy female participants were recruited. The muscles activities of the GM, HS and the GM/HS ratio were measured through electromyography during single-leg deadlift according to three condition of forward trunk lean angles (30°, 60°, and 90°). Results: The GM and HS activities significantly differed among three conditions (p < 0.05). GM/HS ratio was significantly higher at 30°and 60° of forward trunk lean compared to 90°. Moreover, the GM activity was significantly higher at 60°of forward trunk lean than at 30° (p < 0.05). Conclusion: The single-leg deadlift at 60°of forward trunk lean is a proper GM muscle strengthening exercise.

Background: Neuromuscular electrical stimulation (NMES) is used for muscle strengthening. While voluntary muscle contraction follows Henneman et al.’s size principle, the NMES-induced muscle training disrespects the neurophysiology, which may lead to unwanted changes (i.e., declined balance ability). Objects: We examined how the balance was affected by abdominal muscle training with the NMES. Methods: Fifteen young adults (10 males and 5 females) aged between 21 and 30 received abdominal muscle strengthening with NMES for 23 minutes. Before and after the training, participants’ balance was measured through one leg standing on a force plate with eyes open or closed. Outcome variables included mean distance (MDIST), root mean square distance (RDIST), total excursion (TOTEX), mean velocity (MVELO), and 95% confidence circle area (AREA) of center of pressure data. Two-way repeated measures analysis of variance was used to test if these outcome variables were associated with time (pre and post) and vision. Results: All outcome variables were not associated with time (p > 0.05). However, all outcome variables were associated with vision (p = 0.0001), and MVELO and TOTEX were 52.4% (45.5 mm/s versus 95.6 mm/s) and 52.4% (364.1 mm versus 764.5 mm) smaller, respectively, in eyes open than eyes closed (F = 55.8, p = 0.0005; F = 55.8, p = 0.0005). Furthermore, there was no interaction between time and vision (F = 0.024, p = 0.877). Conclusion: Despite the different neurophysiology of muscle contraction, abdominal muscle strengthening with NMES did not affect balance.

Background: The craniocervical flexion test (CCFT) was developed for the activation and endurance of deep cervical flexors. However, the muscle thickness and muscle thickness changing ratio of the sternocleidomastoid (SCM) and deep cervical flexor (DCF) muscles in subjects with and without forward head posture (FHP) have not been reported. Objects: To determine the difference in thickness of the SCM and DCF muscles and the difference in the muscle thickness changing ratio between SCM, DCF, and DCF/SCM 20 mmHg and DCF/SCM 30 mmHg between subjects with and without FHP. Methods: Thirty subjects with and without FHP were enrolled. The muscle thickness of the SCM and DCF was measured when maintained at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg using a pressure biofeedback unit during the CCFT. Ultrasonography was used to capture images of SCM and DCF muscle thickness during the CCFT, which was calculated using the picture archiving and communication system (PACS). Results: We observed a significant difference within the pressure main effect between SCM and DCF at a baseline pressure of 20 mmHg and a maximum pressure of 30 mmHg (p < 0.05). However, there was no significant difference in the muscle thickness and muscle thickness changing ratio for SCM and DCF during CCFT between subjects with and without FHP. Conclusion: There was no significant difference in the muscle thickness recruitment pattern during CCFT in posture changes between subjects with and without FHP.

Background: The serratus anterior (SA) muscle prevents scapular winging (SW) by stabilizing the medial border of the scapula during arm movement. The upper trapezius (UT) and lower trapezius (LT) muscles may compensate for the weak SA muscle in individuals with SW during shoulder flexion. However, there is no study to examine whether compensation by UT and LT occurs in individuals with SW. Objects: This study compared the muscle activities of UT, LT, and SA as well as the SA/UT activity ratio between individuals with and without SW during shoulder flexion with load. Methods: This study recruited 27 participants with SW (n = 14) and without SW (n = 13). Electromyography data of the SA, UT, and LT muscles and SA/UT activity ratio were recorded and analyzed during shoulder flexion with 25% load of the maximal shoulder flexion force. Independent t-test was used to compare the UT, LT, and SA muscle activities and SA/UT ratio between the groups with and without SW; statistical significance was set at α of 0.05. Results: SA activity was significantly lesser in the group with SW than in the group without SW. However, there were no significant differences in the UT and LT activities and SA/UT activity ratio between the two groups. Conclusion: The SA activity was lesser in the group with SW than in the group without SW with 25% load of the maximal shoulder flexion force, but there was no compensatory muscle activity of the UT and LT observed. Therefore, further studies are warranted to clarify the compensatory strategy of scapular stabilization in individuals with SW during shoulder flexion under other heavy load conditions.

Background: Shoulder impingement syndrome, a major cause of shoulder pain, involves weakness of the scapular retractor muscles. The major scapular retractor muscles are the middle trapezius and rhomboid major muscles; however, the latter is excluded in most studies. Objects: We aimed to measure the thickness of the middle trapezius and rhomboid major muscles using an ultrasonic diagnostic imaging system while performing four different shoulder retraction exercises and comparing the thicknesses and ratio of the thicknesses of these muscles. Methods: The thickness of the middle trapezius and rhomboid major muscles was measured in 24 healthy adults using ultrasound. Muscle thickness was measured three times in the Reference posture and four times while performing four different exercises that involved scapular retraction. The averages and standard deviations of the measured muscle thicknesses were obtained and compared. The ratio of muscle thickness and rate of changes in muscle thickness between the reference posture and the four exercises were compared. Results: For both, male (n = 10) and female (n = 14), there was a significant difference in the thickness of the middle trapezius muscle between the reference posture and the four exercises (p < 0.05) and in the thickness of the middle trapezius and rhomboid major muscles between male and female (p < 0.05); however, there was no significant difference in the ratio of the thicknesses of these muscles. Although a significant difference in the rate of change in muscle thickness during the four exercises was noted, there was no significant difference in the ratio of change in muscle thickness. Conclusion: This study demonstrates the ratio of the thicknesses of the middle trapezius and rhomboid major muscles and the rate of change in their thickness during exercises involving scapular retraction in healthy people in their 20s–30s.

Background: Push-up are effective exercises for shoulder stability. Previous studies have documented the effects of support plane and hand position and width on muscle activities during a push-up. Objects: This study aimed to investigate the changes in muscle activities in the upper extremity when performing the standard and the knee-flexed push-up with different hand shapes. Methods: A total of twenty-six healthy males participated in this study. Three different hand shapes (finger abduction, finger adduction, and fists) and two types of push-up posture (standard and knee-flexed push-up) were set as the independent variables. Electrograms were used to measure the muscle activity of the upper trapezius (UT), triceps brachii (TB), pectoralis major (PM), and serratus anterior (SA). Each participant performed the randomly assigned push-up to the sound of the metronome. The mixed-effect linear regression model was used to detect the changes in muscle activities after changing the hand shape and push-up posture. Statistical significance was set at α = 0.05. Results: The UT muscle activity was statistically significantly higher when performing push-up with fists than finger abduction (p = 0.035) or finger adduction (p = 0.044). During the standard push-up, the muscle activity in all muscles was that the push-up with fists showed the highest muscle activity compared to the finger abduction (p < 0.01) and finger adduction (p < 0.01). Regardless of the shape of the hand, UT had the lowest muscle activity compared to other muscles (p < 0.001). In contrast, the SA muscle had the highest muscle activity among four muscles during the standard push-up. Conclusion: Based on the results of this study, we suggest hand shape is related to the difficulty level of push-up either in the standard or the knee-flexed push-up, especially in the push-up with fists. In addition, knee push-up can be recommended as shoulder musclestrengthening exercises for individuals with low shoulder muscle strength.

Background: Although recent studies using virtual reality have been actively conducted, studies on exercise therapy interventions and changes in muscle characteristics in patients with scoliosis are limited. Objectives: To investigate the effects of trunk and pelvic exercises program using virtual reality on the characteristics of paraspinal muscles in patients with scoliosis. Design: A randomized controlled trial. Methods: Thirty college students with scoliosis were randomly assigned to the trunk and pelvic exercise program using virtual reality group (VRG; n=15) and the general stretching exercise group (SG; n=15). The intervention was conducted three times a week for 8 weeks for 30 min per session. The recorded variables were muscle tone (F), muscle stiffness (S), and muscle elasticity (D). The collected data were analyzed after statistical processing. Results: In the cervical vertebrae, F showed significant differences in the amount of inter-group variation in the VRG compared that in the SG on the right side. The VRG showed significant increases in intra-group variation on both the right and left sides. S showed significant differences in the amount of inter-group variation in the VRG compared to that in the SG on the right side. With regard to the intra-group variation of F in the thoracic vertebrae, the right muscle in the VRG demonstrated significantly increased after the experiment, while D significantly increased in the left muscle in the VRG. Conclusion: Pelvic and trunk exercises program using virtual reality may be applied a better therapeutic intervention for patients with scoliosis.

Background: Robot-assisted gait training (RAGT) is an effective method for walking rehabilitation. Additionally, the body weight support (BWS) system reduces muscle fatigue while walking. However, no previous studies have investigated the effects of RAGT with BWS on isokinetic strength of quadriceps and hamstring muscles. Objects: The purpose of this study was to investigate the effects of torque, work, and power on the quadriceps and hamstring muscles during RAGT, using the BWS of three conditions in healthy subjects. The three different BWS conditions were BWS 50%, BWS 20%, and full weight bearing (FWB). Methods: Eleven healthy subjects (7 males and 4 females) participated in this study. The Walkbot_S was used to cause fatigue of the quadriceps and hamstring muscles and the Biodex Systems 4 Pro was used to measure the isokinetic torque, work, and power of them. After RAGT trials of each of the three conditions, the subjects performed isokinetic concentric knee flexion and extension, five at an angular velocity of 60°/s and fifteen at an angular velocity of 180°/s. One-way repeated analysis of variance was used to determine significant differences in all the variables. The least significant difference test was used for post-hoc analysis. Results: On both sides, there were significant differences in peak torque (PT) of knee extension and flexion between the three BWS conditions at an angular velocity of 60°/s and 180°/s conditions. A post-hoc comparison revealed that the PT in the BWS 50% was significantly greater than in the BWS 20% and the FWB and the PT in the BWS 20% was significantly greater than in the FWB. Conclusion: The results of this study suggest that the lower BWS during RAGT seems to lower the isokinetic torque, work, and power of the quadriceps and hamstring muscles because of the muscle fatigue increase.

Background: The CKCUES test evaluates the functional performance of the shoulder joint. The CKCUES test scores CKC exercises of the upper limbs to examine shoulder stability. Although the CKCUES test provides quantitative data on functional ability and performance, no study has determined the relationship between CKCUES scores and SA and TB muscle strength. Objects: The objective of this study is to determine the relationship between the CKCUES test scores and the strength of the SA and TB muscles in the CKCUES and unilateral CKCUES tests. Methods: Sixty-six healthy male volunteers participated in the study. A Smart KEMA strength sensor measured SA and TB muscle strength. Two parallel lines on the floor indicated the initial hand placement to start CKCUES tests. For 15 seconds, the subject raises one hand and reaches over to touch the supporting hand, then returns to the starting position. Results: The correlation between the CKCUES test scores and the strength of the SA was strong (r = 0.650, p < 0.001), and the TB was moderate (r = 0.438, p < 0.001). The correlation between the unilateral CKCUES test and the strength of the SA of the supporting side was strong (r = 0.605, p < 0.001), and swing side was strong (r = 0.681, p < 0.001). The correlation between the unilateral CKCUES test and the strength of the TB of the supporting side was moderate (r = 0.409, p < 0.001), and swing side was moderate (r = 0.482, p < 0.001). Conclusion: Our study showed that the CKCUES test had a strong association with isometric strength of SA and moderate association with that of TB. These findings suggest that the CKCUES test can evaluate the function of the SA. Moreover, the unilateral CKCUES test can evaluate unilateral shoulder function.

Background: The therapeutic exercise method using kinesiology taping (KT) has been reported to be effective in activating the suprahyoid muscle in healthy adults. However, its applicability and effectiveness are not known to the physically vulnerable elderly. Objectives: To investigate the effects of kinesiology taping on the activity of suprahyoid muscles in community-dwelling elderly people. Design: Repeated measure design. Methods: We enrolled 23 healthy elderly adults (age range 60–75 years) with no history of neurologic disease. Participants performed five consecutive spontaneous swallowing actions at 5-second intervals under three conditions (KT with 80% stretch, placebo-KT, and non-KT. Activation of the suprahyoid muscles during swallowing in the three conditions was measured using surface electromyography (sEMG). In addition, a 0–10 numerical rating self-report scale was used to evaluate the required effort and the resistance felt during swallowing. Results: KT with 80% stretch were significantly higher in sEMG mean value, peak value, required effort, and resistance felt during swallowing compared to other two conditions (P<.05, all). KT with 80% stretch required the most effort during swallowing and, consequently, has a positive effect on increasing suprahyoid muscle activation. Conclusion: Our results could be taken into consideration in therapeutic exercise method for suprahyoid muscle in dysphagia rehabilitation.

Background: Forward head posture (FHP) causes various posture imbalances associated with the head and neck. Myofascial release is an effective treatment method used for relaxing muscles and reducing muscle hyperactivity, but no studies have been conducted on suboccipital and neck muscles related to FHP. Objects: The purpose of this study was to investigate the immediate effect of roller massages on the cranio-cervical flexion (CCF) range of motion (ROM) and CCF strength applied to suboccipital and neck muscles in subject with forward head posture. Methods: Twenty-four FHP subjects (male: 13, female: 11) were recruited for this study. All subjects were recruited with a craniovertebral angle (CVA) of 53 degrees or less and a head tilt angle (HTA) of 20.66 degrees or higher. CCF strength was measured using Pressure biofeedback unit (PBU) in the supine posture and CCF ROM was measured using smartphone-based inclinometer. Roller massage (RM) was applied to suboccipital and neck muscles for 2 minutes and CCF ROM and strength were remeasured. Results: These results of this study showed that CCF ROM was a significant difference in CCF ROM before and after RM (p < 0.05). CCF strength also showed a significant difference before and after RM (p < 0.05). Conclusion: RM method might be recommended to increase the immediate ROM and strength of CCF in subjects with forward head posture.

Background: The hip muscle plays various roles. Several types of functional performance tests are used for the assessment of patients with various lower extremity injuries. Hip muscle functions are important to test the performance of maintaining the spine, pelvic, and leg during bridging exercise. We designed a novel functional performance test tool, which we named close kinetic chain dynamic lower extremity stability (CKCLE) test to assess hip muscle functions. Objects: The purpose of this study was to determine the relationship between CKCLE test and hip extensor, external rotator, and abductor strengths. Methods: Twenty-two subjects were recruited in the present study (13 males and 9 females). The hip extensor, external rotator, and abductor muscle strengths were measured using a Smart KEMA strength sensor. When the examiner said “Go”, the subject performed the CKCLE test by moving one leg from the floor and touching the opposite knee and then return to the floor while maintaining the bridging position. The subjects attempted as many “touches” as possible in the allotted time (20 seconds) during the maximal tests. The correlation between the hip muscle (extensor, external rotator, and abductor) strength of the supporting leg and the number of CKCLE tests performed in 20 seconds was determined using the Pearson correlation. Results: Hip extensor (r = 0.626, p < 0.05), hip external rotator (r = 0.616, p < 0.05), and hip abductor muscle strengths (r = 0.475, p < 0.05) positively correlated with the number of CKCLE tests performed. Conclusion: We designed a CKCLE test and found that performance in the test correlated with hip extensor, external rotator, and abductor muscle strengths. The result suggests that the CKCLE test can be applied as a performance test to assess the functions of the hip extensor, external rotator, and hip abductor muscles.

Background: Unstable surface-based core training can significantly enhance core strength, but no studies have compared the effects of balance pad- and sling-assisted exercises. Objects: To study the effects of unstable surface-based balance pad- and sling-assisted core strength exercises on muscle activity. Methods: Twenty male students aged 20–25 years participated in this study. The effects of three types of core strength exercises, performed with a sling or balance pad, on the activities of three muscles, i.e., the right musculus obliquus externus abdominis (EO), right erector spinae (ES), and right gluteus maximus (GM), were examined. Results: 1) In the glute bridge exercise, the percentage of maximum voluntary contraction of the EO, ES, and GM were significantly different between the balance pad- and sling-assisted exercises. The relative contribution of the ES and GM activities to all muscle activity were not significantly different between the two training types, whereas that for EO showed a significant difference. 2) There was no significant difference in the percentage value of maximum voluntary contraction (%MVC) among the EO, ES, and GM during the “leg-lifting with flat support”exercise, and there were no significant difference in the relative contributions between the two training types. 3) In the “side bridge leg separation exercise”, the %MVC of the ES, EO, and GM were significantly different between the two training types. Conclusion: Sling training for core muscles was generally better than balance pad assist training. The majority of physiotherapy patients require core training. Our results could guide physiotherapists in the choice of targeted exercises for these patients.

Background: Weakness of the abdominal and mid thoracic muscles the lead to thoracic kyphosis of stroke patients. The trunk muscles activity of stroke patients is significantly related to upper extremity. Objectives: To investigate the effect of seated exercise of thoracic and abdominal muscles on upper extremity function and trunk muscles activity in stroke patients. Design: One-group pretest-posttest design. Methods: A total of 27 stroke patients were recruited. All stroke patient were given seated abdominal exercise (posterior pelvic tilt exercises) and thoracic exercise (postural-correction exercise). All exercises were conducted for 30 minutes, three times a week for four weeks. The manual function test (MFT) and electromyography (EMG) were measured, and EMG electrodes were attached to thoracic paraspinal muscles and lower rectus abdominal muscles. EMG signal is expressed as %RVC (reference voluntary contraction). Results: Experimental group showed significant increases in abdominal muscles, paraspinal muscles activity and MFT total score, items of arm motion (forward elevation of the upper extremity, lateral elevation of the upper extremity, touch the occiput with the palm) in MFT after four weeks. Conclusion: These results suggest that, in stroke patients, seated exercise of thoracic and abdominal muscles contribute to improve trunk muscles activity and upper extremity function in stroke patients.

Background: For performing various movements well, cooperation between the muscles around the scapula and shoulder has been emphasized. Taping has been widely used clinically as a helpful adjunct to other physiotherapy methods for shoulder pathology and dysfunction treatment. Previous studies have evaluated the effect of taping techniques using dynamic tapes on shoulder function and pain. However, no study investigated the electromyographic (EMG) changes in the shoulder muscles. Objects: This study aimed to investigate the effect of the upper limb offload taping technique using a dynamic tape on EMG activities of the upper trapezius (UT), lower trapezius, serratus anterior (SA), and middle deltoid (MD) muscles during scaption plane elevation. Methods: A total of 26 healthy subjects (19.85 ± 6.40 years, male = 20) volunteered to participate in this study. The subjects were instructed to perform scaption elevation with and without dynamic taping on the shoulder. Shoulder elevation strength tests were performed at 100%, 75%, 50%, and 25%, for the maximal isometric contraction force. Results: There were statistically significant interaction effects between the taping application and shoulder scaption elevation force in EMG activities in the UT (p < 0.05) and MD (p < 0.05). EMG activities in the UT showed significant increases in 50%RVC (reference voluntary contraction, p < 0.05) and 25%RVC (p < 0.01). Furthermore, the EMG activity of the SA significantly increased in 50%RVC (p < 0.01) and 25%RVC (p < 0.01) after dynamic taping. For the MD, the EMG activity level significantly decreased in 100%RVC (p < 0.05). Conclusion: These results indicated that upper limb offload dynamic taping application affects the muscle activities of some shoulder muscles depending on different scaption elevation strength levels. Therefore, we suggest that the upper limb offload dynamic taping can be applied to the shoulders when patients need middle deltoid inhibition or upper trapezius facilitation, such as patients with shoulder impingement syndrome.

Background: It has been argued that changes in muscle activity in the upper trapezius and serratus anterior may or may not cause shoulder joint pain and dysfunction. Objective: To investigate the effects of active vibration exercise on muscle activity regarding scapular stabilization using a flexi-bar. Design: A randomized controlled trial. Methods: A total of 24 subjects were randomly assigned to a flexi-bar group with active vibration and general stick group with non-active vibration. Both groups performed the same four action programs for 6 weeks, three times a week for 30 minutes at a time. The upper trapezius muscle, middle trapezius muscle, lower trapezius muscle and serratus anterior muscle of the dominant side was measured by electromyography before and after the 6 weeks of exercise. The independent t-test and paired t-test were used to analyze data. Results: There was a significant difference between groups in upper trapezius muscle and serratus anterior muscle activity after exercise (P<.05). Also, there was a significant difference in upper trapezius muscle and serratus anterior muscle activity before and after exercise in the flexi-bar group (P<.05). Conclusion: This study demonstrates that active vibration exercise using a flexi-Bar contribute to reduce the activity of the upper trapezius muscle and promote the activity of the serratus anterior muscle.

Background: The bridge exercise targets the gluteus maximus (Gmax) and gluteus medius (Gmed). However, there is also a risk of dominant hamstring (HAM) and erector spinae (ES) muscles. Objects: To analyze the muscle activity the of Gmax, Gmed, HAM and ES during the bridge exercise with and without hip external rotation in different degrees of knee flexion. Methods: Twenty-three subjects were participated. The electormyography (EMG) activity of the Gmax, Gmed, HAM and ES muscles was recorded during the exercise. The subjects performed the bridge exercise under four different conditions: (a) with 90˚ knee flexion, without hip external rotation (b) with 90˚ knee flexion, with hip external rotation (c) with 135˚ knee flexion, without hip external rotation (d) with 135˚ knee flexion, with hip external rotation. Results: There was no significant interaction effect between the degree of knee flexion and hip external rotation. There was a significant main effect for degree of knee flexion in Gmax, HAM muscles activity. Gmax muscle activity was significantly greater in the 135˚ knee flexion position than in the 90˚ knee flexion position (p<.001). While HAM muscle activity was significantly less in 135˚ knee flexion position than in the 90˚ knee flexion position (p<.001). ES muscle activity was significantly less in the 135˚ knee flexion position than in the 90˚ knee flexion position (p=.002). The activity of both the Gmax and Gmed muscles was significantly greater with hip external rotation (p<.001 and p=.005, respectively). Conclusion: For patients performing the bridge exercise, positioning the knee in 135° of flexion with hip external rotation is effective for improving Gmax and Gmed muscle activity while decreasing HAM, and ES muscle activity.

Background: High-heeled shoes can change spinal alignment and feet movement, which leads to muscle fatigue and discomfort in lumbopelvic region, legs, and feet while walking. Objects: This study aimed to identify the effects of different shoe heel heights on the walking velocity and electromyographic (EMG) activities of the lower leg muscles during short- and long-distance walking in young females. Methods: Fifteen young females were recruited in this study. The experiments were performed with the following two different shoe heel heights: 0 ㎝ and 7 ㎝. All participants underwent an electromyographic procedure to measure the activities and fatigue levels of the tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and hamstring muscles with each heel height during both short- and long-distance walking. The walking velocities were measured using the short-distance (10-m walk) and long-distance (6-min walk) walking tests. Results: Significant interaction effects were found between heel height and walking distance conditions for the EMG activities and fatigue levels of TA and MG muscles, and walking velocity (p<.05). The walking velocity and activities of the TA, MG, and RF muscles appeared to be significantly different between the 0 ㎝ and 7 ㎝ heel heights during both short- and long-distance walking (p<.05). Significant difference in the fatigue level of the MG muscle were found between the 0 ㎝ and 7 ㎝ heel heights during long-distance walking. In addition, walking velocity and the fatigue level of the MG muscle at the 7 ㎝ heel height revealed significant differences in the comparison of short- and long-distance walking (p<.05). Conclusion: These findings indicate that higher shoe heel height leads to a decrease in the walking velocity and an increase in the activity and fatigue level of the lower leg muscles, particularly during long-distance walking.