Background: Lateral instability of the ankle is one of the most common causes of musculoskeletal ankle injuries. The peroneus longus (PL) and peroneus brevis (PB) contribute to ankle stability. In early rehabilitation, isometric exercises have been selected for improvement of ankle stability. To effectively train the peroneal muscles during eversion, it is important to consider ankle and body posture. Objects: This study aimed to compare activation of the PL, PB, and biceps femoris (BF) muscles during eversion in different ankle postures (neutral [N], plantarflexed [PF]) and body postures (sitting and side-lying). Methods: Thirty healthy individuals with no history of lateral ankle sprains within the last 6 months were included in the study. Maximal isometric strength of eversion and muscle activation were measured simultaneously. Muscle activation at submaximal eversion was divided by the highest value obtained from maximal isometric eversion among the four postures (percent maximal voluntary isometric contraction [%MVIC]). To examine the differences in muscle activation depending on posture, a 2 × 2 repeated measures analysis of variance (ANOVA) was conducted. Results: There were significant interaction effects of ankle and body postures on PL muscle activation and evertor strength (p < 0.05). The PL muscle activation showed a significantly greater difference in the side-lying and PF conditions than in the sitting and N conditions (p < 0.05). Evertor strength was greater in the N compared to the PF condition regardless of body posture (p < 0.05). In the case of PB and BF muscle activation, only the main effects of ankle and body posture were observed (p < 0.05). Conclusion: Among the four postures, the side-lying-PF posture produced the highest muscle activation. The side-lying-PF posture may be preferred for effective peroneal muscle exercises, even when considering the BF muscle.

Background: The gluteus medius (Gmed) plays a critical role in maintaining frontal plane stability of the pelvis during functional activities, such as one-leg lifting. Side-lying hip abduction (SHA) has been used as a dynamic test to evaluate Gmed function. However, the abduction force of the lower leg against the floor is not controlled during SHA. Therefore, hip abduction performance with contralateral adduction in the side-lying position (HAPCA) can be proposed as an alternative method to assess performance of hip abduction. If the number of HAPCA is related to the lateral pelvic shift distance, a new quantitative measurement for hip abductor function may be presented. Objects: This study aimed to investigate the relationship between the number of successful HAPCA and the lateral pelvic shift distance during one-leg lifting. Methods: Thirty healthy participants were recruited, and lateral pelvic shift distance was measured during one-leg lifting test using two-dimensional analysis. The number of successful HAPCA was counted when participants touched both target bars at the beat of a metronome. Results: There was a negative correlation between the number of HAPCA and lateral pelvic shift distance during one-leg lifting (r = –0.630, p < 0.05). The number of HAPCA accounted for 39.7% of the variance in the lateral pelvic shift distance during one-leg lifting (F = 18.454, p < 0.001). Conclusion: The number of successful HAPCA is significantly correlated with lateral pelvic shift distance during one-leg lifting. This finding suggests that HAPCA can be proposed as a new measurement for hip abductor performance and more research is needed on its relationship with hip abductor strength.

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: Improvement of lumbo-pelvic stability can reduce the compensatory action of the quadratus lumborum (QL) and selectively strengthen the gluteus medius (GM) during side-lying hip abduction (SHA). There are abdominal draw-in maneuver (ADIM) and abdominal bracing (AB) as active ways, and pelvic compression belt (PCB) as a passive way to increase of lumbo-pelvic stability. It is necessary to compare how these stabilization methods affect the selective strengthening of the GM. Objects: To investigate the effects of ADIM, AB, and PCB during SHA on the electromyography (EMG) activity of the GM, QL, external oblique (EO) and internal oblique (IO), and the GM/QL EMG activity ratio. Methods: A total of 20 healthy male adults participated in the study. The subjects performed three conditions in side-lying in random order: SHA with ADIM (SHA-ADIM), SHA with AB (SHA-AB), and SHA with PCB (SHA-PCB). To compare the differences among the three conditions, the EMG activities of the GM, QL, EO and IO, and GM/QL EMG activity ratio were analyzed using one-way repeated ANOVA. Results: The EMG activity of the QL was significantly higher in SHA-AB than in SHA-ADIM and SHA-PCB. The GM/QL activity ratio was significantly higher in SHA-PCB than in SHA-ADIM and SHA-AB. In addition, the figure for SHA-ADIM was significantly higher than that for SHA-AB. In the case of the EO, the figure for SHA-AB was significantly higher than corresponding values for the other two conditions. The figure for SHA-ADIM was significantly higher than that for SHA-PCB. The EMG activity of the IO was significantly higher in SHA-AH than in SHA-PCB. Conclusion: It can be suggested that wearing the PCB can more selectively strengthen the GM than to perform ADIM and AB during SHA. In addition, the ADIM can be recommended when there is a need to strengthen abdominal muscles during SHA.

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 determine if a gentle form of manual lumbar traction could reduce painful lumbar motions associated with lumbar disc degeneration (LDD). This clinical trial incorporated 134 participants with painful active lumbar motion. Participants were randomly assigned to an experimental treatment or sham group. 67 participants received sidelying manual lumbar traction while the other 67 participants received a sham treatment. Pre and post treatment NPRS values for the painful active lumbar motion were recorded for each group. There was a statistically significant improvement (P=0.00) for decreased pain intensity during active lumbar motion in the experimental group as compared to the sham treatment group. The average percent decrease in numeric pain rating scale (NPRS) values was 52.1% for the experimental treatment group and 8.1% for the sham group. The results of the study suggest that side-lying manual lumbar traction can improve painful lumbar motion in patients with LDD.

Background: Many previous studies recommended the side-lying hip abduction (SHA) exercise for targeting the gluteus medius (Gmed) and gluteus maximus (Gmax) muscle activity while the decreasing tensor fasciae latae (TFL) activation. Mischoice of hip position and angle in SHA may increase the risk of lower extremity injuries and undesirable muscle activation. However, information is limited on the effect of composite hip flexion angles and hip rotation on the gluteal muscle activity during SHA. Objects: This study aimed to compare muscle activity (Gmed, TFL, and Gmax) and activity ratios (Gmed/TFL, Gmax/TFL, and Gmed/Gmax) using surface electromyography (EMG) during SHA exercise at three different hip flexion angles either with or without internal rotation (IR) in subjects with Gmed weakness. We hypothesized that applying hip flexion and IR during SHA would increase gluteal muscle activity and decrease TFL activity. Methods: Muscle activity and activity ratios in 20 volunteers with Gmed weakness during 6 different SHA were investigated with surface EMG. One-way repeated-measures analysis of variance was used to determine the statistical significance. Results: Significant differences were found among the six different exercises for Gmed (F2,41=11.817, p<.001) and Gmax (F3,52=5.513, p=.003) muscle activity, and Gmed/TFL (F3,54=8.735, p<.001) and Gmax/TFL (F2,37=4.019, p=.028) activity ratios. Conclusion: Applying hip flexion is an effective method for increasing gluteal activity, and it elicits great Gmed/TFL and Gmax/TFL activity ratios during SHA in subjects with Gmed weakness.

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 purpose of this study was to determine the effect of contralateral hip adduction (CHA) on the muscle activity of lumbar stabilizers and the angle of pelvic lateral tilting during hip abduction in side lying. Twenty healthy male subjects with no medical history of lower extremity or lumbar spine disorders were recruited for the study. Subjects randomly performed preferred hip abduction (PHA) and hip abduction with contralateral hip adduction in side lying. The muscle activities of the dominant side rectus abdominis, external oblique, internal oblique, quadratus lumborum, gluteus medius, and non-dominant side hip adductor longus were measured during PHA and CHA by using a surface electromyography (EMG) system. Pelvic lateral tilting motion was measured by using a three-dimensional motion analysis system. Data on EMG and pelvic motion were collected at the same time during PHA and CHA. A paired t-test was used to compare EMG activity and the angle of pelvic lateral tilting in the two exercises. The study found that the EMG activities of all muscles were more increased significantly in CHA than PHA condition. The angle of pelvic lateral tilting was more decreased significantly in CHA than PHA condition. These findings suggest that CHA could be recommended as a hip abduction exercise for activating lumbar stabilizers and decreasing compensatory pelvic lateral tilting motion.

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.