Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-85. doi: 10.2165/00007256-200939080-00004. Escamilla RF et al
The rotator cuff performs multiple functions during shoulder exercises, including glenohumeral abduction, external rotation (ER) and internal rotation (IR). The rotator cuff also stabilizes the glenohumeral joint and controls humeral head translations. The infraspinatus and subscapularis have significant roles in scapular plane abduction (scaption), generating forces that are two to three times greater than supraspinatus force. However, the supraspinatus still remains a more effective shoulder abductor because of its more effective moment arm. Both the deltoids and rotator cuff provide significant abduction torque, with an estimated contribution up to 35-65% by the middle deltoid, 30% by the subscapularis, 25% by the supraspinatus, 10% by the infraspinatus and 2% by the anterior deltoid. During abduction, middle deltoid force has been estimated to be 434 N, followed by 323 N from the anterior deltoid, 283 N from the subscapularis, 205 N from the infraspinatus, and 117 N from the supraspinatus. These forces are generated not only to abduct the shoulder but also to stabilize the joint and neutralize the antagonistic effects of undesirable actions. Relatively high force from the rotator cuff not only helps abduct the shoulder but also neutralizes the superior directed force generated by the deltoids at lower abduction angles. Even though anterior deltoid force is relatively high, its ability to abduct the shoulder is low due to a very small moment arm, especially at low abduction angles. The deltoids are more effective abductors at higher abduction angles while the rotator cuff muscles are more effective abductors at lower abduction angles. During maximum humeral elevation the scapula normally upwardly rotates 45-55 degrees, posterior tilts 20-40 degrees and externally rotates 15-35 degrees. The scapular muscles are important during humeral elevation because they cause these motions, especially the serratus anterior, which contributes to scapular upward rotation, posterior tilt and ER. The serratus anterior also helps stabilize the medial border and inferior angle of the scapular, preventing scapular IR (winging) and anterior tilt. If normal scapular movements are disrupted by abnormal scapular muscle firing patterns, weakness, fatigue, or injury, the shoulder complex functions less efficiency and injury risk increases. Scapula position and humeral rotation can affect injury risk during humeral elevation. Compared with scapular protraction, scapular retraction has been shown to both increase subacromial space width and enhance supraspinatus force production during humeral elevation. Moreover, scapular IR and scapular anterior tilt, both of which decrease subacromial space width and increase impingement risk, are greater when performing scaption with IR ('empty can') compared with scaption with ER ('full can'). There are several exercises in the literature that exhibit high to very high activity from the rotator cuff, deltoids and scapular muscles, such as prone horizontal abduction at 100 degrees abduction with ER, flexion and abduction with ER, 'full can' and 'empty can', D1 and D2 diagonal pattern flexion and extension, ER and IR at 0 degrees and 90 degrees abduction, standing extension from 90-0 degrees , a variety of weight-bearing upper extremity exercises, such as the push-up, standing scapular dynamic hug, forward scapular punch, and rowing type exercises. Supraspinatus activity is similar between 'empty can' and 'full can' exercises, although the 'full can' results in less risk of subacromial impingement. Infraspinatus and subscapularis activity have generally been reported to be higher in the 'full can' compared with the 'empty can', while posterior deltoid activity has been reported to be higher in the 'empty can' than the 'full can'.
Anterior cruciate ligament strain and tensile forces for weight-bearing and non-weight-bearing exercises: a guide to exercise selection. J Orthop Sports Phys Ther. 2012 Mar;42(3):208-20. Epub 2012 Feb 29. Escamilla RF et al There is a growing body of evidence documenting loads applied to the anterior cruciate ligament (ACL) for weight-bearing and non-weight-bearing exercises. ACL loading has been quantified by inverse dynamics techniques that measure anterior shear force at the tibiofemoral joint (net force primarily restrained by the ACL), ACL strain (defined as change in ACL length with respect to original length and expressed as a percentage) measured directly in vivo, and ACL tensile force estimated through mathematical modeling and computer optimization techniques. A review of the biomechanical literature indicates the following: ACL loading is generally greater with non-weight-bearing compared to weight-bearing exercises; with both types of exercises, the ACL is loaded to a greater extent between 10° to 50° of knee flexion (generally peaking between 10° and 30°) compared to 50° to 100° of knee flexion; and loads on the ACL change according to exercise technique (such as trunk position). Squatting with excessive forward movement of the knees beyond the toes and with the heels off the ground tends to increase ACL loading. Squatting and lunging with a forward trunk tilt tend to decrease ACL loading, likely due to increased hamstrings activity. During seated knee extension, ACL force decreases when the resistance pad is positioned more proximal on the anterior aspect of the lower leg, away from the ankle. The evidence reviewed as part of this manuscript provides objective data by which to rank exercises based on loading applied to the ACL. The biggest challenge in exercise selection post-ACL reconstruction is the limited knowledge of the optimal amount of stress that should be applied to the ACL graft as it goes through its initial incorporation and eventual maturation process. Clinicians may utilize this review as a guide to exercise selection and rehabilitation progression for patients post-ACL reconstruction.
Cruciate ligament forces between short-step and long-step forward lunge. Med Sci Sports Exerc. 2010 Oct;42(10):1932-42. Escamilla RF et al PURPOSE: The purpose of this study was to compare cruciate ligament forces between the forward lunge with a short step (forward lunge short) and the forward lunge with a long step (forward lunge long). METHODS: Eighteen subjects used their 12-repetition maximum weight while performing the forward lunge short and long with and without a stride. EMG, force, and kinematic variables were input into a biomechanical model using optimization, and cruciate ligament forces were calculated as a function of knee angle. A two-factor repeated-measure ANOVA was used with a Bonferroni adjustment (P < 0.0025) to assess differences in cruciate forces between lunging techniques. RESULTS: Mean posterior cruciate ligament (PCL) forces (69-765 N range) were significantly greater (P < 0.001) in the forward lunge long compared with the forward lunge short between 0 degrees and 80 degrees knee flexion angles. Mean PCL forces (86-691 N range) were significantly greater (P < 0.001) without a stride compared with those with a stride between 0 degrees and 20 degrees knee flexion angles. Mean anterior cruciate ligament (ACL) forces were generated (0-50 N range between 0 degrees and 10 degrees knee flexion angles) only in the forward lunge short with stride. CONCLUSIONS: All lunge variations appear appropriate and safe during ACL rehabilitation because of minimal ACL loading. ACL loading occurred only in the forward lunge short with stride. Clinicians should be cautious in prescribing forward lunge exercises during early phases of PCL rehabilitation, especially at higher knee flexion angles and during the forward lunge long, which generated the highest PCL forces. Understanding how varying lunging techniques affect cruciate ligament loading may help clinicians prescribe lunging exercises in a safe manner during ACL and PCL rehabilitation.
An electromyographic analysis of sumo and conventional style deadlifts. Med Sci Sports Exerc. 2002 Apr;34(4):682-8. Escamilla RF et al
PURPOSE: Strength athletes often employ the deadlift in their training or rehabilitation regimens. The purpose of this study was to compare muscle activity between sumo and conventional style deadlifts, and between belt and no-belt conditions. METHODS: Six cameras collected 60-Hz video data and 960-Hz electromyographic data from 13 collegiate football players who performed sumo and conventional deadlifts with and without a lifting belt, employing a 12-RM intensity. Variables measured were knee angles and EMG measurements from 16 muscles. Muscle activity were averaged and compared within three 30-degree knee angle intervals from 90 to 0 degrees during the ascent, and three 30-degree knee angle intervals from 0 to 90 degrees during the descent. RESULTS: Overall EMG activity from the vastus medialis, vastus lateralis, and tibialis anterior were significantly greater in the sumo deadlift, whereas overall EMG activity from the medial gastrocnemius was significantly greater in the conventional deadlift. Compared with the no-belt condition, the belt condition produced significantly greater rectus abdominis activity and significantly less external oblique activity. For most muscles, EMG activity was significantly greater in the knee extending intervals compared with the corresponding knee flexing intervals. Quadriceps, tibialis anterior, hip adductor, gluteus maximus, L3 and T12 paraspinal, and middle trapezius activity were significantly greater in higher knee flexion intervals compared with lower knee flexion intervals, whereas hamstrings, gastrocnemius, and upper trapezius activity were greater in lower knee flexion intervals compared with higher knee flexion intervals. CONCLUSIONS: Athletes may choose to employ either the sumo or conventional deadlift style, depending on which muscles are considered most important according to their training protocols. Moderate to high co-contractions from the quadriceps, hamstrings, and gastrocnemius imply that the deadlift may be an effective closed kinetic chain exercise for strength athletes to employ during knee rehabilitation.
A biomechanical comparison of the traditional squat, powerlifting squat and box squat. J Strength Cond Res. 2012 Apr 10. [Epub ahead of print] Swinton PA et al The purpose of this study was to compare the biomechanics of the traditional squat with two popular exercise variations commonly referred to as the powerlifting squat and box squat. Twelve male powerlifters performed the exercises with 30, 50 and 70% of their measured 1RM, with instruction to lift the loads as fast as possible. Inverse dynamics and spatial tracking of the external resistance were used to quantify biomechanical variables. A range of significant kinematic and kinetic differences (p<0.05) emerged between the exercises. The traditional squat was performed with a narrow stance, whereas the powerlifting squat and box squat were performed with similar wide stances (48.3 ± 3.8cm, 89.6 ± 4.9cm, 92.1 ± 5.1cm, respectively). During the eccentric phase of the traditional squat the knee travelled past the toes resulting in anterior displacement of the system center of mass (COM). In contrast, during the powerlifting squat and box squat a more vertical shin position was maintained, resulting in posterior displacements of the system COM. These differences in linear displacements had a significant effect (p<0.05) on a number of peak joint moments, with the greatest effects measured at the spine and ankle. For both joints the largest peak moment was produced during the traditional squat, followed by the powerlifting squat, then box squat. Significant differences (p<0.05) were also noted at the hip joint where the largest moment in all 3 planes were produced during the powerlifting squat. Coaches and athletes should be aware of the biomechanical differences between the squatting variations and select according to the kinematic and kinetic profile that best match the training goals.
The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res. 2002 Aug;16(3):428-32. Caterisano A et al The purpose of this study was to measure the relative contributions of 4 hip and thigh muscles while performing squats at 3 depths. Ten experienced lifters performed randomized trials of squats at partial, parallel, and full depths, using 100-125% of body weight as resistance. Electromyographic (EMG) surface electrodes were placed on the vastus medialis (VMO), the vastus lateralis, (VL), the biceps femoris (BF), and the gluteus maximus (GM). EMG data were quantified by integration and expressed as a percentage of the total electrical activity of the 4 muscles. Analysis of variance (ANOVA) and Tukey post hoc tests indicated a significant difference (p < 0.001*, p = 0.056**) in the relative contribution of the GM during the concentric phases among the partial- (16.9%*), parallel- (28.0%**), and full-depth (35.4%*) squats. There were no significant differences between the relative contributions of the BF, the VMO, and the VL at different squatting depths during this phase. The results suggest that the GM, rather than the BF, the VMO, or the VL, becomes more active in concentric contraction as squat depth increases.