ORIGINAL RESEARCH Electromyographic Examination of Selected Muscle Activation During Isometric Core Exercises Gretchen D. Oliver, PhD, ATC, Audrey J. Stone, ATC, CSCS, and Hillary Plummer, BS Objective: The purpose of the current study was to quantitatively examine the muscle activations of 3 common isometric core exercises (abdominal bridge, single-leg abdominal bridge, and superman) along with a newly introduced isometric exercise (flying squirrel) and determine if muscle activations differed among the exercises. Design: The design was a comparison study. Setting: An athletic training classroom laboratory was where all data collections occurred. Participants: Thirty healthy collegiate graduate students (age, 23.4 6 1.4 year; height, 171.3 6 10.3 cm; mass, 73.3 6 16.2 kg), regardless of sex, consented to participate. Independent Variable: The independent variable was the muscle selected. Main Outcome Measures: The main outcome measures or dependent variables were the muscle activation reported as percent of maximum voluntary isometric contraction during each exercise. Results: Results revealed that the multifidi produced the greatest muscle activity in all exercises, and the single-leg abdominal bridge exercise produced greater muscle activation than the general abdominal bridge exercise (P , 0.025). Conclusions: The findings of this study demonstrate that any of these exercises may be a part of a core stability program. In addition, these findings may be incorporated into an isometric core exercise program to supplement a currently implemented isometric core exercise program. Key Words: abdominal muscles, EMG, isometric exercises (Clin J Sport Med 2010;20:452–457) INTRODUCTION The concepts of torso stability, core control, and core strength have been vastly explored in the realm of athletic training and strength and conditioning over the past decade.1–11 Submitted for publication April 5, 2010; accepted July 26, 2010. From the Department of Health Science, Kinesiology, Recreation, and Dance, University of Arkansas, Fayetteville, Arkansas. The authors have no financial disclosures or conflicts of interest. Reprints: Gretchen D. Oliver, PhD, ATC, 309 HPER, 1-University of Arkansas, Fayetteville, AR 72701 (e-mail: [email protected]). Copyright Ó 2010 by Lippincott Williams & Wilkins 452 | www.cjsportmed.com There are numerous terms and definitions that surface when trying to define core stability. However, it is important that within the sports medicine or strength and conditioning arenas, we have some operational definitions. The core has been described as the lumbopelvic–hip complex that incorporates anterior, posterior, medial, and lateral musculature.7 Trunk, torso, and core stabilities describe the ability of the body to maintain or resume a position of the torso after both static and dynamic muscular contractions11 and are the products of motor control of the lumbopelvic–hip complex,7 often referred to as postural control. Coordinated movement occurs through sequential activation of muscle contractions through the kinetic chain.12 The kinetic chain is considered a network of individual links (body segments) that are dependent on each other, allowing for coordinated and efficient movements. The kinetic chain model is based on the sequencing of muscle activity patterns in a proximal to distal nature. The proximal links are composed of the lower extremity and trunk muscles, which is where the muscle energy is initiated and then transferred to the distal extremities. The proximal segments allow for the transfer of momentum to more distal segments, such as the shoulder to propel the wrist and hand in throwing activities.6,12,13 An example would be the anticipatory patterns of proximal segment activations that are associated with distal joint movements, which result in effectively moving the center of gravity forward and up toward the side of unilateral shoulder flexion.10 It is the proximal to distal muscle synergies that allow for postural or trunk corrections to counteract disturbances in equilibrium caused by distal movements.4,5,10 Thus, solely focusing on the kinetic chain model, it is evident that the functionality of the core is vital throughout all forms of segmented movement.1,7,12,13 In addition to the core being a vital contributor to efficient and effective segmental movement, it has also been documented as a key component of injury prevention.3,5,7,9 The core musculature innately prevents postural collapse.8,9 Postural collapse then biomechanically leads to inefficiencies in movement. In an attempt to perform with optimal force production, it is vital to be in a biomechanically correct posture.8,9 Lack of torso stability results in decreased force production and compensatory segmental movements. Emphasis has previously been placed on performing various types of abdominal crunches in an attempt to target and strengthen the anterior abdominals.1 Improved understanding that the core is composed of the entire lumbopelvic– hip complex has resulted in an increase in popularity of core stability routines focused on recruiting the anterior, medial, Clin J Sport Med Volume 20, Number 6, November 2010 Clin J Sport Med Volume 20, Number 6, November 2010 lateral, and postural musculature. Efforts to target the core in its entirety have led to the inclusion of core exercises that result in isometric contractions. Studies have shown that in as few as 4 weeks of implementing an isometric core stability program, fourth graders were able to improve their core musculature endurance.14 Thus, with the increased popularity of these isometric core exercises, it was the purpose of our study to quantitatively examine the muscle activations of 3 common isometric core stability exercises (abdominal bridge, single-leg abdominal bridge, and superman) along with a newly introduced core exercise (flying squirrel) and determine if muscle activations differed among the exercises. We hypothesized that all exercises would activate the core musculature and that there would be significant differences in muscle activations among the different exercises. METHODS Study Design A single-group repeated measures design was used to collect muscle activation data for bilateral gluteus maximus, gluteus medius, external oblique, and multifidus muscle groups. Electromyographic data were collected for the following core exercises: superman, flying squirrel, abdominal bridge, and the single-leg abdominal bridge. Participants were given instructions on how to properly perform each exercise, and data were recorded for 3 trials of each exercise. All participants were instructed by the same certified athletic trainer (ATC) throughout all data collection. Participants were instructed on the proper technique (by the same ATC), and then they practiced the technique. The ATC explained the verbal cues that would be given and how the participant should adjust their posture. Instruction was standardized in that the same ATC gave all instructions so that there was no variability between those giving instruction and verbal cues. Participants Thirty healthy collegiate graduate students (age, 23.4 6 1.4 year; height, 171.3 6 10.3 cm; mass: 73.3 6 16.2 kg), regardless of sex, consented to participate in the current study. Healthy collegiate graduate students were defined as having no history of any type of injury in the past 6 months and currently participating in physical activity for at least 30 minutes, 4 times a week. In addition, participants were excluded if they reported a previous history of low back pain. Data collection sessions were conducted indoors at the Health, Physical Education, and Recreation building of the University of Arkansas. All testing protocols used in the current study were approved by the University of Arkansas Institutional Review Board, and before participation, the approved procedures, risks, and benefits were explained to all participants. Informed consent was obtained from the participants, and the rights of the participants were protected according to the guidelines of the University’s Institutional Review Board. Procedure Participants reported for testing before engaging in any vigorous activity on testing day. Location of the core musculature, bilateral gluteus maximus, gluteus medius, q 2010 Lippincott Williams & Wilkins sEMG of Common Core Exercises external oblique, and multifidus, were identified through palpation. Before testing, the identified locations for surface electrode placement were shaved, abraded, and cleaned using standard medical alcohol swabs. Subsequent to surface preparation, adhesive 3M Red-Dot bipolar surface electrodes (3M, Saint Paul, Minnesota) were attached over the muscle bellies and positioned parallel to muscle fibers using techniques described by Basmajian and Deluca.15 In the current study, the selected interelectrode distance was 25 mm.16 The use of surface electrodes was chosen because they have been deemed to be a noninvasive technique that is able to reliably detect the surface muscle activity.15–17 Electrodes were secured before conducting 2 manual muscle tests (MMTs) for each muscle, and the protocols were explained to ensure the participant’s full understanding. These MMTs were used to identify the approximate maximum voluntary isometric contraction (MVIC) for each muscle and were performed following the techniques described by Kendall et al.16 All MMTs consisted of a 5-second isometric contraction for each muscle, with MVIC data for the first and last second of each contraction removed to obtain steadystate results. Each MMT was conducted to establish baseline readings for each participant’s maximum muscle activity to which all surface electromyographic (sEMG) data could be compared. Electromyographic data were collected via a Noraxon Myopac 1400L 8-channel amplifier (Noraxon USA, Inc, Scottsdale, Arizona). The signal was full-wave rectified and root mean squared at 100 milliseconds. Throughout all testing, sEMG data were sampled at a rate equal to 1000 Hz. Filtering of all sEMG data was completed using standard band-pass filtering techniques with band-pass filters set at cutoffs of 20 Hz and 350 Hz, respectively. In addition, all sEMG data were notch filtered at frequencies of 59.5 and 60.5 Hz, respectively.18 After electrode placement, investigators instructed the participants on proper technique for each of the core exercises. Participants were randomly assigned the order in which core exercises would be completed. Each participant performed each exercise as a warm-up trial before any data were collected. During the trials, participants were instructed on proper posture through verbal cures. The exercises that the participants performed were the following. Superman Participants performed the superman lying prone with arms straight out over the head and legs fully extended. They were then instructed to raise arms and legs off the floor and to hold that position for 10 seconds (Figure 1). Flying Squirrel Participants performed the flying squirrel lying prone with knees flexed, hips internally rotated, and legs lifted off the floor. Participants’ arms were flexed at the elbows, shoulders externally rotated, and lifted off the floor. This position was held for 10 seconds (Figure 2). www.cjsportmed.com | 453 Oliver et al Clin J Sport Med Volume 20, Number 6, November 2010 FIGURE 1. Superman exercise. Arms and legs raised off the floor and held for 10 seconds. Abdominal Bridge Participants performed the abdominal bridge lying supine with knees flexed and feet on the floor. Arms were crossed over the chest, and the torso was lifted off the floor, positioning the torso and pelvis in a neutral alignment. The position was held for 10 seconds (Figure 3). Abdominal Bridge With One-Leg Support Participants performed the abdominal bridge with single-leg support similar to the abdominal bridge. Participants performed the abdominal bridge and then lifted one foot off the floor by extending the knee. While the participant was in single-leg support, the torso and pelvis maintained neutral alignment. This exercise was performed on each leg and held for 10 seconds each (Figure 4). Statistical Analysis Data from each muscle were normalized by being expressed as a percent contribution of the MVIC. Statistical analyses were performed using SAS version 9.2 (SAS Institute, Inc, Cary, North Carolina). Repeated measures multivariate analysis of variance was conducted to determine a global difference in muscle activation among all 5 exercises. Tukey’s Honestly Significant Different (HSD) test was used to identify all possible pairwise comparisons in muscle activations within each exercise. An overall a level was set a priori at P # 0.05. In an effort to control for type I error due to multiple analyses, the a level was adjusted to P # 0.025 using Bonferroni correction. FIGURE 2. Flying squirrel. Arms flexed at elbows, shoulders externally rotated, and lifted off the floor. Knees flexed, hips internally rotated, and legs lifted off the floor. The position was held for 10 seconds. 454 | www.cjsportmed.com FIGURE 3. Abdominal bridge. With arms crossed over the chest, the torso was lifted off the floor and position was held for 10 seconds. RESULTS The mean EMG activity of each muscle was expressed as a percent of MVIC (%MVIC). Figures 5–8 show %MVIC for each muscle within each exercise. Figure 5 is a graphic representation of muscle activations (mean 6 SD) in the multifidi for both left and right sides. The squirrel and superman exercises produced significantly greater %MVIC in the multifidi than the bridge exercises (squirrel, 57 6 29 in the left and 56 6 22 in the right; superman, 61 6 28 in the left and 62 6 22 in the right; bridge, 32 6 18 in the left and 33 6 18 in the right; P , 0.025). Figure 6 displays the muscle activations (mean 6 SD) in the gluteus maximus for both left and right sides. The bridge exercise produced significantly lower %MVIC in the gluteus maximus for both the left and right sides (left, 20 6 14 and right, 16 6 11; P , 0.025), and the bridge with leg lift produced significantly lower %MVIC of the gluteus maximus ipsilateral of the lifted leg (right bridge, 31 6 19 in the left and 7 6 5 in the right; left bridge, 8 6 5 in the left and 25 6 18 in the right; P , 0.025). Figure 7 displays the muscle activations (mean 6 SD) in the gluteus medius for both left and right sides. Similarly, the bridge exercise produced significantly lower %MVIC in the gluteus medius for both the left and right sides (left, 17 6 9 and right, 17 6 11; P , 0.025), and the bridge with leg lift produced significantly lower %MVIC of the gluteus medius ipsilateral of the lifted leg (right bridge, 35 6 17 in the left and 14 6 14 in the right; left FIGURE 4. Abdominal bridge with one-leg support. Perform abdominal bridge and then lift one leg off floor by extending at knee. The position was held for 10 seconds. q 2010 Lippincott Williams & Wilkins Clin J Sport Med Volume 20, Number 6, November 2010 sEMG of Common Core Exercises lowest power to be 0.94 when examining differences in %MVIC between multifidi and other muscles during any of the 5 exercises. DISCUSSION FIGURE 5. Muscle activation of the multifidi. Percent maximum involuntary isometric contraction (%MVIC) recorded for multifidi activation are presented per each exercise. *Significantly lower than squirrel and superman %MVIC (P , 0.025). bridge, 10 6 13 in the left and 33 6 16 in the right; P , 0.025). Figure 8 shows the muscle activations (mean 6 SD) in the obliques for both the left and right sides. The bridge exercise produced significantly lower %MVIC in the obliques for both left and right sides (left, 9 6 8; right, 8 6 8; P , 0.025) than the bride with leg lift exercise (right bridge, 15 6 11 in the left and 14 6 10 in the right; left bridge, 17 6 15 in the left and 14 6 11 in the right; P , 0.025). Overall, the multifidi produced the greatest %MVIC in all exercises, and the bridge with leg lift exercise produced greater muscle activation than the general bridge exercise. A post hoc power analysis was conducted using paired means and found the FIGURE 6. Muscle activation of the gluteus maximus. Percent maximum involuntary isometric contraction (%MVIC) recorded for gluteus maximus activation are presented per each exercise. *Significantly lower than squirrel, superman, and bridge with right leg lift %MVIC (P , 0.025). †Significantly lower than squirrel, superman, and bridge with left leg lift %MVIC (P , 0.025). q 2010 Lippincott Williams & Wilkins The purpose of this study was to quantitatively examine the muscle activations of 3 common isometric core stability exercises (abdominal bridge, abdominal bridge with leg lift, and superman) and 1 newly introduced core exercise (flying squirrel). The data presented were a representation of %MVIC of each muscle acting on the lumbopelvic–hip complex. Although this study did not examine all the muscles acting on the lumbopelvic–hip complex, all muscles examined are a part of the lumbopelvic–hip complex. Typically, the most commonly mentioned muscles of the lumbopelvic–hip complex are the transverse abdominis and multifidi. However, due to the deep location of the transverse abdominis, the investigators did not feel that sEMG would adequately describe its muscle activation. Just as data regarding the muscles controlling the pelvic floor would be advantageous in displaying the efficiency of the exercises proposed, the methodology used limited the ability to examine the deep musculature of the lumbopelvic–hip complex. It is believed that those muscles examined were a reliable representation of lumbopelvic muscle activation. The data from the current study can be applied to core strengthening and rehabilitation regimens. The current study is in agreement with the previous work examining the abdominal bridge and the abdominal bridge with the leg lift.19 However, the previous studies have not examined the superman or the flying squirrel exercises. It has been shown that the core musculature, specifically the transverse abdominis, is the first to fire during unexpected trunk loading or trunk self-loading and during any upper or lower extremity movement, regardless of the direction of FIGURE 7. Muscle activation of the gluteus medius. Percent maximum involuntary isometric contraction (%MVIC) recorded for gluteus medius activation are presented per each exercise. *Significantly lower than squirrel, superman, and bridge with right leg lift %MVIC (P , 0.025). †Significantly lower than squirrel, superman, and bridge with left leg lift %MVIC (P , 0.025). www.cjsportmed.com | 455 Oliver et al FIGURE 8. Muscle activation of the external obliques. Percent maximum involuntary isometric contraction (%MVIC) recorded for oblique activation are presented per each exercise. *Significantly lower than bridge with leg lift %MVIC (P , 0.025). movement.20 After the transverse abdominis, it is believed that the multifidi are next to fire.21 In a study examining the multifidi between healthy patients and patients with low back pain, the patients exhibiting back pain had a reduced capacity to activate their multifidi.22 The results presented display that the multifidi were activated greater than 50% MVIC on both the right and left sides when performing the superman and flying squirrel exercise. Clinically, it has been demonstrated that small increases in activation of the multifidi are required for spinal stability.2 Ultimately, it has been discussed that the decreased multifidi activation in patients with low back pain could be a result of the back pain. MacDonald et al23 also recently reported that those individuals who had a history of low back pain had delayed activation of the multifidus than those without back pain, thus alluding to the discussion that those with back pain may exhibit altered motor strategies in an attempt to avoid pain vexation.24 Therefore, it should be noted that all participants in the current study were pain free and had no history of low back pain. It has been proposed that the multifidi and the transverse abdominis co-contract during abdominal hollowing,21 suggesting that the co-contraction allows for spinal stability or postural control. Thus, with the evidence that supports the multifidi as a key component of spinal stability, it would seem fundamental that the multifidi should be the focus of any core strengthening and/or rehabilitation program. It should be noted that the multifidus muscle group is complex, in that there are superficial and deep fibers. However, it is difficult to differentiate them both anatomically and biomechanically,25,26 although it has been assumed that the superficial multifidi allow for more efficient control of lumbar extension and spinal orientation control.27 The gluteal muscle group also acts to stabilize the pelvis. Particularly, the gluteus maximus acts to externally rotate the hip and extend the trunk, whereas the gluteus medius abducts the hip, stabilizes the pelvis, and assists in external hip rotation. Grelsamer and McConnel28 describe the effects of a weak gluteus maximus resulting in a contralateral drop of the 456 | www.cjsportmed.com Clin J Sport Med Volume 20, Number 6, November 2010 pelvis and internal rotation at the hip, thus increasing one’s functional quadriceps angle. It has been reported that weak hip abductors (gluteal muscle group) have been associated with anterior knee pain.29,30 In addition, weak hip external rotation has been correlated with greater incidence of knee injury.7 Recently, it was reported that individuals with patellofemoral pain had a significant alteration in the gluteal and trunk musculature.31 The present study demonstrated greatest gluteus maximus and gluteus medius activations when performing the squirrel, superman, and single-leg bridge. The oblique muscle group is activated in directionspecific patterns in an effort to support the pelvis before limb movement.4,5,10 The obliques in the current study were activated the least compared with other muscles examined with the single-leg support bridges, and the squirrel displayed the greatest activation. The obliques investigated were the external obliques, which are activated during rotation. Typically, when rotating to the right, the contralateral or left external oblique is activated. The decrease in oblique activation was expected because none of the exercises performed were rotational in nature. With the strong relationship of the muscles of the lumbopelvic–hip complex playing a role in injury prevention,3,6,7,9,11,29,31 it would be ideal if these exercises were incorporated not only in the rehabilitation process but also in the basic maintenance conditioning regimens. Based on the findings of the current study, by incorporating these isometric core exercises into rehabilitation or maintenance conditioning, there is a greater chance for patients and athletes to maintain pelvic neutral throughout their activities and ultimately attempt to decrease the incidence of injury. Limitations It should be noted that all participants in the study were healthy and free of any injury for the past 6 months and had no history of back injury or low back pain. Often, isometric core exercises are encouraged for those individuals who are suffering from low back pain. If individuals with low back pain were examined, they may display different trends in muscle activation. A second limitation was the use of sEMG. Although electrode placement was in accordance to Kendall et al,16 sEMG does have a limitation of cross talk between electrodes. The nature of sEMG often allows for cross talk among muscles that are close in proximity. In addition, it has been noted that when trying to record sEMG of the multifidus, the longissimus thoracis muscle activity is often recorded instead. When keeping with the sEMG protocol, it is recommended that if it is the multifidi that are of interest, then further investigation of the longissimus thoracis should also be included in attempt to differentiate the 2 muscle activations. CONCLUSIONS The data revealed that the flying squirrel and superman exercises produced the greatest overall muscle activations of the core musculature investigated. In addition, the abdominal bridge with the leg lift displayed increased muscle activation of the gluteal group, especially the gluteus medius of the support q 2010 Lippincott Williams & Wilkins Clin J Sport Med Volume 20, Number 6, November 2010 leg (opposite the leg lifted). The flying squirrel, abdominal bridge, abdominal bridge with leg lift, and superman exercises provided muscle activations in what we previously defined as the primary musculature of the core. The findings of this study demonstrate that any of these exercises may be incorporated into a core stability program. In addition, these findings may be used as adjuncts to supplement a currently implemented core stability program. Based on the results of this study, further research is warranted. Future research should focus on not only healthy populations but also individuals with low back pain. An intervention study would allow for these exercises to be examined on both healthy populations and individuals with back pain. After performing the exercises for a period, it would be interesting to examine the muscle activation in the individuals with back pain after the pain had subsided. ACKNOWLEDGMENTS The authors acknowledge the assistance of Katelyn Bishop and Jaime Hall. REFERENCES 1. Bliss LS, Teeple P. Core stability: the centerpiece of any training program. Curr Sports Med Rep. 2005;4:179–183. 2. Cholewicki J, Juluru K, McGill SM, et al. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J Biomech. 1999;32:13–17. 3. Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech (Bristol, Avon). 1996;11:1–15. 4. Cordo PJ, Nashner LM. 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