Draw-in is a promising intervention for regaining isolated control of the transverse abdominis (TrA). Exercises to stimulate isolated contractions are needed; however, the appropriate methods are unclear. The objectives of this study were to examine how the muscle activity and muscle activity ratio of abdominal muscles change with various verbal instructions and to determine the onset of the abdominal muscles during drawin. The participants were 21 healthy men. TrA electromyography was performed using fine-wire electrodes, and the internal oblique (IO), external oblique (EO), and rectus abdominis (RA) were determined using surface electrodes. The participants performed seven abdominal exercises according to verbal instructions and isolated voluntary contraction of the TrA for more than 5 sec. The TrA showed higher activity in bracing. IO and EO activities were highest in bracing, whereas RA showed the highest activity in maximum bracing. TrA/IO and TrA/EO were not significantly different between conditions. The results of the onset activity analysis of the abdominal muscles during the draw-in maneuver showed that the TrA was significantly earlier than the other muscles. The activity ratios of TrA to IO and EO were highly individualized and did not differ according to the verbal instruction. Maximum draw-in showed more significant IO activity, and bracing showed co-contraction of the superficial and deep abdominal muscles. During draw-in, the TrA initiated the earliest activity among the abdominal muscles and then isolated activity for 1.1 sec.

BACKGROUND: Trunk muscle activity during isometric exercise is altered by external-focus instruction. OBJECTIVE: To check alterations in trunk muscle activity during side plank exercise both with and without instructions to refrain from crushing an item (external-focus instruction method). METHODS: Twenty-one healthy men aged 20–49 participated in this study. Ten trunk muscle activities were measured using surface electromyography during side plank exercises both with and without external-focus instruction. The unpaired t-test or Mann–Whitney U test was used to compare differences between exercise tasks and between sides. RESULTS: Side plank exercise with external-focus instruction increased activity of the upper trapezius, lower trapezius, latissimus dorsi, medial head of the triceps, and internal oblique on the supported side when compared with that without external-focus instruction (p< 0.05 for all). On the unsupported side, side plank exercise with external-focus instruction significantly increased activity of the upper trapezius, lower trapezius, latissimus dorsi, medial head of the triceps, clavicular part of the pectoralis major serratus anterior, external oblique, rectus abdominis, internal oblique, and multifidus when compared with that without external-focus instruction (p< 0.001 for all). CONCLUSIONS: Adding the external-focus instruction method to the conventional side plank exercise may be effective in increasing the trunk muscles’ activity.

BACKGROUND: External focus isometric exercises using a paper balloon can change trunk muscle activation in the chest squeeze; however, it is unknown whether this method affects muscle activities in conventional exercises. OBJECTIVE: To check variations of trunk muscle activity during front plank (static task) and shoulder press (dynamic task) both with and without instruction to avoid crushing an object. METHODS: Twenty-six healthy adult males aged 19–49 were recruited. Ten trunk muscle activities were measured using surface electromyography during a front plank and dynamic shoulder press exercises, both with and without external-focus instruction. RESULTS: Adding the external-focus using the paper balloon to the front plank significantly activated 8 out of the 10 muscles. In the downward shoulder press, 5 out of 10 muscles with 50% 1 RM, 2 out of 10 muscles with 100% 1 RM were significantly activated. CONCLUSIONS: Adding external-focus instruction using paper-balloon increases trunk muscles in front plank and shoulder press while possibly improving trunk stability. Novel exercises using paper balloon may efficiently activate specific muscles without external loading thus possibly reducing the stress on the involved joints during exercise.

<title>Abstract</title><sec>
<title>Background</title>
Medial tibial stress syndrome is a common sports related injury. Altered foot kinematics can be a risk factor for the injury. Since foot segments can move independently, intersegment coordination is important for proper foot function. This study aimed to compare the foot intersegmental coordination pattern and single segment kinematics between female lacrosse players with and without a history of medial tibial stress syndrome during drop jump.


</sec><sec>
<title>Methods</title>
Twelve players with a medial tibial stress syndrome history and 12 players with no history were enrolled. Foot kinematics, including angle at landing and peak angle and excursion at the rearfoot, midfoot, and forefoot during single-leg drop jumps were analysed. Each segment motion data from landing to leaping was time-scaled to 100% to analyse the intersegmental coordination with a modified vector coding technique. Instant intersegmental coordination of every 1% was classified into four patterns (in-phase, two segments rotate in the same direction with similar amplitudes; anti-phase, two segments rotate in opposite directions; proximal phase, proximal segment dominantly rotates in the same direction compared to the distal segment; and distal phase, distal segment dominantly rotates in the same direction compared to the proximal segment). The percentage of intersegmental coordination pattern and kinematics in each segment were compared between the groups using the Student’s t test.


</sec><sec>
<title>Results</title>
Groups with a history of medial stress syndrome showed a significantly higher percentage of proximal phase between the rearfoot and midfoot in the sagittal (Mean ± SD; history, 52.2 ± 17.9%, no history, 29.3 ± 16.7%; <italic>p</italic> = 0.004) and coronal planes (history, 40.3 ± 22.0%, no history, 15.9 ± 9.1%; <italic>p</italic> = 0.004). Dorsiflexion excursion (history, 34.5 ± 4.5°, no history, 29.6 ± 2.1°; <italic>p</italic> = 0.003) were significantly larger in a history of medial tibial stress syndrome group compared to no history group.


</sec><sec>
<title>Conclusions</title>
Rearfoot dominant motion pattern relative to the midfoot may be related to medial tibial stress syndrome. Intersegmental coordination analysis may be useful for detecting abnormal foot coordination patterns. Also, stabilization for the rearfoot may be required rather than the midfoot for intervention.


</sec>

This study aimed to clarify the differences in electromyographic activity between the quadratus lumborum anterior (QL-a) and posterior layers (QL-p), and the relationship among trunk muscles and gluteus medius (GMed) activities during forward landing. Thirteen healthy men performed double-leg and single-leg (ipsilateral or contralateral sides as the electromyography measurement of trunk muscles) forward landings from a 30 cm-height-box. The onset of electromyographic activity in pre-landing and the electromyographic amplitude of the unilateral QL-a, QL-p, abdominal muscles, lumbar multifidus (LMF), erector spinae (LES), and bilateral GMed were recorded. Two-way ANOVA was used to compare the onset of electromyographic activity (3 landing leg conditions × 10 muscles) and electromyographic amplitude among (3 landing leg conditions × 2 phases). The onset of QL-p was significantly earlier in contralateral-leg landing than in the double-leg and ipsilateral-leg landings. The onset of LMF and LES was significantly earlier than that of the abdominal muscles in contralateral-leg landing. QL-p activity and GMed activity on the contralateral leg side in the pre-landing were significantly higher in contralateral-leg landing than in the other leg landings. To prepare for pelvic and trunk movements after ground contact, LMF, LES, QL-p on non-support leg side, and GMed on support leg side showed early or high feedforward activation before ground contact during single-leg forward landing.

<italic><bold>Context</bold>:</italic> The quadratus lumborum (QL) is expected to contribute to segmental motor control of the lumbar spine to prevent low back pain. It has different layers (anterior [QL-a] and posterior [QL-p] layers), whose functional differences are becoming apparent. However, the difference between the QL-a and QL-p activities during bridge exercises utilized in rehabilitation is unclear. <italic><bold>Objective</bold>:</italic> To compare QL-a and QL-p activities during bridge exercises. <italic><bold>Design</bold>:</italic> Repeated-measurement design was used to assess electromyographic activity of trunk muscles recorded during 14 types of bridge exercises. <italic><bold>Setting</bold>:</italic> University laboratory. <italic><bold>Participants</bold>:</italic> A total of 13 healthy men with no history of lumbar spine disorders participated. <italic><bold>Intervention</bold>:</italic> The participants performed 14 types of bridge exercises (3, 3, and 8 types of side bridge, back bridge, and front bridge [FB], respectively). <italic><bold>Main Outcome Measures</bold>:</italic> Fine-wire electromyography was used for QL-a and QL-p activity measurements during bridge exercises. <italic><bold>Results</bold>:</italic> Both QL-a and QL-p showed the highest activity during the side bridge with hip abduction  (47.3% [29.5%] and 43.0% [32.9%] maximal voluntary isometric contraction, respectively). The activity of the QL-a was significantly higher than that of the QL-p during back bridge with ipsilateral leg lift and FB elbow–toe with ipsilateral arm and contralateral leg lift (<italic>P</italic> &lt; .05). With regard to the QL-p, the activity of the FB hand–knee with contralateral arm and ipsilateral leg lift, the FB elbow–knee with contralateral arm and ipsilateral leg lift, and the FB elbow–toe with contralateral arm and ipsilateral leg lift were significantly higher than that of the FB elbow–knee and FB elbow–toe (<italic>P</italic> &lt; .05). <italic><bold>Conclusion</bold>:</italic> This study indicates different regional activities; the QL-a activated during the back bridge with ipsilateral leg lift and FB with ipsilateral arm lift, and the QL-p activated during the FB with ipsilateral leg lift. These results have implications for the rehabilitation of low back pain or lumbar scoliosis patients based on QL recruitment.

OBJECTIVE: Pelvic tilt exercises are used clinically to correct lumbopelvic alignment. The anterior and posterior layers of the quadratus lumborum are important for pelvic motor control in the coronal plane. This study aimed to evaluate whether the anterior and posterior activity is related to the pelvic tilt angle during pelvic tilt exercises. DESIGN: The study design was single-occasion repeated measures in a randomized manner. Twelve healthy men performed the four directions of the pelvic tilt exercises (anterior or posterior pelvic tilt and lateral pelvic elevation on the ipsilateral or contralateral measurement side). The electromyographies of the anterior and posterior were recorded using intramuscular fine-wire electrodes and normalized to isometric peak electromyography. RESULTS: The activity of the anterior and posterior during lateral pelvic elevation on the ipsilateral measurement side (19.0 ± 16.0 percent of maximal voluntary isometric contraction) was significantly higher than that during other directions of the pelvic tilt exercises (P < 0.01). There was a significant positive correlation between the anterior activity and the maximum change angles of pelvic tilt during lateral pelvic elevation on the ipsilateral measurement side (r = 0.674, P = 0.016). CONCLUSIONS: The anterior activity was related to a large lateral pelvic elevation angle on the ipsilateral side during pelvic tilt exercises.

This study aimed to clarify the difference in the onset of EMG activity between eight trunk muscles, including the anterior (QL-a) and posterior (QL-p) layers of the quadratus lumborum during rapid shoulder joint abduction. Thirteen healthy men participated in this study. Electromyography of the QL-a, QL-p, transversus abdominis (TrA), internal oblique (IO), external oblique (EO), rectus abdominis (RA), lumbar multifidus (LMF), lumbar erector spinae (LES) on non-movement side, and middle deltoid (MD) on the movement side were measured. Subjects who were standing in a relaxed position performed rapid shoulder abduction with the dominant hand after light stimulus with or without a 3 kg wrist weight. Two-way ANOVA (muscles × weight conditions) was used to compare the onset of trunk muscles relative to that of MD. There was a significant main effect of the muscles. The onset of the QL-a, QL-p, and TrA was significantly earlier than that of the IO, EO, LMF, and LES (P < 0.01). This result suggests that the activities of the QL-a, QL-p, and TrA have a crucial role in controlling the center of mass within the base of support and stabilizing the lumbar spine in the coronal plane during shoulder abduction.

The purpose of this study was to examine the influence of a history of low back pain (LBP) on pelvic and lumbar kinematics during baseball hitting. Twenty collegiate male baseball players (age, 21±1 years; height, 172.8±4.7 cm; weight, 72.7±6.2 kg; baseball experience, 13±1 years) performed 5 bat swings. Participants were categorized into the LBP group (n=10) or control group (n=10) based on having experienced lumbar spine pain due to bat swing that lasted more than 24 h within the last 12 months. Three-dimensional kinematic data of the pelvis and lumbar spine during bat swing were measured. Two-way ANOVAs were used to compare pelvic and lumbar kinematics throughout the bat swing between groups, and independent t-tests were used to compare the other outcomes between groups. There was a significant main effect between groups in lumbar flexion angle throughout the bat swing (p=0.047). The mean lumbar flexion angle of the LBP group throughout the bat swing was less than that of the control group. Additionally, the peak angular velocity of lumbar flexion of the LBP group was significantly faster than that of control group (p=0.047). These results can be helpful for longitudinal studies that identify the risk factors of LBP due to bat swing.

The purpose of this study was to clarify the influence of different postures on the activity of the shoulder girdle and lower back muscles while using a smartphone. Sixteen healthy male participants maintained two postures while using a smartphone : a good posture in which the tragus and acromion were closer to the vertical line passing through the greater trochanter, and a poor posture in which the tragus and acromion were farther from the vertical line passing through the greater trochanter. The target muscles were the rhomboid major (Rhom), upper trapezius, middle trapezius, lower trapezius (LT), lumbar erector spinae (LES), and lumbar multifidus (LMF). The activities of the Rhom and LT were significantly lower with poor posture than those with good posture. The activities of LES and LMF were significantly higher with poor posture than those with good posture. The results of this study indicated that poor posture was associated with hypoactivity of the shoulder girdle muscles and hyperactivity of the lower back muscles when compared with good posture. Poor posture for prolonged periods while using a smartphone would lead to malfunction of the shoulder girdle muscles and musculofascial lower back pain. J. Med. Invest. 67 : 274-279, August, 2020.

[Purpose] To compare the lumbar lordosis angle and electromyographic activities of the trunk and lower-limb muscles in the hip neutral position and external rotation during back squats. [Subjects and Methods] Ten healthy males without severe low back pain or lower-limb injury participated in this study. The lumbar lordosis angle and electromyographic activities were measured using three-dimensional motion-capture systems and surface electrodes during four back squats: parallel back squats in the hip neutral position and external rotation and full back squats in the hip neutral position and external rotation. A paired t-test was used to compare parallel and full back squats measurements in the hip neutral position and external rotation, respectively. [Results] During parallel back squats, the average lumbar lordosis angle was significantly larger in hip external rotation than in the hip neutral position. During full back squats, lumbar erector spinae and multifidus activities were significantly lower in hip external rotation than in the hip neutral position, whereas gluteus maximus activity was significantly higher in hip external rotation than in the hip neutral position. [Conclusion] The back squat in hip external rotation induced improvement of lumbar kyphosis, an increasing of the gluteus maximus activity and a decrease of both lumbar erector spinae and multifidus activities.

Low back pain (LBP) often occurs in baseball players;however, the characteristics of the location of their LBP with respect to their throwing and hitting sides have not been clarified. In order to clarify the left-right asymmetry of LBP that occurs in baseball players, we surveyed 247 university baseball players using an LBP questionnaire. The main investigational items were:throwing and hitting side, position at the time of LBP experience, and LBP location. Based upon the indication of their throwing and hitting side, subjects were classified into unilateral rotational (UR) or bilateral rotational (BR) types. Subjects were also classified into categories of LBP location as described by ipsilateral or contralateral to dominant side of throwing or hitting. Chi-square test or Fisher exact test were used to compare LBP location side by rotational type (UR/BR) in all subjects and by position (pitcher/fielder). We found that among fielders, LBP occurring contralateral to the hitting side in UR was significantly more frequent than that in BR. We conclude that LBP occurred in baseball fielders with a left-right asymmetry, which suggests that high frequency unilateral rotation causes the lumbar region contralateral to the dominant hitting side to be subject to a high load. J. Med. Invest. 65:56-59, February, 2018.

[Purpose] To measure electromyographic activity of the piriformis using fine-wire electrodes during 7 hip movements. [Subjects and Methods] Eleven healthy men, without severe low back pain or lower limb injury, participated in this study. Fine-wire electrodes were inserted into the piriformis and surface electrodes were attached to the muscles in the hip region and the trunk muscles on the dominant arm side. Electromyographic signal amplitude was measured during 7 hip movements: side-lying external rotation in hip neutral position, side-lying abduction in hip neutral position, side-lying abduction in hip external rotation, side-lying abduction in hip internal rotation, prone extension in hip neutral position, prone extension in hip external rotation, and prone extension in hip internal rotation. Repeated-measures one-way analysis of variance was used to examine electromyographic activity in each of the 7 hip movements. [Results] Piriformis electromyographic activity was highest during prone hip extension in external rotation. Both the superior and inferior portions of the gluteus maximus were also highly activated during prone hip extension in external rotation. [Conclusion] Prone hip extension in external rotation induced high electromyographic activity in the piriformis and superior and inferior gluteus maximus muscles.