Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Jun 2010

Surface Electromyography Biofeedback Training to Address Muscle Inhibition as an Adjunct to Postoperative Knee Rehabilitation

MA, LPC, BCB and
MS, PT
Page Range: 56 – 63
DOI: 10.5298/1081-5937-38.2.56
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Abstract

Following a knee injury and surgery, pain-related and fear-related muscle inhibition can interfere with rehabilitation and may contribute to the development of chronic pain. Surface electromyography biofeedback can help patients identify and overcome muscle inhibition during physical therapy exercises, so that normal muscle strength and range of motion can be regained.

Keywords: surface electromyography; vastus medialis oblique; vastus lateralis; quad set; straight leg raise
Copyright: Association for Applied Psychophysiology & Biofeedback
Figure 1
Figure 1

Bones and ligaments of the knee. From Wikipedia Commons.

Figure 2
Figure 2

Supine straight leg raise exercise for strengthening the knee. Reproduced with permission of VHI (http://www.vhikits.com, © 2009, VHI).

Figure 3
Figure 3

Muscles of the knee and leg. From Wikipedia Commons.

Figure 4
Figure 4

Surface electromyography (SEMG) placement for vastus medialis oblique (VMO) and vastus lateralis (VL). Reproduced from The Biofeedback Tutor with permission of Biosource Software.

Figure 5
Figure 5

Baseline surface electromyography (SEMG) measure of the right knee with vastus medialis oblique (VMO) and vastus lateralis (VL) placements. While in an upright sitting position, Case Example 1 was asked to extend her knee, straighten her leg, and produce a maximal knee contraction two times.

Figure 6
Figure 6

Baseline surface electromyography (SEMG) measure of the right knee with vastus medialis oblique (VMO) and vastus lateralis (VL) placements. While lying supine on the floor (as in Figure 2), Case Example 1 was asked to produce two quad sets (notice that the second one was so weak that it did not register), to produce four straight leg raises (notice minimal VMO activation), and to point the knee toward the ceiling, interlace the fingers beneath the knee (as in Figures 8 and 9), and allow the knee to bend and stretch (notice good flexion-relaxation during the knee bend).

Figure 7
Figure 7

Surface electromyography (SEMG) measure of the right knee during straight leg raise (SLR) exercises, with vastus medialis oblique (VMO) and vastus lateralis (VL) placements. While lying supine on the floor (as in Figure 2) and receiving visual SEMG feedback and verbal instruction, Case Example 1 is practicing a two-part SLR strategy of “quad set, then raise and hold.” Notice the first contraction “dies” somewhat in the VMO upon raising the leg. By the third attempt, this patient was demonstrating better success with maintaining the contraction during the SLR.

Figure 8
Figure 8

Baseline surface electromyography (SEMG) measure of the right knee, with vastus medialis oblique (VMO) and vastus lateralis (VL) placements. Case Example 2 was asked to hold the leg below the knee and allow the knee to bend and stretch. Notice elevated SEMG readings during the stretch, showing a lack of flexion-relaxation.

Figure 9
Figure 9

Training surface electromyography (SEMG) measure of the right knee, with vastus medialis oblique (VMO) and vastus lateralis (VL) placements. While receiving visual and auditory SEMG feedback and verbal instruction, Case Example 2 is practicing flexion-relaxation during a gravity-assisted knee stretch. Notice increased range of motion compared with the baseline stretch in Figure 8.

Contributor Notes

Correspondence: Randy Neblett, Productive Rehabilitation Institute of Dallas for Ergonomics, 5701 Maple Avenue, #100, Dallas, TX 75235, e-mail: randy@nebletthome.com.
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