PHOEBE RUNCIMAN DR. YUMNA ALBERTUS-KAJEE PROF. WAYNE DERMAN DR. SUZANNE FERREIRA
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1 NOVEL USES OF ELECTROMYOGRAPHY IN EVALUATION OF SKELETAL MUSCLE RECRUITMENT DURING EXERCISE IN ATHLETES WITH DISABILITIES: A KEY TO INJURY PREVENTION AND FUTURE CLASSIFICATION? PHOEBE RUNCIMAN DR. YUMNA ALBERTUS-KAJEE PROF. WAYNE DERMAN DR. SUZANNE FERREIRA
2 Electromyography (EMG) The study of muscle activation by examination of the electrical signals that emanate from skeletal muscle Neuromuscular conditions: Amyotrophic lateral sclerosis (ALS) & Cerebral Palsy (CP) Musculoskeletal injury: Chronic gluteal strains & Chronic hamstring strains
3 FUNCTIONAL MUSCLE ACTIVITY: ALS vs. CP
4 Background: Athletes ALS Lower motor neuron form of ALS Age: 43 yrs Time since diagnosis: 4 yrs Prognosis: months 2 yrs participation Classification- S9 Side most affected: Left Swimming event: freestyle CP Spastic hemiplegic CP Age: 25 yrs 8 yrs participation Classification- T37 Side affected: Right Track events: 100m, 200m
5 Testing protocol Pre fatigue: ALS 15 strokes: blue band Muscles: Fatigue: Primary Swimming power strokes muscles: using black Anterior bands for deltoid, 30 sec Posterior deltoid Pectoralis major Serratus anterior Latissimus dorsi 15 strokes using blue band Secondary support muscles: Upper trapezius, Lower trapezius External oblique Post fatigue: CP Sufficient warm up Initial trial (10s) Muscles: Sprint cycling trial Erector spinae 30 seconds maximal effort Gluteus medius Biceps femoris Vastus lateralis Gastrocnemius medialis Normalised to 10s sprint Normalised to 10s max trial
6 Results: ALS Muscle Left Right Same Pectoralis Major 4.5 % Posterior Deltoid 16.8 % Anterior Deltoid 20 % Serratus Anterior 0 % Latissimus Dorsi 21 % Upper Trap 1.2 % Lower trap 18.8 % External Obliques 11.6 %
7 Results: ALS fatigue and symmetry AFFECTED SIDE NON AFFECTED SIDE Power muscles Power muscles Support muscles Support muscles Belief of poor affected side Change biomechanics Done to protect affected side Over-activation and fatigue Supported by LatDorsi: starts to activate with fatigue Due to loss of conscious constraint Power: Post delt, Ant delt, Pect major, Serr ant, Lat dorsi With fatigue: natural stroke returned INCORRECT BIOMECHANICS? Support: Upper traps, Lower traps, External obliques
8 Results: CP: Pre-fatigue symmetry Muscle Non affected side Affected side Erector spinae 23 % Similar Gluteus medius 4 % Biceps femoris 13 % Vastus lateralis 25 % Gastrocnemius 1 %
9 Results: CP: Post-fatigue symmetry Muscle Non affected side Affected side Erector spinae 27 % Similar Possible compensation for lack of BF over-activation on affected side Gluteus medius 30 % Biceps femoris 9 % Vastus lateralis 25 % Gastrocnemius 6 %
10 CP: A closer look shows a muscle irregularity 1000 LT BICEPS FEM., uv RT BICEPS FEM. Analyzed Signals / Periods Able bodied Amplitude (mv) VLO BF LT VLO, uv RT VLO Periods 1 Pre-event Markers 1 Marker s LT BICEPS FEM., uv Analyzed Signals / Periods RT BICEPS FEM. Cerebral palsy Affected Affected Affected Amplitude (mv) VLO BF BF VLO 500 LT VLO, uv RT VLO 0 Periods 1 Begin Markers 1 Marker s
11 Summary: ALS &CP ALS: The results suggest that by protecting the side that he believed to be severely affected, he was compromising his whole stroke This is supported by the correction of his stroke post-fatigue With knowledge of muscle activation: Know that the rehabilitation is working (keep doing what he is doing) Correct stroke (and performance) by changing flawed ideas CP: Compensation for the BF may indicate reliance on the non-affected side for power output in this cycling task May also be a result of co-activation of the affected BF The identification of this co-activation is of clinical significance
12 MUSCLE INJURIES IN TWO VISUALLY IMPAIRED ATHLETES
13 Athletes: Injury history Case 1: T/F m, 200m, LJ Case 2: T m, 400m No precipitating trauma Prior right foot strain Prior achilles injury No precipitating trauma Prior right foot fracture Right proximal hamstring strain at 2011 IPC WC Chronic gluteus mediuspain/ strains (bilateral) Chronic left hamstrings strains Previous literature in athletes with visual impairment?
14 Methodology: Testing protocol Case 1: 3 starts 2 max sprints Fatigue (1km at 400m pace) 1 max sprint Muscles: Erector spinae Gluteus medius Gluteus maximus Biceps femoris Gastrocnemius lateralis Case 2: 3 block starts 5 400m pace 1 block start Muscles: Tibialis anterior Gluteus maximus Vastus lateralis Biceps femoris Gastrocnemius lateralis Normalised to 20m max sprint Normalised to 20m max sprint
15 Bilateral gluteus medius pain Results: Case 1 2 nd max sprint Muscle Left Right Erector spinae 33.8 % Gluteus medius 34.8 % Left leg muscles compensating for low Glut Max activation Gluteus maximus 91.1 % Biceps femoris 71 % Lateral gastrocnemius 24.3 %
16 Bilateral gluteus medius pain Results: Case 1 Glut Med Only one peak on right Combination of these can contribute to recurrent strains Glut Max Left not firing! Gazendam et al, 2007
17 Left hamstring strains Results: Case 2 400m pace run Low stability on left stride: overloading on other muscles (hamstring strains) Glut Max: co-activation on Right stride
18 Left hamstring strains Case 2: Rehabilitation Glut max rehabilitation As opposed to glut med rehabilitation Biofeedback EMG Shockwave therapy Sports Medicine Clinic
19 Summary: EMG for injury Case 1: We identified a possibly large compensation for extremely high gluteus maximus activation during maximal sprinting Identification of reciprocal EMG irregularities in the gluteus muscles exposed possible contributing factors for chronic gluteal strains and pain Case 2: It is possible that co-activation of gluteus maximuson right stride may lead to low stability on the left stride This may lead to overloading on surrounding muscles on the left side, thus leading to injury EMG allowed us to pursue correct rehabilitation of the injury
20 Clinical application of EMG EMG is recommended as a tool in clinical management of all athletes WITHand WITHOUT disabilities EMG allows for identification of neuromuscular asymmetry, which is becoming a vital addition to overall clinical assessment In depth investigation into muscle pathology GOES BEYOND functional testing
21 Clinical application of EMG cont. Abnormal recruitment patterns can persist for months or years after original injury Use information to inform clinicians on correct rehabilitation Easy to administer / User friendly
22 Possible implications for classification? EMG can be used to assess functional muscle activity in athletes with NM conditions: Different activation levels in classes NA A 5-15 T38 1 T38 2 T373
23 Thank you! Acknowledgements Contact David Karpul, UCT Wayne Lombard, SSISA HPC Athletes participation - Dr. Suzanne Ferreira NRF/DAAD - Doctoral Funding - DAAD In-Country Short-Term Research Grant to Germany Boundary Road, Newlands Cape Town, South Africa phoebe.runciman@gmail.com phoebe.runciman@paralympic.org International Paralympic Committee - Medical and Scientific Internship
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