• Journal of the Korea Convergence Society
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• v.7 no.2
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• pp.43-52
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• 2016

The purpose of this study was to suggest the effective squat exercise position to strengthening vastus medialis oblique, and vastus lateralis in quadriceps. Subjects were twenty patients with patellofemoral pain syndrome (PFPS) volunteered to participate in this study. All subjects were applied to static squat convergence exercise with knee flexed $45^{\circ}$, $60^{\circ}$, and $90^{\circ}$ for 30 seconds total 5 times. Measurement variables were maximal voluntary isometric contraction (MVIC) of the quadriceps, Q angle and length of thigh. Those were measured before and after the squat exercise on knee joint angle, change rate of which were used for statistical analysis. As a result, squat exercise with knee flexed $90^{\circ}$ increase significantly among knee joint angle in the MVIC change rates of quadriceps (p<.05), however the rates of Q-angle and length change of thigh showed no significant difference. Therefore, this findings suggest that squat exercise with knee flexed $90^{\circ}$ strengthen quadriceps effectively in patients with PFPS.

• Journal of the Korean Society of Physical Medicine
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• v.6 no.2
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• pp.165-175
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• 2011

Purpose: This study examined the effect of the strengthening exercise and stretching exercise to decrease symptom patellofemoral pain syndrome (PFPS). Methods: The Anterior Knee Pain Scale (AKPS) and Clark's test performed for diagnosis of intrinsic PFPS among young adults. Selected thirty young adults subjects who aged 20~26 years participated in the study. Participants were randomly assigned to strengthening, stretching, or control groups. Strengthening group consisted of quadriceps, hamstring and iliotibia band training used elastic band. Stretching group consisted of quadriceps, hamstring and iliotibia band trainings used stretching exercises program. Participants received 50-minute individualized exercise sessions, 3 times a week for 6 weeks. Results: The results were as follow: there were significantly difference stretching exercise group by all muscles on muscular strength test (p<.05). there were significantly difference both strengthening and stretching exercise group by all muscles on flexibility test (p<.05). There were significantly difference stretching exercise group by all muscles on step-down test (p<.05). There were significantly difference both strengthening and stretching exercise group by all muscles on visual analog scale (p<.05). Conclusion: Results suggest important implications for exercise programs of PFPS that stretching exercise is more improved knee pain, functional performance, patella mobility than strengthening exercise.

• Physical Therapy Korea
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• v.8 no.2
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• pp.1-16
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• 2001

This study was designed to identify the effects of foot position on electromyographic (EMG) activity of the quadriceps femoris during maximum voluntary contraction (MVC) in standing. Twenty young adults who had not experienced any knee injuries were recruited. Their Q-angles were within a normal range. They were asked to stand in five different foot positions ($40^{\circ}$ externally rotated, $30^{\circ}$ internally rotated, neutral, $20^{\circ}$ plantarflexed, and $10^{\circ}$ dorsiflexed foot position). The EMG activities of the vastus lateralis (VL), rectus femoris (RF), and vastus medialis oblique (VMO) were recorded in standing by surface electrodes and normalized by MVC EMG values derived from manual muscle test. The normalized EMG activity levels (%MVC EMG) of muscles in the five foot positions were compared using repeated measures ANOVA. The EMG activity levels of the VL, RF, and VMO were the highest when foot was externally rotated. The EMG activity levels of the VL and RF were significantly different among the foot positions (p<.05). However, EMG activity levels of the VL, RF, VMO, and VMO/VL ratio did not show significant differences in each foot position (p> .05). The results suggest that the quadriceps femoris may be effectively activated by performing MVC at an externally rotated foot position. Therefore, the externally rotated foot position can be considered as an effective foot position for quadriceps femoris strengthening exercise. Further studies are needed to identify whether there are differences in the effects of foot position on muscle strength after MVC exercise of quadriceps femoris in standing.

• Physical Therapy Korea
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• v.17 no.2
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• pp.1-9
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• 2010

To develop effective training methods for strengthening a weakened quadriceps femoris muscle in hemiplegic patients, we examined the effects of maximal isometric contraction of the nonparalyzed knee joint on the electromyographic activities of the paralytic muscle. An electromyogram (EMG) was used to record the electromyographic activities of the paralytic quadriceps femoris muscle in 27 hemiplegic patients. The maximal isometric contraction was measured for each subject to normalize the electromyographic activities. The maximal isometric extension and flexion exercises were randomly conducted when the knee joint angles of the nonparalyzed knees were $0^{\circ}$, $45^{\circ}$, and $90^{\circ}$. The patients were encouraged to maintain maximal isometric contractions in both knee joints during each measurement, and three measurements were taken. A one-minute rest interval was given between each measurement to minimize the effects of muscle fatigue. An average from the three values was taken as being the root mean square of the EMG and was recorded as being the maximal isometric contraction. The electromyographic activity obtained for each measurement was expressed as a percentage of the reference voluntary contraction, which was determined using the values obtained during the maximal isometric contraction. The results of this study are summarized as follows: First, when the knee joint angle of the nonparalyzed knee was $0^{\circ}$, the electromyographic activities of the paralytic medial aspect of rectus femoris were related to measurement by a maximal isometric flexion exercise than by an extension exercise (p<.05). Second, when the knee joint angle of the nonparalyzed knee was $90^{\circ}$, the electromyographic activities of the paralytic lateral aspect of rectus femoris were related to measurement by a maximal isometric flexion exercise than by an extension exercise (p<.05). The results show that myoelectrical activities of paralytic quardriceps were not related to measurement angles and exercise directions of the nonparalized knee joint. Studies on various indirect intervention to improve muscular strength of patients with nervous system disorders of the weakened muscle should be constantly conducted.

• Physical Therapy Rehabilitation Science
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• v.9 no.4
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• pp.287-294
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• 2020

Objective: This study aimed to investigate the effects of an ultrasound-based bar graph proportional to the quadriceps muscle thickness as a real-time visual feedback training tool in the elderly. Design: Cross-sectional study. Methods: Twenty-four elderly persons participated in this study and were randomly divided into three groups: oral training group (n=8, group 1), ultrasound imaging group (n=8, group 2), and graph group (n=8, group 3). In the pre condition, all participants performed maximal voluntary isometric contraction (MVIC) of the quadriceps with knee extension three times with oral training. In the post condition, group 1 performed MVIC of the quadriceps with oral training, group 2 performed MVIC of the quadriceps with real-time visual feedback using ultrasound imaging, and group 3 performed MVIC of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness, three times for all groups. Muscle thickness, activity (mean, peak), tone, stiffness, logarithmic decrement, relaxation, and creep were measured in both conditions in all participants. Results: Visual feedback with a bar graph showed significant effects on muscle thickness, mean muscle activity, and peak muscle activity compared with oral training and visual feedback with ultrasound imaging (p<0.05). Conclusions: Isometric training of the quadriceps with real-time visual feedback using a bar graph proportional to the quadriceps muscle thickness may be more effective than other methods in improving muscle thickness and muscle activity. This study presented a tool that can help increase muscle thickness in the elderly.

• Physical Therapy Korea
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• v.23 no.1
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• pp.20-30
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• 2016

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC ($n_1$=19) or the QIIC ($n_2$=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

• Journal of Korean Medicine Rehabilitation
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• v.26 no.1
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• pp.63-77
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• 2016

Objectives The objective of this study is to interpretate Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu] in a modern kinesiologic approach. Methods Based on the interpretation of [Jebyungwonhuron Huhrobyungjehu] and implementation of its kinesiology, this study presents similar kinesiologies and their purposed, with the reference to various documents on modern kinesiology. Results 1) Exercises in Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu], which are similar to resistance exercise, can be used for isometric exercise of knee joint extensor and cervical extensor. 2) Exercises in Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu], which are similar to stretching exercise, has its purpose to stretch semitendinosus m., semimembranous m., gastrocnemius m., quadriceps femoris m., upper trapezius m., levator scapulae m., serratus m., and splenius capitis m. 3) Exercises in Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu], which are similar to active exercise, can be used for strengthen quadriceps femoris m.. 4) Yangsaeng-Doinibub also describes breathing methods, which help normalization of breathing exercised and increase the efficiency of spine and joint exercises. Conclusions The modern interpretation on kinesiology of Yangsaeng-Doinbub presented in [Jebyungwonhuron Huhrobyungjehu] leads to a conclusion that Yangsaeng-Doinbub consists of various exercises for knee joint, neck and upper extremity.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.3 no.1
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• pp.1-12
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• 2005

This study aimed at examining the maximal isometric contraction caused by voluntary exercise and at comparing its aspects of decrease and restoration in their different repeated application, as to the quadriceps muscles of thigh in the subjects composed of patients with spastic hemiplegia and normal adults. Using isokinetic exercise analyser(Biodex Medical Systems Inc., Biodex System 3PRO, U.S.A.), experiment was conducted as to the normal group composed of fifteen adults and the patient group composed of fifteen patients with spastic hemiplegia. As to each group, MVIC(maximal voluntary isometric contraction) of the quadriceps muscle of thigh caused by voluntary exercise and the aspects of decrease and restoration of the isometric contraction were examined with the method to induce isometric exercise, and their SDI(strength decrement index) and SRI(strength recovery index) were also calculated. The results can be summarized as follows: 1. As for decrease of maximal isometric contraction, both groups showed slow decrease in voluntary exercise, but the normal group showed rapid decrease later phase. 2. As for SDI, no significant differences could be observed in comparison between groups. 3. As for restoration of maximal isometric contraction, both groups showed slow restoration in voluntary exercise, but the normal group showed rapid restoration early phase. 4. As for SRI, comparison between groups showed significant differences in voluntary exercise. These results lead us to the conclusions that spastic muscle is characterized by slow decrease and restoration of MVIC in comparison with normal muscle in voluntary exercise.

• Physical Therapy Korea
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• v.6 no.3
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• pp.22-37
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• 1999

It was recently reported that exercise-induced fatigue is related to joint position sense although some controversy remains. The purposes of this study were to examine the effect on the accuracy of reproducing the knee angles after a fatiguing isokinetic quadriceps exercise at four different levels (10%, 30%, 50%, and 70% of maximal force) and to find the optimal exercise level without causing knee joint proprioception impairment. Forty healthy women, ages 19 to 27, were randomly assigned to four experimental groups. Before and after the exercise, accuracy of positioning with respect to auditory feedback for specific angles was estimated by calculating the mean errors between specific angles and reproduction angles. Fatigue was measured by EMG signals displayed by a frequency spectrum analysis during the quadriceps exercise. Results showed that there was no significant difference in accuracy of the knee joint positioning sense following the exercises in group 1, group 2, and group 3 (10%, 30%, and 50% of maximal force, respectively); the exception being group 4 (70%). Fatigue level was significantly increased in group 4 but there were no significant increases of fatigue level in group 1, group 2, or group 3. The results concluded that the optimal exercise level to acquire the therapeutic exercise effectiveness without position sense impairment was at 50% of maximal force. Further studies using large sample size and patient groups with poor knee joint proprioception would be needed to confirm this conclusion and to clarify the possibility of clinical applications.

• The Journal of Korean Physical Therapy
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• v.15 no.2
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• pp.123-130
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• 2003

This case study was performed to assess the effectiveness of taping therapy for the patient who have patellofemoral joint pain during knee extension exercise. The results were as follows: 1. Pain degree of VAS was decreased at every taping therapy. 2. A number of knee extension was increased at every taping therapy. 3. Diameter of quadriceps was increased at every taping therapy. 4. Pattern of gait was normalized at every taping therapy. We found improve of pain degree, a number of knee extension, diameter of quadriceps, and pattern of gait. These results are imply that taping therapy may have effectiveness to those who have patellofemoral joint pain during knee extension exercise.