Foot-dominance does not influence force variability during ankle dorsiflexion and foot adduction.

The aim of our study was to compare the force steadiness and the discharge characteristics of motor units in the tibialis anterior (TA) during ankle dorsiflexion and foot adduction produced by submaximal isometric contractions with the dominant and non-dominant foot. Fifteen young men performed maximal and submaximal contractions at five target forces with both legs, and motor unit activity in TA was recorded using high-density electromyography. Maximal force and the fluctuations in force during submaximal contractions were similar between the two legs (p > 0.05). Motor unit activity was characterized by measures of mean discharge rate (MDR), coefficient of variation for interspike interval (CoV for ISI), and standard deviation of the filtered cumulative spike train (SD of fCST). There were no statistically significant differences in motor unit activity between legs during ankle dorsiflexion. In contrast, the MDR and the CoV for ISI but not the SD of fCST, were greater for the non-dominant foot compared with the dominant foot during foot adduction. Nonetheless, these differences in motor unit activity were not sufficient to influence the force fluctuations during the submaximal contractions. These results indicate that control of the force produced by TA during the two actions was not influenced by limb dominance.

EMG coherence of foot and ankle muscles increases with a postural challenge in men.

BACKGROUND: The functional role of intrinsic foot muscles in the control of standing balance is often overlooked in rehabilitation, partly because the interactions with ankle muscles are poorly understood. RESEARCH QUESTION: How does coactivation of Flexor Digitorum Brevis (FDB) and soleus (SOL) vary across standing tasks of increasing difficulty. METHODS: Postural sway (Centre of Pressure, CoP) and the electromyographic (EMG) activity of FDB, SOL, Medial Gastrocnemius (MG) and Tibialis Anterior (TA) were measured during bipedal standing, tandem stance, one-legged balance, and standing on toes. Coherence of the rectified EMG signals for SOL and FDB in two bandwidths (0-5 and 10-20 Hz) was calculated as a coactivation index. RESULTS AND SIGNIFICANCE: The CoP sway and the EMG activity of all muscles was greater (P<0.05) for the three difficult tasks. Significant coherence between the SOL and FDB EMG activity was found in both frequency regions: 0-5 and 10-20 Hz. The coherence integral increased with the difficulty of the postural task, especially in the 10-20 Hz band. The findings underscore the important role of FDB in the control of standing balance across tasks and its coactivation with SOL. Clinical recommendations to improve balance control need to consider the interaction between the plantar flexor and intrinsic-foot muscles.

Effects of plyometric training techniques on vertical jump performance of basketball players.

The aim of our study was to compare the effects of two different plyometric training programs (targeting knee extensors or plantar flexors) on jump height and strength of leg muscles. Twenty-nine male basketball players were assigned to the knee-flexed (KF), knee-extended (KE), or control groups. In addition to regular training, the KF group performed plyometric jumps (10 sets of 10 jumps, 3 sessions/week, 4 weeks) from 50 cm boxes with the knee flexed (90°-120°), whereas the KE group performed the jumps from 30 cm boxes with the knee much more extended (130°-170°). Jumping ability was evaluated with squat jumps (SJs), countermovement jumps (CMJs), and drop jumps from 20 cm (DJ20) and 40 cm (DJ40). Knee and ankle muscles were assessed during maximal isokinetic and isometric tests, and EMG activity was recorded from vastus lateralis and medial gastrocnemius. The KF group increased SJ (+10%, d = 0.86) and CMJ (+11%, d = 0.70) but decreased DJ40 height (-7%, d = -0.40). Conversely, the KE group increased DJ20 (+10%, d = 0.74) and DJ40 (+12%, d = 0.77) but decreased SJ height (-4%, d = -0.23). The reactivity index during DJs increased (+10% for DJ20, d = 0.47; +20% for DJ40, d = 0.91) for the KE group but decreased (-10%, d = -0.48) for the KF group during DJ40. Plantar flexor strength increased for the KE group (d = 0.72-1.00) but not for the KF group. Negative transfer across jumps is consistent with the principle of training specificity. Basketball players interested to perform fast rebounds in their training should avoid plyometric jumps with large knee flexions and long contact times.

More Variability in Tibialis Anterior Function during the Adduction of the Foot than Dorsiflexion of the Ankle.

INTRODUCTION: The aim of the study was to compare maximal force, force steadiness, and the discharge characteristics of motor units in the tibialis anterior (TA) muscle during submaximal isometric contractions for ankle dorsiflexion and adduction of the foot. METHODS: Nineteen active young adults performed maximal and submaximal isometric dorsiflexion and adduction contractions at five target forces (5%, 10%, 20%, 40%, and 60% maximal voluntary contraction [MVC]). The activity of motor units in TA was recorded by high-density EMG. RESULTS: The maximal force was similar between dorsiflexion and adduction, despite EMG amplitude for TA being greater ( P < 0.05) during dorsiflexion than adduction. Τhe coefficient of variation (CV) for force (force steadiness) during dorsiflexion was always less ( P < 0.05) than during adduction, except of 5% MVC force. No differences were observed for mean discharge rate; however, the regression between the changes in discharge rate relative to the change of force was significant for dorsiflexion ( R2 = 0.25, P < 0.05) but not for adduction. Discharge variability, however, was usually less during dorsiflexion. The CV for interspike interval was less ( P < 0.05) at 10%, 20%, and 40% MVC but greater at 60% MVC during dorsiflexion than adduction. Similarly, the SD values of the filtered cumulative spike train of the motor units in TA were less ( P < 0.05) at 5%, 10%, 20%, and 40% MVC during dorsiflexion than adduction. CONCLUSIONS: Although the mean discharge rate of motor units in TA was similar during foot adduction and ankle dorsiflexion, discharge variability was less during dorsiflexion resulting in less accurate performance of the steady adduction contractions. The neural drive to bifunctional muscles differs during their accessory function, which must be considered for training and rehabilitation interventions.

Footedness but not dominance influences force steadiness during isometric dorsiflexion in young men.

The aim of the study was to assess the potential influence of footedness and dominance on maximal force, force fluctuations and neural drive during dorsiflexion. Fifteen left-footed (LF) and fifteen right-footed (RF) young adults performed 2 maximal voluntary contractions (MVC) and 3 steady submaximal isometric contractions at five target forces (5, 10, 20, 40 and 60% MVC) with the dorsiflexors of both legs. High-density electromyography (EMG) was used to record the discharge characteristics of motor units (MUs) of Tibialis Anterior. MVC force and EMG amplitude (root mean square) were similar between the two legs and groups (p > 0.05). Force fluctuations (Coefficient of Variation, CoV for force), mean discharge rate of MUs, discharge variability (CoV of interspike interval), and variability in neural drive (standard deviation of filtered cumulative spike train) were greater (p < 0.05) and the input-output gain of the MUs (ΔDR/ΔF) was lower (p < 0.05) for the LF relative to the RF group. The differences in force fluctuations during steady contractions with the dorsiflexors were associated with footedness but not with dominance. They reflect greater variability in motor neuron output, as suggested by coefficient of variation for interspike interval (independent input) and the standard deviation of the smoothed discharge times (common input).

Plyometric Exercises: Optimizing the Transfer of Training Gains to Sport Performance.

Rapid force production and its transmission to the skeleton are important factors in movements that involve the stretch-shortening cycle. Plyometric exercises are known to augment this cycle and thereby improve the neuromechanical function of the muscle. However, the training exercises that maximize translation of these gains to sports performance are not well defined. We discuss ways to improve this transfer.

Alternating or Bilateral Exercise Training does not Influence Force Control during Single-Leg Submaximal Contractions with the Dorsiflexors.

The aim of the study was to assess the influence of habitual training history on force steadiness and the discharge characteristics of motor units in tibialis anterior during submaximal isometric contractions. Fifteen athletes whose training emphasized alternating actions (11 runners and 4 cyclists) and fifteen athletes who relied on bilateral actions with leg muscles (7 volleyball players, 8 weight-lifters) performed 2 maximal voluntary contractions (MVC) with the dorsiflexors, and 3 steady contractions at 8 target forces (2.5%, 5%, 10%, 20%, 30%, 40%, 50% and 60% MVC). The discharge characteristics of motor units in tibialis anterior were recorded using high-density electromyography grids. The MVC force and the absolute (standard deviation) and normalized (coefficient of variation) amplitudes of the force fluctuations at all target forces were similar between groups. The coefficient of variation for force decreased progressively from 2.5% to 20% MVC force, then it plateaued until 60% MVC force. Mean discharge rate of the motor units in tibialis anterior was similar at all target forces between groups. The variability in discharge times (coefficient of variation for interspike interval) and the variability in neural drive (coefficient of variation of filtered cumulative spike train) was also similar for the two groups. These results indicate that athletes who have trained with either alternating or bilateral actions with leg muscles has similar effects on maximal force, force control, and variability in the independent and common synaptic input during a single-limb isometric task with the dorsiflexors.

Neuromuscular electrical stimulation improves reaction time and execution time of roundhouse kick in highly skilled martial arts athletes.

The purpose of the study was to evaluate the influence of neuromuscular electrical stimulation (NMES) on a roundhouse kick (RHK) and the rate of force development (RFD) and peak force during maximal isometric contractions with the knee extensors. Sixteen martial arts athletes were randomly assigned to either a training group (NMES + martial arts) or a control group (martial arts). The RHK was performed to a fixed target located approximately 1.5 m away from the athlete. The reaction time and execution time were quantified with a light-sensor system. Participants were tested before and after completing 15 sessions of training (5 weeks, 3 sessions/week, 90 min/session). In addition, the training group performed another 15 sessions (3 sessions/week, 30 min/session) in which electrical stimulation was superimposed on maximal isometric contractions of the quadriceps (100 Hz, 450 µs). There were no statistically significant changes in either RFD or maximal isometric force for either group (p > 0.05). However, the training group experienced significant reductions (p < 0.05) in both reaction time (-9.2%) and the execution time (-5.9%). The findings indicate that supplemental NMES training can improve sport-specific movements, such as the RHK, without any changes in maximal force capabilities in skilled martial arts athletes.

Protocols Targeting Afferent Pathways via Neuromuscular Electrical Stimulation for the Plantar Flexors: A Systematic Review.

This systematic review documents the protocol characteristics of studies that used neuromuscular electrical stimulation protocols (NMES) on the plantar flexors [through triceps surae (TS) or tibial nerve (TN) stimulation] to stimulate afferent pathways. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, was registered to PROSPERO (ID: CRD42022345194) and was funded by the Greek General Secretariat for Research and Technology (ERA-NET NEURON JTC 2020). Included were original research articles on healthy adults, with NMES interventions applied on TN or TS or both. Four databases (Cochrane Library, PubMed, Scopus, and Web of Science) were systematically searched, in addition to a manual search using the citations of included studies. Quality assessment was conducted on 32 eligible studies by estimating the risk of bias with the checklist of the Effective Public Health Practice Project Quality Assessment Tool. Eighty-seven protocols were analyzed, with descriptive statistics. Compared to TS, TN stimulation has been reported in a wider range of frequencies (5-100, vs. 20-200 Hz) and normalization methods for the contraction intensity. The pulse duration ranged from 0.2 to 1 ms for both TS and TN protocols. It is concluded that with increasing popularity of NMES protocols in intervention and rehabilitation, future studies may use a wider range of stimulation attributes, to stimulate motor neurons via afferent pathways, but, on the other hand, additional studies may explore new protocols, targeting for more optimal effectiveness. Furthermore, future studies should consider methodological issues, such as stimulation efficacy (e.g., positioning over the motor point) and reporting of level of discomfort during the application of NMES protocols to reduce the inherent variability of the results.

Leg Dominance Does Not Influence Maximal Force, Force Steadiness, or Motor Unit Discharge Characteristics.

PURPOSE: The aim of our study was to compare maximal force, force steadiness, and discharge characteristics of motor units in tibialis anterior during contractions with the dorsiflexors of the dominant and nondominant legs at low-to-moderate target forces and three ankle angles. METHODS: Twenty young adults performed maximal and submaximal isometric contractions (5%, 10%, 20%, 40%, and 60% of maximal voluntary contraction (MVC)) with the dorsiflexors of the dominant and nondominant legs at three ankle angles (75°, short length; 90°, intermediate length; 105°, long length). High-density EMG signals from the tibialis anterior muscle of each leg were recorded. RESULTS: Maximal force (average dominant, 182.9 ± 64.5 N; nondominant, 179.0 ± 58.8 N) and the fluctuations in force, quantified as absolute (SD) and normalized amplitudes (coefficient of variation (CoV)), were similar between the two legs across the three ankle angles (average CoV for dominant, 1.5% ± 1.0%; nondominant, 1.7% ± 1.3%). The CoV for force for both legs decreased from 5% to 20% MVC force, and then it plateaued at 40% and 60% MVC force. EMG amplitude, mean discharge rate of motor units, discharge variability (interspike interval), and the variability in neural drive (filtered cumulative spike train) were similar between the two legs across the submaximal contractions. CONCLUSIONS: MVC force and force steadiness were similar across ankle angles and target forces between the dominant and nondominant legs. The attributes that underlie the self-reported identification of a dominant leg were not associated with the force capacity or the control of force for the dorsiflexor muscles, at least during isometric contractions.

The length of tibialis anterior does not influence force steadiness during submaximal isometric contractions with the dorsiflexors.

The purpose of the study was to assess the influence of short, intermediate, and long muscle lengths on dorsiflexor force steadiness and the discharge characteristics of motor units in tibialis anterior during submaximal isometric contractions. Steady contractions were performed at 5 target forces (5, 10, 20, 40, and 60% maximal voluntary contraction, MVC) for 3 ankle angles (75°, 90°, and 105°). MVC force was less (p = 0.043) at the smallest joint angle compared with the other two angles. The absolute (standard deviation) and normalised amplitudes (coefficient of variation) of the force fluctuations were similar for all 3 ankle angles at each target force. The coefficient of variation for force decreased progressively from 5% to 20% MVC force and then it plateaued at 40% and 60% MVC force. At all target forces, the mean discharge rate (MDR) of the motor units at 75° was greater than at 90° (p = 0.006) and 105° (p = 0.034). Moreover, the MDR was similar for 5% and 10% MVC forces and then increased gradually until 60% MVC force (p < 0.005). The variability in discharge times (coefficient of variation for interspike interval) and variability in neural drive (coefficient of variation of filtered cumulative spike train) were similar at all ankle angles. Variability in neural drive had a greater influence on force steadiness than did the variability in discharge times. Changes in ankle-joint angle did not influence either the normalised amplitude force fluctuations during steady submaximal contractions or the underlying modulation of the discharge characteristics of motor units in tibialis anterior.

Ankle Angle but Not Knee Angle Influences Force Fluctuations During Plantar Flexion.

The purpose of the study was to evaluate the influence of changes in ankle- and knee-joint angles on force steadiness and the discharge characteristics of motor units (MU) in soleus when the plantar flexors performed steady isometric contractions. Submaximal contractions (5, 10, 20, and 40% of maximum) were performed at two ankle angles (75° and 105°) and two knee angles (120° and 180°) by 14 young adults. The coefficient of variation of force decreased as the target force increased from 5 to 20% of maximal force, then remained unaltered at 40%. Independently of knee angle, the coefficient of variation for force at the ankle angle of 75° (long length) was always less (p<0.05) than that at 105° (shorter length). Mean discharge rate, discharge variability, and variability in neural activation of soleus motor units were less (p<0.05) at the 75° angle than at 105°. It was not possible to record MUs from medial gastrocnemius at the knee angle of 120° due to its minimal activation. The changes in knee-joint angle did not influence any of the outcome measures. The findings underscore the dominant role of the soleus muscle in the control of submaximal forces produced by the plantar flexor muscles.

Posture dependent ankle and foot muscle responses evoked by Achilles' tendon vibration.

To investigate the link between the triceps surae and the intrinsic muscles of the foot, often underestimated in posture maintenance, we asked how Achilles' tendon vibration modulates the EMG activity of the soleus and flexor digitorum brevis (FDB) muscles during different postural tasks: sitting, standing and forward leaning. Young healthy participants (n = 19, age = 24 ± 7.4 years) stood for 60 s in three visually controlled postures, while vibration (1.5-1.8 mm, 80 Hz) was bilaterally applied over the Achilles' tendon during the middle 20 s. Center of Pressure (CoP) and EMG activity of the soleus and FDB muscle were summarized in 5 s epochs and compared across time (before, during and after vibration) and postural tasks. Achilles' tendon vibration shifted the CoP position forward in sitting and backward in standing and leaning and increased the root mean square of the CoP velocity to a greater extent in standing and leaning compared to sitting. Soleus and FDB EMG amplitude also increased in response to vibration. These responses were posture dependent, being greater in standing (soleus: 57 %, FDB: 67 % relative to pre-vibration) compared to sitting (soleus: 36 %, FDB: 27 % relative to pre-vibration) and leaning (soleus: 26 %, FDB: 8% relative to pre-vibration). After vibration offset, both soleus and FDB showed sustained activation across all three postures. Results highlight the presence of Ia afferent projections from the soleus to the α motor neurons of the FDB muscle triggered by Achilles' tendon vibration. This link is posture dependent serving a functional role in standing and forward leaning in the presence of externally applied perturbations.

Electrical Stimulation of Muscle: Electrophysiology and Rehabilitation.

The generation of action potentials in intramuscular motor and sensory axons in response to an imposed external current source can evoke muscle contractions and elicit widespread responses throughout the nervous system that impact sensorimotor function. The benefits experienced by individuals exposed to several weeks of treatment with electrical stimulation of muscle suggest that the underlying adaptations involve several physiological systems, but little is known about the specific changes elicited by such interventions.

Neuromuscular electrical stimulation can improve mobility in older adults but the time course varies across tasks: Double-blind, randomized trial.

Declines in mobility with advancing age are often associated with a reduction in the use of lower leg muscles. We examined the influence of two interventions that involved neuromuscular electrical stimulation (NMES) applied to the triceps surae muscles on the mobility and muscle function of older adults. Thirty healthy older adults (73.5 ±â€¯4.8 yrs) participated in a 6-week intervention comprising 3 weekly sessions of either narrow- or wide-pulse NMES. Motor function was assessed at Weeks 0, 4, 7, and 10. There were no statistically significant differences in the changes in mobility for the two groups of participants, so the data for the two groups were combined to examine changes across time. Time to walk 400 m decreased and maximal walking speed increased after 3 wks of NMES (Week 4) but did not change further at Weeks 7 and 10. In contrast, time to complete the chair-rise and rapid-step tests decreased progressively up to Week 7 but did not change further at Week 10. Moreover, the increase in plantar flexor strength was only observed at Week 7. NMES can elicit improvements in the motor function of older adults, but the time course of the adaptations differs across the mobility tests.

Motor unit activity in biceps brachii of left-handed humans during sustained contractions with two load types.

The purpose of the study was to compare the discharge characteristics of single motor units during sustained isometric contractions that required either force or position control in left-handed individuals. The target force for the two sustained contractions (24.9 ± 10.5% maximal force) was identical for each biceps brachii motor unit (n = 32) and set at 4.7 ± 2.0% of maximal voluntary contraction (MVC) force above its recruitment threshold (range: 0.5-41.2% MVC force). The contractions were not sustained to task failure, but the duration (range: 60-330 s) was identical for each motor unit and the decline in MVC force immediately after the sustained contractions was similar for the two tasks (force: 11.1% ± 13.7%; position: 11.6% ± 9.9%). Despite a greater increase in the rating of perceived exertion during the position task (task × time interaction, P < 0.006), the amplitude of the surface-recorded electromyogram for the agonist and antagonist muscles increased similarly during the two tasks. Nonetheless, mean discharge rate of the biceps brachii motor units declined more during the position task (task × time interaction, P < 0.01) and the variability in discharge times (coefficient of variation for interspike interval) increased only during the position task (task × time interaction, P < 0.008). When combined with the results of an identical study on right-handers (Mottram CJ, Jakobi JM, Semmler JG, Enoka RM. J Neurophysiol 93: 1381-1392, 2005), the findings indicate that handedness does not influence the adjustments in biceps brachii motor unit activity during sustained submaximal contractions requiring either force or position control.

Fatigue-induced adjustment in antagonist coactivation by old adults during a steadiness task.

The purpose of this study was to determine the adjustments in the level of coactivation during a steadiness task performed by young and old adults after the torque-generating capacity of the antagonist muscles was reduced by a fatiguing contraction. Torque steadiness (coefficient of variation) and electromyographic activity of the extensor and flexor carpi radialis muscles were measured as participants matched a wrist extensor target torque (10% maximum) before and after sustaining an isometric contraction (30% maximum) with wrist flexors to task failure. Time to failure was similar (P = 0.631) for young (417 ± 121 s) and old (452 ± 174 s) adults. The reduction in maximal voluntary contraction torque (%initial) for the wrist flexors after the fatiguing contraction was greater (P = 0.006) for young (32.5 ± 13.7%) than old (21.8 ± 6.6%) adults. Moreover, maximal voluntary contraction torque for the wrist extensors declined for old (-13.7 ± 12.7%; P = 0.030), but not young (-5.4 ± 13.8%; P = 0.167), adults. Torque steadiness during the matching task with the wrist extensors was similar before and after the fatiguing contraction for both groups, but the level of coactivation increased after the fatiguing contraction for old (P = 0.049) but not young (P = 0.137) adults and was twice the amplitude for old adults (P = 0.002). These data reveal that old adults are able to adjust the amount of antagonist muscle activity independent of the agonist muscle during steady submaximal contractions.

Modulation of motor unit activity in biceps brachii by neuromuscular electrical stimulation applied to the contralateral arm.

The purpose of the study was to determine the influence of neuromuscular electrical stimulation (NMES) current intensity and pulse width applied to the right elbow flexors on the discharge characteristics of motor units in the left biceps brachii. Three NMES current intensities were applied for 5 s with either narrow (0.2 ms) or wide (1 ms) stimulus pulses: one at 80% of motor threshold and two that evoked contractions at either ∼10% or ∼20% of maximal voluntary contraction (MVC) force. The discharge times of 28 low-threshold (0.4-21.6% MVC force) and 16 high-threshold (31.7-56.3% MVC force) motor units in the short head of biceps brachii were determined before, during, and after NMES. NMES elicited two main effects: one involved transient deflections in the left-arm force at the onset and offset of NMES and the other consisted of nonuniform modulation of motor unit activity. The force deflections, which were influenced by NMES current intensity and pulse width, were observed only when low-threshold motor units were tracked. NMES did not significantly influence the discharge characteristics of tracked single-threshold motor units. However, a qualitative analysis indicated that there was an increase in the number of unique waveforms detected during and after NMES. The findings indicate that activity of motor units in the left elbow flexors can be modulated by NMES current and pulse width applied to right elbow flexors, but the effects are not distributed uniformly to the involved motor units.

Reliability of Single-leg and Double-leg Balance Tests in Subjects with Anterior Cruciate Ligament Reconstruction and Controls.

The purpose of this study was to assess the test-retest reliability of postural balance in patients with anterior cruciate ligament reconstruction (ACL) and controls. Ten healthy subjects and 15 individuals with ACL reconstruction performed single-leg and double-leg balance tests. The center of pressure (COP) was recorded using a pressure platform. For the total COP path, the intraclass correlation coefficient (ICC) ranged from 0.79 to 0.91. For the COP standard deviation, the ICCs ranged from 0.68 to 0.94. For the COP velocity, the ICCs ranged from 0.72 to 0.91. The sway area and ellipse scores displayed ICCs values of 0.67 to 0.95 and 0.53 to 0.92, respectively. The ICCs were higher for double leg tests compared with single-stance ones. These results indicate that 30 s balance tests in double and single-leg stance are reliable tools to assess static balance. The use of such tests to monitor rehabilitation programs following ACL reconstruction is recommended.

Synergetic and antagonist muscle strength and activity in women with knee osteoarthritis.

BACKGROUND AND PURPOSE: People with knee osteoarthritis (OA) display limitations in daily activities and a lower quality of life. The purpose of this study was to investigate the differences in strength balance and activation during maximum strength efforts between women with knee OA and asymptomatic women. METHODS: Twelve women with knee OA (age 60.33 ± 6.66 years) and 11 controls (age 56.54 ± 5.46 years) performed maximum isokinetic eccentric and concentric knee extension and flexion tests at 60°/s, 120°/s, and 150°/s. Surface electromyography (EMG) was recorded from the biceps femoris (BF), vastus lateralis (VL), and vastus medialis (VM). Hamstrings-to-quadriceps moment ratios (H/Q), the synergetic (VL/VM), and co-contraction (BF/[VM + VL]) EMG ratios were calculated. RESULTS: Analysis-of-variance designs showed that women experiencing knee OA had significantly higher H/Q moment ratios and VM/VL EMG ratios than controls (P < 0.05). The co-contraction index was significantly lower in the OA group only during knee flexion (P < 0.05). CONCLUSIONS: Women with knee OA showed a higher H/Q moment ratios probably because of the need for better joint stability or a lower quadriceps capacity. This deficiency was accompanied by a higher VM activation, which probably serves to stabilize the patella upon maximum contraction as well as a higher activation of antagonist muscles.