Boston Sports Medicine and Performance Group, LLC Blog

Evidence in Motion - Optimized Sequence

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“Observation-based assessments of movement are a standard component in clinical assessment of patients with non-specific low back pain. While aberrant motion patterns can be detected visually, clinicians are unable to assess underlying neuromuscular strategies during these tests.”

-E. Nelson-Wong et al, Journal of Electromyography and Kinesiology 2013


Clinicians and coaches wish or sometimes believe they have X-Ray eyes and can see muscles “fire” with just the naked eye. While the human eye is an amazing organ, muscle recruitment does not always manifest with visual hints from the patient’s or athlete’s body and EMG is our guide to underlying neuromuscular activity.  An essential part of working with athletes who have experienced chronic or acute injuries is the managing their avoidance of pain, and the neuromuscular changes that compromise outcomes associated with it. Guarding of joints and compensation is talked about in the literature, but the most direct way of solving movement impairments is to see the actions of the body and neuromuscular strategies employed by the athlete relearning after injury. Surface EMG provides clarity to what is happening below the surface, and the information gleaned from its use can accelerate the process of improving performance.

Improving Neuromuscular Recruitment Strategies

Several approaches work with improving movement quality, using Biofeedback makes a mind to muscle connection that bypasses the struggle of learning or changing motion. Finding the right sequence is not easy with athletes who are injured and are in pain, but simple activities can be enhanced with patient and athlete assisted EMG techniques. A simple guideline to ensuring optimized movement is to think of the acronym D.O.T.S.  Below are the four factors in that practitioners should think about in athletic movements when performing return to play strategies.

▪      Duration of Near Peak Activity - Mean and Peak values for EMG are two very powerful metrics that reveal how the muscle is working overtime and how successfully it was engaged. Looking at both the average work during mean activation and the top end range (peak) is an excellent benchmark when devising early post-surgical rehabilitation programs or return to play protocols.

▪      Order of Sequence - A simple path to neuromuscular enhancement is ensuring the right order of muscular recruitment is displayed when an athlete performs a sporting action. Success in joint integrity is highly dependent on the right order of muscle recruitment.

▪      Timing of Activity- Precise timing of activity to muscle groups will determine if a joint is prepared for landing during gait or able to increase the power potential of general movement. Timing and order of muscle firing are not isolated qualities, and are highly dependent on each other for the right interaction.

▪      Silence Period- The select time when muscles are resting is a perfect way to screen for guarding or fears of pain or dysfunction. Athletes will not trust their bodies and resort to protection strategies, causing early fatigue and possible re-injury.


Lumbopelvic Stability Enhancement with EMG - Example of Current Options

Low back pain is a complex and very common problem with athletes and the general population, and most approaches can be enhanced with the use of surface EMG.  Several strategies exist with low back pain and common approaches can be made more effective, starting from the screening process and finishing with a discharge report, all done rapidly and easily with surface EMG. Examples of integrating and pairing EMG with your existing treatment processes are the following:

▪      Dynamic Neuromuscular Stabilization - Neurodevelopmental aspects of motor control are supported with a combined approach, and practitioners can see how reflexive actions are involved in the rehabilitation process. Normally the approach is very qualitative and subjective, but a combined approach with surface EMG can accelerate the rehabilitation and increase patient awareness.

▪      Chronic Pain Therapy - Emotional or Cognitive perception of threats, specifically pain, can be reduced through mindset changes when athletes have confidence in the therapy. Practitioners can see therapeutic milestones of restored norms when athletes are able to remove fear avoidance tendencies and guarding patterns.  Biofeedback with therapist support breaks through mental and physical barriers and normal patterns of activity can be restored or acquired with surface EMG techniques.

▪      Postural Enhancement Training - Proper spinal positioning can be fine-tuned with EMG by either biofeedback of the core and lower extremities or by scoring visual and EMG readings later.  Sport or training postures can enhance performance and reduce injury, making the combined approach effective for both coaches and therapists.

EMG integration is only limited by the imagination and goals of the therapy and training. Adding a simple set of sensors with the process unlocks the doors of better information and is currently improving patient outcomes and athlete performance.


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