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Objectives: Myofascial trigger points (MTrPs) are considered the principal clinical feature of myofascial pain syndrome (MPS). An MTrP consists of spot tenderness within a taut band of muscle fibers and its stimulation can produce both local and referred pain. The clinical diagnosis of MPS depends on correct history taking and a physical examination aimed at identifying the presence of MTrP. The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle., Methods: Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values., Results: The intraclass correlation coefficient ICC(1,1) values were 0.62 (95% CI: 0.30-0.81) for X and 0.81 (95% CI: 0.61-0.91) for Y. The Bland-Altman plots for X and Y showed a mean of difference of 0.04 and -0.2 mm, respectively. Limits of agreement for X ranged from -26.3 to 26.2 mm and for Y from -27 to 26.4 mm., Discussion: The ICC(1,1) for the observed values revealed a moderate to high correlation and the Bland-Altman analysis showed means of difference very close to zero with narrow limits of agreement. An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol.

Anatomical studies on the external anal sphincter (EAS) indicate that superficial muscle fibres are circular at low depth within the anal canal. A more complex geometry of the fibres is documented for increasing depth within the muscle and along the anal canal. Monopolar intra-anal EMG signals recorded using an array of electrodes placed in circular direction have no common mode components if the muscle fibres are circular, with constant depth within the muscle and parallel to the detection array. Thus, the presence of common mode signals may provide indications about the geometry of muscle fibres of EAS. Intra-anal EMG signals were recorded from EAS of 12 subjects using an anal probe carrying three circumferential arrays of 16 electrodes at three depths within the anal canal. Contribution of common mode components in single MUAPs was lower for MUs located superficially in the muscle (Pearson correlation coefficient: R=-0.75, p≪0.001) and at a lower depth within the anal canal (non-parametric one way Kruskal-Wallis ANOVA, Χ=17.3, p<0.001), in line with EAS anatomy. A large contribution of common mode components was found in the interference signal, suggesting that the signal receives contributions from far, large muscles (e.g. puborectalis, glutei)., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Space permanence simulations such as prolonged bed-rest can mimic some of the physiological modifications in the human body and provide study conditions that are more accessible than during space flight. A short term bed-rest experiment was organized to simulate the effects of weightlessness for studying the adaptation to this condition. Eight healthy young volunteers were studied before and immediately after the 14day periods of strict bed-rest. Surface EMG signals were detected with linear electrode arrays from vastus medialis, vastus lateralis and tibialis anterior muscle during isometric voluntary contractions at 20% MVC. Motor unit action potentials (MUAPs) of individual motor units were extracted from the interference EMG signals with a partial decomposition algorithm and averaged. MUAP templates generated by the same motor unit could be retrieved before and after bed-rest period. Muscle fiber conduction velocity (CV) was estimated from each averaged MUAP template and from the global EMG signal. Both global and single MU conduction velocity was observed to decrease by about 10% after the bed-rest period (p<0.05). Amplitude and power spectral parameters did not significantly change after the bed-rest period. It is concluded that a short term bed-rest reduces the CV of individual motor units without a significant effect on muscle force or on other electrophysiological parameters., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

This article is the second part of a larger review work that has been structured in three parts. The three parts concern a) advances in surface EMG detection and processing techniques, b) recent progress in surface EMG clinical research applications, and c) myoelectric control in neurorehabilitation. This second part concerns state of the art applications of surface EMG techniques to a) the external anal sphincter in relation to episiotomy and incontinence; b) the assessment of postural control mechanisms; c) exercise physiology, electrical stimulation and muscle cramps; and d) ergonomics and work-related neuromuscular disorders. The material is presented with an effort to fill gaps left by previous reviews and identify areas open for future research.

Two physiological factors are assumed in this paper to mainly determine the myoelectric manifestations of fatigue: (1) the decrease of the conduction velocity (CV) of motor unit action potentials (MUAP) (peripheral fatigue), and (2) the increase of MU synchronization by the central nervous system (central fatigue). To describe separately the peripheral and central components of the myoelectric manifestations of fatigue, we investigated the following indexes: (1) mean spectral frequency - MNF, (2) median spectral frequency - MDF, (3) root mean square - RMS, (4) average rectified value - ARV, (5) estimation of muscle fiber conduction velocity - ECV, (6) percentage of determinism - %DET, (7) spectral indexes defined as the ratio between signal spectral moments - FI(k), (8) MNF estimated by autoregressive analysis - MNF(AR), (9) MNF estimated by Choi-Williams time-frequency representation - MNF(CWD), (10) MNF estimated by continuous wavelet transform - MNF(CWT), (11) signal entropy - S, (12) fractal dimension - FD. The indexes were tested with a set of synthetic EMG signals, with different CV distribution and level of MU synchronization. The indexes were calculated on epochs of 0.5s. It was observed that ECV is uncorrelated with the level of simulated synchronization (promising index of peripheral fatigue). On the other hand FD was the index least affected by CV changes and most related to the level of synchronism (promising index of central fatigue). A representative application to some experimental signals from vastus lateralis muscle during an isometric endurance test supported the results of the simulations. The vector (ECV, FD) is suggested to provide selective indications of peripheral and central fatigue. The description of EMG fatigue by a bi-dimensional vector opens new perspectives in the assessment of muscle properties, with potential application in both clinical and sport sciences.

Multi-channel surface mechanomyographic (MMG) signals generated by individual motor units were analyzed to investigate whether the surface mechanical waves induced by fiber contraction propagate over the skin surface. The MMG signals were recorded from the tibialis anterior muscle of ten healthy subjects with 13 uniaxial accelerometers, located both along and transverse to the fiber direction. Intramuscular electromyographic signals served to identify individual motor units whose action potentials were used to trigger the averaging of the MMG signals. The spike-triggered averaged MMG had similar characteristics in locations along the longitudinal direction; however, its amplitude decreased along the transverse direction. Moreover, the time-to-positive peak increased along the transverse direction, indicating a transverse wave propagation with a velocity of 2.4 +/- 1.1 m/s in the linear direction. The results support the hypothesis that the MMG signal mainly originates from muscle fiber displacement underlining a bending mode due to contraction and provide the basis for interpreting the interference MMG in relation to motor unit activity.

Muscle fiber conduction velocity (CV) was estimated in 20 healthy subjects with a multichannel technique using a linear electrode array placed on the upper trapezius (UT) muscle during isometric voluntary contractions at 20% of the maximal voluntary effort. The array had 16 contacts spaced by 5mm and was centered in the middle of the line connecting C7 and the acromion. The effect of array displacement was investigated by shifting it either cranially or caudally by 1, 2 and 3cm. The effect of array misalignment was investigated by rotating it either clockwise or counterclockwise, by 10 degrees , 20 degrees and 30 degrees . The thickness of subcutaneous fat was measured by ultrasonic echography (range was 3-18mm). The average location of the innervation zone of the UT is in the middle of the line connecting C7 to the acromion, however, individual differences of up to 2cm were observed. The lateral side, near the acromion, should be preferred for electrode placement because of the thinner fat layer. The double differential (DD) montage should be preferred to the single differential (SD) electrode configuration. In this case, displacements of +/-1cm or misalignments of +/-10 degrees do not imply statistically significant bias in the estimate of CV. The same applies to amplitude and frequency variables estimated from the SD signals. CV estimates based on DD signals are lower because they are less affected by the thickness of the subcutaneous fat than estimates based on SD signals.

The study presents analytical, simulation, and experimental analyses of amplitude cancellation of motor-unit action potentials (APs) in the interference electromyogram (EMG) and its relation to the size of the spike-triggered average (STA) EMG. The amount of cancellation of motor-unit APs decreases monotonically as a function of the ratio between the root mean square (RMS) of the motor-unit AP and the RMS of the interference EMG signal. The theoretical derivation of this association indicates a method to measure cancellation in individual motor units by STA of the interference and squared EMGs. The theoretical relation was examined in both simulated EMG signals generated by populations of 200 motor units and experimental recordings of 492 and 184 motor-unit APs in the vastus medialis and abductor digiti minimi muscles, respectively. Although the theoretical relation predicted (R2 = 0.95; P < 0.001) the amount of cancellation in the simulated EMGs, the presence of motor-unit synchronization decreased the strength of the association for small APs. The decrease in size of the STA obtained from the squared EMG relative to that extracted from the interference EMG was predicted by the experimental measure of cancellation (R2 = 0.65; P < 0.001, for vastus medialis; R2 = 0.26; P < 0.05, for abductor digiti minimi). The results indicate that cancellation of APs in the interference EMG can be analytically predicted and experimentally measured with STA from the discharge times of the motor units into the surface EMG.

Purpose: The purpose of the study was to demonstrate that anatomical features of individual motor units of the puborectalis muscle can be detected with non-invasive electromyography (EMG) and to evaluate differences in electrophysiological properties of the puborectalis muscles in a small group of healthy and pathologic subjects., Methods: Multichannel EMG was recorded by means of a flexible probe applied on the gloved index finger and carrying an array of eight equally spaced (1.15 mm) electrodes. A multichannel EMG amplifier provided seven outputs corresponding to the pairs of adjacent electrodes. Tests were performed in three different positions (dorsal, left and right) over the puborectalis muscle on 20 subjects (nine healthy, seven constipated and four incontinent patients). Motor unit action potentials (MUAPs) generated at the innervation zone of a MU and propagating along the muscle fibers generated repetitive characteristic patterns on the seven output channels allowing identification of anatomical features of the motor units., Results: MUAPs were observed travelling in either one or both directions with the array in dorsal position, and mainly in ventral-to-dorsal direction in either lateral position. MUAP amplitude was lower in constipated and incontinent patients with respect to healthy subjects. The conduction velocity estimated on the identified MUAPs was lower for constipated patients with respect to healthy subjects suggesting different mechanical properties of the active motor units., Conclusions: This technique allows the extraction of relevant information about the anatomical features (innervation zone position and overlapping of motor unit branches) of the puborectalis muscle and its electrophysiological properties and maybe can be applied as an novel methodology for assessing the anorectal function in patients.

In order to better understand the mechanisms of generation of mechanomyography (MMG) signals, the two-dimensional distribution of surface MMG produced by the activity of single motor units was analyzed by a novel two-dimensional recording method. Motor unit action potentials were identified from intramuscular electromyographic (EMG) signals and used to trigger the averaging of MMG signals detected over the tibialis anterior muscle of 11 volunteers with a grid of 5x3 accelerometers (20-mm inter-accelerometer distance). The intramuscular wires were inserted between the first and second accelerometer in the middle column of the grid, proximal to the innervation zone. The subjects performed three contractions with visual feedback of the intramuscular EMG signals. In each contraction, a new motor unit was recruited at the minimum stable discharge rate (mean+/-S.D., N = 11 subjects, 7.3+/-2.3 pulse/s), resulting in torque of 2.4+/-2.8% of the maximal voluntary contraction (MVC), 4.6+/-2.7% MVC, and 6.3+/-3.1% MVC (all different, P < 0.01). For 23 out of 33 detected motor units, it was possible to extract the motor unit surface acceleration map (MUAM). A negative MUAM peak (-2.7+/-2.2 mm/s2) was detected laterally and a positive MUAM peak (4.1+/-2.4 mm/s2) medially (P < 0.001). The time-to-peak was shorter in the medial part of the muscle (2.9+/-0.4 ms) than in the other locations (3.4+/-0.5 ms, P < 0.001). The double integrated signals (muscle displacement) indicated negative deflection in the lateral part and inflation close to the tibia bone. The maps of acceleration showed spatial dependency in single motor unit MMG activities. The technique provides a new insight into motor unit contractile properties.

The aim was to investigate with a novel technique the spatial inhomogeneity in surface mechanomyographic (MMG) response to muscle contraction at varying force levels. MMG signals were detected over the dominant tibialis anterior muscle of 10 volunteers using a 5 x 3 grid of accelerometers. The subjects performed 3 s long isometric contractions at forces ranging from 0% to 100% of the maximal force (10% increment) in a randomised order. From the two-dimensional MMG recordings, maps of absolute and normalized temporal and spectral MMG descriptors were obtained. The centroid and entropy of these maps were computed to describe the spatial centre of activity and degree of homogeneity, respectively. MMG absolute amplitude did not depend on location over the muscle while normalized amplitude did and the centroid shifted with increasing force. Amplitude increased with force and its entropy decreased. Absolute and normalized spectral variables depended on location over the muscle and their centroid shifted with increasing force. In addition, the dependency of absolute and normalized spectral variables on force was affected by location. These results highlight limitations when using single-channel MMG features for the assessment of motor unit control strategies, due to a substantial effect of position on the relation between force and MMG characteristics.

Purpose: The purpose of the study was the non-invasive investigation of the innervation zone (IZ) location of the gracilis muscle of both thighs by means of surface electromyography (EMG)., Materials and Methods: Multichannel EMG signals were detected by means of a flexible array of 16 equally spaced silver bar electrodes. Tests were performed on both gracilis muscles on 15 subjects. Motor unit (MU) action potentials were visually identified and extracted. The locations of the IZs of the recognized MUs were statistically analyzed to find significant differences between the subjects and between the right and left muscle of each subject., Results and Conclusions: A statistically significant difference was found between the gracilis IZ position in the two sides, with more proximal IZs on the left side. This difference suggests a possible role of surface EMG in preoperative evaluation of patients prepared for the dynamic graciloplasty procedure. This test would provide an objective criterion for the choice of the gracilis muscle to be transposed with the highest probability of success.

The aim of the study was to investigate amplitude and frequency content of single motor unit (MU) electromyographic (EMG) and mechanomyographic (MMG) responses. Multi-channel surface EMG and MMG signals were detected from the dominant biceps brachii muscle of 10 volunteers during isometric voluntary contractions at 20%, 50%, and 80% of the maximal voluntary contraction (MVC) force. Each contraction was performed three times in the experimental session which was repeated in three non-consecutive days. Single MU action potentials were identified from the surface EMG signals and their times of occurrence used to trigger the averaging of the MMG signal. At each contraction level, the MUs with action potentials of highest amplitude were identified. Single MU EMG and MMG amplitude and mean frequency were estimated with normalized standard error of the mean within subjects (due to repetition of the measure in different trials and experimental sessions) smaller than 15% and 7%, respectively, in all conditions. The amplitude of the action potentials of the detected MUs increased with increasing force (mean +/- SD, 244 +/- 116 microV at 20% MVC, and 1426 +/- 638 microV at 80% MVC; P < 0.001) while MU MMG amplitude increased from 20% to 50% MVC (40.5 +/- 20.9 and 150 +/- 88.4 mm/s(2), respectively; P<0.001) and did not change significantly between 50% and 80% MVC (129 +/ -82.7 mm/s(2) at 80% MVC). MU EMG mean frequency decreased with contraction level (20% MVC: 97.2 +/- 13.9 Hz; 80% MVC: 86.2 +/- 11.4 Hz; P < 0.001) while MU MMG mean frequency increased (20% MVC: 33.2 +/- 6.8 Hz; 80% MVC: 40.1 +/- 6.1 Hz; P < 0.001). EMG peak-to-peak amplitude and mean frequency of individual MUs were not correlated with the corresponding variables of MMG at any contraction level.

Many previous studies were focused on the influence of anatomical, physical, and detection-system parameters on recorded surface EMG signals. Most of them were conducted by simulations. Previous EMG models have been limited by simplifications which did not allow simulation of several aspects of the EMG generation and detection systems. We recently proposed a model for fast and accurate simulation of the surface EMG. It characterizes the volume conductor as a non-homogeneous and anisotropic medium, and allows simulation of EMG signals generated by finite-length fibers without approximation of the current-density source. The influence of thickness of the subcutaneous tissue layers, fiber inclination, fiber depth, electrode size and shape, spatial filter transfer function, interelectrode distance, length of the fibers on surface, single-fiber action-potential amplitude, frequency content, and estimated conduction velocity are investigated in this paper. Implications of the results on electrode positioning procedures, spatial filter design, and EMG signal interpretation are discussed.