EMG for Functional Movements 1

EMG Analysis of Lower Extremity Muscles during Functional Movements

Julia Villani

Gracie Jaeger

Carrie Meyer, EdD, ATC

Fort Lewis College

 EMG for Functional Movements 2

ABSTRACT: Purpose: Functional movements, such as squatting and lunging are crucial
during athletic performance. The purpose of this study was to see if an individuals level
of muscle activation had an effect on an individuals ability to move functionally. It was
hypothesized that there would be a positive correlation between an athletes FMS score
for and overhead squat and in-line and their levels of activity in their lower extremity
muscles. Methods: There were a total of 26 subjects in our study, 13 males and 13
females from a variety of club and varsity sports. Three EMG leads were placed bilaterally
on the tibialis anterior, vastus lateralis, and biceps femoris. An overhead squat and an in-
line lunge with each leg forward were each performed 3 times, and the trial with the best
functional movement score was taken. The EMG data collected was normalized by finding
the peak muscle activation. A Persons Correlation was performed comparing the peak
EMG levels and FMS score for each participant. Results: A statistically significant
correlation was found between the tibialis anterior and the FMS overhead squat score (p
= 0.394, r = 0.046). There were no significant correlations found for the in-line lunge,
however, the right tibialis anterior was close to having a statistically significant negative
correlation during the right lunge (p = -0.360, r =.071). Conclusion: This data did not
support our hypothesis, therefore should be repeated with a larger sample size to confirm
result. A better understanding of the underlying cause of dysfunctional movement has the
potential to help create better injury prevention exercise programs.
Key Terms: Muscle activation, Overhead squat, In-line lunge, Collegiate athletes

Introduction
Biomechanical assessment of human movement can help us to understand how

the body functions normally. There are several ways movement can be assessed. One

common assessment tool, the Functional Movement Screening (FMS), has recently

gained popularity due to its ease of use. In addition, research has shown that the FMS

can help accurately predict injury.1 Most athletes will experience an injury in their career,

yet few athletes have had a thorough FMS assessment. If more athletes are tested using

the FMS, its ability to predict injury can be utilized to a greater extent. While the functional

movement screen can predict injury, there is limited knowledge as to how. The answer to

this problem may be solved by looking at muscular activity during the functional

movements.
 EMG for Functional Movements 3

Significance

The goal of the FMS is to aid healthcare professionals in injury prevention. The

assessment tool detects individuals who are at risk of injury.1 This has been accomplished

by studying normative FMS scores as well has the correlation between score and rate of

injury.2,3 Research has shown that the average FMS composite score is 15.7 on a scale

of 21 in a young, healthy population, ages 18-40,2 and a score of 14 or less accurately

predicts injury.3 While a score of 14 is the standard measurement for injury risk, an

additional study found that a composite score below 17 has 4.7 times greater chance of

lower extremity injury.1 The risk of injury is due to an individuals functional movement

deficiency. If appropriate mobility and motor control is not utilized weaknesses and

imbalances become noticeable. However, there is limited research on the cause of the

biomechanical abnormalities.

One area of study that needs to be researched further to identify the source of

movement deficiency is the level of muscular activity during functional movements. A

handful of studies have analyzed muscle activity, with an electromyography (EMG),

during functional movement, but there are none looking at muscle activation during a FMS

assessment. This research study aims to examine muscle activity in respects to an FMS

score. Current evidence shows that low levels of muscle activation have been associated

with dysfunctional movements.4-6 Therefore, a correlation between levels of muscle

activity and FMS scores may exist.

If a correlation is found, the data collected about the levels of muscle activation

could be used to create a muscle specific exercise program. There are current FMS

exercise programs to help improve individuals FMS scores.7 With information about
 EMG for Functional Movements 4

specific muscular deficiencies a corrective exercise program could be created to target

the specific problem. A more personalized exercise program has the potential to prevent

injury more effective than a generalized exercise program.

Research Question/Hypothesis

Levels of muscle activation in the lower extremities will positively correlate with

FMS tests scores. Research as shown that decreased levels of muscle activation and low

FMS scores both occur with dysfunctional movements. 3-6 Therefore, a relationship

between muscle activation and FMS score should exist.

Methodology

Subject Selection

The subjects that participated in this study were traditional college aged students,

ranging from 18-22 years old, at Fort Lewis College, participating in athletics at the varsity

or club level. A total of 26 athletes, both male and female, volunteered for the study from

a variety of sports including: football, volleyball, softball, soccer, and lacrosse. There were

an equal number of males and female with a varying number of athletes from each sport

ranging from one to five. (Table 1) Participants were excluded if they an orthopedic injury

in the last 6 months that caused them to miss any practices or games or an orthopedic

surgery within the last year.

 EMG for Functional Movements 5

Informed Consent/ IRB Approval

FORT LEWIS COLLEGE

INFORMED CONSENT TO PARTICIPATE IN A RESEARCH PROJECT
TITLE OF PROJECT: Muscle Activation testing during exercises from the Functional
Movement Screening

NAME OF PRINCIPAL INVESTIGATOR: Dr. Carrie Meyer

NAME OF CO-INVESTIGATOR: Julia Villani, Gracie Jaeger

CONTACT NAME AND PHONE NUMBER FOR QUESTIONS\PROBLEMS ABOUT

RESEARCH: Dr. Carrie Meyer (970) 247-7581

CONTACT NAME AND PHONE NUMBER FOR QUESTIONS\PROBLEMS ABOUT

RESEARCH-RELATED HEALTH PROBLEMS: Fort Lewis College Health Center -
(970) 247-7355

CONTACT NAME AND PHONE NUMBER FOR QUESTIONS\PROBLEMS ABOUT

PARTICIPANT RIGHTS OR ETHICAL CONSIDERATIONS: Fort Lewis College IRB
representative: Sarah Roberts-Cady, (970) 247-7002

PURPOSE OF THE RESEARCH:

The purpose of this research is to look at a person's ability to move. We want to see
if there is a relationship between the level of functional movement and muscle activity
in the lower body.

PROCEDURES /METHODS TO BE USED:

We are inviting all traditional college students with an athletic background and no
history of injury in the last 6 months. The research takes place over one day in total.
During that time, it will be necessary for you to come to the exercise science lab in
Skyhawk 160, for 1-2 hours. When you come in to be tested, you will be asked to fill
out an information form including height, weight, age, gender, sport, and history of
injury in the last year. This study will use surface electromyography (EMG) to test
levels of muscle activation. It involves placing electrodes on the muscles to measure
the electrical current. During the evaluation you will be hooked up to the EMG and
then perform an overhead squat, and in-line lunge. Each movement will be done three
times. During the test, you will be video recorded to look at your movement.

RISKS INHERENT IN THE PROCEDURES:

There is minimal risk in participation of this research. Performing the FMS testing has
a minimal risk of orthopedic injury. While the possibility of this happening is very low,
 EMG for Functional Movements 6

you should still be aware of the possibility. We will try to decrease the chances of this
happening by thoroughly explaining the FMS movements you will perform beforehand.
It is not possible to identify all potential risks in an experimental procedure, but the
researcher(s) have taken reasonable safeguards to minimize any known risks.

BENEFITS:
If you participate in this research, you will have the following benefits: Assess to your
final scores on the movements and EMG. This will give you some information about
how your muscles are being used while performing common movements in athletics.
There may not be any benefit for you but your participation is likely to help us find the
answer to the research question

COSTS/COMPENSATION:
You will not be given any money or reimbursement to participate in this study.

CONFIDENTIALITY:
While one cannot ever guarantee complete confidentiality, steps will be taken to
prevent anyone from associating participants names with the data gathered. The
individual names of research participants will not appear on any of the papers on which
the data are recorded, nor will they appear in the final research document. The only
place the names of participants will appear is on this signed informed consent form.
The consent forms will be stored separately from the data. Your face will be blurred
out of any video that is taken and these files will be kept on a flash drive in a secured
location. These video files will be deleted once the FMS score is finalized. In addition
to the researchers, the federal research regulatory bodies and the Fort Lewis College
Institutional Review Board may have access to the research records.

LIABILITY:
In the event that you suffer a research-related injury, your medical expenses will be
your responsibility or that of your third-party payer, although you are not precluded
from seeking to collect compensation for injury related to fault or blame on the part of
those involved in the research. However, the Colorado Governmental Immunity Act
determines and may limit Fort Lewis Colleges legal responsibility if an injury happens
because of this study. Claims against the College must be filed within 180 days of the
injury.

PARTICIPATION:
Your participation in the research is voluntary. If you decide to participate in the
study, you may withdraw your consent and stop participating at any time without
penalty or loss of benefits to which you are otherwise entitled. If at some point during
the research, there are new findings that may affect your willingness to participate in
the study, you will be informed of those findings.

Your signature acknowledges that you have read or have had read to you the
information stated and willingly sign this consent form. Your signature also
 EMG for Functional Movements 7

acknowledges that you have received, on the date signed, a copy of this document
containing 2 pages.

Participants Name (printed)

Participants Signature Date

Investigator or co-investigator Date

 EMG for Functional Movements 8

December 19, 2015

To: Carrie Meyer

From: Sarah Roberts-Cady, Chair
Institutional Review Board
Fort Lewis College

Subject: IRB2015-0411 Muscle Activation While Performing Exercises from the

Functional Movement Screening Assessment

In accordance with the Colleges regulation implementing the Common Rule for the
Protection of Research Subjects, 45 CFR 46, the Institutional Review Board (IRB) of
Fort Lewis College has reviewed the research proposal referred to above, and has
recommend approval for your project.
This approval is for research which takes place within one calendar year of this letter. If
your project extends beyond this date and no significant changes are made, you must
seek approval from the IRB for continuing the research by filling out the CHANGE OF
STATUS / ANNUAL REVIEW / FINAL REPORT form, available on the IRB web page. If
your project extends beyond one year and significant changes are made, you must
submit a new application form to seek approval for the research.
Please note that the Common Rule also requires that research investigators promptly
report to the IRB any proposed changes in the research activity, and that no changes
affecting the rights or welfare of research subjects may be initiated without prior IRB
review and approval except when necessary to eliminate apparent immediate hazards
to the subjects. Forms are available on the IRB website to report these instances.
Also note that you should report to the IRB any unanticipated problems involving risks to
subjects or others, or any serious or continuing noncompliance with the Common Rule
for the protection of research subjects (45 CFR 46).
If you have questions or concerns about the research project, the IRBs Review, or the
protection of human subjects, please contact the IRB via e-mail or by phone at 970-247-
7002.
 EMG for Functional Movements 9

Study protocol
The participants had individual appointments in the Exercise Science Lab at Fort

Lewis College. The informed consent form was given to the participant to read and sign.

Each participant also completed a short demographic information sheet. (Appendix A)

Once it was verified that the athletes met the study criteria, a brief description of the data

collection procedure was given. After the EMG led were places the participant read the

instructions for the FMS movements. The FMS tests was performed by the athlete and

the data was collected. After the tests, the participants could request their EMG and FMS

scores. Only the raw scores were provided; feedback about the data was not given. It

was assumed that participants will answered the questionnaire about their injury history

honestly and that they perform the FMS tests to the best of their abilities.

Instrumentation

The Cometa Wave Wireless EMG was used to measure muscle activity was

selected as it is a non-invasive method to accurately measure electrical activity in

superficial muscles.5 The EMG used eight wireless leads that allowed each of the four

muscles to be tested on both limbs simultaneously. If the subjects skin was visibly dirty,

an alcohol pad was used to clean the area. The led placements are shown in figure 1 In

addition to using the EMG, the FMS equipment was used. This included a wooden pole,

1 inch in diameter, to grip during the overhead squat and in-line lunge, as well as a

wooden board, dimensions 2x4x48, which the participant will stand on. The scoring for

the FMS tests ranges from 0 to 3.

 EMG for Functional Movements 10

To perform the deep squat the subject will stand with feet shoulder width apart,

feet pointed forward. To position their hands on the dowel, the subject will rest the dowel

on the top of their head, subject will grip the bar when their elbows are at 90 degree. They

will then press the bar straight overhead before performing a squat. During the overhead

over squat participants will receive a 3 if the upper torso is parallel with the tibia, the femur

is below horizontal, and knees and dowel are aligned over feet. A subject will receive a 2

if the above criteria are met while heels are elevated on the board. A 1 is given when this

criterion is not met and the subject has lumbar flexion.

For the in-line lunge, the subject will stand on the board with their feet in a lunge

position. The distance between their feet is equal to the height of their tibial tuberosity. A

subject will receive a 3 if the dowel remains vertical and in contact with the body at the

head, upper back, lower back, and hand, no torso movement is noted, the dowel and feet
 EMG for Functional Movements 11

remain in the sagittal plane, and the knee touches the board behind the heel of the front

foot. A score of 2 is received if they dont meet this criteria, and a 1 if loss of balance is

noted. The details about the instructions is in appendix B and scoring criteria is in

appendix C

Data collection procedures

The athlete performed three trials for the overhead squat and a forward lunge with

each leg leading. Of the three trials, the best score was recorded along with the

corresponding EMG data. The EMG recorded at 1000 Hz and using a 500 Hz filter at 50

m/s to limit background noise. The EMG data was integrated with respect to time and

then normalized by dividing by the peak EMG amplitude.

Reliability and Validity

There were reliability and validity issues that had to be addressed. There was only

one researcher score participants on the functional movements as to avoid interrater

error. In addition video recording was used so that scorer could confirm initial scores.

Research done to identify the reliability of EMG has found that intrarater and interrater

reliability range from good to excellent with every trial performed. 8 To ensure that the

electrodes were being placed in the same location on each participant, one administrator

placed the electrodes. The electrodes were placed according to Surface

ElectroMyoGraphy for the Non-Invasive Assessment of Muscles (SENIAM)

recommendations.9
 EMG for Functional Movements 12

Limitations

A limitation of this study it the population size, as the research is being done on a

small sample of collegiate athletes. This is considered a limitation because the data

collected may not be significant depending on the number of volunteers. In addition, when

the test is performed there are variables that we are unable to control included electrical

noise in the testing room that may interfere with the EMG reading.

Statistics

There were two different statistical tests performed to analyze the data. The first

test performed was a correlation analysis between the FMS scores and EMG data. A

correlation analysis was chosen due to both variables being independent. This test was

to verify the hypothesis, a positive relationship between an individuals scores of a portion

of the FMS and their levels of muscle activity.

Results

The FMS overhead squat scores (M = 1.85, SD = 0.675) were correlated with the

right and left leg averages of the peak muscle activation level for the tibialis anterior (M =

56.70, SD = 35.59), vastus lateralis (M = 96.31, SD = 56.26), and biceps femoris (79.48,

SD = 101.05). The FMS score and tibialis anterior peak activation were significantly

correlated, r = 0.394, p = 0.046. (Figure 2) The FMS had a nonsignificant correlation with

the vastus lateralis, r =0.095, p = .644 and the biceps femoris, r = 0.114, p = 0.578.
 EMG for Functional Movements 13

250

200
Muscle Activation

150

100

50

0
1 2 3
FMS Score

Figure 2: Squat Tibialis Anterior Correlation

The FMS in-line lunge (IIL) scores (right leg forward, left leg forward) were

correlated with each individual peak muscle activation. The left leg back IIL was

nonsignificant with the right TA (r = 0.063, p = 0.760), right VL (r = -0.041, p = 0.842),

right BF (r = -0.081, p = 0.694), left TA (r = 0.186, p = 0.364), left VL (r = 0.181, p = 0.377)

and left BF (r = -0.126, p = 0.539). The right leg back IIL was nonsignificant with the right

TA (r = -0.360, p = 0.071), right VL (r = -0.200, p = 0.328), right BF (r = -0.214, p = 0.295),

left TA (r = -0.099, p = 0.631), left VL (r = -0.129, p = 0.529), left BF (r = -0.167, p = 0.416).

Discussion

A significant correlation for the overhead squat was found between the tibialis

anterior and the individual FMS score. We examined the specific movement while
 EMG for Functional Movements 14

performing the overhead squat. According to the FMS criteria, if the participant wasnt

able to perform the squat they were placed on a board that elevated their heels, our

previous research examined how different ankle flexion can change the levels of muscle

activity. It was found that there is a difference in muscle activation with heel elevation

which explains the result shown by having the significant correlation only in the tibialis

anterior.

The vastus lateralis and the biceps femoris had a negative nonsignificant

correlation during the overhead squat. This is an area where further research would be

needed to understand this relationship.

There have been studies researching the FMS but no research on what could be

the cause of the different scores. Our study aimed to see if muscle activity could be one

of the causes. If with future research, if a correlation is found this information can be

applied to injury prevention programs that can be specified to each individual athlete.

One limitation of our study was our small sample size. This was due to several

factors including equipment malfunctions and time constraints. If this study were to be

repeated, we would want to have more participants and participants with a wider variety

of sports. Another limitation was the uneven distribution of FMS scores with many 2s and

few 1s and 3s. If this study would be repeated a larger variety of scores would be needed

to see if a correlation exists. Another limitation of this study was following the FMS criteria

with the overhead squat. By changing the motion this aided the reliability of the results.

This study had a several results that are unexplainable and some that can be

explained through previous research. This is knowledge is adding to the knowledge that
 EMG for Functional Movements 15

we already have on the FMS. This information can aid the field of exercise science by

allowing ones preventions programs to be specialized to each individual.

Acknowledgements

Thank you to the athletes who volunteered in our study. Thank you to Melissa

Thompson for all of her assistance with the use of the EMG Wave Wireless. Lastly, thank

you to Carrie Meyer for all of her guidance and contribution throughout the entire research

project.
 EMG for Functional Movements 16

References

1. Letafatkar A, Hadadnezhad M, Shojaedin S, Mohamadi E. Relationship between

functional movement screening score and history of injury. International Journal Of
Sports Physical Therapy [serial online]. February 2014;9(1):21-27. Available from:
MEDLINE, Ipswich, MA.

2. Schneiders A, Davidsson A, Hrman E, Sullivan S. Functional movement screen

normative values in a young, active population. International Journal Of Sports
Physical Therapy [serial online]. June 2011;6(2):75-82. Available from: MEDLINE,
Ipswich, MA.

3. Kiesel K, Plisky P, Voight M. Can Serious injury in professional football be predicted

by a preseason functional movement screen?. North American Journal Of Sports
Physical Therapy: NAJSPT [serial online]. August 2007;2(3):147-158. Available
from: MEDLINE, Ipswich, MA.

4. Sriwarno A, Shimomura Y, Iwanaga K, Katsuura T. The effects of heel elevation on

postural adjustment and activity of lower-extremity muscles during deep squatting-
to-standing movement in normal subjects. Journal Of Physical Therapy
Science [serial online]. June 2008;20(1):31-38. Available from: SPORTDiscus with
Full Text, Ipswich, MA.

5. Nishiwaki G, Urabe Y, Tanaka K. EMG analysis of lower extremity muscles in three

different squat exercises. Journal Of The Japanese Physical Therapy Association =
Rigaku Ryh [serial online]. 2006;9(1):21-26. Available from: MEDLINE, Ipswich,
MA.
6. Chang-Hwan B, Yeon-Woo J, Jung-Ho L. Analysis of muscle activations in lower
extremities muscles at various angles of ankle flexion using wedges during static
squat exercise. Journal Of Physical Therapy Science [serial online]. September
2015;27(9):2853-2855. Available from: SPORTDiscus with Full Text, Ipswich, MA.

7. Kiesel K, Plisky P, Butler R. Functional movement test scores improve following a

standardized off-season intervention program in professional football
players.Scandinavian Journal Of Medicine & Science In Sports [serial online]. April
2011;21(2):287-292. Available from: SPORTDiscus with Full Text, Ipswich, MA.

8. Barn R, Rafferty D, Turner D, Woodburn J. Reliability study of tibialis posterior and

selected leg muscle EMG and multi-segment foot kinematics in rheumatoid arthritis
associated pes planovalgus. Gait & Posture [serial online]. July 2012;36(3):567-571.
Available from: SPORTDiscus with Full Text, Ipswich, MA.

9. Cook, Grey. Movement: Functional Movement SystemsScreening, Assessment,

Corrective Strategies. 2010.
 EMG for Functional Movements 17

Appendix A
Muscle Activation While Performing Exercises from the Functional Movement
Screening Questionnaire

Please answer the following questions to the best of your ability.

Name: ___________________
Gender: ________________
Age: ________
Sport: ______ __________ Varsity OR Club
Have you had a physical and been cleared by a physician to participate in your sport for

the 2015-2016 academic year? Yes OR No

List and with any injuries you have sustained within the last year in the space below

List and date any orthopedic surgeries you have sustained within the last year in the
space below

Were you unable to participate in practice or game(s) due to any injuries? Yes OR No
If yes, please list which injuries:
 EMG for Functional Movements 18

Appendix B
FMS instruction
Deep Squat
Equipment needed: Dowel
Instructions
Stand tall with your feet approximately shoulder width apart and toes pointing forward.
Grasp the dowel in both hands and place it horizontally on top of your head so your
shoulders and elbows are at 90 degrees.
Press the dowel so that it is directly above your head.
While maintaining an upright torso, and keeping your heels and the dowel in position,
descend as deep as possible.
Hold the descended position for a count of one, then return to the starting position.

Inline Lunge
Equipment needed: Dowel, 2x6 Board
Instructions
Place the dowel along the spine so it touches the back of your head, your upper back
and the middle of the buttocks.
While grasping the dowel, your right hand should be against the back of your neck,
and the left hand should be against your lower back.
Step onto the 2x6 with a flat right foot and your toe on the zero mark.
The left heel should be placed at _____________mark.
This is the tibial measurement marker.
Both toes must be pointing forward, with feet flat.
Maintaining an upright posture so the dowel stays in contact with your head, upper
back and top of the buttocks, descend into a lunge position so the right knee touches
the 2x6 behind your left heel.
Return to the starting position.

Excerpted from the book, Movement: Functional Movement SystemsScreening,

Assessment, Corrective Strategies. Copyright 2010 Gray Cook.
 EMG for Functional Movements 19

Appendix C
FMS Scoring
DEEP SQUAT
3
Upper torso is parallel with tibia or toward vertical
Femur below horizontal
Knees are aligned over feet
Dowel aligned over feet
2
Upper torso is parallel with tibia or toward vertical
Femur is below horizontal
Knees are aligned over feet
Dowel is aligned over feet
Heels are elevated
1
Tibia and upper torso are not parallel
Femur is not below horizontal
Knees are not aligned over feet
Lumbar flexion is noted

The athlete receives a score of zero if pain is associated with any portion of this test.
A medical professional should perform a thorough evaluation of the painful area.
 EMG for Functional Movements 20

INLINE LUNGE
3
Dowel contacts maintained
| Dowel remains vertical
| No torso movement noted
Dowel and feet remain in sagittal plane
| Knee touches board behind heel of front foot
2
Dowel contacts not maintained
| Dowel does not remain vertical
| Movement noted in torso
Dowel and feet do not remain in sagittal plane
| Knee does not touch behind heel of front foot
1
Loss of balance is noted

The athlete receives a score of zero if pain is associated with any portion of this test.
A medical professional should perform a thorough evaluation of the painful area.