513

ORIGINAL ARTICLE

Effect of Isometric Upper-Extremity Exercises on the

Activation of Core Stabilizing Muscles
Sami P. Tarnanen, MSc, Jari J. Ylinen, MD, PhD, Kirsti M. Siekkinen, PT, Esko A. Mlki, PhD,
Hannu J. Kautiainen, BA, Arja H. Hkkinen, PhD
ABSTRACT. Tarnanen SP, Ylinen JJ, Siekkinen KM,
Mlki EA, Kautiainen HJ, Hkkinen AH. Effect of isometric
upper-extremity exercises on the activation of core stabilizing
muscles. Arch Phys Med Rehabil 2008;89:513-21.
Objective: To evaluate whether isometric exercises for the
upper extremities could sufficiently activate core stabilizing
muscles to increase muscle strength.
Design: Cross-sectional study.
Setting: Department of physical medicine and rehabilitation
at a Finnish hospital.
Participants: Healthy adult women (N20).
Interventions: Not applicable.
Main Outcome Measures: Peak isometric strength of the
back and abdominal muscles was measured and relative loading in
5 test exercises was evaluated by surface electromyography.
Results: The rectus abdominis and obliquus externus abdominis were activated to the greatest degree in a bilateral shoulder extension exercise and the average surface electromyographic activity was 114% and 101% compared with the
amplitude elicited during the maximal isometric trunk flexion
exercise. Horizontal shoulder extension elicited the greatest
activation of the longissimus and multifidus muscles. In this
exercise, the activity levels of the left side multifidus and
longissimus muscles were 84% and 69%, respectively, compared with the level of activity elicited during trunk extension.
Conclusions: Of all the exercises studied, bilaterally performed isometric shoulder extension and unilaterally performed horizontal shoulder extension elicited the greatest levels of activation of the trunk musculature. Thus, it can be
assumed that these exercises elicit sufficient levels of contraction of the trunk muscles for the development of their endurance and strength characteristics in rehabilitation.
Key Words: Abdominal muscles; Back; Electromyography;
Exercise, isometric; Rehabilitation.
2008 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and
Rehabilitation
HERAPEUTIC EXERCISE is an effective method for the
reduction of pain and functional impairment resulting from
T
the pain, as well as of absences from employment in persons
suffering from chronic, nonspecific low back pain (LBP).1-3

From the Department of Health Sciences, University of Jyvskyl, Jyvskyl,

Finland (Tarnanen, Siekkinen, Mlki, Hkkinen); Department of Physical Medicine
and Rehabilitation, Jyvskyl Central Hospital, Jyvskyl, Finland (Ylinen, Hkki nekoski, Finland (Kautiainen).
nen); and Medcare, A
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit upon the authors or upon any
organization with which the authors are associated.
Reprint requests to Sami P. Tarnanen, MSc, Dept of Physical and Rehabilitation
Medicine, Jyvskyl Central Hospital, Keskussairaalantie 19, Jyvskyl, Finland
40620, e-mail: sami.tarnanen@kolumbus.fi.
0003-9993/08/8903-00083$34.00/0
doi:10.1016/j.apmr.2007.08.160

There is also evidence that the performance capacity of LBP

patients can be improved with exercise.4 Further, exercise has
been included as a central component in several recommendations for the conservative treatment of LBP.5,6
However, on the basis of a systematic literature review and
treatment recommendations, it is still not possible to determine
what kinds of exercises should be performed and how they
should be prescribed, because the interventions used in the
different studies have differed greatly. There have also been
flaws in the description of how the exercises included in a
number of studies were actually performed.7-9
Many functional and structural changes of the back are
associated with LBP. In comparison with healthy people, the
extension and flexion strength levels of LBP patients are diminished and the extension to flexion strength ratio is decreased.10,11 Diminished muscle strength levels have also been
observed in the lower limbs.12 In addition to the muscular
strength characteristics, the muscular endurance of the trunk
extensor muscles has also been proven to be diminished.13,14
The reaction times of the trunk muscles of LBP patients,
which are associated with coordination and movement control,
have been shown to be increased and control of lumbar spine
position, postural and positional awareness, as well as psychomotor speed, have been noticed to be diminished. Further,
the degree and speed of postural sway is greater and the
recruitment patterns of the muscles have been shown to be
altered.15-21
In relation to anatomic structures, the cross-sectional area of
the muscles in the lumbar spine region was found to be decreased and there was also shown to be a decrease in the
relative numbers of type I muscle fibers.22,23 Collagen synthesis in LBP patients has been shown to be decreased compared
with healthy people24; however, the cause-effect relationship
between these changes and back pain is still unclear.
Strength training aims to achieve structural, neural, hormonal, and metabolic changes in the musculoskeletal and neuromuscular systems in order to improve the functional and
structural changes associated with LBP. These changes can be
observed, for example, as hypertrophy of the muscles and
connective tissues, improvements in muscle activation levels,
increased energy stores, and as increased activity of enzymes
and then, ultimately, as an improvement in performance capacity.25,26 With the selection of correct and appropriate exercise,
it is possible to focus these changes on the desired structures.
In order to achieve a training effect, exercises should be challenging in terms of their intensity and volume, and they should
also be performed for a sufficiently long period of time.26
In the determination of the appropriate intensity level of the
exercises used in rehabilitation, it is often possible to use the
general recommendations that have been created for healthy
people who are just commencing exercise programs. In the
early, familiarization stage of an exercise program, exercise
loads should be at decreased levels. However, after this initial
phase, the load should be gradually increased to a level that is
sufficient to result in changes in the bodys tissues. For examArch Phys Med Rehabil Vol 89, March 2008

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UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

Table 1: Background Information of the Study Subjects
Characteristics

Mean SD

Age (y)
Weight (kg)
Height (cm)
BMI (kg/m2)
Physical activity level (METS)*

38.17.2
62.96.3
165.26.7
232
31

Abbreviations: BMI, body mass index; SD, standard deviation.

*A time-weighted intensity average metabolic equivalent (METS)
level (work, commuting, leisure time physical activity, controlled
exercises).

ple, to achieve changes in muscle endurance characteristics, a

sufficiently high level of resistance for the designed exercises
should be 50% to 70% of 1 repetition maximum (1-RM).27
Similarly, for the improvement of muscle strength characteristics, the resistance level should be 60% to 80% of 1-RM.
The activity level of the muscles during the performance of
the exercises can be estimated using surface electromyography.
In the studies that have looked at the activation of the trunk
musculature, the resistance used in the exercises has been the
subjects own body weight or the load has been directed at the
trunk musculature through movements of the upper and lower
limbs.28-34 The effect of an unstable base of support on the
surface electromyographic amplitude levels of the trunk musculature has also been reported in various studies.35-38
In earlier studies involving surface electromyography, the
amplitudes recorded during many of the studied exercises were
noticeably less than 50% of the maximal amplitude levels.
Thus, these exercises may not be sufficiently intense to develop
the strength characteristics of the trunk musculature.29,31,32,34
The effects on trunk muscle activity during the performance of
upper-limb exercises have been studied earlier by Arokoski29,31
and Behm37 and colleagues, but either a standard resistance
level was used or the load was not specified. The aim of this
current study was to determine, with surface electromyography, if upper-extremity exercises are able to load the core
stabilizing muscles sufficiently to increase muscle strength.
METHODS
The study was performed in the biomechanics laboratory in
the Department of Physical and Rehabilitation Medicine at
Jyvskyl Central Hospital. The research project received the
approval of the local ethics committee. We provided information to all subjects on how the study would be conducted and
what it would include. All subjects signed a consent form prior
to participation in the study.

Participants
For this study, we recruited 20 women, aged 20 to 45 years.
Subjects were secretarial and nursing staff as well as doctors at
Jyvskyl Central Hospital. The background information of the
subjects is shown in table 1. Subjects were excluded if they had
any neuromuscular, orthopedic, or cardiorespiratory problems
that prevented the type of physical exertion required for this
study. The physical activity level of all subjects was determined using a written questionnaire. From the responses, a
time-weighted intensity average metabolic equivalent level was
calculated for each subjects daily active time (work, commuting, leisure time physical activity, controlled exercises) using
the MetPro software program.a
Surface Electromyography Recording
We used an 8-channel ME3000P8 surface electromyographb
for measurements. Raw electromyographic data were recorded
using a sampling frequency of 1000Hz and band-pass filtered
using a band-width of 8 to 500Hz (Butterworth). A differential
amplifier was used to strengthen and filter the measured signal,
as well as for the dampening of noise, with a common mode
rejection ratio greater than 110dB, a root mean square of noise
less than 1.6V, and an amplification level of 412. The amplifiers feed impedance was greater than 10G. The surface
electromyographic signal was changed into a digital format
with a 12-bit analog-to-digital converter, after which it was
saved on a computer for analysis. The raw electromyographic
signal was rectified and averaged. The average amplitude level
(in V) of every exercise was calculated as the average of each
of the analysis periods data segments (100ms). A 4-second
time period was selected for analysis at the point where the
electric activity level was at its greatest in each exercise.
Round, single use Ag/AgCl surface electrodesc were used.
The skin at the electrode attachment sites was shaved, cleaned
with sandpaper, and then wiped with alcohol in order to decrease skin impedance. The pairs of electrodes were positioned
onto the rectus abdominis, obliquus externus abdominis, longissimus, and multifidus muscles on both sides of the body in
the direction of the muscle fibers (table 2). The distance between the mid-points of the electrodes was 25mm. The reference electrodes, to which a preamplifier was attached, were
positioned in the area of the iliac spine. After the attachment of
the electrodes, a period of 15 minutes was allowed to pass
before the commencement of measurements.
Measurements
In the first phase, we determined individualized adjustments
for each subject in the isometric strength measurement frame
and they had the opportunity to practice the exercises until

Table 2: Electrode Placement

Muscle
46

Rectus abdominis

Electrode Location

Obliquus externus abdominis46

1cm above the navel and 2cm laterally

from the mid-line
Just below the curvature of the ribs

Longissimus54
Multifidus54,55

3cm laterally from the L1 spinous process

2cm laterally from the L5 spinous process

Arch Phys Med Rehabil Vol 89, March 2008

Direction

Vertical line
On the line extending from the most
inferior point of the costal margin
to the opposite pubic tubercle
Vertical line
On the line extending between the
spinous processes of L1 and L2
and the posterior superior iliac
spine

UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

515

Fig 1. Maximal isometric force measurement of the trunk. (A) Exercise 1: flexion; (B) exercises 2 and 3: lateral flexion to the right and left;
and (C) exercise 4: extension.

performance technique was correct. The average time between

this familiarization and the actual measurement phase was 8
days (range, 4 17d). On the second test occasion the subjects
performed 3 submaximal warm-up trials for each exercise.
Reference exercises were performed first and then the upperlimb exercises. Both were performed in a random order. A rest
period of at least 1 minute was allowed between each effort and
there was a 5-minute rest period between the reference and
upper-limb exercises.39,40
Reference exercises. Isometric exercises of the trunk were
the exercises to which we compared the actual exercises being
studied (fig 1). They were performed in a standing position in
the measurement frame with the feet positioned side by side
and 20cm apart. For the trunk flexion (exercise 1) and extension (exercise 4), the subjects were supported in the measurement frame with a 10cm wide pelvic support and a 5cm wide
belt at the level of the greater trochanter. An additional 10cm
wide support was used at the midpoint of the thighs. A harness
was fastened around the shoulders and chest just below the
clavicles and this was attached to a strain-gauge dynamometerd
with a metal lock. For the lateral flexion to the right (exercise 2)
and left (exercise 3), the subject was positioned sideways in
relation to the measuring frame so that the upper edge of the
cushioned plate, which was attached to the dynamometer, was
positioned just below the level of the acromion process. Fixation was also provided at the level of the pelvis and thighs. The
upper limbs were held folded at the front of the chest and the
subjects set their gaze at a fixed point at the level of the eyes.
After the command to commence each exercise, the subjects
performed a maximal effort for approximately a 5-second
period. Two maximal efforts were performed. If the measured
strength level increased more than 10% from the first effort, 1
additional effort was performed. Repeatability of isometric
strength tests has been evaluated elsewhere.41
Upper-limb exercises. Isometric exercises of the upper
limbs were performed with the lower limbs set in a striding
position in which the heel of the left foot was in the same line
as the toes of the right foot (fig 2). The lateral distance between
the feet was 20cm. The left knee was in slight flexion and the

pelvis was fixed as in the reference exercises. The right elbow

was at 90 flexion. The upper arm was held against the side of
the body in the right shoulder extension (exercise 5) and flexion
(exercise 6). In the right shoulder horizontal extension (exercise 7) and flexion (exercise 8), the shoulder was held in 90 of
abduction so that the arm was in the horizontal plane. During
these exercises, the test subject held on to a handle that was
attached to the dynamometer. Bilateral shoulder extension (exercise 9) was performed with the upper arms held in 45 of
flexion. The angle of the upper arm was determined with an
electronic inclinometer.e In this exercise, each subject gripped
the bar that was attached to the dynamometer, with a palm
down grip with the hands 20cm apart. Subjects were instructed
not to move their trunk. Two maximal efforts of each exercise
were performed and the effort with a higher strength value was
chosen for analysis. The relative loading of the trunk muscles
was determined by comparing the ratio of surface electromyographic amplitude during maximal isometric effort of the upper-limb exercises to the amplitude elicited during maximal
isometric efforts of the trunk flexion and extension exercises.
Statistical Analysis
The results are presented as averages and standard deviations. We used repeated measures analysis of variance in the
comparisons of the surface electromyographic activity of each
muscle, which were elicited during the different exercises.
Paired t tests were used in the comparison of the force values
and surface electromyographic activities of the exercises in the
different shoulder positions (shoulder extension, shoulder horizontal extension and shoulder flexion, shoulder horizontal
flexion) and between the sides. No adjustment was made for
multiple testing, but this information can be obtained by multiplying the actual P value by the number of comparisons
made. Statistical analyses were performed using the SPSS
statistical analysis software program.f
RESULTS
The mean maximal isometric force results of the trunk and
upper-limb exercises are shown in table 3. The force values
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UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

Fig 2. Maximal isometric force measurement of the upper limb with the pelvis supported. (A) Exercises 5 and 6: shoulder extension and
flexion; (B) exercises 7 and 8: shoulder horizontal extension and flexion; and (C) exercise 9: bilateral shoulder extension.

produced in upper-limb exercises 5 and 6 were greater than in

exercises 7, 8, and 9 (P.001). Individual differences in force
production were the smallest in exercise 6 and the greatest in
exercise 7.
The mean surface electromyographic amplitude of the rectus
abdominis during exercise 1 was greater on both sides than the
activity levels during the most upper-limb exercises (P.031)
(fig 3). However, in exercise 9 the mean activity level of the
rectus abdominis was 114% compared with that of reference
exercise 1.
The activation of the obliquus externus abdominis was at its
greatest in reference exercise 1 on both sides and in exercise 2
and 3 on the side of the lateral flexion. The mean surface
electromyographic amplitude during reference exercise 1 was
greater than those during the upper-limb exercises (P.007),
except for the amplitude levels during exercises 8 and 9 on the
left side and during exercises 6, 8, and 9 on the right side (fig
4). On the left side, the surface electromyographic amplitude of
the obliquus externus abdominis was, on average, 82% of that
elicited during trunk flexion in exercise 8 and 99% in exercise 9.
The figures for the right side were 74% in exercise 6, 85% in
exercise 8, and 102% in exercise 9. In exercise 8, surface

Table 3: Force Production Values for Different Exercises of the

Trunk and Upper Limbs
Isometric Force

1.
2.
3.
4.
5.
6.
7.
8.
9.

Trunk flexion
Trunk lateral flexion to the right
Trunk lateral flexion to the left
Trunk extension
Shoulder extension
Shoulder flexion
Shoulder horizontal extension
Shoulder horizontal flexion
Bilateral shoulder extension

Mean SD (N)

Range (N)

29771
36388
36084
35498
23463
20735
15651
16831
17427

142429
190509
209476
174511
138347
149258
85270
104245
131250

Arch Phys Med Rehabil Vol 89, March 2008

electromyographic amplitude was greater than in exercise 6 on

both the left and right sides (P.036). The surface electromyographic amplitude on the right side in exercise 6 and on the left
side in exercise 7 were greater compared with the contralateral
sides for both exercises (P.017).
The surface electromyographic amplitude of the right and
left longissimus during reference exercise 4 was significantly
greater (P.001) than that elicited during the upper-limb exercises (fig 5). Of all the upper-limb exercises, the greatest
level of surface electromyographic amplitude was produced
during exercise 7, in which it was 69% of the amplitude level
observed during exercise 4 on the left side and 53% on the right
side. In exercises 5 and 7, the surface electromyographic amplitudes of the longissimus were significantly greater on the left
side of the trunk compared with the contralateral side
(P.007).
The surface electromyographic amplitudes of both the right
and the left multifidus muscles during reference exercise 4
were greater compared with the upper-limb exercises (P.033)
(fig 6). In regard to the upper-limb exercises, the multifidus
muscles were activated to the greatest degree in exercise 7. The
surface electromyographic amplitude was 84% of the activity
level of the exercise 4 on the left side and 52% on the right side.
The amplitude level of the multifidus was greater on the left
side in exercises 5 and 7 compared with the contralateral side
(P.005).
Activation during reference exercises 2 and 3 was significantly greater on the side of the lateral flexion in all muscles
(P.001).
DISCUSSION
Of all exercises included in this study, the greatest surface
electromyographic amplitudes of the rectus abdominis and
obliquus externus abdominis were elicited in bilateral shoulder
extension (exercise 9). This was surprising because the reference trunk exercises were supposed to produce the best activation of the trunk muscles. The reason may be that the arm
forms a long lever arm and the upper-body muscles were able

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UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

Right

Left
1. Trunk flexion
2. Trunk lateral flexion (right)
3. Trunk lateral flexion (left)
4.Trunk extension
5. Shoulder extension
6. Shoulder flexion
7. Shoulder horizontal extension
8. Shoulder horizontal flexion
Fig 3. The averaged surface
electromyographic amplitude
(EMG) of the left and right rectus abdominis muscles during
maximal isometric efforts of
the different study exercises.

9. Bilateral shoulder extension

150

100

50

50

100

150

EMG Rectus abdominis (V)

muscle group in at least 1 maximally performed upper-limb

exercise.
In many earlier studies, researchers normalized results by
comparing the surface electromyographic amplitude elicited
during the exercises with that produced during the assumed
maximal voluntary contraction exercises. Direct conclusions
about the suitability of certain exercises for the development of
the performance capacity of muscles have been made on the
basis of normalized values.29,33,36 However, this may be misleading in relation to the clinical interpretation of the results.

to produce sufficient torque to load the trunk muscles to a

greater degree compared with the trunk flexion exercise.
Shoulder horizontal extension (exercise 7) activated the longissimus and multifidus muscles on contralateral side to the
greatest degree. The surface electromyographic amplitude levels of the back and abdominal muscles were greater in those
exercises using longer lever arms. Assuming that the trunk
muscles attained their maximal levels of activity during the
reference exercises, then, a sufficient intensity for the development of muscular strength (60%) was attained for each

Right

Left
1. Trunk flexion
2. Trunk lateral flexion (right)
3. Trunk lateral flexion (left)
4.Trunk extension
5. Shoulder extension
6. Shoulder flexion
7. Shoulder horizontal extension
8. Shoulder horizontal flexion
9. Bilateral shoulder extension
150

100

50

50

EMG Obliquus externus (V)

100

150

Fig 4. The averaged surface electromyographic amplitude of the

left and right obliquus externus
abdominis muscles during maximal isometric efforts of the different study exercises.

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UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

Right

Left
1. Trunk flexion
2. Trunk lateral flexion (right)
3. Trunk lateral flexion (left)
4.Trunk extension
5. Shoulder extension
6. Shoulder flexion
7. Shoulder horizontal extension
8. Shoulder horizontal flexion
9. Bilateral shoulder extension
150

100

50

50

100

150

EMG Longissimus (V)

First, the interpretations are affected by the fact that maximal

surface electromyographic amplitude levels may not have been
attained during the selected exercises or positions. Maximal
trunk strength and muscle activity is not produced in the neutral
position.42-44 Second, large individual variations in the values
need to be considered when using averages, even with normalized values. Exercises do not activate the muscles at the same
relative level for all subjects. In the interpretation of activity

Fig 5. The averaged surface

electromyographic amplitude of the left and right
longissimus muscles during
maximal isometric efforts of
the different study exercises.

levels, it is also important to remember that the force- electromyographic activity ratio is not linear.45 Thus, the relative
activity levels reported for the exercise efforts only act as a
guide in the planning of exercise programs.
The comparability of the surface electromyographic values
obtained from the reference and upper-limb exercises was
improved by the performance of all the exercises isometrically
in a standing position. In this way, problems with the interpre-

Right

Left
1. Trunk flexion
2. Trunk lateral flexion (right)
3. Trunk lateral flexion (left)
4.Trunk extension
5. Shoulder extension
6. Shoulder flexion
7. Shoulder horizontal extension
8. Shoulder horizontal flexion
Fig 6. The averaged surface
electromyographic amplitude
of the left and right multifidus
muscles during maximal isometric efforts of the different
study exercises.

9. Bilateral shoulder extension

Arch Phys Med Rehabil Vol 89, March 2008

150

100

50

50

EMG Multifidus (V)

100

150

UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

tation of surface electromyographic amplitude associated with

the different types of muscle contractions, as well as those due
to the effect of different measurement positions on the surface
electromyographic signals, could be avoided, and we also ruled
out problems with the standardization of the velocity. The
variation in the actual performance of the exercises was minimized by strict standardization of the positions of the subjects
during the exercises and by providing instructions in the correct
performance of the exercises, as well as by practicing the
movements before the actual measurement events. Also, performing the measurements with maximal effort was central to
the comparability of the results between the test exercises. In
earlier studies that have evaluated surface electromyography of
trunk muscles, and in which external loads were used, a standard load has been used as the resistance.29,31,37 Using a
standard load can lead to problems because the load may be too
light for the stronger subjects and too heavy for weaker subjects. Further, according to surface electromyography results,
the loading in general in the previous studies has been too low.
With surface electromyography, it has been shown that it is
possible to study the activity of the superficial muscles. However, possible cross-talk from other muscles that are not being
studied needs to be taken into account in the interpretation of
data. The obliquus internus and, possibly, the transversus abdominis to some degree, may probably have an effect on the
level of activity of the flat obliquus externus muscles because
they are located underneath it.46 It has been observed that both
the obliquus and transversus abdominis muscles are active
during rotational exercises of the trunk.47 This has significance
in the interpretation of the results, especially in relation to the
unilaterally performed exercises, which result in loads being
directed at the trunk in a rotational direction. The obliquus
externus and internus muscles on the same side produce force
in different directions during rotational exercises, and this may
reduce the observed activity difference between the left and
right sides. The difference between sides could be greater only
if the activity of the obliquus externus is examined. There is
conflicting information on the possibilities of using surface
electromyography to study the activity of the multifidus. In the
study by Arokoski et al,29 the results achieved with wire and
surface electromyography were compared with each other.
According to the study, surface electromyography is a valid
method to study the activity of the multifidus. Stokes et al48
stated that measurement of the multifidus with surface electromyography provides a better representation of the activity of
the longissimus muscle. However, the research methods used
in these studies differed from each other and so additional
research is required in order to form a definitive conclusion
about the use of surface electromyography in the measurement
of the activity of the multifidus. The depth to which a wire
electrode is positioned in a muscle can also have an effect on
the different interpretations, because the multifidus possesses
differing functions with the superficial part producing movement while the deeper part controls intersegmental movement.49
In the present study the subjects had an opportunity to
practice each exercise only in 1 testing session. Several sessions would have probably improved the ability to produce
maximal efforts, but the same can also be said of the reference
exercises. The positioning of the lower limbs also probably
affected the results. The striding position of the lower limbs
used during the upper-limb exercises provided additional support and allowed greater force producing capacity of the trunk

519

musculature, which was observed during the guidance of the

exercises by the researchers. In addition, it must be remembered that the activity levels achieved during the studied exercises are the maximal levels achieved during these exercises.
When several repetitions are performed, it is not possible to
maintain the same level of activity. Thus, the average level of
muscle activity achieved during exercise sessions will be lower
than the achieved maximal results. This margin needs to be
considered when evaluating exercise intensity.
In earlier surface electromyographyrelated research studies, only one of the upper-limb exercises was the same as in the
current study; Arokoski et al31 found that the average surface
electromyographic activity of the rectus abdominis was at the
same level that we found in bilateral shoulder extension (exercise 9), but the activity of the obliquus externus abdominis
was clearly lower. The difference in the results can be explained by the fact that the subjects in the study by Arokoski31
stood with their feet side by side and their upper arms held in
90 of flexion during the performance of the movements. Thus,
the prerequisites for force production were probably less favorable.
It is important to consider the safety of the exercises included in the rehabilitation programs of LBP patients, as well
as any background functional and structural changes on which
the exercise program is aiming to have a positive effect.50 It is
possible to increase exercise safety by the performance of the
exercises with the lumbar spine in a neutral position. In this
position, the structures of the spine are better able to withstand
the loads directed at it, because they are more optimally distributed between the vertebral disks and the facet joints.51
The exercises should be directed at the muscles that improve
stability of the lumbar spine. No single group of muscles has
yet been shown to be more important in regards to the stability
of the lumbar spine than other muscles.52,53 Efforts should be
made to include, in exercise programs, the types of exercises
where the load can be directed as effectively as possible to all
the muscles of the trunk.
Study Limitations
When applying the results in practice, 2 things need to be
taken into account. First, the upper-limb exercises resulted in
higher levels of activity than the reference exercises did in
several subjects. Thus, the assumption that maximal muscular
activation was produced during the reference exercises was not
correct. Second, we used pelvic support during the measurement. If the exercises are performed without support, the activity levels of the muscles are likely to be noticeably lower.
Pelvic support makes exercise more nonfunctional, but at the
same time it makes exercise easier to perform. With pelvic
support, it is possible to perform exercise effectively and
safely, even if the patient has impaired postural control.
CONCLUSIONS
Of all the exercises included in this study, the activity level
of the abdominal muscles during the performance of the bilateral shoulder extension exercise was close to that elicited
during trunk flexion. In turn, the activity level of the back
muscles, especially on the left side of the trunk during the
performance of horizontal shoulder extension, was close to that
produced during trunk extension. It can be assumed that the
loads required for the development of the strength and endurance characteristics of the back and abdominal musculature can
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UPPER-EXTREMITY EXERCISES FOR TRUNK MUSCLES, Tarnanen

be achieved during the performance of these upper-extremity

exercises when the pelvis has been supported.
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1. Abenhaim L, Rossignol M, Valat JP, et al. The role of activity in
the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine 2000;25(4 Suppl):
1S-33.
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