Anda di halaman 1dari 6

ML Roberts Prize Winner

This literature review won the ML Roberts prize in 2004. The ML Roberts prize is awarded annually for the best
4th year undergraduate study research project. NZJP publishes the resulting paper without peer review.

A structured review of the role of gluteus maximus in rehabilitation


Judy Wilson, MEd, Dip PhysEd, Dip Physio
School of Physiotherapy, University of Otago
Emma Ferris BPhty*
Anna Heckler BPhty*
Lisa Maitland, BPhty*
Carol Taylor BPhty*

*These authors were, at the time this study was undertaken, 4th year Physiotherapy Students at the University of Otago.

Abstract
Gluteus maximus is the largest muscle in the body and is important in many functional
activities such as walking, running and lifting. The aim of this structured review was to
investigate the role of gluteus maximus in functional rehabilitation. A computerised
literature search of five electronic databases was conducted to seek papers which
reported investigations of function, altered function and rehabilitation of gluteus
maximus. A total of 34 articles were identified for inclusion in the present structured
review. Gluteus maximus has a role in walking and lifting activities as well as providing
stability to the sacroiliac joint. The function and properties of gluteus maximus may be
altered when changes to the kinetic chain of the lower limb occur as a result of injury
or altered biomechanics. The activation level of gluteus maximus was found to be
highest when a full squat exercise was performed. Incline running, the use of balance
shoes and, to a lesser extent, level running are also effective methods of increasing
the activity of gluteus maximus. While research has identified which exercises most
effectively activate gluteus maximus, it is still unknown whether the neuro-muscular
activation during these particular exercises is high enough to bring about a training
effect within the normal population. Wilson J, Ferris E, Heckler A, Maitland L, Taylor C
(2005). A structured review of the role of gluteus maximus in rehabilitation. New Zealand
Journal of Physiotherapy 33(3) 95-100.
Key words: Gluteus maximus, function, rehabilitation

Introduction to its attachment into the iliotibial tract, gluteus


Gluteus maximus is superficially the largest maximus may play a role in stabilising the knee
muscle of the body. This important muscle is in extension. Fischer & Houtz (1968) found in an
distinctive in comparison with other primates due electromyographic (EMG) study that the strongest
to evolutionary postural changes from quadrupeds contractions of gluteus maximus occurred with
to bipeds. In the human, gluteus maximus has muscle setting by isometric contraction, external
increased leverage due to its superior attachment rotation, abduction with resistance and vigorous
on to the dorsal ilium (Marzke et al., 1988) and hyperextension exercises of the thigh and trunk in an
in a morphological study comparing baboon hind erect posture. To obtain a significant strengthening
legs with human legs, it was found that gluteus effect, it was suggested by Atha (1981), that the level
maximus has a larger relative weight in humans of activity required must exceed 66% of maximum
(Ito et al., 2000). This single joint muscle allows voluntary isometric contraction (MVIC).
for increased force production to maintain an Gluteus maximus is important in many daily
upright position needed for bipedalism. Jenkins activities such as lifting, walking and running, and
(1998) describes the insertion of gluteus maximus plays a role in pelvis stability. It is appropriate to
proximally into the sacrum, the dorsal sacral investigate, therefore, not only the manner in which
ligaments, the posterior portion of the crest of the gluteus maximus functions during these daily
ilium and the sacrotuberous ligament. The muscle activities, but also how its function is altered due
fibres run inferiorly and laterally to the distal to pathology or altered biomechanics. Treatment of
insertion, where it splits in two components. The impairment needs to be incorporated into activities
upper half of the muscle inserts into the iliotibial that can be repeated on a daily basis in order to
tract of the fascia lata and the lower half into the have a carry over effect from physiotherapy to
gluteal tuberosity of the femur. function. The purpose of this structured review was
Due to its attachments, gluteus maximus is to synthesize the information on the role of gluteus
primarily involved in hip extension and lateral maximus in functional rehabilitation and to identify
rotation (Kendall et al., 1993). In addition to these areas of further research. At the time of undertaking
latter actions, the upper fibres abduct and the lower this work no other structured review addressing the
fibres adduct the thigh. It is also thought that, due role of gluteus maximus in functional rehabilitation

NZ Journal of Physiotherapy – November 2005. Vol. 33, 3  95


was able to be identified. Although a wide variety strength for lifting and control of gait. Stability to
of different exercises are advocated to train and the SIJ is provided by compression thus creating
condition gluteus maximus and surrounding a self-bracing mechanism. There is very little
musculature, there are no specific guidelines for movement at the SIJ which is important for the
rehabilitation using best evidence based practice. primary function of load transfer from the trunk
A critical review of the literature, therefore, with to legs. If excess movement occurs at the joint, a
an emphasis on functional rehabilitation would positional change may occur between the ilia and
seem timely and appropriate. sacrum thus compromising the L5-S1 intervertebral
joints and disc, SIJ and pubic symphysis and could
Search Strategy lead to SIJ dysfunction and low back pain. Due to
A computerized literature search of five electronic its proximal attachment on to the sacrotuberous
databases was conducted: Medline (Index Medicus), ligament, gluteus maximus is thought to cause
CINAHL (Cumulative Index to Nursing and Allied tightening of the ligament, giving dynamic joint
Health Literature), EMBASE (Excerpta Medica), stability and thereby reducing mobility (Vleeming
AMED (Allied and Complementary Medicine) et al., 1989). Snijders et al (1993) also examined
and PubMed (National Center for Biotechnology SIJ stability using a biomedical model and
Information). Using these databases the search hypothesized that the large shear forces caused
strategy was based on the key words: gluteus by the body weight above the sacrum would be
maximus, function and rehabilitation. The counteracted by the self-bracing and compressive
search was expanded by using the related terms: mechanism of a gluteus maximus contraction. In
gluteal muscles, anatomy, structure, treatment, a study on male weight lifters, Lafond et al (1998)
strengthening, impairment, exercise, training found that hip extensor contraction reduced sacral
protocol and hip extension. mobility significantly. This appreciation of the role
Articles were retrieved from the University of gluteus maximus in the control of the SIJ may
of Otago Dunedin Medical Library, Electronic have a practical application in the treatment of SIJ
Journals, Document Delivery and Remote Services dysfunction.
both within New Zealand and overseas. On During the task of lifting gluteus gluteus
obtaining the articles their reference lists were maximus has also been shown to have an important
searched for further articles to be included in our role in extending the hips and stabilising the pelvis.
research. Only articles written in the English Research has shown that emphasis should be
language were included in any of the searches. placed on contraction during the early phase of
The selected articles examined a broad range of the lift to provide pelvic stability, enabling a safe
functions associated with gluteus maximus. There and effective movement to occur (Noe et al., 1992;
were limited studies on the gluteus maximus Vakos et al., 1994).
muscle specific to the topic of rehabilitation and Gluteus maximus also makes a large contribution
no randomized controlled trials were reported. to gait, and ineffective functioning can compromise
Therefore the scope was widened to include a many aspects of the gait cycle. The muscle
range of papers that addressed the function of contributes most significantly to support the lower
gluteus maximus in healthy subjects. Articles limb via the vertical ground reaction force during
were excluded if mention was only made to gluteus the early stance phase from foot flat to just after
maximus in the abstract or the introduction but contralateral toe off (Anderson & Pandy, 2003).
without further reference to the muscle. Gluteus maximus initiates foot rotation in the
Thirty four articles were included in this study rocker action, and also has a role in the amplitude
and were allocated into three categories; function, of the second rocker (Jonkers et al, 2003a). In
altered function and rehabilitation. Of the studies addition, knee extension during stance is partially
reporting clinical trials the following outcome controlled by gluteus maximus working as an
measures had been used: EMG, MVIC. speed of lift, antagonist. During the stance and swing phases,
biomedical models, video analysis, sacroiliac joint gluteus maximus contributes to hip extension
(SIJ) stiffness, force displacement, electromagnetic and controls the rate of hip flexion. Jonkers et al
sensor, ground reaction force, electro-goniometer (2003a) also found that when gluteus maximus
and isokinetic dynamometer measures. As only was excluded from the stance limb, hip flexion was
six papers specifically addressed the role of gluteus prolonged. This was found to prevent initiation of
maximus in functional rehabilitation, papers hip extension and of the 3rd rocker stage thereby
discussing function in both normal and altered inducing prolonged stance-phase knee flexion. The
biomechanics were included. These two aspects were action of the gluteus maximus, therefore, is not
considered to be fundamental to understanding the confined to the proximal hip joint which it directly
functional role of gluteus maximus and therefore spans, but also to the control of the more distal
its importance in rehabilitation. joints.

The Role of Gluteus Maximus in Normal Role of Gluteus Maximus in Abnormal


Function Function
Gluteus maximus has many different functions Alterations in function and properties of gluteus
such as providing sacroiliac joint (SIJ) stability, maximus have been found in association with

 96 NZ Journal of Physiotherapy – November 2005. Vol. 33, 3


kinetic chain changes of the lower limb due to pain found to fatigue faster in subjects with low back
or injury. For example, patients (n=20) suffering pain (Kankaanpää et al., 1998) with avoidance
from ankle sprain injuries have been shown to of aggravating movements of the lumbar spine
have reduced activation levels of gluteus maximus leading to subsequent deconditioning of the back
(Bullock-Saxton et al., 1994). Freeman et al and hip extensor muscles. The finding of increased
(1965) proposed that damage to the proprioceptive fatigue levels in gluteus maximus highlights the
feedback loop via a lateral ankle sprain may alter need to incorporate this muscle in low back pain
postural control by changing muscle firing patterns rehabilitation as a strategy to minimize the potential
in lower limb muscles. Bullock-Saxton et al (1994) cycle of pain avoidance behaviour.
investigated altered hip muscle function in patients
with a Grade II or III ankle sprain and found that Analysis of Gluteus Maximus in Task Specific
in the injured subjects, the activation patterns Exercise
of gluteus maximus during hip extension were The literature suggests rehabilitation of
significantly delayed (p<0.01) compared with the gluteus maximus is an important strategy in the
controls. Notably, this delay was not only isolated correction of lower limb biomechanics following
to the injured limb but affected hip extension injury or dysfunction. While a wide variety of
bilaterally. These findings suggest there is a need different exercises are used clinically to strengthen
to focus on muscle activation and co-ordination of gluteus maximus, however, little is known about
more proximal muscles during the rehabilitation their effectiveness in specifically targeting this
process even with injuries in the distal part of the muscle.
limb. Konrad et al (2001) investigated the activation
The changes in muscle firing patterns and co-activation patterns of the main trunk
identified in gluteus maximus have implications and hip muscles, including that of gluteus
for rehabilitation of lower limb dysfunction. For maximus, in various positions of hip flexion and
example, an antalgic gait at the time of injury extension, trunk flexion, extension and lateral
may lead to muscle inhibition or atrophy and if the flexion. These investigators found that in a
activation of gluteus maximus is delayed, pelvic diagonal hip and shoulder extension exercise
stability may become compromised. Potentially, this gluteus maximus showed a low mean activation
could result in compensation by the lower back and in comparison with the other exercises. Further,
other structures round the SIJ leading to further in the bridging exercise, which is commonly used
altered firing patterns and function. The finding in the rehabilitation setting, the activation level
of altered firing patterns in gluteus maximus in was found to be less than 14%. of MVIC thus
more distal lower limb problems also demonstrates demonstrating that gluteus maximus was not the
the clinical significance of examining beyond the primary force generating muscle in this particular
immediate site of injury. In the case of ankle set of exercise (Konrad et al., 2001).
injuries, rehabilitation may need to focus more on In yet another exercise Worrell et al (1998)
muscle activation and co-ordination of proximal found that gluteus maximus displayed relatively
muscles such as gluteus maximus. consistent levels of activation during the lateral
Altered activation patterns in gluteus maximus step-up without resistance with small increases in
are not limited to acute trauma. It has been found activation when holding weights. Both exercises,
that in patients with single above-knee amputations, however, showed low levels of EMG activation with
gluteus maximus has slower activation patterns less than 25% of MVIC. On the basis of these latter
along with increased atrophy on the amputated findings the lateral step-up exercise, therefore,
side in comparison with the other side (Burger cannot be recommended as a specfic exercise to
et al., 1996). These authors also found that gait strengthen gluteus maximus.
dysfunction when walking with a prosthesis was due Clark et al (2002) evaluated the effect of increased
to imbalance of the muscles around the hip following resistance and repetitions on EMG activity of the
the removal of major muscles such as hamstrings, gluteus maximus, biceps femoris and lumbar
adductors and quadriceps. The associated change extensor muscles during dynamic trunk extension.
in muscle activation patterns in gluteus maximus Their results showed that EMG activity of gluteus
emphasizes the need for above-knee amputees to maximus increased significantly in comparison
undertake strengthening exercises for this muscle to that of the lumbar extensor muscles. With an
to help control the prosthesis during gait. increase in resistance there was a corresponding
Patients who suffer from low back pain often significant increase in EMG activity of gluteus
avoid painful movements and subsequently have maximus Clark et al (2002). Hypothetically, this
reduced activity of gluteus maximus and decreased would suggest gluteus maximus is responsible for
muscle endurance through disuse. Low back accommodating the increased resistance.
pain has been associated with changes in the Souza et al (2001) compared the EMG activity
hip extensor recruitment pattern and disturbed of the trunk flexors and extensors during two
lumbo-pelvic rhythm, both to which the gluteus different spine stabilisation exercises, dying bug
maximus muscle contributes (Leinonen et al., 2000; and quadruped exercises (the dying bug exercise
Vogt et al., 2003). Gluteus maximus has also been performed in supine and that of the quadruped

NZ Journal of Physiotherapy – November 2005. Vol. 33, 3  97


exercise in the four point kneeling, both with shoulder width) and wide stance (140 % of shoulder
reciprocal arm and leg movements). The quadruped width), with low resistance (60 % of 1 Repetition
exercise, in the four point kneeling position, Maximum) and high resistance (75 % of 1 Repetition
showed gluteus maximus was the most active Maximum). The EMG values showed a significant
muscle during leg raise on the ipsilateral side. load by stance relationship with greater values in
During the leg lowering phase of this exercise the wide stance compared with a narrow stance, but
the ipsilateral gluteus maximus activity dropped only with high loads. On average the EMG values
to less than 6% MVIC. During contralateral leg for the ascent phase of the squat were 2.25 times
raising and lowering, gluteus maximus activity was higher than those for the descent phase.
greatly reduced implying that this muscle does not Blanpied (1999) compared gluteal EMG activity
contribute to stability of the pelvis during these during a wall slide squat and a squat machine
phases. As exercise instensity increased there exercise. The exercises were varied in two ways;
was also an increase in EMG activity of the gluteus firstly having the foot in line with the hip compared
maximus muscle. In the dying bug exercise, with the foot forward, and secondly with the support
gluteus maximus showed no functionally significant located at the hip compared with the scapula level.
activity during any phase and did not vary with They found the gluteal muscle activation was
exercise intensity. The results showed that even maximal with the foot placed forward with scapular
though gluteus maximus muscle was active in the support for both the wall slide and squat machine
quadruped exercise, it did not give a strengthening exercises. Activation of the gluteal muscles was
effect in the healthy subjects as the EMG activity greater for the squat machine in comparison with
was less than 32% (Souza et al., 2001). the wall slide (Blanpied, 1999).
The influence of unilateral hip extension Collectively, the above results show that, in
exercise in prone with flexed knees on the gluteus order to target and activate gluteus maximus, a
maximus activation pattern has also been examined full squat should be performed with a wider stance
(Arokoski et al (1999). Again it was found, however, and with higher loads (McCaw and Melrose, 1999).
that with this task EMG activity was less than Also a squat machine with scapular support
30% MVIC indicating that in a normal population, and feet placed forward is the preferred protocol
these exercises performed in this way would compared with a wall squat protocol for maximal
not give a strengthening effect. When knee and gluteus maximus activation during squat exercises
hip extension were combined, gluteus maximus (Blanpied, 1999).
force production was reduced (Yamashita 1988),
indicating that combined hip and knee extension Analysis of Gluteus Maximus During Running
is another unsuitable exercise for strengthening To improve sprint performance, training
gluteus maximus. programmes have been designed to enhance muscle
loading at the hip, knee and ankle by including
Analysis of Glueus Maximus in Closed Kinetic incline treadmill running. Swanson & Caudwell
Chain Exercise (2000) compared incline treadmill running with
Closed kinetic chain exercises allow functional that of level running with two different conditions
muscle recruitment patterns to occur throughout using EMG. Gluteus maximus was significantly
multiple joints and are frequently used in more active during the incline running at 4.5ms-1 at
strengthening and functional rehabilitation of the 30% incline in comparison with level running. The
lower limb. The squat is a closed kinetic chain activity of gluteus maximus during the swing phase
exercise and is a complex movement involving also increased in response to the level running with
the ankle, knee and hip joints. Analysis of EMG the same higher stride frequency as the incline
activity in the unloaded squat, has demonstrated condition. Therefore this finding suggests that
that, while gluteus maximus is active throughout incline running and, to a lesser extent, level running
the entire squat, it is most active from 90-60º of with a high stride frequency, are effective methods
hip flexion during the ascent phase. Furthermore of increasing the activity of gluteus maximus.
it was estimated that during the ascent phase An unstable base of support creates the need
gluteus maximus worked at an average of 16.9 % for increased postural activity inducing heightened
of the MVIC. (Isear et al., 1997). Schwab & Worrell proprioceptive flow via the cerebellovestibular
(1995) have also measured the EMG activity of regulatory circuits of motor control. Bullock-Saxton
gluteus maximus during an isometric squat and et al (1993) found a significant increase in the EMG
found that the isometric squat EMG values for activity of gluteus maximus in subjects wearing
gluteus maximus were equal to or less than 40 % balance shoes during gait compared with barefoot
of the MVIC. on the first day. There was also a significant
Altering positions of body segments and support decrease in the time taken for gluteus maximus to
during a squat may change the way in which reach 50%, 75% and 90% of maximum activation
these exercises are performed and the muscles during a gait cycle following one week of training
which are targeted (Blanpied, 1999). McCaw & with balance shoes. These results demonstrate the
Melrose (1999) analyzed the EMG activity of gluteus immediate response of the body to sensorimotor
maximus during a squat of narrow stance (75 % of stimulation and the need for an establishment of

 98 NZ Journal of Physiotherapy – November 2005. Vol. 33, 3


a motor programme for gait that incorporates a gluteus maximus. A reservation regarding these
more effective activation of the gluteus maximus recommended exercises is made if effectiveness
muscle (Bullock-Saxton et al 1993). Sensorimotor is defined in terms of strength improvement, as
stimulation in the form of balance shoes offers a the neuromuscular activation of these exercises is
form of rehabilitation that automatically facilitates probably not high enough to bring about a training
gluteus maximus, which may otherwise be difficult effect in the normal population. Further research is
to activate effectively with conscious control during needed to investigate a training programme which
complex activities such as gait. incorporates exercises such as the full squat in
order to identify the relevant parameters required to
The Response of Gluteus Maximus to Strength bring about a training effect in gluteus maximus.
Training
Mooney et al (2001) carried out a study using a Acknowledgement
The authors wish to thank Dr Gillian Johnson, Senior Lecturer,
rotary strengthening exercise program for training
School of Physiotherapy, University of Otago, for assistance in the
gluteus maximus on patients with sacroiliac preparation of this paper for publication.
dysfunction (N=5) and found all patients returned
to normal function with no need for further pain References
medication. It needs to be noted, however, that Anderson FC and Pandy MG (2003): Individual muscle
the MedX torso machine which has been used in contributions to support in normal walking. Gait & Posture
this research project is not widely used in New 17: 159-169.
Arokoski JPA., Kankaanpää M., Valta T, Juvonen I, Partanen J,
Zealand. Taimela S, Lindgren K and Airaksinen O (1999): Back and
hip extensor muscle function during therapeutic exercises.
Conclusions and Implications Archives of Physical Medical Rehabilitation 80(7): 842-850.
Atha J (1981): Strengthening muscle. Exercise and Sports
for Clinical Practice Science Reviews 9: 1-73.
Gluteus maximus has many different functions Blanpied PR (1999): Changes in muscle activation during
such as providing SIJ stability, strength for lifting wall slides and squat-machine exercise. Journal of Sport
and control of gait and it is hypothesised that it Rehabilitation Medicine 8, 123-124.
Bullock-Saxton JE, Janda V and Bullock MI (1993): Reflex
provides stability to the SIJ by creating a self- activation of gluteal muscles in walking. Spine 17(2): 225-
bracing mechanism. Gluteus maximus has also 229. 18(6): 704-708.
been shown to be an important muscle during Bullock-Saxton JE, Janda V and Bullock MI (1994): The
influence of ankle sprain injury on muscle activation during
lifting activities. Research has shown that emphasis
hip extension. International Journal of Sports Medicine 15:
should be placed on contraction during the early 130-134.
phase of the lift to provide pelvic stability thus Burger H, Valencic V, Marincek C and Kogovsek N (1996):
enabling a safe and effective movement to occur. Properties of musculus gluteus maximus in above-knee
amputees. Clinical Biomechanics 11(1): 35-38.
Gluteus maximus also makes a large contribution Clark BC, Manini TM, Mayer JM, Ploutz-Snyder LL and Graves
to gait and ineffective functioning can compromise JE (2002): Electromyographic activity of the lumbar and hip
many aspects of the gait cycle. Weakness of this extensors during dynamic trunk extension exercise. Archives
muscle may affect not only movement at the hip of Physical Medical Rehabilitation 83: 1547-1552.
Fischer FJ and Houtz SJ (1968): Evaluation of the function of
joint during gait, but also the distal joints. the gluteus maximus muscle. American Journal of Physical
Changes to the kinetic chain of the lower limb Medicine 47(4): 182-191.
via pain or injury has shown to cause alterations Freeman MAR, Dean MRE and Hanham IWF (1965): The
to the function and properties of gluteus maximus aetiology and prevention of functional instability of the foot.
Journal of Bone Joint Surgery 47: 578-685.
in conditions such as ankle sprains, above knee Indahl A., Kaigle A, Reikeras, O and Holm, S (1999): Sacroiliac
amputations and low back pain. The findings would joint involvement in activation of the porcine spinal and
suggest that re-education and/or strengthening gluteal musculature. Journal of Spinal Disorders 12(4):
of gluteus maximus should be considered in 325-330.
Isear JA, Erickson JC and Worrell TW (1997): EMG analysis
many conditions involving lower limb dysfunction of lower extremity muscle recruitment patterns during an
including that of the lumbar spine. unloaded squat. Medicine & Science in Sports & Exercise
In comparison with other exercises both the 29(4): 532-539.
Ito J, Shiraishi N, Umino M, Kimura T and Akita, H (2000):
quadruped exercise and full squat exercise achieve
Morphological evaluation of the baboon hind limb muscles
high levels of activation specific to gluteus maximus. based on relative weight Okajimas Folia Anatomy Japan
It is recommended, however, that the full squat 77(5): 161-166.
exercise should be performed with a wide stance Jenkins D (1998): Hollinshead’s functional anatomy of the
limbs and back. (7th ed) Philadelphia; London; Boston: WB
and high loads to target gluteus maximus optimally. Saunders .
In addition a squat machine with scapular support Jonkers I, Stewart C and Spaepen A (2003a): The study of
and with feet placed forward is the preferred protocol muscle action during single support and swing phase of gait:
compared with a wall squat. Incline running and clinical relevance of forward simulation techniques. Gait &
Posture 17(2): 97-105.
to a lesser extent, level running with a high stride Jonkers I, Stewart C and Spaepen A (2003b): The
frequency, are also effective methods of increasing complementary role of the plantarflexors, hamstrings and
the activity of gluteus maximus. Rehabilitation gluteus maximus in the control of stance limb stability
of gluteus maximus may also be performed using during gait. Gait & Posture, 17(2): 264-272.
Kankaanpää M, Taimela S, Laaksonen D, Hanninen O and
sensorimotor stimulation in the form of balance Airaksinen O (1998): Back and hip extensor fatigability in
shoes designed to reflexly recruit contraction of chronic low back pain patients and controls. Archives of

NZ Journal of Physiotherapy – November 2005. Vol. 33, 3  99


Physical Medical Rehabilitation 79, 412-417. Snijders CJ, Vleeming A and Stoeckart R (1993): Transfer
Kawamura H, Fuchioka S, Inoue S, Kuratsu S, Yoshikawa H, of lumbosacral load to iliac bones and legs. Clinical
Katou K and Uchida A (1999): Restoring normal gait after Biomechanics 8, 285-294.
limb salvage procedures in malignant bone tumours of the Souza GM, Baker LL and Power CM (2001): Electromyographic
knee. Scandinavian Journal of Rehabilitation Medicine 31, activity of selected trunk muscles during dynamic spine
77-81. stabilization exercises. Archives of Physical Medical
Kendall F, McCreary E and Provance P (1993): Muscles testing Rehabilitation 82, 1551-1557.
and function. (4th ed). Baltimore: Williams & Wilkin. Swanson SC and Caldwell G (2000): An integrated biomechanical
Konrad P, Schmitz K and Denner A (2001): Neuromuscular analysis of high speed incline and level treadmill running.
evaluation of trunk-training exercises. Journal of Athletic Medicine and Science in Sports and Exercise 32(6), 1146-
Training 36(2), 109-118. 1155.
Lafond D, Normand MC and Gosselin G (1998) Rapport force. Vakos JP, Nitz AJ, Threlkeld AJ, Shapiro R and Horn T (1994):
Journal of Canadian Chiropractor Association 42(2), 90-100. Electromyographic activity of selected trunk and hip muscles
Leinonen V, Kankaapää M, Airaksinen O and Hanninen O during a squat lift. Spine 19(6), 687-695.
(2000): Back and hip extensor activities during trunk Vleeming A, Van Wingerden JP, Snijders CJ, Stoeckart R and
flexion/extension: effects of low back pain and rehabilitation. Stijnen T (1989): Load application to the sacrotuberous
Archives of Physical Medical Rehabilitation 81, 32-37. ligament; influences on sacroiliac joint mechanics. Clinical
Marzke MW, Longhill JM and Rasmussen SA (1988): Gluteus Biomechanics, 4(4), 204-209.
maximus muscle function and the origin of hominid Vogt L, Pfeifer K and Banzer W (2003): Neuromuscular control
bipedality. American Journal of Physical Anthropology 77, of walking with chronic low-back pain. Manual Therapy
519-528. 8(1), 21-28.
McCaw ST, Melrose DR (1999): Stance width and bar load effects Worrell TW, Crisp E and LaRosa C (1998): Electromyographic
on leg muscle activity during the parallel squat. Medicine & reliability and analysis of selected lower extremity muscles
Science in Sports & Exercise 31(3), 428-436. during lateral step-up conditions. Journal of Athletic Training
Mooney V, Pozos R, Vleeming A. Gulick J and Swenski D (2001): 33(2), 156-163.
Exercise treatment for sacroiliac pain. Orthopedics 24(1), Yamashita N (1988): EMG activities in mono- and bi-articular
29-32. thigh muscles in combined hip and knee extension.
Noe DA, Mostardi RA, Jackson, ME, Porterfield JA and Askew MJ European Journal of Applied Physiology 58, 274-277.
(1992): Myoelectric activity and sequencing of selected trunk
muscles during isokinetic lifting. Spine 17(2), 225-229.
Schaub PA and Worrell TW (1995): EMG activity of six muscles Address for correspondence
and VMO:VL ratio determination during a maximal squat Mrs J.G.Wilson, School of Physiotherapy, University of Otago,
exercise. Journal of Sport Rehabilitation 4, 195-202. PO Box 56, Dunedin, New Zealand.

PHYSIOTHERAPISTS - Work in the UK


Quality Locums, part of the MATCH GROUP - one of the UK’s
largest healthcare staffing companies, helps internationally
trained Physio’s and other allied-health professionals find work
across the UK.

We offer:
x Assistance with UK registration (HPC)
x Great pay and benefits (inc. holiday pay)
x Choice of city and rural areas
x Flexible locum and contract positions
x Support from consultants with first-hand UK experience
x Wide variety of positions and specialties to choose from
x Work Permits organised if required (i.e. over 31)
x Help with banking, tax, accommodation & more!

To find out more or to request one of our


free UK information packs, please contact
our New Zealand office.

Freecall: 0800 10 75 73
E: enquiries@matchgroup.co.nz

 100 NZ Journal of Physiotherapy – November 2005. Vol. 33, 3