Strengthening Exercises of the Thigh Muscles- A Review
Nor Azizah Hussin1, Naresh Bhaskar Raj1*, Nordin Bin Simbak2,
Mohd Khairuddin Mohd Safee1, Mahadeva Rao US2
1Faculty of Health Sciences, Universiti Sultan Zainal Abidin (UniSZA), 20400 Kuala Terengganu,
Terengganu Darul Iman, Malaysia
2Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), 21300 Kuala Terengganu,
Terengganu Darul Iman, Malaysia
*Corresponding Author E-mail: bnaresh@unisza.edu.my
ABSTRACT:
The muscles of the thigh are important in the functioning of the lower extremity. The main muscles of the lower limb that is effectively involved in the biomechanics of the lower limb are the quadriceps femoris and hamstring. Many researchers have investigated the activity of these muscles during various daily activities and exercises. The main focus of this review is to highlight the anatomy of these muscles, the methodology of measuring the activity of these muscles and researches that have measured the activity of these muscles in different strengthening exercises that were commonly used in rehabilitation of people with orthopedic crises. The main articles that were included in the review were those in which the exercises such as static quadriceps, inner range quadriceps, straight leg raise, active knee extension and semi squat were performed and the activity of quadriceps femoris and hamstrings were measured. Electromyography (EMG) analysis provides information on the relative amount of muscular activity during the exercise. The main muscles that were reviewed were those of the vastus medialis oblique, vastus lateralis, rectus femoris and biceps femoris. This review has highlighted the importance of the exercises that were frequently advised for patients with orthopedic problems and the activity of the muscles during the exercises. There are evidences that the strength of the thigh muscles influence the quality of life an individual. The level of activity of the muscles is evident from this review and it could give a clear idea on the exercises that could be performed in order to strengthen an individual muscle.
KEYWORDS: Quadriceps femoris, Hamstrings, Strengthening Exercise, Electromyography.
INTRODUCTION:
Thigh muscles involve quadriceps femoris and hamstring. The function of the quadriceps is to act as a decelerator when it is necessary to decrease speed for changing direction or to prevent falling when landing. Quadriceps muscles consist of rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. These muscles are superficial and palpable, except the vastus intermedius, which is under the rectus femoris.[1]
The rectus femoris is a long, fusiform muscle forming the anterior superficial portion of the quadriceps muscle group[2] and functions as a hip flexor and knee extensor. The rectus femoris is originating from anterior inferior iliac spine of the ilium and superior margin of the acetabulum, and inserting at superior aspect of the patella and patellar tendon to the tibial tuberosity.[1]It is at high risk of getting injured when dealing with the eccentrically contracting activity mainly during an increase in running pace.[3]
Vastus lateralis muscle originates from intertrochanteric line, anterior and inferior borders of the greater trochanter, gluteal tuberosity, upper half of the linea aspera and entire lateral intermuscular septum, and inserting on lateral border of patella and patellar tendon to the tibial tuberosity. Vastus medialis muscle originates from whole length of the linea aspera and the medial condyle ridge and it is inserting on the medial half of the upper border of the patella and patellar tendon to the tibial tuberosity. Vastus intermedius originates from the upper two-thirds of the anterior surface of the femur and inserting on the upper border of the patella and patellar tendon to the tibial tuberosity.[1]
The quadriceps muscles are innervated by femoral nerve (L2-L4). The vastus lateralis, vastus medialis and vastus intermedius extends the knee.[1] The vastus lateralis (VL) and vastus medialis oblique (VMO) muscles acts synchronously in late swing for knee extension and in stance phase for patellar and knee stabilization.[3]
Hamstring muscles consists of biceps femoris (BF), semimembranosus and semitendinosus. Their function includes flexion of the knee and extension of the hip. BF has its origin from ischial tuberosity (long head) and lower half of the linea aspera, and lateral condyloid ridge (short head). It is inserting at the lateral condyle of the tibia and head of the fibula while innervated by sciatic nerve-tibial division (S1-S3) (long head) and sciatic nerve-peroneal division (L5, S1-S2) (short head). Semitendinosus and semimembranosus originate from ischial tuberosity. The insertion for semimembranosus is on postermedial surface of the medial tibial condyle while semitendinosus is on the upper anterior medial surface of the tibia just below the condyle. Semimembranosus and semitendinosus are innervated by sciatic nerve-tibial division (L5, S1, S2).[1] The muscle-tendon junction of the long head of BF muscle is often injured than the muscles of semimembranosus and semitendinosus.[4-5] The BF is at the highest levels of muscle-tendon unit stretch throughout the crucial terminal swing phase in high speed running.[6] Besides that it is a functional muscle that features as biarticular hamstring bellies.[7]
Muscle strength is defined as the force generation capacity of an individual which is generated during or while attempting a given movement.[8] The strength of the muscle peaks in the second and third decades of life and shows an imperceptible progressive decrease until the age of approximately 50 years. Then, it begins to decrease thereafter at a rate between 1.4% and 2.5% per year, with more rapid losses after 65 years of age.[8-9] Lower-limb muscles have a greater propensity to lose mass and functional capability. [10]
Reduction in the strength of the lower limb muscles may conduce functional limitations in daily living[11], increase the risk of falls[12-13], hip fractures[14] and adverse physiological changes such as osteoporosis.[15] Restoring a normal strength of hamstring decreases the incidence of hamstring injury and also the recurrent injury. [16]
The strength of the quadriceps musculature is one of the intrinsic factors that have been shown to affect the knee joint functions. It is evident that lower limb strength has a major role in knee joint shock attenuation during weight bearing activities[17] (Minor, 1999). A reduced quadriceps strength has been shown to be associated with the presence of disorders such as osteoarthritis in the knee [18]and patellofemoral pain syndrome (PFPS).[19]Inadequate quadriceps muscle strength after the anterior cruciate ligament (ACL) injury or reconstruction may result in functional instability of the knee joint. [20]
Strength training is now widely recommended for older adults to increase muscle mass, strength, and ultimately, independence in activities of daily living.[21] Strength training can be accomplished in a number of different ways, depending on the physiological, functional or performance goals. Static quadriceps exercise (SQE), inner range quadriceps (IRQ), straight leg raise[22-23] (SLR), active knee extension and half squat[23] are the examples of strengthening exercises that are often used in lower limb rehabilitation including rehabilitation of post anterior cruciate ligament (ACL) reconstruction.[24] The isometric exercises are the most appropriate and easy to understand by the patients besides that, it can be easily and safely performed at the home because they require no or minimal apparatus.[22] The isometric exercises cause the least intraarticular inflammation, pressure, and bone destruction[25]. These exercises are simple and inexpensive to perform and that they rapidly improve the strength[26].
Among the athletes, studies have shown the importance of thigh muscle strengthening training in the prevention of injuries[27]. Isometric quadriceps exercise program have shown the beneficial effects on quadriceps muscle strength, pain, and functional disability among patients with knee osteoarthritis[22]. Restoring the strength of the vastus medialis muscle among patients with patelofemoral pain syndrome in preventing the lateral tracking of the patella has been the focus of the clinicians as a treatment[28].
Lee and Park(2013)[29] revealed that lower limb strengthening exercises may lead to improvement in the balance and lower limb strength. The study involves 74 elderly with normal cognition. The intensity of exercise for the first week was 45–55% of 1RM, and it was progressively increased up to 65–75% by the 11–12 week. The frequency of exercise performed was 10–12 repetitions for three sets with 60 seconds rest between sets. Leg extension and curl exercises were performed using Milon exercise equipment (Milon, Emersacker, Germany), because the resistance of the equipment could be set digitally. To find out lower limb strength, the participants stood in front of an armless chair and was asked to take a seated position followed by a standing position as many times as possible within 30 seconds. During a 2-minute step in-place exercise, the examiner counted the elevation of only the right lower limb and informed the participant of the time at the end of the first minute and 30 seconds before the time was up. For balance, the limit of stability was measured using a BioRescue (RM Ingénierie, Rodez, France) with a safety bar. At the end of the study it was observed that the participants had improved strength and balance.
The research by Tagesson, Oberg, Good, and Kvist (2008)[30] on patients with anterior cruciate ligament (ACL) injury shows that the isometric contraction exercises for the knee flexors and extensors increase strength of the quadriceps muscle while do not have the effect on the hamstrings. Witvrouw, Lysens, Bellemans, Peers, and Vanderstraeten (2000)[31] evaluated the efficacy of open versus closed kinetic chain exercises in the nonoperative management of patellofemoral pain. The exercises used in the study were maximum static quadriceps muscle contraction with knee in full extension, straight leg raise and short arc movement from 10 degree knee flexion to terminal extension. The result showed that there was a decrease in pain and an increase in functional performance of the subjects. Inner range quadriceps exercise can improve muscle strength of vastusmedialis and vastuslateralis[28, 32- 33] Straight leg raise exercise is able to improve the strength of rectus femoris[34] (Soderberg and Cook, 1983). Squat is a closed kinetic exercise and frequently used in rehabilitation programs of patellofemoral dysfunctions and total joint replacement[31]. It is giving beneficial strength effect to the quadriceps and hamstring muscles [35, 36].
Electromyography (EMG) is a method that can record more information on the activities occurring inside the muscle during an activity. EMG is an experimental technique concerned with the development, recording and analysis of myoelectric signals. Myoelectric signals are formed by physiological variations in the state of muscle fiber membranes[37]. There are two types of EMG viz; invasive and non-invasive. In most cases, skin surface electrodes (non-invasive) are used in kinesiological studies. Besides the benefit of easy handling, their main limitation is that only surface muscles can be detected. For deeper muscles, due to muscle movements during kinesiological studies, thin and flexible fine-wire or needle electrodes (invasive) are inevitable[38]. There are general guidelines to be followed for electrode application such as the inter-electrode distance of 2 cm (center point to center point), application of electrodes parallel to the muscle fiber direction and its placement on the dominant middle portion of the muscle belly. The placements of electrodes are done usually according to the SENIAM guidelines, which is the mostly commonly used method for electrode application[39].Maximum voluntary contraction (MVC) normalized data provides an understanding at what capacity the muscles worked[38].The placement of electrodes for the rectus femoris is at 50% of the distance from the anterior superior iliac spine (ASIS) to the superior pole of the patella, for vastus medialis muscle is about 80% of the distance from ASIS to the medial joint line of the knee, for vastus lateralis muscle it is about 2/3rddistance from ASIS to the lateral joint line of the knee and for biceps femoris it is 50% of the distance from the ASIS to lateral epicondyle of the tibia.
CONCLUSION:
The strength of the quadriceps and hamstring muscles are essential in the prevention of the musculoskeletal disorder such as osteoarthritis, patellofemoral pain syndrome and prevention of the sport injuries such as hamstring strain and recurrent injury in sport. The strengthening exercises are used in treatment, rehabilitation regimes and training to improve or/and maintain the muscles strength. The selection of the exercises will influence the degree of muscular activity which is required for the specified therapeutic purpose. This review has provided an insight into the common exercises used and also the muscles that are active during these exercises thereby helping the rehabilitation specialist in deciding the appropriate exercise for strengthening the appropriate muscle.
The study is supported by grant of University Research Fund (UNISZA/2015/DPU/48).
CONFLICT OF INTEREST:
Declared None.
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Received on 24.07.2017 Modified on 19.09.2017
Accepted on 13.10.2017 © RJPT All right reserved
Research J. Pharm. and Tech 2017; 10(10):3601-3604.
DOI: 10.5958/0974-360X.2017.00653.9