Journal of Electromyography and Kinesiology 25 (2015) 310–315

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Journal of Electromyography and Kinesiology

journal homepage: www.elsevier.com/locate/jelekin

Isometric hip abduction using a Thera-Band alters gluteus maximus

muscle activity and the anterior pelvic tilt angle during bridging exercise
Sil-Ah Choi, Heon-Seock Cynn ⇑, Chung-Hwi Yi, Oh-Yun Kwon, Tae-Lim Yoon, Woo-Jeong Choi,
Ji-Hyun Lee
Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, 1 Yonseidae-gil, Wonju-si, Gangwon-do
220-710, South Korea

a r t i c l e i n f o a b s t r a c t

Article history: The purpose of this study was to investigate the effects of bridging with isometric hip abduction (IHA)
Received 7 February 2014 using the Thera-Band on gluteus maximus (GM), hamstring (HAM), and erector spinae (ES) muscle activ-
Received in revised form 3 June 2014 ity; GM/HAM and GM/ES ratios; and the anterior pelvic tilt angle in healthy subjects. Twenty-one sub-
Accepted 1 September 2014
jects participated in this study. Surface EMG was used to collect EMG data of GM, HAM, and ES muscle
activities, and Image J software was used to measure anterior pelvic tilt angle. A paired t-test was used
to compare GM, HAM, and ES muscle activity; the GM/HAM and GM/ES ratios; and the anterior pelvic tilt
Keywords:
Bridging
angle with and without IHA during the bridging exercise. GM muscle activity increased significantly and
Gluteus maximus the anterior pelvic tilt angle decreased significantly during bridging with IHA using the Thera-Band
Preactivation (p < 0.05). However, there were no significant differences in the activity of the HAM and ES and the
Thera-Band GM/HAM and GM/ES ratios between bridging with and without IHA (p > 0.05). The results of this study
suggest that bridging with IHA using the Thera-Band can be implemented as an effective method to facil-
itate GM muscle activity and reduce the anterior pelvic tilt angle.
Ó 2014 Elsevier Ltd. All rights reserved.

1. Introduction to the pelvis during ambulation (Hossain and Nokes, 2005;

The gluteus maximus (GM) is one of the largest and strongest
muscles in the body. The GM originates from the posterior sacrum
and coccyx as well as the posterior gluteal line of the ilium and
inserts on the iliotibial tract and gluteal tuberosity of the femur
(Frank and Netter, 1987). The GM is a powerful extensor and exter-
nal rotator of the hip, and the superior part of the GM acts as a hip
abductor because muscle fibers in the GM are directed downward
and outward (Frank and Netter, 1987; Long et al., 1993). Hip exten-
sors, especially the GM, are important for many functional activi-
ties of daily living such as moving from sitting to standing,
climbing stairs, and maintaining an upright posture during walking
(Winter, 1991). Because the direction of the GM muscle fibers,
especially deep sacral fibers of the GM, are perpendicular to the
sacroiliac (SI) joint, GM contraction improves SI joint stability
and plays a part in force transmission from the lower extremity
⇑ Corresponding author. Tel.: +82 33 760 2427; fax: +82 33 760 2496.
E-mail addresses: silah88@naver.com (S.-A. Choi), cynn@yonsei.ac.kr (H.-S.
Cynn), pteagle@yonsei.ac.kr (C.-H. Yi), kwonoy@yonsei.ac.kr (O.-Y. Kwon),
free0829@gmail.com (T.-L. Yoon), cwj7354@gmail.com (W.-J. Choi), rapa60@
naver.com (J.-H. Lee).
Leinonen et al., 2000; Mooney et al., 2001).
However, the GM is frequently weak and lengthened because
many people spend a great amount of time remaining seated
(Sahrmann, 2002). Decreased activity of the GM is one cause of
low back pain (LBP) and results in SI joint instability and dysfunc-
tion (van Wingerden et al., 2004). In addition, hamstring (HAM)
tightness can be observed as a compensatory mechanism for a
weak GM (Massoud Arab et al., 2011; van Wingerden et al.,
2004). Also, excessive anterior pelvic tilt, lumbar lordosis with
dominant erector spinae (ES), and lumbar rotation occur in place
of a weak GM or delayed GM activation during hip extension
(Chaitow, 1996; Sahrmann, 2002).
Bridging exercises are the most commonly used by people with
weak hip extensors and trunk muscles in physical therapy pro-
grams. However, bridging exercises are associated with a risk of
dominant HAM and ES activity and excessive anterior pelvic tilt
as a compensation for GM weakness regardless of the type of
bridging exercise performed. Therefore, bridging exercise with iso-
metric hip abduction (IHA) using a Thera-Band (Hygenic Corp.,
Akron, OH, USA) was devised in this study. No previous studies
have compared GM with HAM and ES muscle activity and pelvic
kinematics during bridging with IHA using the Thera-Band. Thus,
the purpose of this study was to investigate the effects of bridging

http://dx.doi.org/10.1016/j.jelekin.2014.09.005
1050-6411/Ó 2014 Elsevier Ltd. All rights reserved.
 S.-A. Choi et al. / Journal of Electromyography and Kinesiology 25 (2015) 310–315
with IHA using the Thera-Band on GM, HAM, and ES muscle activ-
ity; GM/HAM and GM/ES ratios; and the anterior pelvic tilt angle in
healthy subjects. It was hypothesized that bridging with IHA using
the Thera-Band would result in increased GM muscle activity,
increased GM/HAM and GM/ES ratios, and a decreased anterior
pelvic tilt angle.
2. Methods
2.1. Subjects
A power analysis was performed with G*power software ver.
3.1.2 (Franz Faul, University of Kiel, Kiel, Germany) using the
results of a pilot study involving five subjects. The calculation of
sample size was carried out with a power of 0.80, alpha level of
0.05, and effect size of 0.89. This provided a necessary sample size
of ten subjects for this study. Twenty-one healthy subjects (6
males, 15 females) were recruited from a university population
(age = 22.5 ± 1.0 years, height = 165.3 ± 7.1 cm, weight = 57.5 ±
8.7 kg, and body mass index = 20.9 ± 1.8 kg/m2).
The exclusion criteria were: (1) limitations in range of motion of
the bilateral hip, knee, and ankle joints; (2) a history of LBP or
lower extremity dysfunctions such as iliotibial band friction syn-
drome, patellofemoral pain syndrome, anterior cruciate ligament
sprains, or chronic ankle instability (Cichanowski et al., 2007;
Fredericson et al., 2000; Friel et al., 2006; Hewett et al., 2006;
Ireland et al., 2003) in the past 12 months; (3) iliopsoas, rectus
femoris, or tensor fasciae latae tightness as evidenced by the
Thomas test, Ely’s test, or modified Ober’s test, respectively
(Kendall et al., 2005; Magee, 2007); and (4) lumbopelvic instability
demonstrated by performing the active straight leg raising test with
a pressure biofeedback unit (Liebenson, 2004; Mens et al., 1999).
Prior to collecting data, the examiner informed the subjects of
the study procedures and each subject completed an informed
consent form. The study protocol was approved by the Yonsei
University Wonju Institutional Review Board.
2.2. Exercise procedures
Subjects underwent a familiarization period of approximately
20 min to achieve a proper exercise performance capability. When
Fig. 1. Starting position of bridging exercise.
Fig. 2. Bridging without isometric hip abduction.
311
subjects failed to perform the standardized position and maintain
the position during the exercise period, data collection was imme-
diately stopped. Subjects performed two conditions (with IHA and
without IHA) of the same bridging exercise twice and maintained
each position for 5-s. Bridging without IHA was followed by bridg-
ing with IHA to minimize the carry over or learning effect (Park
et al., 2013). A 5-min rest between the two conditions and a
1-min rest between every two trials was given to avoid muscle
fatigue.
2.2.1. Bridging without isometric hip abduction
The subjects were placed in a supine position. Both knees were
flexed at 90°, the feet were hip-width apart while resting on the
floor, and the toes were facing forward. The arms were crossed
over the chest to minimize arm support (Fig. 1). Two plastic poles
were placed vertically along the lateral aspect of the bilateral knee
joint to maintain hip abduction of 30°. A wooden target bar was
placed at the height of the middle point of the thigh between the
greater trochanter and femoral condyle when the trunk, pelvis,
and thigh were aligned in a straight line (hip extension of 0°). A
universal goniometer was used for knee and hip angle measure-
ments. The subject was instructed to lift his pelvis comfortably at
a self-selected speed while maintaining contact between the lat-
eral aspects of the bilateral knee joint and vertically placed plastic
poles. When both thighs touched the wooden target bar during
bridging, the subject was asked not to lift his pelvis further and
to hold the bridging position for 5-s without pelvic or thigh move-
ment (Fig. 2).
2.2.2. Bridging with isometric hip abduction
Bridging with IHA followed the same procedure as bridging
without IHA, with the exception of the application of a blue-col-
ored Thera-Band, which is recommended by the manufacturer
for an intermediate or advanced workout level. The Thera-Band
was wrapped around both thighs just proximal to the knees, pro-
viding consistent resistance to IHA. Tension was controlled by
lengthening or shortening the Thera-Band. The tension in the
Thera-Band was determined when the subject was able to perform
more than ten repetitions of hip abduction of 30° in hook-lying
position using the Thera-Band (Decker et al., 1999; Park et al.,
2013) (Fig. 3).
312 S.-A. Choi et al. / Journal of Electromyography and Kinesiology 25 (2015) 310–315
Fig. 3. Bridging with isometric hip abduction using the Thera-Band.
2.3. Surface electromyography and data processing
Electromyographic (EMG) data were collected using a wireless
TeleMyo DTS (Noraxon Inc., Scottsdale, AZ, USA) and Myo-Research
Master Edition 1.06 XP software was used for analyzing EMG data.
The EMG signals were sampled at 1000 Hz. A band pass filter was
used between 20 and 450 Hz and notch filter was preset to reject
60 Hz. The raw data were processed into the root mean square
(RMS) with a window of 50 ms. The electrode sites were shaved
and then rubbing alcohol was used to reduce skin impedance.
Two surface electrodes with an interelectrode distance of 2 cm
were positioned on the upper fibers of GM, the general part of
HAM, and ES muscle bilaterally. Electrodes were placed in the mid-
dle of each muscle belly and parallel to the direction of each mus-
cle fiber.
In this study, all subjects should maintain the standardized
position of bridging with hip abduction of 30° for comparing bridg-
ing with IHA and without IHA. In this reason, we chose the upper
fibers of the as representative of the GM because they anatomically
act as hip abductor more than lower fiber (Criswell, 2011; Frank
and Netter, 1987; Kang et al., 2013). The electrode for the upper
GM was placed half the distance between the trochanter and sacral
vertebrae in the middle of the muscle at an oblique angle at the
level of the trochanter. For recordings of the general part of
HAM, the electrode was placed parallel to the muscle in the center
of the back of the thigh, approximately half the distance from the
gluteal fold to the back of the knee. The electrode for the ES was
placed parallel to the spine at the level of the iliac crest, approxi-
mately 2 cm apart from the spine over the muscle mass
(Criswell, 2011). EMG data were collected for the mean value of
bilateral GM, HAM, and ES because there was no significant differ-
ence between right and left of GM, HAM, and ES muscle activity
when we conducted an independent t-test (p > 0.05).
Normalization was needed to minimize variables or differences
between different recoding sites and individuals. The maximal vol-
untary isometric contraction (MVIC) normalization method was
applied to each tested muscle and MVIC was recorded during a
manual muscle test (MMT) in the positions described by Kendall
et al. (2005). To collect MVIC data, subjects maintained the MMT
position of each tested muscle against manual resistance for 5-s
twice. The middle 3-s contraction, excluding each 1-s at the
Fig. 4. Measurement of anterior pelvic tilt angle.
beginning and end, was used for data analysis, and a 30-s rest
was given between the two trials (Bolgla and Uhl, 2007; Bolgla
et al., 2010). The mean value of middle 3-s contraction of the
two trials for the maximal contraction in each muscle was taken
as the MVIC.
All EMG data during two conditions of bridging exercise were
recorded for 5-s twice and calculated from the middle 3-s isomet-
ric phase except for each 1-s at the beginning and end. The mean
value of the middle 3-s contraction of the two trials for each con-
dition was used for data analysis. To calculate the GM/HAM and
GM/ES ratios, the normalized GM amplitude was divided by the
normalized HAM and the normalized GM was divided by the nor-
malized ES amplitude, respectively.
2.4. Measurement of anterior pelvic tilt angle
To obtain pelvic kinematic data, two reflective markers were
placed on specific anatomical landmarks; namely, the anterior
superior iliac spine (ASIS) and posterior superior iliac spine (PSIS).
In this study, the anterior pelvic tilt was defined as an angle
between a line joining the ASIS, PSIS, and the vertical line from
the ASIS (Fig. 4). The examiner took a picture of the subject’s pelvis
with a digital camera when the subject maintained the position
under two conditions of bridging exercises. The location of the dig-
ital camera and distance from the digital camera to the subject
were consistent. These pictures were then transferred to Image J
software (National Institutes of Health, Bethesda, MD, USA) and
used to measure the anterior pelvic tilt angle.
2.5. Statistical analysis
A Kolmogorov–Smirnov Z-test was performed to confirm a nor-
mal distribution. Test–retest reliability of EMG and pelvic tilt mea-
surements in two conditions (with IHA and without IHA) of
bridging exercises was assessed by intra-class correlation (ICC),
95% confidence interval (CI), the standard error of measurement
(SEM), and minimal detectable difference (MDC). SEM was calcu-
lated for each measurement to assess absolute consistency
pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
[SEM = SD 1  ICC. MDC (95% confidence interval) [MDC95 =
p
SEM ⁄ 1.96 2] was calculated (Ries et al., 2009). Effect size index
(ESI) is calculated to determine meaningful changes between the
 S.-A. Choi et al. / Journal of Electromyography and Kinesiology 25 (2015) 310–315
bridging exercise with and without IHA [Mean of the bridging
exercise with IHA – Mean of the bridging exercise without IHA/
standard deviation of the bridging exercise without IHA]. A one-
way, repeated-measures analysis of variance (ANOVA) was used
to access the statistical significance of the GM, HAM, and ES muscle
activity; the GM/HAM and GM/ES ratios; and the anterior pelvic tilt
angle during the bridging exercise with and without IHA. Statistical
significance was set at 0.05. If a significant difference was found, a
Bonferroni correction was performed (a = 0.025). All statistical
analyses were performed using PASW Statistics ver. 18.0 (SPSS,
Inc., Chicago, IL, USA).
3. Results
The test–retest reliabilities for EMG measurement of GM, HAM,
and ES muscle were substantial in both bridging with and without
IHA. (Bridging with IHA: ICC = 0.98, 95% CI = 0.97–0.99, SEM = 1.72,
and MDC = 4.77 for GM, and ICC = 0.96, 95% CI = 0.93–0.99,
SEM = 3.38, and MDC = 9.37 for HAM, and ICC = 0.96, 95%
CI = 0.93–0.99, SEM = 3.88, and MDC = 10.76 for ES; Bridging with-
out IHA: ICC = 0.93, 95% CI = 0.85–0.99, SEM = 3.44, and
MDC = 9.54 for GM, ICC = 0.95, 95% CI = 0.89–0.99, SEM = 4.52,
and MDC = 12.53 for HAM, and ICC = 0.98, 95% CI = 0.97–0.99,
SEM = 2.60, and MDC = 7.21 for ES).
3.1. Gluteus maximus, hamstrings, and erector spinae muscle activity
In terms of muscle activity, there was a significant difference in
GM muscle activity between bridging with IHA using the Thera-
Band and without IHA (F1,20 = 9.098, P = .007, ESI = .365). Bridging
with IHA using the Thera-Band resulted in significantly greater
GM muscle activity than bridging without IHA (P = .007) (Fig. 5).
However, there were no significant differences in the activity of
the HAM (F1,20 = 4.163, P = .055, ESI = .247) and ES (F1,20 = 0.319,
P = .578, ESI = .064) between bridging with and without IHA.
3.2. Gluteus maximus/hamstrings and gluteus maximus/erector spinae
muscle activity ratios
In terms of muscle ratios, there were no significant differences
in the GM/HAM (F1,20 = .014, P = .906) and GM/ES (F1,20 =
.559.163, P = .463) ratios between bridging with and without IHA.
3.3. Anterior pelvic tilt angle
With regard to pelvic kinematics, there was a significant differ-
ence in the anterior pelvic tilt angle between with IHA using the
Thera-Band and without IHA (F1,20 = 15. 624, P = .001). Bridging
Fig. 5. Comparison of gluteus maximus muscle activity between bridging exercise
with and without isometric hip abduction (GM: Gluteus maximus, IHA: Isometric
hip abduction). ⁄p < 0.05.
313
Fig. 6. Comparison of anterior pelvic tilt angle between bridging exercise with and
without isometric hip abduction (IHA: Isometric hip abduction). ⁄p < 0.05.
with IHA using the Thera-Band showed significantly lesser anterior
pelvic tilt angle than bridging without IHA (P = .001) (Fig. 6).
4. Discussion
To our knowledge, this study is the first to evaluate the effect of
IHA with the Thera-Band on GM muscle activity and pelvic kine-
matics during a bridging exercise. The results partially supported
the research hypothesis.
GM activity increased significantly by 21.1% during bridging
with IHA using the Thera-Band, supporting the research hypothe-
sis. A possible explanation is that applying IHA with the Thera-
Band during bridging and maintaining hip abduction of 30°
induced facilitation of the GM in advance before initiation of the
bridging movement, consequently increasing GM muscle activity.
Our present finding is in agreement with those of previous studies
demonstrating the effect of muscle preactivation on muscle firing
or force. Kyrolaïnen et al. (1999) emphasized the importance of
the preactivation of leg extensor for increasing running speed. Spe-
cifically, preactivity of the gastrocnemius muscle functioned as a
preparatory requirement to enhance muscle activity and the tim-
ing of muscular action with respect to ground contact during the
running cycle. Mrdakovic et al. (2008) confirmed that when a knee
extensor bench exercise was performed before a leg press exercise
by means of muscle preactivation, an increased EMG signal was
recorded from the vastus lateralis muscle. This result indicates that
preactivation performance by a single-joint exercise increases the
number of motor units recruited during a multi-joint exercise.
The GM is quadrilateral in shape, and its fibers are obliquely
directed inferiorly and laterally. It functions not only as a hip
extensor, but also as a hip abductor and external rotator (Frank
and Netter, 1987; McAndrew et al., 2006). In this study, hip abduc-
tion of 30° was sustained by two plastic poles placed vertically
along the lateral aspect of the bilateral knee joints. Such hip abduc-
tion during bridging might facilitate GM activity in terms of the
action of the GM as a hip abductor and external rotator. In a previ-
ous study, Kang et al. (2013) reported that the GM EMG amplitude
was greatest at 30° of hip abduction during prone hip extension
with knee flexion. Because the GM is a fusiform muscle that is opti-
mized when the direction of muscle pull is parallel to the muscle
fiber, hip abduction during prone hip extension with knee flexion
leads to an increased EMG amplitude of the GM.
It was expected that HAM and ES activity would be reduced
when GM activity was increased by applying IHA with the Thera-
Band during bridging exercise. This hypothesis was based on the
findings of previous studies demonstrating that synergistic mus-
cles work together to perform the same range of motion (Jonkers
et al., 2003; Kang et al., 2013; Park et al., 2013). Based on these
findings, synergistic muscles during bridging (i.e., trunk extensors
314 S.-A. Choi et al. / Journal of Electromyography and Kinesiology 25 (2015) 310–315
such as the GM, HAM, and ES) can affect one another during bridg-
ing: increased GM activity could reduce HAM and ES activity.
Although GM activity was significantly increased in this study, it
failed to elicit significant changes in the GM/HAM and GM/ES
ratios between bridging with and without IHA. The unexpected
findings in this study may be the result of several differences from
previous studies. First, healthy subjects participated in the present
study and exhibited HAM or ES activity that was dominant to (or
greater than) the GM activity at the beginning of the study. In
many previous studies that investigated GM activity during vari-
ous bridging or prone hip extension exercises in healthy subjects,
the mean activity levels of the ES and HAM at baseline (i.e., before
the intervention) were less than or similar to the mean value for
the GM (Ekstrom et al., 2007, 2008; Kang et al., 2013; Sakamoto
et al., 2009). However, because the mean value of HAM and ES
muscle activity was about 1.8 and 2.5 times that of the GM, respec-
tively, during bridging without IHA in this study (without interven-
tion or at entry), bridging with IHA would not likely lead to
significant decreases in the dominant HAM and ES in a cross-
sectional study.
Second, because a wooden target bar was used to control pelvic
lift during bridging, increased activation of the HAM and ES was
not likely to occur in the present study. No previous studies have
recommended the most appropriate level of pelvic lifting during
bridging during bridging can be disadvantageous due to potential
overactivation of the already-dominant HAM and ES; thus, a woo-
den target bar was placed to provide contact, cueing the subjects
not to over-lift the pelvis while performing the two types of bridg-
ing. However, this valid use of a wooden target bar could have lim-
ited the level of the lumbopelvis and consequently might have
prevented overactivation of the HAM and ES during bridging. Thus,
HAM and ES activity may have differed if the subjects had
performed bridging without a wooden target bar.
The anterior pelvic tilt angle decreased significantly by 20.5%
during bridging with IHA using the Thera-Band, supporting the
research hypothesis. Although the change of anterior pelvic tilt
angle was small, it could be a meaningful result in consideration
of measurement position because anterior pelvic tilt was measured
in bridging position in this study. Lembeck et al. (2005) reported
that average pelvic tilt angle in the lying position was lower than
standing position. Thus, bridging with IHA using a Thera-Band
resulted in facilitation of the GM in advance, and the increased
GM activity could have contributed to reduce anterior pelvic tilt.
In other words, when the femur was fixed, such as bridging posi-
tion, contraction of the GM induced the pelvis to move posteriorly
and decrease anterior pelvic tilt and lumbar lordosis. Many previ-
ous studies have emphasized that an important function of the GM
is to maintain pelvic stability. Oh et al. (2007) suggested that per-
formance of the abdominal drawing-in maneuver during prone hip
extension encouraged activation of the hip extensors while
decreasing activation of the ES and reducing the anterior pelvic tilt.
They explained that increased GM muscle activity could be
affected by biomechanical alterations such as a reduced anterior
pelvic tilt. Tateuchi et al. (2012) focused on improvements in hip
muscle balance between agonists and antagonists, which could
reduce the anterior pelvic tilt. An altered balance in muscle activa-
tion, especially a hip flexor (tensor fasciae latae) dominant to the
hip extensors (GM and semitendinosus), during prone hip exten-
sion resulted in abnormal movement patterns, such as anterior
pelvic tilt and excessive lumbar extension.
Our study has several limitations. First, measurement errors
were likely to have occurred when measuring the pelvic kinemat-
ics because this study used only two-dimensional image process-
ing software. A three-dimensional or real-time measuring system
will be needed to improve the precision of measurement in future
studies. Second, the findings of this study are difficult to generalize
to the entire patient population because only healthy and young
subjects participated. Subjects with a broad age range and clinical
symptoms such as GM weakness should be investigated in future
to strengthen the clinical implications of this study. Third, this
study did not perform force measurement. It could help to further
differentiate between the two exercise protocols and EMG/force
data would be interesting indications for future studies in this
filed. Finally, this study used a cross-sectional design. Future longi-
tudinal studies are necessary to identify distinct differences and
the long-term effects of facilitation of the GM on HAM and ES
activity.
5. Conclusion
This study investigated the effects of bridging with IHA using a
Thera-Band on GM, HAM, and ES activity; the GM/HAM and ES
ratios; and the anterior pelvic tilt angle. GM muscle activity
increased significantly and the anterior pelvic tilt angle decreased
significantly during bridging with IHA using a Thera-Band. These
findings indicate that the application of a Thera-Band facilitates
the GM in advance before the initiation of bridging, consequently
enhances GM activity, and prevents excessive anterior pelvic tilt
during bridging. Therefore, bridging with IHA using the Thera-Band
can be implemented as an effective method to facilitate GM muscle
activity and reduce the anterior pelvic tilt angle.
Conflict of interest
The authors declare that they have no conflict of interest.
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Liebenson C. The relationship of the sacroiliac joint, stabilization musculature, and From 1993 onwards he has been employed as a
lumbo-pelvic instability. J Bodyw Mov Ther 2004;8(1):43–5. professor in the Department of Physical Therapy at
Long WT, Dorr LD, Healy B, Perry J. Functional recovery of noncemented total hip the College of Health Science of Yonsei University.
arthroplasty. Clin Orthop Relat Res 1993;288:73–7. His research interests include motion, posture anal-
Magee DJ. Orthopedic physical assessment. 5th ed. St. Louis, MO: Saunders; 2007.
ysis, and the development of outcome measures for
Massoud Arab A, Reza Nourbakhsh M, Mohammadifar A. The relationship between
evaluating disability.
hamstring length and gluteal muscle strength in individuals with sacroiliac
joint dysfunction. J Man Manip Ther 2011;19(1):5–10.
McAndrew D, Gorelick M, Brown JMM. Muscles within muscles: a
mechanomyographic analysis of muscle segment contractile properties within
human gluteus maximus. J Musculoskelet Res 2006;10:23–35.
Mens JM, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ. The active straight leg raising
test and mobility of the pelvic joints. Eur Spine J 1999;8(6):468–73. Oh-Yun Kwon is a professor in the Department of
Mooney V, Pozos R, Vleeming A, Gulick J, Swenski D. Exercise treatment for Physical Therapy at the College of Health Science of
sacroiliac pain. Orthopedics 2001;24(1):29–32. Yonsei University. He received his B.S. degree in
Mrdakovic V, Ilic DB, Jankovic N, Rajkovic Z, Stefanovic D. Pre-activity modulation of Physical therapy and M.P.H. degree from Yonsei
lower extremity muscles within different types and heights of deep jump. J University in 1986 and 1992 respectively, and Ph.D.
Sports Sci Med 2008;7(2):269–78.
degree from Keimyung University in 1998. He had
Oh JS, Cynn HS, Won JH, Kwon OY, Yi CH. Effects of performing an abdominal
research experience in Program in Physical Therapy
drawing-in maneuver during prone hip extension exercises on hip and back
at Washington University in St Louis as a Post Doc-
extensor muscle activity and amount of anterior pelvic tilt. J Orthop Sports Phys
Ther 2007;37(6):320–4. toral Fellow. He is a director in Lab of Kinetic Ergocise
Park KM, Cynn HS, Yi CH, Kwon OY. Effect of isometric horizontal abduction on based on Movement Analysis (KEMA). He is inter-
pectoralis major and serratus anterior EMG activity during three exercises in ested in the mechanisms of movement impairment,
subjects with scapular winging. J Electromyogr Kinesiol 2013;23(2):462–8. movement analysis, and prevention and manage-
Ries JD, Echternach JL, Nof L, Gagnon Blodgett M. Test–retest reliability and minimal ment of the work related musculoskeletal pain syn-
detectable change scores for the timed ‘‘up & go’’ test, the six-minute walk test, drome.
and gait speed in people with Alzheimer disease. Phys Ther 2009;89(6):569–79.
Sahrmann SA. Diagnosis and treatment of movement impairment syndromes. 1st
ed. St. Louis, MO: Mosby; 2002. Tae-Lim Yoon is a professor in the Department of
Sakamoto ACL, Teixeira-Salmela LF, Rodrigues De Paula F, Guimarães CQ, Faria
Physical Therapy at the College of Health and Wall-
CDCM. Gluteus maximus and semitendinosus activation during active prone
fare of Woosong University and Ph.D. Candidate in
hip extension exercises. Braz J Phys Ther 2009;13(4):335–42.
the Department of Physical Therapy at the Graduate
Tateuchi H, Taniguchi M, Mori N, Ichihashi N. Balance of hip and trunk muscle
activity is associated with increased anterior pelvic tilt during prone hip School of Yonsei University. He received B.S. degree
extension. J Electromyogr Kinesiol 2012;22(3):391–7. in Physical Therapy from Yonsei University, M.A.
van Wingerden JP, Vleeming A, Buyruk HM, Raissadat K. Stabilization of the degree in Physical Therapy from New York Univer-
sacroiliac joint in vivo: verification of muscular contribution to force closure of sity. He is a member of applied kinesiology and
the pelvis. Eur Spine J 2004;13(3):199–205. ergonomic technology laboratory, and his research
Winter DA. The biomechanics and motor control of human gait: normal, elderly and interests are movement analysis, human factors and
pathological. 2nd ed. Kitchener, ON: Waterloo Biomechanics; 1991. ergonomics, and prevention and management of
musculoskeletal problems.

Sil-Ah Choi received her B.S. degree in Physical

Therapy from Yonsei University, and M.S. degree in
Physical Therapy from Yonsei University. She is a
member of applied kinesiology and ergonomic tech-
nology laboratory. Her research focuses on the
musculoskeletal problems and movement disorders,
especially in muscle imbalance and dysfunction of
hip, knee, and shoulder joint, using the electromy-
ograpic system.
Woo-Jeong Choi is a M.S. Student in the Department
of Physical Therapy at the Graduate School of Yonsei
University. She received B.S. degree in Physical
Therapy from Yonsei University in 2013. She is a
member of applied kinesiology and ergonomic tech-
nology laboratory. Her research interests include
electromyographic and kinematic analysis of thera-
peutic exercise for musculoskeletal syndromes,
including scapular dyskinesis.

Heon-Seock Cynn is a professor in the Department

of Physical Therapy at the College of Health Science
of Yonsei University. He received B.S. degree in
Physical Therapy from Yonsei University, M.A. degree
in Physical Therapy from New York University, and
Ph.D. degree in Physical Therapy from Yonsei Uni-
versity. He was a full time lecturer of Seoul Health
College and an associate professor of Hanseo Uni-
versity. He is a director of applied kinesiology and
ergonomic technology laboratory, and his research
interests are identification of etiologic factors, clas-
sification, and intervention approaches for move-
ment disorders and musculoskeletal diseases.
Ji-Hyun Lee is a Ph.D. Student in the Department of
Physical Therapy at the Graduate School of Yonsei
University. She received B.S. degree in Physical
Therapy from Hanseo University, M.S. degree in
Physical Therapy from Yonsei University. She is a
member of applied kinesiology and ergonomic tech-
nology laboratory, and she is a part time lecturer of
Yonsei University. Her main research interests are
shoulder and hip assessment and treatment strategy.
Her papers have been published in several interna-
tional journals in these fields.