Journal of Electromyography and Kinesiology 17 (2007) 102–111

www.elsevier.com/locate/jelekin

Reliability of electromyographic normalization methods

for evaluating the hip musculature
a,* b
Lori A. Bolgla , Timothy L. Uhl
a
Department of Physical Therapy, Medical College of Georgia, CH-100, Augusta, GA 30912, United States
b
Division of Athletic Training, University of Kentucky, 900 S. Limestone, Lexington, Kentucky 40536-0200, United States

Received 21 December 2004; received in revised form 17 November 2005; accepted 28 November 2005

Abstract

The purpose of this study was to determine the reliability of three normalization methods for analyzing hip abductor activation during
rehabilitation exercises. Thirteen healthy subjects performed three open kinetic chain and three closed kinetic chain hip abductor exer-
cises. Surface EMG activity for the gluteus medius was collected during each exercise and normalized based on a maximum voluntary
isometric contraction (MVIC), mean dynamic (m-DYN), and peak dynamic activity (pk-DYN). Intraclass coefficient correlations
(ICCs), intersubject coefficients of variation (CVs), and intrasubject CVs were then calculated for each normalization method. MVIC
ICCs exceeded 0.93 for all exercises. M-DYN and pk-DYN ICCs exceeded 0.85 for all exercises except for the sidelying abduction exer-
cise. Intersubject CVs ranged from 55% to 77% and 19% to 61% for the MVIC and dynamic methods, respectively. Intrasubject CVs
ranged from 11% to 22% for all exercises under all normalization methods. The MVIC method provided the highest measurement reli-
ability for determining differences in activation amplitudes between hip abductor exercises in healthy subjects. Future research should
determine if these same results would apply to a symptomatic patient population.
Ó 2005 Elsevier Ltd. All rights reserved.

Keywords: Reproducibility; Rehabilitation; Measurement; Hip exercises; Gluteus medius; Normalization; Electromyography

1. Introduction EMG normalization is required to compare muscle

Therapeutic exercise is one of the most important treat-
ment modalities used by rehabilitation professionals. They
have analyzed electromyographic (EMG) muscle activity
during exercise and theorized that exercises that produce
higher activation amplitudes would benefit patients.
Although many studies have investigated amplitudes dur-
ing knee [18,21,22,28,42] and shoulder [6,34,41,45] exer-
cises, none have determined amplitudes during hip
abduction exercises. Hip abduction (HA) exercises have
important functional implications because they enable
patients to regain the muscle strength needed for perform-
ing activities of daily living and sports.
*
Corresponding author. Tel.: +1 859 333 6356; fax: +1 859 323 6003.
E-mail address: lbolgla@mail.mcg.edu (L.A. Bolgla).
activity among different subjects. Prior studies have nor-
malized EMG signals based on a maximum voluntary iso-
metric contraction (MVIC); however, this method has
certain limitations like the assumption that subjects pro-
vided a maximum effort during testing and that activation
represented total muscle activity required for the task
[48,49]. Other investigations have normalized muscle activ-
ity based on mean dynamic or peak dynamic amplitudes
because these methods patterned muscle activation pro-
duced during the specific task [5,33,36,47,49]. In addition,
dynamic methods may be more appropriate for patients
who cannot safely perform a MVIC.
Reliability is the extent to which measurements are con-
sistent, dependable, and free from error [17,39]. It also
refers to the stability and consistency of measures with
respect to time so that variations between measures result
from changes in the variable being measured [25]. With

1050-6411/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jelekin.2005.11.007
 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111
respect to EMG analysis of rehabilitation exercises, mea-
surement variations should represent true differences in
muscle activity among each exercise condition. Therefore,
researchers should normalize muscle activity using the
most reliable method in order to make appropriate infer-
ences regarding muscle activation.
Prior works have examined the reliability of EMG nor-
malization methods during gait [5,11,47,49] and single leg
stance tasks [26] based on a MVIC and dynamic activities
and calculated intraclass correlation coefficients (ICCs),
intersubject coefficients of variation (CVs), and intrasubject
CVs to establish measurement reliability. Some researchers
[11,26] recommended a MVIC method because it repre-
sented absolute demands required for a specific task; others
advocated a dynamic method because it reduced intersub-
ject variability and provided information on the pattern
of muscle activation during a task [47,49].
One should note that many factors might affect the
interpretation of EMG activity [29]. Heckathorne and
Childress [23] demonstrated how changes in muscle length
and rate of change altered the magnitude of EMG ampli-
tudes. Generally, amplitudes were greater during concen-
tric (shortening) muscle contractions, compared to
isometric contractions, because muscle fibers had greater
difficulty producing force in a shortened state [1,32]. Like-
wise, eccentric (lengthening) muscle contractions produced
less EMG activity because of a more favorable length–ten-
sion relationship of the actin-myosin cross bridges [1,32].
Therefore, changes in a muscle’s length-tension relation-
ship accounted for higher EMG amplitudes observed dur-
ing dynamic contractions. The rate of change of force also
influenced EMG amplitudes; EMG for a given force level
generally increased as velocity decreases [23]. Because of
these confounding factors, it is unknown how they might
affect the reliability of normalization methods.
Recently, clinicians have reported on the importance of
the HA musculature in lower extremity rehabilitation pro-
grams [19,24,30,37]. In determining which exercises best
activate the HA musculature, researchers must use a nor-
malization method that will provide reliable information.
Therefore, the purpose of this study was to examine mea-
surement reliability of HA amplitudes during six rehabilita-
tion exercises using a MVIC, mean dynamic, and peak
dynamic normalization method.
2. Methods
2.1. Participants
We used data obtained from 13 healthy subjects (7 men,
6 women; age = 24 ± 7 years; height = 1.6 ± 0.2 m;
weight = 765.2 ± 137.3 N) who participated in a larger
study that examined muscle activation amplitudes during
HA rehabilitation exercises [9]. They represented a sample
of convenience recruited from the local University commu-
nity. Subjects participated in the study only if they if they
had no lower extremity dysfunction and could safely per-
103
form a single leg stance on each lower extremity. Subjects
could not participate if they had a history of significant
lower extremity injury or surgery in the preceding year.
The primary investigator explained the testing procedures
and associated risks and benefits specific to the study to
all subjects. Participants signified their voluntary decision
to participate by signing a University-approved informed
consent form.
2.2. Subject preparation
The principal investigator prepared subjects’ skin for the
surface EMG electrodes in a standard manner [4]. Bipolar
Ag/AgCl surface electrodes (Medicotest, Rolling Meadows,
IL) were placed one-half the distance between the iliac crest
and greater trochanter over the muscle belly of the right glu-
teus medius (GM) because placement in this manner can
minimize the recording of activity from the nearest motor
unit action potential and minimize musculature interference
[4,13]. Surface electrodes, placed parallel to the GM muscle
fibers, measured 5 mm in diameter and had a 20 mm inter-
electrode distance. The principal investigator also donned
a ground electrode on the ipsilateral acromion process.
The principal investigator visually confirmed the electrical
signal on an oscilloscope using common manual muscle test-
ing techniques and secured the electrodes with electrode tape
to prevent slippage during testing. Finally, a two-dimen-
sional electrical goniometer was placed on the lateral aspect
of the right and left hips over the greater trochanter for pur-
poses of delineating repetitions during exercise.
2.3. Protocol
Subjects reported to the Musculoskeletal Laboratory for
a single occasion testing session. Prior to testing, subjects
rode a stationary bike at a submaximal speed for 5 min.
They also performed gentle hamstring, calf, and quadriceps
stretching consisting of five repetitions with a 15 s hold.
Next, subjects practiced each exercise to the beat of a met-
ronome (60 beats per minute) to familiarize themselves
with each task (see Table 1). For each exercise, we also
demarcated the appropriate range of motion using wooden
blocks. Subjects performed each exercise until they demon-
strated proficiency as determined by the researchers and
rested 10 min prior to testing to reduce fatigue. The princi-
pal investigator implemented these warm-up activities to
ensure that all subjects performed each exercise in a stan-
dardized and correct manner during testing.
Since clinicians typically use both open kinetic chain
(OKC) and closed kinetic chain (CKC) exercises in rehabil-
itation programs, we included three variations of each type
exercise. For the OKC exercises, we donned a cuff weight
equal to 3% body weight on subjects’ right ankle. For the
CKC exercises (except the pelvic drop), we placed the same
weight on subjects’ left ankle. We used an ankle weight
because it provided a known mass throughout the entire
range of motion for each exercise.
104 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111
Table 1
Description of Hip Abduction Exercises
Exercise
Standing hip abduction
Standing hip abduction with flexed hip
Single leg stance with contralateral load [27]a
Sidelying hip abduction [15,23]
Single leg stance with contralateral load and flexed hipa
Pelvic drops [15]
a
Cuff weight donned on the left ankle.
Subjects performed 15 repetitions of each exercise to a
metronome set at 60 beats per minute and in a standard-
ized manner to ensure similar rates and ranges of motion
among subjects [42]. For the hip sidelying and standing
abduction exercises, subjects raised the specific lower
extremity on one beat, lowered it on the next, and rested
one beat, a sequence they repeated for 15 repetitions. For
the pelvic drop exercise, subjects lowered the left lower
extremity on one beat and raised it on the next one in a
continuous manner. Subjects rested 3 min between each
exercise and testing order randomized to reduce fatigue
and ordering bias.
Fig. 1. Subject position for obtaining MVIC for right hip abduction.
Description
Subjects stand with both lower extremities 10 cm apart. They abduct the right lower
extremity 25 degrees and adduct it to the starting position during this exercise, while
standing solely on the left lower extremity with the pelvis in a level position
Subjects stand with both lower extremities 10 cm apart with the hips and knees in 20° of
flexion. They abduct the right lower extremity 25 degrees and adduct it to the starting
position during this exercise, while standing solely on the left lower extremity with the pelvis
in a level position
Subjects stand with both lower extremities 10.16 cm apart. They abduct the left lower
extremity 25 degrees and adduct it to the starting position during this exercise, while
standing solely on the right lower extremity with the pelvis in a level position
Subjects lie on their left side with the right lower extremity parallel to the left one. They
abduct the right lower extremity to 25 degrees and adduct it to the starting position during
this exercise
Subjects stand with both lower extremities 10.16 cm apart with the hips and knees in 20° of
flexion. They abduct the left lower extremity 25 degrees and adduct it to the starting position
during this exercise, while standing solely on the right lower extremity with the pelvis in a
level position
Subjects stand solely on the right lower extremity on a 600 step. With both knees in a fully
extended position, they lower the left pelvis toward the floor in order to adduct the right hip.
Subjects then contract the right GM to return the pelvis to a level position
2.3.1. Reference muscle activation for normalization
We determined reference values both before and after
exercise for purposes of establishing measurement reliabil-
ity. To determine reference values for the MVIC normali-
zation method, subjects assumed a left sidelying position
with the right lower extremity in 25 degrees of hip abduc-
tion as determined through goniometric measurement.
We maintained this position by placing pillows between
each subject’s lower extremities and securing them with a
mobilization (immovable) strap over the lateral femoral
condyle (see Fig. 1). A mobilization strap was used since
previous works have demonstrated the reliability of this
 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111
method for producing a maximum contraction for the hip
abductors [24,27,35,46]. We chose 25 degrees of hip abduc-
tion as our reference point since this position has been
commonly used for manual muscle testing [15].
The principal investigator instructed subjects to generate
maximum hip abductor force using the ‘‘make test’’ [2,7].
For the ‘‘make test,’’ subjects generated maximum hip
abductor force over a 2 s period and held the maximum
contraction for a 5 s period. Prior to testing, subjects famil-
iarized themselves with the test position and sequence by
performing two submaximal isometric contractions. For
testing purposes, subjects performed three MVICs using
the ‘‘make test’’ and rested 1 min between each effort to
minimize fatigue. The principal investigator provided
strong verbal encouragement to facilitate subjects’ ability
to perform a MVIC [12]. To determine reference values
for the mean and peak dynamic normalization methods,
subjects performed 15 repetitions of active right hip abduc-
tion (0–25 degrees) in the sidelying position with no load
(no ankle weight) at a rate of 60 beats per minute. We ran-
domized order for determining reference muscle activation
to reduce ordering bias.
2.3.2. EMG data collection
We used a 16-channel EMG system (Run Technologies,
Mission Viejo, CA) to record muscle activity. Subjects wore
a Myopac transmitter belt unit (Run Technologies) that
transmitted all raw EMG data at 1000 Hz via a fiber optic
cable to its receiver unit where signals were converted from
analog to digital using a 12-byte A/D board (Computer-
Boards Inc., Middleboro, MA). Unit specifications for the
Myopac included a common mode rejection ratio of
90 dB, an amplifier gain of 2000 for the surface EMG elec-
trodes, and an amplifier gain of 1000 for the electric goniom-
eters. Raw EMG data were band pass filtered at 20–500 Hz
using Datapac software (Run Technologies), stored on a PC
computer, and analyzed using Datapac software. Electrical
goniometer signals were linear smoothed over a moving
15 ms window and used to demarcate GM activity during
each repetition.
2.4. EMG data reduction
2.4.1. MVIC
Using the three MVICs performed by each subject, we
determined the maximum root mean squared (RMS)
amplitude recorded over a 500 millisecond (ms) window
[3], which represented 100% MVIC amplitude. For each
exercise condition, we calculated the RMS amplitude
for each repetition and expressed each as a percentage
of the MVIC (% MVIC). We normalized EMG signals
from each exercise a second time using the post-testing
MVIC value for purposes of calculating ICCs. The %
MVIC for the last 10 repetitions (pre- and post-testing
MVIC) for each exercise were then averaged and used
for statistical analysis.
105
2.4.2. Mean dynamic activity
EMG signals collected during the 15 repetitions of the
unloaded (no ankle weight) sidelying HA exercise were full
wave rectified and linear smoothed using a 250 ms time
constant with Datapac software [5]. The mean amplitude
for this linear envelope was determined and represented
100% mean dynamic amplitude (m-DYN). For each exer-
cise condition, we processed signals using this linear enve-
lope, calculated the mean amplitude, and expressed these
amounts as a percentage of the m-DYN (% m-DYN).
We normalized EMG signals from each exercise a second
time using the post-testing m-DYN value for purposes of
calculating ICCs. The % m-DYN for the last 10 repetitions
(pre- and post-testing m-DYN amplitudes) for each exer-
cise were then averaged and used for statistical analysis.
2.4.3. Peak dynamic activity
EMG signals collected during the 15 repetitions of the
unloaded (no ankle weight) sidelying HA exercise were full
wave rectified and linear smoothed using a 250 ms time
constant with Datapac software [5]. The peak amplitude
for this linear envelope was determined and represented
100% peak dynamic amplitude (pk-DYN). For each exer-
cise condition, we processed signals using this linear enve-
lope, calculated the peak amplitude for each repetition, and
expressed these amounts as a percentage of the pk-DYN
(% pk-DYN). We normalized EMG signals from each exer-
cise a second time using the post-testing pk-DYN value for
purposes of calculating ICCs. The % pk-DYN for the last
10 repetitions (pre- and post-testing peak dynamic ampli-
tudes) for each exercise were then averaged and used for
statistical analysis.
2.5. Statistical analysis
MVIC reliability was assessed to ensure that electrodes
did not displace during each testing session [31,40]. To
evaluate reproducibility, the intraclass correlation coeffi-
cient (ICC) (model [2,1]) [43] was calculated using the
maximal 500 ms of RMS amplitude generated during the
pre-testing and the post-testing MVICs.
To determine measurement reliability for each exercise
condition, we calculated separate ICCs (model [2,10]) [43]
using the pre-testing and post-testing % MVIC, % m-
DYN, and % pk-DYN values. We also calculated the stan-
dard error of measure (SEM) to describe the precision of
each measurement [16]. All statistical analyses were con-
ducted using SPSS Version 12.0 (SPSS Inc., Chicago, IL)
at the 0.05 level of significance.
Although not a measure of reliability, intersubject CVs
are inversely related to reproducibility and have been used
as a criteria for selecting a particular normalization method
[10,11,26,47,49]. We calculated intersubject CVs for each
exercise condition by dividing the overall standard devia-
tion by the grand mean (Intersubject CV ¼ s=X ) using val-
ues derived from each pre-testing % MVIC, % m-DYN,
and % pk-DYN normalization method [38].
106 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111

We determined intrasubject reliability using the middle
five repetitions that subjects performed for each exercise.
We first determined the total mean square error (MSE)
by performing separate analyses of variance (ANOVA)
with repeated measures on values determined under each
normalization method using SPSS Version 12.0 (SPSS
Inc.) at the 0.05 level of significance. We then calculated
intrasubject CVs for each exercise by dividing the square
root of the overall MSE
pffiffiffiffiffiffiffiffiffi
ffi by the mean EMG activity (Intra-
subject CV ¼ MSE=x) using values from each pre-testing
normalization method [26].
ICCs ranged from 0.93 to 0.96 using the MVIC method,
0.41 to 0.97 using the mean dynamic method, and 0.71 to
0.98 using the peak dynamic method. Table 4 summarizes
the intersubject and intrasubject CVs. Intersubject CVs
ranged from 55% to 77% using the MVIC method, 19%
to 44% for the mean dynamic method, and 26% to 61%
using the peak dynamic method. Intrasubject CVs ranged
from 11% to 22% for all methods.
4. Discussion

3. Results Clinicians [14,19,20,30,37] have recognized the role of

ICC2,1 for assessing pre-testing and post-testing MVICs
was 0.92, which inferred minimal electrode movement and
consistent effort. Table 2 summarizes descriptive statistics
for each exercise. Table 3 summarizes the ICCs and SEMs.
the HA musculature when developing successful rehabilita-
tion programs. Although exercise prescription is an impor-
tant intervention, only a single study [9] has examined
EMG amplitudes of the hip musculature during therapeu-
tic exercises. Information regarding HA activation during

Table 2
Summary of means and standard deviations of hip abductor muscle amplitudes during exercise based on a percentage of maximum voluntary isometric
contraction (% MVIC), mean dynamic activity (% m-DYN), and peak dynamic activity (% pk-DYN)
Exercise % MVIC % m-DYN % pk-DYN
a a
Mean SD Mean SD Mean SDa
Sidelying abduction 40 22 59 21 125 33
Standing abduction 30 21 38 14 88 34
Standing abduction with 20° hip flexion 27 20 32 15 84 39
Pelvic drop 54 30 84 38 156 66
Single leg stance with contralateral load 40 26 58 38 113 68
Single leg stance with contralateral load and 20° hip flexion 44 34 62 30 116 53
a
SD: standard deviation.

Table 3
Summary of intraclass correlation coefficients (ICCs) and standard error of measurement (SEMs) for hip abductor amplitude during exercise based on a
maximum voluntary isometric contraction (MVIC), mean dynamic activity (m-DYN), and peak dynamic activity (pk-DYN)
Exercise MVIC m-DYN pk-DYN
ICC SEMa ICC SEMa ICC SEMa
Sidelying abduction 0.93 5 0.41 8 0.71 12
Standing abduction 0.96 4 0.85 6 0.95 7
Standing abduction with 20° hip flexion 0.96 4 0.93 5 0.96 6
Pelvic drop 0.95 6 0.95 13 0.94 13
Single leg stance with contralateral load 0.96 4 0.97 7 0.98 9
Single leg stance with contralateral load and 20° hip flexion 0.96 6 0.95 9 0.97 9
a
SEM stated as a % EMG activity based on each normalization method.

Table 4
Summary of intersubject (Inter) and intrasubject (Intra) coefficients of variation for hip abductor amplitude during exercise based on a maximum
voluntary isometric contraction (MVIC), mean dynamic activity (m-DYN), and peak dynamic activity (pk-DYN)
Exercise MVIC m-DYN pk-DYN
Inter (%) Intra (%) Inter (%) Intra (%) Inter (%) Intra (%)
Sidelying abduction 55 12 19 11 26 12
Standing abduction 70 18 22 14 40 22
Standing abduction with 20° hip flexion 74 17 35 17 44 22
Pelvic drop 56 11 39 12 41 16
Single leg stance with contralateral load 65 11 44 9 61 14
Single leg stance with contralateral load and 20° hip flexion 77 11 37 11 47 15
 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111
rehabilitation exercises will assist clinicians in exercise
prescription.
Historically, clinicians have utilized lower extremity
therapeutic exercises on the assumption that those exercises
that produce higher EMG amplitudes will produce greater
strengthening effects. These studies [18,21,22,28,42] have
based recommendations on data expressed as a % MVIC
without examining measurement reliability. Reliability
means that measurement methods should detect differences
in % EMG amplitudes that resulted from changes in the
variable (exercise) being examined [25]. Reliability is also
analogous with reproducibility, meaning that others should
obtain similar measures with testing replication [26].
With respect to upper extremity exercise, investigators
have examined the reproducibility of isometric and
dynamic normalization methods. Morris et al. [33] reported
that the mean and peak dynamic normalization methods
provided more reproducible measures compared to those
using a MVIC. Based on these findings, we wanted to
determine if an isometric or dynamic normalization
method would provide greater measurement reliability
when investigating HA activation amplitude during thera-
peutic exercises.
4.1. Normalization based on a MVIC
Prior work [18,26] has shown that use of the MVIC
method can provide a reliable measure of muscular
demands during a specific lower extremity task or exercise.
Earl et al. [18] examined quadriceps activation during
dynamic mini-squat exercises and reported ICCs of 0.99
when using a MVIC reference value, which agree with
the present study’s calculations (ICCs P 0.93). High ICCs
infer not only good measurement reliability but also rea-
sonable validity [39]. The MVIC normalization method
also resulted in low SEMs, which inferred acceptable mea-
surement precision and stability when using this method
[16].
Intersubject CVs are inversely related to reproducibility,
and researchers [47,49] have used them as a criteria for
selecting a particular normalization method. Although
intersubject CVs are not a measure of reliability, we calcu-
lated them to compare results to other studies [10,26,47,49].
The present study’s intersubject CVs, which ranged from
55% to 77% in the present study, are relatively large but
agree with those reported by Knutson et al. [26]. These
researchers analyzed gastrocnemius EMG activity during
a single leg stance activity and calculated an intersubject
CV of 91.3%. They also emphasized that large intersubject
CVs are not necessarily ‘‘good or bad’’ because data vari-
ability is required to identify differences. Knutson et al.
[26] also stated that lower intersubject CVs might infer
group homogeneity and limit comparisons of results to
future studies.
Yang and Winter [49] advocated using normalization
methods that reduce intersubject variability in their studies
designed for establishing normative values of muscle acti-
107
vation during gait. The purpose of their studies was to pro-
vide patterns of muscle activation that clinicians could use
in identifying patient gait abnormalities. Our higher inter-
subject CVs may contradict Yang and Winter’s recommen-
dations; however, the purpose of the present study was to
determine differences in muscle demands, not patterns of
activation, during HA exercise [11,26]. Therefore, intersub-
ject CVs provided limited information regarding measure-
ment reliability.
Intrasubject CVs relate more to measurement reproduc-
ibility and stability because they are calculated from sub-
ject repeated measures and may detect measurement error
[26]. We examined repeatability using the middle five repe-
titions for each exercise; values calculated for all normali-
zation methods were less than 20%. Our calculations
mirrored those employed in the Knutson study [26] and
were well below the 38.1% value reported by these
researchers.
In summary, we believe that studies that investigate HA
muscle activation using a healthy group of subjects should
continue using a MVIC normalization method. The combi-
nation of high ICCs, lower SEMs, and low intrasubject
CVs associated with data expressed as a % MVIC inferred
high measurement reliability.
4.2. Normalization based on dynamic activities
A potential limitation with using a MVIC reference
value is that symptomatic subjects cannot perform a max-
imum contraction because of pain and muscle inhibition.
Dynamic methods based on mean or peak muscle activity
do not depend on a maximal contraction, and previous
work [11,47,49] has shown that these methods may provide
a better representation of the muscle activity required for a
specific task. Furthermore, Yang and Winter [49] have rec-
ommended dynamic methods because they produce lower
intersubject CVs, which may increase surface EMG sensi-
tivity when analyzing gait.
ICCs calculated for each exercise using the dynamic
methods exceeded 0.85 except for the sidelying abduction
exercise. For this exercise, we calculated ICCs of 0.41
and 0.71 for the m-DYN and pk-DYN methods, respec-
tively. Although we cannot conclusively determine the rea-
son for these findings, we can make the following inference.
This exercise was the only one that patients did not per-
form in a standing position. We made every effort to ensure
that subjects performed this exercise with both lower
extremities positioned parallel to each other; however, they
could have moved the right extremity in an anterior posi-
tion. Such changes in position could have resulted in a dif-
ferent recruitment of motor units that negatively affected
the ICC calculations.
Intersubject CVs ranged from 19% to 44% using the m-
DYN method and from 26% to 61% using the pk-DYN
method, ranges similar to those reported by others
[11,26,49] who used mean and peak dynamic normalization
108 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111

methods. A comparison of intersubject CVs for individual We believe that the m-DYN method may provide a
exercises demonstrated that the MVIC method had greater more reliable measurement of EMG data compared to
variability than the dynamic methods. With respect to the the pk-DYN. With respect to ICCs, the sidelying exercise
dynamic methods, the m-DYN method had lower intersub- had a lower m-DYN ICC value and a lower (more precise)
ject CVs than the pk-DYN method. These findings support SEM. ICC calculations are based on data variability [39],
previous findings that revealed lower intersubject CVs meaning that differences are more difficult to detect when
when normalizing EMG using a m-DYN method using less variable data. In our study, a lower SEM may
[11,26,49]. have accounted for a lower ICC value [8]. All other ICCs
Intrasubject CVs were less than 19% and 23% for the m- were acceptable and similar between methods for the
DYN and pk-DYN methods, respectively. Although Knut- remaining exercises.
son et al. [26] reported intrasubject CVs ranging from 23% A comparison of CVs for both methods revealed that
to 31% when analyzing gastrocnemius activity, we found the m-DYN method resulted in lower intersubject (see
greater intrasubject reproducibility of data with repeated Table 4) and intrasubject CVs (see Fig. 2). Together, these
measures using both dynamic normalization methods. See results inferred greater stability of measures using the m-
Fig. 2 for a comparison of intrasubject measurement DYN method and agree with previous studies [26,47,49].
repeatability using each normalization method. Based on the calculated ICCs and CVs, we believe that

Sidelying Stand
200 140
180
120
160
140 MVIC 100 MVIC
% EMG Activity
% EMG Activity

120 m-DYN 80
m-DYN
100 pk-DYN pk-DYN
60
80
60 40
40
20
20
0 0
1 3 5 7 9 1 2 3 4 5 6 7 8 9 10
A Repetitions B Repetitions

Flex Stand Pelvic Drop

200
400
180
350
% EMG Activity

160
% EMG Activity

140 300
120 MVIC 250 MVIC
100 m-DYN 200 m-DYN
80 pk-DYN 150 pk-DYN
60
40 100

20 50
0 0
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
C Repetitions D Repetitions

Single Leg Stance Flexed Hip Single Leg Stance

350 300

300 250
% EMG Activity

% EMG Activity

250
200
200 MVIC MVIC
150
150 m-DYN m-DYN
pk-DYN 100
100 pk-DYN
50 50

0 0
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10
E Repetitions F Repetitions

Fig. 2. Comparison of hip abductor musculature amplitude patterns for each exercise (A) sidelying abduction, (B) standing hip abduction, (C) standing
hip abduction with 20° hip flexion, (D) pelvic drop, (E) single leg stance with a contralateral load, and (F) single leg stance with a contralateral load in 20°
hip flexion based on a percentage of maximum voluntary isometric contraction (MVIC), mean dynamic activity (m-DYN), and peak dynamic activity (pk-
DYN).
 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111
the m-DYN method provided greater measurement reli-
ability than the pk-DYN method when evaluating HA
muscle activation amplitudes during therapeutic exercises.
4.3. Comparison of EMG amplitudes between normalization
methods
The MVIC method had lower percent EMG amplitudes
compared to dynamic methods. We expected these lower
values because subjects performed exercises requiring sub-
maximal muscular effort. To perform a MVIC, subjects
required higher levels of motor unit recruitment. Therefore,
the percent EMG activity required for submaximal exercise
would be much lower when normalized to higher EMG
MVIC activation levels. For the dynamic normalization
methods, subjects performed a sidelying hip abduction
exercise with no weight applied to the lower extremity, a
task that required less EMG activity than a MVIC. Based
on this information, we expected greater percent EMG
activation using dynamic normalization methods. During
testing, subjects performed non-weight bearing with an
ankle weight and weight bearing HA exercises, which
placed greater demands on the hip abductors than the ref-
erence sidelying exercise. Therefore, the percent EMG
activity calculated using the dynamic methods would be
higher because the reference activation level was less than
that during a MVIC.
4.4. Limitations
The current study has certain limitations that we would
like to address. An inherent limitation associated with
MVIC normalization has been the assumption that sub-
jects provide a maximal effort. To facilitate a MVIC, we
positioned subjects in a manner consistent with standard
manual muscle testing techniques in combination with
resistance from an immovable object (firmly secured mobi-
lization strap instead of against manual resistance). Prior
works have shown that use of straps can facilitate reliabil-
ity for generating a MVIC [2,27,35,46]. We also gave
strong verbal encouragement, a proven technique for elicit-
ing a maximum contraction [12] and practice to familiarize
themselves with the task. We believe that the combination
of positioning, verbal encouragement, and task familiariza-
tion facilitated a subject’s ability to perform a reliable
MVIC as evidence by the calculated ICC of 0.92. A high
ICC would also infer measurement validity [39].
We did not utilize a burst-superimposition technique to
determine a ‘‘true’’ MVIC since similar studies have not
employed this technology. A burst-superimposition tech-
nique delivers a supramaximum stimulus to a muscle as a
subject performs a voluntary isometric contraction against
an isokinetic dynamometer [44]. During a valid MVIC, the
supramaximum stimulus application would not result in
any increased force output. Future studies may implement
this technique to address this limitation.
109
Another potential limitation associate with surface
EMG studies relates to signal crosstalk. Adjacent muscles,
like the gluteus minimus and tensor fascia lata, might have
influenced EMG signals. To address this limitation, we
donned electrodes over the muscle belly of the gluteus med-
ius in a standardized manner [4,13] and confirmed EMG
signals prior to testing using standard manual muscle test-
ing techniques. Future researchers can easily address this
issue by replicating the study using intramusculature dual
fine wire electromyography.
Finally, we cannot generalize our findings to symptom-
atic subject populations. Our findings revealed that the
MVIC method provided the most reliable measures, which
agreed with other studies [18,26]. We also found acceptable
reliability measures for the m-DYN method. Although we
would expect to find similar HA activation amplitudes
using symptomatic subjects, we cannot make this conclu-
sion based on results from the present study.
5. Conclusion
To our knowledge, this study was the first to examine
the reliability of normalization methods that researchers
may use to determine muscle activation during HA thera-
peutic exercises. Historically, investigators have examined
muscle amplitudes using healthy subjects and have inferred
similar findings to symptomatic subject populations.
Future studies should examine muscle activation in sub-
jects diagnosed with pathology in order to generalize find-
ings because symptomatic subjects may demonstrate
different motor unit recruitment patterns.
Our results demonstrated that the MVIC normalization
method provided greater measurement reliability for evalu-
ating activation amplitudes during HA exercise. With study
replication to symptomatic subjects, researchers may need
an alternative method to evaluate exercise if subjects can-
not elicit a valid MVIC because of pain and muscle inhibi-
tion. In these cases, researchers should consider using the
m-DYN method because it can identify HA amplitude dif-
ferences among exercises but with little risk of injury or dis-
comfort to symptomatic subjects.
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 L.A. Bolgla, T.L. Uhl / Journal of Electromyography and Kinesiology 17 (2007) 102–111
Dr. Lori A. Bolgla is assistant professor in the
Department of Physical Therapy, School of
Allied Health Sciences at the Medical College
of Georgia. Dr. Bolgla received her Bachelor in
Science degree in physical therapy from the
Medical College of Georgia in 1993 and her
Master in Science degree in physical therapy
from the Medical College of Georgia in 1998.
She received her doctor of philosophy degree in
Rehabilitation Sciences from the University of
Kentucky in 2005. Her research has focused on
the evaluation and rehabilitation of lower
extremity overuse injuries.
111
Dr. Tim L. Uhl is associate professor in the
Department of Rehabilitation Sciences, College
of Health Sciences and the director of the
Musculoskeletal Laboratory at the University
of Kentucky. Dr. Uhl received his bachelor’s
degree in physical therapy from the University
of Kentucky in 1985 and his Master of Science
degree in kinesiology from the University of
Michigan in 1992. In 1998, he completed his
doctor of philosophy degree in education at the
University of Virginia with a focus in Sports
Medicine. He is currently the president of
American Society of Shoulder and Elbow Therapists. His research has
primarily concentrated on evaluation/rehabilitation of shoulder injuries.