Accepted Manuscript

Comparison of EMG activity on abdominal muscles during plank exercise with

unilateral and bilateral additional isometric hip adduction

Soo-Yong Kim, Min-Hyeok Kang, Eui-Ryong Kim, In-Gui Jung, Eun-Young

Seo, Jae-seop Oh

PII: S1050-6411(16)30032-3
DOI: http://dx.doi.org/10.1016/j.jelekin.2016.05.003
Reference: JJEK 1973

To appear in: Journal of Electromyography and Kinesiology

Received Date: 13 January 2016

Revised Date: 3 May 2016
Accepted Date: 6 May 2016

Please cite this article as: S-Y. Kim, M-H. Kang, E-R. Kim, I-G. Jung, E-Y. Seo, J-s. Oh, Comparison of EMG
activity on abdominal muscles during plank exercise with unilateral and bilateral additional isometric hip adduction,
Journal of Electromyography and Kinesiology (2016), doi: http://dx.doi.org/10.1016/j.jelekin.2016.05.003

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 1 Title Page

2 1. Title

3 Comparison of EMG activity on abdominal muscles during plank exercise with unilateral and

4 bilateral additional isometric hip adduction

6 2. Full name of each author / Degree / Affiliation

7 1) Soo-Yong Kim, MS, PT, Department of Physical therapy, Graduate School, INJE University,

8 Gimhae, South Korea (gasigogi11@naver.com)

9 2) Min-Hyeok Kang, PhD, PT, Department of Physical therapy, Graduate School, INJE

10 University, Gimhae, South Korea (kmhyuk01@naver.com)

11 3) Eui-Ryong Kim, PhD, PT, Busan Sling Exercise Center, Busan, South

12 Korea(sling01@hanmail.net)

13 4) In-Gui Jung, MS, PT, Department of Rehabilitation Medicine, Pusan National University

14 Yangsan Hospital, Yangsan, South Korea (wjddlsrnl111@naver.com)

15 5) Eun-YoungSeo, BHS, PT, Department of Physical Therapy, The Graduate School of Public

16 Health, Inje University, Gimhae, South Korea (kika9468@naver.com)

17 6) Jae-seop Oh, PhD, PT, Professor, Department of Physical Therapy, INJE University, Gimhae,

18 South Korea (ysrehab@inje.ac.kr)

19

1
 1 3. Keywords

2 Electromyography

3 Hip adduction

4 Plank exercise

5 Trunk stability

7 4. ACQKNOWLEDGEMENT

8 This research was supported by Basic Science Research Program through the National

9 Research Foundation of Korea (NRF) funded by the Ministry of Education (No.

10 2015R1D1A1A01056853).

11

12 5. Corresponding author

13 JAE-SEOP, OH, PT, PhD

14 Department of Physical Therapy

15 College of Biomedical Science and Engineering

16 INJE University 607 Obang-dong, Gimhae-si,

17 Gyeongsangnam-do, South Korea, 621-749

18 ysrehab@inje.ac.kr; Tel.: +82 55 320 3679; Fax: +82 55 329 1678

19

2
 1 1. Introduction

2 Trunk stability provides maintenance for spinal alignment, appropriate control of movement for

3 functional activities and is crucial to prevent and treat low back pain (Lehman et al., 2005; Kim et al.,

4 2013). Core muscles contribute to the mechanism of trunk stability, and include the internal oblique

5 (IO), the transverse abdominis, the multifidus, and the external oblique (EO) muscles. One of the core

6 muscles is the IO, attached to the lumbar vertebrae and contributes to the trunk stability through the

7 control of intervertebral stiffness. The EO muscle acts as a guide wire to control the spinal orientation

8 and equilibrium for external loads, transferring the load from the upper trunk to the pelvis (Bergmark,

9 1989). Hence, exercise that increases the activities of the IO and EO muscles are needed to control the

10 neutral position of the spine during dynamic functional activities.

11 The plank exercise is used to strengthen the core muscles, including the IO and EO muscles (Snarr

12 et al., 2014). Schellenberg et al. (2007) showed that the activity of the abdominal muscles increases

13 compared to the back extensor during the plank exercise; this exercise is an appropriate exercise for

14 abdominal core muscles. Recent research has shown that using the plank exercise, compared with the

15 sit up exercise, reduces lower-back injuries (McGill, 2007; Peterson, 2013). Because the traditional

16 sit-up exercise increases the compression forces on the spinal column it causes various degenerative

17 spinal injuries (McCill, 2010). However, when performed the lumbopelvic region in a neutral

18 position, the plank exercise may decrease the load on the spinal column. Therefore, the plank exercise

19 is an optimal exercise to increase abdominal muscle activity and strength (Snarr et al., 2014).

20 Additional limb movement has been shown to increase abdominal activity during exercise (Lee,

21 2013). Abdominal muscle activity occurs earlier and with a larger amplitude when a predictable

22 perturbation caused by additional limb movement is applied to the trunk (Hodges et al., 1999) and the

23 activation pattern of abdominal muscles is related to the direction of limb movement (Lee, 2013;

24 Aruin and Latash 1995; Hodges et al., 1999). Also, unilateral limb movement during the exercise

25 created greater activity of the abdominal muscles relating to trunk stability (Behm et al., 2005), and

3
 1 agrees with control of the neutral spine position (Aruin and Latash 1995; Hodges et al., 1999). Hip

2 adduction movement generates contralateral lateral flexion of the trunk (Neumann, 2010), inducing

3 greater abdominal muscle demand to maintain trunk stability. In previous studies, Park et al. (2014)

4 reported that hip abduction and adduction movements during the bridge exercise increased IO and

5 multifidus activity in healthy subjects.

6 Based on previous studies, the standard plank exercise and additional limb movement during the

7 exercise has been suggested as an effective program for increasing abdominal muscle activity.

8 However, no experimental study has investigated the combined effects of the additional isometric hip

9 adduction during the standard plank exercise.

10 Thus, the purpose of this study was to determine the effects of the isometric hip adduction exercise

11 during the plank exercise on abdominal muscle activity in healthy subjects. We hypothesized that the

12 activity of the abdominal muscles would be greater during the plank with additional unilateral and

13 bilateral isometric hip adduction compared with the standard plank, and the unilateral isometric hip

14 adduction would be greater than the bilateral isometric hip adduction.

15

16 2. Methods

17 2.1 Participants

18 The present study is a crossover design that enrolled 20 healthy male volunteers (age, 30.44 ± 2.65

19 years; height, 175.55 ± 5.74 cm; weight 70.33 ± 5.24 kg). The inclusion criteria were as follows: (1)

20 no previous or current neurological or musculoskeletal pathology that could influence exercise

21 performance; and (2) no psychological problems; and (3) the ability to perform hip adduction using a

22 40 cm stretched Thera-Band and to hold an isometric hip adduction more than 10 times. The

23 exclusion criteria were: 1) the subject could not maintain the correct posture (e.g., inducing hyper

4
 1 forward neck posture, thoracic kyphosis, and lumbar lordosis) during the plank exercise by placing a

2 straight bar from the head to the buttocks before testing, or 2) were suffering pain, particularly in the

3 back or shoulder. Prior to the experiment, all subjects were given an explanation about the exercise

4 protocols and signed an informed consent form approved by the Inje University Ethics Committee for

5 Human Investigations.

6 The sample size was calculated using the previous findings (Park et al., 2013) that showed

7 significantly greater muscle activity of the IO. The results of the power analysis indicated that at least

8 17 participants would be required to achieve a power of 0.80 at a significance level of 0.05.

10 2.2 Plank exercise

11 Thirty min before starting the experiment, each subject practiced the plank exercise under the

12 supervision of a physical therapist for 10 min. The isometric contraction for the plank exercises within

13 the practice session were held for 5-s, and repeated twice with 30 s between each trial and 4 min

14 between positions. All subjects performed the three types of plank exercise: 1) standard plank

15 exercise; 2) the plank exercise with unilateral isometric hip adduction (UIHA); and 3) the plank

16 exercise with bilateral isometric hip adduction (BIHA). The three types of plank exercises were

17 performed in a randomized order, which was decided by choosing a single card, randomly from

18 among three cards marked A, B, and C.

19 To perform the standard plank exercise, the subjects were instructed to assume a position with the

20 shoulders and elbows flexed at 90° with only the forearms and toes in contact with the ground. The

21 subjects had to maintain a straight, strong line from the head to the toes with an extended leg position,

22 keeping the head and spine in a neutral position. The distance between the big toes was maintained at

23 hip width to prevent inducing hip adduction force (Czaprowski et al., 2014). A straight bar was

24 positioned from the head to the buttocks to confirm the correct trunk position and subjects were asked

5
 1 to maintain this position during each plank exercise (Fig. 1).

2 The plank combined with BIHA and UIHA followed the same process as the standard plan

3 k exercise. Each subject performed the plank with BIHA and UIHA using a Thera-Band (Hy

4 genic Corp., Akron, OH, USA). The blue color band was used in this study, which is sugges

5 ted by the manufacturer as an intermediate resistance. Five bands were prepared to minimize

6 the change in the elasticity of the Thera-Band caused by repeated use. For the plank exercise

7 with BIHA, poles were set up 1 m lateral on each side of the subjects’ toes where the subj

8 ect performed a standard plank. The Thera-Bands were fixed to the poles, and the length of t

9 he Thera-Band was 60 cm. The end of the ipsilateral side of the Thera-Band was positioned

10 on each subject just above the medial malleolus. To perform plank exercises with BIHA, the

11 participants were asked to adduct both hips to neutral hip positions and then to perform a sta

12 ndard plank exercise (Fig. 2). The tensile load of the Thera-Band was used as resistance duri

13 ng the plank exercises with BIHA and UIHA. When performing BIHA and UIHA, a 40 cm l

14 ength of the Thera-Band was stretched to provide resistance. The amount of resistance was d

15 etermined when the participants could perform more than 10 repetitions of the hip adduction

16 without compensatory movements in a standing position (Choi et al., 2015), in our pilot study

17 . To perform a repeated hip adduction, participants adducted the hip to a neutral hip position

18 and held it for 5 s. Based on the results of the pilot study, 40 cm of stretched Thera-Band

19 was determined as the amount of resistance in the present study. All participants performed

20 10 repetitions of the hip adduction movement 30 min before the testing trials to identify whe

21 ther they met the inclusion criteria.

22 Because the subjects showed no difference in the strength of the left or right hip adductor, the plank

23 with UIHA was applied to the left side only. Each subject wrapped the left side band around the left

24 medial malleolus. The subject performed the left isometric hip adduction, followed by the standard

25 plank exercise (Fig. 3).

6
 1 The plank exercise was held for 5 s under isometric contraction and repeated three times. Each

2 subject had a 30 s rest time between trials and a 3 min rest time between each position to prevent

3 muscular fatigue. When the subject could not maintain the correct plank position due to increasing

4 kyphotic curvature in the thoracic spine, increasing lumbar lordosis curvature, hip flexion, winging of

5 the scapular, or head flexion or extension, EMG data collection was stopped.

7 2.3 Surface electromyography and data processing

8 EMG data were collected using a wireless TeleMyo DTS (Noraxon Inc., Scottsdale, AZ, USA) and

9 Myo-Research Master Edition 1.06 XP software was used for the analysis. The EMG data for each of

10 the muscles were collected simultaneously from the selected bilateral abdominal muscles (RA, EO,

11 and IO).

12 Before placing the electrodes, the attachment sites were shaved and cleaned using alcohol-soaked

13 cotton to minimize skin impedance. The electrodes for the RA were placed proximally, 2 cm lateral to

14 the umbilicus (Cram et al., 1998; Stevens et al., 2006), and the electrodes for the IO were positioned 2

15 cm medial to the ASIS (Cram et al., 1998). The electrodes for the EO were placed on the inferior edge

16 of the eighth rib superolateral to the costal margin (Cram et al., 1998). Bipolar electrodes (Ag/AgCl)

17 had a pre-gelled diameter of 10 mm and the inter-electrode distance was 2 cm. The raw EMG signals

18 were sampled at 1,000 Hz and were processed into a root mean square (RMS) with a window of 50

19 ms. A band pass filter of 20–450 Hz was used together with notch filters at 60 Hz.

20 Normalization of the EMG data collected from each muscle was performed by calculating the RMS

21 of a 5 s maximal voluntary isometric contraction (MVIC) for the muscles at the manual muscle-test-

22 position, as suggested by Kendall et al. (2005). The RA muscle was tested in the supine position, with

23 the hips and knees at 90° flexion with the feet supported. The subject’s trunk was then flexed

7
 1 maximally. Resistance was provided at both shoulders toward the trunk extension direction by the

2 examiner. The EO and IO muscles were also tested using the same position as the RA muscle. For the

3 EO, subjects flexed and rotated their trunk maximally to the left, with resistance applied at the

4 shoulders towards the trunk extension and right rotation direction by the examiner. For the IO,

5 subjects flexed and rotated the trunk maximally to the right, with resistance at the shoulders towards

6 the trunk extension and left rotation direction applied by the examiner. All EMG data were measured

7 for 3 s, discarding the first and last s. The average MVIC value of the three trials was calculated. The

8 subjects were given a 3 min rest between each trial.

9 The EMG data collected during the three plank exercises was expressed as a percentage of MVIC

10 (%MVIC). All abdominal EMG data during the three types of plank exercises were measured for 5 s,

11 three times, and recorded for the middle 3 s excluding the 1 s at the start and end. The

12 average %MVIC value of the three trials for each plank was used for data analysis.

13

14 2.4 Statistical analysis

15 We measured the means ± the standard deviation of the EMG data for the abdominal muscles. One

16 way repeated measurement analysis of variance (ANOVA) was used to determine the difference in the

17 EMG data of the bilateral abdominal muscles (RA, EO, and IO). If any significant differences

18 between the plank conditions were detected, post hoc analysis using the Bonferroni correction was

19 performed. A paired t-test was used for comparison of the same muscles in each plank position. A p-

20 value < 0.05 was considered statistically significant and statistical analyses were performed with

21 SPSS for Windows software (ver. 20.0; SPSS Inc., Chicago, IL, USA).

22

23 3. Results

24 The EMG activity data from the bilateral abdominal muscles during the plank exercise, and the plank

8
 1 exercises with BIHA and UIHA, are shown in Table 1. There was a significant difference in RA, EO,

2 and IO muscle activity between the different plank conditions. The EMG activity of the abdominal

3 muscles was significantly greater during the plank exercise with UIHA and with BIHA compared with

4 the standard plank exercise (p < 0.05) (Table 1). The plank exercise with UIHA resulted in

5 significantly greater abdominal muscle activity than the plank exercise with BIHA (p < 0.05), except

6 for the right RA (p = 0.179) (Table 2, Fig. 4). There was no significant difference between the right

7 and left sides of the same muscle in each position (p > 0.05).

9 4. Discussion

10 We have investigated the effect of additional isometric hip adduction on bilateral abdominal muscle

11 activity during the standard plank exercise. Subjects performed the standard plank exercise, the plank

12 exercise with BIHA, and the plank exercise with UIHA. The findings of the present study show a

13 significant difference in RA, EO, and IO muscle activity when comparing the three types of plank

14 exercises. Additional isometric hip adduction during the plank exercise produced significantly greater

15 abdominal muscle activity compared with the standard plank exercise, and the plank exercise with

16 UIHA showed significantly greater abdominal muscle activity than the standard plank exercise with

17 BIHA.

18 In the present study, EMG activity of the abdominal muscles, including RA, EO, and IO, was

19 significantly greater when the plank exercise was combined with UIHA and BIHA compared with the

20 standard plank exercise (p < 0.05). There are three possible reasons that greater abdominal muscle

21 activation occurred during the plank exercise with isometric hip adduction. First, abdominal muscles

22 counteract to the same magnitude, but in the opposite direction for anticipatory postural control when

23 the limbs are moved. Mullington et al. (2009) has reported that shoulder abduction promotes

24 contralateral abdominal muscle activity to control the generated ipsilateral trunk lateral flexion. Based

9
 1 on previous findings, it seems logical that hip adduction facilitates the ipsilateral abdominal muscle to

2 create predictable perturbation by hip adduction. This leads to an increase in abdominal muscle

3 activity. Second, additional isometric hip adduction can generate additional perturbation. During the

4 plank exercise, perturbation generated from the additional hip adduction increased the requirement of

5 the abdominal muscle activity to maintain the neutral position. Park et al. (2014) has reported that

6 additional hip abduction and adduction during the bridge exercise was significantly greater in the RA,

7 IO, and multifidus muscles compared with the bridge exercise alone. Third, isometric hip adduction

8 during the plank contributes to the delivery of forces to the ipsilateral IO and contralateral EO because

9 the hip adductor is linked with the connected ipsilateral IO (Snijders et al., 1993; Vleeming et al.,

10 1995). As a result, the contraction of the hip adductor may affect the activation of the trunk muscles

11 (Park et al., 2014). Thus, our results suggest that additional isometric hip adduction may be beneficial

12 to increase abdominal muscle activity during the standard plank exercise.

13 In the present study, left RA, EO, and IO muscle activity was significantly increased in the plank

14 with UIHA compared with the plank with BIHA (p < 0.05). Unilateral limb movement destabilizes the

15 torque and the trunk muscles must counteract this instability (Behm et al., 2005). During the plank

16 exercise with BIHA, one-sided isometric hip adduction decreases the destabilizing torque of the

17 contralateral isometric hip adduction. However, performing a left isometric hip adduction during the

18 plank exercise induces a greater right trunk lateral bending moment because there is no counter force,

19 such as contralateral isometric hip adduction. This may have contributed to the increased left

20 abdominal muscle activity. Behm et al. (2005) reported that the unilateral dumbbell press significantly

21 increases the lumbosacral and the upper lumbar erector spinae, and the lower abdominal muscle

22 activity compared to the bilateral dumbbell press in healthy subjects. They suggested that the

23 imbalanced movement caused by the resistance of the unilateral arm outer base of support would

24 result in a destabilizing torque that was countered by the activation of the contralateral trunk muscles.

25 In our findings, the EMG results from the right EO and IO muscles were also significantly greater

10
 1 during the plank with UIHA than the plank with BIHA (p < 0.05). Because the IO and EO muscle

2 contribute to the stability of the trunk and pelvis (Stevens et al., 2007) the activity of the IO muscle

3 increases the intra-abdominal pressure, which is an important trunk stabilizer during various dynamic

4 activities (Juker et al., 1998) because this muscle is linked to the thoracolumbar fascia and IO

5 contraction represents activity of the Transverse abdominis. Also, the activity of the EO muscle

6 controls the upright posture (Lee et al., 2013), and this action may prevent hyper thoracic kyphosis

7 during the plank exercise. Lee et al. (2013) reported that paretic EO muscle activity was significantly

8 increased compared with non-paretic EO during non-paretic shoulder extension and horizontal

9 abduction for maintaining the upright posture in stroke patients. The plank with UIHA requires

10 additional trunk stabilizers including IO and EO for postural control compared with BIHA. Thus, the

11 IO and EO activity may be greater in the plank exercise with UIHA. Therefore, our results suggest

12 that the plank with UIHA may be useful to increase abdominal core muscle activity compared with

13 BIHA.

14 There was no significant difference between BIHA and UIHA in the right RA activity. UIHA

15 would generate destabilizing torque causing contralateral bending and the ipsilateral trunk muscles

16 must counteract this to maintain the trunk stability. However, because the right RA muscle is the

17 contralateral abdominal muscle, the BIHA and UIHA showed no difference in the right RA activity.

18 Many therapists and clinicians use the general plank exercise to increase core muscle activity and

19 many studies have determined the effect of the various types of plank exercise. However, there is a

20 lack of research investigating the exercise method for increasing specific muscle activity. Based on

21 our findings, increases in EMG activity of IO and EO muscles during the plank exercises with BIHA

22 and UIHA, plank exercise with additional isometric hip adduction may be used as a core stability

23 program, especially for increasing the muscle activity of the IO and EO muscles.

24 Our study had some limitations. First, young and healthy men were enrolled in this study and the

25 sample size was small. Thus, our results may not be generalizable to the wider population. Second,

11
 1 this study used a crossover design. Further studies are needed to identify the long-term effects of

2 additional isometric hip adduction on abdominal muscle activity. Third, although we made an effort to

3 maintain the alignment of the spine and hip during the three types of plank exercises, we were unable

4 to present quantitative data, regarding for example how much of the spine maintains a neutral

5 position. Forth, we measured MVIC using manual resistance. Finally, it is difficult to exclude

6 completely the effects of other characteristics of the participants (e.g., leg length, body mass and hip

7 adductor strength) on our findings.

9 5. Conclusions

10 We investigated the effects of additional isometric hip adduction during the plank exercise bilaterally

11 on the RA, EO, and IO. All abdominal muscle activity was significantly greater during the plank

12 exercise with isometric hip adduction compared with the standard plank exercise, and RA, EO, and IO

13 muscle activity was significantly greater with UIHA than BIHA, with the exception of the right RA.

14 According to these findings, additional isometric hip adduction during the plank exercise is an

15 effective method for promoting abdominal muscle activity, and the plank with UIHA is a more

16 favorable method than the plank with BIHA. Thus, we recommend that the plank exercise begins with

17 the standard plank exercise, progressing to the plank exercise with BIHA, and finally to the plank

18 exercise with UIHA to increase the trunk stability by facilitating abdominal core muscle activation in

19 healthy subjects.

20

21 References

22 Aruin AS, Latash ML. Directional specificity of postural muscles in feed-forward postural reaction

23 during fast voluntary arm movements. Exp Brain Res 1995;103(2): 323-32.

24 Behm BG, Leonard AM, Young WB, Bonsey WA, MacKinnon SN. Trunk muscle

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 1 electromyographicactivity with unstable and unilateral exercises. J Strength Cond Res

2 2005;19(1):193-201.

3 Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. ActaOrthopScandSippl

4 1989;230:1-54.

5 Choi SA, Cynn HS, Yi CH, Kwon OY, Yoon TL, Choi WJ, et al. Isometric hip abduction using a

6 Thera-Band alters gluteus maximus muscle activity and the anterior pelvic tilt angle during

7 bridging exercise. J ElectromyogrKinesiol 2015;25(2):310-5.

8 Cram JR, Kasman GS, Holtz J. Introduction to surface electromyography. Gaithersburg: Aspen

9 Publishers, 1998.

10 Czaprowski D, Afeltowicz A, Gebicka A, Pawlowska P, Kedra A, Barrios C, et al. Abdominal muscle

11 EMG-activity during bridge exercises on stable and unstable surfaces.PhysTher Sport

12 2014;15(3):162-8.

13 Hodges P, Cresswell A, Thorstensson A. Preparatory trunk motion accompanies rapid upper limb

14 movement. Exp Brain Res 1999;124(1):69-79.

15 Juker D, McGill S, Knopf P, Steffen T. Quantitative intramuscular myoelectric activity of lumbar

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18 Kendall FP, McCreary EK. Muscles: testing and function. 5th ed. Baltimore: Williams & Wilkins,

19 2005.

20 Kim MJ, Oh DW, Park HJ. Integrating arm movement into bridge exercise: effect on EMG activity of

21 selected trunk muscles. J ElectromyogrKinesiol 2013;23(5):1119-23.

22 Lee DK, Kang MH, Kim JW, Kin YG, Park JH, Oh JS. Effects of non-paretic arm exercises using a

23 tubing band on abdominal activity in stroke patients. NeuroRehabilitation 2013;33(4):605-10.

24 Lehman GJ, hoda W, Oliver S. Trunk muscle activity during exercises on and off a Swiss ball.

25 ChiorprOsteopat 2005;13:14.

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 1 McGill S. Low back disorders: evidence-based prevention and rehabilitation.2nd ed. Champaign:

2 Human Kinetics, 2007.

3 McGill S.Core training: evidence translating to better performance and injury prevention. J Strength

4 Cond Res 2010;32(3):33-46.

5 Mullington CJ, Klungarvuth L, Catley M, McGregor AH, Strutton PH. Trunk muscle responses

6 following unpredictable loading of an abducted arm. Gait Posture 2009;30(2):181–6.

7 Neumann DA.Kinesiology of the musculoskeletal system: foundations for rehabilitation. 2nd ed. St

8 Louis: Mosby, 2010.

9 Park KH, Ha SM, Kim SJ, Park KN, Kwon OY, Oh JS. Effects of the pelvic rotatory control method

10 on abdominal muscle activity and the pelvic rotation during active straight leg raising.Man Ther

11 2013;18(3):220-4.

12 Park HJ, Oh DW, Kim SY. Effects of integrating hip movements into bridge exercises on

13 electromyographic activities of selected trunk muscles in healthy individuals. Man Ther

14 2014;19(3):246-51.

15 Peterson DD. Proposed performance standards for the plank for inclusion consideration into the

16 navy’s physical readiness test. J Strength Cond Res2013;35:22-6.

17 Schellengerg et al. (2007) have showed that abdominal muscles activity is increased much higher than

18 back extensor during plank exercise and this exercise is appropriate exercise for abdominal

19 muscle.

20 Snarr RL, Esco MR. Electromyographical comparison of plank variations performed with and without

21 instability devices. J Strength Cond Res 2014;28(11):3298-305.

22 Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and leg.

23 1:biomechanicsof self-bracing of the sacroiliac joints and its significance for treatment and

24 exercise. ClinBiomech (Bristol Avon) 1993;8(6):285-94.

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 1 Stevens VK, Bouche KG, Mahieu NN, Coorevits PL, Vanderstraeten GG, Danneels LA. Trunk muscle

2 activity in healthy subjects during bridging stabilization exercises. BMC MusculoskeletDisord

3 2006;20(September):75.

4 Stevens VK, Vleeming A, Bouche KG, Mahieu NN, Vanderstraeten GG, Danneels LA.

5 Electromyographic activity of trunk and hip muscles during stabilization exercise in four-point

6 kneeling in healthy volunteers. Eur Spine J 2007;16(5):711-8.

7 Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ. The posterior layer

8 of the thoracolumbar fascia: its function in load transfer from spine to legs. Spine (Phila Pa

9 1976) 1995;20(7):753-8.

10

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13 The English in this document has been checked by at least two professional editors, both
14 native speakers of English. For a certificate, please see:
15

16 http://www.textcheck.com/certificate/h0RYqs
17

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 1
2 Soo-yong Kim
3

4
5

6 Min-hyeok Kang

9 Eui-ryong Kim
10

16
 1
2 In-gui Jung
3

6
7

8 Eun-young Seo

10

11

17
1

2 Jae-seop Oh

18
 1

2 Soo-yong Kim received his Master’s degree in physical therapy from Inje University, Gimhae,
3 Republic of Korea since 2015, and is the doctor’s course in Rehabilitation Science at the Inje
4 University. He is currently doing research in the Physical Performance & Movement Science
5 (PP&MS) laboratory. His research focuses on the evaluation and therapeutic exercise in
6 musculoskeletal disorder.

9 Min-hyeok Kang earned Ph.D. in department of Rehabilitation Science from Inje University,
10 Gimhae, Republic of Korea, in 2012 and is now a post-doctoral researcher in Physical Therapy at Inje
11 University. His research interests include gait analysis, 3-D motion analysis, postural and movement
12 analysis, and movement system impairment syndrome.

13

14

15 Eui-ryong Kim received a master’s degree in Health Science from Inje University (Busan, Republic
16 of South Korea) in 2006, he graduated in 2015 as a doctorial in Rehabilitation Sciences and Physical
17 Therapy, at the University of Inje (Kimhae, Republic of South Korea). He has been worked Redcord
18 exercise center from 2003, and he is primarily interested in the evidence based physical therapy,
19 biofeedback movement training & movement science, and informed-decided intervention.
20

21

22 In-gui Jung earned his Master's degree in science in physical therapy from Inje University, Gimhae,
23 Republic of Korea, in 2016. He is currently doing research in the movement science laboratory. He is
24 involved in the research of postural and movement analysis.
25

26

27 Eun-young Seo Eun-young Seo is a MPH student in the Department of physical therapy at the
28 Graduate School of Public Health, Inje University, Pusan, Republic of Korea. Her research interests
29 biofeedback training and therapeutic exercise for stroke.

30

31

32 Jae-seop Oh received the Ph.D. in Physical Therapy Treatments for Musculoskeletal Disorders from

19
1 the Yonsei University, the Republic of Korea, in 2008. He is currently assistant professor in the

2 department of Physical Therapy at Inje University in Gimhea, Gyeongsangnam-do, Republic of

3 Korea. He is working as the main researcher of National Research Foundation of Korea for lumbar

4 stabilization research. His research interests include movement impairmrnt syndrome, movement

5 science, and lumbopelvic stability in physical therapy.

20
1 Table 1
2 EMG activities of bilateral abdominal muscles during each plank exercise

Type
Muscle F P
Plank with Plank with
Plank
BIHA UIHA
Rt. 38.83±16.43 43.41±20.03 46.19±18.19 6.59 0.010*
RA
Lt. 41.16±18.19 48.77±18.16 55.46±17.51 13.51 0.001*

Rt. 42.47±10.66 47.78±12.35 55.50±13.14 9.06 0.003*

EO
Lt. 43.52±13.31 48.68±15.14 55.10±18.02 9.37 0.003*

Rt. 29.16±14.10 32.87±17.25 39.45±19.93 5.50 0.017*

IO
Lt. 34.18±13.17 40.18±17.80 43.56±17.76 9.57 0.002*
3 BIHA: bilateral isometric hip adduction, EO: external oblique, IO: internal oblique, Lt.: left, RA;
4 rectus abdominis, Rt.: right. UIHA: unilateral isometric hip adduction

5 *: p<0.05
6
7

21
1 Table 2
2 Comparison between types of plank exercise

Muscle Side Type comparison P

RA Rt. plank vs plank with BIHA 0.016*

plank vs Plank with UIHA 0.003*

plank with BIHA vs Plank with UIHA 0.179

Lt. plank vs plank with BIHA 0.004*

plank vs PIUHA <0.001*

plank with BIHA vs Plank with UIHA 0.026*

EO Rt. plank vs plank with BIHA 0.033*

plank vs Plank with Plank with UIHA 0.001*

plank with BIHA vs Plank with UIHA 0.001*

Lt. plank vs plank with BIHA 0.005*

plank vs Plank with UIHA 0.001*

plank with BIHA vs PIUHA 0.023*

IO Rt. plank vs plank with BIHA 0.022*

plank vs Plank with UIHA 0.004*

plank with BIHA vs Plank with UIHA 0.006*

Lt. plank vs plank with BIHA 0.003*

plank vs Plank with UIHA <0.001*

plank with BIHA vs Plank with UIHA 0.027*

3 BIHA: bilateral isometric hip adduction, EO: external oblique, IO: internal oblique, Lt.: left, RA;
4 rectus abdominis, Rt.: right. UIHA: unilateral isometric hip adduction
5 *: p<0.05

22
1

2 Fig. 1. General plank exercise.

23
1

2 Fig. 2. In the starting position, participants performed bilateral hip abductions with a 40 cm distance fr

3 om the neutral position. For the plank with the bilateral isometric hip adduction, participants adducted

4 both hips to the neutral position, so that the Thera-Band was stretched as much as 40 cm.

24
1

2 Fig. 3. In the start position, participants performed left hip abductions with 40 cm of distance

3 from neutral position. For plank with unilateral isometric hip adduction, participants adducted

4 left hip to neutral position, so that Thera band was stretched as much as 40 cm.

25
1

2 Fig. 4. Comparison of abdominal muscle activity between conditions (BIHA: Bilateral isometric hip
3 adduction; Lt.: Left; Rt.: Right; UIHA: Unilateral isometric hip adduction) Rectus abdominis, (B)
4 external oblique, (C) internal oblique. *p < 0.05

26