The effects of verbal cues on EMG activity during a quadriceps setting exercise

Context A quadriceps setting (quad set) exercise is commonly utilized following knee injury, but there is great variation in cues that clinicians provide to patients when performing the exercise. Objectives To determine if internal, external, or visual cues results in the greatest quadriceps electromyographical (EMG) activity during a quadriceps setting exercise in healthy individuals. Design Descriptive laboratory study Setting University research laboratory Participants Thirty healthy individuals volunteered for this study. Participants were given one of five cues in a randomized order: internal cue “tighten your thigh muscles,” internal cue “push your knee down,” external cue “push into the bolster,” external cue “push into the strap,” or visual biofeedback using the cue “raise the value on the screen as high as you can.” Main Outcome Measures Normalized vastus lateralis EMG activity. Results Both visual biofeedback (83.2±24.9%) and “press into the strap” (76.8±24.4%) produced significantly greater (p< 0.001) EMG activity than the push knee down (53.2±27.0%), tighten thigh (52.7±27.3%), or push into the bolster (50.8±26.3) conditions. There was no significant difference (p= 0.10) between the visual biofeedback and “press into the strap” conditions as well as no significant difference (p> 0.38) between the push knee down, tighten thigh, or push into the bolster conditions Conclusions If the clinical aim during a quadriceps setting exercise is to obtain the greatest volitional muscle recruitment, the use of visual biofeedback or pressing into a strap is recommended.