Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning

Abstract

The aim of the study was to investigate the uniformity of the muscle motor point location for lower limb muscles in healthy subjects. Fifty-three subjects of both genders (age range: 18-50 years) were recruited. The muscle motor points were identified for the following ten muscles of the lower limb (dominant side): vastus medialis, rectus femoris, and vastus lateralis of the quadriceps femoris, biceps femoris, semitendinosus, and semimembranosus of the hamstring muscles, tibialis anterior, peroneus longus, lateral and medial gastrocnemius. The muscle motor point was identified by scanning the skin surface with a stimulation pen electrode and corresponded to the location of the skin area above the muscle in which an electrical pulse evoked a muscle twitch with the least injected current. For each investigated muscle, 0.15 ms square pulses were delivered through the pen electrode at low current amplitude (<10 mA) and frequency (2 Hz). 16 motor points were identified in the 10 investigated muscles of almost all subjects: 3 motor points for the vastus lateralis, 2 motor points for rectus femoris, vastus medialis, biceps femoris, and tibialis anterior, 1 motor point for the remaining muscles. An important inter-individual variability was observed for the position of the following 4 out of 16 motor points: vastus lateralis (proximal), biceps femoris (short head), semimembranosus, and medial gastrocnemius. Possible implications for electrical stimulation procedures and electrode positioning different from those commonly applied for thigh and leg muscles are discussed.

Electrical stimulation for neuromuscular testing and training: state-of-the art and unresolved issues

“…We recommend that the procedure described by Gobbo et al (2011), which is completed in less than a minute, should be consistently incorporated in both clinical and research contexts to optimize NMES application. Botter et al (2011) investigated the uniformity of the muscle motor point location in the lower limb of healthy subjects and found different motor points innervating different portions of the quadriceps, posterior thigh, and tibialis anterior muscles. On this basis, they suggested that a maximization of the spatial recruitment during NMES could also be obtained through a multi-channel stimulation technique that involves a non-synchronous activation of different muscle volumes.…”

“…In order to maximize the spatial recruitment during NMES, thus minimizing the extent of muscle fatigue, it has been recommended to implement different expedients during a treatment session such as progressive increase in current intensity, alteration in muscle length, and displacement of active electrodes (Maffiuletti 2010). In this cluster of articles, further approaches have been proposed to alleviate, at least in part, discomfort and other possible complications associated to the electrically evoked contractions (Botter et al 2011;Bergquist et al 2011;Gobbo et al 2011). Fig.…”

Evaluation of the neuromuscular compartments in the peroneus longus muscle through electrical stimulation and accelerometry

“…For example, the peroneus longus muscle stabilizes the frontal plane through the eversion action of the foot. The direct or indirect dysfunction of the peroneus longus muscle requires a rehabilitation process that includes various interventions, such as proprioception, neuromuscular and strength training 16 , neuromuscular electric stimulation (NMES) 17 , functional electric stimulation (FES) 18 , and implantable stimulators of the fibular nerve 19 , among others. Interventions based on electrical principles take advantage of the physiological characteristics of muscles and nerves to generate therapeutic effects.…”

Comparison Study about Surface Mapping of Motor Points in Biceps Brachii Muscle Using Surface EMG and Electric Probe

“…운동점의 위치 탐색에 관해서는 많은 연구들이 보고되고 있는데, 해부학적인 방법 [8][9][10][11] , 조직학적인 염색 방법 12,13) , 전기적인 방법 1,2,14,15) …”