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The Andrews/Paulos Research and Education Institute – Preface
The Andrews/Paulos Research and Education Institute (APREI) recently concluded testing and compiled results of a comprehensive surface EMG (electromyography) study focusing on specific muscles to measure and evaluate their reaction to inward and outward rotation of the hip.
The research study is attached in its entirety in the tab entitled Andrews/Paulos EMG Research Study. It is appreciated that research jargon is sometimes difficult to interpret, therefore significant points of interest and analytical impressions are included in this preface.
The study focus and protocols were originally dictated by several leading physical therapists to compare Rotex with the most common exercises for hip rehabilitation performed with flexible tubing. Although commonly used in general practice, the existing flexible tubing exercises are executed in either a seated or prone position, with either the hip and/or knee bent to 90° and thus non-weight bearing and non-functional.
The internal and external rotation for both the seated and prone flexible tubing exercises exhibited high contraction values for two specific muscles each. But it is important to note, in each exercise, a pre-stress load was put on those muscles. To explain, taut flexible tubing was attached to the ankle at a 90° angle before the exercise began, so the muscles involved were already working to hold the joint steady well before the EMG values were recorded. Please see pictures at the end of the research study.
Conversely, the Rotex exercises performed in the study are highly functional exercises, all done in a standing, close packed position (close packed is when bones of a joint are put into a position where they have as much surface area possible aligned with their opposing bone). Rotex showed high EMG activity on all nine muscles originally selected for the study (two others were added to satisfy the curiosity of the researcher). Also, all of the muscles tested were completely relaxed prior to the start of the exercise, so there were no pre-stressed positions on the Rotex.
The following quote is the CONCLUSIONS at the end of the research study as written by Rafael F. Escamilla, Ph.D., P.T., C.S.C.S., F.A.C.S.M., Director of Research, Andrews-Paulos Research and Education Institute:
“The Rotex device was significantly more effective in recruiting total trunk and hip musculature compared to traditional sitting or prone position hip IR and ER exercises. Overall, the Rotex device was significantly more effective than the tubing exercises in recruiting internal oblique, external oblique, rectus abdominis, lumbar paraspinal, gluteus maximus, and medial hamstring musculature.”
We at Rotex have been working for the past few years with hundreds of people and athletes directly, and thousands indirectly (university, Olympic and professional teams and clinics who use the machine for a host of different functions for their athletes, patients and clients). Here are some of the things we either learned or substantiated through this study:
Note: This is how to read the EMG activity in Table 1 of the research (separate attachment and included in the entire research study). There are two numbers, side by side, for each muscle’s EMG activity. The left is the percent of maximum contraction of the muscle. For example, in 20±12, the 20 on the left of the ± means the muscle contracted to 20% of its full potential. The 12 on the right of the ± means basically that of the 14 people tested in the study, there was a dispersion of 12. In other words, to get a 20% average contraction, one person may have had EMG activity of 14% of maximum, while another may have had 26% of maximum, with all the other participants within that range. That is the simplified version, but I think it should work to help most to have a basic understanding of standard deviation (SD).
- Please see EMG Table 1, Row b), under Internal Oblique. In internal hip rotation, the internal oblique has high EMG activity. Internal oblique works in conjunction with and research confirms is nearly impossible to separate from both the transverse abdominis and the multifidus muscles, so if there is a strong contraction of one, there is a strong contraction of the other two. The significance here is these three muscles are considered the inner core of the body and there is a dramatic contraction of these muscles in internal hip rotation on Rotex.
The internal oblique, transverse abdominis, and multifidus are all either obliquely or transversely oriented in relation to the ground. To properly train any muscle for strength, speed or endurance, the muscle fibers must be properly aligned with the force of resistance or weight. For example, when training the biceps of the arm, as in a biceps curl, the elbow is bent up and down in a straight line with the muscle fibers of the biceps. Due to their oblique or transverse alignment, the inner core muscles are most effectively trained while resisting rotation, since they are considered stabilizers, not movers.
The transverse abdominis’ action, as described in texts and research, is to form a girdle to protect the spine, in exercises such as pulling the navel in toward the spine, a yelling action or a straining action. To our knowledge, it has never been considered a muscle that has the action to resist rotation, but in fact, its muscle fibers align in the transverse plane, which are aligned more perfectly than any others in the trunk region to resist rotation. Since most injuries occur when the body is engaged in some sort of rotation, this has huge implications.
- Please see EMG Table 1, Rows b) and f), under Rectus Abdominis, External Oblique, Internal Oblique (Transverse Abdominis and Multifidus implied), and Lumbar Paraspinal. As described by Stuart McGill in Ultimate Back Fitness and Performance, the ability to create abdominal bracing and superstiffness in any dynamic athletic or work activity is paramount for injury prevention and superior performance. The same muscles he has documented are needed to create full abdominal bracing, and in fact superstiffness, show strong EMG activity in both the internal and external hip rotation exercises on Rotex, while maintaining a posterior pelvic tilt. To note, as these muscles are being trained to resist rotation, the nervous system is learning how to create superstiffness.
- Please see EMG Table 1, Row b), under Medial Hamstrings. In Internal Hip Rotation with a posterior pelvic tilt, there is a strong contraction of the Medial Hamstrings. Texts and research list these muscles as working in conjunction with a few others to create internal rotation of the hip and thigh (as a matter of fact, they have oblique fibers to create or resist rotation), but to our knowledge, they have never been targeted for strengthening in this method. The significance here is that the medial hamstrings stabilize and protect the medial knee. Any weakness in this area will subject the knee to possible ACL, MCL or other injuries.
- Please see EMG Table 1, Row b), under Gluteus Medius. Gluteus Medius, specifically the part of it that assists in turning the hip inward, has traditionally been trained in abduction (that is when the hip is brought out away from the body). However, most actions of the hip in athletic or dynamic activity are in rotation, not abduction. Training the hip in rotation while in a one leg standing, weight bearing position is a most functional exercise for the gluteus medius. Since hip rotation is involved in virtually every activity, this has great implications.
- Please see the difference in EMG activity in EMG Table 1, between Row b), under Internal Oblique and Row b), under External Oblique. Then compare those values with the same muscles in Row f). Especially in the case of a person with an anterior pelvic tilt, External Oblique is highly involved in low back and hip pain, as it is actually stronger than its counterparts, the inner core muscles (internal oblique, transverse abdominis and multifidus). A person with an overly strong and facilitated external oblique usually develops pain, stiffness or strain in the low back at the top, outside of the pelvis, just below the lowest rib. To our knowledge, there is no other exercise that will actively strengthen the muscles of the inner core and at the same time inhibit (relax) the same side external oblique. This is most likely the reason that the majority of people who use the Rotex feel a dramatic release in and around the low back and hip area immediately after use, which becomes permanent with consistent use.
The above preface to the study is the personal, professional observation and interpretation of Dr. Joe LaCaze, based on two and a half years of clinical experience, demonstration, testing and personal use of Rotex. Please also note this research was done on only two of the seven possible exercises performed on the Rotex.
We wish to thank Andrews/Paulos Research and Education Institute (APREI) and Dr. Rafael Escamilla for accepting, designing and conducting this EMG study of the Rotex and comparison with flexible tubing. We also would like to thank the people who volunteered as subjects for the study.
Blu Sky Solutions, the parent company of Rotex, is in no way associated with APREI and did not participate in the research study in any way except to supply a Rotex machine for the duration of the study, and training thereof, to Dr. Escamilla so he could instruct the subjects of the study.
As always, we invite questions, observations and recommendations to Blu Sky Solutions on the Rotex.
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*Rotex, used in this study as the only variant between the Experimental and Control Group, provides a superior platform to train and strengthen the muscles that rotate and stabilize the hips and shoulders. It has proven to be an important component of strength training, targeting both the mechanical and neuromuscular systems. Rotex has been tested and proved to restore range of motion to the hip and shoulder joint, as well as prevent or reduce several athletically induced injuries. It has also been used in the reduction of Lower and Upper Crossed Syndromes with superior results.
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