Electromyographic analysis of balance exercises in single-leg stance using different instability modalities of the forefoot and rearfoot

Purpose: To investigate the activity of lower extremity muscles in response to single-leg stance on a training device, destabilizing the forefoot while the rearfoot stands on a fixed plate and vice versa compared with a balance pad and the floor. Design: Cross-sectional study. Setting: University's laboratory. Participants: Twenty-seven healthy adults. Methods: Surface electromyography and 2D video analysis were used to record the activity of lower extremity muscles and to control sagittal knee joint angle during single-leg stance trials under one stable control condition and five unstable conditions. Results: The majority of lower extremity muscles were significantly more active when the forefoot was destabilized while the rearfoot remained stable compared with the stable condition and the conditions where the forefoot was stable and the rearfoot unstable (p < 0.001). Mean change of knee joint angle was significantly increased under the conditions rearfoot stable/forefoot unstable (p = 0.001). The soleus muscle activation was significantly increased when balancing on the balance pad (p < 0.001). Conclusions: Increased activity in the majority of lower extremity muscles and sagittal knee joint angles indicate that destabilizing the forefoot while the rearfoot remains stable is the most challenging balance task. Soleus muscle activation increased when performing ankle plantarflexion on the soft balance pad. (C) 2018 Elsevier Ltd. All rights reserved.