Electromyography

Who else wants to jump in here? Dave, what do you got?

My just quick thought is that I think it's really important to do an objective strength assessment to figure out what specifically somebody has a deficit in and then use research with EMG activity to get a little more volume.

Because like, if you want to get your quad stronger, so say like you're an Olympic lifter and you want to get your quad stronger to squat heavier in a competition, um, you wouldn't do one or one exercise, three sets of eight.

And that's the only thing you do for your quads, maybe twice a week, right? And if you think about some of the shoulder programs that we give people, I think sometimes they know sidelining external rotation is important, but they're literally doing like one exercise that's generically seen online.

If you really want to target the posterior cuff, I think it's good to have two to three exercises that are overlapping in EMG activity.

So sidelining, if you're prone, you, if you can do it, like you can change the scaption angle, like I think it's important to mix in a couple of different exercises in different planes for like the highest EMG and do those in more volume because you're not going to add like to your guys point, you're not going to just be like, you know, only load ever is the only thing I think about.

I think like volume density that doesn't really get thought about a lot with shoulder cuff exercises, but we give people programs that it's like five to six exercises all straight through in two or three sets in a row because we're trying to build a lot of volume in a short amount of time.

And I think that like sometimes people just do like one set or one exercise sideline ER twice a week, three sets of eight.

Electromyogram.

Yeah, EMG.

No, you got it.

EMG.

Okay, thank you.

So here's the thing.

If they have classical skin features and they have elevated CKs, I'm often happy to stop there.

The additional testing comes in if we're unsure, if we need to document it for other reasons, whether it's you know, God help us insurance access to a medication, which sometimes comes up with IVIG and some other things.

Is there things that mentally could be causing your pain, mentally that could be causing stress, mentally that could be causing inflammation, where when nerves are inflamed, there's not going to be a lab test that shows us that all the time.

There's EMG tests.

We can measure nerve conduction studies.

That gives us a little information about whether the nerves have been damaged.

day

after day in the EMG lab.

And Chris, it's great to have you on this lessons.

So welcome.

Yeah, it's a great one to work through.

Yeah.

You know, it made me think, and it was a challenging case, but it made me think about just when we educate in general and when we teach and we go through cases and you look at textbooks and or any EMG resource, most of the cases that are presented are classic.

They're the classic cases, the classic on and off, the classic carpal tunnel.

So now we have a back-to-back study as far as which exercise is more effective at activating this very important intrinsic muscle, the abductor hallucis.

And then the conclusion of this study was that short foot exercise, this was through EMG studies, electromyograph studies, short foot exercise is more useful strengthening the foot through the increased activation of the abductor hallucis and therefore it could be concluded to help in the prevention of lowering or falling of medial arches so that was a comparison of towel crunches versus short foot.

So if you had to choose one, I would choose one that shows higher EMG activity to the abductor hallucis.

Here's another study.

This is looking at the effect of foot orthotics and short foot exercise at the hypertrophy of the abductor hallucis.

This is something that is always looked at as used in combination with strengthening our feet.

So here is a study that is actually just demonstrating through cadaver the actual effect of abductor hallucis on the medial arch.

So does the abductor hallucis actually lift the medial arch? Meaning, if we've done an EMG study that showed that short foot strengthens abductor hallucis, could we then say short foot, because it strengthens abductor hallucis, can lift your arch? That's the conclusion we're trying to make.

And, and you got a 50/50 shot on that.

But, um, we use surface EMG.

So-

Oh, wow, okay

... you can also fake that, but it's a little bit easier for us to...

Uh, you, surface EMG, which is called p- biofeedback, and in this specific space, perineal biofeedback, which Medicare covers, Tricare cov- you know, a lot of these insurances do cover if you have it all...

You know, you gotta do it all correctly-

Right, right, right

And about 20 years ago, there was a study in ophthalmologists, not oculofacial surgeons, ophthalmologists, and they found that performing more than four cases a week or seeing more than 100 patients in a clinic a week was associated with increased neck, upper extremity, and lower back symptoms.

And then the Surface EMG studies by Anna Kitzman and her colleagues really showed increased muscular activity in the anterior deltoid and the upper trapezius with slit lamp exam and indirect ophthalmoscopy.

You know, the last thing I would add is that there are other activities

that are influencing your risk for neck injury.

Visualization can be super difficult, right? So just walk me through a little bit of what you think are the unique inside the OR aspects for oculofacial surgeons when it comes to ergonomic risk.

Well, you know, a number of years ago, we actually, similar to what Linda was talking about, objectively looked at postures in the operating room.

And we collected 3D kinematic data, as well as surface EMG from three oculoplastic surgeons, all of different body habitus.

short, tall, a female, two males, while they perform surgery.