Effects of 6-week CKC Training on Proprioception and Electrical Activity of Some Lower Extremity Muscles in Females with Generalized Joint Hypermobility Syndrome

Document Type : Research Paper


1 MSc in Sport Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran

2 Assistant Professor, Department of Biomechanics and Sport Injuries,Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran

3 Assistant professor, Department of Sport Sciences, School of Education and Psychology, Shiraz University, shiraz,Iran


Effects of 6-week CKC Training on Proprioception and Electrical Activity of Some Lower Extremity Muscles in Females with Generalized Joint Hypermobility Syndrome
Generalized joint hypermobility syndrome causes abnormality, knee joint injury and instability. It has also been reported to have a deficit in the joint position sense and differences in the level of muscle activity. The purpose was to determine the effect of closed-kinetic-chain training on proprioception and the electrical activity of some lower extremity muscles in hypermobile females. Twenty-four females with generalized joint hypermobility syndrome participated voluntarily in this study. The subjects were randomly divided into Control and experimental groups. The muscle activity of the some lower extremity muscles; vastus medialis, rectus femoris, vastus lateralis, semitendinosus, biceps femoris and medial gastrocnemius was measured during drop landing by surface electromyography and knee position sense error via Imaged-based goniometry. Then experimental group performed training program for six weeks. Finally Shapirovilk test and covariance was used to data analyzing. The results showed, the closed-kinetic-chain training improves proprioception and the level of feed-forward activity of the Vastus medialis, Vastus lateralis, semitendinosus and medial gastrocnemius and the feedback muscle activity of Vastus Medialis and Vastus lateralis increased significantly. We concluded, the closed-kinetic-chain training can be considered as a safe and effective training method to improve the essential factors for stability of joints in the hypermobile females.
CKC training, Electromyography, Generalized joint hypermobility syndrome, instability, joint position sense


1. Grahame R, Keer R. (2003). ''Hypermobility Syndrome: Recognition and Management
for Physiotherapists: Butterworth Heinemann''. PP: 103.
2. Simmonds JV, Keer RJ. (2007). ''Hypermobility and the hypermobility syndrome''.
Manual therapy. 12(4): PP: 298-309.
3. Strunk R, Pfefer MT, Andrews L. (2012). ''The diagnosis of benign joint hypermobility
syndrome in two female patients with chronic pain''.
4. Simpson MR. (2006). ''Benign joint hypermobility syndrome: evaluation, diagnosis, and
management''. Journal American osteopathic association. 106(9): PP: 53-60.
5. Shah Y, Bhave A, Sonetha V. (2015). ''Fatigue Analysis of the Knee Joint. Procedia
Computer Science''. 45: PP: 250-255.
6. Malik A, Ferrell W. (1994). ''Impaired proprioceptive acuity at proximal inter phalangeal
joints in patients with hypermobility''. Br J Rheumatic. 33: PP: 631-637.
7. Jensen BR, Olesen AT, Pedersen MT, Kristensen JH, Remvig L Simonsen EB, et al.
(2013). ''Effect of generalized joint hypermobility on knee function and muscle activation
in children and adults''. Muscle Nerve. 48(2): PP: 762–769.
8. Juul-Kristensen B, Johansen K, Hendriksen P, Melcher P, Sandfeld J, Jensen BR. (2015).
''Girls with generalized joint hypermobility display changed muscle activity and postural
sway during static balance tasks''. Scandinavian journal of rheumatology. 20(2): PP: 1-9.
تأثیر 6 هفته تمرینات زنجیرة حرکتی بسته بر حس عمقی و فعالیت الکتریکی برخی عضلات اندام ... 257
9. Medina, J. M., McLeod, T. C. V., Howell, S. K., &Kingma, J. (2008). ''Timing of
neuromuscular activation of the quadriceps and hamstrings prior to landing in high school
male athletes, female athletes, and female non-athletes''. Journal of Electromyography and
Kinesiology. 18(4): PP: 0591-597.
10. Kemp S, Roberts I, Gamble C, Wilkinson S, Davidson JE, Baildam EM, et al. (2010). ''A
randomized comparative trial of generalized vs targeted physiotherapy in the management
of childhood hypermobility''. Rheumatology (Oxford, England). 49(2): PP: 315-25.
11. Ferrell, W. R., Tennant, N., Sturrock, R. D., Ashton, L., Creed, G., Brydson, G., Rafferty,
D. (2004). ''Amelioration of symptoms by enhancement of proprioception in patients with
joint hypermobility syndrome''. Arthritis & Rheumatology. 50(10): PP: 3323-3328.
12. Keer R, Simmonds J. (2011). ''Joint protection and physical rehabilitation of the adult
with hypermobility syndrome''. Current opinion in rheumatology. 23(2): PP: 131-136.
13. Snyder-Mackler, L. (1996). ''Scientific rationale and physiological basis for the use of
closed kinetic chain exercise in the lower extremity''. Journal of Sport rehabilitation. 5(1):
PP: 2-12.
14. Lass, P., Kaalund, S., Iefevre, S., Arendt-Nielsen, L., Sinkjæ, T., &Simonsen, O. (1991).
''Muscle coordination following rupture of the anterior cruciate ligament:
electromyographic studies of 14 patients''. Act an orthopedic Scandinavia. 62(1): PP: 9-
15. Henning, C. E., Lynch, M. A., & Glick JR, K. R. (1985). ''An in vivo strain gage study of
elongation of the anterior cruciate ligament''. The American journal of sports medicine.
13(1): PP: 22-26.
16. Wood, L., & Ferrell, W. (1985). ''R.Response of slowly adapting articular
mechanoreceptors in the cat knee joint to alterations in intra-articular volume''. Annals of
the rheumatic diseases. 43(2): PP: 327-332.
17. Junge T, Wedderkopp N, Thorlund J, Søgaard K, Juul-Kristensen B. (2015). ''Altered
knee joint neuromuscular control during landing from a jump in 10-15 year old children
with Generalized Joint Hypermobility'' A sub study of the CHAMPS-study Denmark. J
Electromyography Kinesiology. 48: PP: 762–769.
18. Stillman, B. C. (2000). ''An investigation of the clinical assessment of joint position
sense'' [PhD Tesis]. Melbourne: The University of Melbourne.
19. SENIAM. From http://www.seniam.org/
20. Webster, Kathryn A., Brian G. (2016). ''Pietrosimone, and Phillip A. Gribble. Muscle
activation during landing before and after fatigue in individuals with or without chronic
ankle instability''. Journal of athletic training. 51(8): PP: 629-636.
21. Konrad, Peter. (2005). ''A Practical Introduction to Kinesiological Electromyography'',
Noraxon INC.
22. Zebis, M. K., Bencke, J., Andersen, L. L., Døssing, S., Alkjær, T., Magnusson, S. P.,
&Aagaard, P. (2008). ''The effects of neuromuscular training on knee joint motor control
during side cutting in female elite soccer and handball players''. Clinical Journal of Sport
Medicine. 18(4): PP: 329-337.
258 طب ورزشی، دورة 9، شمارة 2، پاییز و زمستان 1396
23. Holm, I., Fosdahl, M. A., Friis, A., Risberg, M. A., Myklebust, G., & Steen, H. (2004).
''Effect of neuromuscular training on proprioception, balance, muscle strength, and lower
limb function in female team handball players''. Clinical Journal of Sport Medicine. 14(2):
PP: 88-94.
24. Filipa, A., Byrnes, R., Paterno, M. V., Myer, G. D., & Hewett, T. E. (2010).
''Neuromuscular training improves performance on the star excursion balance test in
young female athletes''. Journal of orthopaedic& sports physical therapy. 40(9): PP: 551-
25. Lephart, S. M., Warner, J. J., Borsa, P. A., & Fu, F. (1994). ''Proprioception of the
shoulder joint in healthy, unstable, and surgically repaired shoulders''. Journal of shoulder
and elbow surgery. 3(6): PP: 371-380.
26. Risberg MA, Mørk M, Jenssen HK, Holm I. (2001). ''Design and implementation of a
neuromuscular training program following anterior cruciate ligament reconstruction''.
Journal of Orthopaedic& Sports Physical Therapy. 31(11): PP: 620-631.
27. Prentice, William E., and Thomas W. Kaminski. (2004). ''Rehabilitation techniques for
sports medicine and athletic training''. New York: McGraw-Hill