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J Athl Train. 1999 Apr-Jun; 34(2): 165–176.
PMCID: PMC1322906

Using Surface Electromyography To Assess Sex Differences in Neuromuscular Response Characteristics

Sandra J. Shultz, PhD, ATC, CSCS and David H. Perrin, PhD, ATC



To provide an overview of the continuum of muscular responses that typically occur with joint perturbation. The applications and limitations of surface electromyography (sEMG) in evaluating these responses are also addressed. Research applications assessing sex differences in these neuromuscular response characteristics are discussed along with suggestions for future research.

Data Sources:

MEDLINE was searched from 1969 through 1998. Sport DISCUS was searched from 1975 through 1998. Terms searched included “anterior cruciate ligament,” “epidemiology,” “neuromuscular control,” “neuromuscular performance,” “electromyography,” “latency,” “reflex,” “electromechanical delay,” “dynamic stability,” “intrinsic stiffness,” “short-range stiffness,” “muscle,” “mechanoreceptors,” and “reaction time.”

Data Synthesis:

It is widely accepted that efficient neuromuscular control is essential to dynamic joint stability and protection. Many studies have established the significant role of the muscles, and particularly the hamstrings, in providing knee stability. By observing the timing, phasing, and recruitment of reflexive muscular activation after a loading stress to the knee, we can better understand the coordinative mechanisms necessary to protect the joint and prevent ligament injury. A number of research models have employed the use of sEMG to evaluate neuromuscular responses at the knee after joint loading or perturbation. However, very few studies have specifically addressed potential sex differences in these response characteristics.


From the limited research available, it appears that a sex difference may exist in some aspects of neuromuscular responses. However, further research is needed to explore these differences at the knee and their potential role as predisposing factors to the higher incidence of anterior cruciate ligament injuries in females. Future studies should examine sex differences in neuromuscular response characteristics at the knee under functional, weight-bearing conditions while controlling for training and other confounding variables. The limitations of sEMG should be considered when interpreting neuromuscular response studies.

Full text

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Selected References

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  • Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 1995 Nov-Dec;23(6):694–701. [PubMed]
  • Emerson RJ. Basketball knee injuries and the anterior cruciate ligament. Clin Sports Med. 1993 Apr;12(2):317–328. [PubMed]
  • Engström B, Johansson C, Törnkvist H. Soccer injuries among elite female players. Am J Sports Med. 1991 Jul-Aug;19(4):372–375. [PubMed]
  • Robbins PW, Overbye K, Albright C, Benfield B, Pero J. Cloning and high-level expression of chitinase-encoding gene of Streptomyces plicatus. Gene. 1992 Feb 1;111(1):69–76. [PubMed]
  • Gray J, Taunton JE, McKenzie DC, Clement DB, McConkey JP, Davidson RG. A survey of injuries to the anterior cruciate ligament of the knee in female basketball players. Int J Sports Med. 1985 Dec;6(6):314–316. [PubMed]
  • Zelisko JA, Noble HB, Porter M. A comparison of men's and women's professional basketball injuries. Am J Sports Med. 1982 Sep-Oct;10(5):297–299. [PubMed]
  • Oliphant JG, Drawbert JP. Gender differences in anterior cruciate ligament injury rates in wisconsin intercollegiate basketball. J Athl Train. 1996 Jul;31(3):245–247. [PMC free article] [PubMed]
  • Ferretti A, Papandrea P, Conteduca F, Mariani PP. Knee ligament injuries in volleyball players. Am J Sports Med. 1992 Mar-Apr;20(2):203–207. [PubMed]
  • Gomez E, DeLee JC, Farney WC. Incidence of injury in Texas girls' high school basketball. Am J Sports Med. 1996 Sep-Oct;24(5):684–687. [PubMed]
  • Beckett ME, Massie DL, Bowers KD, Stoll DA. Incidence of Hyperpronation in the ACL Injured Knee: A Clinical Perspective. J Athl Train. 1992;27(1):58–62. [PMC free article] [PubMed]
  • Caraffa A, Cerulli G, Projetti M, Aisa G, Rizzo A. Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):19–21. [PubMed]
  • Harner CD, Paulos LE, Greenwald AE, Rosenberg TD, Cooley VC. Detailed analysis of patients with bilateral anterior cruciate ligament injuries. Am J Sports Med. 1994 Jan-Feb;22(1):37–43. [PubMed]
  • Huston LJ, Wojtys EM. Neuromuscular performance characteristics in elite female athletes. Am J Sports Med. 1996 Jul-Aug;24(4):427–436. [PubMed]
  • LaPrade RF, Burnett QM., 2nd Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1994 Mar-Apr;22(2):198–203. [PubMed]
  • Liu SH, Al-Shaikh RA, Panossian V, Finerman GA, Lane JM. Estrogen affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury. Am J Sports Med. 1997 Sep-Oct;25(5):704–709. [PubMed]
  • Loudon JK, Jenkins W, Loudon KL. The relationship between static posture and ACL injury in female athletes. J Orthop Sports Phys Ther. 1996 Aug;24(2):91–97. [PubMed]
  • Möller-Nielsen J, Hammar M. Women's soccer injuries in relation to the menstrual cycle and oral contraceptive use. Med Sci Sports Exerc. 1989 Apr;21(2):126–129. [PubMed]
  • Muneta T, Takakuda K, Yamamoto H. Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament. A cadaveric knee study. Am J Sports Med. 1997 Jan-Feb;25(1):69–72. [PubMed]
  • Smith J, Szczerba JE, Arnold BL, Perrin DH, Martin DE. Role of hyperpronation as a possible risk factor for anterior cruciate ligament injuries. J Athl Train. 1997 Jan;32(1):25–28. [PMC free article] [PubMed]
  • Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med. 1993 Jul-Aug;21(4):535–539. [PubMed]
  • Wojtys EM, Wylie BB, Huston LJ. The effects of muscle fatigue on neuromuscular function and anterior tibial translation in healthy knees. Am J Sports Med. 1996 Sep-Oct;24(5):615–621. [PubMed]
  • Wojtys EM, Huston LJ, Taylor PD, Bastian SD. Neuromuscular adaptations in isokinetic, isotonic, and agility training programs. Am J Sports Med. 1996 Mar-Apr;24(2):187–192. [PubMed]
  • Wojtys EM, Huston LJ, Lindenfeld TN, Hewett TE, Greenfield ML. Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes. Am J Sports Med. 1998 Sep-Oct;26(5):614–619. [PubMed]
  • Woodford-Rogers B, Cyphert L, Denegar CR. Risk factors for anterior cruciate ligament injury in high school and college athletes. J Athl Train. 1994 Dec;29(4):343–346. [PMC free article] [PubMed]
  • Bell DG, Jacobs I. Electro-mechanical response times and rate of force development in males and females. Med Sci Sports Exerc. 1986 Feb;18(1):31–36. [PubMed]
  • Winter EM, Brookes FB. Electromechanical response times and muscle elasticity in men and women. Eur J Appl Physiol Occup Physiol. 1991;63(2):124–128. [PubMed]
  • Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980 Mar;62(2):259–270. [PubMed]
  • Baratta R, Solomonow M, Zhou BH, Letson D, Chuinard R, D'Ambrosia R. Muscular coactivation. The role of the antagonist musculature in maintaining knee stability. Am J Sports Med. 1988 Mar-Apr;16(2):113–122. [PubMed]
  • Solomonow M, Baratta R, Zhou BH, Shoji H, Bose W, Beck C, D'Ambrosia R. The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports Med. 1987 May-Jun;15(3):207–213. [PubMed]
  • Hagood S, Solomonow M, Baratta R, Zhou BH, D'Ambrosia R. The effect of joint velocity on the contribution of the antagonist musculature to knee stiffness and laxity. Am J Sports Med. 1990 Mar-Apr;18(2):182–187. [PubMed]
  • Louie JK, Mote CD., Jr Contribution of the musculature to rotatory laxity and torsional stiffness at the knee. J Biomech. 1987;20(3):281–300. [PubMed]
  • Markolf KL, Graff-Radford A, Amstutz HC. In vivo knee stability. A quantitative assessment using an instrumented clinical testing apparatus. J Bone Joint Surg Am. 1978 Jul;60(5):664–674. [PubMed]
  • Renström P, Arms SW, Stanwyck TS, Johnson RJ, Pope MH. Strain within the anterior cruciate ligament during hamstring and quadriceps activity. Am J Sports Med. 1986 Jan-Feb;14(1):83–87. [PubMed]
  • Walla DJ, Albright JP, McAuley E, Martin RK, Eldridge V, El-Khoury G. Hamstring control and the unstable anterior cruciate ligament-deficient knee. Am J Sports Med. 1985 Jan-Feb;13(1):34–39. [PubMed]
  • Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am. 1976 Jul;58(5):583–594. [PubMed]
  • McNair PJ, Marshall RN. Landing characteristics in subjects with normal and anterior cruciate ligament deficient knee joints. Arch Phys Med Rehabil. 1994 May;75(5):584–589. [PubMed]
  • Pope MH, Johnson RJ, Brown DW, Tighe C. The role of the musculature in injuries to the medial collateral ligament. J Bone Joint Surg Am. 1979 Apr;61(3):398–402. [PubMed]
  • Konradsen L, Voigt M, Højsgaard C. Ankle inversion injuries. The role of the dynamic defense mechanism. Am J Sports Med. 1997 Jan-Feb;25(1):54–58. [PubMed]
  • Hoffer JA, Andreassen S. Regulation of soleus muscle stiffness in premammillary cats: intrinsic and reflex components. J Neurophysiol. 1981 Feb;45(2):267–285. [PubMed]
  • Joyce GC, Rack PM. Isotonic lengthening and shortening movements of cat soleus muscle. J Physiol. 1969 Oct;204(2):475–491. [PubMed]
  • Kearney RE, Stein RB, Parameswaran L. Identification of intrinsic and reflex contributions to human ankle stiffness dynamics. IEEE Trans Biomed Eng. 1997 Jun;44(6):493–504. [PubMed]
  • Rack PM, Westbury DR. The short range stiffness of active mammalian muscle and its effect on mechanical properties. J Physiol. 1974 Jul;240(2):331–350. [PubMed]
  • Sojka P, Johansson H, Sjölander P, Lorentzon R, Djupsjöbacka M. Fusimotor neurones can be reflexly influenced by activity in receptor afferents from the posterior cruciate ligament. Brain Res. 1989 Mar 27;483(1):177–183. [PubMed]
  • Beard DJ, Kyberd PJ, Fergusson CM, Dodd CA. Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery? J Bone Joint Surg Br. 1993 Mar;75(2):311–315. [PubMed]
  • Branch TP, Hunter R, Donath M. Dynamic EMG analysis of anterior cruciate deficient legs with and without bracing during cutting. Am J Sports Med. 1989 Jan-Feb;17(1):35–41. [PubMed]
  • Brask B, Lueke RH, Soderberg GL. Electromyographic analysis of selected muscles during the lateral step-up exercise. Phys Ther. 1984 Mar;64(3):324–329. [PubMed]
  • Gauffin H, Tropp H. Altered movement and muscular-activation patterns during the one-legged jump in patients with an old anterior cruciate ligament rupture. Am J Sports Med. 1992 Mar-Apr;20(2):182–192. [PubMed]
  • Kålund S, Sinkjaer T, Arendt-Nielsen L, Simonsen O. Altered timing of hamstring muscle action in anterior cruciate ligament deficient patients. Am J Sports Med. 1990 May-Jun;18(3):245–248. [PubMed]
  • Wilk KE, Escamilla RF, Fleisig GS, Barrentine SW, Andrews JR, Boyd ML. A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Am J Sports Med. 1996 Jul-Aug;24(4):518–527. [PubMed]
  • Wojtys EM, Huston LJ. Neuromuscular performance in normal and anterior cruciate ligament-deficient lower extremities. Am J Sports Med. 1994 Jan-Feb;22(1):89–104. [PubMed]
  • Wilkins EG. The diagnostic value of glucose in pleural/peritoneal fluid in tuberculosis. Indian J Pediatr. 1985 Nov-Dec;52(419):561–563. [PubMed]
  • Zimny ML, Schutte M, Dabezies E. Mechanoreceptors in the human anterior cruciate ligament. Anat Rec. 1986 Feb;214(2):204–209. [PubMed]
  • Schultz RA, Miller DC, Kerr CS, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am. 1984 Sep;66(7):1072–1076. [PubMed]
  • Löfvenberg R, Kärrholm J, Sundelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. 1995 Jul-Aug;23(4):414–417. [PubMed]
  • BOYD IA. The histological structure of the receptors in the knee-joint of the cat correlated with their physiological response. J Physiol. 1954 Jun 28;124(3):476–488. [PubMed]
  • Freeman MA, Wyke B. The innervation of the knee joint. An anatomical and histological study in the cat. J Anat. 1967 Jun;101(Pt 3):505–532. [PubMed]
  • Johansson H, Sjölander P, Sojka P. Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng. 1991;18(5):341–368. [PubMed]
  • Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med. 1982 Nov-Dec;10(6):329–335. [PubMed]
  • Sjölander P, Johansson H, Sojka P, Rehnholm A. Sensory nerve endings in the cat cruciate ligaments: a morphological investigation. Neurosci Lett. 1989 Jul 17;102(1):33–38. [PubMed]
  • Small C, Waters JT, Jr, Voight M. Comparison of two methods for measuring hamstring reaction time using the Kin-Com isokinetic dynamometer. J Orthop Sports Phys Ther. 1994 Jun;19(6):335–340. [PubMed]
  • Eccles JC. Physiology of motor control in man. Appl Neurophysiol. 1981;44(1-3):5–15. [PubMed]
  • Chan CW, Jones GM, Kearney RE, Watt DG. The 'late' electromyographic response to limb displacement in man. I. Evidence for supraspinal contribution. Electroencephalogr Clin Neurophysiol. 1979 Feb;46(2):173–181. [PubMed]
  • Matthews PB. The human stretch reflex and the motor cortex. Trends Neurosci. 1991 Mar;14(3):87–91. [PubMed]
  • Marsden CD, Rothwell JC, Day BL. Long-latency automatic responses to muscle stretch in man: origin and function. Adv Neurol. 1983;39:509–539. [PubMed]
  • Joyce GC, Rack PM. Isotonic lengthening and shortening movements of cat soleus muscle. J Physiol. 1969 Oct;204(2):475–491. [PubMed]
  • Hoffer JA, Andreassen S. Regulation of soleus muscle stiffness in premammillary cats: intrinsic and reflex components. J Neurophysiol. 1981 Feb;45(2):267–285. [PubMed]
  • Rack PM, Westbury DR. The short range stiffness of active mammalian muscle and its effect on mechanical properties. J Physiol. 1974 Jul;240(2):331–350. [PubMed]
  • Hsieh HH, Walker PS. Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Joint Surg Am. 1976 Jan;58(1):87–93. [PubMed]
  • Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC. The role of joint load in knee stability. J Bone Joint Surg Am. 1981 Apr;63(4):570–585. [PubMed]
  • Soderberg GL, Cook TM. Electromyography in biomechanics. Phys Ther. 1984 Dec;64(12):1813–1820. [PubMed]
  • Tibone JE, Antich TJ, Fanton GS, Moynes DR, Perry J. Functional analysis of anterior cruciate ligament instability. Am J Sports Med. 1986 Jul-Aug;14(4):276–284. [PubMed]
  • Struys MA, Jonkman EJ, Strijers RL. Measurement of patellar and ankle tendon reflexes in normal subjects. Electromyogr Clin Neurophysiol. 1997 Jan-Feb;37(1):13–18. [PubMed]
  • Di Fabio RP. Reliability of computerized surface electromyography for determining the onset of muscle activity. Phys Ther. 1987 Jan;67(1):43–48. [PubMed]
  • Gabel RH, Brand RA. The effects of signal conditioning on the statistical analyses of gait EMG. Electroencephalogr Clin Neurophysiol. 1994 Jun;93(3):188–201. [PubMed]

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