Manual Therapy 14 (2009) 484489

Contents lists available at ScienceDirect

Manual Therapy
journal homepage: www.elsevier.com/math

Original Article

The inuence of increasing sacroiliac joint force closure on the hip

and lumbar spine extensor muscle ring pattern
Hiroshi Takasaki a, b, *, Takeshi Iizawa b, c, Toby Hall d, Takuo Nakamura e, Shouta Kaneko b
a
Graduate School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, Hokkaido, Japan
b
Shinoro Orthopedic, 4-5-3-9, Shinoro, Kita-ku, Sapporo, Hokkaido, Japan.
c
School of Health Sciences, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, Hokkaido, Japan
d
Adjunct Senior Teaching Fellow, School of Physiotherapy, Curtin University, Perth, Western Australia
e
Department of Physical Therapy, Sapporo Medical University School of Health Sciences, South-1, West-17, Chuo-ku, Sapporo, Hokkaido, Japan

a r t i c l e i n f o a b s t r a c t

Article history: The prone hip extension (PHE) test is commonly used in the evaluation of lumbo-pelvic dysfunction. It
Received 30 May 2008 has been suggested that altered motor control identied by the PHE test can be improved with the
Received in revised form application of compression force across the pelvis, to increase force closure on the sacroiliac joint (SIJ).
14 October 2008
This repeated measure study design investigated the effect of three levels of pelvis compression (0 N,
Accepted 8 November 2008
50 N, 100 N) on the muscle ring pattern during the PHE test in 20 asymptomatic male subjects tested on
two occasions 4-weeks apart. The right gluteus maximus, right semitendinosus and bilateral lumbar
Keywords:
erector spinae were analyzed using surface electromyography (EMG). Subjects were instructed to
Muscle ring pattern
Sacroilliac joint perform right hip extension in prone position while maintaining knee-extension in each measurement
Gluteus maximus condition. Compared with the onset of the semitendinosus muscle, gluteus maximus became active
263.3  99.5 ms later with no pelvic compression, 183.5  77.9 ms later with 50 N compression,
91.5  49.7 ms later with 100 N compression. While signicant differences (a 0.05) were found in EMG
onset for gluteus maximus under different levels of pelvis compression, this was not the case for the
erector spinae, which had an inconsistent pattern of temporal onset and was not inuenced by the level
of pelvis compression force.
2008 Elsevier Ltd. All rights reserved.

1. Introduction pattern of activation of muscles during PHE represents the muscle

Functional stability of the pelvis is generated by a combination
of force closure and form closure. The term form closure was
coined by Snijders and Vleeming (Vleeming et al., 1990a, b; Snijders
et al., 1993a, b) and is used to describe how the joints shape
contributes to stability. On the other hand, force closure refers to
other forces acting across the joint to create stability. According to
theoretical modeling of force closure effects (Pel et al., 2008), the
application of 50 N medial compression force at the anterior
superior iliac spine increases SIJ compression force by 52%.
Furthermore, it has been said that the stronger the force closure the
more form closure is obtained (Snijders et al., 1993a, b).
A number of tests have been developed which are said to
evaluate the functional stability and control of the pelvis (Buyruk
et al., 1995a, b, 1999; Mens et al., 1999, 2001; Lee and Lee, 2004).
The PHE test is one commonly used in the evaluation of lumbo-
pelvic function (Lee and Lee, 2004). It has been theorized that the
* Corresponding author. Shinoro Orthopedic, 4-5-3-9, Shinoro, Kita-ku, Sapporo,
Hokkaido, Japan. Tel.: 81 011 772 7255; fax: 81 011 772 7256.
E-mail address: physical_therapy_takasaki@yahoo.co.jp (H. Takasaki).
recruitment pattern of hip extension during gait (Lehman et al.,
2004). According to Janda (Janda, 1978), the ideal sequence of
muscle activation during the PHE test in temporal order is ipsilat-
eral hamstring, ipsilateral gluteus maximus, and contralateral
lumbar erector spinae.
It has been theorized that aberration in the temporal recruitment
pattern of these muscles decreases the stability of the pelvis during
gait and thus hinders the bodys mechanical efciency. One of the
most commonly described patterns of dysfunction seen clinically
during PHE is too much delay in the recruitment of the gluteus
maximus (Sahrmann, 2002). In this case hip extension is achieved
by hamstring muscle activation, this creates compensatory anterior
pelvic tilt and thus lumbar hyperlordosis. In addition poor gluteus
maximus strength and activation is postulated to decrease the
efciency of gait (Janda, 1992, 1996). Moreover, Sahrmann (Sahr-
mann, 2002) has suggested that if the hamstrings are dominant, and
gluteus maximus is inhibited, abnormal displacement of the greater
trochanter can be palpated during the PHE, which is a nding
reported in cases of hip pain (Sahrmann, 2002).
A number of studies have investigated the temporal pattern of
muscle recruitment during PHE (Bullock-Saxton et al., 1994; Vogt

1356-689X/$ see front matter 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.math.2008.11.003
 H. Takasaki et al. / Manual Therapy 14 (2009) 484489 485

and Banzer, 1997; Lehman et al., 2004). To date, no consistent

pattern of activation has been found. However, one common thread
through these various studies is the consistent report of delayed
activation of the gluteus muscle compared with the hamstrings
(Vogt and Banzer, 1997; Lehman et al., 2004).
It has been said that if the efciency of PHE was improved with
the application of compression force across the pelvis, this might
have some effect on improving force closure and therefore improve
the muscle ring pattern (Lee and Lee, 2004). However, to date no
studies have investigated the inuence of compressive force across
Fig. 2. Prone hip extension.
the pelvis on the PHE test.
The purpose of this study was to determine whether compres-
sive force applied across the pelvis inuences the muscle ring
patterns of the semitendinosus, gluteus maximus, and erector 143.2  11.2 N. As a number of subjects complained of pain when
spinae. We hypothesized that applying compression force across compression force of 150 N was applied this level of force was not
the pelvis would reduce the onset delay for gluteus maximus and used in the main study.
semitendinosus while having no inuence on the erector spinae
muscles. 2.2. Subjects

For this study, 20 males (Right leg dominant, Average height:

2. Methods
2.1. Pilot study
Prior to the main experiment, a preliminary study was designed
to determine the amount of force routinely applied across the
pelvis to increase force closure during the PHE. Five physical ther-
apists, each with three years post-graduate experience, were asked
to apply three kinds of pressure to ve participants (ve males,
Average age: 22.2 (SD 0.8) years old) across the pelvis, simulating
the PHE test (Fig. 1): normal, strong, and maximum. The therapists
were required to apply the pressure on the pelvis bilaterally
through hand-held dynamometers (mTas, ANIMA Co. Ltd., Tokyo).
The average force under normal pressure was 51.8  11.0 N,
under strong pressure 98.2  11.5 N and under maximum pressure
172.6 (SD 5.40) cm, Average weight: 64.3 (SD 5.2) kg, Average
age: 22.0 (SD 1.3) years old) with no history of lumbar, sacroiliac
or lower limb injury within the past year were recruited from
undergraduate students in Sapporo medical university. Subjects
who had a previous history of lumbar surgery, spondylophathies, or
arthritic disorders were excluded. Individuals with past episodes of
ankle sprain (grade 2 or 3) were also excluded because Bullock-
Saxton et al. reported that ankle sprain inuenced the muscle ring
pattern of the gluteus maximus (Bullock-Saxton et al., 1994).
2.3. Instrumentation
The activation patterns of the right gluteus maximus, right
semitendinosus muscle group and bilateral lower erector spinae
were assessed by surface EMG. Surface electrodes (Ag/AgCl) were
placed in pairs and parallel to the muscle bers (Cram et al., 1998).
For gluteus maximus, electrodes were placed at mid belly between
sacral vertebrae and the greater trochanter. For semitendinosus,
electrodes were attached at the mid point between the inferior
gluteal fold and knee joint line. For lower erector spinae electrodes
were placed longitudinally 2 cm lateral to the L3 spinous process,
bilaterally.

Condition A Condition B

PHE PHE
without pelvic without pelvic
compression compression
5 5
10 people
Rest (2min) 20 people
10 people Rest (2min)
PHE
Rest (2min) with 100 N PHE
compression without pelvic
PHE compression
with 50 N 5
Rest (2min)
compression
5 Rest (2min)
PHE
with 50 N PHE
Rest (2min)
compression without pelvic
5 compression
PHE 5
with 100 N Rest (2min)
compression Rest (2min)
5
PHE PHE
Rest (2min) without pelvic without pelvic
compression compression
5 5

Fig. 1. Procedure used in the pilot study to measure compressive force across the Fig. 3. Flow chart showing study protocol. Hatched circles indicate no measurements
pelvis using hand-held dynamometers. were taken during those trials.
486 H. Takasaki et al. / Manual Therapy 14 (2009) 484489

2.4. Procedures Table 1

Average Gluteus Maximus onset time for each subject relative to semitendinosus
muscle ring.
The protocol for testing is described in the ow chart in Fig. 2.
Due to operational and time constraints, the testing procedure was Subject No Compression 50 N 100 N No Compression
conducted in two parts with Condition A and B carried out one (1st) Compression Compression (2nd)

month apart using the same set of 20 subjects. Condition B was 1 130.4 83 60.2 61.0
2 137.2 85.8 59.0 65.0
essentially to determine the reliability of repeated measurements.
3 430.8 385.4 260.2 432.8
Subjects were instructed to lie on the measurement table in 4 243.0 214.6 124.2 131.2
a prone position and perform right hip extension until the lower 5 327.2 212.2 93.2 133.8
edge of the patella was raised more than 15 cm from the starting 6 213.2 151.4 60.0 163.6
position while maintaining knee-extension (Fig. 3). 7 324.0 271.4 123.8 244.0
8 164.0 109.4 79.2 127.4
A standardized compressive force of zero, 50 N, and 100 N was 9 249.0 200.6 104.2 144.4
applied across the pelvis by the device shown in Fig. 4. Two 10 189.4 105.0 60.5 164.6
experimental conditions were employed; Condition A was PHE 11 213.0 150.4 61.2 154.8
under the three different levels of compressive force (0 N, 50 N and 12 316.4 210.6 106.8 153.0
13 190.0 83.0 22.2 79.2
100 N). For Condition A all subjects were initially evaluated with no
14 342.2 245.6 123.4 244.6
compression force. Half the sample was then tested with increasing 15 109.2 102.2 60.6 90.6
compression force (50 N and 100 N) and the remaining half tested 16 471.8 238.2 109.6 264.6
with reducing compression force (100 N and 50 N). The nal trials 17 316.6 229.8 122.0 201.0
in Condition A were with no compression force. Condition B was 18 367.6 239.4 88.2 201.6
19 230.8 148.8 46.4 175.6
PHE without compressive force (Fig. 3). For Condition A and B a set 20 299.4 203.4 64.4 197.2
of ve trials were obtained for each level of force, with a 2-min rest
Mean 263.3 183.5 91.5 171.5
period between each set. Subjects were instructed to perform hip
SD 99.5 77.9 49.7 84.3
extension at their natural speed, repeating the movement each
time from rest. The mean onset of muscle activity for each set was
calculated from the ve trials within that set.
Before the initiation of data collection, subjects provided written signals were full wave rectied, low- and high-pass ltered, with
informed consent. This study was approved by Sapporo medical cut-off frequencies of 500 and 10 Hz, respectively, and recorded at
university. a sampling rate of 1000 Hz (Sakamoto et al., 2009).
Muscle activation patterns were described after determining the
EMG onset for each muscle. The onset of muscular activity was
2.5. Statistics
considered to occur when the value exceeded two standard devi-
ations from the mean value observed at baseline for a 50 ms period
EMG data processing was performed using Acknowledge soft-
(Hodges and Bui, 1996; Brindle et al., 1999).
ware (Chart v.5.2.1, ADInstruments Pty Ltd., Australia). The EMG
Muscle onsets were calculated with respect to onset of muscle
activity for the semitendinosus muscle. A one-way ANOVA was
used to determine the inuence of pressure across the pelvis on the
timing of muscle onset relative to the onset of semitendinosus
muscle activity. Statistical analysis was performed using SPSS
version 11.5 (SPSS Inc., Tokyo, Japan). Statistical signicance was
attributed to P values less than 0.05.

3. Results

3.1. Gluteus maximus

Under Condition A, with the semitendinosus muscle acting as

Fig. 4. Pelvis compression device.
the relative starting point at 0 ms, gluteus maximus become
active 263.3  99.5 ms later with no pelvic compression, 183.5 
77.9 ms later with 50 N compression, 91.5  49.7 ms later with
100 N compression, and 171.5  84.3 ms later when no pelvic
compression was repeated. In all subjects semitendinosus muscle
onset occurred prior to gluteus maximus (Table 1). Signicant
differences were found in EMG onset between no pelvic
compression and 50 N compression (P < 0.05), between no pelvic
compression and 100 N compression (P < 0.001) and between the
two trials of no pelvic compression (P < 0.01). Additionally, there
were signicant differences between EMG onset for 100 N
compression and 50 N compression (P < 0.01), and between 100 N
compression and the second trial of no pelvic compression
(P < 0.05) (Fig. 5).
Under Condition B, gluteus maximus contracted 270.2  90.3 ms
later than semitendinosus muscle during rst ve sets of PHE, and
218.5  71.2 ms later during the last ve sets of PHE.
Signicant differences were found in EMG onset between the
second trial of no pelvic compression in Condition A and the rst
 H. Takasaki et al. / Manual Therapy 14 (2009) 484489 487

*p<0.05,p<0.01,p<0.001 2nd
Condition B
1st
2nd
Condition B
1st
No Compression (2nd)

100 N Compression
No Compression (2nd) Condition A
* 50 N Compression
100 N Compression
Condition A
No Compression (1st)
50 N Compression
* -100 -50 0 50
No Compression (1st)
Latency (ms)
-500 -400 -300 -200 -100 0
Latency (ms) Fig. 6. The latency (ms) of ipsilateral erector spinae compared with the onset of
semitendinosus for condition A and B. Negative values indicate delayed activation.
Fig. 5. The latency (ms) of gluteus maximus compared with the onset of semite- There was no signicant difference between any condition (a 0.05).
ndinosus for condition A and B. Negative values indicate delayed activation.

muscle, with the rst trials of no pelvic compression, were

trial in Condition A (P < 0.01), and between the average of the rst
ve sets of trials in Condition B (P < 0.01) (Fig. 5).
3.2. Ipsilateral erector spinae
Under Condition A, ipsilateral erector spinae became active
0.1  39.6 ms before the onset of the semitendinosus muscle with
the rst trials of no pelvic compression, 27.3  54.3 ms later with
50 N compression, 10.2  31.4 ms later with 100 N compression,
and 13.4  37.2 ms later with the second set of trials of no pelvic
compression. In 13 out of 20 subjects the ipsilateral erector spinae
contracted before semitendinosus muscle (Table 2). There was no
signicant difference (a 0.05) between any of these conditions
(Fig. 6).
Under Condition B, the ipsilateral erector spinae contracted
0.5  37.2 ms before the onset of the semitendinosus muscle during
rst ve sets of PHE, and 1.4  31.1 ms prior in the last ve sets of
PHE.
Signicant differences (a 0.05) were not found between any of
Condition A and B (Fig. 6).
3.3. Contralateral erector spinae
Under Condition A, the averaged onset of the contralateral
erector spinae, compared with the onset of the semitendinosus
17.7  35.7 ms prior, 2.1  39.9 ms prior with 50 N compression,
2.1  32.4 ms later with 100 N compression, 6.7  40.5 ms prior
with the second set of trials of no pelvic compression. Activation
prior to semitendinosus muscle was seen in 15 out of 20 subjects
(Table 3). There was no signicant difference (a 0.05) between
any of these conditions (Fig. 7).
Under Condition B, contralateral erector spinae become active
11.4  38.0 ms prior to the onset of the semitendinosus muscle
during the rst ve sets of PHE, and 11.3  30.7 ms prior during the
last ve sets of PHE.
There was no signicant differences (a 0.05) between any of
Condition A and B (Fig. 7).
4. Discussion
This study found gluteus maximus muscle onset was consis-
tently delayed with respect to the semitendinosus muscle during
the PHE test. No such consistent pattern of temporal activation was
found for either the ipsilateral or contralateral erector spinae,
which is in line with previous reports (Lehman et al., 2004).
Compression force across the pelvis, appeared to reduce the
onset delay of gluteus maximus, but this had no such effect on the
erector spinae in asymptomatic subjects.
Delayed onset gluteus maximus muscle activation (relative to
the hamstring muscles) has been suggested as a signicant factor in

Table 2 Table 3
Average ipsilateral erector spinae onset time for each subject relative to semite- Average contralateral erector spinae onset time for each subject relative to sem-
ndinosus muscle ring. itendinosus muscle ring.

Subject No Compression 50 N 100 N No Compression Subject No Compression 50 N 100 N No Compression

(1st) Compression Compression (2nd) (1st) Compression Compression (2nd)
1 13.6 5.6 16.4 26.2 1 19.0 20.2 28.0 32.0
2 6.6 3.4 24.8 21.6 2 33.8 31.0 11.8 2.2
3 28.4 139.6 29.4 12.2 3 35.4 23.6 24.0 82.4
4 53.0 72.8 27.0 76.4 4 66.2 3.8 4.6 29.2
5 31.8 81.6 24.6 9.2 5 57.2 93.6 48.8 5.8
6 30.2 55.8 6.8 31.6 6 18.8 65.6 69.0 40.4
7 35.0 10.4 13.4 99.6 7 34.6 6.2 7.2 79.0
8 29.6 15.2 9.4 33.4 8 15.8 15.4 7.4 42.4
9 57.8 44.0 59.0 28.2 9 29.8 0.4 3.4 37.4
10 69.8 80.2 65.6 27.8 10 38.8 56.4 37.6 28.0
11 79.4 48.0 47.0 39.4 11 32.6 16.6 36.8 45.8
12 10.0 22.8 30.8 0.8 12 38.6 0.4 5.8 25.4
13 58 7.2 9.2 27.4 13 51.4 10.2 15.6 19.6
14 24.0 12.0 0.4 6.0 14 31.6 43.8 50.8 42.6
15 31.4 149.6 50.2 70.2 15 31.4 90.6 50.4 32.6
16 31.0 36 8.0 16.0 16 50.6 5.4 0.4 46.2
17 29.2 0.8 10.8 26.4 17 57.6 6.2 1.0 41.6
18 4.0 30.8 58.0 16.8 18 15.8 13.2 47.8 3.4
19 22.2 5.2 9.2 13.0 19 46.6 17.6 1.8 27.2
20 10.6 4.8 17.4 19.4 20 19.4 28.8 28.8 30.8

Mean 0.1 27.3 10.2 13.4 Mean 17.7 2.1 2.1 6.7
SD 39.6 54.3 31.4 37.2 SD 35.7 39.9 32.4 40.5
488 H. Takasaki et al. / Manual Therapy 14 (2009) 484489
2nd
Condition B
1st
No Compression (2nd)
100 N Compression
Condition A
50 N Compression
No Compression (1st)
-100 -50 0 50
Latency(ms)
Fig. 7. The latency (ms) of contralateral erector spinae compared with the onset of
semitendinosus for condition A and B. Negative values indicate delayed activation.
There was no signicant difference between any conditions (a 0.05).
the development of hip pain (Sahrmann, 2002; Hungerford et al.,
2003; Vogt et al., 2003). The present study and previous studies
have reported delayed gluteus maximus activation in normal
subjects (Bullock-Saxton et al., 1994; Vogt and Banzer, 1997; Leh-
man et al., 2004), but failed to reach agreement on the magnitude
of the delay. Latency of gluteus maximus contraction in our study of
male subjects with no compression was approximately 270 ms, in
contrast to 500 ms reported by Sakamoto et al (Sakamoto et al.,
2009). In that study the standard deviation was three times larger
at 300 ms. This disparity might be explained by gender differences,
with participants in Sakamoto et als study of both genders. Further
research investigating a more diverse sample of normal subjects
and patients with hip pain is required to identify whether a greater
timing delay occurs in symptomatic subjects when compared to
healthy controls.
Gluteus maximus activation has a major functional role in the
early stance phase of gait, where 60% of body weight is transferred
in 0.02 s, resulting in abrupt loading of the forward limb (Anderson
and Pandy, 2003). At this point the gluteus maximus compresses
the SIJ to provide stability of the pelvis (Hossain and Nokes, 2005).
Additionally, it has been suggested that lack of control of the pelvis
may further increase the movement of an already mobile lumbar
spine segment (McConnell, 2002). It has been established that
excessive movement, particularly in rotation of the lumbar motion
segment, is a contributory factor to disc injury and torsional forces
may irrevocably damage the annulus brosus (Farfan et al., 1970;
Kelsey et al., 1984).
Our study analyzed the muscle ring pattern during hip
extension in prone, as it has been suggested that the pattern of
activation of muscles during PHE represents the muscle recruit-
ment pattern of hip extension during gait (Lehman et al., 2004). To
our knowledge no studies have compared muscle onset patterns
between the two positions. There may be major changes to the
pattern of activation of the lumbo-pelvic stabilizing muscles in
prone compared to the upright posture. Additionally, gravitational
inuences in both positions are different and may inuence both
force and form closure and so pelvic stability. Therefore relating our
ndings of the ring pattern during the PHE test to the normal gait
cycle is not possible. Much further research is required comparing
the muscle ring pattern during normal gait with that found during
the PHE test.
The synovial SIJ is supported by the anterior, posterior and
interosseous sacroiliac ligaments. While the posterior sacroiliac
ligament is strong, the interosseous ligament is the strongest
ligament between the sacrum and ilium (Clemete, 1997). When the
therapist applies force across the pelvis, the strong sacroiliac liga-
ments increase the lever arm acting on the SIJ, which theoretically
results in much greater compression force at the SIJ surface and
increased force closure. Although there are no studies that have
directly measured this in cadavers, one study has modeled the
forces (of the same magnitude as used in our study) and found
medial compression force on the pelvis increases force closure at
the SIJ (Pel et al., 2008). Similarly both Mens and Damen (Damen
et al., 2002; Mens et al., 2006) found medially applied pelvis force
(using a pelvic belt) at the level of the anterior superior iliac spines
produced signicantly less SIJ laxity in both healthy women and
those with pelvic pain.
The SIJ has been reported to be richly innervated (Solonen, 1957;
Ikeda, 1991; Grob et al., 1995). Ikeda (Ikeda, 1991) reported that the
ventral portion of the SIJ was mainly supplied by ventral ramus of
the L5, whereas the lower ventral portion was mainly supplied by
ventral ramus of the S2. Thick, thin, and unmyelinated nerve bers
have been reported, which are compatible with a broad repertoire
of sensory receptors, indicating encapsulated mechanoreceptors
(Ikeda, 1991; Grob et al., 1995). According to Indahl, et al. (Indahl
et al., 1999) stimulation of the porcine SIJ capsule elicited activity in
the multidus muscle (L5 level), additionally stimulation of the
anterior aspect of the joint elicited responses in quadratus lum-
borum and gluteus maximus.
In our study, the stronger the force applied across the pelvis, the
earlier the onset of gluteus maximus activity occurred. In contrast
this was not the case for the erector spinae muscles. These ndings
correspond with previous reports (Indahl et al., 1999)
With respect to the results of the latency of gluteus maximus
compared with the onset of semitendinosus in Condition A,
a signicant difference was found between the rst and second trial
of no compression. In contrast, repeated trials of no compression
force in Condition B were not different and were no different to the
rst trial of no compression in Condition A. It appears that the
change in onset of gluteus maximus activity continued even after
pelvis compression force was removed. This result, suggests
a lasting effect of compression force, at least temporarily. We
suggest that stimulation of the SIJ by the compressive force across
the pelvis causes reex changes in muscle activation, which facili-
tates an earlier onset of gluteus maximus activity. It remains
unclear how long this effect is maintained.
It is possible that other unidentied factors inuenced the
muscle ring pattern, besides the SIJ compression/force closure
theory. For example in our study standardization of the pelvis force
application was achieved by the use of a mechanical device. No
subject reported pain with this device, but it is possible that
subjects may have felt discomfort or experienced difculty with
movement. It is known that experimentally induced pain changes
the pattern of muscle activation around the pelvis, even in normal
subjects (Hodges et al., 2003). However negating this possibility is
that changes to the ring pattern were maintained even after the
compression force was removed, indicating a carry over effect.
Many further studies are required to investigate this phenomenon
as well as the duration of carry over effect, and whether changes to
the muscle ring pattern during PHE inuences the pattern of
recruitment during normal gait before clinical implications can be
considered.
5. Conclusions
In asymptomatic males, gluteus maximus muscle onset was
consistently delayed with respect to the semitendinosus muscle
during the PHE test, but no consistent temporal pattern of activa-
tion of the erector spinae was found. Compressive force applied
medially across the pelvis signicantly reduced the muscle onset
delay for gluteus maximus but had no effect on the erector spinae.
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