Original research| Volume 97, ISSUE 9, P1542-1551.e2, September 2016

Optimal Combinations of Isometric Normalization Tests for the Production of Maximum Voluntary Activation of the Shoulder Muscles

  • Fabien Dal Maso
    Corresponding author Fabien Dal Maso, PhD, Université de Montréal, 1700, rue Jacques Tétreault, Laval, QC H7N 0B6, Canada.
    Laboratory of Movement Simulation and Modeling, Montreal University, Montreal, QC, Canada

    Rehabilitation Engineering Chair Applied to Pediatrics, Polytechnic Montreal, Montreal, QC, Canada

    Marie-Enfant Readaptation Center, Sainte Justine UHC, Montreal, QC, Canada
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  • Patrick Marion
    Laboratory of Movement Simulation and Modeling, Montreal University, Montreal, QC, Canada

    Marie-Enfant Readaptation Center, Sainte Justine UHC, Montreal, QC, Canada
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  • Mickaël Begon
    Laboratory of Movement Simulation and Modeling, Montreal University, Montreal, QC, Canada

    Marie-Enfant Readaptation Center, Sainte Justine UHC, Montreal, QC, Canada
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Published:January 19, 2016DOI:



      To identify the smallest combinations of maximum voluntary isometric contraction (MVIC) tests that produce near-maximum voluntary activation (MVA) for a large proportion of participants for the shoulder girdle muscles.


      Cross-sectional study.


      Research center.


      Healthy participants (N=38).


      Not applicable.

      Main Outcome Measures

      The electromyography of 12 shoulder muscles was recorded while participants performed 15 MVIC tests. The smallest combinations of MVIC tests that met our acceptance criterion (ie, produce 90% of MVA for 90% of participants) were identified. Optimal combinations were identified for each of the 12 muscles individually and for the 12 muscles simultaneously. Electromyographic activation levels of the 95th highest percentile obtained with our optimal combinations and with the Four Normalization Tests previously recommended were compared using paired t tests.


      Between 2 and 6 MVIC tests were required for each of the 12 muscles, and 12 MVIC tests were required for the 12 muscles to meet the acceptance criterion. These optimal combinations produced electromyographic activation levels of the 95th highest percentile comprised between 97% and 100% of MVA. These electromyographic activation levels were significantly higher than the electromyographic activation levels obtained with the Four Normalization Tests.


      Although the number of MVIC tests to normalize 12 shoulder muscles was increased compared with previous recommendations, the proposed method ensures that near-MVA (>90%) was obtained for a large proportion of participants (>90%). Moreover, because electromyographic activation levels of the 95th highest percentile were at least 97% of MVA, the identified combinations could reduce the interparticipant variability. The proposed combinations could help to improve electromyographic normalization and therefore reduce the misinterpretations regarding shoulder muscle activation levels.


      List of abbreviations:

      MVA (maximum voluntary activation), MVIC (maximum voluntary isometric contraction)
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