Muscle activity and balance control during sit-to-stand across symmetric and asymmetric initial foot positions in healthy adults

Rising from a sit to a stand has biomechanical factors that are dependent on initial foot position. Little is known about the effect of initial foot position on leg muscle activation patterns during a sit-to-stand and balance maintenance of stance after a sit-to-stand.

What are the effects of different symmetric and asymmetric initial foot positions on leg muscle activation patterns and balance during and after a sit-to-stand?

Three symmetric (neutral; both ankles positioned under the knees at a 90° flexion; one-third; and two-thirds foot length posterior to neutral) and three asymmetric (neutral non-dominant leg with one-third back dominant leg, neutral non-dominant with two-thirds back dominant leg, and one-third back non-dominant leg with two-thirds back dominant leg) initial foot positions were tested. EMG of the lower extremity muscles and sagittal plane kinematic data were measured along with balance assessments in the anterior-posterior and medial-lateral axes.

In the symmetric initial foot positions, a faster forward velocity of the body's center of mass was required for more anterior initial foot positions. Even though the hip extensors activated earlier to decelerate the forward velocity of the body's center of mass before rising, the greater forward velocity caused postural sway following completion of upright stance. In the asymmetric initial foot positions, the posterior leg supported more weight during the sit-to-stand, resulting in balance perturbations in the posterior leg. In the one-third back non-dominant leg with two-thirds back dominant leg asymmetric initial foot position, however, the weight-bearing symmetry was not different from the symmetric initial foot positions during the sit-to-stand. Postural stability after completion of uprising was also improved in this asymmetric initial foot position, showing greater but delayed onset of the tibialis anterior in the anterior leg during the momentum transfer phase.

With a neutral symmetric initial foot position, earlier onset of the hip extensors during eccentric lengthening contributed to decelerating the forward velocity of the body's center of mass for balance control during a sit-to-stand. With asymmetric initial foot positions, the weight distribution during a sit-to-stand can be increased by positioning both feet posterior to neutral foot position. Performing a sit-to-stand with this asymmetric initial foot position can improve postural stability after uprising. Thus, this foot position could be used in designing rehabilitation interventions for clinical populations and the frail elderly.