Skip to main content

Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning

European Journal of Applied Physiology volume 111, Article number: 2461 (2011) Cite this article

Abstract

The aim of the study was to investigate the uniformity of the muscle motor point location for lower limb muscles in healthy subjects. Fifty-three subjects of both genders (age range: 18–50 years) were recruited. The muscle motor points were identified for the following ten muscles of the lower limb (dominant side): vastus medialis, rectus femoris, and vastus lateralis of the quadriceps femoris, biceps femoris, semitendinosus, and semimembranosus of the hamstring muscles, tibialis anterior, peroneus longus, lateral and medial gastrocnemius. The muscle motor point was identified by scanning the skin surface with a stimulation pen electrode and corresponded to the location of the skin area above the muscle in which an electrical pulse evoked a muscle twitch with the least injected current. For each investigated muscle, 0.15 ms square pulses were delivered through the pen electrode at low current amplitude (<10 mA) and frequency (2 Hz). 16 motor points were identified in the 10 investigated muscles of almost all subjects: 3 motor points for the vastus lateralis, 2 motor points for rectus femoris, vastus medialis, biceps femoris, and tibialis anterior, 1 motor point for the remaining muscles. An important inter-individual variability was observed for the position of the following 4 out of 16 motor points: vastus lateralis (proximal), biceps femoris (short head), semimembranosus, and medial gastrocnemius. Possible implications for electrical stimulation procedures and electrode positioning different from those commonly applied for thigh and leg muscles are discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  • An XC, Lee JH, Im S, Lee MS, Hwang K, Kim HW, Han SH (2010) Anatomic localization of motor entry points and intramuscular nerve endings in the hamstring muscles. Surg Radiol Anat 32:529–537

    PubMed  Article  CAS  Google Scholar 

  • Apaydin N, Loukas M, Kendir S, Tubbs RS, Jordan R, Tekdemir I, Elhan A (2008) The precise localization of distal motor branches of the tibial nerve in the deep posterior compartment of the leg. Surg Radiol Anat 30:291–295

    PubMed  Article  Google Scholar 

  • Bax L, Staes F, Verhagen A (2005) Does neuromuscular electrical stimulation strengthen the quadriceps femoris? A systematic review of randomised controlled trials. Sports Med 35:191–212

    PubMed  Article  Google Scholar 

  • Becker I, Baxter GD, Woodley SJ (2010) The vastus lateralis muscle: an anatomical investigation. Clin Anat 23:575–585

    PubMed  Article  CAS  Google Scholar 

  • Bergquist AJ, Clair JM, Collins DF (2011) Motor unit recruitment when neuromuscular electrical stimulation is applied over a nerve trunk compared to a muscle belly: triceps surae. J Appl Physiol 110:627–637

    PubMed  Article  CAS  Google Scholar 

  • Bigland-Ritchie B, Jones DA, Woods JJ (1979) Excitation frequency and muscle fatigue: electrical responses during human voluntary and stimulated contractions. Exp Neurol 64:414–427

    PubMed  Article  CAS  Google Scholar 

  • Binder-Macleod SA, Snyder-Mackler L (1993) Muscle fatigue: clinical implications for fatigue assessment and neuromuscular electrical stimulation. Phys Ther 73:902–910

    PubMed  CAS  Google Scholar 

  • Davies PS, Jones PR, Norgan NG (1986) The distribution of subcutaneous and internal fat in man. Ann Hum Biol 13:189–192

    PubMed  Article  CAS  Google Scholar 

  • Gandevia SC (2001) Spinal and supraspinal factors in human muscle fatigue. Physiol Rev 81:1725–1789

    PubMed  CAS  Google Scholar 

  • Gobbo M, Gaffurini P, Bissolotti L, Esposito F, Orizio C (2011) Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response. Eur J Appl Physiol [Epub ahead of print]

  • Gregory CM, Bickel CS (2005) Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther 85:358–364

    PubMed  Google Scholar 

  • Hultman E, Sjöholm H, Jäderholm-Ek I, Krynicki J (1983) Evaluation of methods for electrical stimulation of human skeletal muscle in situ. Pflugers Arch 398:139–141

    PubMed  Article  CAS  Google Scholar 

  • Jones PR, Davies PS, Norgan NG (1986) Ultrasonic measurements of subcutaneous adipose tissue thickness in man. Am J Phys Anthropol 71:359–363

    PubMed  Article  CAS  Google Scholar 

  • Karaca P, Hadzić A, Vloka JD (2000) Specific nerve blocks: an update. Curr Opin Anaesthesiol 13:549–555

    PubMed  Article  CAS  Google Scholar 

  • Kim MW, Kim JH, Yang YJ, Ko YJ (2005) Anatomic localization of motor points in gastrocnemius and soleus muscles. Am J Phys Med Rehabil 84:680–683

    PubMed  Article  Google Scholar 

  • Lee NG, You JH, Park HD, Myoung HS, Lee SE, Hwang JH, Kim HS, Kim SS, Lee KJ (2009) The validity and reliability of the motor point detection system: a preliminary investigation of motor points of the triceps surae muscles. Arch Phys Med Rehabil 90:348–353

    PubMed  Article  Google Scholar 

  • Lee JH, Lee BN, An X, Chung RH, Kwon SO, Han SH (2011) Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles. Clin Anat 24:232–236

    PubMed  Article  Google Scholar 

  • Lefebvre R, Leroux A, Poumarat G, Galtier B, Guillot M, Vanneuville G, Boucher JP (2006) Vastus medialis: anatomical and functional considerations and implications based upon human and cadaveric studies. J Manipulative Physiol Ther 29:139–144

    PubMed  Article  Google Scholar 

  • Lieb FJ, Perry J (1968) Quadriceps function. An anatomical and mechanical study using amputated limbs. J Bone Joint Surg Am 50:1535–1548

    PubMed  CAS  Google Scholar 

  • Maffiuletti NA (2010) Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol 110:223–234

    PubMed  Article  Google Scholar 

  • Maganaris CN, Baltzopoulos V (1999) Predictability of in vivo changes in pennation angle of human tibialis anterior muscle from rest to maximum isometric dorsiflexion. Eur J Appl Physiol Occup Physiol 79:294–297

    PubMed  Article  CAS  Google Scholar 

  • Malesević NM, Popović LZ, Schwirtlich L, Popović DB (2010) Distributed low-frequency functional electrical stimulation delays muscle fatigue compared to conventional stimulation. Muscle Nerve 42:556–562

    PubMed  Article  Google Scholar 

  • Merletti R, Knaflitz M, De Luca CJ (1992) Electrically evoked myoelectric signals. Crit Rev Biomed Eng 19:293–340

    PubMed  CAS  Google Scholar 

  • Nordander C, Willner J, Hansson GA, Larsson B, Unge J, Granquist L, Skerfving S (2003) Influence of the subcutaneous fat layer, as measured by ultrasound, skinfold calipers and BMI, on the EMG amplitude. Eur J Appl Physiol 89:514–519

    PubMed  Article  CAS  Google Scholar 

  • Oprandi G, Botter A, Lanfranco F, Merletti R, Minetto MA (2010) Atlas of the muscle motor points for lower limb muscles. J Sports Med Phys Fitness 50(3 Suppl 1):5

    Google Scholar 

  • Place N, Casartelli N, Glatthorn JF, Maffiuletti NA (2010) Comparison of quadriceps inactivation between nerve and muscle stimulation. Muscle Nerve 42:894–900

    PubMed  Article  Google Scholar 

  • Prentice WE (2005) Therapeutic modalities in rehabilitation, 3rd edn. McGraw-Hill, New York

    Google Scholar 

  • Reid RW (1920) Motor points in relation to the surface of the body. J Anat 54:271–275

    PubMed  CAS  Google Scholar 

  • Seidel PM, Seidel GK, Gans BM, Dijkers M (1996) Precise localization of the motor nerve branches to the hamstring muscles: an aid to the conduct of neurolytic procedures. Arch Phys Med Rehabil 77:1157–1160

    PubMed  Article  CAS  Google Scholar 

  • Sook Kim H, Hye Hwang J, Lee PK, Kwon JY, Yeon Oh-Park M, Moon Kim J, Ho Chun M (2002) Localization of the motor nerve branches and motor points of the triceps surae muscles in korean cadavers. Am J Phys Med Rehabil 81:765–769

    PubMed  Article  Google Scholar 

  • Sunderland S, Hughes ES (1946) Metrical and non-metrical features of the muscular branches of the sciatic nerve and its medial and lateral popliteal divisions. J Comp Neurol 85:205–222

    PubMed  Article  CAS  Google Scholar 

  • Sung DH, Jung JY, Kim HD, Ha BJ, Ko YJ (2003) Motor branch of the rectus femoris: anatomic location for selective motor branch block in stiff-legged gait. Arch Phys Med Rehabil 84:1028–1031

    PubMed  Article  Google Scholar 

  • Thiranagama R (1990) Nerve supply of the human vastus medialis muscle. J Anat 170:193–198

    PubMed  CAS  Google Scholar 

  • Travnik L, Pernus F, Erzen I (1995) Histochemical and morphometric characteristics of the normal human vastus medialis longus and vastus medialis obliquus muscles. J Anat 187:403–411

    PubMed  Google Scholar 

  • Wallner SJ, Luschnigg N, Schnedl WJ, Lahousen T, Sudi K, Crailsheim K, Möller R, Tafeit E, Horejsi R (2004) Body fat distribution of overweight females with a history of weight cycling. Int J Obes Relat Metab Disord 28:1143–1148

    PubMed  Article  CAS  Google Scholar 

  • Yoo WK, Chung IH, Park CI (2002) Anatomic motor point localization for the treatment of gastrocnemius muscle spasticity. Yonsei Med J 43:627–630

    PubMed  Google Scholar 

Download references

Acknowledgments

Musculoskeletal Images are from the University of Washington “Musculoskeletal Atlas: A Musculoskeletal Atlas of the Human Body” by Carol Teitz, M.D. and Dan Graney, Ph.D. Copyright 2003–2004 University of Washington. All rights reserved including all photographs and images. No re-use, re-distribution or commercial use without prior written permission of the authors and the University of Washington. The authors are grateful to Prof. R. Merletti (LISiN, Politecnico di Torino, Italy) for his careful review of the final version of the manuscript and to Dr. D. Antista (School of Motor Sciences, Turin, Italy) for his valuable assistance in subject recruitment and evaluation. This study was supported by Regional Health Administration Project “Ricerca Sanitaria Finalizzata 2009” and by bank foundations “Compagnia di San Paolo” (Project “Neuromuscular Investigation and Conditioning in Endocrine Myopathy”), “Fondazione Cariplo” (Project “Steroid myopathy: Molecular, Histopathological, and Electrophysiological Characterization”) and “Fondazione Cassa di Risparmio di Saluzzo”.

Author information

Affiliations

  1. Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics, Politecnico di Torino, Turin, Italy

    Alberto Botter, Gianmosè Oprandi & Marco Alessandro Minetto

  2. Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, Molinette Hospital, University of Turin, C.so Dogliotti 14, 10126, Turin, Italy

    Fabio Lanfranco, Stefano Allasia & Marco Alessandro Minetto

  3. Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland

    Nicola A. Maffiuletti

Authors
  1. Alberto Botter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianmosè Oprandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Lanfranco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Allasia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicola A. Maffiuletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Alessandro Minetto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Alessandro Minetto.

Additional information

This article is published as part of the Special Issue Cluster on the XVIII Congress of the International Society of Electrophysiology and Kinesiology (ISEK 2010) that took place in Aalborg, Denmark on 16–19 June 2010.

Communicated by Roberto Bottinelli.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Botter, A., Oprandi, G., Lanfranco, F. et al. Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning. Eur J Appl Physiol 111, 2461 (2011). https://doi.org/10.1007/s00421-011-2093-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00421-011-2093-y

Keywords

  • Neuromuscular electrical stimulation
  • Motor entry point
  • Motor branch
  • Lower limb