Rehabilitative and Conditioning Exercises That Selectively Activate Individual Lower Extremity Muscles: A Systematic Review

This systematic review pooled 106 studies measuring which exercises selectively activate individual lower extremity muscles (not just whole muscle groups), using EMG, ultrasound, MRI and elastography across hip, thigh, leg, and foot muscles. It found wide variation in evidence quality (mean MINORS 19.1 for RCTs vs 9.7 for non-RCTs) and coverage (29 muscles studied, with biceps femoris the focus of 48/106 studies while muscles like abductor hallucis brevis had only 1), and summarized specific exercise modifications (e.g., prone hip extension with 90° knee flexion increasing gluteus maximus activation by 70.93%, external foot rotation favoring medial gastrocnemius) that preferentially recruit specific muscles.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersGives clinicians and trainers an evidence-mapped catalog of exercises for targeted muscle activation in rehab and injury prevention, while exposing major gaps (e.g., piriformis, pectineus) that limit current individualized prescription.

Presenting this at rounds? Start here

• ?Given that biceps femoris dominates the hamstring literature, how should clinicians adapt rehab programs for patients needing selective semitendinosus or semimembranosus strengthening when the evidence is thinner?
• ?If gluteus medius activation differs so much by rotation and plane of movement, how should this change exercise selection for patients with hip abductor weakness after THA or ACL reconstruction?