A Musculoskeletal model for the lumbar spine

Skin marker-based subject-specific spinal alignment modeling: A feasibility study

Musculoskeletal models have the potential to improve diagnosis and optimize clinical treatment by predicting accurate outcomes on an individual basis. However, the subject-specific modeling of spinal alignment is often strongly simplified or is based on radiographic assessments, exposing subjects to unnecessary radiation. We therefore developed and introduced a novel skin marker-based approach for modeling subject-specific spinal alignment and evaluated its feasibility by comparing the predicted L1/L2 spinal loads during various functional activities with the loads predicted by the generically scaled models as well as with in vivo measured data obtained from the OrthoLoad database. Spinal loading simulations resulted in considerably higher compressive forces for both scaling approaches over all simulated activities, and AP shear forces that were closer or similar to the in vivo data for the subject-specific approach during upright standing activities and for the generic approach during activities that involved large flexions. These results underline the feasibility of the proposed method and associated workflow for inter- and intra-subject investigations using musculoskeletal simulations. When implemented into standard model scaling workflows, it is expected to improve the accuracy of muscle activity and joint loading simulations, which is crucial for investigations of treatment effects or pathology-dependent deviations.

Clarify Sit-to-Stand Muscle Synergy and Tension Changes in Subacute Stroke Rehabilitation by Musculoskeletal Modeling

Post-stroke patients exhibit distinct muscle activation electromyography (EMG) features in sit-to-stand (STS) due to motor deficiency. Muscle activation amplitude, related to muscle tension and muscle synergy activation levels, is one of the defining EMG features that reflects post-stroke motor functioning and motor impairment. Although some qualitative findings are available, it is not clear if and how muscle activation amplitude-related biomechanical attributes may quantitatively reflect during subacute stroke rehabilitation. To better enable a longitudinal investigation into a patient's muscle activation changes during rehabilitation or an inter-subject comparison, EMG normalization is usually applied. However, current normalization methods using maximum voluntary contraction (MVC) or within-task peak/mean EMG may not be feasible when MVC cannot be obtained from stroke survivors due to motor paralysis and the subject of comparison is EMG amplitude. Here, focusing on the paretic side, we first propose a novel, joint torque-based normalization method that incorporates musculoskeletal modeling, forward dynamics simulation, and mathematical optimization. Next, upon method validation, we apply it to quantify changes in muscle tension and muscle synergy activation levels in STS motor control units for patients in subacute stroke rehabilitation. The novel method was validated against MVC-normalized EMG data from eight healthy participants, and it retained muscle activation amplitude differences for inter- and intra-subject comparisons. The proposed joint torque-based method was also compared with the common static optimization based on squared muscle activation and showed higher simulation accuracy overall. Serial STS measurements were conducted with four post-stroke patients during their subacute rehabilitation stay (137 ± 22 days) in the hospital. Quantitative results of patients suggest that maximum muscle tension and activation level of muscle synergy temporal patterns may reflect the effectiveness of subacute stroke rehabilitation. A quality comparison between muscle synergies computed with the conventional within-task peak/mean EMG normalization and our proposed method showed that the conventional was prone to activation amplitude overestimation and underestimation. The contributed method and findings help recapitulate and understand the post-stroke motor recovery process, which may facilitate developing more effective rehabilitation strategies for future stroke survivors.

Investigating the active contractile function of the rat paraspinal muscles reveals unique cross-bridge kinetics in the multifidus

PURPOSE

Various aspects of paraspinal muscle anatomy, biology, and histology have been studied; however, information on paraspinal muscle contractile function is almost nonexistent, thus hindering functional interpretation of these muscles in healthy individuals and those with low back disorders. The aim of this study was to measure and compare the contractile function and force-sarcomere length properties of muscle fibers from the multifidus (MULT) and erector spinae (ES) as well as a commonly studied lower limb muscle (Extensor digitorum longus (EDL)) in the rat.

METHODS

Single muscle fibers (n = 77 total from 6 animals) were isolated from each of the muscles and tested to determine their active contractile function; all fibers used in the analyses were type IIB.

RESULTS

There were no significant differences between muscles for specific force (sF_o) (p = 0.11), active modulus (p = 0.63), average optimal sarcomere length (p = 0.27) or unloaded shortening velocity (V_o) (p = 0.69). However, there was a significant difference in the rate of force redevelopment (k_tr) between muscles (p =  < 0.0001), with MULT being significantly faster than both the EDL (p =  < 0.0001) and ES (p = 0.0001) and no difference between the EDL and ES (p = 0.41).

CONCLUSIONS

This finding suggests that multifidus has faster cross-bridge turnover kinetics when compared to other muscles (ES and EDL) when matched for fiber type. Whether the faster cross-bridge kinetics translate to a functionally significant difference in whole muscle performance needs to be studied further.

The Multi-Modal Risk Analysis and Medical Prevention of Lumbar Degeneration, Fatigue, and Injury Based on FEM/BMD for Elderly Chinese Women Who Act as Stay-Home Grandchildren Sitters

Background: An increasing number of Chinese elderly women stay at home and act as grandchildren sitters. In consequence of the frequent load-bearing, chronic lumbar fatigue probably caused a higher risk of lumbar degeneration, fatigue, and injury which has become one of the most important aging and health problems in China. In this study, a multi-mode lumbar finite element model (FEM) with specific bone mineral density (BMD) were developed and validated for further spine injury prevention and control.

Methods: The material properties of lumbar vertebra were modified according to degenerated bone mineral density, and geometry was adjusted based on intervertebral disc height. The motion of lifting children was simulated by a 76 year-old Chinese women's FEM, and the stress distribution was calculated and predicted.

Results: The pressure of L5-S intervertebral disc in the bending 3-year-old dummy lifting posture was significantly higher than the same posture without lifting, the maximum effective stress of endplate cartilage in the upright child lifting posture was 1.6 times that of the bending without lifting posture. And the fatigue risk limitation frequency of the upright with dummy posture was predicted with the functional equation of fatigue and stress which was deduced by genetic algorithm, which combined with the effective stress of lumbar vertebrae spongy bone calculated from FEM.

Conclusions: The child-lifting motion could increase the risk of lumbar degeneration, fatigue, and injury in elderly women, and they should keep below the frequency limit of the motion of lifting children in their daily life. This study could put forward scientific injury prevention guidance to Chinese elderly women who lift children in daily life frequently.

Comparing the risk of low-back injury using model-based optimization: Improved technique versus exoskeleton assistance

Although wearable robotic systems are designed to reduce the risk of low-back injury, it is unclear how effective assistance is, compared to improvements in lifting technique. We use a two-factor block study design to simulate how effective exoskeleton assistance and technical improvements are at reducing the risk of low-back injury when compared to a typical adult lifting a box. The effects of assistance are examined by simulating two different models: a model of just the human participant, and a model of the human participant wearing the SPEXOR exoskeleton. The effects of lifting technique are investigated by formulating two different types of optimal control problems: a least-squares problem which tracks the human participant's lifting technique, and a minimization problem where the model is free to use a different movement. Different lifting techniques are considered using three different cost functions related to risk factors for low-back injury: cumulative low-back load (CLBL), peak low-back load (PLBL), and a combination of both CLBL and PLBL (HYB). The results of our simulations indicate that an exoskeleton alone can make modest reductions in both CLBL and PLBL. In contrast, technical improvements alone are effective at reducing CLBL, but not PLBL. The largest reductions in both CLBL and PLBL occur when both an exoskeleton and technical improvements are used. While all three of the lifting technique cost functions reduce both CLBL and PLBL, the HYB cost function offers the most balanced reduction in both CLBL and PLBL.

Hybrid Predictive Model for Lifting by Integrating Skeletal Motion Prediction with an OpenSim Musculoskeletal Model

OBJECTIVE

In this study, a novel hybrid predictive musculoskeletal model is proposed which has both motion prediction and muscular dynamics assessment capabilities.

METHODS

First, a two-dimensional (2D) skeletal model with 10 degrees of freedom is used to predict a symmetric lifting motion, outputting joint angle profiles, ground reaction forces (GRFs), and center of pressure (COP). These intermediate outputs are input to the scaled musculoskeletal model in OpenSim for muscle activation and joint reaction load analysis. Finally, the experimental validation is carried out.

RESULTS

Static Optimization tool is used to estimate the muscle activation data in OpenSim for the predicted lifting motion. Joint reaction forces of the lumbosacral joint (L5-S1) are generated using the OpenSim Joint Reaction analysis tool. The predicted joint angles, muscle activations, and peak joint reaction forces are compared with experimental data and data from literature to validate the hybrid model.

CONCLUSION

The proposed hybrid model combines the skeletal models rapid motion prediction with OpenSims complex muscular dynamics assessment, and it can serve as a new generic tool for motion prediction and injury analysis in ergonomics and biomechanics.

Subject-Specific Alignment and Mass Distribution in Musculoskeletal Models of the Lumbar Spine

Musculoskeletal modeling is a well-established method in spine biomechanics and generally employed for investigations concerning both the healthy and the pathological spine. It commonly involves inverse kinematics and optimization of muscle activity and provides detailed insight into joint loading. The aim of the present work was to develop and validate a procedure for the automatized generation of semi-subject-specific multi-rigid body models with an articulated lumbar spine. Individualization of the models was achieved with a novel approach incorporating information from annotated EOS images. The size and alignment of bony structures, as well as specific body weight distribution along the spine segments, were accurately reproduced in the 3D models. To ensure the pipeline’s robustness, models based on 145 EOS images of subjects with various weight distributions and spinopelvic parameters were generated. For validation, we performed kinematics-dependent and segment-dependent comparisons of the average joint loads obtained for our cohort with the outcome of various published in vivo and in situ studies. Overall, our results agreed well with literature data. The here described method is a promising tool for studying a variety of clinical questions, ranging from the evaluation of the effects of alignment variation on joint loading to the assessment of possible pathomechanisms involved in adjacent segment disease.

Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders

Low back pain disorders affect more than 80% of adults in their lifetime and are the leading cause of global disability. The muscles attaching to the spine (ie, paraspinal muscles) are critical for proper spine health and play a crucial role in the functioning of the spine and whole body; however, reports of muscle dysfunction and insufficiency in chronic LBP (CLBP) patients are common. This article presents a review of the current understanding of the relationship between paraspinal muscle pathophysiology and spine-related disorders. Human literature demonstrates a clear association between altered muscle structure/function, most notably fatty infiltration and fibrosis, and low back pain disorders; other associations, including muscle cell atrophy and fiber type changes, are less clear. Animal literature then provides some mechanistic insight into the complex relationships, including initiating factors and time courses, between the spine and spine muscles under pathological conditions. It is apparent that spine pathology can directly lead to changes in the paraspinal muscle structure, function, and biology. It also appears that changes to the muscle structure and function can directly lead to changes in the spine (eg, deformity); however, this relationship is less well studied. Future work must focus on providing insight into possible mechanisms that regulate spine and paraspinal muscle health, as well as probing how muscle degeneration/dysfunction might be an initiating factor in the progression of spine pathology.

Stress analysis of intervertebral disc during occupational activities

BACKGROUND AND OBJECTIVE

Manual material handling activities cause large compression of the intervertebral disc of the lumbar spine. Intradiscal pressure (IDP) has generally been employed to predict the risk of low back injury. As an alternative to in vivo measurements, either motion analysis or finite element (FE) analysis has been used to estimate IDP. The purpose of this study is to propose a new biomechanical method that integrates FE analysis with motion analysis, in order to estimate the stresses and deformations of the intervertebral disc of the lumbar spine during occupational activities.

METHODS

In the proposed method, motion analysis is performed first by using motion capture data, and the results are employed as input data to FE analysis at specific times of interest during motion. In this method, an in-house interface program is used to scale an initial reference FE model to the subject of experiment, and transformed to the corresponding posture at a specific time during motion. The muscle forces and GRF obtained from motion analysis are applied to FE analysis as boundary and loading conditions. For a total of eighteen occupational activities, the IDP, shear stress, and strain of the L4-L5 segment are estimated.

RESULTS

Under each in vivo activity, the predicted IDP was in overall agreement with the available in vivo data. For lifting activities according to lift origin position, the maximum IDP occurred in the far-knee position immediately after lifting. As the lift origin position moved away from the spine, the stresses and strains in the disc increased.

CONCLUSIONS

This new proposed method is expected to allow the estimation of the stresses and deformations in the intervertebral disc during various occupational activities.

Load Distribution in the Lumbar Spine During Modeled Compression Depends on Lordosis

Excessive or incorrect loading of lumbar spinal structures is commonly assumed as one of the factors to accelerate degenerative processes, which may lead to lower back pain. Accordingly, the mechanics of the spine under medical conditions, such as scoliosis or spondylolisthesis, is well-investigated. Treatments via both conventional therapy and surgical methods alike aim at restoring a "healthy" (or at least pain-free) load distribution. Yet, surprisingly little is known about the inter-subject variability of load bearings within a "healthy" lumbar spine. Hence, we utilized computer tomography data from 28 trauma-room patients, whose lumbar spines showed no visible sign of degeneration, to construct simplified multi-body simulation models. The subject-specific geometries, measured by the corresponding lumbar lordosis (LL) between the endplates of vertebra L1 and the sacrum, served as ceteris paribus condition in a standardized forward dynamic compression procedure. Further, the influence of stimulating muscles from the M. multifidus group was assessed. For the range of available LL from 28 to 66°, changes in compressive and shear forces, bending moments, as well as facet joint forces between adjacent vertebrae were calculated. While compressive forces tended to decrease with increasing LL, facet forces were tendentiously increasing. Shear forces decreased between more cranial vertebrae and increased between more caudal ones, while bending moments remained constant. Our results suggest that there exist significant, LL-dependent variations in the loading of "healthy" spinal structures, which should be considered when striving for individually appropriate therapeutic measures.

Superficial lumbar muscle recruitment strategies to control the trunk with delayed-onset muscle soreness

PURPOSE

The lumbar region offers various muscle recruitment strategies to achieve a task goal under varying conditions. For instance, trunk movement control can be reorganized under the influence of low back pain. How such task-modulation is obtained is not fully understood. The objective of this study was to characterize superficial lumbar muscle recruitment strategies under the influence of delayed-onset muscle soreness (DOMS) during unexpected trunk perturbations.

METHODS

Healthy participants experienced a series of 15 sudden external perturbations with and without the influence of low back DOMS. During these perturbations, high-density surface electromyography was used to characterize recruitment strategies of superficial lumbar muscles, while kinematics sensors were used to characterize movements of the trunk. Lumbar muscle recruitment strategies, characterized by the amplitude of muscle activity amplitude, the latencies of the reflex activity and the spatial distribution of muscle activity, were compared across perturbations trials and with and without DOMS.

RESULTS

An attenuation of lumbar muscle activity amplitude was observed across perturbation trials without DOMS, but not with DOMS. The spatial distribution of muscle activity was similar with and without DOMS. No significant changes in reflex activity latency and trunk flexion movement were observed.

CONCLUSIONS

Following an unexpected trunk perturbation under DOMS effects, trunk movement are controlled using two different superficial lumbar muscles control strategies: keeping a constant level of their overall muscle activity and using a variable muscle recruitment pattern.

Embodiment of intra-abdominal pressure in a flexible multibody model of the trunk and the spinal unloading effects during static lifting tasks

The role of intra-abdominal pressure (IAP) in spinal load reduction has remained controversial, partly because previous musculoskeletal models did not introduce the pressure generating mechanism. In this study, an integrated computational methodology is proposed to combine the IAP change with core muscle activations. An ideal gas relationship was introduced to calculate pressure distribution within the abdominal cavity. Additionally, based on flexible multibody dynamics, a muscle membrane element was developed by incorporating the muscular fiber deformation, inter-fiber stiffness, and volume constancy. This element was then utilized in discretizing the diaphragm and transversus abdominis, forming an IAP-muscle coupling system of the abdominal cavity. Based on this methodology, a forward dynamic simulation of spinal flexion was presented to examine the unloading effect of abdominal breathing. The results confirm that core muscle contraction during the abdominal breathing cycle can substantially reduce the forces of spinal compression together with trunk extensor muscles, and this effect is more pronounced when the IAP increase is produced by contraction of the transversus abdominis. This unloading effect still holds even with the co-activation of other abdominal muscles, providing a potential choice when designing trunk movements during weight-lifting tasks.

Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains

BACKGROUND

Altered regional activation of the lumbar extensors has been previously observed in individuals with low back pain (LBP) performing high-effort and fatiguing tasks. It is currently unknown whether similar alterations can be observed during low-effort functional tasks. Similarly, previous studies did not investigate whether side differences in regional activation are present in individuals with LBP. Finally, there is limited evidence of whether the extent of the alteration of regional activation is associated with clinical factors. Therefore, the aim of this study was to investigate whether individuals with LBP exhibit asymmetric regional activation of the thoraco-lumbar extensor muscles during functional tasks, and if the extent of neuromuscular control alteration is associated with clinical and psychosocial outcome domains.

METHODS

21 participants with and 21 without LBP performed five functional tasks (gait, sit-to-stand, forward trunk flexion, shoulder flexion and anterior pelvic tilt). The spatial distribution of activation of the thoraco-lumbar extensor muscles was assessed bilaterally using high-density electromyography. For each side, the distribution of electromyographic (EMG) amplitude was characterized in terms of intensity, location and size. Indices of asymmetry were calculated from these features and comparisons between groups and tasks were performed using ANOVA. The features that significantly differed between groups were correlated with self-reported measures of pain intensity and other outcome domains.

RESULTS

Indices of asymmetry did not differ between participants with and without LBP (p > 0.11). The cranio-caudal location of the activation differed between tasks (p < 0.05), but not between groups (p = 0.64). Participants with LBP showed reduced EMG amplitude during anterior pelvic tilt and loading response phase during gait (both p < 0.05). Pearson correlation revealed that greater pain intensity was associated with lower EMG amplitude for both tasks (R<-0.5, p < 0.05).

CONCLUSIONS

Despite clear differences between tasks, individuals with and without LBP exhibited similar distributions of EMG amplitude during low-effort functional activities, both within and between sides. However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. These results have implications in the development or refinement of assessment and intervention strategies focusing on motor control in patients with chronic LBP.

Influence of the femoral offset on the muscles passive resistance in total hip arthroplasty

BACKGROUND

Soft tissue tension is treated as a crucial factor influencing the post-THA dislocation. The femoral offset is regarded as one of the major parameters responsible for the stabilization of the prosthesis. It is unclear which soft tissue is mostly affected by the offset changes.

METHODS

A finite element model of the hip was created. The model comprised muscles, bones, a stem, the acetabular component and a liner. The muscles were modelled as a Hill-type musculo-tendon nonlinear springs. Nonlinear analyses of the hip flexion and internal rotation were performed for the two values of the femoral stem offset.

RESULTS

We observed that the quadratus femoris and gluteus medius produce the largest resisting moment opposing the external load excreted by the surgeon during the intraoperative hip dislocation test.

CONCLUSIONS

An increased femoral offset increases the stretching of the quadratus femoris muscle significantly and provides the growth of its initial passive force. This muscle serves as a stiff band, providing stabilisation of the hip prosthesis, measured during the simulated intraoperative test.

Calibration and validation of a novel hybrid model of the lumbosacral spine in ArtiSynth-The passive structures

In computational biomechanics, two separate types of models have been used predominantly to enhance the understanding of the mechanisms of action of the lumbosacral spine (LSS): Finite element (FE) and musculoskeletal multibody (MB) models. To combine advantages of both models, hybrid FE-MB models are an increasingly used alternative. The aim of this paper is to develop, calibrate, and validate a novel passive hybrid FE-MB open-access simulation model of a ligamentous LSS using ArtiSynth. Based on anatomical data from the Male Visible Human Project, the LSS model is constructed from the L1-S1 rigid vertebrae interconnected with hyperelastic fiber-reinforced FE intervertebral discs, ligaments, and facet joints. A mesh convergence study, sensitivity analyses, and systematic calibration were conducted with the hybrid functional spinal unit (FSU) L4/5. The predicted mechanical responses of the FSU L4/5, the lumbar spine (L1-L5), and the LSS were validated against literature data from in vivo and in vitro measurements and in silico models. Spinal mechanical responses considered when loaded with pure moments and combined loading modes were total and intervertebral range of motions, instantaneous axes and centers of rotation, facet joint contact forces, intradiscal pressures, disc bulges, and stiffnesses. Undesirable correlations with the FE mesh were minimized, the number of crisscrossed collagen fiber rings was reduced to five, and the individual influences of specific anatomical structures were adjusted to in vitro range of motions. Including intervertebral motion couplings for axial rotation and nonlinear stiffening under increasing axial compression, the predicted kinematic and structural mechanics responses were consistent with the comparative data. The results demonstrate that the hybrid simulation model is robust and efficient in reproducing valid mechanical responses to provide a starting point for upcoming optimizations and extensions, such as with active skeletal muscles.

Estimation of forces on anterior cruciate ligament in dynamic activities

In this work, a nonlinear strain rate dependent plugin developed for the OpenSim® platform was used to estimate the instantaneous strain rate (ISR) and the forces on the ACL's anteromedial (aACL) and posterolateral (pACL) bundles during walking and sudden change of direction of running termed as 'plant-and-cut' (PC). The authors obtained the kinematics data for walking via optical motion capture. PC movements, along with running kinematics, were obtained from the literature. A nonlinear plugin developed for ligaments was interfaced with OpenSim® platform to simulate walking and PC motions with a flexed knee and an extended knee. PC phase is sandwiched between an approach phase and take-off phase and was studied at various event velocities (1.8, 3, and 4.2 m s^-1), and angles of PC (23°, 34°, and 45°) as encountered in adult ball games. In both cases of PC-with-extended knee and PC-with-flexed-knee, the maximum forces on both the ACL bundles were observed after the take-off phase. A maximum force of ~ 35 N kg^-1 of body weight (BW) was observed on aACL after the take-off phase for an event velocity of 4.2 m s^-1. In the posterolateral bundle (pACL), the maximum forces (~ 40 N kg^-1 of BW) were observed towards the end of the mid-swing phase (after the take-off phase) for the various combinations of the parameters studied. The forces observed in the simulation of PC-with-flexed-knee and PC-with-extended-knee has resulted in magnitude higher than sustainable by the adults. This study is novel in attempting to incorporate differing rates-of-strain that have been shown to alter soft tissue properties into the OpenSim® musculoskeletal model. The proposed model can be used by researchers to predict the forces during various kinematic activities for other soft tissues.

A Dynamic Optimization Approach for Solving Spine Kinematics While Calibrating Subject-Specific Mechanical Properties

This study aims to propose a new optimization framework for solving spine kinematics based on skin-mounted markers and estimate subject-specific mechanical properties of the intervertebral joints. The approach enforces dynamic consistency in the entire skeletal system over the entire time-trajectory while personalizing spinal stiffness. 3D reflective markers mounted on ten vertebrae during spine motions were measured in ten healthy volunteers. Biplanar X-rays were taken during neutral stance of the subjects wearing the markers. Calculated spine kinematics were compared to those calculated using inverse kinematics (IK) and IK with imposed generic kinematic constraints. Calculated spine kinematics compared well with standing X-rays, with average root mean square differences of the vertebral body center positions below 10.1 mm and below [Formula: see text] for joint orientation angles. For flexion/extension and lateral bending, the lumbar rotation distribution patterns, as well as the ranges of rotations matched in vivo literature data. The approach outperforms state-of-art IK and IK with constraints methods. Calculated ratios reflect reduced spinal stiffness in low-resistance zone and increased stiffness in high-resistance zone. The patterns of calibrated stiffness were consistent with previously reported experimentally determined patterns. This approach will further our insight into spinal mechanics by increasing the physiological representativeness of spinal motion simulations.

The effect of vertebral level on biomechanical properties of the lumbar paraspinal muscles in a rat model

INTRODUCTION

Passive mechanical properties of the paraspinal muscles are important to the biomechanical functioning of the spine. In most computational models, the same biomechanical properties are assumed for each paraspinal muscle group, while cross-sectional area or fatty infiltration in these muscles have been reported to differ between the vertebral levels. Two important properties for musculoskeletal modeling are the slack sarcomere length and the tangent modulus. This study aimed to investigate the effect of vertebral level on these biomechanical properties of paraspinal muscles in a rat model.

METHODS

The left paraspinal muscles of 13 Sprague-Dawley rats were exposed under anesthesia. Six muscle biopsies were collected from each rat: three from multifidus (one per each of the L1, L3, and L5 levels) and similarly three from longissimus. Each biopsy was cut into two halves. From one half, two to three single muscle fibers and two to six muscle fiber bundles (14 ± 7 fibers surrounded in their connective tissue) were extracted and mechanically tested in a passive state. From the resulting stress-strain data, tangent modulus was calculated as the slope of the tangent at 30% strain and slack sarcomere length (beyond which passive force starts to develop) was recorded. The other half of each biopsy, which represented the muscle at the fascicle level, was snap frozen, sectioned, stained for Collagen I and its area fraction was measured. To evaluate the effect of spinal level on these biomechanical properties of multifidus and longissimus, one-way repeated measures ANOVA (p < 0.05) was performed for tangent modulus and slack sarcomere length, while for collagen I content linear mixed-models analysis was adopted.

RESULTS

In total, 192 fibers and 262 fiber bundles were mechanically tested. For both muscle groups, no significant difference in tangent modulus of the single fibers was detected between the three spinal levels (p = 0.9 for multifidus and p = 0.08 for longissimus). Similarly, the tangent modulus values for the fiber bundles were not significantly different between the three spinal levels (p = 0.13 for multifidus and p = 0.49 for longissimus). In both muscle groups, the slack sarcomere lengths were not different among the spinal levels except for multifidus fibers (p = 0.02). Collagen I area fraction in muscle fascicles averaged 6.8% for multifidus and 5.3% for longissimus and was not different between the spinal levels.

DISCUSSION

The results of this study highlighted that the tangent modulus, slack sarcomere length, and collagen I content of the lumbar paraspinal muscles are independent of spinal level. This finding provides the basis for the assumption of similar mechanical properties along a paraspinal muscle group.

An open-source musculoskeletal model of the lumbar spine and lower limbs: a validation for movements of the lumbar spine

Musculoskeletal models of the lumbar spine have been developed with varying levels of detail for a wide range of clinical applications. Providing consistency is ensured throughout the modelling approach, these models can be combined with other computational models and be used in predictive modelling studies to investigate bone health deterioration and the associated fracture risk. To provide precise physiological loading conditions for such predictive modelling studies, a new full-body musculoskeletal model including a detailed and consistent representation of the lower limbs and the lumbar spine was developed. The model was assessed against in vivo measurements from the literature for a range of spine movements representative of daily living activities. Comparison between model estimations and electromyography recordings was also made for a range of lifting tasks. This new musculoskeletal model will provide a comprehensive physiological mechanical environment for future predictive finite element modelling studies on bone structural adaptation. It is freely available on https://simtk.org/projects/llsm/.

A novel coupled musculoskeletal finite element model of the spine - Critical evaluation of trunk models in some tasks

Spine musculoskeletal (MS) models make simplifying assumptions on the intervertebral joint degrees-of-freedom (rotational and/or translational), representation (spherical or beam-like joints), and properties (linear or nonlinear). They also generally neglect the realistic structure of the joints with disc nuclei/annuli, facets, and ligaments. We aim to develop a novel MS model where trunk muscles are incorporated into a detailed finite element (FE) model of the ligamentous T12-S1 spine thus constructing a gold standard coupled MS-FE model. Model predictions are compared under some tasks with those of our earlier spherical joints, beam joints, and hybrid (uncoupled) MS-FE models. The coupled model predicted L4-L5 intradiscal pressures (R² ≅ 0.97, RMSE ≅ 0.27 MPa) and L1-S1 centers of rotation (CoRs) in agreement to in vivo data. Differences in model predictions grew at larger trunk flexion angles; at the peak (80°) flexion the coupled model predicted, compared to the hybrid model, much smaller global/local muscle forces (~38%), segmental (~44%) and disc (~22%) compression forces but larger segmental (~9%) and disc (~17%) shear loads, ligament forces at the lower lumbar levels (by up to 57%) and facet forces at all levels. The spherical/beam joints models predicted much greater muscle forces and segmental loads under larger flexion angles. Unlike the spherical joints model with fixed CoRs, the beam joints model predicted CoRs closer (RMSE = 2.3 mm in flexion tasks) to those of the coupled model. The coupled model offers a great potential for future studies towards improvement of surgical techniques, management of musculoskeletal injuries and subject-specific simulations.

Directional Dependence of Experimental Trunk Stiffness: Role of Muscle-Stiffness Variation of Nonneural Origin

Trunk stiffness is an important parameter for trunk stability analysis and needs to be evaluated accurately. Discrepancies regarding the dependence of trunk stiffness on the direction of movement in the sagittal plane suggest inherent sources of error that require explanation. In contrast to the common assumption that the muscle stiffness remains constant prior to the induction of a reflex during position perturbations, it is postulated that muscle-stiffness changes of nonneural origin occur and alter the experimental trunk stiffness, causing it to depend on the sagittal direction. This is confirmed through reinterpretation of existing test data for a healthy subject, numerical simulation, and sensitivity analysis using a biomechanical model. The trunk stiffness is determined through a static approach (in forward and backward directions) and compared with the model stiffness for assumed scenarios involving deactivated muscles. The difference in stiffness between the opposite directions reaches 17.5% without a preload and decreases when a moderate vertical preload is applied. The increased muscle activation induced by preloads or electrical stimuli explains the apparent discrepancies observed in previous studies. The experimental stiffness invariably remains between low and high model-stiffness estimates based on extreme scenarios of the postulated losses of muscle activation, thereby confirming our hypothesis.

Review of Current Spinal Robotic Orthoses

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

A backpack load sharing model to evaluate lumbar and hip joint contact forces during shoulder borne and hip belt assisted load carriage

Musculoskeletal injuries of the lumbar spine occur frequently among military service members and are associated with heavy backpack loads. Musculoskeletal modeling and simulation facilitate biomechanical evaluation to compare different backpack designs. We developed a backpack attachment model that can be tuned to represent various load distributions between the torso and pelvis. We generated walking simulations to estimate muscle and joint contact forces of unloaded walking and while carrying 38 kg using shoulder-borne backpacks and hip belt-assisted backpacks for six U.S. Marines. Three-dimensional peak and average lumbar (L4-L5) and hip joint contact forces over the stance phase were compared between each load condition. Axial L4-L5 and axial and anterior hip joint contact forces were greater during both backpack conditions compared to the unloaded condition. Joint contact forces were similar between backpack conditions. Future studies incorporating additional participants, walking conditions, and backpack load distributions are suggested for further model development and backpack design evaluation.

Analysis and modeling of human seat interaction with a focus on the upper body and backrest using biomechanics and contact mechanics

BACKGROUND

This paper outlines a method to study the interaction between the human body and the aircraft seat concerning the seat comfort.

METHOD

Firstly, the human body is modeled based on biomechanics and divided into a number of body segments connected by joints according to human anatomy. The angles between the body segments are obtained by curve fitting of the existing biomechanical research data. The contact forces between the human body and the seat are modeled using pairs of bi-lateral point forces. These forces are calculated and located through the analysis of the center of gravity of each body segment and average muscular structure of the human body. The geometry of the human and the seat is obtained from a 3D scan model or a CAD model. Secondly, the pressure distribution between the human body and the seat is modeled and calculated using the contact stress theory. The results of the two parts are combined to analyze the comfortability in relation to different postures, backrest recline angles and changing in shape and material.

RESULTS

Simulations were performed and they are compared with experimental measurement and various FEM studies for validation. It is found that accuracy of this method is comparable with most FEM calculation.

CONCLUSION

This method provides a new direction in cushion conform research. It is faster and convenient to use comparing to the FEM, and the result is reliable.

Development of a multiscale model of the human lumbar spine for investigation of tissue loads in people with and without a transtibial amputation during sit-to-stand

Quantification of lumbar spine load transfer is important for understanding low back pain, especially among persons with a lower limb amputation. Computational modeling provides a helpful solution for obtaining estimates of in vivo loads. A multiscale model was constructed by combining musculoskeletal and finite element (FE) models of the lumbar spine to determine tissue loading during daily activities. Three-dimensional kinematic and ground reaction force data were collected from participants with ([Formula: see text]) and without ([Formula: see text]) a unilateral transtibial amputation (TTA) during 5 sit-to-stand trials. We estimated tissue-level load transfer from the multiscale model by controlling the FE model with intervertebral kinematics and muscle forces predicted by the musculoskeletal model. Annulus fibrosis stress, intradiscal pressure (IDP), and facet contact forces were calculated using the FE model. Differences in whole-body kinematics, muscle forces, and tissue-level loads were found between participant groups. Notably, participants with TTA had greater axial rotation toward their intact limb ([Formula: see text]), greater abdominal muscle activity ([Formula: see text]), and greater overall tissue loading throughout sit-to-stand ([Formula: see text]) compared to able-bodied participants. Both normalized (to upright standing) and absolute estimates of L4-L5 IDP were close to in vivo values reported in the literature. The multiscale model can be used to estimate the distribution of loads within different lumbar spine tissue structures and can be adapted for use with different activities, populations, and spinal geometries.

Muscle-driven and torque-driven centrodes during modeled flexion of individual lumbar spines are disparate

Lumbar spine biomechanics during the forward-bending of the upper body (flexion) are well investigated by both in vivo and in vitro experiments. In both cases, the experimentally observed relative motion of vertebral bodies can be used to calculate the instantaneous center of rotation (ICR). The timely evolution of the ICR, the centrode, is widely utilized for validating computer models and is thought to serve as a criterion for distinguishing healthy and degenerative motion patterns. While in vivo motion can be induced by physiological active structures (muscles), in vitro spinal segments have to be driven by external torque-applying equipment such as spine testers. It is implicitly assumed that muscle-driven and torque-driven centrodes are similar. Here, however, we show that centrodes qualitatively depend on the impetus. Distinction is achieved by introducing confidence regions (ellipses) that comprise centrodes of seven individual multi-body simulation models, performing flexion with and without preload. Muscle-driven centrodes were generally directed superior–anterior and tail-shaped, while torque-driven centrodes were located in a comparably narrow region close to the center of mass of the caudal vertebrae. We thus argue that centrodes resulting from different experimental conditions ought to be compared with caution. Finally, the applicability of our method regarding the analysis of clinical syndromes and the assessment of surgical methods is discussed.

Ergonomics assessment of passive upper-limb exoskeletons in an automotive assembly plant

Over the years, the industry's interest in using external support devices, such as exoskeletons, is increasing. They are introduced as a new technique for improving the conditions of workers and for reducing the risk of musculoskeletal injuries. An investigation of muscle activity, Jonsson's (Jonsson, 1982) ergonomic acceptance ranges, and shoulder range of motion was conducted with a sample of 12 workers using an upper extremity exoskeleton in an automotive assembly line. The operators performed continuous cycles of dynamic overhead work consisting of the assembly of the car body at the underside of the car making use of pneumatic screwdrivers. The EMGs (anterior part of deltoid, trapezius, latissimus dorsi and erector spinae) were measured for the muscle activity analysis on the one hand, and for the ergonomics study on the other hand. The latter consisted of an approach based on Jonsson's work, that establishes acceptance thresholds of cumulative percentage of maximum voluntary contraction of muscle activity (%MVC) in a work cycle. The joint angles motion capture was carried out by measuring the angles of the neck, back, and arms joints. All measurements were performed during experimental sessions with and without an exoskeleton. The key findings show reductions of 34% and 18% of the deltoid and the trapezius muscular activities, respectively, which in turn could lead to a reduction of discomfort and fatigue. The erector spinae and latissimus dorsi muscles were not significantly affected by exoskeleton. The values of muscular activity were also represented over Jonsson's acceptance areas. Referring to the posture, some differences were found in the range of movement of back, neck, and arms owing to the use of the exoskeleton; however, the differences were smaller than 5% in all cases.

Upper Limb End-Effector Force Estimation During Multi-Muscle Isometric Contraction Tasks Using HD-sEMG and Deep Belief Network

In this study, research was carried out on the end-effector force estimation of two representative multi-muscle contraction tasks: elbow flexion and palm-pressing. The aim was to ascertain whether an individual muscle or a combination of muscles is more suitable for the end-effector force estimation. High-density surface electromyography (HD-sEMG) signals were collected from four primary muscle areas of the upper arm and forearm: the biceps brachii (BB), brachialis (BR), triceps brachii (TB), brachioradialis (BRD), and extensor digitorum communis (EDC). The wrist pulling and palm-pressing forces were measured in elbow flexion and palm-pressing tasks, respectively. The deep belief network (DBN) was adopted to establish the relation between HD-sEMG and the measured force. The representative signals of the four primary areas, which were considered as the input signal of the force estimation model, were extracted by HD-sEMG using the principle component analysis (PCA) algorithm, and fed separately or together into the DBN. An index termed mean impact value (MIV) was proposed to describe the priority of different muscle groups for estimating the end-effector force. The experimental results demonstrated that, in multi-muscle isometric contraction tasks, the dominant muscles with the highest activation degree could track variations in the end-effector force more effectively, and are more suitable than a combination of muscles. The main contributions of this research are as follows: (1) To fuse the activation information from different muscles effectively, DBN was adopted to establish the relationship between HD-sEMG and the generated force, and achieved highly accurate force estimation. (2) Based on the well-trained DBN force estimation model, an index termed MIV was presented to evaluate the priority of muscles for estimating the generated force.

New insights into lumbar flexion tests based on inverse and direct kinematic musculoskeletal modeling

Measurement of maximal lumbar flexion is considered to be a crucial element in the assessment of lumbar spine mechanics in situations as diverse as physiotherapy, orthopaedics, ergonomics, sport or aging. However, currently, there is no consensus on a reference test. This study aims to characterise five maximal lumbar flexion tests (four classical tests and a new, specifically-developed test designed to constrain pelvic retroversion) based on a three-dimensional, participant-specific musculoskeletal model. Twenty-six male and female participants performed the five tests. Movements were modelled in OpenSim to estimate change in length in lumbar, hamstring and gluteus muscles, together with lumbar flexion and pelvic tilt. These so-called "inverse" kinematic results were compared using a two-way ANOVA (sex×test). In a second step, lumbar muscle change in length was computed using a direct kinematic method. Lumbar flexion and lumbar muscle change in length were found to be greater when participants were in seated postures, with little pelvic retroversion. Female participants were observed to have less lumbar flexion than male participants (77±14° and 91±12°, respectively). Hip extensor muscles (hamstrings and gluteus) were fully stretched during each of the five tests. Our results highlight the specific roles of hamstrings, gluteus and lumbar muscles into reaching maximal lumbar flexion. Coupling inverse and direct kinematic methods proved to be a useful tool to enhance our knowledge of lumbar tests. Our findings help to characterise the role of the muscles involved in lumbar flexion, and we propose some recommendations for improving and standardising these tests.

Dynamic-joint-strength-based two-dimensional symmetric maximum weight-lifting simulation: Model development and validation

This article presents an optimization formulation and experimental validation of a dynamic-joint-strength-based two-dimensional symmetric maximum weight-lifting simulation. Dynamic joint strength (the net moment capacity as a function of joint angle and angular velocity), as presented in the literature, is adopted in the optimization formulation to predict the symmetric maximum lifting weight and corresponding motion. Nineteen participants were recruited to perform a maximum-weight-box-lifting task in the laboratory, and kinetic and kinematic data including motion and ground reaction forces were collected using a motion capture system and force plates, respectively. For each individual, the predicted spine, shoulder, elbow, hip, knee, and ankle joint angles, as well as vertical and horizontal ground reaction force and box weight, were compared with the experimental data. Both root-mean-square error and Pearson's correlation coefficient (r) were used for the validation. The results show that the proposed two-dimensional optimization-based motion prediction formulation is able to accurately predict all joint angles, box weights, and vertical ground reaction forces, but not horizontal ground reaction forces.

Biomechanical analysis of common solid waste collection throwing techniques using OpenSim and an EMG-assisted solver

The solid waste collection industry is one of the most common occupations resulting in low back pain (LBP). Lumbar peak joint reaction forces and peak and integrated moments are strong correlates of LBP. To investigate these risks, this study compared three common waste collection throwing techniques of varying lumbar symmetry: the symmetric (SYM) technique, the asymmetric fixed stance (AFS) technique, and the asymmetric with pivot (AWP) technique. Lumbar moments and joint reaction loads were computed for throwing garbage bags of 3, 7, and 11 kg to quantify the effects that technique and object weight have on LBP risk. LBP risk factors were computed using a full-body musculoskeletal model in OpenSim. Muscle activations were estimated using two methods: the EMG-assisted method, which included electromyography data in the solution, and the conventional static optimization method, which did not. The EMG-assisted method more accurately reproduced measured muscle activation, resulting in significantly larger peak compressive and shear forces (p < 0.05) of magnitudes indicative of LBP risk. Risk factors associated with the SYM technique were either larger or not statistically different compared to the asymmetric techniques for the 3 kg condition; however, the opposite result occurred for the 7 and 11 kg conditions (p < 0.05). These results suggest using rapid, asymmetric techniques when handling lightweight objects and slower, symmetric techniques for heavier objects to reduce LBP risk during waste collection throwing techniques. Results indicating increased risk between asymmetric techniques were mostly inconclusive. As expected, increasing bag mass generally increased LBP risk factors, regardless of technique (p < 0.05).

Investigation on the Contributions of Different Muscles to the Generated Force based on HD-sEMG and DBN

In this study, we proposed a multi-muscle contraction force estimation framework and implemented it on the elbow flexion task to explore the contributions of different muscles to integrated force at different force levels. High density surface electromyography (HD-sEMG) signals were collected from four muscle groups and the wrist pulling force was measured synchronously. The deep belief network (DBN) was adopted to establish the relationship between HD-sEMG and force. The representative signals of four primary areas, which were considered as the input signal of the force estimation model, were extracted from HD-sEMG by principle component analysis (PCA) algorithm, then fed separately or in common to the DBN to estimate the generated force. And the contributions of different muscle groups to the generated force was analyzed with an index called mean impact value (MIV). The experimental result demonstrates that in multi-muscle contraction task, not all muscles are suitable for force estimation, the force estimation accuracy obtained using only one muscle approximates even exceeds that obtained using multiple muscles, and the relative contributions of different muscle groups to the force can be obtained according to the ranking of MIVs. This scheme provides an effective method for muscle force estimation in multi-muscle contraction tasks, and can be further applied to biomechanics, sports and rehabilitation medicine.

People With Low Back Pain Display a Different Distribution of Erector Spinae Activity During a Singular Mono-Planar Lifting Task

This study aimed to investigate the variation in muscle activity and movement in the lumbar and lumbothoracic region during a singular mono-planar lifting task, and how this is altered in individuals experiencing low back pain (LBP). Muscle activity from the lumbar and lumbothoracic erector spinae of 14 control and 11 LBP participants was recorded using four 13 × 5 high-density surface electromyography (HDEMG) grids. Root mean squared HDEMG signals were used to create spatial maps of the distribution of muscle activity. Three-dimensional kinematic data were recorded focusing on the relationship between lumbar and thoracic movements. In the task, participants lifted a 5 kg box from knee height to sternal height, and then returned the box to the starting position. The center of muscle activity for LBP participants was found to be systematically more cranial throughout the task compared to the control participants (P < 0.05). Participants with LBP also had lower signal entropy (P < 0.05) and lower absolute root mean squared values (P < 0.05). However, there were no differences between groups in kinematic variables, with no difference in contributions between lumbar and thoracic motion segments (P > 0.05). These results indicate that participants with LBP utilize an altered motor control strategy to complete a singular lifting task which is not reflected in their movement strategy. While no differences were identified between groups in the motion between lumbar and thoracic motion segments, participants with LBP utilized a less homogenous, less diffuse and more cranially focussed contraction of their erector spinae to complete the lifting movement. These results may have relevance for the persistence of LBP symptoms and the development of new treatments focussing on muscle retraining in LBP.

Prediction of the Spinal Musculoskeletal Loadings during Level Walking and Stair Climbing after Two Types of Simulated Interventions in Patients with Lumbar Disc Herniation

Background

Low back pain (LBP) continues to be a severe global healthy problem, and a lot of patients would undergo conservative or surgical treatments. However, the improving capacity of spinal load sharing during activities of daily living (ADLs) after interventions is largely unknown. The objective of this study was to quantitatively predict the improvement of spinal musculoskeletal loadings during level walking and stair climbing after two simulated interventions.

Material and Methods

Twenty-six healthy adults and seven lumbar disc herniation patients performed level walking and stair climbing in sequence. The spinal movement was recorded using a motion capture system. The experimental data were applied to drive a musculoskeletal model to calculate all the lumbar joint resultant forces and muscle activities of seventeen main trunk muscle groups. Rehabilitation and reconstruction were selected as the representative of conservative and surgical treatment, respectively. The spinal load sharing after rehabilitation and reconstruction was predicted by replacing the patients' spine rhythm with healthy subjects' spine rhythm and altering the center of rotation at the L5S1 level, respectively.

Results

During both level walking and stair climbing, the joint resultant forces of the lower lumbar intervertebral discs were predicted to reduce after the two simulated inventions. In addition, the maximum muscle activities of the most trunk muscle groups decreased after simulated rehabilitation and conversely increased after simulated reconstruction.

Conclusion

The predictions revealed the different compensatory responses on the spinal load sharing after two simulated interventions, severing as guidance for making preoperative planning and rehabilitation planning.

Regional activation in the human longissimus thoracis pars lumborum muscle

KEY POINTS

•Longissimus activity in the lumbar region was measured using indwelling electromyography to characterize the territory of its motor units. •The distribution of motor units in the longissimus pars lumborum muscle was mainly grouped into two distinct regions. •Regional activation of the longissimus pars lumborum was also observed during functional tasks involving trunk movements. •The regional activation of the longissimus pars lumborum muscle may play a role in segmental stabilization of the lumbar spine.

ABSTRACT

The longissimus pars lumborum contributes to lumbar postural control and movement. While animal studies suggest a segmental control of this muscle, the territory of motor units constituting the human longissimus pars lumborum remains unknown. The aims of this study were to identify the localization of motor unit territories in the longissimus and assess the activation of this muscle during functional tasks. Eight healthy participants were recruited. During isometric back extension contractions, single motor-unit (at L1, L2, L3 and L4) and multi-unit indwelling recordings (at L1, L1-L2, L2, L2-L3, L3, L3-L4 and L4) were used to estimate motor unit territories in the longissimus pars lumborum based on the motor-unit spike-triggered averages from fine-wire electrodes. A series of functional tasks involving trunk and arm movements were also performed. A total of 73 distinct motor units were identified along the length of the longissimus: only two motor units spanned all recording sites. The majority of the recorded motor units had muscle fibres located in two main rostro-caudal territories (32 motor units spanned L1 to L3 and 30 spanned ∼L3 to L4) and 11 had muscle fibres outside these two main territories. We also observed distinct muscle activation between the rostral and caudal regions of the longissimus pars lumborum during a trunk rotation task. Our results show clear rostral and caudal motor unit territories in the longissimus pars lumborum muscle and suggest that the central nervous system can selectively activate regions of the superficial lumbar muscles to provide local stabilization of the spine.

The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis

INTRODUCTION

Chronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have investigated this activity using surface electromyography, in varied muscles and during a number of functional activities. Due to differences in the applied methodology, the results have been difficult to compare, and previous reviews have been limited in scope. In this protocol, we aim to perform a comprehensive review of the effect of chronic low back pain on lumbar muscle activity.

METHODS AND ANALYSIS

This protocol was informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on the Web of Science, PubMed, MEDLINE, EMBASE, ZETOC and CINAHL databases, along with a comprehensive review of grey literature and key journals. One reviewer will conduct the searches, but two independent reviewers will screen potential studies and assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used to assess the quality of the data. Meta-analysis will be conducted where appropriate on groups of studies with homogenous methodology. Where studies are too heterogeneous to allow for meta-analysis, meta-synthesis will instead be completed, comparing results in terms of net increases or decreases of activity.

ETHICS AND DISSEMINATION

This review aims to identify common adaptations of muscle activity in people with low back pain and it is expected that the results will influence future research directions and future rehabilitation approaches. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

PROSPERO REGISTRATION NUMBER

CRD42019125156.

A Dynamic Radiographic Imaging Study of Lumbar Intervertebral Disc Morphometry and Deformation In Vivo

Intervertebral discs are important structural components of the spine but also are significant sources of morbidity, especially for the “low back” lumbar region. Mechanical damage to, or degeneration of, the lumbar discs can diminish their structural integrity and elicit debilitating low back pain. Advancement of reparative or regenerative means to treat damaged or degenerated discs is hindered by a lack of basic understanding of the disc load-deformation characteristics in vivo. The current study presents an in vivo analysis of the morphometry and deformation of lumbar (L2-S1) intervertebral discs in 10 healthy participants while performing a common lifting act, using novel dynamic radiographic imaging of the lumbar vertebral body motion. Data analyses show uniquely different (p < 0.05) characteristics in morphometry, normal and shear strain patterns of the L5S1 discs, while the rest of lumbar discs exhibit great similarity. In particular shear strains in L2-L5 discs exhibited stronger linear correlations (R² ≥ 0.80) between strain changes and amount of lumbar flexion-extension motion compared to L5S1 (R² ≤ 0.5). The study therefore advances the state of knowledge on in vivo mechanical responses of the lumbar intervertebral discs during functional tasks.

Influence of passive elements on prediction of intradiscal pressure and muscle activation in lumbar musculoskeletal models

BACKGROUND AND OBJECTIVE

The objective of this study was to investigate the effect of incorporating various passive elements, which could represent combined or individual effects of intervertebral disc, facet articulation and ligaments, on the prediction of lumbar muscle activation and L4-L5 intradiscal pressure.

METHODS

The passive elements representing the intervertebral disc, facet articulations, and ligaments were added to the existed lumbar musculoskeletal model with nonlinear rotational stiffness or force-strain relationships. The model was fed with kinematics of trunk flexion, extension, axial rotation and lateral bending to calculate muscle activation and L4-L5 intradiscal pressure.

RESULTS

In the trunk axial rotation, the intradiscal pressure values predicted by the models with elements representing facet articulation were much higher than that predicated by models removing these elements. In the trunk flexion, the models with passive elements showed lower muscle activation of extensors than model with no passive elements. At the end of trunk flexion, extension, axial rotation and lateral bending, the intradiscal pressure values predicted by model with intact passive elements were 120.6%, 92.5%, 334.8% and 74.9% of the values predicted by model with no passive elements, respectively.

CONCLUSIONS

Caution must be taken while modeling facet articulation as elements with rotational stiffness, as they may lead to overestimation of intradiscal pressure in trunk axial rotation. The inclusion of ligaments as spring-like elements may improve the simulation of flexion-relaxation phenomenon in trunk flexion. Future models considering detailed properties of passive elements are needed to allow more access to understanding the mechanics of the lumbar spine.

Effects of kinematic complexity and number of muscles on musculoskeletal model robustness to muscle dysfunction

The robustness of motor outputs to muscle dysfunction has been investigated using musculoskeletal modeling, but with conflicting results owing to differences in model complexity and motor tasks. Our objective was to systematically study how the number of kinematic degrees of freedom, and the number of independent muscle actuators alter the robustness of motor output to muscle dysfunction. We took a detailed musculoskeletal model of the human leg and systematically varied the model complexity to create six models with either 3 or 7 kinematic degrees of freedom and either 14, 26, or 43 muscle actuators. We tested the redundancy of each model by quantifying the reduction in sagittal plane feasible force set area when a single muscle was removed. The robustness of feasible force set area to the loss of any single muscle, i.e. general single muscle loss increased with the number of independent muscles and decreased with the number of kinematic degrees of freedom, with the robust area varying from 1% and 52% of the intact feasible force set area. The maximum sensitivity of the feasible force set to the loss of any single muscle varied from 75% to 26% of the intact feasible force set area as the number of muscles increased. Additionally, the ranges of feasible muscle activation for maximum force production were largely unconstrained in many cases, indicating ample musculoskeletal redundancy even for maximal forces. We propose that ratio of muscles to kinematic degrees of freedom can be used as a rule of thumb for estimating musculoskeletal redundancy in both simulated and real biomechanical systems.

Discriminating spatiotemporal movement strategies during spine flexion-extension in healthy individuals

BACKGROUND CONTEXT

The spine is an anatomically complex system with numerous degrees of freedom. Due to this anatomical complexity, it is likely that multiple motor control options exist to complete a given task.

PURPOSE

To identify if distinct spine spatiotemporal movement strategies are utilized in a homogenous sample of young healthy participants.

STUDY DESIGN

Kinematic data were captured from a single cohort of male participants (N=51) during a simple, self-controlled spine flexion-extension task.

METHODS

Thoracic and lumbar flexion-extension data were analyzed to extract the continuous relative phase between each spine subsection. Continuous relative phase data were evaluated using a principal component analysis to identify major sources of variation in spine movement coordination. Unsupervised machine learning (k-means clustering) was used to identify distinct clusters present within the healthy participants sampled. Once distinguished, intersegmental spine kinematics were compared amongst clusters.

RESULTS

The findings of the current work suggest that there are distinct timing strategies that are utilized, within the participants sampled, to control spine flexion-extension movement. These strategies differentiate the sequencing of intersegmental movement and are not discriminable on the basis of simple participant demographic characteristics (ie, age, height, and body mass index), total movement time or range of motion.

CONCLUSIONS

Spatiotemporal spine flexion-extension patterns are not uniform across a population of young healthy individuals.

CLINICAL SIGNIFICANCE

Future work needs to identify whether the motor patterns characterized with this work are driven by distinct neuromuscular activation patterns, and if each given pattern has a varied risk for low back injury.