Sensitivity of kinematics-based model predictions to optimization criteria in static lifting tasks

The Effects of Disc Degeneration and Muscle Dysfunction on Cervical Spine Stability from a Biomechanical Study

Disc degeneration and muscle dysfunction are common spinal degenerations in the elderly. This in vitro study was carried out to investigate the effects of these two degenerative changes on spinal stability. The stability of nine porcine cervical spines (C2–T1) with mechanically simulated cervical muscles (sternocleidomastoid (SCM), splenius capitis (SPL), semispinalis capitis (SSC)) was tested before and after experiment-induced disc degeneration. The patterns of muscle recruitments included: no muscle recruitment, normal recruitment of SCM/SPL/SSC, and SCM/SPL/SSC muscle dysfunctions. The neutral zone (NZ) and the range of motion (ROM) in the sagittal plane were measured to determine spinal stability. The results showed that the NZ and the ROM of a degenerative spine were larger than those of an intact spine under no muscle recruitment, but not under muscle recruitments. For both intact and degenerative spines, the NZ and the ROM were greatest under no muscle recruitment, followed by SSC dysfunction, SCM dysfunction, and SPL dysfunction, and smallest under normal muscle recruitment. In conclusion, muscle recruitments stabilize both intact and degenerative cervical spines, while dysfunctional muscles do not maintain stability efficiently as normal muscles do. Thus, spinal stability is more significantly affected by muscle dysfunction than by disc degeneration. Muscle training is suggested for the elderly with spinal degeneration to improve stability.

Internal kinetic changes in the knee due to high tibial osteotomy are well-correlated with change in external adduction moment: an osteoarthritic knee model

In-vivo quantification of loads in the constitutive structures of the osteoarthritic knee can provide clinical insight, particularly when planning a surgery like the opening-wedge high tibial osteotomy (HTO). A computational knee model was created to estimate internal kinetics during walking gait. An optimization approach partitioned loads between the muscles, ligaments, medial and lateral contact surfaces of the tibial-femoral joint. Three kinetic measures were examined in 30 HTO patients: external knee adduction moment (EKAM), medial compartment load (ML) and the medial-to-lateral compartment loads ratio (MLR). Three time points were compared: immediately pre-HTO, 6 and 12 months post-HTO. Three hypotheses were tested: (1) HTO reduces an EKAM, an ML and an MLR, (2) these measures are not significantly different at 6 and 12 months post-HTO, and (3) the change in the impulse of EKAM due to a HTO is well-correlated with the impulse of an MLR. The three hypotheses were confirmed. First peak of an EKAM during stance phase was reduced significantly by 1.70% BW-ht. ML and MLR at the same instance were reduced significantly by 0.56%BW and 1.0, respectively. These measures were not significantly different between 6 and 12 months post-HTO. Changes in impulse of an EKAM and an MLR were moderately well-correlated between the pre-HTO and 6 months post-HTO time points (R(2)=0.5485). Therefore, the external measure EKAM-impulse is a good proxy of the internal kinetic measure of an MLR-impulse, explaining about 55% of the variance in the change due to a HTO intervention.

A novel approach to evaluate abdominal coactivities for optimal spinal stability and compression force in lifting

A novel optimisation algorithm is developed to predict coactivity of abdominal muscles while accounting for both trunk stability via the lowest buckling load (P(cr)) and tissue loading via the axial compression (F(c)). A nonlinear multi-joint kinematics-driven model of the spine along with the response surface methodology are used to establish empirical expressions for P(cr) and F(c) as functions of abdominal muscle coactivities and external load magnitude during lifting in upright standing posture. A two-component objective function involving F(c) and P(cr) is defined. Due to opposite demands, abdominal coactivities that simultaneously maximise P(cr) and minimise F(c) cannot exist. Optimal solutions are thus identified while striking a compromise between requirements on trunk stability and risk of injury. The oblique muscles are found most efficient as compared with the rectus abdominus. Results indicate that higher abdominal coactivities should be avoided during heavier lifting tasks as they reduce stability margin while increasing spinal loads.

Biodynamic response and spinal load estimation of seated body in vibration using finite element modeling

Trunk biomechanical models play an indispensable role in predicting muscle forces and spinal loads under whole-body vibration (WBV) exposures. Earlier measurements on the force-motion biodynamic response (impedance, apparent mass) at the body-seat interface and vibration transmissibility (seat to head) have led to the development of different mechanical models. Such models could simulate the overall passive response and serve as an important tool for vehicle seat design. They cannot, however, evaluate physiological parameters of interest under the WBV. On the contrary, anatomical models simulating human's physiological characteristics can predict activities in muscles and their dynamic effects on the spine. In this study, a kinematics-driven nonlinear finite element model of the spine, in which the kinematics data are prescribed, is used to analyse the trunk response in seated WBV. Predictions of the active model (i.e., with varying muscle forces) as compared with the passive model (i.e., with no muscle forces) compared satisfactorily with measurements on vertical apparent mass and seat-to-head transmissibility biodynamic responses. Results demonstrated the crucial role of muscle forces in the dynamic response of the trunk. Muscle forces, while maintaining trunk equilibrium, substantially increased the compression and shear forces on the spine and, hence, the risk of tissue injury.

Comparison of trunk muscle forces and spinal loads estimated by two biomechanical models

BACKGROUND

Comparative studies between single-joint electromyography (EMG)- and optimization-driven models of the human spine in estimating trunk muscle and spinal compression forces have not been conclusive. Due to associated implications in ergonomic applications as well as prevention and treatment managements of low-back disorders, there is a need to critically compare existing single- and multi-joint spine models.

METHODS

A comprehensive comparison of muscle forces and spinal loads estimated by a single-joint (L5-S1 or L4-L5) EMG-driven model (EMGAO) and a multi-joint (T1-S1) Kinematics-driven finite element model (KD) of the spine under different static lifting activities in upright standing posture is carried out. Identical geometry for the spine and trunk musculature as well as passive properties are used in both models. Required model inputs including kinematics, force plate and surface EMG data are collected from one asymptomatic male subject.

FINDINGS

Contrary to somewhat similar external moments (with differences <11 Nm) as well as comparable compression forces at the L4-S1 joints (<20% except in the heaviest task with 52% difference) and sum of all trunk muscle forces (<26% except in the heaviest task with 44% difference), both models recruited trunk global and local lumbar muscles in markedly different proportions (ratio of total global over total local muscle forces in cases with load in hands remained >2.4 in the KD model whereas <1.0 in the EMGAO model) which in turn led to significantly different shear force estimates. Results of the EMGAO model were level dependent. Estimated L4-L5 intradiscal pressures were comparable to the measured data except for the heaviest task in which case the EMGAO model overestimated the measured pressure by 67%.

INTERPRETATION

Differences in predictions between these modeling approaches vary depending on the task simulated and the joint considered in the single-joint models of the spine. Such studies are essential to critically evaluate relative performance of existing models and to propose modifications to improve accuracy in estimations. Ergonomic and clinical applications of such model studies should, hence, be carried out with due attention to associated underlying assumptions and shortcomings.

Transient analysis of trunk response in sudden release loading using kinematics-driven finite element model

BACKGROUND

Sudden trunk perturbations occur in various occupational and sport activities. Despite numerous measurement studies, no comprehensive modeling simulations have yet been attempted to investigate trunk biodynamics under sudden loading/unloading.

METHODS

Dynamic kinematics-driven approach was used to evaluate the temporal variation of trunk muscle forces, internal loads and stability before and after a sudden release of a posterior horizontal load. Measured post-disturbance trunk kinematics, as input, and muscle electromyography (EMG) activities, for qualitative validation, were considered.

FINDINGS

Computed agonist and antagonist muscle forces before and after release agreed well with reported EMG activities and demonstrated basic response characteristics such as activation latency and reflex activation. The trunk was found quite stable before release and in early post-release period. Larger applied load substantially increased trunk kinematics, muscle forces and spinal loads.

INTERPRETATION

Excessive spinal loads due to large muscle forces in sudden loading conditions is a risk factor as the central nervous system attempts to reflexively control the sudden disturbances, a situation that further deteriorates under larger perturbations and longer latency periods. Predictions indicate the potential of the kinematics-driven model in ergonomics as well as training and rehabilitation programs.

Trunk biomechanics during maximum isometric axial torque exertions in upright standing

BACKGROUND

Activities involving axial trunk rotations/moments are common and are considered as risk factors for low back disorders. Previous biomechanical models have failed to accurately estimate the trunk maximal axial torque exertion. Moreover, the trunk stability under maximal torque exertions has not been investigated.

METHODS

A nonlinear thoracolumbar finite element model along with the Kinematics-driven approach is used to study biomechanics of maximal axial torque generation during upright standing posture. Detailed anatomy of trunk muscles with six distinct fascicles for each abdominal oblique muscle on each side is considered. While simulating an in vivo study of maximal axial torque exertion, effects of antagonistic coactivities, coupled moments and maximum muscle stress on results are investigated.

FINDINGS

Predictions for trunk axial torque strength and relative muscle activities compared well with reported measurements. Trunk strength in axial torque was only slightly influenced by variations in coupled moments. Presence of abdominal antagonistic coactivities and alterations in maximum strength of muscles had, however, greater effect on maximal torque exertion. Abdominal oblique muscles play crucial role in generating moments in all three planes while back muscles are mainly effective in balancing moments in sagittal/coronal planes. Trunk stability is not of a concern in maximum axial torque exertions nor is it improved by antagonistic abdominal coactivities.

INTERPRETATION

In contrast to previous biomechanical model studies, the Kinematics-driven approach accurately predicts the trunk response in maximal isometric axial torque exertions by taking into account detailed anatomy of abdominal oblique muscles while satisfying equilibrium requirements in all planes/directions. In maximal torque exertions, the spine is at much higher risk of tissue injury due to large segmental loads than of instability.

Trunk biomechanical models based on equilibrium at a single-level violate equilibrium at other levels

Accurate estimation of muscle forces in various occupational tasks is critical for a reliable evaluation of spinal loads and subsequent assessment of risk of injury and management of back disorders. The majority of biomechanical models of multi-segmental spine estimate muscle forces and spinal loads based on the balance of net moments at a single level with no consideration for the equilibrium at remaining levels. This work aimed to quantify the extent of equilibrium violation and alterations in estimations when such models are performed at different levels. Results are compared with those of kinematics-driven model that satisfies equilibrium at all levels and EMG data. Regardless of the method used (optimization or EMG-assisted), single-level free body diagram models yielded estimations that substantially altered depending on the level considered (i.e., level dependency). Equilibrium of net moment was also grossly violated at remaining levels with the error increasing in more demanding tasks. These models may, however, be used to estimate spinal compression forces.

Analysis of squat and stoop dynamic liftings: muscle forces and internal spinal loads

Despite the well-recognized role of lifting in back injuries, the relative biomechanical merits of squat versus stoop lifting remain controversial. In vivo kinematics measurements and model studies are combined to estimate trunk muscle forces and internal spinal loads under dynamic squat and stoop lifts with and without load in hands. Measurements were performed on healthy subjects to collect segmental rotations during lifts needed as input data in subsequent model studies. The model accounted for nonlinear properties of the ligamentous spine, wrapping of thoracic extensor muscles to take curved paths in flexion and trunk dynamic characteristics (inertia and damping) while subject to measured kinematics and gravity/external loads. A dynamic kinematics-driven approach was employed accounting for the spinal synergy by simultaneous consideration of passive structures and muscle forces under given posture and loads. Results satisfied kinematics and dynamic equilibrium conditions at all levels and directions. Net moments, muscle forces at different levels, passive (muscle or ligamentous) forces and internal compression/shear forces were larger in stoop lifts than in squat ones. These were due to significantly larger thorax, lumbar and pelvis rotations in stoop lifts. For the relatively slow lifting tasks performed in this study with the lowering and lifting phases each lasting approximately 2 s, the effect of inertia and damping was not, in general, important. Moreover, posterior shift in the position of the external load in stoop lift reaching the same lever arm with respect to the S1 as that in squat lift did not influence the conclusion of this study on the merits of squat lifts over stoop ones. Results, for the tasks considered, advocate squat lifting over stoop lifting as the technique of choice in reducing net moments, muscle forces and internal spinal loads (i.e., moment, compression and shear force).