Lumbar trunk muscle use in standing isometric heavy exertions

Optimizing normalization methods of the external oblique: A cross-sectional study

BACKGROUND

Adequate normalization methodology to establish maximum voluntary isometric contraction (MVIC) is needed to compare %MVIC values for core exercise completed until discontinuation. Clinicians can use %MVIC classifications to guide their preventative and rehabilitative exercise interventions.

OBJECTIVE

The aim of this study was to compare %MVIC of the external oblique (EO) between normalization techniques of side-lying lateral trunk flexion and Roman chair lateral trunk flexion.

METHODS

Twenty-two participants completed two MVIC techniques followed by one repetition of the prone bridge plank (PBP), torso elevated side plank (TESP), foot elevated side plank (FESP), dead bug and bird dog. The average %MVIC during the first 5-seconds, last 5-seconds and overall duration of exercise were included for analysis. ANOVA was used to compare normalized %MVIC from each of the 5 exercises between MVIC techniques. Alpha set a priori p= 0.05.

RESULTS

The side-lying table technique yielded no %MVIC values above 100%, while the Roman chair technique produced 7 values above 100%. The largest mean difference between techniques was during the last 5-seconds of the torso elevated side plank (57.87 ± 38.51%MVIC, p< 0.001).

CONCLUSION

The side-lying table technique likely provides the optimal methodology of %MVIC determination.

Lower trunk kinematics and muscle activity during different types of tennis serves

BACKGROUND

To better understand the underlying mechanisms involved in trunk motion during a tennis serve, this study aimed to examine the (1) relative motion of the middle and lower trunk and (2) lower trunk muscle activity during three different types of tennis serves - flat, topspin, and slice.

METHODS

Tennis serves performed by 11 advanced (AV) and 8 advanced intermediate (AI) male tennis players were videorecorded with markers placed on the back of the subject used to estimate the anatomical joint (AJ) angles between the middle and lower trunk for four trunk motions (extension, left lateral flexion, and left and right twisting). Surface electromyographic (EMG) techniques were used to monitor the left and right rectus abdominis (LRA and RRA), external oblique (LEO and REO), internal oblique (LIO and RIO), and erector spinae (LES and RES). The maximal AJ angles for different trunk motions during a serve and the average EMG levels for different muscles during different phases (ascending and descending windup, acceleration, and follow-through) of a tennis serve were evaluated.

RESULTS

The repeated measures Skill x Serve Type x Trunk Motion ANOVA for maximal AJ angle indicated no significant main effects for serve type or skill level. However, the AV group had significantly smaller extension (p = 0.018) and greater left lateral flexion (p = 0.038) angles than the AI group. The repeated measures Skill x Serve Type x Phase MANOVA revealed significant phase main effects in all muscles (p < 0.001) and the average EMG of the AV group for LRA was significantly higher than that of the AI group (p = 0.008). All muscles showed their highest EMG values during the acceleration phase. LRA and LEO muscles also exhibited high activations during the descending windup phase, and RES muscle was very active during the follow-through phase.

CONCLUSION

Subjects in the AI group may be more susceptible to back injury than the AV group because of the significantly greater trunk hyperextension, and relatively large lumbar spinal loads are expected during the acceleration phase because of the hyperextension posture and profound front-back and bilateral co-activations in lower trunk muscles.

In vitro disc pressure profiles below scoliosis fusion constructs

STUDY DESIGN

Biomechanical human cadaveric study comparing straight and scoliotic spines with healthy and degenerated L4/5 discs.

OBJECTIVE

To describe the biomechanical environment of discs under various spinal alignments by measuring the coronal intradiscal pressure profiles.

SUMMARY OF BACKGROUND DATA

Abnormal loading of the lumbar discs in the concavity of scoliotic curves may accelerate disc degeneration, which may be related to pain.

METHODS

Eight intact human cadaver spines (T1-S1; mean donor age 47 years old) underwent radiographs, DEXA, and MRI and were graded for disc degeneration. Each specimen was instrumented in a normal (straight coronal) spinal alignment from T4-L4. Intradiscal pressure profiles for the L4/5 disc and resultant moments were obtained under axial follower loads up to 1500 N. Testing was repeated for bilateral 3-cm decompensation. Posterior instrumentation was used to induce scoliosis (thoracic and lumbar curve average = 25 degrees, fractional lumbosacral curve average = 5 degrees), and testing was repeated for all load states.

RESULTS

MRI found 4 healthy (grade I and II) and 4 degenerated (grade III to V) L4/5 discs. Scoliosis and decompensation significantly increased coronal moments (P < 0.003). Disc pressures increased linearly with greater applied loads for all specimens. Healthy L4/5 discs exhibited uniform pressure profiles with normal spinal alignment and minimal effect with simulated scoliosis or decompensation. For degenerated discs, there was a relative pressure profile depression in the nucleus relative to the anulus region; with spinal malalignment, either due to scoliotic curvature, decompensation, or both, there was disc pressure profile asymmetry. The ratio of maximum intradiscal pressure at the concavity relative to the convexity was 1.1 (range, 1.0-1.2) for healthy discs and 3.6 (range, 2.2-4.4) for degenerated discs in the scoliotic specimens (P = 0.008).

CONCLUSION

Disc pressure profilometry below long spinal constructs found asymmetric loading with the greatest loads at the concave inner anulus, especially in the presence of disc degeneration, scoliosis, and decompensation. For the degenerated cases, there was substantial disc pressure profile asymmetry despite only mildly severe scoliotic curvatures. These results suggest that scoliosis surgeons should minimize end-vertebra tilt, maximize lumbar curve, and balance correction at the time of surgical intervention. These results combined with prior animal studies suggest a compounding effect of asymmetric loading and progression of disc degeneration.

Trunk antagonist co-activation is associated with impaired neuromuscular performance

The goal of this paper was to determine if trunk antagonist activation is associated with impaired neuromuscular performance. To test this theory, we used two methods to impair neuromuscular control: strenuous exertions and fatigue. Force variability (standard deviation of force signal) was assessed for graded isometric trunk exertions (10, 20, 40, 60, 80% of max) in flexion and extension, and at the start and end of a trunk extensor fatiguing trial. Normalized EMG signals for five trunk muscle pairs (RA rectus abdominis, EO external oblique, IO internal oblique, TE thoracic erector spinae, and LE lumbar erector spinae) were collected for each graded exertion, and at the start and end of a trunk extensor fatiguing trial. Force variability increased for more strenuous exertions in both flexion (P < 0.001) and extension (P < 0.001), and after extensor fatigue (P < 0.012). In the flexion direction, both antagonist muscles (TE and LE) increased activation for more strenuous exertions (P < 0.001). In the extension direction, all antagonist muscles except RA increased activation for more strenuous exertions (P < 0.05) and following fatigue (P < 0.01). These data demonstrate a strong relationship between force variability and antagonistic muscle activation, irrespective of where this variability comes from. Such antagonistic co-activation increases trunk stiffness with the possible objective of limiting kinematic disturbances due to greater force variability.

Model-based estimation of muscle forces exerted during movements

Estimation of individual muscle forces during human movement can provide insight into neural control and tissue loading and can thus contribute to improved diagnosis and management of both neurological and orthopaedic conditions. Direct measurement of muscle forces is generally not feasible in a clinical setting, and non-invasive methods based on musculoskeletal modeling should therefore be considered. The current state of the art in clinical movement analysis is that resultant joint torques can be reliably estimated from motion data and external forces (inverse dynamic analysis). Static optimization methods to transform joint torques into estimates of individual muscle forces using musculoskeletal models, have been known for several decades. To date however, none of these methods have been successfully translated into clinical practice. The main obstacles are the lack of studies reporting successful validation of muscle force estimates, and the lack of user-friendly and efficient computer software. Recent advances in forward dynamics methods have opened up new opportunities. Forward dynamic optimization can be performed such that solutions are less dependent on measured kinematics and ground reaction forces, and are consistent with additional knowledge, such as the force-length-velocity-activation relationships of the muscles, and with observed electromyography signals during movement. We conclude that clinical applications of current research should be encouraged, supported by further development of computational tools and research into new algorithms for muscle force estimation and their validation.

Posture-dependent trunk extensor EMG activity during maximum isometrics exertions in normal male and female subjects

Posture-dependent trunk function data are important for appropriate normalization of submaximal trunk exertions, and is also necessary to define a more precise and specific use for strength testing in the prevention and diagnosis of spinal disorders. The aim of the current study was to quantify maximal effort trunk muscle extensor activity and trunk isometric extension torque over a functional range of sagittal standing postures. Twenty healthy, young adult male and female subjects performed isometric extension tasks over a sagittal posture range of -20 degrees extension to +50 degrees flexion, in 10 degrees increments. Erector spinae muscle activity was recorded bilaterally at the level of L3 using surface EMG electrodes. Isometric trunk extension torque was measured using a trunk dynamometer. EMG and trunk torque differed significantly between genders, but there were no differences between male and female subjects when the data were normalized with respect to the upright posture. For the combined male and female population, upright posture normalized L3 EMG activity (EMGn) and trunk extension torque (Tn) increased 1.7-fold and 3.5-fold, respectively, over the 70 degrees range of sagittal postures examined. The ratio (Tn/EMGn) increased two-fold (0.83 to 1.67) from -20 degrees extension to +50 degrees flexion, indicating that the neuromuscular efficiency increases with flexion. Trunk extension torque normalized with respect to the upright posture was linearly and positively correlated (r = 0.59, P < 0.001) to similarly normalized L3 EMG activity. This relatively weak correlation suggests that trunk muscle synergism and/or intrinsic muscle length-tension relationships are also modulated by posture. This study provides data that can be used to estimate trunk extensor muscle function over a broad range of sagittal postures. Our findings indicate that appropriate postural normalization of trunk extensor EMG activity is necessary for studies where submaximal trunk exertions are performed over a range of upright postures.

Optimization Model Estimates of Trunk Muscle Forces Do Not Correlate with EMG Activity of Females as Well as Males

Biomechanical optimization models are often used to estimate muscular and intervertebral disc forces during physical exertions. The purpose of this study was to determine whether an optimization-based biomechanical model predicts torso muscular activity of males and females equally well. The Minimum Intensity Compression (MIC) model, which has been extensively applied in industrial ergonomic task analysis, was used to estimate muscle forces for 3D moments. Participants (6 M, 6 F) performed 18 isometric exertions resisting 3D L3/L4 moments while electromyographic (EMG) activity was recorded for 8 muscles. Overall, model force estimates correlated better with male EMG activity (R2= 0.43) than with female EMG activity (R2= 0.33). Model force estimates of 4 muscles (LRA, RRA, REO, and RES) correlated better with male EMG activity than with female EMG. We conclude that trunk muscle forces estimated by current biomechanical modeling do not correlate equally well to male and female EMG activity. Future research needs to address validation or improvement of biomechanical trunk models for females.

EMG activity normalization for trunk muscles in subjects with and without back pain

PURPOSE

The aims of the present study were to examine electromyographic (EMG) activity of six bilateral trunk muscles during maximal contraction in three cardinal planes and to determine the direction of contraction that gives maximal activation for each muscle, both for healthy subjects and back-pain patients.

METHODS

Twenty-eight healthy subjects and 15 back-pain patients performed maximum voluntary contractions in three cardinal planes. Surface EMG signals were recorded from rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum, and multifidus bilaterally. Root mean square values of the EMG data were calculated to quantify the amplitude of EMG signals.

RESULTS

For both healthy subjects and back-pain patients, one single direction of contraction was found to give the maximum EMG signals for most muscles. Rectus abdominis demonstrated maximal activity in trunk flexion, external oblique in lateral flexion, internal oblique in axial rotation, and multifidus in extension. For the latissimus dorsi and iliocostalis lumborum, maximal activity was demonstrated in more than one cardinal plane.

CONCLUSION

This study has implications for future research involving normalization of muscle activity to maximal levels required in many trunk EMG studies. As the latissimus dorsi and iliocostalis lumborum demonstrate individual differences in the plane that gives maximal activity, these muscles may require testing in more than one plane.

Functional roles of abdominal and back muscles during isometric axial rotation of the trunk

Electromyographic (EMG) studies have shown that a large number of trunk muscles are recruited during axial rotation. The functional roles of these trunk muscles in axial rotation are multiple and have not been well investigated. In addition, there is no information on the coupling torque at different exertion levels during axial rotation. The aim of the study was to investigate the functional roles of rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum and multifidus during isometric right and left axial rotation at 100%, 70%, 50% and 30% maximum voluntary contractions (MVC) in a standing position. The coupling torques in sagittal and coronal planes were measured during axial rotation to examine the coupling nature of torque at different levels of exertions. Results showed that the coupled sagittal torque switches from nil to flexion at maximum exertion of axial rotation. Generally, higher EMG activities were shown at higher exertion levels for all the trunk muscles. Significant differences in activity between the right and left axial rotation exertions were demonstrated in external oblique, internal oblique, latissimus dorsi and iliocostalis lumborum while no difference was shown in rectus abdominis and multifidus. These results demonstrated the different functional roles of trunk muscles during axial rotation. This is important considering that the abdominal and back muscles not only produce torque but also maintain the spinal posture and stability during axial rotation exertions. The changing coupling torque direction in the sagittal plane when submaximal to maximal exertions were compared may indicate the complex nature of the kinetic coupling of trunk muscles.

Muscle forces and spinal loads at C4/5 level during isometric voluntary efforts

PURPOSE

The goal of this study was to determine neck muscle forces and spinal loads that result from isometric muscle contractions.

METHODS

Electromyographic (EMG) activity of the neck musculature and a three-dimensional biomechanical model of the neck were used. The model was EMG-based and estimated muscle forces and spinal loads at the C4/5 level. EMG signals were collected from eight sites at the C4/5 level of the neck using Ag-AgCl surface electrodes from 10 adult male subjects. The subjects performed isometric contractions gradually developing to maximum efforts in flexion, extension, left lateral bending, and right lateral bending.

RESULTS

During maximum voluntary contraction (MVC) trials most muscles generated high levels of EMG signal during cervical rotation. The posterior surface of the neck (trapezius) was the only electrode site at which maximum activity EMG consistently occurred by the same method (rotation) in all subjects. Variations in the EMG patterns were observed in different experiments that produced overall neck moments of equal magnitudes. With these data the model computed variations in load distribution among the agonist muscles. Consistent also with EMG distributions, the model also computed co-contractions of antagonist muscles. The average (+/- SD) magnitudes of peak moments were 28.3 (+/- 3.3) Nm in extension, 17.7 (+/- 3.1) Nm in flexion, 16.9 (+/- 2.8) Nm in left lateral bending, and 17.0 (+/- 2.9) Nm in right lateral bending. The model predicted C4/5 joint compressive forces during peak moments were 1372 (+/- 140) N in extension, 1654 (+/- 308) N in flexion, 956 (+/- 169) N in left lateral bending, and 1065 (+/- 207) N in right lateral bending.

CONCLUSIONS

Results suggest that higher C4/5 joint loads than previously reported are possible during maximum isometric muscle contractions.

The effects of abdominal muscle coactivation on lumbar spine stability

STUDY DESIGN

A biomechanical model of the lumbar spine was used to calculate the effects of abdominal muscle coactivation on spinal stability.

OBJECTIVES

To estimate the effects of abdominal muscle coactivation on lumbar spine stability, muscle fatigue rate, and lumbar spine compression forces.

SUMMARY OF BACKGROUND DATA

The activation of human trunk muscles has been found to involve coactivation of antagonistic muscles, which has not been adequately predicted by biomechanical models. Antagonistic activation of abdominal muscles might produce flexion moments resulting from abdominal pressurization. Qualitatively, antagonistic activity also has been attributed to the need to stabilize the spine.

METHODS

Spinal loads and spinal stability were calculated for maximum and submaximum (40%, 60% and 80%) efforts in extension and lateral bending using a previously published, anatomically realistic biomechanical model of the lumbar spine and its musculature. Three different antagonistic abdominal muscle coactivation patterns were imposed, and results were compared with those found in a model with no imposed coactivation.

RESULTS

Results were quantified in terms of the sum of cubed muscle stresses (sigma sigma m3, which is related to the muscle fatigue rate), the maximum compressive loading on the lumbar spine, and the critical value of the muscle stiffness parameter (q) required for the spine to be stable. Forcing antagonistic coactivation increased stability, but at the cost of an increase in sigma sigma m3 and a small increase in maximum spinal compression.

CONCLUSIONS

These analyses provide estimates of the effects of antagonistic abdominal muscle coactivation, indicating that its probable role is to stabilize the spine.

Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture

STUDY DESIGN

This study examined the coactivation of trunk flexor and extensor muscles in healthy individuals. The experimental electromyographic data and the theoretical calculations were analyzed in the context of mechanical stability of the lumbar spine.

OBJECTIVES

To test a set of hypotheses pertaining to healthy individuals: 1) that the trunk flexor-extensor muscle coactivation is present around a neutral spine posture, 2) that the coactivation is increased when the subject carries a load; and 3) that the coactivation provides the needed mechanical stability to the lumbar spine.

SUMMARY OF BACKGROUND DATA

Theoretically, antagonistic trunk muscle coactivation is necessary to provide mechanical stability to the human lumbar spine around its neutral posture. No experimental evidence exists, however, to support this hypothesis.

METHODS

Ten individuals executed slow trunk flexion-extension tasks, while six muscles on the right side were monitored with surface electromyography: external oblique, internal oblique, rectus abdominis, multifidus, lumbar erector spinae, and thoracic erector spinae. Simple, but realistic, calculations of spine stability also were performed and compared with experimental results.

RESULTS

Average antagonistic flexor-extensor muscle coactivation levels around the neutral spine posture as detected with electromyography were 1.7 +/- 0.8% of maximum voluntary contraction for no external load trials and 2.9 +/- 1.4% of maximum voluntary contraction for the trials with added 32-kg mass to the torso. The inverted pendulum model based on static moment equilibrium criteria predicted no antagonistic coactivation. The same model based on the mechanical stability criteria predicted 1.0% of maximum voluntary contraction coactivation of flexors and extensors with zero load and 3.1% of maximum voluntary contraction with a 32-kg mass. The stability model also was run with zero passive spine stiffness to simulate an injury. Under such conditions, the model predicted 3.4% and 5.5% of maximum voluntary contraction of antagonistic muscle coactivation for no extra load and the added 32 kg, respectively.

CONCLUSIONS

This study demonstrated that antagonistic trunk flexor-extensor muscle coactivation was present around the neutral spine posture in healthy individuals. This coactivation increased with added mass to the torso. Using a biomechanical model, the coactivation was explained entirely on the basis of the need for the neuromuscular system to provide the mechanical stability to the lumbar spine.

Influence of varying muscle forces on lumbar intradiscal pressure: an in vitro study

The purposes of this study were to determine the effect of including muscle forces in the experimental loading of the spine on the intradiscal pressure and to determine whether this effect correlates with previously established in vivo data. We modeled the spine muscles as of five distinct groups and isolated the effect of each group on the intradiscal pressure (L4-L5). Seven human lumbosacral spines were tested in pure flexion/extension, right/left lateral bending, and left/right axial rotation moments. Stimulated muscle activity strongly influenced load-pressure characteristics, especially for the multifidus. Without muscle forces active, pressure increased proportionately with increasing moment. With five pairs of symmetrical constant muscle forces active (80 N per pair) the pressure increased more than 200% in neutral position and did not increase with increasing moment. The pressure without muscle forces and without axial preload was 0.12 MPa, which is about the same found by earlier in vivo studies of anesthetized subjects in prone position. With simulated muscle forces, the pressure was 0.39 MPa and in the range found for non-anesthetized subjects. We conclude that simulating muscle forces substantially affects intradiscal pressure.

Lumbar muscle activities in rapid three-dimensional pulling tasks

STUDY DESIGN

An experimental and theoretical study in healthy young adults.

OBJECTIVE

To utilize myoelectric signals to investigate muscle recruitment and estimate spine loads during rapid, three-dimensional pulling tasks.

SUMMARY OF BACKGROUND DATA

Most previous research concerning lumbar trunk loads has focused on quasi-static exertions and sagittally symmetric dynamic tasks.

METHODS

Nine young males performed dynamic pulls in five prescribed directions, requiring the active development of combined sagittal, frontal, and/or transverse moments by the lumbar muscles. Myoelectric activities were recorded from 14 lumbar muscles. Individual muscle activities were compared with their biomechanical capability to equilibrate the external moments at the L3-4 lumbar cross-section. Myoelectric signal-to-force models were used to estimate the peak loads on the lumbar spine.

RESULTS

The largest muscle activities always occurred in those muscles having the greatest spatial effectiveness to develop the task moments. However, abdominal oblique and latissimus dorsi muscles were at times active during pulling tasks involving substantial lateral and/or axial moments despite poor spatial effectiveness to equilibrate the task moments. Of ergonomic significance is the finding that the estimated spine compression was substantially greater when asymmetric pulls imposed twisting loads about the spine compared to equivalent symmetric pulls, reflecting the additional muscle activities required to equilibrate the twisting moments.

CONCLUSIONS

Asymmetric pulls resulted in some activities in obliquely oriented muscles not primarily associated with equilibrating the task moments at a single level of the lumbar trunk. Therefore, other factors, such as equilibrium requirements at other lumbar levels and trunk stiffness, may be important determinants of lumbar muscle activities during three-dimensional loadings of the trunk.

An EMG-assisted model of trunk loading during free-dynamic lifting

One of the continuing challenges in biomechanics has been to assess loading of the spine during dynamic lifting exertions. A model was developed to accurately simulate multi-dimensional spinal loads and trunk moments from measured muscle coactivity and external forces during free-dynamic lifting exertions. Model validity was demonstrated by comparing measured and predicted trunk extension moments. Its purpose was to examine realistic representations of lifting kinetics, kinematics, and dynamic trunk mechanics that may influence spinal loading, and to demonstrate that EMG-assisted modeling techniques can be applied to the analysis of free-dynamic exertions. Spinal loads and trunk moments were predicted from the muscle force vectors and external loads. Muscle tensile forces were determined from the product of normalized EMG data modulated to account for contractile dynamics, muscle cross sectional area, and muscle force per unit cross-sectional area. Model output was physiologically valid, i.e. average predicted muscle force per unit cross-sectional area of 50-65 N cm-2, and accurately predicted measured, dynamic, lifting moments, with an average R2 = 0.81 in the sagittal plane and R2 = 0.76 in the lateral plane. Results indicated that compressive and shear loading increased significantly with exertion load, lifting velocity, and trunk asymmetry.

Modeling and simulation of paraplegic ambulation in a reciprocating gait orthosis

We developed a three dimensional, four segment, eight-degree-of-freedom model for the analysis of paraplegic ambulation in a reciprocating gait orthosis (RGO). Model development was guided by experimental analysis of a spinal cord injured individual walking in an RGO with the additional assistance of arm crutches. Body forces and torques required to produce a dynamic simulation of the RGO gait swing phase were found by solving an optimal control problem to track the recorded kinematics and ground reaction forces. We found that high upper body forces are required, not only during swing but probably also during double support to compensate for the deceleration of the body during swing, which is due to the pelvic thrust necessary to swing the leg forward. Other stimulations showed that upper body forces and body deceleration during swing can be reduced substantially by producing a ballistic swing. Functional neuromuscular stimulation of the hip musculature during double support would then be required, however, to establish the initial conditions needed in a ballistic swing.

Evaluating the effect of co-contraction in optimization models

The effect of co-contraction of antagonist muscles on spinal compression force is estimated using Karush-Kuhn-Tucker (K-K-T) multipliers. Co-contraction is modelled as an incremental increase in the lower bounds on the allowable muscle forces in an optimization model formation. The K-K-T multipliers associated with each lower bound provide an estimate of the partial derivate of the optimal objective function value with respect to a change in the lower bound. A model whose objective function is spinal compression force is analyzed to estimate the effect of co-contraction on spinal compression force. While the effect depends on the specific muscle and task under consideration, the marginal effect of co-contraction on spinal compression force can be as high as 5.52 N additional spinal compression force for every additional N of muscle force. Paradoxically, the co-contraction may slightly decrease predicted spinal compression in special circumstances.

Loads in the spinal structures during lifting: development of a three-dimensional comprehensive biomechanical model

Epidemiological studies have shown that loads imposed on the human spine during daily living play a significant role in the onset of low back pain. The loads applied to the lumbar spine are shared by a number of structures: muscles; posterior elements, including facets and ligaments; and the disc of a ligamentous motion segment. In vivo, it is not practical to determine forces in these structures using experimental techniques. Biomechanical models, based on an optimization technique of electromyographic activities of the trunk muscles, have been proposed to predict forces in the load transmitting structures. The mathematical models reported in the literature are based on information collected from a wide variety of sources, of which the subject that takes part in the experiment is only one. The present study describes techniques developed in our laboratory to collect from the subjects themselves all the data needed for the formulation of a biomechanical model. The results demonstrated that back lifting with 0 N (no load), 90 N, and 180 N in the hands created maximum external flexion moments respectively of 109.6 Nm, 137.9 Nm, and 161.7 Nm, at the L3-4 disc level. The corresponding external axial compression forces on the disc were 469.5 N, 511.8 N, and 601.5 N. The predicted disc compression varied from 3.4 to 5.0 times the body weight. In comparison to the static lifting mode, the dynamic lifting task caused an increase in the disc compression force ranging from 15.8% to 39.4% depending on the load being lifted (e.g., 3256 N for the dynamic mode vs. 2516 N for the static mode when the subject lifted 90 N). The salient features of the entire protocol developed by the authors and the need for further improvements are also presented.

The effect of strict muscle stress limits on abdominal muscle force predictions for combined torsion and extension loadings

The objective of this study was to determine to what extent the central nervous system activates torso muscles so as to equalize the largest muscle stresses. Two optimization models that treat large muscle stresses differently were formulated. One model minimized spinal compression force subject to the lowest possible muscle stress limit, and the other model minimized the sum of cubed muscle stresses. Experimental conditions were determined for which the two models made different muscle force predictions. Specifically, the models predicted different rectus abdominis activity levels for tasks involving torsion and extension moment loadings. Surface electromyography was used to evaluate the model predictions. Applied loads were chosen to assure that the rectus abdominis EMG exceeded 30% MVC. Analysis of variance indicated that rectus abdominis activity was not affected by torsion loading at the p < 0.05 level of significance in a statistical design having 90% power, which was consistent with the predictions of the model that minimized the sum of cubed muscle stresses. Thus, it was concluded that equalization of the largest muscles stress was not the paramount objective of the central nervous system in the tasks studied.

Muscle lines-of-action affect predicted forces in optimization-based spine muscle modeling

This study describes the effects of varied torso muscle geometries commonly assumed in optimization-based muscle force prediction models. Specifically, the sensitivity of predicted muscle and spinal forces to assumed muscle lines-of-action (LOA) is systematically examined. The practical significance of varied muscle LOAs is addressed by determining the relative precision needed for individual muscle LOAs and assessing which muscles are more critical to accurate prediction of spinal forces. To perform this analysis a nonlinear optimization model was used to generate muscle force predictions during combined frontal and sagittal plane moment loadings with an assumed erect posture. The LOAs of the erector spinae, rectus abdominus, internal and external oblique, and latissimus dorsi were systematically varied in the frontal and sagittal planes over an anatomically feasible range. The results indicated that moderate changes in the assumed LOA could substantially alter the magnitudes of predicted muscle and spinal forces. The estimated activity level of a muscle, as well as the predicted active/silent state could be affected by the LOA of that muscle and others. The patterns of predicted muscle activity, with respect to load orientation, underwent only minor alterations with changing LOA. The relative activation of several muscles, however, was dependent on LOA, and frequently led to variations in predicted spinal compression (> 100 N change) and shear forces (> 50 N change). This dependence of estimated spinal forces on assumed muscle geometry was most pronounced for the obliques and minimal for the more vertically oriented muscles and when loads were sagittally symmetric. This study suggests that muscle LOAs are critical inputs when interpreting absolute muscle and spinal force values predicted by models of physical exertions.

Comparison of muscle forces and joint load from an optimization and EMG assisted lumbar spine model: towards development of a hybrid approach

The purpose of this study was to determine whether the same estimates of individual muscle and L4/L5 lumbar joint compressive forces result from an optimization (OPT) compared to an electromyography (EMG) assisted approach for solving the inderminate moment equilibrium equations in the same anatomical model. Four male subjects performed near maximum, isometric, ramp efforts in trunk flexion, extension and lateral bending in a testing apparatus. The EMG approach was sensitive to subject and trial differences in the magnitudes of individual muscle forces needed to produce the same reaction moment. In contrast, the OPT method converged on a similar estimate of muscle forces for all subjects and trials producing the same moment. The OPT method predicted lower L4/L5 joint compression values, on average, by 32, 43 and 23% in trunk extension, flexion and lateral bending, respectively, because, unlike the EMG method, it could not predict co-contraction of anatomically antagonistic muscles. We incorporated the OPT method's advantage of forcing an equilibrium in the reaction moments into the EMG method in a new approach we have called 'EMG assisted optimization' (EMGAO). Muscle force estimates from the EMG and EMGAO methods differed from those from the OPT method, on average, by 123% (RMS) for flexion and extension and by 218% for lateral bends. Data from the two approaches result in different conclusions about spine mechanics. We have more confidence in the EMG assisted methods because they respond to variation in muscle synergy and co-contraction patterns commonly observed in different trials and subjects for the same reaction moments.

Biomechanical risk factors for occupationally related low back disorders

A continuing challenge for ergonomists has been to determine quantitatively the types of trunk motion and how much trunk motion contributes to the risk of occupationally-related low back disorder (LBD). It has been difficult to include this motion information in workplace assessments since the speed at which trunk motion becomes dangerous has not been determined. An in vivo study was performed to assess the contribution of three-dimensional dynamic trunk motions to the risk of LBD during occupational lifting in industry. Over 400 industrial lifting jobs were studied in 48 varied industries. The medical records in these industries were examined so that specific jobs historically categorized as either low, medium, or high risk for occupationally-related LBD could be identified. A tri-axial electrogoniometer was worn by workers and documented the three-dimensional angular position, velocity, and acceleration characteristics of the lumbar spine while workers worked at these low, medium, or high risk jobs. Workplace and individual characteristics were also documented for each of the repetitive lifting tasks. A multiple logistic regression model indicated that a combination of five trunk motion and workplace factors predicted well both medium risk and high risk occupational-related LBD. These factors included lifting frequency, load moment, trunk lateral velocity, trunk twisting velocity, and trunk sagittal angle. Increases in the magnitude of these factors significantly increased the risk of LBD. The analyses have enabled us to determine the LBD risk associated with combined changes in the magnitudes of the five factors. The results indicate that by suitably varying these five factors observed during the lift collectively, the odds of high risk group membership may decrease by over ten times. These results were related to the biomechanical, ergonomic, and epidemiologic literature. The five trunk motion and workplace factors could be used as quantitative, objective measures to redesign the workplace so that the risk of occupationally-related LBD is minimized.

Evaluation of muscle force prediction models of the lumbar trunk using surface electromyography

Optimization-based models for prediction of muscle forces in the lumbar region of the torso are used to estimate the forces acting on spinal motion segments, especially for asymmetric tasks. The objectives of this study were to determine (a) which of four torso model formulations best predicted the electromyographic data, (b) the difference in muscular contribution to spinal compression force for the four models, and (c) the effect of using the lowest possible muscle stress bound in the model formulation. An approach for the investigation of competing optimization model formulations was developed and was illustrated with electromyographic data from static asymmetric loading conditions. This method is based on (a) the choice of experimental conditions in which models predict decidedly different muscle forces, and (b) the ability to ensure that the experimental conditions are such that the minimum number of assumptions about the force-electromyogram relationship must be made in order to choose between competing model predictions. Of the four models analyzed, only the formulation with an objective function that was the sum of cubed muscle stresses predicted the electromyographic data acceptably. The muscular contribution to spinal compression force predicted by these models differed by as much as 160% for some experimental conditions. The use of the lowest possible muscle stress bound does not appear to predict muscle forces that are in agreement with electromyographic data.

Identification of dynamic myoelectric signal-to-force models during isometric lumbar muscle contractions

A 14-muscle myoelectric signal (MES)-driven muscle force prediction model of the L3-L4 cross section is developed which includes a dynamic MES-force relationship and allows for cocontraction. Model parameters are estimated from MES and moments data recorded during rapid exertions in trunk flexion, extension, lateral bending and axial twist. Nine young healthy males participated in the experimental testing. The model used in the parameter estimation is of the output error type. Consistent and physically feasible parameter estimates were obtained by normalizing the RMS MES to maximum exertion levels and using nonlinear constrained optimization to minimize a cost function consisting of the trace of the output error covariance matrix. Model performance was evaluated by comparing measured and MES-predicted moments over a series of slow and rapid exertions. Moment prediction errors were on the order of 25, 30 and 40% during attempted trunk flexion-extensions, lateral bends and axial twists, respectively. The model and parameter estimation methods developed provide a means to estimate lumbar muscle and spine loads, as well as to empirically investigate the use and effects of cocontraction during physical task performances.

Quantitative interpretation of lumbar muscle myoelectric signals during rapid cyclic attempted trunk flexions and extensions

The quantitative relationship between lumbar myoelectric signals (MES) and rapidly varying isometric trunk muscle forces was investigated. Ten young adult males were asked to cycle harmonically between attempted trunk flexion and attempted trunk extension in an upright position at rates of 0.33, 0.67 and 1.0 Hz to peak efforts of 20, 40 and 60% of maximum voluntary exertion levels. The forces voluntarily exerted against a load cell were measured and used along with acquired kinematic data to calculate the time course of the net sagittal moment at the level of the third lumbar vertebra during task performances. A 22 muscle double linear programming biomechanical model was used to predict the lumbar trunk muscle contraction forces from the calculated moments. Rectified and bidirectionally low-pass filtered myoelectric activities were acquired at the L3 level from four abdominal muscles and four back muscles. The processed MES were found to be well correlated (r > 0.90) with predicted muscle forces when the MES were time-shifted to account for electromechanical delay as well as the dynamic phase shift between muscle electrical activity and contraction force. Mean time shifts that maximized the linear MES-force relationship ranged from 111 to 218 ms, were greater for the trunk extensors than the trunk flexors and generally exhibited lateral symmetry. The corresponding approximate phase angles averaged 20 degrees at the slowest rate and 50 degrees at the fastest rate. MES-force phase angles decreased as effort level was increased indicating that the dynamic MES-force relationship is nonlinear. These results illustrate the importance of accounting for the phase lag between muscle electrical activity and force when using MES to quantify muscle loads during rapidly varying exertions.

Revised NIOSH equation for the design and evaluation of manual lifting tasks

In 1985, the National Institute for Occupational Safety and Health (NIOSH) convened an ad hoc committee of experts who reviewed the current literature on lifting, recommend criteria for defining lifting capacity, and in 1991 developed a revised lifting equation. Subsequently, NIOSH developed the documentation for the equation and played a prominent role in recommending methods for interpreting the results of the equation. The 1991 equation reflects new findings and provides methods for evaluating asymmetrical lifting tasks, lifts of objects with less than optimal hand-container couplings, and also provides guidelines for a larger range of work durations and lifting frequencies than the 1981 equation. This paper provides the basis for selecting the three criteria (biomechanical, physiological, and psychophysical) that were used to define the 1991 equation, and describes the derivation of the individual components (Putz-Anderson and Waters 1991). The paper also describes the lifting index (LI), an index of relative physical stress, that can be used to identify hazardous lifting tasks. Although the 1991 equation has not been fully validated, the recommended weight limits derived from the revised equation are consistent with or lower than those generally reported in the literature. NIOSH believes that the revised 1991 lifting equation is more likely than the 1981 equation to protect most workers.

A biomechanical manikin for the evaluation of loads on the body

A simple tool to evaluate loads at body joints is described. Its function is to analyse static tasks performed in the sagittal plane. It consists of an articulated plastic manikin placed in the required posture on a magnetic board. The manikin has a set of scales which indicate moments of forces around the elbow, shoulder, lumbosacral or knee joints generated by any force exertion. The readings take into account several percentiles of stature and body weight and any value and direction of force applied in the task. A graph also provides an estimate of the intervertebral compression forces.

Large compressive preloads decrease lumbar motion segment flexibility

The bending, shear, and torsion flexibilities of 13 intact adult lumbar motion segments (from 11 men, two women, 48-83 years of age) were compared under three different compressive preloads, 0, 2,200, and 4,400 N. Test forces and moments up to 160 N and 16 Nm were applied at the center of the upper end plate of the intact disc. A compressive preload of 2,200 N resulted in a significant decrease in motion segment flexibilities in all seven test directions (p less than 0.06) when compared with results obtained with no preload; the preload decreased flexibility 2.6, 4.5, and 6.1 times in bending, axial torsion, and shear, respectively. These results suggest that studies of internal trunk load-sharing between active and passive tissues during strenuous tasks, which engender large spine compressive loads, should take these changes in spine passive resistance into consideration.

Three-dimensional force model of the low-back for simple computer programming

A three-dimensional static model is described to evaluate the forces on low-back muscles and on the spine during manual handling tasks and other forceful activities. It is simple to use either with a calculator or programmed onto a micro-computer, whilst being more accurate than existing simple models. Comparisons are made with a more sophisticated model that requires mathematical libraries and programming skills. As predictions are similar, so is the area of validity: the proposed model's accuracy is good for light tasks but poorer for strenuous ones.