Passive mechanical properties of the lumbar multifidus muscle support its role as a stabilizer

Influence of foot excitation and shin posture on the vibration behavior of the entire spine inside a seated human body

Due to ethical issues and simplification of traditional biomechanical models, experimental methods and traditional computer methods were difficult to quantify the effects of foot excitation and shin posture on vibration behavior of the entire spine inside a seated human body under vertical whole-body vibration. This study developed and verified different three-dimensional (3D) finite element (FE) models of seated human body with detailed anatomical structure under the biomechanical characteristics to predict vibration behavior of the entire spine inside a seated human body with different foot excitation (with and without vibration) and shin posture (vertical and tilt posture). Random response analysis was performed to study the transmissibility of the entire spine to seat under vertical white noise excitation between 0 and 20 Hz at 0.5 m/s2 r.m.s. The results showed that although the foot excitation could reduce the fore-aft transmissibility in the cervical spine (23% reduction), it could significantly increase that in the lumbar spine (52% increase), which resulted in complex alternating stresses at lumbar spine and made the lumbar spine more vulnerable to injury in long-term vibration environment. Moreover, the shin tilt posture made the maximum fore-aft transmissibility in the lumbar spine move to the upper lumbar spine. The study provided new insights into the influence of foot excitation and shin posture on the vibration behavior of the entire spine inside a seated human body. Foot excitation exposed the lumbar spine to complex alternating stresses and made it more vulnerable to injury in long-term whole body vibration.

Strain-dependent dynamic re-alignment of collagen fibers in skeletal muscle extracellular matrix

Collagen fiber architecture within the skeletal muscle extracellular matrix (ECM) is significant to passive muscle mechanics. While it is thought that collagen fibers re-orient themselves in response to changes in muscle length, this has not been dynamically visualized and quantified within a muscle. The goal of this study was to measure changes in collagen alignment across a range of muscle lengths and compare the corresponding alignment to muscle mechanics. We hypothesized that collagen fibers dynamically increase alignment in response to muscle stretching, and this change in alignment is related to passive muscle stiffness. Further, we hypothesized that digesting collagen fibers with collagenase would reduce the re-alignment response to muscle stretching. Using DBA/2J and D2.mdx mice, we isolated extensor digitorum longus (EDL), soleus, and diaphragm muscles for collagenase or sham treatment and decellularization to isolate intact or collagenase-digested decellularized muscles (DCMs). These DCMs were mechanically tested and imaged using second harmonic generation microscopy to measure collagen alignment across a range of strains. We found that collagen alignment increased in a strain-dependent fashion, but collagenase did not significantly affect the strain-dependent change in alignment. We also saw that the collagen fibers in the diaphragm epimysium (surface ECM) and perimysium (deep ECM) started at different angles, but still re-oriented in the same direction in response to stretching. These robust changes in collagen alignment were weakly related to passive DCM stiffness. Overall, we demonstrated that the architecture of muscle ECM is dynamic in response to strain and is related to passive muscle mechanics. STATEMENT OF SIGNIFICANCE: Our study presents a unique visualization and quantification of strain-induced changes in muscle collagen fiber alignment as they relate to passive mechanics. Using dynamic imaging of collagen in skeletal muscle we demonstrate that as skeletal muscle is stretched, collagen fibers re-orient themselves along the axis of stretch and increase their alignment. The degree of alignment and the increase in alignment are each weakly related to passive muscle stiffness. Collagenase treatments further demonstrate that the basis for muscle Extracellular matrix stiffness is dependent on factors beyond collagen crosslinking and alignment. Together the study contributes to the knowledge of the structure-function relationships of muscle extracellular matrix to tissue stiffness relevant to conditions of fibrosis and aberrant stiffness.

Collagen architecture and biomechanics of gracilis and adductor longus muscles from children with cerebral palsy

Cerebral palsy (CP) describes some upper motoneuron disorders due to non-progressive disturbances occurring in the developing brain that cause progressive changes to muscle. While longer sarcomeres increase muscle stiffness in patients with CP compared to typically developing (TD) patients, changes in extracellular matrix (ECM) architecture can increase stiffness. Our goal was to investigate how changes in muscle and ECM architecture impact muscle stiffness, gait and joint function in CP. Gracilis and adductor longus biopsies were collected from children with CP undergoing tendon lengthening surgery for hamstring and hip adduction contractures, respectively. Gracilis biopsies were collected from TD patients undergoing anterior cruciate ligament reconstruction surgery with hamstring autograft. Muscle mechanical testing, two-photon imaging and hydroxyproline assay were performed on biopsies. Corresponding data were compared to radiographic hip displacement in CP adductors (CPA), gait kinematics in CP hamstrings (CPH), and joint range of motion in CPA and CPH. We found at matched sarcomere lengths muscle stiffness and collagen architecture were similar between TD and CP hamstrings. However, CPH stiffness (R2 = 0.1973), collagen content (R2 = 0.5099) and cross-linking (R2 = 0.3233) were correlated to decreased knee range of motion. Additionally, we observed collagen fibres within the muscle ECM increase alignment during muscular stretching. These data demonstrate that while ECM architecture is similar between TD and CP hamstrings, collagen fibres biomechanics are sensitive to muscle strain and may be altered at longer in vivo sarcomere lengths in CP muscle. Future studies could evaluate the impact of ECM architecture on TD and CP muscle stiffness across in vivo operating ranges. KEY POINTS: At matched sarcomere lengths, gracilis muscle mechanics and collagen architecture are similar in TD patients and patients with CP. In both TD and CP muscles, collagen fibres dynamically increase their alignment during muscle stretching. Aspects of muscle mechanics and collagen architecture are predictive of in vivo knee joint motion and radiographic hip displacement in patients with CP. Longer sarcomere lengths in CP muscle in vivo may alter collagen architecture and biomechanics to drive deficits in joint mobility and gait function.

Study on the biodynamic characteristics and internal vibration behaviors of a seated human body under biomechanical characteristics

To provide reference and theoretical guidance for establishing human body dynamics models and studying biomechanical vibration behavior, this study aimed to develop and verify a computational model of a three-dimensional seated human body with detailed anatomical structure under complex biomechanical characteristics to investigate dynamic characteristics and internal vibration behaviors of the human body. Fifty modes of a seated human body were extracted by modal method. The intervertebral disc and head motions under uniaxial white noise excitation (between 0 and 20 Hz at 1.0, 0.5 and 0.5 m/s2 r.m.s. for vertical, fore-aft and lateral direction, respectively) were computed by random response analysis method. It was found that there were many modes of the seated human body in the low-frequency range, and the modes that had a great impact on seated human vibration were mainly distributed below 13 Hz. The responses of different positions of the spine varied greatly under the fore-aft and lateral excitation, but the maximum stress was distributed in the lumbar under different excitations, which could explain why drivers were prone to lower back pain after prolonged driving. Moreover, there was a large vibration coupling between the vertical and fore-aft direction of an upright seated human body, while the vibration couplings between the lateral and other directions were very small. Overall, the study could provide new insights into not only the overall dynamic characteristics of the human body, but also the internal local motion and biomechanical characteristics under different excitations.

Development and evaluation of sex-specific thoracolumbar spine finite element models to study spine biomechanics

Musculoskeletal disorders and low back pain (LBP) are common global afflictions, with a higher prevalence observed in females. However, the cause of many LBP cases continues to elude researchers. Current approaches seldom consider differences in male and female spines. Thus, this study aimed to compare the load distribution between male and female spines through finite element modeling. Two finite element models of the spine, one male and one female, were developed, inclusive of sex-specific geometry and material properties. The models consisted of the vertebrae, intervertebral discs (IVD), tendons, surrounding spinal muscles, and thoracolumbar fascia and were subjected to loading conditions simulating flexion and extension. Following extensive validation against published literature, intersegmental rotation, IVD stress, and vertebral body stress were evaluated. The female model demonstrated increased magnitudes for rotation and stresses when compared to the male model. Results suggest that the augmented stresses in the female model indicate an increased load distribution throughout the spine compared to the male model. These findings may corroborate the higher prevalence of LBP in females. This study highlights the importance of using patient- and sex-specific models for patient analyses and care.

A biomechanical model of a vehicle passenger in the sagittal plane

Musculoskeletal biomechanical models have wide applications in ergonomics, rehabilitation, and injury estimation. Their use can be extended to enable quantitatively explaining and estimating ride comfort for a vehicle's passenger. A biomechanical model of the upper body in the sagittal plane is constructed, which allows for curved motion to simulate the propagation of disturbance energy within a seated passenger aboard a moving vehicle. The dynamic predictions of the model are validated against experimental results within the literature. Frequency responses show that within the vehicular frequency range, the L4L5 and the L5S1 discs in the lower lumbar region are susceptible to the highest vibration transmission. It was also found that vibration transmission is maximized at around 4.5 Hz. The model provides analytical and geometric intuition into the motion of the various segments of the upper body using a few simple geometric assumptions and can be employed to develop a quantitative ride-comfort metric, such that the most comfortable ride would be that which would induce the least internal motion within the passenger model.

Fatty infiltration of the erector spinae at the upper lumbar spine could be a landmark for low back pain

PURPOSE

Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end-plates, and fatty infiltration in their paraspinal muscles.

METHODS

Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age-, gender- and BMI-matched asymptomatic controls.

RESULTS

Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels.

CONCLUSION

Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.

Finite element analysis of the cervical spine: dynamic characteristics and material property sensitivity study

The study aimed to investigate the dynamic characteristics of the cervical spine and determine the effect of the material properties of the cervical spinal components on it. A finite element model of the head-cervical spine was developed based on CT scan data, and the first six orders of modes (e.g. flexion-extension, lateral bending, and vertical, etc.) were verified by experimental and simulation studies. The material sensitivity study was conducted by varying elasticity modulus of cervical hard tissues (cortical bone, cancellous bone, endplates, and posterior elements) and soft tissues (intervertebral disc and ligaments). The results showed that increasing the elastic modulus of ligaments by 4 times increased the natural frequency by 77%, while increasing that of cancellous bone by 4 times only increased the natural frequency by 6%. In the axial mode, the cervical spine had not only axial deformation but also anterior-posterior deformation, with the largest deformation located at the intervertebral disc C6-C7. Decreasing the elastic modulus of a component in soft tissues by 80% increased modal displacement by up to 62%. The material properties of the intervertebral discs and ligaments had opposite effects on the modal displacement and deformation of the cervical spine. Low cervical discs were more susceptible to injury in a vertical vibration environment. Cervical spine dynamics were more sensitive to soft tissue material properties than to hard tissue material properties. Disc degeneration could reduce the range of vibratory motion of the cervical spine, thereby reducing the ability of the cervical spine to cushion head impacts.

A finite element method study of the effect of vibration on the dynamic biomechanical response of the lumbar spine

BACKGROUND

Studies focusing on lumbar spine biomechanics are very limited, and the mechanism of the effect of vibration on lumbar spine biodynamics is unclear. To provide guidance and reference for lumbar spine biodynamics research and vibration safety assessment, this study aims to investigate the effects of different vibrations on lumbar spine biodynamics.

METHODS

A validated finite element model of the lumbosacral spine was utilized. The model incorporated a 40 kg mass on the upper side and a 400 N follower preload. As a comparison, another model without a coupled mass was also employed. A sinusoidal acceleration with an amplitude of 1 m/s2 and a frequency of 5 Hz was applied to the upper and lower sides of the model respectively.

FINDINGS

When the coupled mass point is not introduced: in the case of upper-side excitation, the lumbar spine shows a significantly larger response in the x-direction than in the z-direction, while in the case of lower-side excitation, the lumbar spine experiences rigid body displacement in the z-direction without any movement, deformation, rotation, or stress changes in the x-direction. When the coupled mass point is introduced: both upper and lower-side excitations result in significant differences in z-directional displacement, with relatively small differences in vertebral rotation angle, disc deformation, and stress. Under upper excitation, low-frequency oscillations occur in the x-direction. In both types of excitations, the anterior-posterior deformation of the L2-L3 and L4-L5 intervertebral discs is greater than the vertical deformation. The peak (maximum) disc stress exceeds the average stress and stress amplitude across the entire disc. Regardless of the excitation type, the stress distribution within the disc at the moment of peak displacement remains nearly identical, with the maximum stress consistently localized on the anterior side of the L4-L5 disc.

INTERPRETATION

Accurately simulating lumbar spine biodynamics requires the inclusion of the upper body mass in the lumbosacral spine model. The physiological curvature of the lumbar spine could escalate the risk of lumbar spine vibration injuries. It is more instructive to apply local high stress in the disc as a lumbar spine vibration safety evaluation parameter.

The role of an active muscular subsystem in prone instability test during rest and leg raise conditions

BACKGROUND

Clinicians commonly used prone instability test (PIT) by assessing the posterior-to-anterior (PA) displacement to identify lumbar instability. Most studies focusing on passive subsystem found greater mobility in lower lumbar (L4-L5) than upper lumbar (L1-L3) spine. However, there is still a lack of evidence to demonstrate the role of active subsystem. Additionally, it is unclear whether sex affects PA displacements.

AIM

To determine differences in displacement among five lumbar segments, between two testing positions (rest and leg raise), and between male and female during PIT in individuals with chronic non-specific low back pain (CNLBP).

DESIGN

A cross-sectional study design.

SETTING

Spine biomechanics laboratory.

POPULATION

Individuals with CNLBP.

METHODS

An electromagnetic tracking system was used to measure PA displacement with sensors attached at T12, S2 and a hand-held dynamometer. Participants were asked to perform PIT, while a 100N force was applied to each lumbar segment during resting and leg raise positions.

RESULTS

Significantly less PA displacement (P<0.05) was seen in lower compared to upper lumbar spine and in leg raise compared to rest at L1 to L4. No significant interaction of sex with different lumbar levels and conditions (P>0.05) during PIT was found.

CONCLUSIONS

Although previous studies have reported that the lower lumbar spine had greater mobility, the lower amount of displacement during the rest position suggests the role of an active subsystem contributing to lumbar stability regardless of sex.

CLINICAL REHABILTATION IMPACT

A reduction in displacement during the leg raise position across L1 to L4 suggesting an interaction of stabilizing subsystems of the spine to provide lumbar stability.

The effect of fatty infiltration, revision surgery, and sex on lumbar multifidus passive mechanical properties

Purpose

Previous research has demonstrated increased stiffness in the multifidus muscle compared to other paraspinal muscles at the fiber bundle level. We aimed to compare single fiber and fiber bundle passive mechanical properties of multifidus muscle: (1) in 40 patients undergoing primary versus revision surgery and (2) in muscle with mild versus severe fatty infiltration.

Methods

The degree of muscle fatty infiltration was graded using the patients' spine magnetic resonance images. Average single fiber and fiber bundle passive mechanical properties across three tests were compared between primary (N = 30) and revision (N = 10) surgery status, between mild and severe fatty infiltration levels, between sexes, and with age from passive stress-strain tests of excised multifidus muscle intraoperative biopsies.

Results

At the single fiber level, elastic modulus was unaffected by degree of fatty infiltration or surgery status. Female sex (p = 0.001) and younger age (p = 0.04) were associated with lower multifidus fiber elastic modulus. At the fiber bundle level, which includes connective tissue around fibers, severe fatty infiltration (p = 0.01) and younger age (p = 0.06) were associated with lower elastic modulus. Primary surgery also demonstrated a moderate, but non-significant effect for lower elastic modulus (p = 0.10).

Conclusions

Our results demonstrate that female sex is the primary driver for reduced single fiber elastic modulus of the multifidus, while severity of fatty infiltration is the primary driver for reduced elastic modulus at the level of the fiber bundle in individuals with lumbar spine pathology.

Lumbar multifidus muscle morphology is associated with low back-related pain duration, disability, and leg pain: A cross-sectional study in secondary care

BACKGROUND

Systematic reviews and studies exploring associations between morphologic change of paraspinal muscles and low back pain or related outcomes such as disability, radiculopathy, and physical workload, have reported conflicting results. This study explores the associations between lumbar multifidus muscle quality and clinical outcomes relating to low back pain.

METHODS

Cross-sectional study of spinal clinic outpatients presenting with a primary complaint of low back and/or leg symptoms. Univariable and multivariable regression models were used to investigate associations between MRI-based multifidus muscle cross-sectional area at L4 and L5 and clinical outcomes for low back pain, leg pain, disability, restricted motion, and strenuous nature of work. Results were reported with β-coefficients, odds ratios (OR), or incidence rate ratios (IRR) and their corresponding 95% confidence intervals, based on a 10% difference in muscle quality for each clinical variable. Multivariable analyses were adjusted for age, sex, and BMI.

RESULTS

875 patients [487 females; mean (SD) age: 43.6 (10.2) years] were included. In the multivariable analyses, muscle quality was significantly associated with disability (0-23 scale) [β: -0.74, 95% CI: -1.14, -0.34], leg pain intensity (0-10 scale) [β: -0.25, 95% CI: -0.46, -0.03], and current pain duration of more than 12 months [OR: 1.27, 95% CI: 1.03, 1.55]. No associations were found for low back pain intensity, morning stiffness, painful active range of motion, or work nature.

CONCLUSIONS

Patients with higher lumbar multifidus muscle quality reported lower levels of low back pain-related disability and leg pain intensity, indicating that muscle quality may play a role in the etiology of lumbar spine disorders. However, the clinical importance of these associations is uncertain due to the low magnitude of identified associations. Future longitudinal studies are needed to understand the effect of lumbar multifidus muscle quality on lumbar-related pain and disability.

The extracellular matrix of dystrophic mouse diaphragm accounts for the majority of its passive stiffness and is resistant to collagenase digestion

The healthy skeletal muscle extracellular matrix (ECM) has several functions including providing structural integrity to myofibers, enabling lateral force transmission, and contributing to overall passive mechanical properties. In diseases such as Duchenne Muscular dystrophy, there is accumulation of ECM materials, primarily collagen, which results in fibrosis. Previous studies have shown that fibrotic muscle is often stiffer than healthy muscle, in part due to the increased number and altered architecture of collagen fibers within the ECM. This would imply that the fibrotic matrix is stiffer than the healthy matrix. However, while previous studies have attempted to quantify the extracellular contribution to passive stiffness in muscle, the outcomes are dependent on the type of method used. Thus, the goals of this study were to compare the stiffness of healthy and fibrotic muscle ECM and to demonstrate the efficacy of two methods for quantifying extracellular-based stiffness in muscle, namely decellularization and collagenase digestion. These methods have been demonstrated to remove the muscle fibers or ablate collagen fiber integrity, respectively, while maintaining the contents of the extracellular matrix. Using these methods in conjunction with mechanical testing on wildtype and D2.mdx mice, we found that a majority of passive stiffness in the diaphragm is dependent on the ECM, and the D2.mdx diaphragm ECM is resistant to digestion by bacterial collagenase. We propose that this resistance is due to the increased collagen cross-links and collagen packing density in the ECM of the D2.mdx diaphragm. Taken altogether, while we did not find increased stiffness of the fibrotic ECM, we did observe that the D2.mdx diaphragm conveyed resistance against collagenase digestion. These findings demonstrate how different methods for measuring ECM-based stiffness each have their own limitations and can produce different results.

Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation

OBJECTIVE

We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy.

METHODS

We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH.

RESULTS

This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy.

CONCLUSION

Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.

Biomechanical evaluation of the thoracolumbar spine comparing healthy and irregular thoracic and lumbar curvatures

BACKGROUND

The geometric alignment of the spine plays an integral role in stability, biomechanical loading, and consequently, pain, and a range of healthy sagittal curvatures has been identified. Spinal biomechanics when sagittal curvature is outside the optimal range remains a debate and may provide insight into the load distribution throughout the spinal column.

METHOD

A thoracolumbar spine model (Healthy) was developed. Thoracic and lumbar curvatures were adjusted by 50% to create models with varying sagittal profiles: hypolordotic (HypoL), hyperlordotic (HyperL), hypokyphotic (HypoK), and hyperkyphotic (HyperK). In addition, lumbar spine models were constructed for the former three profiles. The models were subjected to loading conditions simulating flexion and extension. Following validation, intervertebral disc stresses, vertebral body stresses, disc heights, and intersegmental rotations were compared across all models.

RESULTS

Overall trends demonstrated that HyperL and HyperK models had a noticeable reduction in disc height and greater vertebral body stresses compared to the Healthy model. In comparison, the HypoL and HypoK models displayed opposite trends. Considering the lumbar models, the HypoL model had reduced disc stresses and flexibility, while the contrary was observed in the HyperL model. Results indicate that the models with excessive curvature may be subjected to greater stress magnitudes, while the straighter spine models may reduce these stresses.

CONCLUSIONS

Finite element modeling of spine biomechanics demonstrated that variations in sagittal profiles influence the load distribution and range of motion of the spine. Considering patient-specific sagittal profiles in finite element modeling may provide valuable insight for biomechanical analyses and targeted treatments.

Nondestructive ultrasound evaluation of microstructure-related material parameters of skeletal muscle: An in silico and in vitro study

Direct and nondestructive assessment of material properties of skeletal muscle in vivo shall advance our understanding of intact muscle mechanics and facilitate personalized interventions. However, this is challenged by intricate hierarchical microstructure of the skeletal muscle. We have previously regarded the skeletal muscle as a composite of myofibers and extracellular matrix (ECM), formulated shear wave propagation in the undeformed muscle using the acoustoelastic theory, and preliminarily demonstrated that ultrasound-based shear wave elastography (SWE) could estimate microstructure-related material parameters (MRMPs): myofiber stiffness μ_f, ECM stiffness μ_m, and myofiber volume ratio V_f. The proposed method warrants further validation but is hampered by the lack of ground truth values of MRMPs. In this study, we presented analytical and experimental validations of the proposed method using finite-element (FE) simulations and 3D-printed hydrogel phantoms, respectively. Three combinations of different physiologically relevant MRMPs were used in the FE simulations where shear wave propagations in the corresponding composite media were simulated. Two 3D-printed hydrogel phantoms with the MRMPs close to those of a real skeletal muscle (i.e., μ_f=2.02kPa, μ_m=52.42kPa, and V_f=0.675,0.832) for ultrasound imaging were fabricated by an alginate-based hydrogel printing protocol that we modified and optimized from the freeform reversible embedding of suspended hydrogels (FRESH) method in literature. Average percent errors of (μ_f,μ_m,V_f) estimates were found to be (2.7%,7.3%,2.4%)in silico and (3.0%,8.0%,9.9%)in vitro. This quantitative study corroborated the potential of our proposed theoretical model along with ultrasound SWE for uncovering microstructural characteristics of the skeletal muscle in an entirely nondestructive way.

A review of the characterizations of soft tissues used in human body modeling: Scope, limitations, and the path forward

Soft tissue material properties are vital to human body models that evaluate interactions between the human body and its environment. Such models evaluate internal stress/strain responses in soft tissues to investigate issues like pressure injuries. Numerous constitutive models and parameters have been used to represent mechanical behavior of soft tissues in biomechanical models under quasi-static loading. However, researchers reported that generic material properties cannot accurately represent specific target populations due to large inter-individual variability. Two challenges that exist are experimental mechanical characterization and constitutive modeling of biological soft tissues and personalization of constitutive parameters using non-invasive, non-destructive bedside testing methods. It is imperative to understand the scope and appropriate applications for reported material properties. Thus, the goal of this paper was to compile studies from which soft tissue material properties were obtained and categorize them by source of tissue samples, methods used to quantify deformation, and material models used to describe tissues. The collected studies displayed wide ranges of material properties, and factors that affected the properties included whether tissue samples were in vivo or ex vivo, from humans or animals, the body region tested, body position during in vivo studies, deformation measurements, and material models used to describe tissues. Because of the factors that affected reported material properties, it is clear that much progress has been made in understanding soft tissue responses to loading, yet there is a need to broaden the scope of reported soft tissue material properties and better match reported properties to appropriate human body models.

Collagen cross-links scale with passive stiffness in dystrophic mouse muscles, but are not altered with administration of a lysyl oxidase inhibitor

In Duchenne muscular dystrophy (DMD), a lack of functional dystrophin leads to myofiber instability and progressive muscle damage that results in fibrosis. While fibrosis is primarily characterized by an accumulation of extracellular matrix (ECM) components, there are changes in ECM architecture during fibrosis that relate more closely to functional muscle stiffness. One of these architectural changes in dystrophic muscle is collagen cross-linking, which has been shown to increase the passive muscle stiffness in models of fibrosis including the mdx mouse, a model of DMD. We tested whether the intraperitoneal injections of beta-aminopropionitrile (BAPN), an inhibitor of the cross-linking enzyme lysyl oxidase, would reduce collagen cross-linking and passive stiffness in young and adult mdx mice compared to saline-injected controls. We found no significant differences between BAPN treated and saline treated mice in collagen cross-linking and stiffness parameters. However, we observed that while collagen cross-linking and passive stiffness scaled positively in dystrophic muscles, collagen fiber alignment scaled with passive stiffness distinctly between muscles. We also observed that the dystrophic diaphragm showed the most dramatic fibrosis in terms of collagen content, cross-linking, and stiffness. Overall, we show that while BAPN was not effective at reducing collagen cross-linking, the positive association between collagen cross-linking and stiffness in dystrophic muscles still show cross-linking as a viable target for reducing passive muscle stiffness in DMD or other fibrotic muscle conditions.

Dysfunctional paraspinal muscles in adult spinal deformity patients lead to increased spinal loading

Purpose

Decreased spinal extensor muscle strength in adult spinal deformity (ASD) patients is well-known but poorly understood; thus, this study aimed to investigate the biomechanical and histopathological properties of paraspinal muscles from ASD patients and predict the effect of altered biomechanical properties on spine loading.

Methods

68 muscle biopsies were collected from nine ASD patients at L4–L5 (bilateral multifidus and longissimus sampled). The biopsies were tested for muscle fiber and fiber bundle biomechanical properties and histopathology. The small sample size (due to COVID-19) precluded formal statistical analysis, but the properties were compared to literature data. Changes in spinal loading due to the measured properties were predicted by a lumbar spine musculoskeletal model.

Results

Single fiber passive elastic moduli were similar to literature values, but in contrast, the fiber bundle moduli exhibited a wide range beyond literature values, with 22% of 171 fiber bundles exhibiting very high elastic moduli, up to 20 times greater. Active contractile specific force was consistently less than literature, with notably 24% of samples exhibiting no contractile ability. Histological analysis of 28 biopsies revealed frequent fibro-fatty replacement with a range of muscle fiber abnormalities. Biomechanical modelling predicted that high muscle stiffness could increase the compressive loads in the spine by over 500%, particularly in flexed postures.

Discussion

The histopathological observations suggest diverse mechanisms of potential functional impairment. The large variations observed in muscle biomechanical properties can have a dramatic influence on spinal forces. These early findings highlight the potential key role of the paraspinal muscle in ASD.

Sex-Related Pain Behavioral Differences following Unilateral NGF Injections in a Rat Model of Low Back Pain

Low back pain (LBP) is a globally prevalent and costly societal problem with multifactorial etiologies and incompletely understood pathophysiological mechanisms. To address such shortcomings regarding the role of neurotrophins in the underlying mechanisms of pain, an LBP model was developed in rats involving two unilateral intramuscular injections of nerve growth factor (NGF) into deep trunk muscles. To date, behavioral investigations of this NGF-LBP model have been limited, especially as it pertains to female pain behaviors. This study compared mechanical sensitivity to noxious (hyperalgesia) and non-noxious (hypersensitivity) stimuli in control and NGF-injected male and female rats through pain resolution. Although the baseline testing revealed no differences between males and females, NGF-injected females demonstrated prolonged ipsilateral deep trunk mechanical hyperalgesia that resolved seven days later than males. Moreover, females showed bilateral trunk mechanical sensitivity to noxious and non-noxious stimuli compared to only ipsilateral behaviors in males. Sex differences were also observed in the severity of behavioral responses, with females displaying greater mean differences from baseline at several timepoints. Overall, these NGF-LBP behavioral findings mirror some of the sex differences reported in the clinical presentation of LBP and accentuate the translatability of this NGF-LBP model. Future studies using this LBP-NGF model could help to elucidate the neurobiological mechanisms responsible for the development, severity, and/or resolution of muscular LBP as well as to provide insights into the processes governing the transition from acute to chronic LBP.

Biomechanical Properties of Paraspinal Muscles Influence Spinal Loading—A Musculoskeletal Simulation Study

Paraspinal muscles are vital to the functioning of the spine. Changes in muscle physiological cross-sectional area significantly affect spinal loading, but the importance of other muscle biomechanical properties remains unclear. This study explored the changes in spinal loading due to variation in five muscle biomechanical properties: passive stiffness, slack sarcomere length (SSL), in situ sarcomere length, specific tension, and pennation angle. An enhanced version of a musculoskeletal simulation model of the thoracolumbar spine with 210 muscle fascicles was used for this study and its predictions were validated for several tasks and multiple postures. Ranges of physiologically realistic values were selected for all five muscle parameters and their influence on L4-L5 intradiscal pressure (IDP) was investigated in standing and 36° flexion. We observed large changes in IDP due to changes in passive stiffness, SSL, in situ sarcomere length, and specific tension, often with interesting interplays between the parameters. For example, for upright standing, a change in stiffness value from one tenth to 10 times the baseline value increased the IDP only by 91% for the baseline model but by 945% when SSL was 0.4 μm shorter. Shorter SSL values and higher stiffnesses led to the largest increases in IDP. More changes were evident in flexion, as sarcomere lengths were longer in that posture and thus the passive curve is more influential. Our results highlight the importance of the muscle force-length curve and the parameters associated with it and motivate further experimental studies on in vivo measurement of those properties.

The influence of longitudinal muscle fascicle growth on mechanical function

Skeletal muscle has the remarkable ability to remodel and adapt, such as the increase in serial sarcomere number (SSN) or fascicle length (FL) observed after overstretching a muscle. This type of remodelling is termed longitudinal muscle fascicle growth, and its impact on biomechanical function has been of interest since the 1960s due to its clinical applications in muscle strain injury, muscle spasticity, and sarcopenia. Despite simplified hypotheses on how longitudinal muscle fascicle growth might influence mechanical function, existing literature presents conflicting results partly due to a breadth of methodologies. The purpose of this review is to outline what is currently known about the influence of longitudinal muscle fascicle growth on mechanical function and suggest future directions to address current knowledge gaps and methodological limitations. Various interventions indicate longitudinal muscle fascicle growth can increase the optimal muscle length for active force, but whether the whole force-length relationship widens has been less investigated. Future research should also explore the ability for longitudinal fascicle growth to broaden the torque-angle relationship's plateau region, and the relation to increased force during shortening. Without a concurrent increase in intramuscular collagen, longitudinal muscle fascicle growth also reduces passive tension at long muscle lengths; further research is required to understand whether this translates to increased joint range of motion. Lastly, some evidence suggests longitudinal fascicle growth can increase maximum shortening velocity and peak isotonic power, however, there has yet to be direct assessment of these measures in a neurologically intact model of longitudinal muscle fascicle growth.

Diaphragm muscle fibrosis involves changes in collagen organization with mechanical implications in Duchenne muscular dystrophy

In Duchenne muscular dystrophy (DMD), diaphragm muscle dysfunction results in respiratory insufficiency, a leading cause of death in patients. Increased muscle stiffness occurs with buildup of fibrotic tissue, characterized by excessive accumulation of extracellular matrix (ECM) components such as collagen, and prevents the diaphragm from achieving the excursion lengths required for respiration. However, changes in mechanical properties are not explained by collagen amount alone and we must consider the complex structure and mechanics of fibrotic tissue. The goals of our study were to 1) determine if and how collagen organization changes with the progression of DMD in diaphragm muscle tissue and 2) predict how collagen organization influences the mechanical properties of the ECM. We first visualized collagen structure with scanning electron microscopy (SEM) images and then developed an analysis framework to quantify collagen organization and generate image-based finite-element models. Image analysis revealed increased collagen fiber straightness and alignment in mdx over wild type (WT) at 3 mo (straightness: mdx = 0.976 ± 0.0108, WT = 0.887 ± 0.0309, alignment: mdx = 0.876 ± 0.0333, WT = 0.759 ± 0.0416) and 6 mo (straightness: mdx = 0.942 ± 0.0182, WT = 0.881 ± 0.0163, alignment: mdx = 0.840 ± 0.0315, WT = 0.759 ± 0.0368). Collagen fibers retained a transverse orientation relative to muscle fibers (70°-90°) in all groups. Mechanical models predicted an increase in the transverse relative to longitudinal (muscle fiber direction) stiffness, with stiffness ratio (transverse/longitudinal) increased in mdx over WT at 3 mo (mdx = 5.45 ± 2.04, WT = 1.97 ± 0.670) and 6 mo (mdx = 4.05 ± 0.985, WT = 1.96 ± 0.506). This study revealed changes in diaphragm ECM structure and mechanics during disease progression in the mdx muscular dystrophy mouse phenotype, highlighting the need to consider the role of collagen organization on diaphragm muscle function.NEW & NOTEWORTHY Scanning electron microscopy images of decellularized diaphragm muscle from WT and mdx, Duchenne muscular dystrophy model, mice revealed that collagen fibers in the epimysium are oriented transverse to muscle fibers, with age- and disease-dependent changes in collagen arrangement. Finite-element models generated from these images predicted that changes in collagen arrangement during disease progression influence the mechanical properties of the extracellular matrix. Thus, changes in collagen fiber-level structure are implicated on tissue-level properties during fibrosis.

Systematic review of skeletal muscle passive mechanics experimental methodology

Understanding passive skeletal muscle mechanics is critical in defining structure-function relationships in skeletal muscle and ultimately understanding pathologically impaired muscle. In this systematic review, we performed an exhaustive literature search using PRISMA guidelines to quantify passive muscle mechanical properties, summarized the methods used to create these data, and make recommendations to standardize future studies. We screened over 7500 papers and found 80 papers that met the inclusion criteria. These papers reported passive muscle mechanics from single muscle fiber to whole muscle across 16 species and 54 distinct muscles. We found a wide range of methodological differences in sample selection, preparation, testing, and analysis. The systematic review revealed that passive muscle mechanics is species and scale dependent-specifically within mammals, the passive mechanics increases non-linearly with scale. However, a detailed understanding of passive mechanics is still unclear because the varied methodologies impede comparisons across studies, scales, species, and muscles. Therefore, we recommend the following: smaller scales may be maintained within storage solution prior to testing, when samples are tested statically use 2-3 min of relaxation time, stress normalization at the whole muscle level be to physiologic cross-sectional area, strain normalization be to sarcomere length when possible, and an exponential equation be used to fit the data. Additional studies using these recommendations will allow exploration of the multiscale relationship of passive force within and across species to provide the fundamental knowledge needed to improve our understanding of passive muscle mechanics.

The Effect of Posterior Lumbar Spinal Surgery on Biomechanical Properties of Rat Paraspinal Muscles 13 Weeks After Surgery

STUDY DESIGN

Preclinical study in rodents.

OBJECTIVE

To investigate changes in biomechanical properties of paraspinal muscles following a posterior spinal surgery in an animal model.

SUMMARY OF BACKGROUND DATA

Posterior spine surgery damages paraspinal musculature per histological and imaging studies. The biomechanical effects of these changes are unknown.

METHODS

12 Sprague-Dawley rats were divided equally into sham and surgical injury (SI) groups. For sham, the skin and lumbodorsal fascia were incised at midline. For SI, the paraspinal muscles were detached from the vertebrae, per normal procedure. Thirteen weeks postsurgery, multifidus and longissimus biopsies at L1, L3, and L5 levels were harvested on the right. From each biopsy, three fibers and three to six bundles of fibers (∼10-20 fibers ensheathed in their extracellular matrix) were tested mechanically to measure their passive elastic modulus. The collagen content and fatty infiltration of each biopsy were also examined histologically by immunofluorescence staining. Nonparametric statistical methods were used with a 1.25% level of significance.

RESULTS

A total of 220 fibers and 279 bundles of fibers were tested. The elastic moduli of the multifidus and longissimus fibers and longissimus fiber bundles were not significantly different between the SI and sham groups. However, the elastic modulus of multifidus fiber bundles was significantly greater in the SI group compared to sham (SI median 82 kPa, range 23-284; sham median 38 kPa, range 23-50, P = 0.0004). The elastic modulus of multifidus fiber bundles in the SI group was not statistically different between spinal levels (P = 0.023). For histology, only collagen I deposition in multifidus was significantly greater in the SI group (median 20.8% vs. 5.8% for sham, P < 0.0001).

CONCLUSION

The surgical injury increased the passive stiffness of the multifidus fiber bundles. Increased collagen content in the extracellular matrix is the likely reason and these changes may be important in the postoperative compensation of the spine.Level of Evidence: N/A.

Larger muscle fibers and fiber bundles manifest smaller elastic modulus in paraspinal muscles of rats and humans

The passive elastic modulus of muscle fiber appears to be size-dependent. The objectives of this study were to determine whether this size effect was evident in the mechanical testing of muscle fiber bundles and to examine whether the muscle fiber bundle cross-section is circular. Muscle fibers and fiber bundles were extracted from lumbar spine multifidus and longissimus of three cohorts: group one (G1) and two (G2) included 13 (330 ± 14 g) and 6 (452 ± 28 g) rats, while Group 3 (G3) comprised 9 degenerative spine patients. A minimum of six muscle fibers and six muscle fiber bundles from each muscle underwent cumulative stretches, each of 10% strain followed by 4 minutes relaxation. For all specimens, top and side diameters were measured. Elastic modulus was calculated as tangent at 30% strain from the stress–strain curve. Linear correlations between the sample cross sectional area (CSA) and elastic moduli in each group were performed. The correlations showed that increasing specimen CSA resulted in lower elastic modulus for both rats and humans, muscle fibers and fiber bundles. The median ratio of major to minor axis exceeded 1.0 for all groups, ranging between 1.15–1.29 for fibers and 1.27–1.44 for bundles. The lower elastic moduli with increasing size can be explained by relatively less collagenous extracellular matrix in the large fiber bundles. Future studies of passive property measurement should aim for consistent bundle sizes and measuring diameters of two orthogonal axes of the muscle specimens.

In vivo human gracilis whole-muscle passive stress-sarcomere strain relationship

We measured the passive mechanical properties of intact, living human gracilis muscles (n=11 individuals, 10 male and 1 female, age: 33±12 years, mass: 89±23 kg, height: 177±8 cm). Measurements were performed in patients undergoing surgery for free-functioning myocutaneous tissue transfer of the gracilis muscle to restore elbow flexion after brachial plexus injury. Whole-muscle force of the gracilis tendon was measured in four joint configurations (JC1-JC4) with a buckle force transducer placed at the distal tendon. Sarcomere length was also measured by biopsy from the proximal gracilis muscle. After the muscle was removed, a three-dimensional volumetric reconstruction of the muscle was created via photogrammetry. Muscle length from JC1 to JC4 increased by 3.3±1.0, 7.7±1.2, 10.5±1.3 and 13.4±1.2 cm, respectively, corresponding to 15%, 34%, 46% and 59% muscle fiber strain, respectively. Muscle volume and an average optimal fiber length of 23.1±0.7 cm yielded an average muscle physiological cross-sectional area of 6.8±0.7 cm2 which is approximately 3 times that measured previously from cadaveric specimens. Absolute passive tension increased from 0.90±0.21 N in JC1 to 16.50±2.64 N in JC4. As expected, sarcomere length also increased from 3.24±0.08 µm at JC1 to 3.63±0.07 µm at JC4, which are on the descending limb of the human sarcomere length-tension curve. Peak passive muscle stress was 27.8±5.5 kPa in JC4 and muscle modulus ranged from 44.8 MPa in JC1 to 125.7 MPa in JC4. Comparison with other mammalian species indicates that human muscle passive mechanical properties are more similar to rodent muscle than to rabbit muscle. These data provide direct measurements of whole-human muscle passive mechanical properties that can be used in modeling studies and for understanding comparative passive mechanical properties among mammalian muscles.

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.

Biochemical and structural basis of the passive mechanical properties of whole skeletal muscle

Passive mechanical properties of whole skeletal muscle are not as well understood as active mechanical properties. Both the structural basis for passive mechanical properties and the properties themselves are challenging to determine because it is not clear which structures within skeletal muscle actually bear passive loads and there are not established standards by which to make mechanical measurements. Evidence suggests that titin bears the majority of the passive load within the single muscle cell. However, at larger scales, such as fascicles and muscles, there is emerging evidence that the extracellular matrix bears the major part of the load. Complicating the ability to quantify and compare across size scales, muscles and species, definitions of muscle passive properties such as stress, strain, modulus and stiffness can be made relative to many reference parameters. These uncertainties make a full understanding of whole muscle passive mechanical properties and modelling these properties very difficult. Future studies defining the specific load bearing structures and their composition and organization are required to fully understand passive mechanics of the whole muscle and develop therapies to treat disorders in which passive muscle properties are altered such as muscular dystrophy, traumatic laceration, and contracture due to upper motor neuron lesion as seen in spinal cord injury, stroke and cerebral palsy.

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.

Hip and Core Muscle Activation During High-Load Core Stabilization Exercises

BACKGROUND

There is some evidence that high-load lumbar stabilization exercises, such as back bridge, can recruit both local and global muscles.

HYPOTHESIS

Therapeutic exercises would optimize gluteus maximus (GMax), gluteus medius (GMed), multifidus (MF), and transversus abdominis (TrA) activation, while minimizing the activation of the tensor fascia latae (TFL) and erector spinae (ES) muscles in healthy individuals.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

LEVEL OF EVIDENCE

Level 4.

METHODS

In this cross-sectional study, surface electromyography (EMG) of GMax, GMed, TFL, TrA, MF, and ES was used to quantify the gluteal-to-TFL muscle activation (GTA) index and a ratio of local to global (L/G) lumbar muscles during (1) the elbow-toe exercise in the prone position, (2) the elbow-toe with right left lifted, (3) the hand-knee with left arm and right leg lifted, (4) the back bridge, (5) the back bridge with right leg lifted, (6) the back bridge with left leg lifted, (7) the side bridge with left leg lifted, (8) the side bridge with right leg lifted, and (9) the elbow-toe with right leg horizontally lifted exercises in healthy individuals (20 men, 20 women; age, 25 ± 4 years).

RESULTS

The back bridge exercise with left leg lift generated the highest L/G muscles activity ratio (L/G = 3.35) while the hand-knee exercise yielded the lowest L/G muscles activity ratio (L/G = 1.21). The side bridge exercise with left elbow and foot and lifting the right leg (GTA = 63.78), hand-knee exercise (GTA = 49.62), back bridge (GTA = 28.05), and elbow-toe exercise with left leg horizontally lifted (GTA = 23.02) generated the highest GTA indices, respectively. Meanwhile, the normalized EMG amplitude for GMax was significantly less than the TFL, for elbow-toe exercise (P < 0.001), back bridge with left leg lift (P = 0.001), side bridge exercise with the right elbow and foot and lifting the left leg (P = 0.002), and elbow-toe exercise with right leg horizontally lifted (P < 0.001).

CONCLUSION

The highest GTA indexes were observed during (1) the side bridge lifting the dominant leg and (2) the hand-knee horizontally lifting dominant leg, respectively. The L/G ratio was highest during (1) the back bridge lifting nondominant leg, (2) back bridge, and (3) back bridge lifting dominant leg, respectively. This study supports the use of back bridge exercises to strengthen the MF and side bridges to improve gluteal muscle activation.

CLINICAL RELEVANCE

The highest GTA index was observed in the side bridge lifting the right leg. Highest L/G ratio was in the back bridge with nondominant leg lifted. This study supports the use of back bridge exercises to strengthen the MF. This study supports the use of side bridges to improve gluteal muscle activation.

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.

Passive stiffness of fibrotic skeletal muscle in mdx mice relates to collagen architecture

KEY POINTS

The amount of fibrotic material in dystrophic mouse muscles relates to contractile function, but not passive function. Collagen fibres in skeletal muscle are associated with increased passive muscle stiffness in fibrotic muscles. The alignment of collagen is independently associated with passive stiffness in dystrophic skeletal muscles. These outcomes demonstrate that collagen architecture rather than collagen content should be a target of anti-fibrotic therapies to treat muscle stiffness.

ABSTRACT

Fibrosis is prominent in many skeletal muscle pathologies including dystrophies, neurological disorders, cachexia, chronic kidney disease, sarcopenia and metabolic disorders. Fibrosis in muscle is associated with decreased contractile forces and increased passive stiffness that limits joint mobility leading to contractures. However, the assumption that more fibrotic material is directly related to decreased function has not held true. Here we utilize novel measurement of extracellular matrix (ECM) and collagen architecture to relate ECM form to muscle function. We used mdx mice, a model for Duchenne muscular dystrophy that becomes fibrotic, and wildtype mice. In this model, extensor digitorum longus (EDL) muscle was significantly stiffer, but with similar total collagen, while the soleus muscle did not change stiffness, but increased collagen. The stiffness of the EDL was associated with increased collagen crosslinking as determined by collagen solubility. Measurement of ECM alignment using polarized light microscopy showed a robust relationship between stiffness and alignment for wildtype muscle that broke down in mdx muscles. Direct visualization of large collagen fibres with second harmonic generation imaging revealed their relative abundance in stiff muscles. Collagen fibre alignment was linked to stiffness across all muscles investigated and the most significant factor in a multiple linear regression-based model of muscle stiffness from ECM parameters. This work establishes novel characteristics of skeletal muscle ECM architecture and provides evidence for a mechanical function of collagen fibres in muscle. This finding suggests that anti-fibrotic strategies to enhance muscle function and excessive stiffness should target large collagen fibres and their alignment rather than total collagen.

Characterization of Gelatin Hydrogels Cross-Linked with Microbial Transglutaminase as Engineered Skeletal Muscle Substrates

Engineered in vitro models of skeletal muscle are essential for efficiently screening drug safety and efficacy. However, conventional culture substrates poorly replicate physical features of native muscle and do not support long-term culture, which limits tissue maturity. Micromolded gelatin hydrogels cross-linked with microbial transglutaminase (gelatin-MTG hydrogels) have previously been shown to induce C21C2 myotube alignment and improve culture longevity. However, several properties of gelatin-MTG hydrogels have not been systematically characterized, such as changes in elastic modulus during incubation in culture-like conditions and their ability to support sarcomere maturation. In this study, various gelatin-MTG hydrogels were fabricated and incubated in ambient or culture-like conditions. Elastic modulus, mass, and transmittance were measured over a one- or two-week period. Compared to hydrogels in phosphate buffered saline (PBS) or ambient air, hydrogels in Dulbecco’s Modified Eagle Medium (DMEM) and 5% CO₂ demonstrated the most stable elastic modulus. A subset of gelatin-MTG hydrogels was micromolded and seeded with C2C12 or primary chick myoblasts, which aligned and fused into multinucleated myotubes with relatively mature sarcomeres. These data are important for fabricating gelatin-MTG hydrogels with predictable and stable mechanical properties and highlight their advantages as culture substrates for engineering relatively mature and stable muscle tissues.

Mapping of Back Muscle Stiffness along Spine during Standing and Lying in Young Adults: A Pilot Study on Spinal Stiffness Quantification with Ultrasound Imaging

Muscle stiffness in the spinal region is essential for maintaining spinal function, and might be related to multiple spinal musculoskeletal disorders. However, information on the distribution of muscle stiffness along the spine in different postures in large subject samples has been lacking, which merits further investigation. This study introduced a new protocol of measuring bilateral back muscle stiffness along the thoracic and lumbar spine (at T3, T7, T11, L1 & L4 levels) with both ultrasound shear-wave elastography (SWE) and tissue ultrasound palpation system (TUPS) in the lying and standing postures of 64 healthy adults. Good inter-/intra-reliability existed in the SWE and TUPS back muscle stiffness measurements (ICC ≥ 0.731, p < 0.05). Back muscle stiffness at the L4 level was found to be the largest in the thoracic and lumbar regions (p < 0.05). The back muscle stiffness of males was significantly larger than that of females in both lying and standing postures (p < 0.03). SWE stiffness was found to be significantly larger in standing posture than lying among subjects (p < 0.001). It is reliable to apply SWE and TUPS to measure back muscle stiffness. The reported data on healthy young adults in this study may also serve as normative reference data for future studies on patients with scoliosis, low back pain, etc.

Differences between joint-space and musculoskeletal estimations of metabolic rate time profiles

Motion capture laboratories can measure multiple variables at high frame rates, but we can only measure the average metabolic rate of a stride using respiratory measurements. Biomechanical simulations with equations for calculating metabolic rate can estimate the time profile of metabolic rate within the stride cycle. A variety of methods and metabolic equations have been proposed, including metabolic time profile estimations based on joint parameters. It is unclear whether differences in estimations are due to differences in experimental data or due to methodological differences. This study aimed to compare two methods for estimating the time profile of metabolic rate, within a single dataset. Knowledge about the consistency of different methods could be useful for applications such as detecting which part of the gait cycle causes increased metabolic cost in patients. Here we compare estimations of metabolic rate time profiles using a musculoskeletal and a joint-space method. The musculoskeletal method was driven by kinematics and electromyography data and used muscle metabolic rate equations, whereas the joint-space method used metabolic rate equations based on joint parameters. Both estimations of changes in stride average metabolic rate correlated significantly with large changes in indirect calorimetry from walking on different grades showing that both methods accurately track changes. However, estimations of changes in stride average metabolic rate did not correlate significantly with more subtle changes in indirect calorimetry due to walking with different shoe inclinations, and both the musculoskeletal and joint-space time profile estimations did not correlate significantly with each other except in the most downward shoe inclination. Estimations of the relative cost of stance and swing matched well with previous simulations with similar methods and estimations from experimental perturbations. Rich experimental datasets could further advance time profile estimations. This knowledge could be useful to develop therapies and assistive devices that target the least metabolically economic part of the gait cycle.

Unilateral changes of the multifidus in persons with lumbar disc herniation: a systematic review and meta-analysis

BACKGROUND

Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible mediator in the pathophysiology of disc herniation and influences the course of pain and disability after both surgical or nonsurgical treatment. To potentially improve treatment, it may be important to assess multifidus muscle morphology in patients diagnosed with a LDH.

OBJECTIVE

A systematic literature review and meta-analysis regarding the multifidus morphology in patients diagnosed with a LDH was conducted to assess the differences in multifidus muscle morphology between persons with LDH and healthy controls, and between the involved and the uninvolved side within subjects experiencing unilateral LDH.

METHODS

A systematic search was conducted of articles published up to and including November 2019 using the Pubmed, Web of Science, EMBASE, and MEDLINE Ovid search engines. The articles obtained from this search were screened based on title and abstract using the predetermined eligibility criteria. Included full text articles were assessed for their methodologic quality using the modified Downs and Black checklist. Heterogeneous data regarding multifidus muscle morphology was included in the descriptive analysis; data that was homogenous was included in the meta-analysis.

RESULTS

We identified 3,176 articles. Based on the screening for inclusion/exclusion criteria, 18 articles were included. Studies were either cross sectional or case-control studies assessing side-to-side differences or comparing patients diagnosed with a LDH to a healthy control group. Nine studies investigated whole muscle atrophy, six looked at muscle fat infiltration, seven studies assessed microscopic muscle properties including muscle fiber size, distribution, and muscle fibrosis. From the 18 articles, 10 were included in the meta-analysis. In the meta-analysis, a comparison was made between side-to-side differences for muscle fiber size, distribution, and whole muscle size. Descriptive analysis showed increased fat infiltration and atrophy (muscle and individual fiber) of the multifidus muscle when comparing side-to-side differences or comparing cases to controls. Meta-analysis showed a significant decrease in type I and II muscle fiber size (p=.002, .01, respectively) combined with a significant increase in the number of type I muscle fibers (p=.008) at the side of LDH. Regarding whole muscle size, no significant differences were found.

CONCLUSIONS

This study shows the presence of ipsilateral multifidus muscle changes in persons with unilateral LDH.

Training Induced Changes to Skeletal Muscle Passive Properties Are Evident in Both Single Fibers and Fiber Bundles in the Rat Hindlimb

Introduction: The passive mechanical behavior of skeletal muscle represents both important and generally underappreciated biomechanical properties with little attention paid to their trainability. These experiments were designed to gain insight into the trainability of muscle passive mechanical properties in both single fibers and fiber bundles.

Methods: Rats were trained in two groups: 4 weeks of either uphill (UH) or downhill (DH) treadmill running; with a third group as sedentary control. After sacrifice, the soleus (SOL), extensor digitorum longus (EDL), and vastus intermedius (VI) were harvested. One hundred seventy-nine bundles and 185 fibers were tested and analyzed using a cumulative stretch-relaxation protocol to determine the passive stress and elastic modulus. Titin isoform expression was analyzed using sodium dodecyl sulfate vertical agarose gel electrophoresis (SDS-VAGE).

Results: Single fibers: passive modulus and stress were greater for the EDL at sarcomere lengths (SLs) ≥ 3.7 μm (modulus) and 4.0 μm (stress) with DH training compared to UH training and lesser for the SOL (SLs ≥ 3.3 μm) with DH training compared with control; there was no effect of UH training. Vastus intermedius was not affected by either training protocol. Fiber bundles: passive modulus and stress were greater for the EDL at SLs ≥ 2.5 μm (modulus) and 3.3 μm (stress) in the DH training group as compared with control, while no affects were observed in either the SOL or VI for either training group. No effects on titin isoform size were detected with training.

Conclusion: This study demonstrated that a trainability of passive muscle properties at both the single fiber and fiber bundle levels was not accompanied by any detectable changes to titin isoform size.

Fiber Type and Size as Sources of Variation in Human Single Muscle Fiber Passive Elasticity

Studies on single muscle fiber passive material properties often report relatively large variation in elastic modulus (or normalized stiffness), and it is not clear where this variation arises. This study was designed to determine if the stiffness, normalized to both fiber cross-sectional area and length, is inherently different between types 1 and 2 muscle fibers. Vastus lateralis fibers (n = 93), from ten young men, were mechanically tested using a cumulative stretch-relaxation protocol. SDS-PAGE classified fibers as types 1 or 2. While there was a difference in normalized stiffness between fiber types (p = 0.0019), an unexpected inverse relationship was found between fiber diameter and normalized stiffness (r = -0.64; p < 0.001). As fiber type and diameter are not independent, a one-way analysis of covariance (ANCOVA) including fiber diameter as a covariate was run; this eliminated the effect of fiber type on normalized stiffness (p = 0.1935). To further explore the relationship between fiber size and elastic properties, we tested whether stiffness was linearly related to fiber cross-sectional area, as would be expected for a homogenous material. Passive stiffness was not linearly related to fiber area (p < 0.001), which can occur if single muscle fibers are better represented as composite materials. The rule of mixtures for composite materials was used to explore whether the presence of a stiff perimeter-based fiber component could explain the observed results. The model (R2 = 0.38) predicted a perimeter-based normalized stiffness of 8800 ± 2600 kPa/μm, which is within the range of basement membrane moduli reported in the literature.

The lumbar multifidus is characterised by larger type I muscle fibres compared to the erector spinae

The metabolic capacity of a muscle is one of the determinants of muscle function. Muscle fiber type characteristics give an indication about this metabolic capacity. Therefore it might be expected that the lumbar multifidus (MF) as a local stabilizer contains higher proportions of slow type I fibers, compared to the erector spinae (ES) as a global mobilizer. The aim of this study is to determine the muscle fiber characteristics of the ES and MF to provide insight into their structural and metabolic characteristics, and thereby the functional capacity of both muscles. Muscle fiber type characteristics in the ES and MF were investigated with an immunofluorescence staining of the myosin heavy chain isoforms. In both the ES and MF, type I muscle fibers are predominantly present. The cross-sectional area (CSA) of type I muscle fibers is significantly larger in the lumbar MF compared to the ES. However, the mean muscle fiber type percentage for type I was not significantly different, which resulted in an insignificant difference in relative cross-sectional area (RCSA) for type I. No significant differences were found for all other muscle fiber types. This may indicate that the MF displays muscle fiber type characteristics that tend to be more appropriate to maintain stability of the spine. However, because we could not demonstrate significant differences in RCSA between ES and MF, we cannot firmly state that there are functional differences between the ES an MF based only on structural characteristics.

Insight into the genetic architecture of back pain and its risk factors from a study of 509,000 individuals

Back pain (BP) is a common condition of major social importance and poorly understood pathogenesis. Combining data from the UK Biobank and CHARGE consortium cohorts allowed us to perform a very large genome-wide association study (total N = 509,070) and examine the genetic correlation and pleiotropy between BP and its clinical and psychosocial risk factors. We identified and replicated 3 BP-associated loci, including one novel region implicating SPOCK2/CHST3 genes. We provide evidence for pleiotropic effects of genetic factors underlying BP, height, and intervertebral disk problems. We also identified independent genetic correlations between BP and depression symptoms, neuroticism, sleep disturbance, overweight, and smoking. A significant enrichment for genes involved in the central nervous system and skeletal tissue development was observed. The study of pleiotropy and genetic correlations, supported by the pathway analysis, suggests at least 2 strong molecular axes of BP genesis, one related to structural/anatomical factors such as intervertebral disk problems and anthropometrics, and another related to the psychological component of pain perception and pain processing. These findings corroborate with the current biopsychosocial model as a paradigm for BP. Overall, the results demonstrate BP to have an extremely complex genetic architecture that overlaps with the genetic predisposition to its biopsychosocial risk factors. The work sheds light on pathways of relevance in the prevention and management of low BP.

Neck Muscle Stiffness Measured With Shear Wave Elastography in Women With Chronic Nonspecific Neck Pain

OBJECTIVE

Utilizing shear wave elastography, we compared the stiffness of the neck extensor muscles and the stiffness in muscle-specific regions between women with chronic nonspecific neck pain and asymptomatic controls.

DESIGN

Cross-sectional observational study.

METHODS

We measured the average muscle stiffness over multiple neck extensor muscles and in regions corresponding approximately to the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles using ultrasound shear wave elastography in 20 women with chronic nonspecific neck pain and 18 asymptomatic women during multiple tasks. The measurements were automatically quality controlled and computer processed over the complete visible neck region or a large muscle-specific region.

RESULTS

Pooled over all tasks, neck muscle stiffness was not significantly different between those with neck pain and asymptomatic controls (neck pain median, 11.6 kPa; interquartile range, 8.9 kPa and control median, 13.3 kPa; interquartile range, 8.6 kPa; P = .175). The measure of neck muscle stiffness was not correlated with the intensity of neck pain or perceived disability.

CONCLUSION

Shear wave elastography revealed similar muscle stiffness in people with and without chronic neck pain, despite the sensation of increased neck stiffness in those with chronic neck pain. Therapeutic interventions aiming to reduce neck muscle tone are often based on the assumption that perceived neck stiffness corresponds to objective muscle stiffness. The current results question this assumption. J Orthop Sports Phys Ther 2020;50(4):179-188. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8821.

Non-linear Scaling of Passive Mechanical Properties in Fibers, Bundles, Fascicles and Whole Rabbit Muscles

Defining variations in skeletal muscle passive mechanical properties at different size scales ranging from single muscle fibers to whole muscles is required in order to understand passive muscle function. It is also of interest from a muscle structural point-of-view to identify the source(s) of passive tension that function at each scale. Thus, we measured passive mechanical properties of single fibers, fiber bundles, fascicles, and whole muscles in three architecturally diverse muscles from New Zealand White rabbits (n = 6) subjected to linear deformation. Passive modulus was quantified at sarcomere lengths across the muscle’s anatomical range. Titin molecular mass and collagen content were also quantified at each size scale, and whole muscle architectural properties were measured. Passive modulus increased non-linearly from fiber to whole muscle for all three muscles emphasizing extracellular sources of passive tension (p < 0.001), and was different among muscles (p < 0.001), with significant muscle by size-scale interaction, indicating quantitatively different scaling for each muscle (p < 0.001). These findings provide insight into the structural basis of passive tension and suggest that the extracellular matrix (ECM) is the dominant contributor to whole muscle and fascicle passive tension. They also demonstrate that caution should be used when inferring whole muscle properties from reduced muscle size preparations such as muscle biopsies.

Fibre and extracellular matrix contributions to passive forces in human skeletal muscles: An experimental based constitutive law for numerical modelling of the passive element in the classical Hill-type three element model

The forces that allow body movement can be divided into active (generated by sarcomeric contractile proteins) and passive (sustained by intra-sarcomeric proteins, fibre cytoskeleton and extracellular matrix (ECM)). These are needed to transmit the active forces to the tendon and the skeleton. However, the relative contribution of the intra- and extra- sarcomeric components in transmitting the passive forces is still under debate. There is limited data in the literature about human muscle and so it is difficult to make predictions using multiscale models, imposing a purely phenomenological description for passive forces. In this paper, we apply a method for the experimental characterization of the passive properties of fibres and ECM to human biopsy and propose their clear separation in a Finite Element Model. Experimental data were collected on human single muscle fibres and bundles, taken from vastus lateralis muscle of elderly subjects. Both were progressively elongated to obtain two stress-strain curves which were fitted to exponential equations. The mechanical properties of the extracellular passive components in a bundle of fibres were deduced by the subtraction of the passive tension observed in single fibres from the passive tension observed in the bundle itself. Our results showed that modulus and tensile load bearing capability of ECM are higher than those of fibres and defined their quantitative characterization that can be used in macroscopic models to study their role in the transmission of forces in physiological and pathophysiological conditions.

Age-associated changes in the mechanical properties of human cadaveric pelvic floor muscles

Proper function of the female pelvic floor requires intact pelvic floor muscles (PFMs). The prevalence of pelvic floor disorders (PFDs) increases substantially with age, in part due to clinically identified deterioration of PFM function with age. However, the etiology of this decline remains largely unknown. We previously demonstrated that PFMs undergo age-related fibrotic changes. This study sought to determine whether aging also impacts PFMs' passive mechanical properties that are largely determined by the intramuscular extracellular matrix. Biopsies from younger (≤52y) and older (>52y) female cadaveric donors were procured from PFMs, specifically coccygeus (C) and two portions of the levator ani - iliococcygeus (IC) and pubovisceralis (PV), and the appendicular muscles - obturator internus (OI) and vastus lateralis (VL). Muscle bundles were subjected to a passive loading protocol, and stress-sarcomere length (L_s) relationships calculated. Muscle stiffness was compared between groups using 2-way ANOVA and Sidak pairwise comparisons, α < 0.05. The mean age was 43.4 ± 11.6y and 74.9 ± 11.9y in younger (N = 5) and older (N = 10) donors, respectively. In all PFMs, the quadratic coefficient of parabolic regression of the stress-L_s curve, a measure of stiffness, was lower in the younger versus older group: C: 33.7 ± 13.9 vs 87.2 ± 10.7, P = 0.02; IC: 38.3 ± 12.7 vs 84.5 ± 13.9, P = 0.04; PV: 24.7 ± 8.8 vs 74.6 ± 9.6, P = 0.04. In contrast, non-PFM stiffness was not affected by aging: OI: 14.5 ± 4.7 vs 32.9 ± 6.2, P = 0.8 and VL: 13.6 ± 5.7 vs 30.1 ± 5.3, P = 0.9. Age-associated increase in PFM stiffness is predicted to negatively impact PFM function by diminishing muscle load-bearing, excursional, contractile, and regenerative capacity, thus predisposing older women to PFDs.

A micromechanical muscle model for determining the impact of motor unit fiber clustering on force transmission in aging skeletal muscle

This study used a micromechanical finite element muscle model to investigate the effects of the redistribution of spatial activation patterns in young and old muscle. The geometry consisted of a bundle of 19 active muscle fibers encased in endomysium sheets, surrounded by passive tissue to model a fascicle. Force was induced by activating combinations of the 19 active muscle fibers. The spacial clustering of muscle fibers modeled in this study showed unbalanced strains suggesting tissue damage at higher strain levels may occur during higher levels of activation and/or during dynamic conditions. These patterns of motor unit remodeling are one of the consequences of motor unit loss and reinnervation associated with aging. The results did not reveal evident quantitative changes in force transmission between old and young adults, but the patterns of stress and strain distribution were affected, suggesting an uneven distribution of the forces may occur within the fascicle that could provide a mechanism for muscle injury in older muscle.