1
|
Wearing SC, Hooper SL, Langton CM, Keiner M, Horstmann T, Crevier-Denoix N, Pourcelot P. The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques. Healthcare (Basel) 2024; 12:1254. [PMID: 38998789 PMCID: PMC11241410 DOI: 10.3390/healthcare12131254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.
Collapse
Affiliation(s)
- Scott C. Wearing
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | - Sue L. Hooper
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
| | - Christian M. Langton
- Griffith Centre of Rehabilitation Engineering, Griffith University, Southport, QLD 4222, Australia
| | - Michael Keiner
- Department of Exercise and Training Science, German University of Health and Sport, 85737 Ismaning, Bavaria, Germany
| | - Thomas Horstmann
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | | | - Philippe Pourcelot
- INRAE, BPLC Unit, Ecole Nationale Vétérinaire d’Alfort, 94700 Maisons-Alfort, France
| |
Collapse
|
2
|
Mills C, Exell TA, Wakefield-Scurr J, St John ER, Jones MEA. Spinal joint moment prediction following simulated breast surgery using a female whole-body musculoskeletal model. Comput Methods Biomech Biomed Engin 2024:1-12. [PMID: 38907664 DOI: 10.1080/10255842.2024.2364819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/01/2024] [Indexed: 06/24/2024]
Abstract
This study aimed to use a musculoskeletal model to predict changes in spinal moments following simulated breast surgery. A female full body musculoskeletal model with a fully articulated thoracolumbar spine and independent moveable breast segments was customised for this study. Key findings suggest that the simulated removal of breast tissue (750 g to 1501 g) can reduce the magnitude of lumbar spine extensor moments by >0.05 Nm/kg during walking and jogging. A customised female whole-body musculoskeletal model is capable of providing a first approximation of changes in spinal loading following simulated breast surgery.
Collapse
Affiliation(s)
- Chris Mills
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, Portsmouth, UK
| | - Timothy A Exell
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, Portsmouth, UK
| | - Joanna Wakefield-Scurr
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, Portsmouth, UK
| | - Edward R St John
- Oncoplastic Breast Surgeon, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Melissa E A Jones
- School of Sport, Health and Exercise Science, Spinnaker Building, University of Portsmouth, Portsmouth, UK
| |
Collapse
|
3
|
Eremina GM, Smolin AY. Effect of patient-specific factors on regeneration in lumbar spine at healthy disc and total disc replacement. Computer simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108172. [PMID: 38669718 DOI: 10.1016/j.cmpb.2024.108172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Degenerative diseases of the spine have a negative impact on the quality of life of patients. This study presents the results of numerical modelling of the mechanical behaviour of the lumbar spine with patient-specific conditions at physiological loads. This paper aims to numerically study the influence of degenerative changes in the spine and the presence of an endoprosthesis on the creation of conditions for tissue regeneration. METHODS A numerical model of the mechanical behaviour of lumbar spine at healthy and after total disc replacement under low-energy impacts equivalent to physiological loads is presented. The model is based on the movable cellular automaton method (discrete elements), where the mechanical behaviour of bone tissue is described using the Biot poroelasticity accounting for the presence and transfer of interstitial biological fluid. The nutritional pathways of the intervertebral disc in cases of healthy and osteoporotic bone tissues were predicted based on the analysis of the simulation results according to the mechanobiological principles. RESULTS Simulation of total disc replacement showed that osseointegration of the artificial disc plates occurs only in healthy bone tissue. With total disc replacement in a patient with osteoporosis, there is an area of increased risk of bone resorption in the near-contact area, approximately 1 mm wide, around the fixators. Dynamic loads may improve the osseointegration of the implant in pathological conditions of the bone tissue. CONCLUSIONS The results obtained in the case of healthy spine and osteoporotic bone tissues correspond to the experimental data on biomechanics and possible methods of IVD regeneration from the position of mechanobiological principles. The results obtained with an artificial disc (with keel-type fixation) showed that the use of this type of endoprosthesis in healthy bone tissues allows to reproduce the function of the natural intervertebral disc and does not contribute to the development of neoplastic processes. In the case of an artificial disc with osteoporosis of bone tissues, there is a zone with increased risk of tissue resorption and development of neoplastic processes in the area near the contact of the implant attachment. This circumstance can be compensated by increasing the loading level.
Collapse
Affiliation(s)
- Galina M Eremina
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia.
| | - Alexey Yu Smolin
- Institute of Strength Physics and Materials Science of SB RAS, 2/4, pr. Akademicheskii, Tomsk, 634055, Russia
| |
Collapse
|
4
|
Sturdy JT, Sessoms PH, Silverman AK. Psoas force recruitment in full-body musculoskeletal movement simulations is restored with a geometrically informed cost function weighting. J Biomech 2024; 168:112130. [PMID: 38713998 DOI: 10.1016/j.jbiomech.2024.112130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 05/09/2024]
Abstract
Simulations of musculoskeletal models are useful for estimating internal muscle and joint forces. However, predicted forces rely on optimization and modeling formulations. Geometric detail is important to predict muscle forces, and greater geometric complexity is required for muscles that have broad attachments or span many joints, as in the torso. However, the extent to which optimized muscle force recruitment is sensitive to these geometry choices is unclear. We developed level, uphill and downhill sloped walking simulations using a standard (uniformly weighted, "fatigue-like") cost function with lower limb and full-body musculoskeletal models to evaluate hip muscle recruitment with different geometric representations of the psoas muscle under walking conditions with varying hip moment demands. We also tested a novel cost function formulation where muscle activations were weighted according to the modeled geometric detail in the full-body model. Total psoas force was less and iliacus, rectus femoris, and other hip flexors' force was greater when psoas was modeled with greater geometric detail compared to other hip muscles for all slopes. The proposed weighting scheme restored hip muscle force recruitment without sacrificing detailed psoas geometry. In addition, we found that lumbar, but not hip, joint contact forces were influenced by psoas force recruitment. Our results demonstrate that static optimization dependent simulations using models comprised of muscles with different amounts of geometric detail bias force recruitment toward muscles with less geometric detail. Muscle activation weighting that accounts for differences in geometric complexity across muscles corrects for this recruitment bias.
Collapse
Affiliation(s)
- Jordan T Sturdy
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, USA.
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, USA; Quantitative Biosciences and Engineering, Colorado School of Mines, Golden, CO, USA
| |
Collapse
|
5
|
Sibson BE, Banks JJ, Yawar A, Yegian AK, Anderson DE, Lieberman DE. Using inertial measurement units to estimate spine joint kinematics and kinetics during walking and running. Sci Rep 2024; 14:234. [PMID: 38168540 PMCID: PMC10762015 DOI: 10.1038/s41598-023-50652-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
Optical motion capture (OMC) is considered the best available method for measuring spine kinematics, yet inertial measurement units (IMU) have the potential to collect data outside the laboratory. When combined with musculoskeletal modeling, IMU technology may be used to estimate spinal loads in real-world settings. To date, IMUs have not been validated for estimates of spinal movement and loading during both walking and running. Using OpenSim Thoracolumbar Spine and Ribcage models, we compare IMU and OMC estimates of lumbosacral (L5/S1) and thoracolumbar (T12/L1) joint angles, moments, and reaction forces during gait across six speeds for five participants. For comparisons, time series are ensemble averaged over strides. Comparisons between IMU and OMC ensemble averages have low normalized root mean squared errors (< 0.3 for 81% of comparisons) and high, positive cross-correlations (> 0.5 for 91% of comparisons), suggesting signals are similar in magnitude and trend. As expected, joint moments and reaction forces are higher during running than walking for IMU and OMC. Relative to OMC, IMU overestimates joint moments and underestimates joint reaction forces by 20.9% and 15.7%, respectively. The results suggest using a combination of IMU technology and musculoskeletal modeling is a valid means for estimating spinal movement and loading.
Collapse
Affiliation(s)
- Benjamin E Sibson
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA.
| | - Jacob J Banks
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Ali Yawar
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Andrew K Yegian
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| |
Collapse
|
6
|
Zhang S, Kui H, Liu X, Zhang Z. Analysis of Musculoskeletal Biomechanics of Lower Limbs of Drivers in Pedal-Operation States. SENSORS (BASEL, SWITZERLAND) 2023; 23:8897. [PMID: 37960596 PMCID: PMC10649989 DOI: 10.3390/s23218897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
In this study, to establish the biomechanical characteristics of commercial vehicle drivers' muscles and bones while operating the three pedals, a driver pedal-operation simulator was built, and the real-life situation was reconstructed in OpenSim 3.3 software. We set up three seat heights to investigate the drivers' lower limbs, and the research proceeded in two parts: experiment and simulation. Chinese adult males in the 95th percentile were selected as the research participants. In the experiment, Delsys wireless surface electromyography (EMG) sensors were used to collect the EMG signals of the four main muscle groups of the lower limbs when the drivers operated the three pedals. Then, we analyzed the muscle activation and the degree of muscle fatigue. The simulation was based on OpenSim software to analyze the driver's lower limb joint angles and joint torque. The results show that the activation of the hamstrings, gastrocnemius, and rectus femoris muscles were higher in the four muscle groups. In respect of torque, in most cases, hip joint torque > knee joint torque > ankle joint torque. The knee joint angles were the largest, and the ankle joint angles changed the most. The experimental results provide a reference for improving drivers' handling comfort in commercial vehicles and provide theoretical bases for cab design and layout optimization.
Collapse
Affiliation(s)
- Song Zhang
- Department of Automotive Engineering, Hebei Jiaotong Vocational and Technical College, Shijiazhuang 050035, China;
- Transportation College, Jilin University, Changchun 130022, China
| | - Hailin Kui
- College of Biological and Agricultural Engineering, Jilin University, Changchun 130022, China
| | - Xiangyu Liu
- College of Biological and Agricultural Engineering, Jilin University, Changchun 130022, China
| | - Zhonglin Zhang
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin 150001, China
| |
Collapse
|
7
|
Alemi MM, Banks JJ, Lynch AC, Allaire BT, Bouxsein ML, Anderson DE. EMG Validation of a Subject-Specific Thoracolumbar Spine Musculoskeletal Model During Dynamic Activities in Older Adults. Ann Biomed Eng 2023; 51:2313-2322. [PMID: 37353715 DOI: 10.1007/s10439-023-03273-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
Musculoskeletal models can uniquely estimate in vivo demands and injury risk. In this study, we aimed to compare muscle activations from subject-specific thoracolumbar spine OpenSim models with recorded muscle activity from electromyography (EMG) during five dynamic tasks. Specifically, 11 older adults (mean = 65 years, SD = 9) lifted a crate weighted to 10% of their body mass in axial rotation, 2-handed sagittal lift, 1-handed sagittal lift, and lateral bending, and simulated a window opening task. EMG measurements of back and abdominal muscles were directly compared to equivalent model-predicted activity for temporal similarity via maximum absolute normalized cross-correlation (MANCC) coefficients and for magnitude differences via root-mean-square errors (RMSE), across all combinations of participants, dynamic tasks, and muscle groups. We found that across most of the tasks the model reasonably predicted temporal behavior of back extensor muscles (median MANCC = 0.92 ± 0.07) but moderate temporal similarity was observed for abdominal muscles (median MANCC = 0.60 ± 0.20). Activation magnitude was comparable to previous modeling studies, and median RMSE was 0.18 ± 0.08 for back extensor muscles. Overall, these results indicate that our thoracolumbar spine model can be used to estimate subject-specific in vivo muscular activations for these dynamic lifting tasks.
Collapse
Affiliation(s)
- Mohammad Mehdi Alemi
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RN119, Boston, MA, 02215, USA.
| | - Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Andrew C Lynch
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brett T Allaire
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Recent Advances in Coupled MBS and FEM Models of the Spine—A Review. Bioengineering (Basel) 2023; 10:bioengineering10030315. [PMID: 36978705 PMCID: PMC10045105 DOI: 10.3390/bioengineering10030315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
How back pain is related to intervertebral disc degeneration, spinal loading or sports-related overuse remains an unanswered question of biomechanics. Coupled MBS and FEM simulations can provide a holistic view of the spine by considering both the overall kinematics and kinetics of the spine and the inner stress distribution of flexible components. We reviewed studies that included MBS and FEM co-simulations of the spine. Thereby, we classified the studies into unidirectional and bidirectional co-simulation, according to their data exchange methods. Several studies have demonstrated that using unidirectional co-simulation models provides useful insights into spinal biomechanics, although synchronizing the two distinct models remains a key challenge, often requiring extensive manual intervention. The use of a bidirectional co-simulation features an iterative, automated process with a constant data exchange between integrated subsystems. It reduces manual corrections of vertebra positions or reaction forces and enables detailed modeling of dynamic load cases. Bidirectional co-simulations are thus a promising new research approach for improved spine modeling, as a main challenge in spinal biomechanics is the nonlinear deformation of the intervertebral discs. Future studies will likely include the automated implementation of patient-specific bidirectional co-simulation models using hyper- or poroelastic intervertebral disc FEM models and muscle forces examined by an optimization algorithm in MBS. Applications range from clinical diagnosis to biomechanical analysis of overload situations in sports and injury prediction.
Collapse
|
9
|
Nie MD, Huang ZB, Zhang NZ, Fu LJ, Cheng CK. Biomechanical evaluation of a novel intervertebral disc repair technique for large box-shaped ruptures. Front Bioeng Biotechnol 2023; 11:1104015. [PMID: 36845190 PMCID: PMC9945520 DOI: 10.3389/fbioe.2023.1104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Objective: The purpose of this study was to analyze the feasibility of repairing a ruptured intervertebral disc using a patch secured to the inner surface of the annulus fibrosus (AF). Different material properties and geometries for the patch were evaluated. Methods: Using finite element analysis, this study created a large box-shaped rupture in the posterior-lateral region of the AF and then repaired it with a circular and square inner patch. The elastic modulus of the patches ranged from 1 to 50 MPa to determine the effect on the nucleus pulposus (NP) pressure, vertical displacement, disc bulge, AF stress, segmental range of motion (ROM), patch stress, and suture stress. The results were compared against the intact spine to determine the most suitable shape and properties for the repair patch. Results: The intervertebral height and ROM of the repaired lumbar spine was similar to the intact spine and was independent of the patch material properties and geometry. The patches with a modulus of 2-3 MPa resulted in an NP pressure and AF stresses closest to the healthy disc, and produced minimal contact pressure on the cleft surfaces and minimal stress on the suture and patch of all models. Circular patches caused lower NP pressure, AF stress and patch stress than the square patch, but also caused greater stress on the suture. Conclusion: A circular patch with an elastic modulus of 2-3 MPa secured to the inner region of the ruptured annulus fibrosus was able to immediately close the rupture and maintain an NP pressure and AF stress similar to the intact intervertebral disc. This patch had the lowest risk of complications and produced the greatest restorative effect of all patches simulated in this study.
Collapse
Affiliation(s)
- Mao-Dan Nie
- School of Biomedical Engineering and Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Ze-Bin Huang
- Department of Spine Surgery, First Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Ning-Ze Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ling-Jie Fu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Ling-Jie Fu, ; Cheng-Kung Cheng,
| | - Cheng-Kung Cheng
- School of Biomedical Engineering and Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Ling-Jie Fu, ; Cheng-Kung Cheng,
| |
Collapse
|
10
|
Lerchl T, Nispel K, Baum T, Bodden J, Senner V, Kirschke JS. Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges. Bioengineering (Basel) 2023; 10:bioengineering10020202. [PMID: 36829696 PMCID: PMC9952620 DOI: 10.3390/bioengineering10020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.
Collapse
Affiliation(s)
- Tanja Lerchl
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-15365
| | - Kati Nispel
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jannis Bodden
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Veit Senner
- Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| |
Collapse
|
11
|
Lumbar spinal loads and lumbar muscle forces evaluation with various lumbar supports and backrest inclination angles in driving posture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:408-419. [PMID: 36380009 DOI: 10.1007/s00586-022-07446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/14/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The low back pain of professional drivers could be linked to excessive lumbar load. This study aims at developing a musculoskeletal model to study the lumbar spinal loads and lumbar muscle forces of the human body in driving posture, so as to contribute to a better understanding of low back pain and to improve the design of vehicle seats. METHODS A standing musculoskeletal model, including limbs, head and neck, that can reflect several activities of daily living was established based on the Christophy spine model. The model was then validated by comparing the calculated lumbar loads and muscle forces to the experimental data in the previous studies. Referring to radiology studies, the musculoskeletal model was adjusted into different driving postures with several different lumbar supports (0, 2 and 4 cm) and inclinations of the backrest (from 23° to 33°, by 2° intervals). The lumbar biomechanical load with various lumbar supports and backrest inclination angles was calculated. RESULTS The results showed that the overall lumbar spinal load and lumbar muscle force with 4 cm lumbar support were reduced by 11.30 and 26.24%. The lumbar spinal loads and lumbar muscle forces increased first and then decreased with the increase in backrest inclination angles from 23° to 33°. The lumbar biomechanical load varied slightly with the backrest inclination angles from 29° to 33°. CONCLUSIONS There are two findings: (i) the lumbar spinal loads at the L3-L4, L4-L5 and L5-S1, and lumbar muscle forces decreased obviously with the 4 cm lumbar support, while the seat cushion inclination angle was set to 10°. (ii) The recommended backrest inclination angles are 29° to 33° with a 10° seat cushion to the horizontal, which can keep a low level of the lumbar spinal loads and lumbar muscle forces. This study could be used to explain the association between drivers' sitting posture and the lumbar load change, and provide a reference for the prevention of low back pain.
Collapse
|
12
|
Evaluation of spinal force normalization techniques. J Biomech 2023; 147:111441. [PMID: 36680886 DOI: 10.1016/j.jbiomech.2023.111441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/19/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
Division normalization is commonly used in biomechanics studies to remove the effect of anthropometric differences (e.g., body weight) on kinetic variables, facilitating comparison across a population. In spine biomechanics, spinal forces are commonly divided by the body weight or the intervertebral load during a standing posture. However, it has been suggested that offset and power curve normalization are more appropriate than division normalization for normalizing kinetic variables such as ground reaction forces during walking and running. The present study investigated, for the first time, the effectiveness of four techniques for normalizing spinal forces to remove the effect of body weight. Spinal forces at all lumbar levels were estimated using a detailed OpenSim musculoskeletal model of the spine for 11 scaled models (50-100 kg) and during 13 trunk flexion tasks. Pearson correlations of raw and normalized forces against body weight were used to assess the effectiveness of each normalization technique. Body weight and standing division normalization could only successfully normalize L4L5 spinal forces in three tasks, and L5S1 loads in five and three tasks, respectively; however, offset and power curve normalization techniques were successful across all lumbar spine levels and all tasks. Offset normalization successfully removed the effect of body weight and maintained the influence of flexion angle on spinal forces. Thus, we recommend offset normalization to account for anthropometric differences in studies of spinal forces.
Collapse
|
13
|
Knapik GG, Mendel E, Bourekas E, Marras WS. Computational lumbar spine models: A literature review. Clin Biomech (Bristol, Avon) 2022; 100:105816. [PMID: 36435080 DOI: 10.1016/j.clinbiomech.2022.105816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computational spine models of various types have been employed to understand spine function, assess the risk that different activities pose to the spine, and evaluate techniques to prevent injury. The areas in which these models are applied has expanded greatly, potentially beyond the appropriate scope of each, given their capabilities. A comprehensive understanding of the components of these models provides insight into their current capabilities and limitations. METHODS The objective of this review was to provide a critical assessment of the different characteristics of model elements employed across the spectrum of lumbar spine modeling and in newer combined methodologies to help better evaluate existing studies and delineate areas for future research and refinement. FINDINGS A total of 155 studies met selection criteria and were included in this review. Most current studies use either highly detailed Finite Element models or simpler Musculoskeletal models driven with in vivo data. Many models feature significant geometric or loading simplifications that limit their realism and validity. Frequently, studies only create a single model and thus can't account for the impact of subject variability. The lack of model representation for certain subject cohorts leaves significant gaps in spine knowledge. Combining features from both types of modeling could result in more accurate and predictive models. INTERPRETATION Development of integrated models combining elements from different model types in a framework that enables the evaluation of larger populations of subjects could address existing voids and enable more realistic representation of the biomechanics of the lumbar spine.
Collapse
Affiliation(s)
- Gregory G Knapik
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210, USA.
| | - Ehud Mendel
- Department of Neurosurgery, Yale University, New Haven, CT 06510, USA
| | - Eric Bourekas
- Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210, USA
| |
Collapse
|
14
|
Ansari S, Sharma S, Kumar S, Sharma S. Effect of stabilization exercises on balance parameters in chronic low back pain: a systematic review. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Lerchl T, El Husseini M, Bayat A, Sekuboyina A, Hermann L, Nispel K, Baum T, Löffler MT, Senner V, Kirschke JS. Validation of a Patient-Specific Musculoskeletal Model for Lumbar Load Estimation Generated by an Automated Pipeline From Whole Body CT. Front Bioeng Biotechnol 2022; 10:862804. [PMID: 35898642 PMCID: PMC9309792 DOI: 10.3389/fbioe.2022.862804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Chronic back pain is a major health problem worldwide. Although its causes can be diverse, biomechanical factors leading to spinal degeneration are considered a central issue. Numerical biomechanical models can identify critical factors and, thus, help predict impending spinal degeneration. However, spinal biomechanics are subject to significant interindividual variations. Therefore, in order to achieve meaningful findings on potential pathologies, predictive models have to take into account individual characteristics. To make these highly individualized models suitable for systematic studies on spinal biomechanics and clinical practice, the automation of data processing and modeling itself is inevitable. The purpose of this study was to validate an automatically generated patient-specific musculoskeletal model of the spine simulating static loading tasks. Methods: CT imaging data from two patients with non-degenerative spines were processed using an automated deep learning-based segmentation pipeline. In a semi-automated process with minimal user interaction, we generated patient-specific musculoskeletal models and simulated various static loading tasks. To validate the model, calculated vertebral loadings of the lumbar spine and muscle forces were compared with in vivo data from the literature. Finally, results from both models were compared to assess the potential of our process for interindividual analysis. Results: Calculated vertebral loads and muscle activation overall stood in close correlation with data from the literature. Compression forces normalized to upright standing deviated by a maximum of 16% for flexion and 33% for lifting tasks. Interindividual comparison of compression, as well as lateral and anterior–posterior shear forces, could be linked plausibly to individual spinal alignment and bodyweight. Conclusion: We developed a method to generate patient-specific musculoskeletal models of the lumbar spine. The models were able to calculate loads of the lumbar spine for static activities with respect to individual biomechanical properties, such as spinal alignment, bodyweight distribution, and ligament and muscle insertion points. The process is automated to a large extent, which makes it suitable for systematic investigation of spinal biomechanics in large datasets.
Collapse
Affiliation(s)
- Tanja Lerchl
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Tanja Lerchl,
| | - Malek El Husseini
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Amirhossein Bayat
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Anjany Sekuboyina
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luis Hermann
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Kati Nispel
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Veit Senner
- Associate Professorship of Sport Equipment and Sport Materials, School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
16
|
Banks JJ, Umberger BR, Caldwell GE. EMG optimization in OpenSim: A model for estimating lower back kinetics in gait. Med Eng Phys 2022; 103:103790. [PMID: 35500997 DOI: 10.1016/j.medengphy.2022.103790] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/22/2021] [Accepted: 03/14/2022] [Indexed: 12/13/2022]
Abstract
Participant-specific musculoskeletal models are needed to accurately estimate lower back internal kinetic demands and injury risk. In this study we developed the framework for incorporating an electromyography optimization (EMGopt) approach within OpenSim (https://simtk.org/projects/emg_opt_tool) and evaluated lower back demands estimated from the model during gait. Kinematic, external kinetic, and EMG data were recorded from six participants as they performed walking and carrying tasks on a treadmill. For evaluation, predicted lumbar vertebral joint forces were compared to those from a generic static optimization approach (SOpt) and to previous studies. Further, model-estimated muscle activations were compared to recorded EMG, and model sensitivity to day-to-day EMG variability was evaluated. Results showed the vertebral joint forces from the model were qualitatively similar in pattern and magnitude to literature reports. Compared to SOpt, the EMGopt approach predicted larger joint loads (p<.01) with muscle activations better matching individual participant EMG patterns. L5/S1 vertebral joint forces from EMGopt were sensitive to the expected variability of recorded EMG, but the magnitude of these differences (±4%) did not impact between-task comparisons. Despite limitations inherent to such models, the proposed musculoskeletal model and EMGopt approach appears well-suited for evaluating internal lower back demands during gait tasks.
Collapse
Affiliation(s)
- Jacob J Banks
- University of Massachusetts Amherst, Department of Kinesiology, 110 Totman Building, 30 Eastman Lane, Amherst, MA 01003, United States; Beth Israel Deaconess Medical Center, Center for Advanced Orthopaedic Studies, 330 Brookline Avenue, RN 115, Boston, MA 02215, United States; Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA 02115, United States.
| | - Brian R Umberger
- University of Michigan, School of Kinesiology, 830 North University Avenue, Ann Arbor, MI 48109, United States.
| | - Graham E Caldwell
- University of Massachusetts Amherst, Department of Kinesiology, 110 Totman Building, 30 Eastman Lane, Amherst, MA 01003, United States.
| |
Collapse
|
17
|
Mousavi SJ, Lynch AC, Allaire BT, White AP, Anderson DE. Walking Biomechanics and Spine Loading in Patients With Symptomatic Lumbar Spinal Stenosis. Front Bioeng Biotechnol 2021; 9:751155. [PMID: 34869263 PMCID: PMC8636982 DOI: 10.3389/fbioe.2021.751155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/06/2021] [Indexed: 12/05/2022] Open
Abstract
Symptomatic lumbar spinal stenosis is a leading cause of pain and mobility limitation in older adults. It is clinically believed that patients with lumbar spinal stenosis adopt a flexed trunk posture or bend forward and alter their gait pattern to improve tolerance for walking. However, a biomechanical assessment of spine posture and motion during walking is broadly lacking in these patients. The purpose of this study was to evaluate lumbar spine and pelvic sagittal angles and lumbar spine compressive loads in standing and walking and to determine the effect of pain and neurogenic claudication symptoms in patients with symptomatic lumbar spinal stenosis. Seven participants with symptomatic lumbar spinal stenosis, aged 44–82, underwent a 3D opto-electronic motion analysis during standing and walking trials in asymptomatic and symptomatic states. Passive reflective marker clusters (four markers each) were attached to participants at T1, L1, and S2 levels of the spine, with additional reflective markers at other spinal levels, as well as the head, pelvis, and extremities. Whole-body motion data was collected during standing and walking trials in asymptomatic and symptomatic states. The results showed that the spine was slightly flexed during walking, but this was not affected by symptoms. Pelvic tilt was not different when symptoms were present, but suggests a possible effect of more forward tilt in both standing (p = 0.052) and walking (p = 0.075). Lumbar spine loading during symptomatic walking was increased by an average of 7% over asymptomatic walking (p = 0.001). Our results did not show increased spine flexion (adopting a trunk-flexed posture) and only indicate a trend for a small forward shift of the pelvis during both symptomatic walking and standing. This suggests that provocation of symptoms in these patients does not markedly affect their normal gait kinematics. The finding of increased spine loading with provocation of symptoms supports our hypothesis that spine loading plays a role in limiting walking function in patients with lumbar spinal stenosis, but additional work is needed to understand the biomechanical cause of this increase.
Collapse
Affiliation(s)
- Seyed Javad Mousavi
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Andrew C Lynch
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brett T Allaire
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Andrew P White
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| | - Dennis E Anderson
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
18
|
Bibliometric and visualized analysis of current research trends in the finite element analysis of lumbar spine. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
19
|
Favier CD, Finnegan ME, Quest RA, Honeyfield L, McGregor AH, Phillips ATM. An open-source musculoskeletal model of the lumbar spine and lower limbs: a validation for movements of the lumbar spine. Comput Methods Biomech Biomed Engin 2021; 24:1310-1325. [PMID: 33641546 DOI: 10.1080/10255842.2021.1886284] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Musculoskeletal models of the lumbar spine have been developed with varying levels of detail for a wide range of clinical applications. Providing consistency is ensured throughout the modelling approach, these models can be combined with other computational models and be used in predictive modelling studies to investigate bone health deterioration and the associated fracture risk. To provide precise physiological loading conditions for such predictive modelling studies, a new full-body musculoskeletal model including a detailed and consistent representation of the lower limbs and the lumbar spine was developed. The model was assessed against in vivo measurements from the literature for a range of spine movements representative of daily living activities. Comparison between model estimations and electromyography recordings was also made for a range of lifting tasks. This new musculoskeletal model will provide a comprehensive physiological mechanical environment for future predictive finite element modelling studies on bone structural adaptation. It is freely available on https://simtk.org/projects/llsm/.
Collapse
Affiliation(s)
- C D Favier
- Structural Biomechanics in the Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - M E Finnegan
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - R A Quest
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - L Honeyfield
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - A H McGregor
- Musculoskeletal Lab in the Department of Surgery and Cancer, Imperial College London, London, UK
| | - A T M Phillips
- Structural Biomechanics in the Department of Civil and Environmental Engineering, Imperial College London, London, UK
| |
Collapse
|
20
|
Sturdy JT, Sessoms PH, Silverman AK. A backpack load sharing model to evaluate lumbar and hip joint contact forces during shoulder borne and hip belt assisted load carriage. APPLIED ERGONOMICS 2021; 90:103277. [PMID: 33011587 DOI: 10.1016/j.apergo.2020.103277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Musculoskeletal injuries of the lumbar spine occur frequently among military service members and are associated with heavy backpack loads. Musculoskeletal modeling and simulation facilitate biomechanical evaluation to compare different backpack designs. We developed a backpack attachment model that can be tuned to represent various load distributions between the torso and pelvis. We generated walking simulations to estimate muscle and joint contact forces of unloaded walking and while carrying 38 kg using shoulder-borne backpacks and hip belt-assisted backpacks for six U.S. Marines. Three-dimensional peak and average lumbar (L4-L5) and hip joint contact forces over the stance phase were compared between each load condition. Axial L4-L5 and axial and anterior hip joint contact forces were greater during both backpack conditions compared to the unloaded condition. Joint contact forces were similar between backpack conditions. Future studies incorporating additional participants, walking conditions, and backpack load distributions are suggested for further model development and backpack design evaluation.
Collapse
Affiliation(s)
- Jordan T Sturdy
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, 80401, USA
| | - Pinata H Sessoms
- Warfighter Performance, Naval Health Research Center, San Diego, CA, 92106, USA
| | - Anne K Silverman
- Department of Mechanical Engineering, Colorado School of Mines, Golden, CO, 80401, USA.
| |
Collapse
|
21
|
Characterization of the Subchondral Bone and Pain Behavior Changes in a Novel Bipedal Standing Mouse Model of Facet Joint Osteoarthritis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8861347. [PMID: 33224982 PMCID: PMC7669340 DOI: 10.1155/2020/8861347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022]
Abstract
Background The subchondral bone parallels with the progression of osteoarthritis (OA). However, the biomechanical properties and histopathological changes of subchondral bone changes in the lumbar facet joint (LFJ) after long-term axial loading on the spine have not been explored. In this study, we aimed to investigate the subchondral bone histopathological changes that occur in the LFJ and pain behaviors in a novel bipedal standing mouse model. Methods Sixteen 8-week-old male C57BL/6 mice were randomly assigned into bipedal standing and control groups. A finite element stimulate model based on the micro-CT data was generated to simulate the von Mises stress distribution on the LFJ during different positions. The spine pain behaviors tests were analysis. In addition, the change in the subchondral bone of the LFJ was assessed by histological and immunohistochemistry staining. Results The computerized simulation of the von Mises stress distribution in the superior articular process of LFJ at the spine level 5 in the lying position increased and reached a maximum value at the bipedal standing posture. The spine pain behavior test revealed that the threshold of pressure tolerance decreased significantly in bipedal groups relative to control groups, whereas the mechanical hyperalgesia of the hind paw increased significantly in bipedal groups relative to control groups. The axial load accelerates LFJ degeneration with increased histological scores in bipedal groups. The expression of type II collagen and aggrecan (ACAN) was significantly decreased in the bipedal groups compared with the control groups, whereas the expression of MMP13 was increased. Compared with the control groups, the osteoclast activity was activated with higher TRAP-positive staining and associated with increased CD-31-positive vessels and GCRP-positive nerve ending expression in the subchondral bone of LFJ. Conclusion Collectively, long-term axial loading induces the development of spine hyperalgesia in mice associate with increased osteoclast activity and aberrant angiogenesis and nerve invasion into the subchondral bone of LFJ that stimulates the natural pathological change in human LFJ OA. These results indicate that aberrant bone remodeling associate with aberrant nerve innervation in the subchondral bone has a potential as a therapeutic target in LFJ OA pain.
Collapse
|
22
|
Development of a multiscale model of the human lumbar spine for investigation of tissue loads in people with and without a transtibial amputation during sit-to-stand. Biomech Model Mechanobiol 2020; 20:339-358. [PMID: 33026565 DOI: 10.1007/s10237-020-01389-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/19/2020] [Indexed: 01/14/2023]
Abstract
Quantification of lumbar spine load transfer is important for understanding low back pain, especially among persons with a lower limb amputation. Computational modeling provides a helpful solution for obtaining estimates of in vivo loads. A multiscale model was constructed by combining musculoskeletal and finite element (FE) models of the lumbar spine to determine tissue loading during daily activities. Three-dimensional kinematic and ground reaction force data were collected from participants with ([Formula: see text]) and without ([Formula: see text]) a unilateral transtibial amputation (TTA) during 5 sit-to-stand trials. We estimated tissue-level load transfer from the multiscale model by controlling the FE model with intervertebral kinematics and muscle forces predicted by the musculoskeletal model. Annulus fibrosis stress, intradiscal pressure (IDP), and facet contact forces were calculated using the FE model. Differences in whole-body kinematics, muscle forces, and tissue-level loads were found between participant groups. Notably, participants with TTA had greater axial rotation toward their intact limb ([Formula: see text]), greater abdominal muscle activity ([Formula: see text]), and greater overall tissue loading throughout sit-to-stand ([Formula: see text]) compared to able-bodied participants. Both normalized (to upright standing) and absolute estimates of L4-L5 IDP were close to in vivo values reported in the literature. The multiscale model can be used to estimate the distribution of loads within different lumbar spine tissue structures and can be adapted for use with different activities, populations, and spinal geometries.
Collapse
|
23
|
Burkhart K, Grindle D, Bouxsein ML, Anderson DE. Between-session reliability of subject-specific musculoskeletal models of the spine derived from optoelectronic motion capture data. J Biomech 2020; 112:110044. [PMID: 32977297 DOI: 10.1016/j.jbiomech.2020.110044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 01/18/2023]
Abstract
This study evaluated the between-session reliability of creating subject-specific musculoskeletal models with optoelectronic motion capture data, and using them to estimate spine loading. Nineteen healthy participants aged 24-74 years underwent the same set of measurements on two separate occasions. Retroreflective markers were placed on anatomical regions, including C7, T1, T4, T5, T8, T9, T12 and L1 spinous processes, pelvis, upper and lower limbs, and head. We created full-body musculoskeletal models with detailed thoracolumbar spines, and scaled these to create subject-specific models for each individual and each session. Models were scaled from distances between markers, and spine curvature was adjusted according to marker-estimated measurements. Using these models, we estimated vertebral compressive loading for five different standardized postures: neutral standing, 45˚ trunk flexion, 15˚ trunk extension, 20˚ lateral bend to the right, and 45˚ axial rotation to the right. Intraclass correlation coefficients (ICCs) and standard error of measurement were calculated as measures of between-session reliability and measurement error, respectively. Spine curvature measures showed excellent reliability (ICC = 0.79-0.91) and body scaling segments showed fair to excellent reliability (ICC = 0.46-0.95). We found that musculoskeletal models showed mostly excellent between-session reliability to estimate spine loading, with 91% of ICC values > 0.75 for all activities. This information is a necessary precursor for using motion capture data to estimate spine loading from subject-specific musculoskeletal models, and suggests that marker data will deliver reproducible subject-specific models and estimates of spine loading.
Collapse
Affiliation(s)
- Katelyn Burkhart
- Harvard-MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge 02139, MA, United States; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston 02115, MA, United States
| | - Daniel Grindle
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Division of Engineering Mechanics, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Mary L Bouxsein
- Harvard-MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge 02139, MA, United States; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston 02115, MA, United States
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston 02215, MA, United States; Department of Orthopaedic Surgery, Harvard Medical School, Boston 02115, MA, United States.
| |
Collapse
|
24
|
Movement Control Impairment and Low Back Pain: State of the Art of Diagnostic Framing. ACTA ACUST UNITED AC 2019; 55:medicina55090548. [PMID: 31470684 PMCID: PMC6780849 DOI: 10.3390/medicina55090548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/03/2019] [Accepted: 08/26/2019] [Indexed: 01/02/2023]
Abstract
Background and objectives: Low back pain is one of the most common health problems. In 85% of cases, it is not possible to identify a specific cause, and it is therefore called Non-Specific Low Back Pain (NSLBP). Among the various attempted classifications, the subgroup of patients with impairment of motor control of the lower back (MCI) is between the most studied. The objective of this systematic review is to summarize the results from trials about validity and reliability of clinical tests aimed to identify MCI in the NSLBP population. Materials and Methods: The MEDLINE, Cochrane Library, and MedNar databases have been searched until May 2018. The criteria for inclusion were clinical trials about evaluation methods that are affordable and applicable in a usual clinical setting and conducted on populations aged > 18 years. A single author summarized data in synoptic tables relating to the clinical property; a second reviewer intervened in case of doubts about the relevance of the studies. Results: 13 primary studies met the inclusion criteria: 10 investigated inter-rater reliability, 4 investigated intra-rater reliability, and 6 investigated validity for a total of 23 tests (including one cluster of tests). Inter-rater reliability is widely studied, and there are tests with good, consistent, and substantial values (waiter's bow, prone hip extension, sitting knee extension, and one leg stance). Intra-rater reliability has been less investigated, and no test have been studied for more than one author. The results of the few studies about validity aim to discriminate only the presence or absence of LBP in the samples. Conclusions: At the state of the art, results related to reliability support the clinical use of the identified tests. No conclusions can be drawn about validity.
Collapse
|
25
|
Schmid S, Burkhart KA, Allaire BT, Grindle D, Anderson DE. Musculoskeletal full-body models including a detailed thoracolumbar spine for children and adolescents aged 6-18 years. J Biomech 2019; 102:109305. [PMID: 31471110 DOI: 10.1016/j.jbiomech.2019.07.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/11/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022]
Abstract
Currently available musculoskeletal inverse-dynamics thoracolumbar spine models are entirely based on data from adults and might therefore not be applicable for simulations in children and adolescents. In addition, these models lack lower extremities, which are required for comprehensive evaluations of functional activities or therapeutic exercises. We therefore created OpenSim-based musculoskeletal full-body models including a detailed thoracolumbar spine for children and adolescents aged 6-18 years and validated by comparing model predictions to in vivo data. After combining our recently developed adult thoracolumbar spine model with a lower extremity model, children and adolescent models were created for each year of age by adjusting segmental length and mass distribution, center of mass positions and moments of inertia of the major body segments as well as sagittal pelvis and spine alignment based on literature data. Similarly, muscle strength properties were adjusted based on CT-derived cross-sectional area measurements. Simulations were conducted from in vivo studies reported in the literature involving children and adolescents evaluating maximum trunk muscle strength (MTMS), lumbar disc compressibility (LDC), intradiscal pressure (IDP) and trunk muscle activity (MA). Model predictions correlated highly with in vivo data (MTMS: r ≥ 0.82, p ≤ 0.03; LDC: r = 0.77, p < 0.001; IDP: r ≥ 0.78, p < 0.001; MA: r ≥ 0.90, p < 0.001), indicating suitability for the reasonably accurate prediction of maximal trunk muscle strength, segmental loading and trunk muscle activity in children and adolescents. When aiming at investigating children or adolescents with pathologies such as idiopathic scoliosis, our models can serve as a basis for the creation of deformed spine models and for comparative purposes.
Collapse
Affiliation(s)
- Stefan Schmid
- Beth Israel Deaconess Medical Center, Center for Advanced Orthopaedic Studies, Boston, MA, United States; Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA, United States; Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Bern, Switzerland.
| | - Katelyn A Burkhart
- Beth Israel Deaconess Medical Center, Center for Advanced Orthopaedic Studies, Boston, MA, United States; Massachusetts Institute of Technology, Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, United States
| | - Brett T Allaire
- Beth Israel Deaconess Medical Center, Center for Advanced Orthopaedic Studies, Boston, MA, United States
| | - Daniel Grindle
- Beth Israel Deaconess Medical Center, Center for Advanced Orthopaedic Studies, Boston, MA, United States
| | - Dennis E Anderson
- Beth Israel Deaconess Medical Center, Center for Advanced Orthopaedic Studies, Boston, MA, United States; Harvard Medical School, Department of Orthopaedic Surgery, Boston, MA, United States
| |
Collapse
|
26
|
Beaucage-Gauvreau E, Robertson WSP, Brandon SCE, Fraser R, Freeman BJC, Graham RB, Thewlis D, Jones CF. Validation of an OpenSim full-body model with detailed lumbar spine for estimating lower lumbar spine loads during symmetric and asymmetric lifting tasks. Comput Methods Biomech Biomed Engin 2019; 22:451-464. [DOI: 10.1080/10255842.2018.1564819] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Erica Beaucage-Gauvreau
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
- Spinal Research Group, Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - William S. P. Robertson
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Robert Fraser
- Affiliate Professor, The University of Adelaide, Adelaide, South Australia, Australia
- Spinal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Brian J. C. Freeman
- Spinal Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Research Fellow, South Australian Health and Medical Research Institute, Spinal Unit Administration, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ryan B. Graham
- School of Human Kinetics, The University of Ottawa, Ottawa, Ontario, Canada
| | - Dominic Thewlis
- Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Claire F. Jones
- Spinal Research Group, Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- School of Mechanical Engineering, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
27
|
Actis JA, Nolasco LA, Gates DH, Silverman AK. Lumbar loads and trunk kinematics in people with a transtibial amputation during sit-to-stand. J Biomech 2018; 69:1-9. [DOI: 10.1016/j.jbiomech.2017.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/20/2017] [Accepted: 12/28/2017] [Indexed: 11/16/2022]
|