EMG activity of low back extensor muscles during cyclic flexion/extension

Evaluation of ceiling-supported back harnesses in preventing injury in sheep shearing

Lower back injuries are a significant global problem. They are particularly common in occupations that require prolonged or repetitive spinal flexion. Sheep shearing is one such occupation and the prevalence of back injuries is severe. Ceiling-supported back harnesses are a commonly used safety device in this occupation but its effectiveness in sheep shearing tasks has yet to be quantified. It is likely that accumulated and time-dependent changes in kinematics and neuromuscular control are relevant in the development of many lower back injuries. This is supported by the literature in sheep shearing, where 68% more injuries occur towards the end of the working day compared to the start. This means that data collected over a full working day is beneficial for measuring the effectiveness of safety interventions. The previous research in safety interventions in shearing have not collected data for more than 15 minutes, and do not adequately address longer term effects. This study compares the effects of wearing a ceiling-supported back harness on shearer kinematics and muscle activity, from the collected data over a full working day and incorporating time-of-day effects. The outcome shows that the use of ceiling-supported back harness results in improvements in kinematic features, but also an increase in muscle activity and fatigue.

Enabling context aware data analysis for long-duration repetitive stooped work through human activity recognition in sheep shearing

There is evidence to suggest that changes in kinematics and neuromuscular control in activities that take place over long periods of time lead to increased injury risk. The collection of biometric data over long time periods could provide insight into these injuries. However, it is difficult to analyse long period biometric data for occupations as the analysis depends on the activity being performed, and it is not practical to manually label the amount of data required. A sufficiently accurate human activity recognition algorithm can provide a means to segment the activities and allow this analysis, but the classification must be robust to the inter-individual differences, as well as the intra-individual variations in movement over time that are the target of analysis. This work presents a person-independent human activity recognition algorithm for sheep shearing using a Hidden Markov Model with physical features that are identified to be relevant to spinal movement quality. The classifier achieved an F1 score of 96.47% in identifying the shearing task.

Effect of 4-week cyclic stretching program on muscle properties and physical performance in healthy adult men

BACKGROUND

The short-term effect of cyclic stretching (CS) has been found to decrease muscle hardness and improve physical performance. However, the long-term effect of CS program was unclear. This study investigated the long-term effect of CS program on muscle properties and physical performance.

METHODS

Eighteen healthy men participated in this study. The participants were assigned randomly to either the CS or control group (9 participants in each group) to conduct 2 min CS of the plantar flexor muscles 5 times a week for 4 weeks. Before and after intervention, the gastrocnemius medialis muscle hardness, muscle-tendon joint (MTJ) angle, and MTJ displacement (ΔMTJ) were measured as indices of muscle properties. In addition, the maximum range of motion of ankle dorsiflexion (ROM max), normalized maximum peak torque of plantar flexor (NPT), vertical jump height, and dynamic postural stability, dynamic postural stability index (DPSI) were measured as indices of physical performance.

RESULTS

The CS program was found to significantly decrease muscle hardness and increase vertical jump height and ROM max, but not to change the MTJ angle, ΔMTJ, NPT, and DPSI.

CONCLUSIONS

The results of our study suggested that long-term CS program was effective in decreasing muscle hardness and increasing vertical jump height.

Pisa syndrome in Parkinson's disease: electromyographic quantification of paraspinal and non-paraspinal muscle activity

Patients with Parkinson's disease (PD) and Pisa syndrome (PS) may present tonic dystonic or compensatory (i.e. acting against gravity) hyperactivity in the paraspinal and non-paraspinal muscles. Electromyographic (EMG) activity was measured in nine patients with PD and PS, three with PD without PS, and five healthy controls. Fine-wire intramuscular electrodes were inserted bilaterally into the iliocostalis lumborum (ICL), iliocostalis thoracis (ICT), gluteus medius (GM), and external oblique (EO) muscles. The root mean square (RMS) of the EMG signal was calculated and normalized for each muscle. In stance condition, side-to-side muscle activity comparisons showed a higher RMS only for the contralateral ICL in PD patients with PS (p=0.028). Moreover, with increasing degrees of lateral flexion, the activity of the EO and the ICL muscles progressively increased and decreased, respectively. The present data suggest that contralateral paraspinal muscle activity plays a crucial compensatory role and can be dysfunctional in PD patients with PS.

Co-contraction characteristics of lumbar muscles in patients with lumbar disc herniation during different types of movement

Background

Muscular performance is an important factor for the mechanical stability of lumbar spine in humans, in which, the co-contraction of lumbar muscles plays a key role. We hypothesized that when executing different daily living motions, the performance of the lumbar muscle co-contraction stabilization mechanism varies between patients with lumbar disc herniation (LDH) and healthy controls. Hence, in this study, co-contraction performance of lumbar muscles between patients with LDH and healthy subjects was explored to check if there are significant differences between the two groups when performing four representative movements.

Methods

Twenty-six LDH patients (15 females, 11 males) and a control group of twenty-eight subjects (16 females, 12 males) were recruited. Surface electromyography (EMG) signals were recorded from the external oblique, lumbar multifidus, and internal oblique/transversus abdominis muscles during the execution of four types of movement, namely: forward bending, backward bending, left lateral flexion and right lateral flexion. The acquired EMG signals were segmented, and wavelet decomposition was performed followed by reconstruction of the low-frequency components of the signal. Then, the reconstructed signals were used for further analysis. Co-contraction ratio was employed to assess muscle coordination and compare it between the LDH patients and healthy controls. The corresponding signals of the subjects in the two groups were compared to evaluate the differences in agonistic and antagonistic muscle performance during the different motions. Also, sample entropy was applied to evaluate complexity changes in lumbar muscle recruitment during the movements.

Results

Significant differences between the LDH and control groups were found in the studied situations (p < 0.05). During the four movements considered in this study, the participants of the LDH group exhibited a higher level of co-contraction ratio, lower agonistic, and higher antagonistic lumbar muscle activity (p < 0.01) than those of the control group. Furthermore, the co-contraction ratio of LDH patients was dominated by the antagonistic muscle activity during the movements, except for the forward bending motion. However, in the healthy control group, the agonistic muscle activity contributed more to the co-contraction ratio with an exception for the backward bending motion. Conversely, the sample entropy value was significantly lower for agonistic muscles of LDH group compared to the control group (p < 0.01) while the entropy value was significantly greater in antagonistic muscles (p < 0.01) during the four types of movement, respectively.

Conclusions

Lumbar disc herniation patients exhibited numerous variations in the evaluated parameters that reflect the co-contraction of lumbar muscles, the agonistic and antagonistic muscle activities, and their respective sample entropy values when compared with the healthy control group. These variations could be due to the compensation mechanism that was required to stabilize the spine. The results of this study could facilitate the design of efficient rehabilitation methods for treatment of lumbar muscle dysfunctions.

Prolonged Intermittent Trunk Flexion Increases Trunk Muscles Reflex Gains and Trunk Stiffness

The goal of the present study was to determine the effects of prolonged, intermittent flexion on trunk neuromuscular control. Furthermore, the potential beneficial effects of passive upper body support during flexion were investigated. Twenty one healthy young volunteers participated during two separate visits in which they performed 1 hour of intermittent 60 seconds flexion and 30 seconds rest cycles. Flexion was set at 80% lumbar flexion and was performed with or without upper body support. Before and after intermittent flexion exposure, lumbar range of motion was measured using inertial measurement units and trunk stability was assessed during perturbations applied in the forward direction with a force controlled actuator. Closed-loop system identification was used to determine the trunk translational admittance and reflexes as frequency response functions. The admittance describes the actuator displacement as a function of contact force and to assess reflexes muscle activation was related to actuator displacement. Trunk admittance gain decreased after unsupported flexion, while reflex gain and lumbar range of motion increased after both conditions. Significant interaction effects confirmed a larger increase in lumbar range of motion and reflex gains at most frequencies analysed following unsupported flexion in comparison to supported flexion, probably compensating for decreased passive tissue stiffness. In contrast with some previous studies we found that prolonged intermittent flexion decreased trunk admittance, which implies an increase of the lumped intrinsic and reflexive stiffness. This would compensate for decreased stiffness at the cost of an increase in cumulative low back load. Taking into account the differences between conditions it would be preferable to offer upper body support during activities that require prolonged trunk flexion.

Use of antagonist muscle EMG in the assessment of neuromuscular health of the low back

BACKGROUND

Non-specific low back pain (LBP) has been one of the most frequently occurring musculoskeletal problems. Impairment in the mechanical stability of the lumbar spine has been known to lower the safety margin of the spine musculature and can result in the occurrence of pain symptoms of the low back area. Previously, changes in spinal stability have been identified by investigating recruitment patterns of low back and abdominal muscles in laboratory experiments with controlled postures and physical activities that were hard to conduct in daily life. The main objective of this study was to explore the possibility of developing a reliable spine stability assessment method using surface electromyography (EMG) of the low back and abdominal muscles in common physical activities.

METHODS

Twenty asymptomatic young participants conducted normal walking, plank, and isometric back extension activities prior to and immediately after maintaining a 10-min static upper body deep flexion on a flat bed. EMG data of the erector spinae, external oblique, and rectus abdominals were collected bilaterally, and their mean normalized amplitude values were compared between before and after the static deep flexion. Changes in the amplitude and co-contraction ratio values were evaluated to understand how muscle recruitment patterns have changed after the static deep flexion.

RESULTS

Mean normalized amplitude of antagonist muscles (erector spinae muscles while conducting plank; external oblique and rectus abdominal muscles while conducting isometric back extension) decreased significantly (P < 0.05) after the 10-min static deep flexion. Normalized amplitude of agonist muscles did not vary significantly after deep flexion.

CONCLUSIONS

Results of this study suggest the possibility of using surface EMG in the evaluation of spinal stability and low back health status in simple exercise postures that can be done in non-laboratory settings. Specifically, amplitude of antagonist muscles was found to be more sensitive than agonist muscles in identifying changes in the spinal stability associated with the 10-min static deep flexion. Further research with various loading conditions and physical activities need to be performed to improve the reliability and utility of the findings of the current study.

Impact of shoulder position and fatigue on the flexion-relaxation response in cervical spine

BACKGROUND

Neck pain is common among general population with a high prevalence among the people who are routinely exposed to prolonged use of static head-neck postures. Prolonged static loading can cause localized muscle fatigue which may impact the stability of the cervical spine. In this study, flexion-relaxation phenomenon was used to study the post fatigue changes in the stability of cervical spine by evaluating the synergistic load sharing between muscles and viscoelastic elements.

METHODS

Thirteen male participants were recruited for data collection. The variables that influence cervical flexion-relaxation were studied pre- and post-fatigue using neutral and shrugged shoulder postures. The Sorensen protocol was used to induce neck extensor fatigue. Surface electromyography and optical motion capture systems were used to record neck muscle activation and head posture, respectively. Findings The flexion-relaxation phenomenon was observed only in the neutral shoulder position pre- and post-fatigue. The flexion relaxation ratio decreased significantly post-fatigue in neutral shoulder position but remained unchanged in shrugged shoulder position. The onset and offset angles and the corresponding durations of the silence period were significantly affected by the fatigue causing a post-fatigue expansion of silence period. Interpretation The muscular fatigue of neck extensors and shoulder position was found to modulate the cervical flexion-relaxation phenomenon. Early shifting of load sharing under fatigued condition indicates increased demands on the passive tissues to stabilize the cervical spine. Shrugging of shoulder seems to alter muscular demands of neck extensors and make cervical flexion-relaxation phenomenon disappear due to continuous activation of the neck extensors.

Evaluation of methods for the quantification of the flexion-relaxation phenomenon in the lumbar erector spinae muscles

OBJECTIVES

There are various methods to quantify the flexion-relaxation phenomenon (FRP); however, there is little standardization. This study aimed to evaluate the performance of various quantification methods in terms of their ability to identify lumbar erector spinae flexion-relaxation during standing forward trunk flexion.

METHODS

The study was a cross-sectional design in a laboratory setting. Lumbar erector spinae activation levels were measured in 12 male participants performing full trunk flexion movements. Electromyographical signals were assessed using 16 criteria within 4 quantification methods (visual, statistical, threshold, ratio), and the sensitivity of each was assessed relative to the benchmark criterion (visual inspection of raw electromyography data).

RESULTS

Visual inspection and most of the threshold and ratio criteria displayed the highest sensitivity. On average (SD) across the 16 criteria, FRP was positively identified 21.6 (6.2) times of 24 data sets (12 participants, 2 muscles). The visual inspection criteria positively identified FRP in all 24 trials, whereas the statistical method did not identify FRP at all (P = .44 and P = .46 for the left and right sides, respectively). The threshold and ratio criteria positively identified FRP 23.2 (1.5) and 22.5 (3.7) times, on average, respectively. Results from criteria based on differences between upright and fully flexed muscle activation tended to be conservative in FRP identification. The methods were classified as reliable or nonreliable, based on their sensitivity when specific characteristics were evident in the electromyography signals.

CONCLUSIONS

Although many of the criteria identified FRP with 100% sensitivity, others produced unrealistic results. The latter may be suitable for other experimental designs or may require reevaluation regarding their ability to identify FRP. Although visual inspection, threshold, or ratio methods performed well and may be appropriate for either biomechanical or clinical research, the threshold method provided the optimal trade-off between performance, consistency, and feasibility for these data.

Disturbance and recovery of trunk mechanical and neuromuscular behaviors following repeated static trunk flexion: influences of duration and duty cycle on creep-induced effects

Occupations involving frequent trunk flexion are associated with a higher incidence of low back pain. To investigate the effects of repeated static flexion on trunk behaviors, 12 participants completed six combinations of three static flexion durations (1, 2, and 4 min), and two flexion duty cycles (33% and 50%). Trunk mechanical and neuromuscular behaviors were obtained pre- and post-exposure and during recovery using sudden perturbations. A longer duration of static flexion and a higher duty cycle increased the magnitude of decrements in intrinsic stiffness. Increasing duty cycle caused larger decreases in reflexive muscle responses, and females had substantially larger decreases in reflexive responses following exposure. Patterns of recovery for intrinsic trunk stiffness and reflexive responses were consistent across conditions and genders, and none of these measures returned to pre-exposure values after 20 min of recovery. Reflexive responses may not provide a compensatory mechanism to offset decreases in intrinsic trunk stiffness following repetitive static trunk flexion. A prolonged recovery duration may lead to trunk instability and a higher risk of low back injury.

Disturbance and recovery of trunk mechanical and neuromuscular behaviours following repetitive lifting: influences of flexion angle and lift rate on creep-induced effects

Repetitive lifting is associated with an increased risk of occupational low back disorders, yet potential adverse effects of such exposure on trunk mechanical and neuromuscular behaviours were not well described. Here, 12 participants, gender balanced, completed 40 min of repetitive lifting in all combinations of three flexion angles (33, 66, and 100% of each participant's full flexion angle) and two lift rates (2 and 4 lifts/min). Trunk behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness and reflexive responses were compromised after lifting exposures, with larger decreases in stiffness and reflexive force caused by larger flexion angles, which also delayed reflexive responses. Consistent effects of lift rate were not found. Except for reflex delay no measures returned to pre-exposure values after 20 min of recovery. Simultaneous changes in both trunk stiffness and neuromuscular behaviours may impose an increased risk of trunk instability and low back injury.

PRACTITIONER SUMMARY

An elevated risk of low back disorders is attributed to repetitive lifting. Here, the effects of flexion angle and lift rate on trunk mechanical and neuromuscular behaviours were investigated. Increasing flexion angle had adverse effects on these outcomes, although lift rate had inconsistent effects and recovery time was more than 20 min.

Describing the active region boundary of EMG-assisted biomechanical models of the low back

BACKGROUND

Electromyography-assisted (EMG-assisted) biomechanical models are used to characterize the muscle and joint reaction forces in the lumbar region. However, during a full-range trunk flexion, there is a transition of extension moment from the trunk extensor muscles to the passive tissues of the low back, indicating that the empirical EMG data used to drive these EMG-assisted models becomes less correlated with the extensor moment. The objectives of this study were to establish the trunk flexion angles at which the passive tissues generate substantial trunk extension moment and to document how these angles change with asymmetry.

METHODS

Participants performed controlled trunk flexion-extension motions in three asymmetric postures. The trunk kinematics data and the electromyographic activity from L3- and L4-level paraspinals and rectus abdominis were captured. The time-dependent net internal active moment (from an EMG-assisted model) and the net external moment were calculated. The trunk and lumbar angles at which the net internal active moment was less than 70% of the external moment were found.

FINDINGS

The trunk flexion angle at which the net internal moment reaches the stated criteria varied as a function of asymmetry of trunk flexion motion with the sagittally symmetric case providing the deepest flexion angle of 38° (asymmetry 15°: 33°; asymmetry 30°: 26°).

INTERPRETATION

These results indicate that EMG-assisted biomechanical models need to consider the role of passive tissues at trunk flexion angles significantly less than previously thought and these flexion angles vary as a function of the asymmetry and direction of motion.