1
|
Firouzabadi A, Arjmand N, Zhang T, Pumberger M, Schmidt H. Effect of low back pain on the kinetics and kinematics of the lumbar spine - a combined in vivo and in silico investigation. J Biomech 2024; 164:111954. [PMID: 38310006 DOI: 10.1016/j.jbiomech.2024.111954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 02/05/2024]
Abstract
Lifting is a significant risk factor for low back pain (LBP). Different biomechanical factors including spinal loads, kinematics, and muscle electromyography (EMG) activities have previously been investigated during lifting activities in LBP patients and asymptomatic individuals to identify their association with LBP. However, the findings were contradictory and inconclusive. Accurate and subject-specific prediction of spinal loads is crucial for understanding, diagnosing, planning tailored treatments, and preventing recurrent pain in LBP patients. Therefore, the present study aimed to estimate the L5-S1 compressive and resultant shear loads in 19 healthy and 17 non-specific chronic LBP individuals during various static load-holding tasks (holding a 10 kg box at hip, chest, and head height) using full-body and personalized musculoskeletal models driven by subject-specific in vivo kinematic/kinetic, EMG, and physiological cross-sectional areas (PCSAs) data. These biomechanical characteristics were concurrently analyzed to identify potential differences between the two groups. Statistical analyses showed that LBP had almost no significant effect on the range of motion (trunk, lumbar, pelvis), PCSA, and EMG. There were no significant differences (p > 0.05) in the predicted L5-S1 loads. However, as the task became more demanding, by elevating the hand-load from hip to head, LBP patients experienced significant increases in both compressive (33 %, p = 0.00) and shear (25 %, p = 0.02) loads, while asymptomatic individuals showed significant increases only in compressive loads (30 %, p = 0.01). This suggests that engaging in more challenging activities could potentially magnify the effect of LBP on the biomechanical factors and increase their discrimination capacity between LBP and asymptomatic individuals.
Collapse
Affiliation(s)
- Ali Firouzabadi
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Tianwei Zhang
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
2
|
Larivière C, Eskandari AH, Mecheri H, Ghezelbash F, Gagnon D, Shirazi-Adl A. Effect of personalized spinal profile on its biomechanical response in an EMG-assisted optimization musculoskeletal model of the trunk. J Biomech 2024; 162:111867. [PMID: 37992597 DOI: 10.1016/j.jbiomech.2023.111867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Recent developments in musculoskeletal (MS) modeling have been geared towards model customization. Personalization of the spine profile could affect estimates of spinal loading and stability, particularly in the upright standing posture where large inter-subject variations in the lumbar lordosis have been reported. This study investigates the biomechanical consequences of changes in the spinal profile. In 31 participants (healthy and with back pain), (1) the spine external profile was measured, (2) submaximal contractions were recorded in a dynamometer to calibrate the EMG-driven MS model and finally (3) static lifting in the upright standing challenging spine stability while altering load position and magnitude were considered. EMG signals of 12 trunk muscles and angular kinematics of 17 segments were recorded. For each participant, the MS model was constructed using either a generic or a personalized spinal profile and 17 biomechanical outcomes were computed, including individual muscle forces, ratios of muscle group forces, spinal loading and stability parameters. According to the ANOVA results and corresponding effect sizes, personalizing the spine profile induced medium and large effects on about half MS model outcomes related to the trunk muscle forces and negligible to small effects on spinal loading and stability as more aggregate outcomes. These effects are explained by personalized spine profiles that were a little more in extension as well as more pronounced spine curvatures (lordosis and kyphosis). These findings suggest that spine profile personalization should be considered in MS spine modeling as it may impact muscle force prediction and spinal loading.
Collapse
Affiliation(s)
- C Larivière
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada.
| | - A H Eskandari
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada; Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - H Mecheri
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - F Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| | - D Gagnon
- Faculty of Physical Activity Sciences, University of Sherbrooke, Canada
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Canada
| |
Collapse
|
3
|
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
|
4
|
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
|
5
|
Zhao G, Wang H, Wang L, Ibrahim Y, Wan Y, Sun J, Yuan S, Liu X. The Biomechanical Effects of Different Bag-Carrying Styles on Lumbar Spine and Paraspinal Muscles: A Combined Musculoskeletal and Finite Element Study. Orthop Surg 2022; 15:315-327. [PMID: 36411502 PMCID: PMC9837261 DOI: 10.1111/os.13573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Bags such as handbags, shoulder bags, and backpacks are commonly used. However, it is difficult to assess the biomechanical effects of bag-carrying styles on the lumbar spine and paraspinal muscles using traditional methods. This study aimed to evaluate the biomechanical effects of bag-carrying styles on the lumbar spine. METHODS We developed a hybrid model that combined a finite element (FE) model of the lumbar spine and musculoskeletal models of three bag-carrying styles. The image data was collected from a 26-years-old, 176 cm and 70 kg volunteer. OpenSim and ABAQUS were used to do the musculoskeletal analysis and finite analysis. Paraspinal muscle force, intervertebral compressive force (ICF), and intervertebral shear force (ISF) on L1 were calculated and loaded into the FE model to assess the stress distribution on the lumbar spine. RESULTS Different paraspinal muscle activation occurred in the three bag-carrying models. The increase in the ICF generated by all three bags was greater than the bags' weights. The handbag produced greater muscle force, ICF, ISF, and peak stress on the nucleus pulposus than the backpack and shoulder bag of the same weight. Peak stress on the intervertebral discs in the backpack model and the L1-L4 segments of the shoulder bag model increased linearly with bag weight, and increased exponentially with bag weight in the handbag model. CONCLUSION Unbalanced bag-carrying styles (shoulder bags and handbags) led to greater muscle force, which generated greater ICF, ISF, and peak stress on the lumbar spine. The backpack produced the least burden on the lumbar spine and paraspinal muscles. Heavy handbags should be used carefully in daily life.
Collapse
Affiliation(s)
- Geng Zhao
- Present address:
Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina,Cheeloo College of MedicineShandong UniversityJinanChina
| | - Hongwei Wang
- Present address:
Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina,Collage of Artificial Intelligence and Big Data for Medical SciencesShandong First Medical UniversityJinanChina
| | - Lianlei Wang
- Present address:
Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Yakubu Ibrahim
- Cheeloo College of MedicineShandong UniversityJinanChina
| | - Yi Wan
- School of Mechanical EngineeringShandong UniversityJinanChina
| | - Junyuan Sun
- Present address:
Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina,Cheeloo College of MedicineShandong UniversityJinanChina
| | - Suomao Yuan
- Present address:
Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Xinyu Liu
- Present address:
Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| |
Collapse
|
6
|
El Bojairami I, Driscoll M. Formulation and exploration of novel, intramuscular pressure based, muscle activation strategies in a spine model. Comput Biol Med 2022; 146:105646. [PMID: 35751204 DOI: 10.1016/j.compbiomed.2022.105646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/26/2022] [Accepted: 05/14/2022] [Indexed: 12/31/2022]
Abstract
Optimization models are often devised to assess spinal stability via estimating individual muscle forces. However, neglecting muscles' fluidic behavior remains an approximation due to the role of muscle pressure in force transmission. The purpose of this study was to leverage a validated Finite Element (FE) model of the spine, inclusive of Intra-Muscular Pressure (IMP), to explore muscle activation strategies towards maintaining equilibrium spinal stability. Three conventional strategies governing minimizing muscle effort, minimizing IVD compressive forces, and maintaining stability at all costs were first investigated to explore model's validity. Thereafter, two novel IMP-based strategies were devised and explored, specifically minimizing and maximizing IMP. The model was previously shown valid in light of in vivo and in silico observations with an average discrepancy of 6%. This being the case, the conventional strategies dictated efficacy in muscular activations whilst maintaining an equilibrium stable position, as quantified in the present paper, with a difference of 9.8% from documented data. In addition, the explored novel IMP-based strategies suggested the presence of a threshold individual muscles IMP, approximately 272 mmHg for the longissimus muscle for example, beyond which muscles potentially start to share radial loads with surrounding tissues, whilst limiting the contraction of the underlying muscles. In conclusion, this study theoretically supports the possibility of activation strategies based on muscular pressure, which the developed, verified, and validated FE spine model was leveraged to investigate. The explored novel IMP-based strategies may have significance in informing clinical applications such as motion analysis and functional electrical stimulation of muscles.
Collapse
Affiliation(s)
- Ibrahim El Bojairami
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montréal, Quebec, Canada; Orthopaedic Research Lab, Montreal General Hospital, McGill University Hospital Center Research Institute, Montréal, Quebec, Canada.
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montréal, Quebec, Canada; Orthopaedic Research Lab, Montreal General Hospital, McGill University Hospital Center Research Institute, Montréal, Quebec, Canada.
| |
Collapse
|
7
|
Malakoutian M, Sanchez CA, Brown SHM, Street J, Fels S, Oxland TR. Biomechanical Properties of Paraspinal Muscles Influence Spinal Loading—A Musculoskeletal Simulation Study. Front Bioeng Biotechnol 2022; 10:852201. [PMID: 35721854 PMCID: PMC9201424 DOI: 10.3389/fbioe.2022.852201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Masoud Malakoutian
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
- ICORD, University of British Columbia, Vancouver, BC, Canada
| | - C. Antonio Sanchez
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - John Street
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Sidney Fels
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Thomas R. Oxland
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada
- ICORD, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Thomas R. Oxland,
| |
Collapse
|
8
|
Rajaee MA, Arjmand N, Shirazi-Adl A. A novel coupled musculoskeletal finite element model of the spine - Critical evaluation of trunk models in some tasks. J Biomech 2021; 119:110331. [PMID: 33631665 DOI: 10.1016/j.jbiomech.2021.110331] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Abstract
Spine musculoskeletal (MS) models make simplifying assumptions on the intervertebral joint degrees-of-freedom (rotational and/or translational), representation (spherical or beam-like joints), and properties (linear or nonlinear). They also generally neglect the realistic structure of the joints with disc nuclei/annuli, facets, and ligaments. We aim to develop a novel MS model where trunk muscles are incorporated into a detailed finite element (FE) model of the ligamentous T12-S1 spine thus constructing a gold standard coupled MS-FE model. Model predictions are compared under some tasks with those of our earlier spherical joints, beam joints, and hybrid (uncoupled) MS-FE models. The coupled model predicted L4-L5 intradiscal pressures (R2 ≅ 0.97, RMSE ≅ 0.27 MPa) and L1-S1 centers of rotation (CoRs) in agreement to in vivo data. Differences in model predictions grew at larger trunk flexion angles; at the peak (80°) flexion the coupled model predicted, compared to the hybrid model, much smaller global/local muscle forces (~38%), segmental (~44%) and disc (~22%) compression forces but larger segmental (~9%) and disc (~17%) shear loads, ligament forces at the lower lumbar levels (by up to 57%) and facet forces at all levels. The spherical/beam joints models predicted much greater muscle forces and segmental loads under larger flexion angles. Unlike the spherical joints model with fixed CoRs, the beam joints model predicted CoRs closer (RMSE = 2.3 mm in flexion tasks) to those of the coupled model. The coupled model offers a great potential for future studies towards improvement of surgical techniques, management of musculoskeletal injuries and subject-specific simulations.
Collapse
Affiliation(s)
- M A Rajaee
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - A Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique, Montréal, Québec, Canada
| |
Collapse
|
9
|
Fan Y, To MKT, Yeung EHK, Wu J, He R, Xu Z, Zhang R, Li G, Cheung KMC, Cheung JPY. Does curve pattern impact on the effects of physiotherapeutic scoliosis specific exercises on Cobb angles of participants with adolescent idiopathic scoliosis: A prospective clinical trial with two years follow-up. PLoS One 2021; 16:e0245829. [PMID: 33493172 PMCID: PMC7833215 DOI: 10.1371/journal.pone.0245829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background Current clinical evidence suggests that a well-planned physiotherapeutic scoliosis specific exercise (PSSE) program is effective for scoliosis regression. Objectives We investigated the effect of curve patterns on Cobb angles with PSSE. Methods This was a non-randomized prospective clinical trial that recruited participants with adolescent idiopathic scoliosis between January and June 2017. Participants were grouped by curve pattern into major thoracic and major lumbar groups. An outpatient-based PSSE program was conducted with the following schedule of intensive exercise: ≥ 1 session of supervised PSSE per month and > 30min of home exercise 5 days/week in the first 6 months, after which exercise frequency was reduced to 1 session of supervised PSSE every three months and > 30min of home exercise 5 days/week until 2 years after study initiation. Radiographic Cobb angle progressions were identified at the 1, 1.5 and 2-year follow-ups. A mixed model analysis of variance (ANOVA) was performed to examine the differences in Cobb angles between groups at four testing time points. The two-tailed significance level was set to 0.05. Results In total, 40 participants were recruited, including 22 with major thoracic curves (5 males and 17 females; mean age 13.5±1.8 years; Cobb angle 18–45 degrees) and 18 with major lumbar curves (7 males and 11 females; mean age 12.7±1.7 years; Cobb angle 15–48 degrees). Curve regressions, namely the reduction of Cobb angles between 7 to 10 degrees were noted in 9.1% of participants in the major thoracic group; reductions of 6 to 13 degrees were noted in 33.3% of participants in the major lumbar group at the 2-year follow-up. Repeated measurements revealed a significant time effect (F2.2,79.8 = 4.1, p = 0.02), but no group (F2.2,79.8 = 2.3, p = 0.1) or time × group (F1,37 = 0.97, p = 0.3) effects in reducing Cobb angles after 2 years of PSSE. A logistic regression analysis revealed that no correlation was observed between curve pattern and curve regression or stabilization (OR: 0.2, 95% CI: 0.31–1.1, p = 0.068) at the 2-year follow-up. Conclusion This was the first study to investigate the long-term effects of PSSE in reducing Cobb angles on the basis of major curve location. No significant differences in correction were observed between major thoracic and major lumbar curves. A regression effect and no curve deterioration were noted in both groups at the 2-year follow-up. Trial registration ChiCTR1900028073.
Collapse
Affiliation(s)
- Yunli Fan
- Department of Orthopaedics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- Department of Physiotherapy, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Michael K. T. To
- Department of Orthopaedics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Eric H. K. Yeung
- Department of Physiotherapy, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Jianbin Wu
- Department of Orthopaedics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Rong He
- Department of Physiotherapy, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Zhuoman Xu
- Department of Physiotherapy, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Ruiwen Zhang
- Department of Physiotherapy, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Guangshuo Li
- Department of Physiotherapy, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Kenneth M. C. Cheung
- Department of Orthopaedics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Jason P. Y. Cheung
- Department of Orthopaedics, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| |
Collapse
|
10
|
Sharifzadeh-Kermani A, Arjmand N, Vossoughi G, Shirazi-Adl A, Patwardhan AG, Parnianpour M, Khalaf K. Estimation of Trunk Muscle Forces Using a Bio-Inspired Control Strategy Implemented in a Neuro-Osteo-Ligamentous Finite Element Model of the Lumbar Spine. Front Bioeng Biotechnol 2020; 8:949. [PMID: 32850767 PMCID: PMC7431630 DOI: 10.3389/fbioe.2020.00949] [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: 05/29/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
Low back pain (LBP), the leading cause of disability worldwide, remains one of the most common and challenging problems in occupational musculoskeletal disorders. The effective assessment of LBP injury risk, and the design of appropriate treatment modalities and rehabilitation protocols, require accurate estimation of the mechanical spinal loads during different activities. This study aimed to: (1) develop a novel 2D beam-column finite element control-based model of the lumbar spine and compare its predictions for muscle forces and spinal loads to those resulting from a geometrically matched equilibrium-based model; (2) test, using the foregoing control-based finite element model, the validity of the follower load (FL) concept suggested in the geometrically matched model; and (3) investigate the effect of change in the magnitude of the external load on trunk muscle activation patterns. A simple 2D continuous beam-column model of the human lumbar spine, incorporating five pairs of Hill's muscle models, was developed in the frontal plane. Bio-inspired fuzzy neuro-controllers were used to maintain a laterally bent posture under five different external loading conditions. Muscle forces were assigned based on minimizing the kinematic error between target and actual postures, while imposing a penalty on muscular activation levels. As compared to the geometrically matched model, our control-based model predicted similar patterns for muscle forces, but at considerably lower values. Moreover, irrespective of the external loading conditions, a near (<3°) optimal FL on the spine was generated by the control-based predicted muscle forces. The variation of the muscle forces with the magnitude of the external load within the simulated range at the L1 level was found linear. This work presents a novel methodology, based on a bio-inspired control strategy, that can be used to estimate trunk muscle forces for various clinical and occupational applications toward shedding light on the ever-elusive LBP etiology.
Collapse
Affiliation(s)
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Gholamreza Vossoughi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Aboulfazl Shirazi-Adl
- Division of Applied Mechanics, Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines, Jr. VA Hospital, Hines, IL, United States
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| |
Collapse
|
11
|
Li SSW, Chow DHK. Comparison of Predictions Between an EMG-Assisted Approach and Two Optimization-Driven Approaches for Lumbar Spine Loading During Walking With Backpack Loads. HUMAN FACTORS 2020; 62:565-577. [PMID: 31189071 DOI: 10.1177/0018720819851299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The efficacy of two optimization-driven biomechanical modeling approaches has been compared with an electromyography-assisted optimization (EMGAO) approach to predict lumbar spine loading while walking with backpack loads. BACKGROUND The EMGAO approach adopts more variables in the optimization process and is complex in data collection and processing, whereas optimization-driven approaches are simple and include the fewest possible variables. However, few studies have been conducted on the efficacy of using the optimization-driven approach to predict lumbar spine loading while walking with backpack loads. METHOD Anthropometric information of 10 healthy male adults as well as their kinematic, kinetic, and electromyographic data acquired while they walked with various backpack loads (no-load, 5%, 10%, 15%, and 20% of body weight) served as inputs into the model for predicting lumbosacral joint compression forces. The efficacy of two optimization-driven models, namely double linear optimization with constraints on muscle intensity and single linear optimization without any constraints, was investigated by comparing the resulting force profile with that provided by a current EMGAO approach. RESULTS The double and single linear optimization approaches predicted mean deviations in peak force of -5.1%, and -19.2% as well as root-mean-square differences in force profile of 16.2%, and 25.4%, respectively. CONCLUSION The double linear optimization approach was a relatively comparable estimator to the EMGAO approach in terms of its consistency, slight bias, and efficiency for predicting peak lumbosacral joint compression forces. APPLICATION The double linear optimization approach is a useful biomechanical model for estimating peak lumbar compression forces while walking with backpack loads.
Collapse
Affiliation(s)
- Simon S W Li
- 229051 66390 The Education University of Hong Kong
| | | |
Collapse
|
12
|
Ataei G, Abedi R, Mohammadi Y, Fatouraee N. Analysing the effect of wearable lift-assist vest in squat lifting task using back muscle EMG data and musculoskeletal model. Phys Eng Sci Med 2020; 43:651-658. [PMID: 32524453 DOI: 10.1007/s13246-020-00872-5] [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: 12/11/2019] [Accepted: 04/17/2020] [Indexed: 12/17/2022]
Abstract
The most common disorders of the musculoskeletal system are low back disorders. They cause significant direct and indirect costs to different societies especially in lifting occupations. To reduce the risk of low back disorders, mechanical lifting aids have been used to decrease low back muscle forces. But there are very few direct ways to calculate muscle forces and examine the effect of personal lift-assist devices, so biomechanical models ought to be used to examine the quality of these devices for assisting back muscles in lifting tasks. The purpose of this study is to examine the effect of a designed wearable lift-assist vest (WLAV) in the reduction of erector spinae muscle forces during symmetric squat lifting tasks. Two techniques of muscle calculation were used, the electromyography-based method and the optimization-based model. The first uses electromyography data of erector spinae muscles and its linear relationship with muscle force to estimate their forces, and the second uses a developed musculoskeletal model to calculate back muscle forces using an optimization-based method. The results show that these techniques reduce the average value of erector spinae muscle forces by 45.38 (± 4.80) % and 42.03 (± 8.24) % respectively. Also, both methods indicated approximately the same behaviour in changing muscle forces during 10 to 60 degrees of trunk flexion using WLAV. The use of WLAV can help to reduce the activity of low back muscles in lifting tasks by transferring the external load effect to the assistive spring system utilized in it, so this device may help people lift for longer.
Collapse
Affiliation(s)
- Gholamreza Ataei
- Department of Radiology Technology, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Rasoul Abedi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Yousef Mohammadi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Nasser Fatouraee
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran.
| |
Collapse
|
13
|
Li SS, Chow DH. Modified electromyography-assisted optimization approach for predicting lumbar spine loading while walking with backpack loads. Proc Inst Mech Eng H 2020; 234:527-533. [PMID: 32053045 DOI: 10.1177/0954411920906243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study modified an electromyography-assisted optimization approach for predicting lumbar spine loading while walking with backpack loads. The modified-electromyography-assisted optimization approach eliminated the electromyography measurement at maximal voluntary contraction and adopted a linear electromyography-force relationship. Moreover, an optimal lower boundary condition for muscle gain was introduced to constrain the trunk muscle co-activation. Anthropometric information of 10 healthy young men as well as their kinematic, kinetic, and electromyography data obtained while walking with backpack loads were used as inputs in this study. A computational algorithm was used to find and analyse the sensitivity of the optimal lower boundary condition for achieving minimum deviation of the modified-electromyography-assisted optimization approach from the electromyography-assisted optimization approach for predicting lumbosacral joint compression force. Results validated that the modified-electromyography-assisted optimization approach (at optimal lower boundary condition of 0.92) predicted on average, a non-significant deviation in peak lumbosacral joint compression force of -18 N, a standard error of 9 N, and a root mean square difference in force profile of 73.8 N. The modified-electromyography-assisted optimization approach simplified the experimental process by eliminating the electromyography measurement at maximal voluntary contraction and provided comparable estimations for lumbosacral joint compression force that is also applicable to patients or individuals having difficulty in performing the maximal voluntary contraction activity.
Collapse
Affiliation(s)
- Simon Sw Li
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Daniel Hk Chow
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong
| |
Collapse
|
14
|
Li SSW, Zheng YP, Chow DHK. Changes of lumbosacral joint compression force profile when walking caused by backpack loads. Hum Mov Sci 2019; 66:164-172. [PMID: 31029838 DOI: 10.1016/j.humov.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/27/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
Walking with backpack loads induces additional mechanical stress on the spine and has been identified as a risk factor of lower-back pain. This study evaluated the effects of walking with backpack loads on the lumbosacral joint compression force profile in both the magnitude and time domains. Ten male adults geared with anatomical markers and trunk surface electromyographic sensors walked along a walkway embedded with three force plates with no load and various backpack loads (5%, 10%, 15%, and 20% body weight). Lower-body movements, ground reaction forces, and trunk muscle activations were measured using a synchronized motion analysis, force plate, and surface electromyography system. The force profiles of identified gait cycles were predicted using an integrated inverse dynamic and electromyography-assisted optimization model and evaluated statistically. The results showed that as backpack load increased, the 10th, 50th, and 90th percentiles of force profiles escalated disproportionately. However, no significant changes were observed in the timing of the two peak force incidences. Such changes in the compression force might be an indication of the combined effects of the increase in both gravitational and mass moment of inertia of the system (body plus pack loads) when walking with a backpack. Pearson correlation coefficients of the force profiles between the five loading conditions were greater than 0.94. Strong associations between the force profiles at different backpack loads were confirmed.
Collapse
Affiliation(s)
- Simon S W Li
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Daniel H K Chow
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong.
| |
Collapse
|
15
|
Akhavanfar MH, Brandon SCE, Brown SHM, Graham RB. Development of a novel MATLAB-based framework for implementing mechanical joint stability constraints within OpenSim musculoskeletal models. J Biomech 2019; 91:61-68. [PMID: 31138478 DOI: 10.1016/j.jbiomech.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/18/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
The Static Optimization (SO) solver in OpenSim estimates muscle activations and forces that only equilibrate applied moments. In this study, SO was enhanced through an open-access MATLAB interface, where calculated muscle activations can additionally satisfy crucial mechanical stability requirements. This Stability-Constrained SO (SCSO) is applicable to many OpenSim models and can potentially produce more biofidelic results than SO alone, especially when antagonistic muscle co-contraction is required to stabilize body joints. This hypothesis was tested using existing models and experimental data in the literature. Muscle activations were calculated by SO and SCSO for a spine model during two series of static trials (i.e. simulation 1 and 2), and also for a lower limb model (supplementary material 2). In simulation 1, symmetric and asymmetric flexion postures were compared, while in simulation 2, various external load heights were compared, where increases in load height did not change the external lumbar flexion moment, but necessitated higher EMG activations. During the tasks in simulation 1, the predicted muscle activations by SCSO demonstrated less average deviation from the EMG data (6.8% -7.5%) compared to those from SO (10.2%). In simulation 2, SO predicts constant muscle activations and forces, while SCSO predicts increases in the average activations of back and abdominal muscles that better match experimental data. Although the SCSO results are sensitive to some parameters (e.g. musculotendon stiffness), when considering the strategy of the central nervous system in distributing muscle forces and in activating antagonistic muscles, the assigned activations by SCSO are more biofidelic than SO.
Collapse
Affiliation(s)
- Mohammad H Akhavanfar
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa K1N 6N5, Ontario, Canada
| | - Scott C E Brandon
- School of Engineering, College of Engineering & Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, College of Biological Science, University of Guelph, Guelph, Ontario, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa K1N 6N5, Ontario, Canada.
| |
Collapse
|
16
|
Kamal Z, Rouhi G, Arjmand N, Adeeb S. A stability-based model of a growing spine with adolescent idiopathic scoliosis: A combination of musculoskeletal and finite element approaches. Med Eng Phys 2019; 64:46-55. [DOI: 10.1016/j.medengphy.2018.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/15/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
|
17
|
Stokes IAF, Gardner-Morse MG. Re: Foresto T, Song I, Kim BS, Lim TH. 2018. Stabilization of the lumbar spine by spinal muscle forces producing compressive follower loads: 3-dimensional computational study. J Orthop Res 2018; 36:3113-3114. [PMID: 30129660 DOI: 10.1002/jor.24128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Ian A F Stokes
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington 05405-0084, Vermont
| | - Mack G Gardner-Morse
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington 05405-0084, Vermont
| |
Collapse
|
18
|
Khoddam-Khorasani P, Arjmand N, Shirazi-Adl A. Trunk Hybrid Passive–Active Musculoskeletal Modeling to Determine the Detailed T12–S1 Response Under In Vivo Loads. Ann Biomed Eng 2018; 46:1830-1843. [DOI: 10.1007/s10439-018-2078-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 06/18/2018] [Indexed: 12/28/2022]
|
19
|
Samadi S, Arjmand N. A novel stability-based EMG-assisted optimization method for the spine. Med Eng Phys 2018; 58:S1350-4533(18)30091-2. [PMID: 29945762 DOI: 10.1016/j.medengphy.2018.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/02/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
Traditional electromyography-assisted optimization (TEMG) models are commonly employed to compute trunk muscle forces and spinal loads for the design of clinical/treatment and ergonomics/prevention programs. These models calculate muscle forces solely based on moment equilibrium requirements at spinal joints. Due to simplifications/assumptions in the measurement/processing of surface EMG activities and in the presumed muscle EMG-force relationship, these models fail to satisfy stability requirements. Hence, the present study aimed to develop a novel stability-based EMG-assisted optimization (SEMG) method applied to a musculoskeletal spine model in which trunk muscle forces were estimated by enforcing equilibrium conditions constrained to stability requirements. That is, second-order partial derivatives of the potential energy of the musculoskeletal model with respect to its generalized coordinates were enforced to be positive semi-definite. Fifteen static tasks in upright and flexed postures with and without a hand load at different heights were simulated. The SEMG model predicted different muscle recruitments/forces (generally larger global and local muscle forces) and spinal loads (slightly larger) compared to the TEMG model. Such task-specific differences were dependant on the assumed magnitude of the muscle stiffness coefficient in the SEMG model. The SEMG model-predicted and measured L4-L5 intradiscal pressures were in satisfactory agreement during simulated activities.
Collapse
Affiliation(s)
- S Samadi
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - N Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| |
Collapse
|
20
|
Relationships Between Trunk Movement Patterns During Lifting Tasks Compared With Unloaded Extension From a Flexed Posture. J Manipulative Physiol Ther 2018; 41:189-198. [PMID: 29549889 DOI: 10.1016/j.jmpt.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 07/29/2017] [Accepted: 09/08/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate between movement patterns of trunk extension from full unloaded flexion and lifting techniques, which could provide valuable information to physical therapists, doctors of chiropractic, and other manual therapists. METHODS A within-participant study design was used. Whole-body kinematic and kinetic data during lifting and full trunk flexion were collected from 16 healthy male participants using a 3-dimensional motion analysis system (Vicon Motion Systems). To evaluate the relationships of joint movement between lifting and full trunk flexion, Pearson correlation coefficients were calculated. RESULTS There was no significant correlation between the amount of change in the lumbar extension angle during the first half of the lifting trials and lumbar movement during unloaded trunk flexion and extension. However, the amount of change in the lumbar extension angle during lifting was significantly negatively correlated with hip movement during unloaded trunk flexion and extension (P < .05). CONCLUSIONS The findings that the maximum hip flexion angle during full trunk flexion had a greater influence on kinematics of lumbar-hip complex during lifting provides new insight into human movement during lifting. All study participants were healthy men; thus, findings are limited to this group.
Collapse
|
21
|
Akhavanfar M, Kazemi H, Eskandari A, Arjmand N. Obesity and spinal loads; a combined MR imaging and subject-specific modeling investigation. J Biomech 2018; 70:102-112. [DOI: 10.1016/j.jbiomech.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/03/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
|
22
|
Narimani M, Arjmand N. Three-dimensional primary and coupled range of motions and movement coordination of the pelvis, lumbar and thoracic spine in standing posture using inertial tracking device. J Biomech 2018; 69:169-174. [DOI: 10.1016/j.jbiomech.2018.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
|
23
|
Azari F, Arjmand N, Shirazi-Adl A, Rahimi-Moghaddam T. A combined passive and active musculoskeletal model study to estimate L4-L5 load sharing. J Biomech 2018; 70:157-165. [DOI: 10.1016/j.jbiomech.2017.04.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
|
24
|
Evaluation of full pelvic ring stresses using a bilateral static gait-phase finite element modeling method. J Mech Behav Biomed Mater 2018; 78:175-187. [DOI: 10.1016/j.jmbbm.2017.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/27/2017] [Accepted: 11/03/2017] [Indexed: 11/21/2022]
|
25
|
Shamsi M, Sarrafzadeh J, Jamshidi A, Arjmand N, Ghezelbash F. Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients. Clin Biomech (Bristol, Avon) 2017; 48:42-48. [PMID: 28728077 DOI: 10.1016/j.clinbiomech.2017.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/14/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Motor control exercise was claimed to improve spinal stability in patients with chronic non-specific back pain, but to investigate the effectiveness of this exercise, other outcome measures have been used rather than spinal stability itself. The aim of our study is to assess motor control exercise effects on spinal stability using a biomechanical model. METHODS Fifty-one patients were assigned to either motor control or general exercises. Before and after trainings, participants were tested for spinal stability at seven isometric tasks. Electromyography signals were recorded from ten superficial muscles, and a hybrid EMG-driven musculoskeletal model estimated spinal stability indices at each task. FINDINGS Pain and disability significantly decreased in both groups. After trainings, patients had both increase and decrease in stability depending on the task, and stability did not increase/decrease uniformly in all patients. In the motor control group, stability increased at all positions but reached to significance only at right lateral pulling. In the general exercise group, except for pulling the trunk backward, stability decreased at other positions and reached to statistical significance only at pulling the trunk forward. No significant difference between groups was found in changing stability after the intervention. INTERPRETATION Interventions yielded no significant difference in disability, pain and stability index between two groups. Significant increase of stability in the motor control group at right lateral pulling may be attributed to more activity of abdominal muscles, and significant decrease of stability in the general exercise group at forward pulling may be attributed to more optimal activity of back muscles.
Collapse
Affiliation(s)
- MohammadBagher Shamsi
- Rehabilitation and Sport Medicine Department, School of Allied Medical Sciences, Kermanshah University of Medical Sciences, Dolat Abad Street, Kermanshah, Iran.
| | - Javad Sarrafzadeh
- Physiotherapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mohseni Square, Tehran, Iran
| | - Aliashraf Jamshidi
- Physiotherapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Mohseni Square, Tehran, Iran
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Farshid Ghezelbash
- Division of Applied Mechanics, Department of Mechanical Engineering, École Polytechnique, Montréal, Canada
| |
Collapse
|
26
|
Gómez L, Díaz CA, Orozco GA, García JJ. Dynamic analysis of forces in the lumbar spine during bag carrying. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2017; 24:605-613. [PMID: 28753120 DOI: 10.1080/10803548.2017.1352224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The intervertebral disc supports axial and shear forces generated during tasks such as lifting and carrying weights. The objective of this study was to determine the forces in the lumbar spine of workers carrying a bag on the head, on the shoulder and on the anterior part of the trunk. METHODS Kinematic measurements were recorded for 10 subjects carrying bags of 10, 20 and 25 kg on each of the three aforementioned positions. A simple dynamic model implemented in a custom program was then developed to determine the lumbar forces using the accelerations and positions obtained from the kinematic analysis. RESULTS The analyses yielded a maximum compressive force of 2338.4 ± 422 N when a 25-kg bag was carried on the anterior part of the trunk. CONCLUSION Carrying bags on the anterior part of the trunk generated higher lumbar forces compared to those developed by carrying the bag on the head or on the shoulder. Force levels suggest that this activity represents a moderate risk for the subjects. However, future biomechanical models should be developed to analyze the cumulative effect in the discs when longer periods of time are spent in this activity.
Collapse
Affiliation(s)
- Lessby Gómez
- a Escuela de Rehabilitación Humana , Universidad del Valle , Colombia.,b Facultad de Ciencias de la Salud , Universidad Libre-Cali , Colombia
| | - Carlos A Díaz
- c Escuela de Ingeniería Mecánica , Universidad del Valle , Colombia
| | - Gustavo A Orozco
- b Facultad de Ciencias de la Salud , Universidad Libre-Cali , Colombia
| | - José J García
- d Escuela de Ingeniería Civil y Geomática , Universidad del Valle , Colombia
| |
Collapse
|
27
|
Eskandari A, Arjmand N, Shirazi-Adl A, Farahmand F. Subject-specific 2D/3D image registration and kinematics-driven musculoskeletal model of the spine. J Biomech 2017; 57:18-26. [DOI: 10.1016/j.jbiomech.2017.03.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 11/26/2022]
|
28
|
Hwang J, Knapik GG, Dufour JS, Marras WS. Curved muscles in biomechanical models of the spine: a systematic literature review. ERGONOMICS 2017; 60:577-588. [PMID: 27189654 DOI: 10.1080/00140139.2016.1190410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Early biomechanical spine models represented the trunk muscles as straight-line approximations. Later models have endeavoured to accurately represent muscle curvature around the torso. However, only a few studies have systematically examined various techniques and the logic underlying curved muscle models. The objective of this review was to systematically categorise curved muscle representation techniques and compare the underlying logic in biomechanical models of the spine. Thirty-five studies met our selection criteria. The most common technique of curved muscle path was the 'via-point' method. Curved muscle geometry was commonly developed from MRI/CT database and cadaveric dissections, and optimisation/inverse dynamics models were typically used to estimate muscle forces. Several models have attempted to validate their results by comparing their approach with previous studies, but it could not validate of specific tasks. For future needs, personalised muscle geometry, and person- or task-specific validation of curved muscle models would be necessary to improve model fidelity. Practitioner Summary: The logic underlying the curved muscle representations in spine models is still poorly understood. This literature review systematically categorised different approaches and evaluated their underlying logic. The findings could direct future development of curved muscle models to have a better understanding of the biomechanical causal pathways of spine disorders.
Collapse
Affiliation(s)
- Jaejin Hwang
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| | - Gregory G Knapik
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| | - Jonathan S Dufour
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| | - William S Marras
- a Biodynamics Laboratory, Department of Integrated Systems Engineering , Spine Research Institute, The Ohio State University , Columbus , OH , USA
| |
Collapse
|
29
|
Validation of a personalized curved muscle model of the lumbar spine during complex dynamic exertions. J Electromyogr Kinesiol 2017; 33:1-9. [DOI: 10.1016/j.jelekin.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/21/2022] Open
|
30
|
Senteler M, Weisse B, Rothenfluh DA, Farshad MT, Snedeker JG. Fusion angle affects intervertebral adjacent spinal segment joint forces-Model-based analysis of patient specific alignment. J Orthop Res 2017; 35:131-139. [PMID: 27364167 DOI: 10.1002/jor.23357] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/30/2016] [Indexed: 02/04/2023]
Abstract
This study addresses the hypothesis that adjacent segment intervertebral joint loads are sensitive to the degree of lordosis that is surgically imposed during vertebral fusion. Adjacent segment degeneration is often observed after lumbar fusion, but a causative mechanism is not yet clearly evident. Altered kinematics of the adjacent segments and potentially nonphysiological mechanical joint loads have been implicated in this process. However, little is known of how altered alignment and kinematics influence loading of the adjacent intervertebral joints under consideration of active muscle forces. This study investigated these effects by simulating L4/5 fusions using kinematics-driven musculoskeletal models of one generic and eight sagittal alignment-specific models. Models featured different spinopelvic configurations but were normalized by body height, masses, and muscle properties. Fusion of the L4/5 segment was implemented in an in situ (22°), hyperlordotic (32°), and hypolordotic (8°) fashion and kinematic input parameters were changed accordingly based on findings of an in vitro investigation. Bending motion from upright standing to 45° forward flexion and back was simulated for all models in intact and fused conditions. Joint loads at adjacent levels and moment arms of spinal muscles experienced changes after all types of fusion. Hypolordotic configuration led to an increase of adjacent segment (L3/4) shear forces of 29% on average, whereas hyperlordotic fusion reduced shear by 39%. Overall, L4/5 in situ fusion resulted in intervertebral joint forces closest to intact loading conditions. An artificial decrease in lumbar lordosis (minus 14° on average) caused by an L4/5 fusion lead to adverse loading conditions, particularly at the cranial adjacent levels, and altered muscle moment arms, in particular for muscles in the vicinity of the fusion. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:131-139, 2017.
Collapse
Affiliation(s)
- Marco Senteler
- Department of Orthopedics, Balgrist, University of Zurich, Lengghalde 5, Zurich 8008, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.,Swiss Federal Laboratories for Materials Science and Technology, Zurich, Switzerland
| | - Bernhard Weisse
- Swiss Federal Laboratories for Materials Science and Technology, Zurich, Switzerland
| | - Dominique A Rothenfluh
- Oxford University Hospitals, NHS Trust, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Mazda T Farshad
- Department of Orthopedics, Balgrist, University of Zurich, Lengghalde 5, Zurich 8008, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist, University of Zurich, Lengghalde 5, Zurich 8008, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
31
|
Abdollahi M, Nikkhoo M, Ashouri S, Asghari M, Parnianpour M, Khalaf K. A model for flexi-bar to evaluate intervertebral disc and muscle forces in exercises. Med Eng Phys 2016; 38:1076-82. [DOI: 10.1016/j.medengphy.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/06/2016] [Accepted: 07/05/2016] [Indexed: 12/20/2022]
|
32
|
Hwang J, Knapik GG, Dufour JS, Aurand A, Best TM, Khan SN, Mendel E, Marras WS. A biologically-assisted curved muscle model of the lumbar spine: Model structure. Clin Biomech (Bristol, Avon) 2016; 37:53-59. [PMID: 27323286 DOI: 10.1016/j.clinbiomech.2016.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/27/2016] [Accepted: 06/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical models have been developed to assess the spine tissue loads of individuals. However, most models have assumed trunk muscle lines of action as straight-lines, which might be less reliable during occupational tasks that require complex lumbar motions. The objective of this study was to describe the model structure and underlying logic of a biologically-assisted curved muscle model of the lumbar spine. METHODS The developed model structure including curved muscle geometry, separation of active and passive muscle forces, and personalization of muscle properties was described. An example of the model procedure including data collection, personalization, and data evaluation was also illustrated. FINDINGS Three-dimensional curved muscle geometry was developed based on a predictive model using magnetic resonance imaging and anthropometric measures to personalize the model for each individual. Calibration algorithms were able to reverse-engineer personalized muscle properties to calculate active and passive muscle forces of each individual. INTERPRETATION This biologically-assisted curved muscle model will significantly increase the accuracy of spinal tissue load predictions for the entire lumbar spine during complex dynamic occupational tasks. Personalized active and passive muscle force algorithms will help to more robustly investigate person-specific muscle forces and spinal tissue loads.
Collapse
Affiliation(s)
- Jaejin Hwang
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Department of Integrated Systems Engineering, 1971 Neil Avenue, 210 Baker Systems Engineering, Columbus, OH 43210, USA.
| | - Gregory G Knapik
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Department of Integrated Systems Engineering, 1971 Neil Avenue, 210 Baker Systems Engineering, Columbus, OH 43210, USA.
| | - Jonathan S Dufour
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Department of Integrated Systems Engineering, 1971 Neil Avenue, 210 Baker Systems Engineering, Columbus, OH 43210, USA.
| | - Alexander Aurand
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Department of Integrated Systems Engineering, 1971 Neil Avenue, 210 Baker Systems Engineering, Columbus, OH 43210, USA.
| | - Thomas M Best
- Department of Family Medicine, The Ohio State University, Martha Moorehouse Medical Plaza, 2050 Kenny Dr., Columbus, OH 43210, USA.
| | - Safdar N Khan
- Department of Orthopeadics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
| | - Ehud Mendel
- Department of Neurological Surgery, The Ohio State University, Columbus, OH 43210, USA.
| | - William S Marras
- Biodynamics Laboratory, Spine Research Institute, The Ohio State University, Department of Integrated Systems Engineering, 1971 Neil Avenue, 210 Baker Systems Engineering, Columbus, OH 43210, USA.
| |
Collapse
|
33
|
Dao TT. Enhanced Musculoskeletal Modeling for Prediction of Intervertebral Disc Stress Within Annulus Fibrosus and Nucleus Pulposus Regions During Flexion Movement. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0156-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
El Ouaaid Z, Shirazi-Adl A, Plamondon A. Effects of variation in external pulling force magnitude, elevation, and orientation on trunk muscle forces, spinal loads and stability. J Biomech 2016; 49:946-952. [DOI: 10.1016/j.jbiomech.2015.09.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
|
35
|
Dreischarf M, Shirazi-Adl A, Arjmand N, Rohlmann A, Schmidt H. Estimation of loads on human lumbar spine: A review of in vivo and computational model studies. J Biomech 2016; 49:833-845. [DOI: 10.1016/j.jbiomech.2015.12.038] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 01/09/2023]
|
36
|
Jamshidnejad S, Arjmand N. Variations in trunk muscle activities and spinal loads following posterior lumbar surgery: A combined in vivo and modeling investigation. Clin Biomech (Bristol, Avon) 2015; 30:1036-42. [PMID: 26432416 DOI: 10.1016/j.clinbiomech.2015.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Iatrogenic injuries to paraspinal muscles during posterior lumbar surgery cause a reduction in their contractile cross-sectional area and thus presumably their postoperative activation. This study investigates the effect of such intraoperative injuries on postoperative patterns of muscle activations and spinal loads during various activities using a combined modeling and in vivo MR imaging approach. METHODS A three-dimensional, multi-joint, musculoskeletal model was used to estimate pre- and postoperative muscle forces and spinal loads under various activities in upright and flexed postures. According to our in vivo pre- and postoperative (~6 months) measurements in six patients using a 3-Tesla-MR scanner, physiological cross-sectional areas of multifidus and erector spinae were reduced in the postoperative model by 26 and 11%, respectively. FINDINGS Postoperative trunk extension strength was predicted to decrease by ~23% from 215 Nm in the intact model to 165 Nm in the postoperative model. Postoperative force in multifidus fascicles decreased by ~21-40% in flexion tasks and by ~14-35% in upright tasks. In contrast, the sum of the forces in all other intact and less injured extensor muscles slightly increased (by <6%) in the postoperative model. Postoperative L5-S1 compressive and shear loads varied slightly (by ~3%). INTERPRETATION Intraoperative injuries induced a shift in load-sharing from the most injured muscle (multifidus) toward other less injured and intact muscles during all simulated activities. Postoperative rehabilitation programs should therefore strengthen and facilitate (while avoiding muscle imbalance) not only the injured multifidus but also other intact and less injured trunk muscles that play a compensatory role after the operation.
Collapse
Affiliation(s)
- Saman Jamshidnejad
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Navid Arjmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| |
Collapse
|
37
|
Mohammadi Y, Arjmand N, Shirazi-Adl A. Comparison of trunk muscle forces, spinal loads and stability estimated by one stability- and three EMG-assisted optimization approaches. Med Eng Phys 2015; 37:792-800. [DOI: 10.1016/j.medengphy.2015.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 05/12/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
|
38
|
Dreischarf M, Albiol L, Zander T, Arshad R, Graichen F, Bergmann G, Schmidt H, Rohlmann A. In vivo implant forces acting on a vertebral body replacement during upper body flexion. J Biomech 2015; 48:560-565. [DOI: 10.1016/j.jbiomech.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
|
39
|
Effect of body weight on spinal loads in various activities: A personalized biomechanical modeling approach. J Biomech 2015; 48:276-82. [DOI: 10.1016/j.jbiomech.2014.11.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/17/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022]
|
40
|
Ghezelbash F, Arjmand N, Shirazi-Adl A. Effect of intervertebral translational flexibilities on estimations of trunk muscle forces, kinematics, loads, and stability. Comput Methods Biomech Biomed Engin 2014; 18:1760-7. [DOI: 10.1080/10255842.2014.961440] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|